The Association between State-Level Structural Racism and Alcohol and Tobacco Use Behaviors among a National Probability Sample of Black Americans.

BACKGROUND: Structural racism is how society maintains and promotes racial hierarchy and discrimination through established and interconnected systems. Structural racism is theorized to promote alcohol and tobacco use, which are risk factors for adverse health and cancer-health outcomes. The current study assesses the association between measures of state-level structural racism and alcohol and tobacco use among a national sample of 1,946 Black Americans. METHODS: An existing composite index of state-level structural racism including five dimensions (subscales; i.e., residential segregation and employment, economic, incarceration, and educational inequities) was merged with individual-level data from a national sample dataset. Hierarchical linear and logistic regression models, accounting for participant clustering at the state level, assessed associations between structural racism and frequency of alcohol use, frequency of binge drinking, smoking status, and smoking frequency. Two models were estimated for each behavioral outcome, one using the composite structural racism index and one modeling dimensions of structural racism in lieu of the composite measure, each controlling for individual-level covariates. RESULTS: Results indicated positive associations between the incarceration dimension of the structural racism index and binge drinking frequency, smoking status, and smoking frequency. An inverse association was detected between the education dimension and smoking status. CONCLUSIONS: Results suggest that state-level structural racism expressed in incarceration disparities, is positively associated with alcohol and tobacco use among Black Americans. IMPACT: Addressing structural racism, particularly in incarceration practices, through multilevel policy and intervention may help to reduce population-wide alcohol and tobacco use behaviors and improve the health outcomes of Black populations.

Intersecting sex and American Indian identity moderates school and individual correlates of binge drinking among reservation-area adolescents.

Reservation-area American Indian (AI) youth demonstrate higher rates of binge drinking (BD) than their non-AI peers. However, individual and school-level differences in BD disparities between reservation-area AI/non-AI female and male adolescents remain unexamined. This study applies an Intersectional framework to examine risk and protective factors of BD among reservation-area youth at the intersection of their sex and AI identities. A nationally representative sample of adolescents (N = 14,769; Mage = 14.6, 49% female; 61% AI) attending 103 reservation-serving schools completed a survey between 2015 and 2019. Multilevel modeling was used to examine differences in risk and protective factors of BD between AI and non-AI male and female adolescents. Our findings indicate that the effects of student and school-level risk and protective factors on adolescents' BD are driven primarily by sex within AI and non-AI groups. Implications for future confirmatory research and tailoring school-based prevention programs are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Race Differences in the Association Between Binge Drinking and Treatment Among First-Time Justice-System-Impacted Youth.

AIMS: We aim to determine whether there are racial/ethnic differences in the association between binge drinking frequency and community-based alcohol treatment among justice-system-impacted adolescents and young adults. METHODS: We examined whether race/ethnicity moderated the relation between binge drinking and youths' likelihood of receiving alcohol treatment. The sample included 1216 male, first-time-arrested youth from the Crossroads Study (2011-2018). Participants were recruited from CA, PA and LA. RESULTS: Among youth who binge drank occasionally, Black youth were less likely to receive alcohol treatment than White (b = -0.08, 95% confidence interval [CI] [-0.13, -0.04]) and Hispanic/Latino (b = -0.06, 95% CI [-0.09, -0.02]) youth. There were no differences between the White and Hispanic/Latino youth. Black youth who were frequent binge drinkers were as likely to receive alcohol treatment as White youth who binge drank significantly less often. There were no racial/ethnic differences in alcohol treatment at the highest level of binge drinking. CONCLUSION: Black youth who binge drink occasionally are less likely than White youth to receive alcohol treatment. The present findings highlight a need for efforts to mitigate racial disparities in access to or motivations to seek community-based treatment.

Belief in the myth of an American Indian/Alaska Native biological vulnerability to alcohol problems among reservation-dwelling participants with a substance use problem.

