Exploring the Association between Community Attachment and Prescription Drug Misuse among American Indian Adolescents

Overview: This paper explores the association between prescription drug use and community attachment among American Indian adolescents in their lifetime and past 30-days. Secondary data analyses were conducted using logistic regression models. Results indicated that community attachment was negatively associated with lifetime use, and identified other protective and risk factors.Proposal text: Background/Rationale
Prescription drug misuse (PDM) has gotten more attention in the past decade (DuPont, 2010; Kelly et al., 2015) and has been a significant health challenge in the US (SAMHSA, 2019b). Even though PDM happens in all racial/ethnic groups, recent empirical studies and data show that American Indians (AI) have a high prevalence of prescription opioid misuse (Schuler et al., 2021). Especially, opioid misuse and prescription pain reliever misuse have increased slightly from 2018 among the AI population aged 12-17 years (SAMHSA,2019a). Since community-oriented approaches have been considered accounting for American Indian values and traditions (Guttmannova et al., 2107), this study explores relationships between PDM and community attachment using two outcome variables, lifetime use and past 30 days use. This study also identifies the protective and risk factors of AI youth PDM.

Methods/Methodology
This study used state-level secondary data from 246 schools across 15 counties. Participants were 2,494 students (47.31% male), aged 13-18, and self-identified as American Indians. Four models of PDM were estimated to examine the effect of community attachment by using hierarchical design:
1) demographic variables and PDM in lifetime;
2) demographic variables and PDM in lifetime plus community attachment;
3) demographic variables and PDM in the past 30 days; and
4) demographic variables and PDM in the past 30 days plus community attachment. All analyses were conducted using logistic regression models.

Results
Results indicated that community attachment was negatively associated with AI youth lifetime PDM (Odds Ratio (OR)=0.78, Confidence Interval (CI)=0.65-0.92), but not significant for the past 30 days users (OR=0.91, CI=0.72-1.15). Results also indicated that both close friends’ negative perceptions of PDM were an overall protective factor. Protective factors included the number of drug-free closest friends and community attachment for lifetime users, youth’s and parental negative perceptions of PDM, and school commitment for the past 30 users. Finally, siblings’ possible history of PDM and ease of access to substances were the strongest risk factors. For the past 30 days users, gang involvement had a significantly greater association with PDM (OR=4.32, CI=2.52-7.39) than for lifetime users (OR=0.55, CI=0.29-1.03).

Conclusions
These findings suggest that community attachment is associated with PDM lifetime users. The study identifies specific protective and risk factors aligned with community-oriented and relationship-based values. These findings advance knowledge about the social and cultural determinants of health related to PDM of AI youth. The findings have implications for future research, policy, and practice.