Abstract
The objectives of the present study were to identify the prevalence of alcohol abuse and marijuana use among First Nations youth living on-reserve, and to identify independent risk indicators associated with these behaviours. Two hundred four students from the Saskatoon Tribal Council (Saskatchewan) who were enrolled in grades 5 through 8 were asked to complete a school health survey. The prevalence of alcohol abuse and marijuana use among First Nations on-reserve youth was 23.5% and 14.7%, respectively. Surprisingly, female First Nations youth were more likely to abuse alcohol and use marijuana than male First Nations youth. The prevalence of alcohol abuse and marijuana use among Saskatoon urban youth of the same age were only 5.4% and 2.7%, respectively. After regression analysis, five independent risk indicators were associated with alcohol abuse and marijuana use among First Nations on-reserve youth. The prevalence of alcohol abuse among First Nations on-reserve youth is higher than that in neighbouring urban youth of the same age.
Keywords: Alcohol abuse, Marijuana use, Minority groups, Risk factors, Youth
Abstract
La présente étude visait à déterminer la prévalence de consommation excessive d’alcool et de consommation de marijuana chez les jeunes des Premières nations qui habitent dans les réserves, ainsi que les indicateurs de risque indépendants associés à ces comportements. Deux cent quatre élèves de cinquième à huitième année du Conseil de bande de Saskatoon, au Canada, ont été invités à répondre à un sondage sur la santé en milieu scolaire. La prévalence de consommation abusive d’alcool et de consommation de marijuana chez les jeunes des Premières nations dans les réserves s’élevait à 23,5 % et 14,7 %, respectivement. Fait surprenant, les jeunes filles de ce groupe étaient plus susceptibles de consommer trop d’alcool et de consommer de la marijuana que les jeunes garçons. La prévalence de consommation excessive d’alcool et de consommation de marijuana chez les jeunes en milieu urbain de Saskatoon ne s’élevait qu’à 5,4 % et 2,7 %, respectivement. Après l’analyse de régression, cinq indicateurs de risque indépendants s’associaient à la consommation excessive d’alcool et à la consommation de marijuana chez les jeunes des Premières nations dans les réserves, dont la prévalence de consommation excessive d’alcool est plus élevée que celle des jeunes du même âge d’un milieu urbain voisin.
Early onset of alcohol abuse and marijuana use has been associated with an increased use of other drugs later in adolescence and adulthood, as well as increases in the incidence of recreational accidents, sexual intercourse, teenage pregnancy and poorer academic performance (1–8).
According to one study regarding youth risk behaviours in the United States (9), the prevalence of alcohol abuse among Aboriginal youth in grades 9 through 12 was 49.4% for boys and 35.7% for girls. In comparison, 38.6% of male and 21.9% of female Caucasian youth abused alcohol. Marijuana use among Aboriginal youth was also higher. In the same study, 47.5% of male and 48.5% of female Aboriginal youth were found to use marijuana in comparison with 29.1% of male and 24.2% of female Caucasian youth.
A study conducted in Manitoba on youths in grades 5 through 12 (10) compared the prevalence of alcohol abuse and marijuana use among Aboriginal youth living off reserve with non-Aboriginal youth. The study found that 61% of Aboriginal youth compared with 54% of non-Aboriginal youth reported use of alcohol. Additionally, the prevalence of marijuana use was 30% in Aboriginal youth and 8% among non-Aboriginal youth.
A study performed in Saskatoon, Saskatchewan, involving youth 10 to 15 years of age (11), reported the prevalence of alcohol abuse and marijuana use in urban Aboriginal (First Nations, Métis) youth and non-Aboriginal youth. The prevalence of alcohol abuse and marijuana use in Aboriginal youth was 16.7% and 21.5%, respectively. Non-Aboriginal youth reported lower prevalences of alcohol abuse and marijuana use at 5.4% and 2.7%, respectively.
The First Nations Regional Longitudinal Health Survey from 2002/2003 indicated that 42.2% of First Nations youth 13 to 17 years of age had answered that they had consumed at least one alcoholic beverage in the previous year and that 32.7% reported using marijuana in 2003. However, these data were not collected with a validated survey and do not capture earlier onset of use (12).
A review of the literature for studies determining the prevalence of, or independent risk factors for, alcohol abuse or marijuana use among First Nations youth living on-reserve in Canada was unsuccessful. Therefore, the first objective of the present study was to determine the prevalence of alcohol abuse and marijuana use in Saskatoon Tribal Council (STC) First Nations youth living on reserve. The second objective was to identify the independent risk indicators for alcohol abuse and marijuana use among on-reserve First Nations youth.
METHODS
The STC consists of seven First Nations reserves within a 250 km radius around Saskatoon. Within the STC, according to the 2006 census (13), the median annual income per household was $8,572, the high school graduation rate was 50.7%, and the male and female adult unemployment rates were 27.5% and 20.7%, respectively. In comparison, the median annual income per household was $23,755, the high school graduation rate was 80.6% and the male and female adult unemployment rates were 5.9% and 5.3%, respectively, among the Saskatchewan adult population (13).
Students in grades 5 through 8 (10 to 16 years of age) within the STC were asked to complete a health survey in May 2010. Within these grades among the seven schools, 271 students were eligible to participate.
Before initiating the study, 41 community consultations occurred with Chiefs, Elders, Band Councillors, Health Directors, the Education Director, principals, teachers, parents, children and community members. An eight-stage consent protocol was followed, which consisted of collecting written consent from the Chiefs, Band Councillors and Health Directors from each of the First Nation communities, as well as from the Education Director. The principal of each school and the teacher of each classroom were required to give verbal consent. Parents or caregivers and each youth participant were required to give written, informed consent before the youth’s participation. The ethics submission included signatures from the Director of Research, the Director of Health and the Director of Education from the STC. The principal investigator was the Director of Research from the STC. Tri-Council guidelines and the principles of ownership, possession, access and control were followed. On completion, a Chiefs Resolution and seven Band Council Resolutions were obtained for the project to proceed. Ethics approval was obtained from the University of Saskatchewan (Saskatoon, Saskatchewan) Behavioural Research Ethics Board (BEH#10–14).
Youth were considered to have abused alcohol if they answered yes to the question: “Have you ever been drunk?”. Marijuana use was defined as someone who responded yes to the question: “Have you used marijuana in the past 12 months?”. Both questions were taken from Statistics Canada’s Youth Smoking Survey (YSS). This survey has been used since 1994 but has excluded First Nations youth living on reserve (14). These questions from the YSS have been evaluated for external validity with the National Population Health Survey, as well as the Canadian Tobacco Use Monitoring Survey, with similar results found despite differences in methodology (15). Both questions on alcohol abuse and marijuana use have been validated and published previously in another article on urban Saskatoon youth (11).
Questions on demographics and socioeconomic status (SES) were taken from Statistics Canada’s National Longitudinal Survey of Children and Youth (NLSCY). This comprehensive health survey was designed to collect information about factors that influence a youth’s social, emotional and behavioural development. The NLSCY has been validated for youth 10 to 13 years of age (16).
Parenting questions came from the Parenting Relationship Scale that was used in the Health Behaviour in School-Aged Children study (17). Although validity and reliability data have never been published, the scale has been used in an international project facilitated by the WHO.
The questions on suicide ideation, self-esteem, self-reported health and mental health were also taken from the NLSCY (16). Questions for the self-esteem scale used in the NLSCY are derived from the Marsh Self Description Questionnaire, which has a coefficient alpha reliability range of 0.80 to 0.94 (18,19).
The instrument used to measure depressed mood was the Center for Epidemiological Studies Depression scale (20). This scale was used on youth in the NLSCY and has a Cronbach’s alpha of 0.85 (21,22). A cut-off score of 16 or higher was used as the cutoff for depressed mood.
Current smoking status for the present study was defined as someone who has smoked one or more entire cigarette(s) within the past 30 days and was also taken from the YSS. The definition of smoking status used in the present study is complementary to Health Canada’s criteria on phases of smoking uptake (23).
Cross tabulations were performed between alcohol abuse, as well as marijuana use, and all measured variables. After these cross tabulations, binary logistic regression was used to determine the independent association between the outcome variable of abusing alcohol (in comparison with not) and using marijuana (in comparison with not) and the potential explanatory variables. The unadjusted effect of each covariate was determined and subsequently entered one step at a time based on changes in the −2 log likelihood and the Wald test (24). The final results were presented as adjusted ORs with 95% CIs.
On completion of the study, 11 knowledge transfer sessions were conducted. Future knowledge translation will be at the discretion of the Tribal Chief. The principles of ownership, possession, access and control were followed. The Tribal Chief was given a full copy of the de-identified data set. The STC Tribal Chief, Director of Research, Director of Health, Director of Education and Manager of Mental Health, among others, reviewed the manuscript before submission. No ethical violations were noted during or after the research study. The Behavioural Research Ethics Board at the University of Saskatchewn closed the file on completion of study without incident.
RESULTS
In total, 204 (75.8%) on-reserve First Nations youth completed the survey. According to the 2006 census, there were 239 known STC youth 10 to 17 years of age living on reserve (25). Because the present sample (204 youth, 10 to 16 years of age) is in accord with what was reported in the 2006 census, it is believed that the sample is representative of the communities.
Overall, 10.3% of the youths were 10 years of age, 48% were 11 to 12 years of age, and 40.2% were 13 to 16 years of age. Males comprised 44.1% of the sample. The majority (55.9%) had a father who was employed, with 92.6% working in a nonprofessional occupation (nonmanagement or an occupation that does not require a degree). In addition, 46.1% of the participants had a mother who was employed, with 73.6% of those employed working in a nonprofessional occupation (26).
The prevalence of alcohol abuse and marijuana use among STC youth was 23.5% and 14.7%, respectively. Both alcohol abuse and marijuana use were initially associated with higher school grade, older age and female sex. For example, 35.8% of female students reported alcohol abuse compared with 12.3% of male students, and 21.2% of female students reported marijuana use compared with 11.4% of male students. As well, 59.4% of grade 8 students abused alcohol compared with 35.9% of grade 7 students, 13% of grade 6 students and 13.8% of grade 5 students (Table 1).
TABLE 1.
Cross tabulations of demographic and socioeconomic variables with alcohol abuse and marijuana use among Saskatoon Tribal Council on-reserve First Nations youth
| Alcohol abuse, % | P | Marijuana use, % | P | |
|---|---|---|---|---|
| School grade | <0.001 | 0.033 | ||
| 5 | 13.8 | 8.6 | ||
| 6 | 13.0 | 13.3 | ||
| 7 | 35.9 | 24.3 | ||
| 8 | 59.4 | 30.3 | ||
| Age, years | 0.004 | 0.006 | ||
| 10 | 9.5 | 6.3 | ||
| 11–12 | 16.9 | 9.3 | ||
| 13–16 | 38.8 | 28.6 | ||
| Sex | <0.001 | 0.096 | ||
| Male | 12.3 | 11.4 | ||
| Female | 35.8 | 21.2 | ||
| Father is employed | 0.521 | 0.794 | ||
| Yes | 24.8 | 16.2 | ||
| No | 29.2 | 17.7 | ||
| If employed, father’s occupation | 0.265 | 0.480 | ||
| Professional | 42.9 | 28.6 | ||
| Nonprofessional | 23.8 | 17.7 | ||
| Mother is employed | 0.493 | 0.809 | ||
| Yes | 28.4 | 17.1 | ||
| No | 23.8 | 18.5 | ||
| If employed, mother’s occupation | 0.102 | 0.500 | ||
| Professional | 14.3 | 10.5 | ||
| Nonprofessional | 32.8 | 16.9 |
Parenting variables that were initially significantly associated with both alcohol abuse and marijuana use included disagreeing that their parents understand them, not having a happy home life, disagreeing that their parents trust them, wanting to leave home and not caring what their parents think of them. For example, 52.3% of youth that did not have a happy home life reported alcohol abuse in comparison with 17.9% who did. Engaging in many arguments with parents was significantly associated with marijuana use but not with alcohol abuse (Table 2).
TABLE 2.
