Self-reported head trauma among Native Americans who inject methamphetamine: a cross-sectional study

Introduction: Traumatic brain injury (TBI) is a significant public health concern, with disparities in prevalence and care access among Native Americans. The syndemic relationship between substance use and TBI remains underexplored in Native Americans who inject methamphetamine, a population at high risk for both conditions. This study examines the association between self-reported TBI and substance use patterns in a sample of Native Americans who inject methamphetamine. Methods: In this cross-sectional study, 60 Fort Peck Tribal members who reported injecting methamphetamine were recruited. Data collection included anthropometric measures, a structured questionnaire (lifetime TBI history, health conditions, and substance use characteristics), and portable X-ray fluorescence to measure tibial lead (Pb) concentrations. Logistic regression analyzes assessed associations between self-reported TBIs and substance use patterns stratified by gender. Results: Self-reported lifetime TBI prevalence was 42%. Among females, cumulative years of sedative (OR: 1.3, 95% CI: 1.0–1.5) and cocaine use (OR: 1.3, 95% CI: 1.0–1.5) were associated with increased TBI reports. For males, hypertension (OR: 754.6, 95% CI: 10.7–53,294.1) was a significant predictor. Elevated tibial Pb levels were associated with increased TBI risk in both females and males. Discussion: Findings highlight the syndemic burden of substance use and TBI in Native Americans who inject methamphetamine. Gender-specific risk factors suggest targeted interventions are needed. The study underscores the need for increased representation of Native Americans in concussion research and supports implementing TBI screening within substance use treatment programs.