Low rates of alcohol and tobacco use, strong cultural ties for Native American college students in the Southwest

Abstract

Introduction

College attendance is associated with an increased risk for substance use yet we know little about substance use among Native American college students and its regional variation. This study examined alcohol, tobacco, and drug use and their relation to gender, institution, age, and cultural involvement among Native American college students in the Southwest.

Methods

Native American community college and university students in a large Southwest city (N = 347) completed an online survey about past-month and lifetime substance use and involvement in cultural activities.

Results

Cultural involvement was related to less past-month substance use. In the past month, 43% drank alcohol, 27% binge drank, 20% used drugs, and 13% were current smokers. Males, community college students, and older individuals were more likely to have a positive CAGE-AID and have used drugs more than 100 times. Younger individuals were more likely to use marijuana in the past month.

Conclusions

These findings highlight cultural strengths and comparatively low rates of tobacco and alcohol use among Native American college students in the Southwest.

Since the 1990s, binge drinking and associated consequences have been recognized as a major public health issue affecting college students; rates of tobacco and other drug use are similar for college and non-college attendees.^1,2 Healthy People 2020 identified reductions in college student binge drinking as a key objective and put forth a goal of reducing college student binge drinking to 36% by 2020. Despite a focus on college student substance use, few studies have considered substance use among Native American college students. This is of particular importance given that Native Americans have a 4-year graduation rate of 40%, compared to 59% of all students.³ This difference is exacerbated at some institutions. For example, the University of New Mexico has a 6-year graduation rate of 47% for all races/ethnicities, but 29% for Native Americans.⁴ Substance use may be one factor that contributes to lower graduation rates.

Pre-colonization, Native Americans had (and still have) ceremonial relationships with substances such as tobacco.⁵ European colonization introduced more harmful relationships with substances, which has negatively impacted Native American communities and contributed both directly and indirectly to s substance-related health disparities.⁶ Native Americans have the highest rates of past-year substance use disorder and higher rates of substance-related mortality.^7,8 At the same time, contrary to common stereotypes, Native Americans are significantly more likely than other groups to completely abstain from alcohol use.⁸

Native American culture is widely seen as the driver of addiction recovery and high abstinence rates. Alaska Native alcohol sobriety movement leaders equated balance – and sobriety – with ongoing engagement with traditional foods and rituals, tribal history and language, connections with ancestors and ceremonies, and being embedded within family and community structures.⁹ Participation in traditional activities, traditional spirituality, and identification with Native American culture were associated with decreased risk of alcohol abuse among Native Americans in the Upper Midwest.¹⁰ Finally, a review of cultural interventions found that they were effective in promoting wellness and recovery.¹¹

Most research on Native American college student substance use has surveyed students at a single campus. In an early study, Goldstein and colleagues found that Native American students at an urban arts and technical school most commonly used alcohol, marijuana, and amphetamines.¹² A comparison of alcohol consumption among White and Native American students at a campus in Oklahoma found similar alcohol use patterns, with 86% of Whites and 97% of Native Americans identifying as current drinkers.¹³

More recent research suggests Native American students have similar substance use patterns relative to general college samples. Collapsing across four waves from 200-plus campuses in the College Alcohol Study, Ward and Ridolfo found alcohol use rates similar to that of general college samples.¹⁴ No gender differences emerged. Sixty-five percent of the 267 Native American students drank in the past month and 41% had a binge drinking episode. In terms of drug use, 31% used marijuana and 22% used another illicit drug in the past year, while 34% were current smokers.¹⁴ There were no significant differences for alcohol or marijuana use by race/ethnicity, but Native American students had higher illicit drug use and current smoking rates than other students.¹⁴ Another secondary analysis found 60% of 2,103 Native American college students drank in the past month, while 16% used marijuana.¹⁵ In another study, Alaska Native students had similar scores on the Alcohol Use Disorders Identification Test as non-Native students but endorsed more past-year alcohol-related consequences.¹⁶ In contrast, lower substance use rates were found among Native Hawaiian community college students. In the past month, 13% had used marijuana, 30% endorsed “getting drunk,” and 20% had used cigarettes.¹⁷ Among tribal college students in the Midwest and Northern Plains, the current smoking rate was 35%.¹⁸

Study Aims

No study has looked at substance use patterns for Native American college students in the Southwest United States, despite evidence from epidemiological studies of regional heterogeneity and lower rates of use in the Southwest than elsewhere.¹⁹ The primary aim of this study was to summarize the prevalence of current and lifetime alcohol, drug, and tobacco use among Native American students at two post-secondary institutions in the Southwestern United States. The secondary aim was to examine how rates of substance use differed by gender, age, type of institution, and particularly level of cultural involvement.

