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ORIGINAL ARTICLE Surveillance of Drug Use Among American Indian Adolescents: Patterns Over 25 Years FRED BEAUVAIS, Ph.D., PAMELA JUMPER-THURMAN, Ph.D., HEATHER HELM, B.A., BARBARA PLESTED, Ph.D., AND MARTHA BURNSIDE, B.A. Purpose: To examine the trends in drug use among American Indian adolescents attending schools on, or near, Indian reservations in the United States, to provide comparisons with non-Indian youth, and to discuss im- plications for prevention. Methods: Reliable and valid school administered drug use surveys have been given every year for 25 years (1975–2000) to representative samples of Indian youth living on reservations, yielding a continuous record of trends in drug use. Comparisons are made with non- Indian youth with data from the Monitoring the Future project. Data were analyzed to obtain measures of life- time prevalence (“ever tried a drug”), use in the last 30 days, and proportions at high risk and at moderate risk from their drug use. Comparisons utilized difference in proportion tests. Results: From 1975 to 2000, reservation Indian youth show elevated levels of drug use for most illicit drugs compared with non-Indian youth. Despite higher levels of use, the trends showing increases and decreases in use over time mirror those shown by non-Indian youth. Indian youth who use drugs can be divided into moder- ate and high levels of use. The number of youth in the moderate category varies over time whereas the number in the high category remains relatively constant. Conclusions: There is a clear need for intensive efforts to reduce the levels of drug use among Indian youth. Although interventions must be tailored to the social and cultural milieu of Indian reservations, the rates of use vary over time in the same pattern as seen for non-Indian youth. Further, interventions must address the differing characteristics of high and moderate risk users of drugs. © Society for Adolescent Medicine, 2004 KEY WORDS: Adolescents American Indian Drug use Prevention Surveillance For over 25 years drug abuse has been recognized as a significant problem for large numbers of American Indian youth residing on reservations. Various stud- ies have found high rates of drug use at one-point- in-time studies or in geographically limited Indian populations [1– 4]. Several larger studies that provide a much more complete picture of Indian adolescent drug use are also available. Blum et al [5] surveyed a nonrandom sample of 13,454 Indian 7th–12th-grad- ers from eight Indian Health Service areas. In addi- tion to higher levels of drug use compared with a Minnesota sample of non-Indian youth, Indian youth who were using drugs had higher levels of other deviant behaviors and attitudes. Similar results were found in results from the Youth Risk Behavior Sur- vey administered to 95% of the Bureau of Indian Affairs schools in 1997 (n 12,596) [6,7]. Mitchell and Beals [8] also confirmed a pattern of general deviancy, including drug abuse, among 1894 Indian youth from five different cultural regions of the United States. Drug use prevalence data from that same study (Voices of Indian Teens), reported in another article [9], were compared with Monitoring the Future (MTF) data. In contrast to other studies of From the Tri-Ethnic Center for Prevention Research, Department of Psychology, Colorado State University, Fort Collins, Colorado. Address correspondence to: Fred Beauvais, Ph.D., 100 Sage Hall, Colorado State University, Fort Collins, CO 80523. E-mail: [email protected] Manuscript accepted July 28, 2003. JOURNAL OF ADOLESCENT HEALTH 2004;34:493–500 © Society for Adolescent Medicine, 2004 1054-139X/04/$–see front matter Published by Elsevier Inc., 360 Park Avenue South, New York, NY 10010 doi:10.1016/j.jadohealth.2003.07.019

Surveillance of drug use among American Indian adolescents: patterns over 25 years

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ORIGINAL ARTICLE

Surveillance of Drug Use Among American IndianAdolescents: Patterns Over 25 Years

FRED BEAUVAIS, Ph.D., PAMELA JUMPER-THURMAN, Ph.D., HEATHER HELM, B.A.,

BARBARA PLESTED, Ph.D., AND MARTHA BURNSIDE, B.A.

Purpose: To examine the trends in drug use amongAmerican Indian adolescents attending schools on, ornear, Indian reservations in the United States, to providecomparisons with non-Indian youth, and to discuss im-plications for prevention.

Methods: Reliable and valid school administered druguse surveys have been given every year for 25 years(1975–2000) to representative samples of Indian youthliving on reservations, yielding a continuous record oftrends in drug use. Comparisons are made with non-Indian youth with data from the Monitoring the Futureproject. Data were analyzed to obtain measures of life-time prevalence (“ever tried a drug”), use in the last 30days, and proportions at high risk and at moderate riskfrom their drug use. Comparisons utilized difference inproportion tests.

Results: From 1975 to 2000, reservation Indian youthshow elevated levels of drug use for most illicit drugscompared with non-Indian youth. Despite higher levelsof use, the trends showing increases and decreases in useover time mirror those shown by non-Indian youth.Indian youth who use drugs can be divided into moder-ate and high levels of use. The number of youth in themoderate category varies over time whereas the numberin the high category remains relatively constant.

