title: Epidemiology and etiology of substance use among American Indians and Alaska Natives: risk, protection, and implications for prevention.
abstract: BACKGROUND
  The epidemiology and etiology of substance use and disorder in American Indian and Alaska Native (AI/AN) communities have received increasing attention over the past 25 years and accumulating evidence provides important insights into substance use patterns in these populations.
  
  
  OBJECTIVE
  We provide a descriptive sketch of the AI/AN population in the United States today, present a brief review of the literature on the epidemiology and etiology of substance use within these populations, and discuss key implications of this literature for prevention efforts.
  
  
  CONCLUSIONS
  Patterns of alcohol use and abuse in AI/AN populations are complex and vary across cultural groups, but alcohol clearly impacts both physical health and mental health within these communities. Tobacco use - and associated health consequences - is typically higher in these populations than among other US groups, although significant variation across Native communities is apparent here as with alcohol. Evidence regarding drug use and disorder is less extensive and thus less conclusive, but evidence demonstrates higher rates of use as well. Etiological explanations for substance use and disorder cut across individual characteristics (e.g., genetics) or experiences (e.g., exposure to trauma), to social contexts (e.g., family disruption), and to cultural factors (e.g., historical trauma). Protective factors likely cut across these multiple levels as well and deserve more focused attention for informing prevention efforts. The development of effective prevention strategies, built through collaboration between researchers and Native communities, drawing from the wisdom of both, is a high priority.
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: Cecelia Big
authors.initials: CB
authors.lastname: Crow
authors.forename: Christina M
authors.initials: CM
authors.lastname: Mitchell
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Novins
mesh_terms: D000413:Alaska / Q000453:epidemiology; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000517:prevention & control; D003299:Cooperative Behavior; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D012306:Risk; D012907:Smoking / Q000453:epidemiology*; D000074606:Smoking Prevention; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control; D014481:United States / Q000453:epidemiology