
The study examined the impact of anxiety and depressive symptoms on the initiation of alcohol use, cannabis use, and prescription opioid misuse among adolescents in high schools on or near Tribal reservations in the U.S. Great Plains. A community randomized trial involving 455 students revealed that every 5-point increase in anxiety was associated with a 28-29% increased likelihood of initiating alcohol and cannabis use, while each 5-point increase in depression correlated with a 25-38% higher risk for initiating alcohol use, cannabis use, and opioid misuse. These findings emphasize the need for targeted mental health interventions to mitigate substance misuse risks among rural and American Indian youth.
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