BACKGROUND: Belief in the myth of an American Indian/Alaska Native (AIAN)-specific biological vulnerability (BV) to alcohol problems is associated with worse alcohol outcomes among AIAN college students who drink, despite also being associated with greater attempts to reduce drinking. This study examined the association of belief in a BV with alcohol use among reservation-dwelling AI adults with a substance use problem. METHODS: Participants (n = 141) who drank alcohol in the past 90 days were selected from a larger AI sample who self-identified as having a substance use problem. Moderated-mediation analyses examined whether belief in a BV was positively associated with alcohol- and substance use-related consequences and whether self-efficacy and craving mediated the association of belief in a BV with alcohol use. RESULTS: Among participants who reported using alcohol but not hard drugs (e.g., methamphetamine, opioids), greater belief in a BV was associated with more drinking days, which in turn was associated with greater alcohol-related consequences. Among participants who used alcohol only, belief in a BV was also significantly associated with greater craving, and in turn with more drinking days. Among individuals who used both alcohol and hard drugs, greater belief in a BV was associated with fewer drinking days, but was not significantly associated with substance use-related consequences. No association was found between belief in a BV and self-efficacy to avoid alcohol or drug use. CONCLUSIONS: Among individuals who use only alcohol, belief in a BV may contribute to more drinking days and greater alcohol-related consequences through its association with greater craving. This study provides further evidence of the potential harm of internalizing the belief that being AIAN contributes to the risk for alcohol problems, a notion that lacks scientific evidence despite decades of research. The findings highlight the importance of combating societal myths regarding AIAN peoples and the internalization of these stereotypes.

Discrimination and Subsequent Mental Health, Substance Use, and Well-being in Young Adults.

OBJECTIVES: Discrimination has been shown to have profound negative effects on mental and behavioral health and may influence these outcomes early in adulthood. We aimed to examine short-term, long-term, and cumulative associations between different types of interpersonal discrimination (eg, racism, sexism, ageism, and physical appearance discrimination) and mental health, substance use, and well-being for young adults in a longitudinal nationally representative US sample. METHODS: We used data from 6 waves of the Transition to Adulthood Supplement (2007-2017, 1834 participants) of the Panel Study of Income Dynamics. Outcome variables included self-reported health, drug use, binge drinking, mental illness diagnosis, Languishing and Flourishing score, and Kessler Psychological Distress Scale score. We used logistic regression with cluster-robust variance estimation to test cross-sectional and longitudinal associations between discrimination frequency (overall, cumulative, and by different reason) and outcomes, controlling for sociodemographics. RESULTS: Increased discrimination frequency was associated with higher prevalence of languishing (relative risk [RR] 1.34 [95% CI 1.2-1.4]), psychological distress (RR 2.03 [95% CI 1.7-2.4]), mental illness diagnosis (RR 1.26 [95% CI 1.1-1.4]), drug use (RR 1.24 [95% CI 1.2-1.3]), and poor self-reported health (RR 1.26 [95% CI 1.1-1.4]) in the same wave. Associations persisted 2 to 6 years after exposure to discrimination. Similar associations were found with cumulative high-frequency discrimination and with each discrimination subcategory in cross-sectional and longitudinal analyses. CONCLUSIONS: In this nationally representative longitudinal sample, current and past discrimination had pervasive adverse associations with mental health, substance use, and well-being in young adults.

Alcohol misuse among older military veterans: an intersectionality theory perspective.

BACKGROUND: Alcohol misuse among older adults is an emerging public health issue. Older veterans are particularly at risk of developing substance use dependency due to the enduring impacts of military service. The purpose of this study was to test the theory of intersectionality on alcohol misuse by veteran status and age, veteran status and sex, and veteran status and race. METHODS: Combined data from the 2016, 2017, and 2018 Brief Risk Factor Resilience Survey (BRFSS) from the Centers for Disease Control and Prevention (CDC) were used in this cross-sectional study. The BRFSS is conducted annually with adults via landline or cellular telephones in all 50 states in the United States, as well as in the District of Columbia, Puerto Rico, and Guam. Alcohol misuse among individuals aged 65+ was examined by veteran status and the interaction between age, race, and sex using survey-weighted logistic regression models. RESULTS: Results show no interaction between veteran status and age or sex. For the interaction between veteran status and race, significant disparities were found. Black/Other race veterans were significantly more likely to engage in binge drinking and heavy drinking compared to nonveterans of the same race, White veterans, and White nonveterans. CONCLUSION: Older veterans who are also Black, Indigenous and/or people of color (BIPOC) are at great risk of engaging in alcohol misuse due to the combined stressors from their intersectional identities. Interventions targeting this population should consider the historical, cultural, and systemic factors that contribute to a disproportionally higher rate of binge drinking and heavy drinking among BIPOC veterans.

Alcohol consumption among older women in the United States.

Few studies have examined alcohol consumption among older women. Using the nationally representative National Survey on Drug Use and Health, we examined binge, moderate, and no alcohol consumption among women ages 50+ (n = 21,178). We calculated population prevalence by age and used multivariate logistic regression, controlling for seven sociodemographic factors. In adjusted results, women ages 65+ were more likely to have moderate or no alcohol consumption than those 50-64; Hispanic and African American women were more likely to engage in binge consumption than whites (all p < .01). More research is needed to understand binge alcohol consumption among older women in racial/ethnic minorities.

