title: Sequences of substance use among American Indian adolescents.
abstract: OBJECTIVE
  To determine whether the predominant pattern of the sequence of use of different classes of substances among a large sample of American Indian (AI) adolescents is consistent with Stage Theory [i.e., (1) alcohol, (2) marijuana, (3) other illicit drugs, and (4) cocaine].
  
  
  METHODS
  Data came from surveys completed by 1,562 AI high school students in 1993. Pairwise comparisons of age of first use for alcohol, marijuana, inhalants, cocaine, and other illicit drugs were examined, as were the prevalence rates of specific sequences of substance use.
  
  
  RESULTS
  Thirty-five percent of the AI youths who had used both alcohol and marijuana reported using alcohol first. Seventy-five percent of youths who had used three or more substances reported a sequence of first use that was inconsistent with Stage Theory. However, a general pattern of using alcohol, marijuana, and/or inhalants prior to the use of cocaine and other illicit drugs was observed. Sequences of first use varied by gender, age of first substance use, community, and number of classes of substances used.
  
  
  CONCLUSIONS
  To enhance the validity of Stage Theory for AI adolescents, the authors recommend its revision to include alcohol, marijuana, and inhalants as initiating substances.
authors.affiliation: National Center for American Indian and Alaska Native Mental Health Research, University of Colorado Health Sciences Center, Denver 80220, USA. douglas.novins@uchsc.edu
authors.forename: D K
authors.initials: DK
authors.lastname: Novins
authors.forename: J
authors.initials: J
authors.lastname: Beals
authors.forename: C M
authors.initials: CM
authors.lastname: Mitchell
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000523:psychology* / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D011582:Psychological Theory; D019966:Substance-Related Disorders / Q000208:ethnology* / Q000523:psychology*; D014481:United States / Q000453:epidemiology