Culturally Based Approaches to Substance Use with Native Youth

Tuesday, July 22, 2025, 12:00 AM - Friday, July 21, 2028, 11:59 PM

A Continuing Medical Education activity presented by the Stanford Center for Youth Mental Health and Wellbeing. This Native American Youth Mental Health session features a ECHO didactic presentation by Claradina Soto, PhD, MPH on American Indian Adolescents Young Adults and Commercial Tobacco and Cannabis Use, followed by a presentation by Steve Sust, MD on Substance Use Disorder in Native American Youth.

The information provided in the first presentation will help learners discuss how to engage American Indian youth and young adolescents in the development of prevention interventions and describe the motivations for co-using commercial tobacco and cannabis among American Indian youth and young adolescents. The information provided in the second presentation will help learners recognize psychiatric comorbidities that could pre-date initial diagnosis of Substance Use Disorder (SUD), list two to three methods of screening for youth SUD, and acquire new knowledge regarding cultural and psychosocial stressors affecting psychiatric and SUD that requires close collaboration between clinicians, schools, parents, and children.

Release Date: July 22, 2025

Expiration Date: July 21, 2028

Estimated Time to Complete: 45 minutes

Registration Fee: FREE

Activity and Learning Materials
Click Begin (at the top) to launch the activity. This session is part of The Native American Youth Mental Health ECHO Project. To learn more about this project and find additional resources, please visit the NAYMH ECHO Project Website.

AMA PRA Category 1 Credits™ (0.75 hours), AAPA Category 1 CME credits (0.75 hours), ACPE Contact Hours (0.75 hours), ANCC Contact Hours (0.75 hours), APA Continuing Education credits (0.75 hours), Non-Physician Participation Credit (0.75 hours)

1. Discuss how to engage American Indian youth and young adolescents in the development of prevention interventions.
2. Describe the motivations for co-using commercial tobacco and cannabis among American Indian youth and young adolescents.
3. Recognize psychiatric comorbidities that could pre-date initial diagnosis of SUD?
4. List two to three methods of screening for youth SUD?
5. Acquire new knowledge regarding cultural and psychosocial stressors affecting psychiatric and SUD that requires close collaboration between clinicians, schools, parents, and children?

In support of improving patient care, Stanford Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

Credit Designation 
American Medical Association (AMA) 
Stanford Medicine designates this Enduring Material for a maximum of 0.75 AMA PRA Category 1 Credits^TM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Accreditation Council of Pharmacy Education (ACPE) 
Stanford Medicine designates this knowledge-based activity for a maximum of 0.75 hours. Credit will be provided to NABP CPE Monitor within 60 days after the activity completion. UAN: JA0000751-0000-25-011-H04-P

For Pharmacists to Claim ACPE Credit: Pharmacists must submit to us their NABP e-Profile ID and Date of Birth for credit to be reported to CPE Monitor. If you wish to claim ACPE credit, please enter your NABP ePID# and Date of Birth in your CE Profile. Log in to Stanford's CME portal > My CE > Profile tile > Credentials > Select NABP ePID# from the drop down and enter your ID number. Please also enter your Date of Birth (month and day) in your profile under Basic Information.  The field will appear when you select your Profession as Pharmacist.

American Nurses Credentialing Center (ANCC) 
Stanford Medicine designates this Enduring Material for a maximum of 0.75 ANCC contact hours. 

American Academy of Physician Associates (AAPA) - Enduring Materials 
Stanford Medicine has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This enduring activity is designated for 0.75 AAPA Category 1 CME credits. Approval is valid until 06.11.28. PAs should only claim credit commensurate with the extent of their participation. 

American Psychological Association (APA) 
Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibility for the content of the programs. 

Accessibility Statement
 Stanford University School of Medicine is committed to ensuring that its programs, services, goods and facilities are accessible to individuals with disabilities as specified under Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Amendments Act of 2008.  If you have needs that require special accommodations, including dietary concerns, please contact the CME.

Cultural and Linguistic Competency
The planners and speakers of this CME activity have been encouraged to address cultural issues relevant to their topic area for the purpose of complying with California Assembly Bill 1195. Moreover, the Stanford University School of Medicine Multicultural Health Portal contains many useful cultural and linguistic competency tools including culture guides, language access information and pertinent state and federal laws.  You are encouraged to visit the Multicultural Health Portal: https://laneguides.stanford.edu/multicultural-health

References
Presentation 1 References:

• Seo YS, Chang YP. Racial and Ethnic Differences in E-Cigarette and Cigarette Use

• Among Adolescents. J Immigr Minor Health. 2022 Jun;24(3):713-720. doi:

• 10.1007/s10903-021-01229-0. Epub 2021 Jun 9. PMID: 34106360. Using 2017 YRBS data

• The Truth Initiative. Tobacco use in the American Indian/Alaska Native community. Website: https://truthinitiative.org/research-resources/targeted-communities/tobacco-use-american-indianalaska-native-community

• D’Silva, Joanne, Erin O’Gara, and Nicole T. Villaluz. "Tobacco industry misappropriation of American Indian culture and traditional tobacco." Tobacco control 27.e1 (2018): e57-e64.

