Updates on American Indian Substance Use with Comparison to Monitoring the Future

Introduction. American Indian (AI) adolescents attending schools on or near reservations consistently report the highest levels of substance use as compared to other U.S. racial/ethnic groups, especially those in early adolescence. Risks associated with these high use rates include higher risk of developing a substance use disorder and more alcohol-related problems including alcohol-attributable death. AI and Alaska Natives are more likely to need treatment for a substance use problem than all other U.S. racial/ethnic groups. These findings underscore the need for continuing surveillance of this at-risk group, particularly given changing trends in perceived harmfulness of illicit substances as new statues liberalize medical and recreational use of cannabis.

Methods. This study uses cross-sectional data from 8^th, 10^th, and 12^th grade students enrolled during the 2016-2017 school year in 30 schools on or near reservations. Schools with at least 20% AI students enrolled were randomly sampled across six cultural regions, with recruitment in each region approximating the percentage of AIs residing there. Rates of lifetime, last year, and 30-day use were calculated for 14 substances. These rates were then compared to 2016 Monitoring the Future rates by grade.

Results. For lifetime use, AI 8^th, 10^th, and 12^th grade rates were significantly greater than MTF rates for all substances, except tranquilizers, which were not significantly different, and amphetamines where MTF rates were higher. The largest differences were for 8^th graders, and within that group were higher AI levels for marijuana, gotten drunk, hallucinogens, and cigarettes. Current use (30 day) rates were also significantly higher for AIs than MTF for most substances, with the largest differences for gotten drunk, binge drinking, marijuana and cigarettes. AI 8^th graders report use of any illicit substance of 26.1% compared to the MTF rate of 6.9%. For 12^th graders, the illicit substance rate is 40.5% compared to the MTF rate of 24.4%. However, fewer significant differences were noted for 12^th graders, which may be due to the high dropout rates of AI youth.

Conclusions. Substance use rates continue to be significantly higher for reservation-based AI students, as compared to the general population of youth. Rates are particularly high for marijuana, as found in our previous results. With current use of any illicit substance 3.8 times higher among AI 8^th graders, it is clear that this group remains at very high risk. With this disparity disappearing by 12^th grade, likely due to the very high rate of school dropout in this group, it will be especially important for future studies to monitor levels of use of those AI students who leave school prematurely.