Abstract
BACKGROUND: Reservation-area American Indian (AI) youth use cannabis at significantly higher rates than their national counterparts. This discrepancy is concerning, as cannabis use-particularly heavy use-can negatively impact adolescents' health. Studies primarily use frequency to classify cannabis use intensity; however, frequency alone may not fully capture heterogenous patterns of use. This study aimed to classify AI adolescents' cannabis use based on multiple intensity indicators, and to investigate interclass differences in problematic characteristics and outcomes of use. METHODS: Participants were 799 reservation-area AI youth (7-12th grade) reporting 12-month cannabis use. Latent Class Analysis (LCA) was used to distinguish cannabis use intensity patterns based on frequency, typical intoxication levels and duration. Auxiliary tests using R3STEP and BCH 3-step procedures were used to assess class predictors (age, initiation age, sex) and interclass differences in simultaneous drug use, stress-motivated use, problems quitting and cannabis-related consequences. RESULTS: Four classes emerged: Light Use (LU; 19 %), Occasional Intoxication (OI; 32 %), Mid-frequency Use(MU; 28 %), and Heavy Use (HU; 21 %). Age and initiation age correlated with membership odds in a heavier use class. Interclass differences in problematic characteristics and outcomes occurred between all classes, particularly for stress-motivated use and cannabis-related consequences-with HU reporting the most problematic characteristics and negative outcomes. CONCLUSION: These findings suggest that accounting for multiple dimensions of usage intensity may be important in studies examining cannabis use and related problems among AI adolescents. Tailoring intervention programming to address complex cannabis use patterns, with particular focus on stress-coping skills and harm reduction, can ensure AI youth most at risk for cannabis problems gain maximal benefit from prevention efforts.