In Reply: Dr Bullock and Ms Bradley are quite right to bring to readers' attention other uses to which the gaming revenues have been put by the EBCI. Although the tribe has made decisions about using its resources with the goal of increasing collective efficacy, our study was not designed to measure these uses, and we should have listed this among the study's limitations.
However, the older 2 age cohorts did not differ from non-Indians of the same age on any of our measures of behavioral health or substance abuse, as one might expect they would if community resources such as enhanced health care, education, social services, or drug abuse prevention programs were having the desired effect. Nor were there significant differences on these outcomes between Indian and non-Indian participants as adults. Moreover, as shown elsewhere,1 there were effects on graduating from high school and avoiding minor crime only in the youngest age cohort, which was exposed to the family income supplement for the longest period.
Costello EJ. Family Income Supplements and Development of Psychiatric and Substance Use Disorders Among an American Indian Population—Reply. JAMA. 2010;304(9):962-963. doi:10.1001/jama.2010.1241