Date of Award

2023

Degree Type

Thesis

Degree Name

Master of Arts in Psychology

Specialization

Clinical Psychology

Department

Psychology

First Advisor

Nichea Spillane

Abstract

Introduction: Substance use among American Indian (AI) adolescents is a major health concern in Indigenous communities due to increased rates of earlier use, heavier use, and increased risk for negative outcomes related to substance use. Primary Socialization Theory (PST), which accounts for how various family and peer relationships and the strength of these relational bonds influence adolescents’ substance use, can be used to understand how relational factors influence adolescent substance use, with family being especially important and influential in AI communities. Another important aspect within AI adolescents, especially for those living on or near reservations, is culture. Researchers have found that having strong ties to one’s cultural identity (i.e., cultural affiliation) may be protective in reducing substance use and harms associated with substances in AI communities. Efforts to reclaim culture and heal from the effects of trauma related to colonization have integrated culture into substance use treatments, some suggesting that culture is treatment. However, there have been mixed findings concerning the protective role that culture plays in substance use. Therefore, further studies are needed to understand better the relationship between culture and substance use, specifically how culture may interact with additional factors that may augment the protective effects of culture, such as family disapproval of substance use. Based on extant literature, this may mean that cultural affiliation may be protective in the relationship between family disapproval of substance use and frequency of substance use. Thus, the primary purpose of this study is twofold: First, to examine the relationship between family disapproval and cultural affiliation and substance use outcomes (past year and lifetime alcohol, cannabis, and illicit drugs). Second, to examine the potential role of cultural affiliation in moderating the association between family disapproval of substance use and substance use, specifically, family disapproval of alcohol use, cannabis use, and illicit drug use and frequency of past-year alcohol use, cannabis use, and count of illicit drug use respectively in a sample of AI adolescents.

Methods: This was a secondary data analysis study utilizing data from the “Our Youth, Our Future” (OYOF) study, an ongoing epidemiologic survey examining trends in substance use in a nationally representative sample of AI adolescents (ages 12-19) living on or near AI reservations. Participants (N = 8,950) has a Mage= 14.64, SD = 1.77, and 49.3% self-identified as male, 50.7% self-identified as female). For the current study, I used the following measures: demographic questionnaire, Multigroup Ethnic Identity Measure (MEIM), Family disapproval of alcohol, cannabis, and illicit drug use, past month frequency of alcohol use, lifetime frequency of alcohol use, past month frequency of cannabis use, lifetime frequency of cannabis use, past month frequency of illicit drug use, and lifetime count of illicit drug use.

Results: Multilevel linear regressions revealed that family disapproval was significantly and negatively associated with frequency of lifetime alcohol use (b = -0.15, SE = 0.02, t = -8.41, p = < .001, 95% CI [-0.18, -0.11] and cannabis use (b = -0.34, SE = 0.02, t = -16.21, p = <.001, 95% CI [-0.39, -0.30]. A multilevel regression analysis examining the interaction between cultural affiliation and family disapproval was significant for the model with alcohol use (b = -0.01, SE = 0.00, t = -3.05, p = .002, 95% CI [-0.02, -0.00]), at high levels of cultural affiliation (b = -0.27, SE = 0.04, t = -6.46, p = <.001, 95% CI [-0.35, -0.19]), but not at low levels of cultural affiliation (b = -0.07, SE = 0.09, t = -0.71, p = .475, 95% CI [-0.25, 0.12]). Multilevel regression analysis was also significant for the interaction between cultural affiliation and family disapproval of cannabis use (b = -0.01, SE = 0.00, t = -2.56, p = .010, 95% CI [-0.02, -0.00]) at high levels of cultural affiliation (b = -0.51, SE = 0.05, t = -10.18, p = <.001, 95% CI [-0.60, -0.41]) and low levels of cultural affiliation (b = -0.32, SE = 0.11, t = -2.82, p = .005, 95% CI [-0.53, -0.10]). Lastly, multilevel regression analysis revealed the interaction between cultural affiliation and family disapproval was nonsignificant for the model with illicit drug use (b = 0.001, SE = 0.06, t = 0.11, p = .915, 95% CI [-0.01, 0.01]).

Conclusions: The results indicate that family disapproval of substance use is associated with decreased substance use among AI adolescents. Further, findings suggest that the effectiveness of family disapproval of alcohol use and cannabis use is bolstered by cultural affiliation. These results lend their support to encouraging families to discuss the negative impacts of substance use while simultaneously sharing the importance of AI culture with their adolescents and finding ways to further opportunities to affiliate with their culture.

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