Motivations for Nonuse as Predictors of Substance Use Among Reservation-Based Youth in a Computerized Screening and Brief Intervention: The Power of Positive People.

Adolescent substance use is a critical public health issue in rural and American Indian communities with disparities persisting into young adulthood. This study examines motivations for nonuse as predictors of substance use trajectories among adolescents in a computerized Screening and Brief Intervention in 10 high schools on and near the Cherokee Nation Reservation. Low-risk students (n = 360) reported their motivations for nonuse during the initial Screening and Brief Intervention session, and substance use outcomes (alcohol, cannabis, prescription opioid misuse, vaping) were assessed in subsequent surveys. Results from longitudinal growth curve models indicated that most motivations for nonuse were not associated with differential trajectories of substance use over time. One notable exception was "having positive people in one's life," which predicted a significantly lower likelihood of nicotine vaping at the initial follow-up, followed by a faster increase in vaping over subsequent semesters. In secondary wave-specific models, this motivation also predicted reduced cannabis use at the first follow-up, whereas endorsing "it makes me feel bad" predicted higher cannabis use. Reinforcing positive social influences and addressing negative feelings may be an important part of prevention strategies like Screening and Brief Intervention. This study offers new evidence on motivations for nonuse to inform the design of digital prevention tools for underserved rural youth.