1.1 Method

1.1.1 Participants

Eligibility criteria included: (a) enrolled part-time or more at a community college or four-year public university in a large Southwestern city, (b) 18 years and older, (c) enrolled tribal member or at least ¼ Native American, and (d) completed the survey while in this Southwestern city. Graduate students were not eligible to participate. A total of 347 students completed the online survey between mid-February and mid-July of 2013.

1.1.2 Procedure

[IRB informational removed for MS blinding]. Participants were recruited for the study via posted flyers, Facebook advertisements, postings on the study Facebook page [link removed for study blinding], listserv and email announcements, and attendance at Native American student organization meetings. In addition, a list of students identifying as Native American and enrolled at the two schools was obtained from the registrar's office. These students were emailed an invitation to participate; this was the most common method in which participants found out about the study. After clicking on the survey link, informed consent was obtained online before starting the survey. At the end, participants were given the option to provide their contact information for a gift card raffle (e.g., Amazon, iTunes), with values ranging from $5 to $200. Average time spent on the survey was 27 minutes (SD = 14.10; range = 10 – 117 minutes).

1.1.3 Measures

1.1.3.1 Alcohol use

Participants indicated how many of the past 30 days they had at least one standard drink of alcohol.²⁰ This variable was used to compute whether or not they were current drinkers, defined as drinking any alcohol on one or more of the past 30 days. Participants also indicated the number of days they had five or more drinks (males) or four or more drinks (females) on one occasion in the past month.²¹ Current binge drinkers were those who had at least one binge drinking episode in the past month.

1.1.3.2 Drug Use

Participants indicated frequency of lifetime and past-month drug use in 10 categories taken from National Institute on Drug Abuse Clinical Trials Network procedures.²² Drug use categories included (a) marijuana, (b) cocaine, (c) methamphetamines, (d) inhalants, (e) sedatives/sleeping pills, (f) hallucinogens, (g) heroin/opium, (h) prescribed stimulants for non-medical reasons, (i) prescription opioids/painkillers for non-medical reasons, and (j) other. For each drug category, participants indicated their lifetime frequency of use (never, 1-10 times, 11-99 times, or 100+ times) and whether they had used each drug in the past month.²³ For this study we separately report past-month use of marijuana, prescription opioids, and any drug. We also report lifetime use of any drug more than 100 times to match the drug use variable used in the CARDIA study.²³

1.1.3.3 Tobacco use

Tobacco use was assessed with a question adapted from the Behavioral Risk Factor Surveillance System.²¹ Participants were asked to indicate whether they (a) smoked every day, (b) smoked some days, (c) were a former smoker, or (d) had never smoked. Based on feedback from pilot participants and community advisory board members, two additional response options (“I do not categorize myself as a former smoker but have smoked in the past” and “I smoke only for ceremonial purposes”) were added. Most prior studies have not included a separate category for ceremonial tobacco use.

1.1.3.4 Problematic Substance Use

The CAGE-AID is a four-item measure designed to screen for substance use disorders.²⁴ CAGE-AID questions were answered as “yes” or “no” in reference to participants' entire lives. Scores of two and above (i.e., positive CAGE-AID score) were considered indicative of problematic substance use and were used as a dichotomous outcome variable in this study. Leonardson and colleagues gave the CAGE-AID to 50 Native Americans in the Northern Plains who were seeking treatment for Type II diabetes, and found adequate convergent and discriminative validity.²⁵

1.1.3.5 Traditional Spiritual Act iv ities

A three-item measure was used to gauge participation in and importance of traditional Native American spiritual activities.¹⁰ A single item – “how important are traditional spiritual values to the way you lead your life” – was included in these analyses. Response options included don't know/doesn't refer to me, (0) not at all important, (1) not too important, (2) somewhat important, and (3) very important. The response options of “not at all” and “not too” important were combined for the following analyses, resulting in a three-point scale that ranged from 0 to 2.

