Examining the Relationship Between Social Determinants of Health and Substance Use for Urban American Indian Adolescents in the United States

Most American Indian (AI) families in the USA now live in urban areas, but rigorous research is lacking on the social determinants of their health. Urban AI youth (UAIY) report higher rates, earlier initiation, and more severe consequences of substance use than their non-AI counterparts. Family disruptions, stresses related to moving, and difficulties in establishing and sustaining social and cultural connections are frequently mentioned as contributing to adverse health outcomes for UAIY. Ecodevelopmental theory is useful for understanding how social determinants operating at peer, family, school, and neighborhood levels interact to influence substance use among urban AI youth.  This presentation examines how negative peer and family influences act as social determinants of health to influence substance use among UAIY, as well as how positive familial and peer influences can moderate (buffer) these risky determinants. Data come from the 2012 Arizona Youth Survey, a state-wide self-report survey of 8^th, 10^th, and 12^th grade students, which includes 2,407 UAIY. Confirmatory factor analysis (CFA) and structural equation modeling (SEM) tested the direct and moderated effects of last 30-day alcohol, cigarette and marijuana use.  The CFA results comprised four latent variables: two negative influences- substance users in the family and associations with anti-social peers; and, two positive influences- supportive family environment and involvement with pro-social peers. SEM results indicate that the negative constructs significantly increased substance use, however tests of moderation showed that the positive family and peer influences significantly buffered the negative effects on substance use. The emerging patterns and relationships between ecodevelopmental factors on substance use help to identify issues that urban AI youth face when navigating within larger socio-environmental contexts that influence the youth’s vulnerability to health disparities. Understanding possible moderators can be useful in designing and delivering strengths-based prevention programs that enhance health and wellbeing of urban AI youth.