Developmental Trajectories of Alcohol, Mental Health and Physical Health among American Indian and First Nation Adolescents: Understanding the Role of Land-Based Cultural Engagement, Family, and Peers.

We applied the Indigenous Traditional Ecological Knowledge (ITEK) framework to understand patterns of wellbeing among American Indian and First Nation (AI/FN) adolescents; risks and protective factors associated with alcohol use, mental health, and physical health that can be translated into prevention intervention strategies. Latent profile analysis and growth mixture modeling (GMM) were applied to identify and examine patterns of change among distinct subgroups of AI/FN youth (Wave 1 N = 735, M age = 11.09, 50.2% female) residing on or near a Tribal Nation or Reserve on the role of land-based cultural activity participation, family warmth and support, and having risk-taking peers at baseline. GMM explored how risk and protective factors were related to trajectories of alcohol use, mental health symptoms, and physical health across five waves. Four trajectory groups were identified: (1) Prosocial, low cultural engagement (62%); (2) High-risk profile (11%); (3) Risk-taking peers, mixed engagement (21%); and (4) Prosocial, high cultural and family engagement (5%). Having more risk-taking peers increased risk for alcohol use, symptoms of depression and anxiety, and lower physical health. High land-based cultural activity participation with high family warmth and support decreased risk for alcohol use and mental health indicators and lower physical health with trajectories staying below other subgroups or stable across adolescence. The ITEK framework aided in understanding critical factors for AI/FN wellbeing. Land-based healing efforts hold promise in preventing substance use and negative affect and promoting overall wellbeing among AI/FN adolescents.