Binge drinking inequities patterned by grade, race/ethnicity, sex, and sexual identity among U.S. high school students: An application of intersectional MAIHDA.

Authors

Thinh Toan Vu, Luisa N Borrell

Published in

Addictive behaviors. Volume 184. Pages 108851. Sep 11, 2026. Epub Sep 11, 2026.

Abstract

Binge drinking among U.S. adolescents varies by developmental stage, race/ethnicity, sex, and sexual identity. However, few studies have examined how these positions/identities intersect to shape drinking patterns. This study examined inequities in binge drinking among U.S. high school students using an intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy.
We used data from 88,291 students who participated in the 2023 Youth Risk Behavior Surveillance System. Multilevel logistic regression models were fitted with students nested within 224 intersectional strata defined by grade, race/ethnicity, sex, and sexual identity. We calculated the variance partition coefficient (VPC), proportional change in variance, and area under the receiver operating characteristic curve.
Approximately 10.4% of students reported binge drinking. The null model VPC was 10.7%, with grade, race/ethnicity, sex/gender, and sexual identity explaining 79.6% of the between-stratum variance in binge drinking. Higher grades (12th: odds ratio [OR]: 3.18, 11th: OR: 2.20, and 10th: OR: 1.44 vs. 9th), girls (OR: 1.15 vs. boys), and gay/lesbian (OR: 1.77) and bisexual identities (OR: 1.34 vs. heterosexual/straight) were associated with greater odds of binge drinking. Asian (OR: 0.52) and Black (OR: 0.63) students had lower odds, whereas Native Hawaiian/Other Pacific Islander students had higher odds (OR: 1.41) than white students.Predicted probabilities of binge drinking ranged from 1.96% to 30.49% across strata, with 12th-grade, white, heterosexual girls and boys exhibiting the highest positive departures from the predicted probabilities.
Binge drinking inequities were largely explained by grade, race/ethnicity, sex, and sexual identity, although intersectional interaction effects remained. Findings call for proportionate universal public health interventions with a focus on high-risk groups.

PMID:
42771957
Bibliographic data and abstract were imported from PubMed on 23 Sep 2026.

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