Intersections Of Neighborhood Co-Ethnic Density and Nativity Status On Heavy Drinking In a General Population Sample Of US Latinos and Asians.

AIMS: Greater neighborhood co-ethnic density (living in proximity with people sharing an ethnicity) and being foreign-born each can protect against risky drinking, but little is known about whether these two factors interact. Using a representative sample of Latinos and Asians from California, USA, we investigate main and interactive effects of neighborhood co-ethnic density and nativity status in relation to heavy episodic drinking (HED). METHODS: This study uses the California Health Interview Survey (N = 30,203) linked with neighborhood data to investigate associations of co-ethnic density and nativity status with HED. Co-ethnic density was based on matching each respondent's ethnicity to the proportion of residents of the corresponding group in their Census tract. Using weighted logistic regression, we first examined main effects of neighborhood co-ethnic density and respondent nativity status on HED. Next, we assessed the interaction of co-ethnic density and nativity status. Finally, we estimated nativity-stratified models to investigate variation in effects of co-ethnic density. RESULTS: Co-ethnic density was not associated with HED for the full sample, but US-born nativity status was associated with increased odds of past-year HED. The interaction model showed co-ethnic density and nativity had synergistic effects, whereby greater levels of neighborhood co-ethnic density buffered risk associated with being US-born. Further, greater neighborhood co-ethnic density was associated with reduced odds of HED for US-born respondents, but it was not associated with HED for foreign-born respondents. CONCLUSIONS: Protective effects of high neighborhood co-ethnic density on HED are stronger for US-born than for foreign-born Latinos and Asians in California.

Longer time spent at home during COVID-19 pandemic is associated with binge drinking among US adults.

Background: The COVID-19 pandemic has introduced and exacerbated stressors (e.g., job loss, poor mental health) for adults across the United States (US) since the first statewide shelter-in-place order on March 19, 2020. Limited research has evaluated if, and how, pandemic-related stressors are associated with changes in alcohol consumption and binge drinking.Objectives: This analysis aims to identify COVID-19-related stressors associated with changes in alcohol consumption and binge drinking since the outbreak of the coronavirus.Methods: Data were collected on sociodemographics, alcohol consumption, and COVID-19-related stressors (household composition, job status, essential worker, stay-at-home duration, and depression) using a web-based, self-report survey to US adults from mid-March to mid-April 2020. Multivariable logistic and multinomial regression models were used to assess associations between COVID-19-related stressors and binge drinking and changes in alcohol consumption. Among 1,982 participants, 69% were female and 31% male.Results: Thirty-four percent of the sample reported binge drinking during the COVID-19 pandemic. More binge drinkers increased alcohol consumption during the pandemic (60%) than non-binge drinkers (28%). After adjusting for sociodemographics, for every 1-week increase in time spent at home during the pandemic, there was 1.19 (95% CI: 1.06-1.34) greater odds of binge drinking. Additionally, binge drinkers with a previous diagnosis of depression and current depression symptoms had greater odds of increased alcohol consumption compared to those reporting no depression (AOR: 1.77, 95% CI: 1.16, 2.73).Conclusion: Specific COVID-19-related stressors are related to alcohol consumption. This highlights the ancillary and unintended effects of the COVID-19 pandemic which could have long-lasting population health consequences.

Racial Discrimination, Protective Parenting, and Binge Drinking Among Emerging Adult Black Men.

PURPOSE: Rural Black men experience escalating rates of binge drinking during emerging adulthood. We hypothesized that exposure to racial discrimination would predict growth in their binge-drinking trajectories and that protective parenting, including emotional and instrumental support and high expectations for success, would attenuate the influence of racial discrimination on growth in binge drinking. METHODS: Hypotheses were tested with 3 waves of data from 505 men (ages 20.3, 21.9, and 23.1) participating in the African American Men's Project. Conditional and multigroup latent growth curve models (LGCMs) were implemented using Mplus. RESULTS: LGCM indicated that binge-drinking frequency increased linearly across time; exposure to racial discrimination at baseline predicted growth in binge drinking (ß = 0.19, p < 0.01). Multigroup comparison procedures indicated significant moderation by protective parenting. When protective parenting was high, racial discrimination had no significant influence on rates of young men's binge drinking (ß = 0.01, p = 0.51). In contrast, when protective parenting was low, the influence of discrimination was heightened (ß = 0.21, p < 0.01). CONCLUSIONS: Racial discrimination is a pernicious stressor that contributes to increases in binge drinking among young Black men. When parents engaged in emotionally and instrumentally supportive parenting, however, racial discrimination had little influence on binge-drinking trajectories during emerging adulthood. Study findings underscore the importance of the emerging adult transition as a period of vulnerability and suggest directions for targeting alcohol preventive interventions. IMPLICATIONS AND CONTRIBUTION: After high school, young Black men are exposed to racial discrimination that can increase rates of binge drinking. When young men's parents were emotionally and instrumentally supportive toward them, however, racial discrimination did not predict increases in binge drinking.