Cross tabulations of parenting relationship and alcohol abuse and marijuana use among Saskatoon Tribal Council on-reserve First Nations youth
| Alcohol abuse, % | P | Marijuana use, % | P | |
|---|---|---|---|---|
| My parents understand me | 0.002 | <0.001 | ||
| Strongly agree or agree | 20.3 | 10.7 | ||
| Neither agree nor disagree, disagree or strongly disagree | 42.9 | 34.0 | ||
| I have a happy home life | <0.001 | <0.001 | ||
| Strongly agree or agree | 17.9 | 9.5 | ||
| Neither agree nor disagree, disagree or strongly disagree | 52.3 | 39.5 | ||
| My parents expect too much of me | 0.865 | 0.292 | ||
| Strongly agree or agree | 26.7 | 21.4 | ||
| Neither agree nor disagree, disagree or strongly disagree | 27.8 | 15.1 | ||
| My parents trust me | 0.013 | 0.008 | ||
| Strongly agree or agree | 21.1 | 12.3 | ||
| Neither agree nor disagree, disagree or strongly disagree | 39.2 | 29.2 | ||
| I have a lot of arguments with my parents | 0.753 | 0.018 | ||
| Strongly agree or agree | 28.3 | 28.0 | ||
| Neither agree nor disagree, disagree or strongly disagree | 26.0 | 12.8 | ||
| There are times when I would like to leave home | <0.001 | 0.025 | ||
| Strongly agree or agree | 39.8 | 23.3 | ||
| Neither agree nor disagree, disagree or strongly disagree | 11.9 | 10.3 | ||
| What my parents think of me is important | 0.001 | 0.032 | ||
| Strongly agree or agree | 20.6 | 13.6 | ||
| Neither agree nor disagree, disagree or strongly disagree | 46.3 | 27.9 | ||
| My parents expect too much from me at school | 0.945 | 0.264 | ||
| Strongly agree or agree | 26.8 | 14.7 | ||
| Neither agree nor disagree, disagree or strongly disagree | 27.3 | 21.4 |
Depressed mood, suicide ideation and lower self-reported mental health were associated with both alcohol abuse and marijuana use. Lower self-reported health was associated with marijuana use only. Not having someone who shows love and affection was associated with alcohol abuse alone. Being a current smoker was associated with both outcomes, while marijuana use was associated with alcohol abuse, and alcohol abuse was associated with marijuana use. For example, 66.7% of youth who reported alcohol abuse were current smokers compared with 10.9% of nonsmokers (Table 3).
TABLE 3.
Cross tabulations of mental health, social support and risk behaviour variables with alcohol abuse and marijuana use among Saskatoon Tribal Council on-reserve First Nations youth
| Alcohol abuse, % | P | Marijuana use, % | P | |
|---|---|---|---|---|
| Mental health | ||||
| Self-reported health | 0.072 | 0.045 | ||
| Excellent, very good | 20.7 | 11.0 | ||
| Good, fair or poor | 32.6 | 22.5 | ||
| Self-reported mental health | 0.045 | 0.048 | ||
| Excellent, very good | 17.7 | 8.3 | ||
| Good, fair or poor | 31.8 | 20.0 | ||
| Self-esteem scale | 0.559 | 0.430 | ||
| Low self-esteem | 30.8 | 23.1 | ||
| Normal self-esteem | 25.3 | 16.7 | ||
| Depressed mood scale | 0.047 | 0.022 | ||
| Yes | 38.3 | 28.9 | ||
| No | 23.3 | 13.7 | ||
| Suicide ideation in past 12 months | 0.001 | <0.001 | ||
| Yes | 47.1 | 39.4 | ||
| No | 19.7 | 9.1 | ||
| Social support scale | ||||
| I have someone who shows me love and affection | 0.019 | 0.866 | ||
| All or most of the time | 23.0 | 16.8 | ||
| Some or almost none of the time | 42.1 | 17.9 | ||
| Risk behaviours | ||||
| Smoking status | <0.001 | <0.001 | ||
| Current smoker | 66.7 | 46.9 | ||
| Nonsmoker | 10.9 | 5.7 | ||
| What is your experience with using marijuana products? | <0.001 | – | ||
| Never | 19.3 | – | ||
| Ever | 70.0 | – | ||
| Have you ever been drunk? | – | <0.001 | ||
| Yes | – | 43.8 | ||
| No | – | 22.6 |
Binary logistic regression was performed to determine independent risk factors for alcohol abuse and marijuana use. The independent risk indicators for alcohol abuse included older age, female sex, agreeing they would like to leave home, being a current smoker and marijuana use (Table 4).
TABLE 4.
