Cultural risk and protective factors for tobacco use behaviors and depressive symptoms among American Indian adolescents in California

2013-08-05Background: American Indian (AI) populations suffer the greatest health disparities in the United States. AI youth bear a larger burden both in terms of higher prevalence of mental health problems and substance abuse. This dissertation investigates the specific challenges and potential protective factors to behavioral and mental health disparities, specifically smoking behaviors and depressive symptoms among a sample of AI adolescents in urban and reservation areas of California. Study 1 documents AI adolescents’ exposure to ceremonial and commercial tobacco use during five cultural practices, including the type of tobacco used, who used tobacco, and how it was used, as well as the prevalence of recreational cigarette use, other tobacco product use, and preferred commercial tobacco brands. Associations of ceremonial tobacco use and social/environmental exposure with cigarette smoking are examined. Study 2 and 3 examine AI adolescents’ thoughts of historical loss as a mediator between three predictor (ethnic identity, participation in cultural activities, and stressful life events) variables to depressive symptoms and smoking behaviors. ❧ Methods: AI youth in California (N= 940, ages 13-19, recruited from 49 different tribal youth organizations and cultural events in urban and reservation areas of California) completed a culturally-specific tobacco survey. In Study 1 variations across gender, age, smoking status, and region (urban vs. reservation) were examined. Multiple logistic regressions were used to determine associations between predictor variables and smoking behavior outcomes. In Study 2 and 3, Structural Equation Modeling analysis was used to assess the observed and latent variables. ❧ Results: More than half of the participants were female (59%), mean age was 15.5 years, and 60% were urban youth (i.e. lived in cities rather than on reservations). Twenty-five percent were past-month smokers and 30% were experimental smokers. Findings from study 1 indicated AI youth who smoke tobacco in a ceremonial way and use commercial tobacco at ceremonies were at risk for recreational smoking. Additionally, having a grandparent(s) who smokes served as a protective factor against smoking cigarettes. Studies 2 and 3 results showed historical trauma to mediate the participation in cultural activities and stressful life events to depressive symptoms and smoking outcomes. However, an inconsistent mediated effect occurred with a negative direct effect from ethnic identity to both study outcomes and a positive indirect effect from ethnic identity to historical trauma to both study outcomes. As hypothesized, all exogenous variables predicted historical trauma. A significant positive path emerged from historical trauma to the outcome. Lastly, a significant positive path emerged from stressful life events to depressive symptoms. ❧ Conclusions: Taken together, findings from these studies indicate AI youth are at risk for smoking cigarettes and depressive symptoms. Continued research is needed on the effects of historical trauma to develop effective interventions to reduce emotional suffering and risky behaviors. Interventions should be guided by the AI community to improve quality of life, specifically behavioral health and well-being