• Cruz, Tess Boley, Shyanika W. Rose, Brianna A. Lienemann, M. Justin Byron, Helen I. Meissner, Lourdes Baezconde-Garbanati, Li-Ling Huang, Dana M. Carroll, Claradina Soto, and Jennifer B. Unger. "Pro-tobacco marketing and anti-tobacco campaigns aimed at vulnerable populations: a review of the literature." Tobacco induced diseases 17 (2019).

• Unger, J. B., Sussman, S., Begay, C., Moerner, L., & Soto, C. Spirituality, ethnic identity and substance use among American Indian/Alaska Native Adolescents in California. Substance use and misuse, 55(7), 1194-1198.

• Odani S, Armour BS, Graffunder CM, Garrett BE, Agaku IT. Prevalence and Disparities in Tobacco Product Use Among American Indians/Alaska Natives —United States, 2010–2015 . Morbidity and Mortality Weekly Report, 2017;66(50):1374-8 [accessed 2022 Mar 19].

• Substance Abuse and Mental Health Services Administration. Results from the 2018 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, 2019 [accessed 2022 Mar 19].

• Espey DK, Jim MA, Cobb N, et al. Leading Causes of Death and All-Cause Mortality in American Indians and Alaska Natives. American Journal of Public Health, 2014;104(Suppl 3):S303–S311 [accessed 2022 Mar 19].

Presentation 2 References:

• Twardowski MA, Link MM, Twardowski NM. Effects of Cannabis Use on Sedation Requirements for Endoscopic Procedures. J Am Osteopath Assoc. 2019 Apr 15. doi: 10.7556/jaoa.2019.052. Epub ahead of print. PMID: 30985870.

• Clark, J. D., & Winterowd, C. (2012). Correlates and predictors of binge eating among Native American women. Journal of Multicultural Counseling and Development, 40(2), 117–127. https://doi.org/10.1002/j.2161-1912.2012.00011.x

• CDC-Kaiser ACE Study. Website: https://www.cdc.gov/violenceprevention/aces/about.html

• Swaim, R. C., & Stanley, L. R. (2018). Substance use among American Indian youths on reservations compared with a national sample of US adolescents. JAMA Network Open, 1(1), e180382. https://doi.org/10.1001/jamanetworkopen.2018.0382

• Kulak JA, Griswold KS. Adolescent Substance Use and Misuse: Recognition and Management. Am Fam Physician. 2019 Jun 1;99(11):689-696. PMID: 31150174.

• Cummins, L. H., Chan, K. K., Burns, K. M., Blume, A. W., Larimer, M., & Marlatt, G. A. (2003). Validity of the CRAFFT in American-Indian and Alaska-Native adolescents: screening for drug and alcohol risk. Journal of Studies on Alcohol, 64(5), 727–732. https://doi.org/10.15288/jsa.2003.64.727

• CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble). Website: https://crafft.org/get-the-crafft/

• National Institute on Drug Abuse. AUDIT - C (Alcohol Use Disorders Identification Test-Concise). Website: https://nida.nih.gov/sites/default/files/files/AUDIT.pdf

• Nestler, Eric J. & Luscher, Christian. (2019). The Molecular Basis of Drug Addiction: Linking Epigenetic to Synaptic and Circuit Mechanisms. Neuron, 102(1), 48-59.

• Retention Toolkit: Motivational Interviewing. Website: https://adai.uw.edu/retentiontoolkit/interviewing.htm

• Beckwith VZ, Beckwith J. Motivational Interviewing: A Communication Tool to Promote Positive Behavior Change and Optimal Health Outcomes. NASN School Nurse. 2020;35(6):344-351. doi:10.1177/1942602X20915715

• Kamilla L. Venner, PhD and Nadine Tafoya, MSW, LISW. Native American Motivational Interviewing: Weaving Native American and Western Practices (A Manual for Counselors in Native American Communities). Website: https://zerosuicide.edc.org/resources/resource-database/native-american-motivational-interviewing-weaving-native-american-and

For Native American Youth Mental Health ECHO Project Team question, please contact
     Email: [email protected]

For CME general questions, please contact 
     Email: [email protected]

Mitigation of Relevant Financial Relationships

Stanford Medicine adheres to the Standards for Integrity and Independence in Accredited Continuing Education.

There are no relevant financial relationships with ACCME-defined ineligible companies for anyone who was in control of the content of this activity, except those listed in the table below. All of the relevant financial relationships listed for these individuals have been mitigated.

Speakers:

Claradina Soto, PhD, MP - Nothing to disclose

Steven Sust, MD - Nothing to disclose

Planners (see table below)