Conclusions: There is a clear need for intensive effortsto reduce the levels of drug use among Indian youth.Although interventions must be tailored to the social andcultural milieu of Indian reservations, the rates of usevary over time in the same pattern as seen for non-Indianyouth. Further, interventions must address the differing

characteristics of high and moderate risk users of drugs.© Society for Adolescent Medicine, 2004

KEY WORDS:AdolescentsAmerican IndianDrug usePreventionSurveillance

For over 25 years drug abuse has been recognized asa significant problem for large numbers of AmericanIndian youth residing on reservations. Various stud-ies have found high rates of drug use at one-point-in-time studies or in geographically limited Indianpopulations [1–4]. Several larger studies that providea much more complete picture of Indian adolescentdrug use are also available. Blum et al [5] surveyed anonrandom sample of 13,454 Indian 7th–12th-grad-ers from eight Indian Health Service areas. In addi-tion to higher levels of drug use compared with aMinnesota sample of non-Indian youth, Indian youthwho were using drugs had higher levels of otherdeviant behaviors and attitudes. Similar results werefound in results from the Youth Risk Behavior Sur-vey administered to 95% of the Bureau of IndianAffairs schools in 1997 (n � 12,596) [6,7]. Mitchelland Beals [8] also confirmed a pattern of generaldeviancy, including drug abuse, among 1894 Indianyouth from five different cultural regions of theUnited States. Drug use prevalence data from thatsame study (Voices of Indian Teens), reported inanother article [9], were compared with Monitoringthe Future (MTF) data. In contrast to other studies of

From the Tri-Ethnic Center for Prevention Research, Department ofPsychology, Colorado State University, Fort Collins, Colorado.

Address correspondence to: Fred Beauvais, Ph.D., 100 Sage Hall,Colorado State University, Fort Collins, CO 80523. E-mail:[email protected]

Manuscript accepted July 28, 2003.

JOURNAL OF ADOLESCENT HEALTH 2004;34:493–500

© Society for Adolescent Medicine, 2004 1054-139X/04/$–see front matterPublished by Elsevier Inc., 360 Park Avenue South, New York, NY 10010 doi:10.1016/j.jadohealth.2003.07.019

Indian adolescents, Indian youth did not demon-strate higher rates for a number of drugs; there werealso regional differences for rates of use. It should benoted that the Voices of Indian Teens projects in-cluded only 10 schools in five regions and thus maybe limited in making population comparisons.

Previous studies of the Tri-Ethnic Center for Pre-vention Research have shown higher rates of the useof most drugs since 1975 for representative samplesof Indian youth living on reservations across theUnited States [10–17].

In addition, in 1992 the Tri-Ethnic Center gainedaccess to a large sample of United States adolescentsthat included a substantial number of Indian youthwho were not living on reservations. These youthhad rates of drug use that were lower than those forreservation Indian youth but higher than the rates fornon-Indian youth [14]. This finding leads to thespeculation that although rural reservation life hasmany positive aspects, there may be environmentalvariables (e.g., isolation, prejudice, and pervasivepoverty) that promote higher levels of drug use;Indian youth not living on reservations may notexperience such harsh socioeconomic conditions.Studies have shown only minor variation in drug usefrom one reservation to another [8,13,14], suggestingthat there are important etiological factors that arecommon across tribal locations rather than a result ofcultural or geographic factors.

The similarity of adolescent drug use rates acrossreservations does not imply that there is culturalhomogeneity across reservations and tribes. Indeed,there is considerable cultural variability encom-passed by the rubric “American Indian” [18] andprevention and treatment approaches to drug abusemust take local cultural attitudes, beliefs, and prac-tices into account [19].

Despite having higher rates of use, the patterns ofdrug use for Indian youth across time have paral-leled those for other youth [11]. For example, therewas a substantial increase in drug use through theearly 1980’s when use peaked, followed by a decline.This decline continued through 1992, at which pointuse began to rise again for both Indian and non-Indian youth, suggesting the possibility of changingenvironmental influences over time that affect bothIndian and non-Indian youth.

In this report we update the trends in use forIndian and non-Indian youth through the year 2000.It is essential to follow these trends because theyshould influence policy and allocation of resourcesand have important implications for prevention. Spe-cifically, we will compare trends from 1975 to 2000 in

Indian youth drug use with those of non-Indianyouth, compare the rates of use for specific drugsbetween these groups, and identify patterns of In-dian drug use.

