Drug Alcohol Depend. 2026 Jun 24;286:113238. doi: 10.1016/j.drugalcdep.2026.113238. Online ahead of print.
ABSTRACT
BACKGROUND: The association between cultural identity and substance use varies across studies, highlighting the need to quantify this relationship and identify sources of variability. This meta-analysis quantified the relationship between cultural identity and substance use among North American Indigenous youth, tested potential moderators, and described measurement approaches and tribal nation representation.
METHOD: A systematic literature search identified 18 studies reporting a quantifiable association between cultural identity and substance use with samples of at least 75% Indigenous youth between the ages of 10 and 20 years. Random effects models were used to calculate pooled effect sizes (Pearson’s r), and meta-regressions assessed for potential moderating effects of age, sex, measurement approach, and living on a reservation.
RESULTS: Overall, there was no significant pooled association between cultural identity and substance use in Indigenous youth (r = -0.003, p = .86). Effects were similar across alcohol, tobacco, and cannabis. However, heterogeneity was high (I2=72%), and funnel plot asymmetry suggested possible publication bias (p = .04). Age, sex, living on a reservation, and measurement approach did not moderate the overall effect (p’s > .49). Tribal affiliation was largely not reported.
CONCLUSIONS: This is the first meta-analysis to quantify the association between cultural identity and substance use among Indigenous youth. Although the overall pooled association was not statistically significant, this likely reflects limitations in how cultural identity is operationalized within quantitative research, leaving the question as to how cultural identity may impact substance use among Indigenous youth as of yet unanswered. Identifying which components of cultural identity are most relevant for Indigenous youth substance use will yield a better understanding of this relationship to inform the development of culturally sensitive interventions.
PMID:42364285 | DOI:10.1016/j.drugalcdep.2026.113238
