The protective role of culture and family disapproval on substance use among American Indian adolescents

Background: American Indian communities consistently identify adolescent substance use as a major concern. However, limited empirical work has examined how culturally specific protective factors - such as family disapproval and cultural affiliation - interact to influence substance use behavior. Given the importance of kinship networks and cultural continuity, understanding these dynamics is critical for informing culturally grounded prevention strategies.Objectives: This study examines the moderating role of cultural affiliation in the association between family disapproval of substance use and actual use among American Indian adolescents, a population often excluded from national health datasets.Methods: Secondary analysis was conducted using self-report data from the Our Youth, Our Future study, a nationally representative sample of American Indian adolescents attending schools on or near reservations (N = 8,950; 51% female; Mage = 14.64 years, SD = 1.77).Results: Multilevel analyses revealed that family disapproval was negatively associated with lifetime alcohol (b = -0.15, p < .001) and cannabis use (b = -0.34, p < .001), controlling for age. Among adolescents who endorsed use, cultural affiliation moderated the relationship between family disapproval and past-year alcohol and cannabis use. Specifically, family disapproval was significantly associated with lower alcohol use at high (b = -0.01, p = .002) but not low (b = -0.07, p = .48) levels of cultural affiliation. For cannabis use, the association was stronger at high (b = -0.51, p < .001) versus low (b = -0.32, p = .005) levels.Conclusions: Cultural affiliation strengthens the protective effects of family disapproval on substance use among American Indian youth. Findings support culturally responsive, family-based prevention efforts that promote cultural identity and intergenerational communication.