Author

Megan Hoopes

Date

May 2008

Document Type

Thesis

Degree Name

M.S.

Department

Dept. of Public Health and Preventive Medicine

Institution

Oregon Health & Science University

Abstract

Background - American Indians and Alaska Native (AIANs) as a group are at increased risk for many drug abuse and mental health disorders relative to other races. The abuse and production of methamphetamine in the U.S. has surged in the past decade, presenting major challenges to health care, criminal justice, and public health systems. Survey data and anecdotal accounts suggest that methamphetamine poses a disproportionate burden in Indian country (Colliver, 2007), and the drug is widely cited by tribal agencies as the single greatest drug threat to their communities (Evans, 2006). Additionally, anecdotal accounts increasingly identify nonmedical use of prescription pain relievers as a growing problem in Indian Country (AP, 2007; Melmer, 2007), and tribal leaders have expressed concern that the high availability of prescription analgesics may be fueling a new illicit drug trade on some reservations (AP, 2007). Risk factors and correlates for methamphetamine and prescription pain reliever abuse have been well described in the general population but less is known about correlates of the use of these two drugs among AIANs. Methods - The National Survey on Drug Use and Health (NSDUH) is a nationally representative, cross-sectional survey conducted annually by the Substance Abuse and Mental Health Services Administration; the survey collects information on the prevalence and correlates of drug use in the U.S. population ages 12 years and older and includes sampling on Indian reservations. Lifetime and past-year prevalence of methamphetamine use and nonmedical use of prescription pain relievers among AIANs were estimated from 2005-2006 NSDUH public-use data (n=1609, weighted=1.27 million). Multivariable logistic regression analyses were conducted using all AIAN participants to model correlates of lifetime methamphetamine use and lifetime nonmedical use of prescription pain relievers. Measures of mental health status were included in the range of potential correlates. Interactions with county type (rural, small metropolitan, large metropolitan), gender, and age were examined to describe potentially differing patterns of drug use in varying subpopulations of AIANs. Results - Nearly 12% of AIANs reported using methamphetamine at least once in their lives, and over 18% had used a prescription pain reliever nonmedically. AIANs with a history of methamphetamine and/or nonmedical prescription pain reliever use were more likely to have experienced mental health problems. Important correlates of the drug use outcomes included gender, age, abuse of other substances, history of arrest, and mental health symptomology, though associations with these factors varied between the two drug outcomes. Additionally, some correlates were found to differ by county type of residence in the methamphetamine model, and by gender in the pain reliever model. Measures of socioeconomic status were not highly correlated with either drug use outcome. Conclusion - This study has described a range of factors associated with the use of two drugs of current concern in many AIAN communities, and highlighted associations between mental health morbidities and drug use. Several interactions were identified, suggesting that drug availability, accessibility, and initiation factors may differ by county type and gender. Improved recognition and treatment of mental health symptomology may represent an important intervention strategy against drug abuse. We anticipate that these results will assist tribal health leaders in identifying those at highest risk and inform culturally-specific prevention and intervention strategies.

Identifier

doi:10.6083/M4N29TXV

School

School of Medicine

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