title: Childhood exposure to adversity and risk of substance-use disorder in two American Indian populations: the meditational role of early substance-use initiation.
abstract: OBJECTIVE
  We examined the relationship of childhood exposure to adversity and risk of substance-use disorder in two culturally distinct American Indian reservation communities, exploring both the role of early initiation of substance use in mediating this relationship and variation in risk across types of adversity exposure.
  
  
  METHODS
  The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project provided data from 2,927 American Indians on the occurrence and age at onset of adversities, substance use, and substance-use-disorder symptoms.
  
  
  RESULTS
  The risk of substance-use disorder associated with early adversity was explained partially by early initiation of substance use. Three types of adversity (major childhood events, traumas, and witnessed violence) were associated with early onset of substance use and increased risk of substance-use disorder. Gender and tribe were also related to variation in both early substance use and substance-use disorder.
  
  
  CONCLUSIONS
  Early exposure to adverse events was associated with early substance use and the subsequent development of substance-use disorders among American Indians. public health initiatives targeting substance use and substance-use disorders in American Indian communities should include efforts to help children in these communities cope with adversities they encounter.
authors.affiliation: Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Denver, Aurora, CO 80045, USA. nancy.whitesell@ucdenver.edu
authors.forename: Nancy Rumbaugh
authors.initials: NR
authors.lastname: Whitesell
authors.forename: Janette
authors.initials: J
authors.lastname: Beals
authors.forename: Christina M
authors.initials: CM
authors.lastname: Mitchell
authors.forename: Spero M
authors.initials: SM
authors.lastname: Manson
authors.forename: R Jay
authors.initials: RJ
authors.lastname: Turner
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D002648:Child; D003431:Cross-Cultural Comparison; D003625:Data Collection; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000523:psychology* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult