Alcohol and illicit drug use problems in American Indian youth: Multiple, interactive and joint determinants, and their implications

It is well documented that alcohol and illicit drug problems are a critical issue among American Indian youth. This dissertation study examines multiple (i.e., individual, familial, social, and cultural) determinants of adolescent alcohol and illicit drug problems. In doing this, this study focuses on investigating how the multiple determinants are interactively and jointly related to such problems. There is a scarcity of research examining direct, interactive, and joint associations of such problems in this population. It may help provide guidance towards specific and effective intervention and prevention strategies for adolescent alcohol and illicit drug problems.;A stratified sample of 401 American Indian adolescents (aged 13 to 19 years) in 2001 and 341 adolescents from the sample in 2004, living in Southwestern urban and reservation areas, was interviewed. The study uses a structured diagnostic interview to assess for alcohol and illicit drug problems, and individual problems. Existing measures with established reliability and validity are used to assess for familial, social, and cultural environments.;The cross-sectional and longitudinal findings revealed that individual problems (conduct disorder symptoms and depression symptoms), and negative familial (addicted family members), social (negative peer influences and negative neighborhood environment) and cultural (generic cultural activities) environments were positively associated with alcohol and/or illicit drug abuse/dependence symptoms. Of these, conduct disorder symptoms and negative peer influences were most strongly related to both symptoms. There were interactive associations of the multiple determinants in predicting alcohol and/or illicit drug symptoms. Moreover, the longitudinal findings showed that later depression symptoms, addicted family members, and/or negative peer influences increased the effects of early alcohol and illicit drug symptoms on later alcohol and illicit drug symptoms, respectively.;On the other hand, the cross-sectional findings revealed that religious participation and positive parent-adolescent relations were negatively related to alcohol and/or illicit drug symptoms. The positive environments decreased such symptoms by negatively moderating or mediating the effects of individual problems, and/or problematic familial and social environments.;These findings suggest that the multiple determinants and their complex associations of alcohol and illicit drug symptoms should be assessed for and incorporated into intervention and prevention programs for adolescents with alcohol and illicit drug problems.