Exploring Risk and Protective Factors for Binge Alcohol and Drug Use Among American Indian Adolescents

Introduction:   American Indian (AI) youth are more likely to start using alcohol and other substances at an earlier age, use more substances, meet criteria for substance use disorders, and maintain higher levels than general U.S. samples. AI adolescents also have reported the highest rate of past month binge drinking in a nationally representative survey (Chen et al., 2012). Binge alcohol use can be associated with serious immediate consequences such as losing consciousness and risky sex/rape. Understanding risk and protective factors for binge drinking among AI youth is important to designing targeted prevention and intervention initiatives for this particularly high risk population.

Methods: This was a mixed-methods, cross-sectional, case-control study. The sample consisted of AIs 10-19 years old from a reservation in the Southwestern U.S. Cases (N=68) required medical attention due to binge use. Controls (N=55) were hospitalized for an unrelated reason and reported no lifetime binge use. All participants completed a computer administered survey to collect data on risk/protective factors for binge use. Logistic regression was used to calculate odds ratios and 95% confidence intervals with case/control status as the outcome, controlling for age and gender.

Results: AI youth who reported currently living with their parents (OR: 0.23, p=0.041), and increased length of time in current home (OR: 0.89, p=0.002) had statistically significantly lower odds of binge use, while those who reported living with non-family members (OR: 10.19, p=0.036) and in larger households (OR: 1.26, p=0.027) had increased odds. Controls demonstrated higher level functioning across several summary measures, indicated by lower POSIT scale scores, including family functioning (OR: 1.38, p=0.003), mental health (OR: 1.19, p=0.025) and peer interactions (OR: 1.48, p=0.001). In addition, the odds of binge use was statistically significantly higher among those who reported higher levels of impulsivity (OR: 55.83, p<0.0001) and aggression (OR: 1.04, p=0.001). Finally, those reporting that following traditional beliefs (OR: 0.08, p=0.006) and having traditional values (OR: 0.03, p=0.003) were very important to them had lower odds of binge use.

Conclusions:  Findings suggest several areas of risk and possible intervention points for binge alcohol and drug use among AI youth, notably self-reported impulsivity and living in a large household which includes non-family members. Whereas living in stable families led by parents and engaging cultural/spiritual beliefs and practices appeared to protect against such risky behaviors, possibly acting through increased positive mental health and peer influences, and should be the focus of prevention efforts.