MethodsThis study consists of an ongoing series of annualcross-sectional surveys that produce a continuousrecord of drug use rates among reservation-basedAmerican Indian youth for the years 1975 to 2000.Questionnaires are administered each year to a rep-resentative sample of 7th–12th grade Indian youthattending schools across the country on, or near,recognized Indian reservations [14]. Eight to 12schools are surveyed per year. Although the numberof schools surveyed each year is small, aggregationof adjacent years provides a large enough sample toestablish a stable record of trends in drug use overtime. It has been our standard policy to not identifythe tribes with which we work to respect theirconfidentiality and reputation.

There are a number of inherent problems in struc-turing a sample to capture a representative group ofIndian adolescents. There is wide cultural variationfrom tribe to tribe across the country; the populationsof different reservations vary from a few hundred tohundreds of thousands; Indian youth attend a vari-ety of school systems which may include essentiallyall Indian students or only a small proportion ofIndian students. There is, however, a superordinateclassification of tribes that provides structure inobtaining a representative sample. Tribes in the 48contiguous states can be categorized into sevengroups that possess some level of cultural similarity(i.e., East, Plains, Plateau, Basin, Southwest, North-west Coast, and California) and, as the names imply,this classification also provides geographic diversity.

The actual selection of tribes is based on a sam-pling of schools within each of these groupings. Theunit of sampling is school districts, although some-times all of the schools in a district do not agree toparticipate. Each year schools are selected from eachgeographic/cultural area to produce a sample ofapproximately 1500 to 2500 students in the 7th–12thgrades. This number may vary from year to yearowing to the number of schools within a district andthe number agreeing to participate. In some locationsyouth living on a reservation attend schools in non-reservation border towns. In these instances thoseschools are included in the study, however, dataanalyses are limited only to those students whoindicate on the survey that they are American Indian.

494 BEAUVAIS ET AL JOURNAL OF ADOLESCENT HEALTH Vol. 34, No. 6

Using this method, precise balancing across geo-graphic/cultural areas is not possible in any givenyear. In these instances an attempt is made in thefollowing year to oversample in previously under-sampled regions, to assure that, when the data pointsfor trend analysis are combined across 2 years ofsurveying, a representative distribution is achieved.Although some schools may be included more thanonce in the samples taken over this 2 1/2 decadeperiod, no school is included twice in the same 2 yeardata point. This sampling procedure has produced,over this extended period, relatively smooth trendsfor data that represent drug use rates among reser-vation Indian youth.

Specifically excluded from the sample are youthfrom Alaska and Oklahoma. Native populations inthese locations do not reside on reservations and assuch the differing socioeconomic and demographicconditions may lead to differences that could affectlevels and patterns of deviance, including drugabuse. It is important to note that the selectionprocedure is not based on the assumption that allreservations/tribes are culturally similar. Rather it isan attempt to sample the cultural variability thatoccurs in Indian communities. The surveys are givento all youth attending the selected schools and thusthe results are limited to such youth and do notrepresent school absentees or dropouts. Thus, thedata presented here may underestimate drug use ofthe entire age cohort [10,20].

Prior to questionnaire administration, parents aresent a first-class letter describing the survey andindicating that they may remove their child from theproject by returning a signed form, calling the school,or dropping by the school for notification. In addi-tion, at least one other announcement regarding thesurvey is made through an appropriate media outletin the community (e.g., radio, tribal newsletter, localnewspaper). Just prior to survey administration, in-structions are provided by the classroom teacher,including the stipulation that it is totally voluntaryand that students can refuse to answer any or all ofthe questions without penalty. The refusal rate, ei-ther by parents or students, is generally under 2%.These procedures, as well as other human subjectsissues, have been approved by the University Insti-tutional Review Board.

The questionnaire has been developed and refinedover the course of the project and has proven effec-tive in eliciting reliable and valid drug use informa-tion [21]. These data have been used in a variety ofways, not the least of which is to provide each tribewith a comprehensive report of their drug use rates

for use in seeking program funding and for thedesign and evaluation of prevention programs. Inaddition, the database has provided a rich source ofinformation for examining the etiology and conse-quences of drug use and abuse among Indian youth[21–29].

The data reported here are from the standardquestions used on most large scale drug use ques-tionnaires, including lifetime, annual, and 30-dayprevalence and frequency of use within those peri-ods for 18 different drugs, including alcohol andcigarettes. Because such measures do not completelycapture the intensity of use or the use of multipledrugs, we have developed a categorization of overallinvolvement with drugs [29]. The first step in con-structing this typology is obtaining a score represent-ing involvement with each individual drug, includ-ing items assessing frequency of drug use, itemsassessing self-rating as a user (i.e. “Are you a ‘non,’‘very light,’ ‘light,’ ‘moderate,’ ‘heavy,’ or ‘veryheavy’ user) of that drug, and items assessing inten-sity of use (e.g. “How do you like to drink?” . . .Enough to feel it ‘a little’, ‘a lot’, ‘until I get reallydrunk’). The scales for each drug range from 3 to 10items and have reliabilities from .74 to .96. The fulltypology, incorporating patterns involving multipledrugs, classifies respondents into 1 of 34 levels ofdrug involvement but can be usefully collapsed intothree categories: “none/low,” “moderate,” and“high” [29].