1.1.3.6 Enculturation

The Cultural Questionnaire measured participation in traditional activities and connection to home reservation or tribal lands.²⁶ Two dichotomous items, “Do you participate in your tribe's traditional ceremonies or dances?” and “Do you speak your tribe's language,” were included in these analyses. Negative responses were coded 0 and affirmative responses were coded 1.

1.2 Results

1.2.1 Background Characteristics

Participants (N = 347; 66% female) were 28 years old on average (SD = 9.97; range = 18 – 65 years). Ninety percent were in good, very good, or excellent health and 11% were lesbian, gay, or bisexual. Sixty-eight percent of participants attended the community college (n = 237) and the remaining one-third attended the university (n = 110). Most participants usually received A's or B's in their classes (n = 305; 88%). Of the 252 participants who knew their parents' educational level, 64% were first generation students (i.e., neither parent with bachelor's degree; n = 245). Seventy-two percent attended school full-time. Forty-three percent of participants had an annual household income of $10,000 or less, 36% were not working and looking for a job, and 40% had children. Table 1 further details these characteristics.

Table 1. Participant Characteristics (N = 347).

	n (%)
Gender
Female	227 (65.6)
Male	119 (34.4)
Sexual Orientation
Lesbian, gay, bisexual	38 (11.1)
Heterosexual	304 (88.9)
Children
Yes	140 (40.3)
No	207 (59.7)
School
Community college	237 (68.3)
University	110 (31.7)
School enrollment
Part-time	98 (28.3)
Full-time	248 (71.7)
First generation student
Yes	245 (72.7)
No	92 (27.3)
Usual Grades
As or Bs	305 (87.9)
Cs	39 (11.2)
Ds or Fs	3 (0.9)
Employment Status
Not working, looking for a job	123 (35.5)
Not working, not looking	81 (23.4)
Working full-time	59 (17.1)
Working part-time	83 (24.0)
Annual Household Income
< $5,000	90 (26.2)
$5,000-$9,999	57 (16.6)
$10,000-$29,999	104 (30.2)
$30,000-$49,999	44 (12.8)
$50,000+	49 (14.2)
Health
Good, very good, or excellent	312 (89.9)
Fair or poor	35 (10.1)
Where childhood was spent
On or near a reservation	178 (52.0)
Small town far from reservation	31 (9.1)
In a city	75 (21.9)
Some combination of above three options	56 (16.4)
On military bases	2 (0.6)

1.2.2 Cultural Variables

All participants were Native American; 86% selected only Native American as their racial or ethnic background when given the option to select multiple racial/ethnic categories. Nearly all were enrolled tribal members (96%). Ninety percent were from Southwest tribes and half had grown up on or near a reservation (Table 1). Fifty-two percent of participants could speak their tribe's language; 57% participated in their tribe's traditional ceremonies or dances; and 49% said that traditional spiritual values were very important to the way they led their lives.

1.2.3 Current Substance Use

In the past month, 43% of participants (n = 150) drank alcohol and, of these participants, 61% (n = 92) reported at least one binge drinking episode. In other words, of the entire sample, only 27% binge drank in the past month. Twenty percent (n = 69) had used drugs. The three drugs most commonly used were marijuana (n = 46; 14%), sedatives/sleeping pills (n = 16; 5%), and prescription opioids for non-medical reasons (n = 15; 4%; Table 2 and Appendix).

Table 2. Comparison of Past-Month and Lifetime Substance Use by Gender, School, and Age.

