According to data published in JAMA Network Open, reservation-based American Indian students are at a higher risk for substance use compared with US youth in general, highlighting the necessity of increased intervention efforts for this population.

Researchers conducted a population-based survey study of 8th, 10th, and 12th grade students attending participating schools on or near reservations during the 2016 and 2017 school year. Substance use rates were stratified by region and compared with those of a national sample of comparably aged students from the Monitoring the Future study. Specifically, lifetime and last 30-day self-reported use of alcohol, marijuana, and other drugs were captured and quantified using relative risk (RR) ratios. Substance use figures were also compared against similar survey data from 2009 to 2012.

Study participants included 570 students in 8th grade (49.6% girls; mean age, 13.5 years), 582 in 10th grade (50.0% girls; mean age, 15.4 years), and 508 in 12th grade (53.5% girls; mean age, 17.4 years). American Indian students reported significantly higher lifetime and last 30-day substance use rates compared with the national sample. Lifetime use rates for American Indian students were higher than those of the national sample for all substance measures except tranquilizers and amphetamines (all P <.05). The greatest discrepancy was observed for 8th grade students: last 30-day substance use RRs were 2.1 (95% CI, 1.4-3.0) for alcohol, 4.2 (95% CI, 3.1-5.8) for marijuana, and 2.4 (95% CI, 1.7-3.3) for other illicit drugs. The 2016 to 2017 RRs between American Indian and Monitoring the Future students for lifetime alcohol and marijuana use changed little from 2009 to 2012. However, lifetime RR for use of other illicit drugs increased substantially, from an RR of 1.8 (95% CI, 1.7-1.9) for 2009 to 2012 to an RR of 3.0 (95% CI, 2.9-3.2) for 2016 to 2017.

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These study data demonstrate that reservation-based American Indian adolescents are at a substantially higher risk for lifetime exposure to substance use than other adolescents in the United States, with the discrepancy increasing over time. Researchers thus emphasized the necessity of developing targeted interventions to address such health disparities among American Indian communities.


Swaim RC, Stanley LR. Substance use among American Indian youths on reservations compared with a national sample of US adolescents. JAMA Network Open. 2018;1(1):e180382.