The non-Indian comparison data are taken fromthe (MTF) project at the University of Michigan [30].For this project, each year, a multistage randomsampling procedure is used to select approximately16,000 each of 8th-, 10th-, and 12th-graders fromacross the country. The questionnaires are adminis-tered in the classroom and contain the standardprevalence questions, similar to those on the ques-tionnaire used in this project, so direct comparisonsacross the surveys are possible.

All statistical comparisons reported here wereperformed using difference in proportions tests. Thetests are performed for differences between adjacentdata points.

ResultsComparisons With Non-Indian Youth forIndividual Drugs

Table 1 presents a comparison of the 1998–2000 ratesof lifetime and last 30-day use of individual drugs forIndian and non-Indian youth in the 8th, 10th, and

June 2004 INDIAN ADOLESCENT DRUG USE 495

12th grades. The national figures are from the MTFstudy [30]. (These grades were selected because theyare the ones available from MTF.) The general pat-tern is for higher rates of use for Indian youth. Therate of marijuana use is especially high. The surveyasked about perceived harm from using marijuanaand alcohol. Among Indian students, only 28% indi-cate that using marijuana regularly will lead to “alot” of harm (either physical or psychological),whereas 76% of Indian youth believe that gettingdrunk regularly will produce “a lot” of harm.

The rate of alcohol intoxication also seems partic-ularly high among Indian youth. Further, Indian8th-graders are more likely to have ever used inhal-ants, although the last 30-day use among 10th- and12th-graders is similar to non-Indian youth.

Long-term Trends in Use

Table 2 shows the trends in lifetime prevalence forIndian 7th–12th-graders for the most commonlyused drugs since 1975. The difference in proportionstest between a large number of adjacent data pointsshow that many of the year to year changes in druguse rates are significant.

Figure 1 shows the changes in marijuana use overthe 25 year period for Indian and non-Indian youth.

The data for non-Indian youth are for high schoolseniors only and are from the MTF study, whereasthe data for Indian youth are for a combined sampleof 7th through 12th grade students. Note that al-though the Indian sample is considerably younger,their use of marijuana is, nevertheless, higher thanthat found for the national sample of high schoolseniors. In general, as trends in use change fornon-Indian youth, those changes are mirrored forIndian youth; for both groups, marijuana use in-creased until the early 1980’s, declined until the early1990’s, and then increased again. The most recentdata show a slight divergence, because marijuanause in the national sample of seniors has leveled off,whereas there are slight increases in use amongIndian youth. Although not presented here, the anal-ysis for other drugs yields a similar pattern. Anexception is inhalant use. Inhalant use was very highamong Indian youth for many years. It has nowdropped to a level comparable with that of otheryouth.

Level of Drug Involvement

Figure 2 shows the membership of Indian 7th–12th-graders in the “high risk” and “moderate risk”groups for the years between 1975 and 2000. The

Table 1. Percent of Indian and Non-Indian 8th- 10th- and 12th-Grade Students who Have Ever Used Drugs and HaveUsed in the Last 30 Days

Grade

8th 10th 12th

Lifetime 30-Day Lifetime 30-Day Lifetime 30-Day

Indian(n � 578)

Non-Indian(n �

16,700) IndianNon-

IndianIndian

(n � 403)

Non-Indian(n �

15,400) IndianNon-

IndianIndian

(n � 227)

Non-Indian(n �

15,800) IndianNon-

Indian

Any alcohol 72 52** 37 22** 86 71** 46 41** 93 80** 58 50**Been drunk 54 25** 25 8** 68 49** 30 24** 86 62** 42 32**Marijuana 72 20** 46 9** 80 40** 51 20** 88 49** 51 22**Inhalants 27 18** 9 5** 22 17* 3 3 24 14** 1 2Cocaine 10 5** 5 1 17 7** 5 2** 26 9** 7 3**Stimulants 17 10** 4 3 20 16* 2 5** 30 16** 4 5Sedatives 5 NA — — 6 NA — — 2 9** 3 3Heroin 5 2** 2 1** 3 2 2 1** 2 2 1 1Psychedelics 16 5** 8 1** 29 9** 8 2** 34 13** 8 3**Tranquilizers 3 4 — — 2 7** — — 5 9* — —PCP 4 NA — — 4 NA — — 6 3** — —Cigarettes 76 41** — — 83 55** — — 83 63** — —Smokeless

tobacco41 13** — — 41 19** — — 46 23** — —

Narcoticsother thanheroin

— — — — — — — — — — 2 3

* p � .05; ** p � .01.