	Overall sample (n=347)	Female (n=226)	Male (n=119)		Community college (n=237)	University (n=110)		18-25 years (n=178)	26 years + (n=169)
Variable	n (%)	n (%)	n (%)	p-value	n (%)	n (%)	p-value	n (%)	n (%)	p-value
Past-month alcohol use
Any alcohol	150 (43.2)	95 (41.9)	55 (46.2)	.493	96 (40.5)	54 (49.1)	0.162	80 (44.9)	70 (41.4)	.517
Binge drinking	92 (26.6)	57 (25.2)	35 (29.4)	.443	59 (25.0)	33 (30.0)	0.361	51 (28.8)	41 (24.3)	.394
Past-month drug use
Drug usea	69 (20.2)	40 (17.9)	29 (24.8)	.156	47 (20.3)	22 (20.0)	1.00	39 (22.0)	30 (18.3)	.420
Marijuana	46 (13.6)	26 (11.7)	20 (17.4)	.180	31 (13.5)	15 (13.6)	1.00	31 (18.1)	14 (8.6)	.011
Prescription opioids, non-medical reasons	15 (4.4)	6 (2.7)	9 (7.6)	.050	10 (4.3)	5 (4.5)	1.00	5 (2.8)	10 (6.1)	.187
Lifetime substance use
CAGE-AID score of 2 or more	129 (37.8)	68 (30.5)	61 (52.1)	.000	100 (42.7)	29 (27.1)	.006	47 (26.9)	82 (49.4)	.000
Drug usea in any category >100×	74 (22.3)	39 (18.1)	35 (30.4)	.013	59 (26.1)	15 (14.2)	.016	27 (15.7)	47 (29.4)	.004
Current tobacco use
Everyday	17 (4.9)	7 (3.1)	10 (8.4)	.015	15 (6.4)	2 (1.9)	.103	6 (3.4)	11 (6.6)	.002
Some days	27 (7.8)	12 (5.4)	15 (12.6)		20 (8.5)	7 (6.5)		13 (7.3)	14 (8.4)
Former smoker	34 (9.9)	20 (8.9)	14 (11.8)		21 (8.9)	13 (12.0)		10 (5.6)	24 (14.4)
Smoked in past, not former smoker	97 (28.2)	68 (30.4)	29 (24.4)		73 (30.9)	24 (22.2)		50 (28.2)	47 (28.1)
Never	99 (28.8)	72 (32.1)	26 (21.8)		60 (25.4)	39 (36.1)		66 (37.3)	33 (19.8)
Ceremonial use only	70 (20.3)	45 (20.1)	25 (21.0)		47 (19.9)	23 (21.3)		32 (18.1)	38 (22.8)

Note. Differences between groups tested using chi-square test; results significant at p < .05 level are bolded.

^aDrugs included marijuana, cocaine, methamphetamine, inhalants, sedatives/sleeping pills, hallucinogens, heroin/opium, prescribed stimulants or prescription opioids/painkillers for non-medical reasons.

Participants described their current tobacco use as follows: smoke every day (n = 17; 5%), smoke some days (n = 27; 8%), former smoker (n = 34; 10%), do not categorize self as former smoker but have smoked in the past (n = 97; 28%), have never smoked (n = 99; 29%), and only smoke for ceremonial purposes (n = 70; 20%; Table 2). Combining rates of those who smoked some days and every day, the current smoking rate was 13% (n = 44).

1.2.4 Lifetime Substance Use

Twenty-two percent (n = 74) had used a drug more than 100 times in their lives (Table 2; Appendix). The three substances most commonly used more than 100 times included marijuana (n = 56; 16%), cocaine (n = 16; 5%), and prescription opioids for non-medical reasons (n = 13; 4%). Thirty-eight percent of participants (n = 129) had scores of two or higher on the CAGE-AID, indicating a lifetime history of problematic substance use.

1.2.5 Associations between substance use and other variables

1.2.5.1 Gender

Male participants were significantly more likely than female participants to have a positive CAGE-AID score (52% versus 31%) and have used a drug more than 100 times in their lives (30% versus 18%; Table 2). Current tobacco use also differed significantly by gender: male participants had higher rates of daily (8% versus 3%) and occasional (13% versus 5%) smoking than females. However, there were no significant gender differences in rates of past-month alcohol or drug use.

1.2.5.2 School

Community college students were significantly more likely than university students to have a positive CAGE-AID score (43% versus 27%) and to have used a drug more than 100 times in their lives (26% versus 14%; Table 2). Past-month alcohol, drug, and tobacco use did not differ by school.

