Early Substance Use Initiation Is Associated With Difficulty Quitting Among American Indian and Non-American Indian...

Early initiation of substance use during adolescence is linked to immediate and long-term risks, including impaired cognitive development; challenges in social, academic, and psychological functioning; and increased vulnerability to addiction. This study examined whether early initiation of cigarettes, alcohol, and cannabis was related to difficulty quitting.

A national sample of 9,178 7th- to 12th-grade adolescents (ages 10 through 18) across 42 schools participated in a cross-sectional, epidemiologic survey of substance use among reservation-based American Indian (AI) and non-AI youth between 2021 and 2023. Discrete-time survival analysis estimated hazard and survival probabilities for cigarette, alcohol, and cannabis use. Multinomial logistic regression models tested age at initiation as a predictor of self-reported difficulty quitting.

AI youth were more likely than non-AI youth to report initiating cigarette and cannabis use from ages 10 to 14, whereas hazard probabilities were similar between groups from age 15 onward. There was no consistent evidence of differences in the initiation of alcohol use between the two groups of adolescents. For all three substances, earlier initiation was associated with increased odds of being unable to quit (compared with being able to quit). These associations did not differ between AI and non-AI students.

Early prevention is needed to delay the onset of substance use, particularly among AI adolescents. Early initiation of substance use may signal later dependence for both AI and non-AI youth. Screening of students who report early initiation and difficulty quitting may identify the need for tertiary prevention or early treatment for dependence.