496 BEAUVAIS ET AL JOURNAL OF ADOLESCENT HEALTH Vol. 34, No. 6

heaviest involvement group has varied only slightlysince 1979, although the percent of students in themoderate drug use group parallels the trends seenfor the lifetime prevalence rates in Table 1 and Figure1. Of particular importance is the considerable in-crease seen in the last two reporting periods in the“moderate risk” category. Currently, 24% of Indian7th–12th-graders are in the “high risk” category, and40% of Indian youth are in the “moderate risk”category.

DiscussionThe data presented here once again demonstrate theneed for comprehensive, concerted attention to drugabuse problems among American Indian youth liv-

ing on, or near, reservations. The physical and psy-chological consequences of such use must exact aheavy toll on these youth in communities whereresources are scarce. Indeed, previous research hasshown that Indian youth who use drugs are alsoinvolved in very high rates of other deviant behav-iors [5,8].

A limitation in this study involves not having datafor entire age cohorts of Indian youth owing to thelarge number of school dropouts. As high as are thereported rates, they would be higher if school drop-outs were included. Data have been reported previ-ously that indicate that Indian dropouts do havemuch higher levels of drug use [10]. Widely varyingestimates of the dropout rate have been put forth.Chavers [20] examined the available data and esti-mated the overall rate at about 50%, but data are not

Figure 1. Percent of Indian 7th–12th-graders and non-Indian 12th-graders who have ever used marijuana.

Figure 2. Percent of Indian 7th–12th-graders in the moderate and highuse groups over time.

Table 2. Percent of Indian 7th–12th-Graders Who Have Ever Used Drugs

1975(n � 1235)

1977/78and

1978/79(n � 3105)

1980/81and

1981/82(n � 2159)

1982/83and

1983/84(n � 1411)

1984/85and

1985/86(n � 1510)

1986/87and

1987/88(n � 2683)

1988/89and

1989/90(n � 5300)

1990/91and

1991/92(n � 1710)

1992/93and

1993/94(n � 2096)

1996/97and

1997/98(n � 1848)

1998/99and

1999/00(n � 2331)

Any alcohol 76 79* 85* 81** 79 81 75** 75 68** 68 77**Alcohol

intoxicationa— — — — 46 49 55** 62** 51** 52 61**

Marijuana 41 53** 74** 70** 57** 61* 55** 56 50** 69** 75**Inhalants 16 26** 30* 31 21** 24* 24 25 21** 15** 23**Cocaine 6 7 11** 6** 7 8 9 12** 9** 13** 14Stimulantsb 10 15** 24** 22 21 25** 17** 18 13** 18** 17Legal Stimulantsa — — — — 14 15 13* 15* 14 18** 19Sedativesb 6 10** 9 7* 10** 11 7** 6 4** 5 5Heroin 3 4 5 2** 5** 5 4* 3 3 4 3*Psychedelics 7 9* 9 6** 9** 10 13** 22** 19* 21 22Tranquilizersa,b — 9 6** 3** 7** 7 3* 2* 2 2 3*PCPa — — — — 10 10 7* 3** 3 5** 4Cigarettesa — — — — 79 78 71** 74* 71* 76** 79*Smokeless

tobaccob— — — — — 58 56 52** 45** 39** 40

* p � .05; ** p � .01.a Data not available for earlier years.b Only illicit, or nonprescribed, use is included.

June 2004 INDIAN ADOLESCENT DRUG USE 497

available to show whether these levels and patternschange over time.

The reasons that reservation Indian youth showthese consistently higher rates of drug involvementare not known, but they probably relate to prejudice,poverty, isolation, lack of recreational resources, andlack of opportunity. Consideration should also begiven to historical forces that may have shaped thecontemporary social environment for Indian youth[31]. The history of oppression of Indian people hasno doubt created a set of stressors for Indian youththat may help set the stage for the high levels of druguse that they experience. Lack of recreational andemployment opportunity on reservations may exac-erbate drug use. Historical social conditions such asrequired attendance at Boarding Schools may haveaffected long-term adolescent social norms. Preven-tion approaches must recognize these circumstancesand provide specific intervention elements that ad-dress these effects. For example, it could be helpful toprovide the opportunity for Indian young people todevelop the means for countering the prejudice theyencounter in their everyday life. Whitbeck et al [32],in their work with Indian youth, found that per-ceived prejudice is associated with feelings of anger,acting out, and eventually higher levels of drug use.