1.2.5.3 Age

Those 26 years and older were significantly more likely than participants aged 18 to 25 years to have a positive CAGE-AID score (49% versus 27%) and to have used a drug more than 100 times in their lives (29% versus 16%; Table 2). Rates of tobacco use also differed by age: those 25 and younger were more likely to have never smoked than those who were 26 years and older (37% versus 20%). Past-month marijuana use was significantly more common among younger than older participants (18% versus 9%). Outside of marijuana use, rates of past-month alcohol and drug use did not differ significantly by age.

1.2.5.4 Cultural variables

The general direction of results was such that there were lower rates of past-month alcohol and drug use for those who spoke their tribe's language, rated traditional spiritual values as important, and participated in their tribe's traditional ceremonies and dances compared to those who did not (Table 3). A handful of these differences were significant. Those who participated in their tribe's traditional ceremonies and dances had significantly lower rates of past-month drug use compared to those who did not (16% versus 26%), as did those who could speak their tribe's language compared to those who could not (16% versus 25%). Those who rated traditional spiritual values as ‘very important’ to how they led their lives were less likely to drink alcohol in the past month than those who rated these values as ‘not at all’ or ‘not too’ important (39% versus 56%). There also were significant differences in current tobacco use: those who participated in traditional ceremonies, rated traditional spiritual values as important to how they led their lives, and spoke their language all were more likely to use tobacco only for ceremonial purposes than those who did not endorse these measures of cultural involvement.

Table 3. Comparison of Past-Month and Lifetime Substance Use by Cultural Involvement.

		Traditional ceremonies			Importa nce				Langua ge
	Overall sample (n=347 )	No (n=151)	Yes (n=19 6)		Not at all/not too (n=79)	Somew hat (n=82)	Very (n=17 1)		No (n=167)	Yes (n=179)
Variables	n (%)	n (%)	n (%)	p- valu e	n (%)	n (%)	n (%)	p- valu e	n (%)	n (%)	p- valu e
Past-month alcohol use
Any alcohol	150 (43.2)	73 (48.3)	77 (39.3)	.102	44 (55.7)	34 (41.5)	66 (38.6)	0.037	78 (46.7)	72 (40.2)	0.234
Binge drinking	92 (26.6)	46 (30.5)	46 (23.6)	.177	23 (29.1)	17 (20.7)	46 (27.1)	.432	48 (28.7)	44 (24.7)	0.46 5
Past-month drug use
Drug usea	69 (20.2)	38 (25.5)	31 (16.1)	0.04 1	19 (24.4)	13 (16.3)	35 (20.8)	0.44 8	41 (24.8)	28 (16.0)	0.04 4
Marijuana	46 (13.6)	26 (17.4)	20 (10.5)	.079	14 (17.9)	9 (11.3)	21 (12.7)	.415	26 (15.8)	20 (11.6)	0.27 1
Prescription opioids, non-medical reasons	15 (4.4)	10 (6.7)	5 (2.6)	.108	7 (9.0)	2 (2.5)	6 (3.6)	.101	9 (5.4)	6 (3.5)	0.43 6
Lifetime substance use
CAGE-AID score of 2 or more	129 (37.8)	54 (35.8)	75 (39.5)	.502	30 (38.5)	23 (28.4)	67 (40.1)	.188	62 (37.1)	67 (38.7)	0.82 3
Drug usea in any category >100×	74 (22.3)	41 (28.1)	33 (17.7)	.033	17 (22.1)	17 (21.8)	36 (22.0)	.999	45 (27.8)	29 (17.2)	0.02 5
Current tobacco use
Everyday	17 (4.9)	7 (4.6)	10 (5.2)	<.0 0 1	5 (6.4)	3 (3.7)	8 (4.7)	.003	10 (6.1)	7 (3.9)	0.00 2
Some days	27 (7.8)	12 (7.9)	15 (7.8)		5 (6.4)	6 (7.4)	15 (8.8)		14 (8.5)	13 (7.3)
Former smoker	34 (9.9)	24 (15.9)	10 (5.2)		12 (15.4)	6 (7.4)	13 (7.6)		25 (15.2)	9 (5.1)
Smoked in past, not former	97	44 (29.1)	53		24	28	41		46	51
smoker	(28.2)		(27.5)		(30.8)	(34.6)	(24.1)		(27.9)	(28.7)
Never	99 (28.8)	50 (33.1)	49 (25.4)		29 (27.2)	21 (25.9)	43 (25.3)		49 (29.7)	49 (27.5)
Ceremonial use only	70 (20.3)	14 (9.3)	56 (29.0)		3 (3.8)	17 (21.0)	50 (29.4)		21 (12.7)	49 (27.5)

