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Robert W. Blum, MD, MPH, PhD; Brian Harmon; Linda Harris; Lois Bergeisen; Michael D. Resnick, PhD

JAMA. 1992;267(12):1637-1644.

Abstract
Objective.
—To assess risk behaviors, health problems, worries and concerns, and resiliency-promoting factors among American Indian—Alaska Native adolescents.

Design.
—Survey.

Setting.
—Nonurban schools from eight Indian Health Service areas.

Participants.
—A total of 13454 seventh- through 12th-grade American Indian— Alaska Native youths.

Main Outcome Measures.
—A revised version of the Adolescent Health Survey, a comprehensive, anonymous, self-report questionnaire with 162 items addressing 10 dimensions of health.

Results.
—Poor physical health was reported by 2% of the study sample and was significantly correlated with social risk factors of physical and/or sexual abuse, suicide attempts, substance abuse, poor school performance, and nutritional inadequacies. Injury risk behaviors included never wearing seatbelts (44%), drinking and driving (37.9% of driving 10th through 12th graders), and riding with a driver who had been drinking (21.8%). Physical and sexual abuse prevalence was 10% and 13%, respectively, with 23.9% of females reporting physical abuse and 21.6% of females reporting sexual abuse by the 12th grade. Almost 6% of the entire sample endorsed signs of severe emotional distress. Eleven percent of the teens surveyed knew someone who had killed himself or herself, and 17% had attempted suicide themselves. Sixty-five percent of males and 56.8% of females reported having had intercourse by the 12th grade. Weekly or more frequent alcohol use rose from 8.2% of seventh graders to 14.1% by the 12th grade; for males, the survey noted an increase in regular alcohol use of 3% to 5% a year to 27.3% by the 12th grade. For each variable measured, rates are much higher for American Indian adolescents than those for rural white Minnesota youth, except for age at first intercourse and alcohol use.

Conclusions.
—American Indian—Alaska Native adolescents reported high rates of health-compromising behaviors and risk factors related to unintentional injury, substance use, poor self-assessed health status, emotional distress, and suicide. Interventions must be culturally sensitive, acknowledge the heterogeneity of Indian populations, be grounded in cultural traditions that promote health, and be developed with full participation of the involved communities.

(JAMA. 1992;267:1637-1644)

Author Affiliations
From the Division of General Pediatrics and Adolescent Health, University of Minnesota Hospital and Clinic, Minneapolis (Dr Blum); the Adolescent Health Program, Program in Hospital and Health Care Administration, School of Public Health, Minneapolis, Minn (Mr Harmon, Ms Harris, and Dr Resnick); and the Division of Minority Health, Education, and Prevention, American Association of Medical Colleges, Washington, DC (Ms Bergeisen).

Footnotes
Reprint requests to Division of General Pediatrics and Adolescent Health, University of Minnesota Hospital and Clinic, Box 721, UMHC, Harvard Street at East River Road, Minneapolis, MN 55455 (Dr Blum).

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