A limitation of the study is that the two curvesshowing trends in drug use for Indian and non-Indian youth are not directly comparable, because itwas not possible to disaggregate the Indian youthdata by grade to allow a direct comparison with highschool seniors. Despite this limitation, a comparisonof these curves provides important information onthe trends in drug use over time. The trends overtime reported here indicate that, for most drug use,Indian youth exhibit essentially the same trends asnon-Indian youth. The most recent non-Indian datafrom the MTF study show a leveling off in use. Thattrend has not yet appeared among Indian youth.Given the close correspondence between Indian andnon-Indian youth in past trends, it will be interestingto see whether future data will show this leveling offor whether, after 2 decades of parallel changes inrates of youth, Indian youth may diverge from otheryouth in their trends in drug use.

Although reservation Indian youth live in a verydifferent physical, social, and cultural environmentthan other American youth, up until now the trendsin drug use have been essentially the same over time.This suggests that, despite major environmental andsocial differences between the groups, similar factorsmay be influencing the changes in drug use. Al-though Indian youth are involved in many different

and distinctive cultures that are not shared by otherAmerican youth, the data suggest that they are alsopart of a larger “adolescent culture” in the UnitedStates. They appear to be affected by many of theelements of that culture, particularly those factorsthat produce changes in adolescent drug use. Expo-sure of Indian youth to this national adolescent drugculture is probably through two sources. The firstsource results from the lack of employment oppor-tunities on reservations. Many Indian families moveback and forth between reservations and other com-munities where parents can find work. Many reser-vation youth, therefore, spend considerable time innon-reservation schools and communities. Theseyouth would not only be influenced by non-reserva-tion youth, but would carry that influence back to thereservation. A second source of influence on Indianadolescent drug use is media. Indian reservations areno longer as isolated as they were in the past andthrough various electronic media the changingnorms of the national adolescent culture are nearlyinstantaneously communicated to even the mostremote reservations. Kunitz and Levy [33] noted thisover the course of a 30-year research project amongthe Navajo people ending in the year 2000. Theyobserved a strong rise in drug use behavior amongNavajo youth that they attributed to the growth of a“youth culture” on the reservation. A rise in adoles-cent gang membership and activity also rose rapidlyduring this period.

The nature of the environmental parameters thatproduce changes in adolescent drug use are not wellunderstood. Johnston et al [30], however, have iden-tified that “perceived harm from the use of drugs” isan important factor that mediates between environ-mental factors and drug use. As a cohort perceivesgreater harm from drug use, their tendency to usedrugs decreases. Results from this study are inagreement, showing very high levels of marijuanause among Indian youth accompanied by very lowlevels of perceived harm from marijuana use. Nearlynine of every ten seniors and three of every four8th-graders have used marijuana at least once. Thefigures showing very high rates of use in the last 30days suggest that, across the grades, about one-halfof the reservation students are using marijuana on aregular basis. These rates are two to three times thosefound for non-Indian youth. Such high rates wouldsuggest that, on Indian reservations, marijuana use isnormative behavior and that there are few sanctionsagainst use. Results from other questionnaire itemsused in this project corroborate this. For example,one of the items asks the students about the harm

498 BEAUVAIS ET AL JOURNAL OF ADOLESCENT HEALTH Vol. 34, No. 6

induced by various drugs. Only 28% of Indian stu-dents indicate that using marijuana regularly willlead to “a lot” of harm (either physical or psycholog-ical). In contrast, 76% of Indian youth believe thatgetting drunk regularly will produce “a lot” of harm.Although this relationship is fairly robust, a furtherquestion must be answered. What is it in the socialmilieu that shapes perceived harm and other perti-nent adolescent attitudes and beliefs about drugs? Agreat number of explanations have been put for-ward, including media and advertising, economicconditions, public and sports role models, and cer-tain precipitating events such as a major war [34].Whatever the environmental factors are that lead tochanges in adolescent drug use over time, theyappear to influence both Indian and non-Indianyouth, and it would be important to identify them indesigning prevention programs for both groups.

There is an exception to these parallel trendsbetween Indian and non-Indian youth found formost drugs. For a period of time inhalant abuse wasan exceptionally serious and intractable problem forIndian youth, and rates were much higher than thosefound among other American youth [15]. There hasbeen a considerable decline in the use of inhalants byIndian adolescents since the mid-1980’s. This pattern,across a wide sample of Indian communities and foran extended period of time, is an important findingbecause it likely reflects a major shift in perceptionsand attitudes that now make inhalant use much lessacceptable among young Indian people. Thesechanges in a significant adolescent drug use problemprovide some optimism that even serious, long-termdrug problems among Indian youth can be altered. Ifthe reasons for this change in inhalant use can bedetermined through future research, these insightscan be directed at prevention of other drug use andrelated behaviors.

