Risk and protective factors for heavy binge alcohol use among American Indian adolescents utilizing emergency health services.
American Indian (AI) adolescents are disproportionately burdened by alcohol abuse and heavy binge use, often leading to problematic drinking in adulthood. However, many AI communities also have large proportions of adults who abstain from alcohol.



To understand these concurrent and divergent patterns, we explored the relationship between risk and protective factors for heavy binge alcohol use among a reservation-based sample of AI adolescents.



Factors at individual, peer, family, and cultural/community levels were examined using a cross-sectional case-control study design. Cases were adolescents with recent heavy binge alcohol use that resulted in necessary medical care. Controls had no lifetime history of heavy binge alcohol use. 68 cases and 55 controls were recruited from emergency health services visits. Participants were 50% male; average age 15.4 years old, range 10 to 19. Independent variables were explored using logistic regression; those statistically significant were combined into a larger multivariate model.



Exploratory analyses showed adolescents who were aggressive, impulsive, had deviant peers, poor family functioning or more people living at home were at greater risk for heavy binge alcohol use. Protective factors included attending school, family closeness, residential stability, social problem-solving skills, having traditional AI values and practices, and strong ethnic identity. Confirmatory analysis concluded that school attendance and residential stability reduce the probability of heavy binge alcohol use, even among those already at low risk.



Findings deepen the understanding of AI adolescent heavy binge alcohol use and inform adolescent intervention development fostering trajectories to low-risk drinking and abstinence.
a Department of International Health , Johns Hopkins Center for American Indian Health , Baltimore , MD , USA.
Lauren
L
Tingey
a Department of International Health , Johns Hopkins Center for American Indian Health , Baltimore , MD , USA.
Mary F
MF
Cwik
a Department of International Health , Johns Hopkins Center for American Indian Health , Baltimore , MD , USA.
Summer
S
Rosenstock
a Department of International Health , Johns Hopkins Center for American Indian Health , Baltimore , MD , USA.
Novalene
N
Goklish
a Department of International Health , Johns Hopkins Center for American Indian Health , Baltimore , MD , USA.
Francene
F
Larzelere-Hinton
a Department of International Health , Johns Hopkins Center for American Indian Health , Baltimore , MD , USA.
Angelita
A
Lee
a Department of International Health , Johns Hopkins Center for American Indian Health , Baltimore , MD , USA.
Rosemarie
R
Suttle
a Department of International Health , Johns Hopkins Center for American Indian Health , Baltimore , MD , USA.
Melanie
M
Alchesay
a Department of International Health , Johns Hopkins Center for American Indian Health , Baltimore , MD , USA.
Kirk
K
Massey
a Department of International Health , Johns Hopkins Center for American Indian Health , Baltimore , MD , USA.
Allison
A
Barlow
D000293:Adolescent; D000294:Adolescent Behavior / Q000208:ethnology; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000208:ethnology; D063425:Binge Drinking / Q000453:epidemiology* / Q000208:ethnology; D002648:Child; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010379:Peer Group; D065840:Protective Factors; D012307:Risk Factors; D055815:Young Adult
Adolescent; American Indian; heavy binge alcohol use; protective factor; risk factor