Note. Differences between groups tested using chi-square test; results significant at p < .05 level are bolded.

^aDrugs included marijuana, cocaine, methamphetamine, inhalants, sedatives/sleeping pills, hallucinogens, heroin/opium, prescribed stimulants or prescription opioids/painkillers for non-medical reasons.

1.3 Discussion

This study offered an investigation of substance use among Native American college students in the Southwest, including a picture of their cultural involvement. The past-month alcohol use rate in this sample was 43%, much lower than previous estimates of 60-80% in other Indigenous college samples.^13–15 In addition, the past-month binge drinking rate of 27% was low compared to other college samples.⁸ Healthy People 2020 has called for a decrease in binge drinking rates among college students from the 2010 rate of 41% to a rate of 37% by 2020.²⁷ The Native American college students in this study have already reached that goal, similar to Native Hawaiian community college students of which only 30% reported “getting drunk” in the past month.¹⁷

Past studies have identified Native Americans as having the highest rates of tobacco use among all races and ethnicities. National estimates of current tobacco use for Native Americans range from 37% to 50%, compared to 22% among all races/ethnicities.^8,19,28 In this study, the current rate of tobacco use was 13%. This lower figure may reflect regional heterogeneity among Native Americans. For example, in a tribal college sample, current tobacco use was 44% for Northern Plains students versus 28% for Midwest students.¹⁸ Whereas in a large general Native American sample, only 14% of participants from Southwest tribes were current tobacco users.¹⁹ Ninety percent of participants in this study were from Southwest tribes. A second explanation for the lower tobacco use could be the inclusion of the response option “only smoke for ceremonial purposes.” One in five participants selected this option, and post-hoc analyses revealed that selecting this category was associated with less alcohol use, even more so than for those who had never smoked tobacco. Unfortunately, previous studies of Native American tobacco use and the National Survey on Drug Use and Health have not included a “tobacco use only for ceremonial purposes” response option.^8,19,28 This response addition was suggested by the study's community advisory board to more accurately reflect their experiences with tobacco, and it would be useful to include in other studies going forward. Finally, high rates of never using tobacco among the younger cohort (age 18-25) are a positive sign for prevention efforts and the long-term health of this cohort.

In contrast to the alcohol and tobacco use rates, twenty percent of participants endorsed past-month drug use, which is twice as high as national prevalence estimates (9.4%) and higher than Native American specific estimates (12.3%).⁸ However, it does concur with national all-races past-month illicit drug use estimate of 21.5% for 18 to 25 year olds and 22.3% for full-time college students ages 18 to 22.⁸ While the entire sample endorsed a past-month marijuana use rate of 13.6%, the younger cohort had a rate of 18.1% and the older cohort had a rate of 8.6%. This maps onto 2013 National Survey on Drug Use and Health data, in which those 18 to 25 years had a past-month marijuana use rate of 19.1%, while the entire sample had a past-month marijuana use rate of 7.5%.⁸ Here, the past-month marijuana use rate among 18 to 25 year olds mirrors that of 13% in the Native Hawaiian community college sample and 16% in a national sample of Native American students.^15,17

Culture as a Protective Factor

The strong cultural ties of this sample were associated with less substance use; post-secondary institutions should consider how to support students in these connections to foster health. Despite 80% of participants living away from their home reservation or tribal lands for more than a year, they still had strong cultural ties. These findings speak to the importance of culture as a protective factor. In an upper Midwest sample, greater cultural involvement, cultural identity, and traditional spirituality were related to a lower likelihood of past year alcohol abuse.^10,29 Cultural involvement may also facilitate transitioning away from problematic substance use: in this study, older individuals had higher rates of lifetime drug use and substance-related problems than younger participants, but similar rates of past-month substance use. Community advisory board members shared stories of middle-aged Native American men shifting from recreational to ceremonial tobacco use and/or away from other substance use as they matured through participation in traditional ceremonies.