With the exception of inhalant use, the trends foruse of drugs for Indian and non-Indian youth tend tobe highly similar. The changes over time amongIndian youth, however, do not seem to affect heavydrug users. These heavy users make up about 20% ofIndian youth. The proportion of youth in this highdrug-using group has not changed significantly since1980, despite changing social conditions, changingoverall drug use rates, and changes in attitudesabout the dangers of drug use. This high drug-usinggroup of Indian youth appear to have developed asubculture with a strong focus on heavy use of drugsand alcohol. Intervention with these youth will re-quire much more than attempts to change responsesto prevailing social attitudes. Heavy drug users

among both Indian and non-Indian youth are likelyto have more serious personal, family, and schoolproblems than youth in the moderate drug-usinggroup and thus may require more intense interven-tion and at earlier ages [35]. Given the observationthat moderate drug users seem to be influenced bysecular trends whereas “high risk” users are not, it islikely that drug use among the high using groupderives from different etiological factors. Unlessthese differences are identified, research on treat-ment and prevention will produce only mixed re-sults.

Although the data presented here suggest thatthere are common social influences on drug use forboth Indian and non-Indian youth, it cannot beassumed that the same prevention programs will beequally effective for both groups. There are likelycultural factors that moderate how these social influ-ences impinge on the lives of Indian youth. There hasbeen a strong, recent movement toward the utiliza-tion of culturally sensitive approaches to drug abuseprevention among ethnic minority populations and agrowing awareness of the cross-cultural elementsthat need to be considered [36,37]. Future researchneeds to address the cultural elements that moderatedecreases in drug use and how they can be inte-grated into prevention programming.

In conclusion, we have presented the most recentdata from a longstanding study of drug use amongIndian youth. The results have been consistent overtime. Indian youth continue to use most drugs athigher rates than non-Indian youth, with the oneencouraging sign that inhalant use has been declin-ing. The trends in use over time have been highlysimilar for Indian youth and for other Americanyouth over a 25-year span of time, suggesting thatsimilar etiologic factors are probably influencingchanges in drug use for both Indian youth and otheryouth. Prevention efforts need to be designed, eval-uated, and implemented in a manner that is congru-ent with the cultural milieu of Indian communities.

The preparation of this manuscript was supported by funds fromthe National Institute on Drug Abuse of the National Institutes ofHealth (Grant #DA03371). This study was funded by the NationalInstitute on Drug Abuse (#DA 03371).

References1. Cockerham W. Drinking attitudes and practices among Wind

River Reservation Indian youth. Q J Stud Alcohol 1975;36:321–6.

2. Dick R, Manson S, Beals J. Alcohol use among male and femaleNative American adolescents: Patterns and correlates of stu-

June 2004 INDIAN ADOLESCENT DRUG USE 499

dent drinking in a boarding school. J Stud Alcohol 1993;54:172–7.

3. Longclaws L, Barnes GE, Grieve L, et al. Alcohol and drug useamong the Brokenhead Ojibwa. J Stud Alcohol 1980;41:21–36.

4. Plunkett M, Mitchell CM. Substance use rates among Ameri-can Indian adolescents: Regional comparisons with Monitor-ing the Future high school seniors. J Drug Issues 2000;30:593–620.

5. Blum R, Harmon B, Harris L, et al. American Indian-AlaskaNative youth health. JAMA 1992;267:1637–44.

6. Shaughnessy L, Everett S, Ranslow S. Youth Risk BehaviorSurvey of Middle School Students Attending Bureau FundedSchools. Washington, DC: Bureau of Indian Affairs, 1997.

7. Shaughnessy L, Everett S, Ranslow S. Youth Risk BehaviorSurvey of High School Students Attending Bureau FundedSchools. Washington, DC: Bureau of Indian Affairs, 1997.

8. Mitchell C, Beals J. The structure of problem and positivebehavior among American Indian adolescents: Gender andcommunity differences. Am J Community Psychol 1997;25:257–88.

9. Plunkett M, Mitchell C. Substance use rates among AmericanIndian adolescents: Regional comparisons with Monitoringthe Future high school seniors. J Drug Issues 2000;39:575–92.

10. Beauvais F. Trends in drug use among American Indianstudents and dropouts, 1975–1994. Am J Public Health 1996;86:1594–8.

11. Beauvais F, Chavez E, Oetting E. Drug use, violence, andvictimization among White American, Mexican American,and American Indian dropouts, students with academic prob-lems, and students in good academic standing. J CounsPsychol 1996;43:292–9.

12. Beauvais F, Oetting E, Wolf W, Edwards R. American Indianyouth and drugs, 1976–1987. Am J Public Health 1989;79:634–6.

13. Beauvais F, LaBoueff S. Drug and alcohol abuse interventionin American Indian communities. Int J Addict 1985;20:139–71.

