Starting cannabis before age 14 was linked to greater difficulty quitting among both American Indian and non-American Indian youth

American Indian youth were more likely than non-AI youth to initiate cigarette and cannabis use from ages 10-14, with similar rates from 15 onward. For all three substances (cigarettes, alcohol, cannabis), earlier initiation was associated with increased odds of being unable to quit. These associations did not differ between AI and non-AI students.

Cross-sectional epidemiologic survey of 9,178 7th-12th graders (ages 10-18) across 42 schools, comparing reservation-based American Indian and non-AI youth from 2021-2023. Discrete-time survival analysis estimated hazard probabilities. Multinomial logistic regression tested age of initiation as a predictor of difficulty quitting.

This study highlights that early cannabis initiation predicts quitting difficulty across racial groups, suggesting it may serve as an early warning sign for future dependence. The elevated early initiation rates among AI youth point to a need for culturally tailored prevention.

The finding that early initiation predicts quitting difficulty regardless of ethnicity suggests a shared developmental vulnerability. The fact that AI youth start earlier but show the same initiation-dependence pattern points to environmental rather than biological risk factors.

Cross-sectional design relies on retrospective reporting of initiation age. "Difficulty quitting" is self-reported and may not align with clinical dependence criteria. Reservation-based schools may not represent all AI youth. Cannot control for all confounders.