A strong cultural base may also speak to social cohesion and family support, factors that have been associated with lower likelihood of substance use disorder in Asian Americans and Latinos.³⁰ Currie and colleagues likewise found that Aboriginal students in Canada saw cultural traditions as a way to manage stress and connect with others.³¹ As one student in their study explained, “there is a smudging room on campus, so I smudge 3 times a week when I need to relax and get in touch with myself—when things get too hectic” (p. 739).

1.3.1 Strengths and limitations

Study strengths included being the largest sample of Native American college students focused on substance use to date. Students in this study had strong cultural connections, with over half speaking a Native American language and participating in traditional ceremonies and dances. In contrast to prior studies, tobacco use for ceremonial purposes only was included as its own category. Future studies should also consider separating out use of peyote in the Native American Church. Limitations include the cross-sectional nature of the data as well as the binge drinking question focusing on “one occasion” versus two hours, and covering a month as compared to the two weeks of the College Alcohol Study. The project's generalizability also is limited because it focused on students in the Southwest United States living in an urban center. Students who had not continued with their education were not included. Nonetheless, this study contributes to our knowledge of substance use patterns among Native Americans in higher education, and particularly more nuanced understandings of regional patterns of substance use.

Making substance use prevention and treatment available for Native American college students while showcasing high rates of overall alcohol abstinence and dispelling stereotypes about Native American alcohol use is an important area for future work. A large randomized controlled trial of Indigenous Māori university students in New Zealand found that online risky alcohol use screening and brief intervention reduced alcohol use and intensity and academic problems at a five month follow-up compared to screening alone.³² Native American students with elevated substance use could benefit from intervention efforts, particularly norms based on Native American students so as not to skew their alcohol use upwards. Future studies may also implement surveys and longitudinal studies of Native American college student substance use at the national level or focus on tribal colleges. Studies should examine the educational trajectories of Native American students and whether education at Indigenous-based or reservation schools affects substance use and graduation rates. Given the lower rates of substance use in this sample (particularly alcohol use), nationwide intervention efforts to reduce college student binge drinking could be informed by the strengths of this group.

Highlights.

• Native American students had less tobacco/alcohol use than general college samples.

• Rates of past-month marijuana use were similar to other college samples.

• Participation in traditional cultural activities was related to less substance use.

Appendix: Frequency of Past-Month and Lifetime Drug Use, N (%)

		Frequency of lifetime drug use
	Past-month use	Never	1-10 times	11-99 times	100+ times
Marijuana	46 (13.6%)	104 (30.3%)	132 (38.5%)	51 (14.9%)	56 (16.3%)
	16 (4.7%)	261 (76.1%)	55 (16.0%)	18 (5.2%)	9 (2.6%)
Sedatives/sleeping pills
Rx opioids, non-medical reasons	15 (4.4%)	265 (77.7%)	45 (13.2%)	18 (5.3%)	13 (3.8%)
Cocaine	6 (1.8%)	250 (73.1%)	54 (15.8%)	22 (6.4%)	16 (4.7%)
Rx stimulants, non-medical reasons	6 (1.8%)	312 (91.2%)	21 (6.1%)	8 (2.3%)	1 (0.3%)
Hallucinogens	5 (1.5%)	261 (76.8%)	58 (17.1%)	13 (3.8%)	8 (2.4%)
Heroin/opium	5 (1.5%)	314 (92.1%)	19 (5.6%)	6 (1.8%)	2 (0.6%)
Methamphetamines	3 (0.9%)	292 (85.4%)	25 (7.3%)	15 (4.4%)	10 (2.9%)
Inhalants	0 (0.0%)	303 (88.9%)	30 (8.8%)	6 (1.8%)	2 (0.6%)

Note. Rx = Prescription.