Independent risk indicators associated with alcohol abuse among Saskatoon Tribal Council on-reserve First Nations youth
| Independent variable | OR (95% CI) | P |
|---|---|---|
| Age, 13 to 16 years | 2.08 (0.841–5.15) | 0.113 |
| Female sex | 5.29 (1.51–18.51) | 0.009 |
| There are times when I would like to leave home (agree, strongly agree) | 1.39 (1.21–1.72) | 0.012 |
| Current smoker, yes | 4.50 (1.38–14.70) | 0.010 |
| Marijuana use in the last 12 months, yes | 7.72 (1.65–36.04) | 0.009 |
Reference categories: Age (10 to 12 years of age); Male sex; There are times when I would like to leave home – Neither agree nor disagree, disagree or strongly disagree; Nonsmoker; Have not tried marijuana
The independent risk indicators for marijuana use included older age, not agreeing that their parents understand them, not having someone that shows them love and affection, being a current smoker and alcohol abuse (Table 5).
TABLE 5.
Independent risk indicators associated with marijuana use among Saskatoon Tribal Council on-reserve First Nations youth
| Independent variable | OR (95% CI) | P |
|---|---|---|
| Age, 13 to 16 years | 2.02 (0.63–6.50) | 0.237 |
| My parents understand me (neither agree nor disagree, disagree or strongly disagree) | 3.14 (1.23–8.00) | 0.016 |
| I have someone who shows me love and affection (all or most the time) | 1.12 (1.02–1.88) | 0.037 |
| Current smoker, yes | 11.33 (2.43–52.79) | 0.002 |
| Ever been drunk, yes | 7.43 (1.63–33.94) | 0.010 |
Reference categories: Age (10 to 12 years of age); My parents understand me – Strongly agree or agree; I have someone who shows me love and affection – Some or almost none of the time; Nonsmoker; Never been drunk
DISCUSSION
We found that 23.5% of STC First Nations youth living on reserve abused alcohol and 14.7% used marijuana. There are no available data to confirm whether the reported prevalence from the present study is consistent with other on-reserve First Nations youth across Canada and, as such, our research fills a void in the literature. In comparison, a study of Saskatoon youth 10 to 15 years of age reported that 5.4% of Caucasian youth abused alcohol and 2.7% used marijuana, while urban Aboriginal youth within Saskatoon reported a prevalence of 16.7% for alcohol abuse and 21.5% for marijuana use (11).
Before statistical adjustment, 15 variables were associated with alcohol abuse and 14 variables were associated with marijuana use. After regression analysis, there were only five independent risk indicators for each. Older age and current smoking were risk indicators for both alcohol abuse and marijuana use. Female sex, wanting to leave home and marijuana use were independent risk indicators for alcohol abuse, whereas not having parents that understand them, not having someone who shows love and affection and alcohol abuse were independent risk indicators for marijuana use.
The risk indicators of older age, poor relationship with parents, current smoking status and marijuana use are all consistent with the literature as being risk indicators of alcohol abuse and drug use among Aboriginal youth (27–29). However, the finding that female youth were more likely to abuse alcohol and use marijuana is inconsistent with the literature (27–29). This is an important finding that suggests the need for more awareness and intervention for this target population within on-reserve First Nations youth.
The importance of age should not be discounted. Significant alcohol abuse and marijuana use was already present at 10 years of age and increased significantly by 16 years of age. To decrease the likelihood of developing a lifetime dependence on alcohol and marijuana, it is important to intervene early in an attempt to prevent or delay the age of onset (30). School-based intervention programs should be comprehensive and focus on the development of life skills rather than educational programs alone (31). Programs should contain mental health services that are delivered in a nospecialized care setting while remaining culturally sensitive (32,33).
Initially inconsistent with the literature, SES was not a major indicator in a relative sense. As of 2006, the median annaul income of on-reserve First Nations adults living in STC communities was $8,573. This number is much lower compared with the median annaul income in Saskatchewan ($23,755) in 2006 (34). Given the low SES of essentially all children and their parents, SES was not a relative risk indicator for alcohol abuse or marijuana abuse relative to other First Nations children. However, lower SES is likely associated with higher rates of alcohol abuse and marijuana use in an absolute sense among First Nations on-reserve youth compared with non-Aboriginal youth (11).
A limitation to the present study was that it was cross-sectional in nature and, therefore, cannot determine causation.
CONCLUSIONS
The prevalence of alcohol abuse and marijuana use was high among on-reserve First Nations youth. Identification of a more limited number of independent risk indicators could aid in the delivery of comprehensive programs to prevent or delay onset.
Footnotes
FUNDING: Funding for the present study was provided by a grant from the Public Health Agency of Canada (Ottawa, Ontario) (grant # 6785-15-2009-9010892).
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