Alcohol- and drug-related consequences across latent classes of substance use among American Indian adolescents

Highlights

• Nearly one-third of adolescents reported any past month substance use.

• Adolescents had experienced an average of 2–3 substance-related consequences.

• Use of a greater number of substances was associated with greater consequences.

Abstract

Introduction

Substance use among American Indian (AI) adolescents is a significant public health concern, as they report greater health disparities related to substance use compared to other racial/ethnic groups. The present study examines differences across classes of substance use behaviors regarding alcohol- and drug-related consequences.

Methods

The current study was a secondary analysis of the dataset used by Stanley and Swaim (2018). AI adolescents (n = 3498, 47.8% female, M_age = 14.8) completed a survey including substance use and related consequences. Protocols were approved by institutional IRB, tribal authority, school boards, and parental consent/child assent were obtained.

Results

In line with Stanley and Swaim (2018), we identified four classes of substance use: no past month substance use; marijuana and cigarette use only; alcohol, marijuana, and cigarette use only; and polysubstance use. Cross-class comparisons revealed that adolescents in classes characterized by the use of a greater number of substances also reported experiencing greater alcohol- and drug-related consequences with one exception: the class characterized by marijuana and cigarette use reported greater drug-related consequences compared to the class characterized by alcohol, marijuana, and cigarette use.

Conclusions

AI adolescents who engage in the use of multiple substances should be provided with psychoeducation around the increased risk of associated negative consequences. Given the health disparity experienced by AI adolescents, interventions to alleviate the burden of negative consequences are necessary.

Introduction

Substance use among American Indian (AI) adolescents represents a major public health concern (Whitbeck, Hoyt, Johnson, & Chen, 2006). Although there is great heterogeneity among groups, AI adolescents have been found to exhibit high rates of use for nearly all substances (Friese et al., 2011, Stanley et al., 2014, Swaim and Stanley, 2018, Whitbeck et al., 2014) and have an increased likelihood of having used marijuana, inhalants, cigarettes, or having drank alcohol until intoxicated compared to their non-AI peers (Spillane et al., 2019, Stanley and Swaim, 2015). Research has also found AI adolescents to be more likely to initiate using substances at young ages (Beauvais, 1996, Friese et al., 2011, Henry et al., 2011, Stanley and Swaim, 2015, Whitesell et al., 2012, Yu and Stiffman, 2007). Furthermore, a strong body of literature finds AI adolescents experience disproportionate substance-related consequences, substance-related mortality and morbidity and increased likelihood of developing a substance-use disorder (Henry et al., 2011, Landen et al., 2014, Centers for Disease Control and Prevention, 2008, Indian Health Services, 2018, Stanley et al., 2014, Szlemko et al., 2006).

Given the clear substance-related health disparity with AI adolescents, it is vital to consider patterns of using two or more substances within this population; however, to date, a dearth of research has examined the use of two or more substances among AI adolescents. To begin to address this gap, Stanley and Swaim (2018) conducted a latent class analysis among a large, population-based sample of AI adolescents on or near reservations in order to examine patterns in endorsement of the use of various substances. They identified subgroups of individuals using “latent classes” —or otherwise unobservable groups— who share similar characteristics and use substances in similar combinations within this population. They found four classes of substance use for AI adolescents: no past month substance use (the largest class); marijuana and cigarette use only; alcohol, marijuana, and cigarette use only; and polysubstance use, defined as use of any other substance in addition to alcohol, marijuana, and cigarettes (the smallest class; Stanley & Swaim, 2018). Understanding these latent classes may provide valuable insight on nuanced substance use and related health disparities within this population.

The work of Stanley & Swaim (2018) is crucial given that little research has examined polysubstance use in this vulnerable population. Polysubstance use among adolescents has distinct harmful substance-related consequences, including greater likelihood of engagement in risky sexual behavior, greater psychological distress (e.g., anxiety, depression), and greater likelihood of not completing school (Connell et al., 2009, Kelly et al., 2015, Kelly et al., 2015, Morley et al., 2015, Stanley and Swaim, 2018). Although a strong body of literature shows AI adolescents experience disproportionate substance-related consequences (Henry et al., 2011, Landen et al., 2014, Centers for Disease Control and Prevention, 2008, Indian Health Services, 2018, Stanley et al., 2014, Szlemko et al., 2006), we know very little about how these consequences differ based on patterns of endorsement of the use of various substances, and in particular, how polysubstance use contributes to this health disparity. Understanding patterns of endorsing use of various substances is imperative in order to gain insight into AI adolescent substance-related consequences. Thus, the purpose of the present study is to expand upon the work of Stanley and Swaim (2018) by examining differences in alcohol- and drug-related consequences across the four classes of substance use identified by Stanley and Swaim (2018): no past month substance use; marijuana and cigarette use only; alcohol, marijuana, and cigarette use only; and polysubstance use. Given the clear health disparity among AI adolescents who use substances and experience disproportionate substance-related harm, we hypothesize that adolescents in classes characterized by use of a greater number of substances would also endorse experiencing the greatest alcohol- and other drug-related consequences.