14. Beauvais F. Indian adolescent drug and alcohol use: Recentpatterns and consequences [Special Issue]. Am Indian AlskNative Ment Health Res 1992;5:v–78.

15. Beauvais F, Oetting, ER. Indian youth and inhalants: Anupdate. In: Crider RA, Rouse BA (eds). Epidemiology ofInhalant Abuse: An Update. Rockville, MD: National Instituteon Drug Abuse (NIDA Research Monograph No. 85) 1988:34–48.

16. Oetting E, Edwards R, Goldstein G, et al. Drug use amongadolescents of five Southwestern Native American tribes. Int JAddict 1980;15:449–55.

17. Oetting ER, Goldstein G. Drug use among Native Americanadolescents. In: Beschner G, Freidman A (eds). Youth DrugAbuse. Lexington, MA: Lexington Books, 1979:113–30.

18. Trimble J, Medicine B. Diversification of American Indians:Forming an indigenous perspective. In: Kim V, Berry J (eds).Cross-Cultural Research and Methodology Series, IndigenousPsychologies: Research and Experience in Cultural Context,Vol. 17. Newbury Park, CA: Sage Publications, 1993:133–51.

19. Trimble J. Ethnic specification, validation prospects and thefuture of drug abuse research. Int J Addict 1990–91;25:149–69.

20. Chavers D. Indian education: Dealing with a disaster. Princi-pal 1991;70:28–9.

21. Oetting ER, Beauvais F. Adolescent drug use: Findings ofnational and local surveys. J Consult Clin Psychol 1990;58:385–94.

22. Beauvais F. An integrated model for prevention and treatmentof drug abuse among American Indian youth. J Addict Dis1992;11:63–80.

23. Beauvais F, Segal B. Drug use patterns among AmericanIndian and Alaskan Native youth: Special rural populations.In: Edwards R (ed). Drug Use In Rural American Communi-ties. New York: Haworth Press, 1992:77–94.

24. Binion A, Miller C, Beauvais F, et al. Rationales for the use ofalcohol, marijuana and other drugs by eighth-grade NativeAmerican and Anglo youth. Int J Addict 1988;23:47–64.

25. Oetting ER, Beauvais F. Orthogonal Cultural IdentificationTheory: The cultural identification of minority adolescents. IntJ Addict 1990–91;25:655–85.

26. Oetting ER, Beauvais F, Edwards R. Alcohol and Indian youth:Social and psychological correlates and prevention. J DrugIssues 1988;18:87–101.

27. Oetting ER, Swaim R, Chiarella M. Factor structure andinvariance of the Orthogonal Cultural Identification Scaleamong American Indian and Mexican-American youth. Hisp JBehav Sci 1998;20:131–54.

28. Oetting ER, Swaim R, Edwards R, et al. Indian and Angloadolescent alcohol use and emotional distress: Path models.Am J Drug Alcohol Abuse 1989;15:153–72.

29. Oetting ER, Beauvais F. A typology of adolescent drug use: Apractical classification system for describing drug use pat-terns. Academic Psychol Bull 1983;5:55–69.

30. Johnston L, O’Malley P, Bachman J. Monitoring the Futurenational survey results on drug use, 1975–2000. Vol. I Second-ary school students. Bethesda MD: National Institute on DrugAbuse, 2001; NIH publication no. 01-4924.

31. Fleming C. American Indians and Alaska Natives: Changingsocieties past and present. In: Orlandi M, Weston R, Epstein L(eds). Cultural Competence for Evaluators: A Guide for Alco-hol and Other Drug Prevention Practitioners Working WithEthnic/Racial Communities. Rockville, MD: Office for Sub-stance Abuse Prevention, 1992:142–72.

32. Whitbeck L, McMorris BJ, Hoyt DR, et al. Perceived discrim-ination and early substance use among American Indianchildren. J Health Soc Behav 2001;42:405–24.

33. Kunitz S, Levy J. Conclusions. In: Kunitz S, Levy J (eds).Drinking, Conduct Disorder and Social Change: Navajo Expe-riences. New York: Oxford, 2000:155–78.

34. Johnston L. Toward a theory of drug epidemics. In: DonohewL, Sypher D, Bukoski W (eds). Persuasive Communication andDrug Abuse Prevention. Hillsdale, NJ: Lawrence Erlbaum,1991:93–132.

35. Swaim RC. Childhood risk factors and adolescent drug andalcohol abuse. Educational Psychol Rev 1991;3:363–98.

36. Resnikow K, Soler R, Braithwaite R, et al. Cultural sensitivityin substance abuse prevention. J Community Psychol 2000;28:271–90.

37. Jumper-Thurman P, Plested B, Edwards R, et al. CommunityReadiness: A promising model for community healing. Uni-versity of Oklahoma Health Sciences Center, Center on ChildAbuse and Neglect. 2000.

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