title: Understanding the relationship between substance use and self-injury in American Indian youth.
abstract: BACKGROUND
  American Indian communities compared to other US populations are challenged by the largest health disparities in substance abuse and suicidal behavior among youth ages 15-24.
  
  
  OBJECTIVE
  This article examines the co-occurrence of substance use and self-injury among reservation-based youth in the US.
  
  
  METHODS
  White Mountain Apache tribal leaders and Johns Hopkins University formed a partnership to address self-injury and substance abuse among Apache youth. Data on suicide (deaths, attempts, ideation), non-suicidal self-injury, and substance use were analyzed from the White Mountain Apache tribally mandated self-injury surveillance registry from 2007 to 2010, including 567 validated incidents from 352 individuals aged 15-24 years. Findings regarding characteristics of co-occurrence - including differences in the type of self-harm behavior, gender, and reported reasons for the act - were interpreted through a community-based participatory research process.
  
  
  RESULTS
  From 2007 to 2010, 64% (n = 7/11) of Apache youth ages 15-24 were "drunk or high" at the time of suicide death with data missing for 2/11 deaths; 75.7% (n = 118/156) were "drunk or high" during suicide attempt; 49.4% (n = 83/168) during suicidal ideation; and 49.4% (81/166) during non-suicidal self-injury. Co-occurrence of substance use was higher for more lethal acts and among males.
  
  
  CONCLUSIONS
  High rates of co-occurring self-injury and substance use within this population highlight the importance of research to understand relationships between these behaviors to design preemptive and integrated interventions.
  
  
  CONCLUSIONS
  Tribal-specific and culturally informed data on the co-occurrence of self-injury and substance use hold promise for reducing the combined toll of years of productive life lost among American Indian youth.
authors.affiliation: Center for American Indian Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Barlow
authors.forename: Lauren
authors.initials: L
authors.lastname: Tingey
authors.forename: Mary
authors.initials: M
authors.lastname: Cwik
authors.forename: Novalene
authors.initials: N
authors.lastname: Goklish
authors.forename: Francene
authors.initials: F
authors.lastname: Larzelere-Hinton
authors.forename: Angelita
authors.initials: A
authors.lastname: Lee
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Suttle
authors.forename: Britta
authors.initials: B
authors.lastname: Mullany
authors.forename: John T
authors.initials: JT
authors.lastname: Walkup
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D011446:Prospective Studies; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000208:ethnology; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000208:ethnology; D059020:Suicidal Ideation; D013405:Suicide / Q000208:ethnology / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000208:ethnology / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D055815:Young Adult