Spirituality, Ethnic Identity, and Substance Use among American Indian/Alaska Native Adolescents in California.

American Indian/Alaska Native (AIAN) adolescents have a higher prevalence of commercial tobacco, alcohol, and marijuana use than other racial/ethnic groups in the United States. It is unclear whether cultural factors such as ethnic identity, spirituality, and ceremonial use of traditional tobacco are associated with substance use, especially use of emerging tobacco products such as electronic cigarettes, among AIAN adolescents. This study investigated the association between hypothesized cultural protective factors (ethnic identity, spirituality, and ceremonial use of traditional tobacco) and past-month use of commercial cigarettes, e-cigarettes, marijuana, blunts, and alcohol among 156 AIAN adolescents in California (mean age = 15.3 years, 55% female). Adolescents from six AIAN schools and afterschool programs completed paper-and-pencil surveys. We used Logistic regression analyses to identify the significant cultural correlates of past-month substance use, controlling for demographic covariates. As hypothesized, strong ethnic identity was protective against cigarette, marijuana, and alcohol use. However, it was not protective against e-cigarette or blunt use. Spirituality was associated with an increased risk of cigarette and marijuana use. Previous ceremonial use of traditional tobacco was not associated with past-month recreational substance use. Results indicate that the associations between cultural factors and substance use vary across substances. Future research should identify cultural factors that protect AIAN adolescents against use of newer products such as e-cigarettes and blunts.