High Tribal Identity Is Protective Against Alcohol Use Among Native Adolescents

The association between high pain interference and alcohol use is attenuated by Tribal identity among American Indian and Alaska Native (AIAN) adolescents. These findings were published in JAMA Pediatrics.

Previous studies have demonstrated that AIAN adolescents have higher rates of early substance use initiation and a higher prevalence of pain symptoms and pain-related disorders, relative to their peers of other racial and ethnic backgrounds. Given that research has found a positive influence of Native culture on mental health issues and substance use, investigators designed a cross-sectional study (NCT04839978) to evaluate significant modifiers of the relationship between pain and substance use among AIAN adolescents.

The investigators recruited students who identified as AIAN and attended the 10^th grade at 20 high schools in or around the Cherokee Nation Reservation in Oklahoma between 2021 and 2024. The participants responded to a survey which asked about substance use in the past 30 days, evaluated pain interference using the Patient-Reported Outcomes Measurement Information System-Pediatric Pain Interference (PROMIS-PPI) scale, anxiety using the Generalized Anxiety Disorder 7-item (GAD-7) scale, depression using the 8-item Patient Health Questionnaire depression (PHQ-8) scale, and Tribal identity using the 6-item Multigroup Ethnic Identity Measure-Revised (MEIM-R) instrument.

A total of 514 students were included in the analysis. The adolescents had a mean (SD) age of 15.59 (0.62) years, PROMIS-PPI score of 1.97 (1.00), GAD-7 score of 6.81 (5.89), PHQ-8 score of 7.59 (6.13), MEIM-R score of 3.19 (1.08), and 49.0% were girls.

Overall, 20.4% of participants endorsed using alcohol (mean=0.51 [1.43] days per month), 16.3% endorsed using marijuana (mean=1.95 [6.59] days per month), and 3.8% endorsed misusing prescription opioids (mean= 0.22 [2.03] days per month).

After controlling for age, gender, food insecurity, anxiety, and depression, the relationship between pain interference and alcohol use was mediated by Tribal identity (coefficient, -0.13; 95% CI, -0.23 to -0.02; P =.02). Individuals with low Tribal identity were more affected by pain interference, in which those with high pain interference engaged in more alcohol use days. However, pain interference had little effect on alcohol use days among those with high Tribal identity.

Tribal identity was not a significant modifier of the relationship between pain interference and either marijuana use or prescription opioid misuse. However, pain interference and misuse of prescription opioids were positively associated (adjusted rate ratio [aRR], 2.27; 95% CI, 1.27-4.04; P =.005).

“[H]igher levels of Tribal identity were found to mitigate the association between pain interference and alcohol use,” the investigators concluded. “Efforts to prevent alcohol use among American Indian/Alaska Native youth may be effective if Tribal identity is preserved, promoted, and included in culturally grounded intervention strategies.”

As the youth in this study were recruited from schools surrounding the Cherokee Nation Reservation, the results of this study may not be generalizable for all AIAN youth.

This article originally appeared on Psychiatry Advisor