Examining Disparities in Excessive Alcohol Use Among Black and Hispanic Lesbian and Bisexual Women in the United States: An Intersectional Analysis.

OBJECTIVE: Sexual minority (i.e., lesbian, bisexual) women and racial-ethnic minority groups in the United States are disproportionately harmed by excessive alcohol use. This study examined disparities in excessive alcohol use at the intersection of race-ethnicity and sexual identity for non-Hispanic Black and Hispanic sexual minority women. METHOD: Using data from the 2015 National Survey on Drug Use and Health, we compared the age-adjusted prevalence of binge drinking and heavy alcohol use among sexual minority women of color, sexual minority White women, and heterosexual women of color with that of White heterosexual women. The joint disparity is the difference in the prevalence of excessive alcohol use between sexual minority women of color and White heterosexual women. The excess intersectional disparity is the portion of the joint disparity that is due to being both a racial-ethnic minority and a sexual minority woman. RESULTS: Black and Hispanic sexual minority women reported the highest prevalence of binge drinking (45.4% and 43.4%, respectively), followed by White sexual minority women (35.7%) and White heterosexual women (23%). Black and Hispanic heterosexual women reported the lowest prevalence of binge drinking (20.8% and 20.2%, respectively). The joint disparity in binge drinking between Black sexual minority women and White heterosexual women was 21.2%, and the excess intersectional disparity was 17.7%. The joint disparity in binge drinking between Hispanic sexual minority women and White heterosexual women was 16.8%, and the excess intersectional disparity was 10.8%. CONCLUSIONS: Disparities in excessive alcohol consumption for Black and Hispanic sexual minority women, compared with White heterosexual women, were larger than what would be expected when considering differences by race or sexual identity individually.

An Evolutionary Approach to Binge Drinking Impression Formation: A Cross-Cultural Comparison Between France and Peru.

Evolutionary medicine proposes studying alcohol use and abuse through the lens of modern evolutionary theory. This study ( https://osf.io/p48 uw/) follows this approach and uses an evolutionary framework to predict how young adults (18-35 years old) form impression of a binge drinker. We predicted that displaying sexual dysfunctions (short-term risk) in a binge drinking video would negatively influence attitudes and expectations of a target when compared to cognitive (short-term risk) or long-term deficits. In the following studies, we use a Zahavian framework to understand and influence impression formation of a male binge drinker among women (intersexual selection) and men (intrasexual competition) participants in a subsequent task. Via a randomized experimental online study in France (N = 177, M = 23.39 [4.91], 43.50% men) and a preregistered conceptual replication study in Peru (N = 176, M = 25.61 [4.76], 53.41% men), women exposed to a binge drinking video-describing sexual impotence after a binge drinking episode-tended to downgrade attractiveness evaluation of the binge drinker. However, male participants were not impacted by the different types of signals displayed in the videos. These results show that evolutionary theory could help us understand impression formation in binge drinking context and call for gender-specific health messages.

Substance Use Outcomes for Hispanic Emerging Adults Exposed to Incarceration of a Household Member during Childhood.

This study investigates whether Hispanic emerging adults exposed to household incarceration before age 18 report higher rates of past 30-day cigarette, alcohol, binge drinking, marijuana use, and negative substance use consequences, relative to participants not exposed to incarceration of a household member. Respondents were matched on key characteristics to create balanced groups of exposed and nonexposed respondents. Negative binomial regression models assessed primary research questions. There were significant long-term associations between household incarceration and the frequency of past 30-day binge drinking, marijuana use, and number of negative substance use consequences. Policies and health programs addressing household incarceration may be a promising prevention approach to reduce negative substance use outcomes among Hispanic emerging adults.

Acculturative stress and binge drinking among international students in the United States: Resilience and vulnerability approaches.

Objective: While international students frequently face behavioral health risks due to the stress of adjusting to new cultures, many demonstrate effective coping skills that minimize negative outcomes. The current study tested the mediating effects of resilience and mental health on the relationship between acculturative stress and binge drinking. Participants: International students (N = 322) in the United States. Methods: A cross-sectional design using both online and paper-based survey was implemented. Structural equation modeling was conducted to test the hypothesized mediation model. Results: The results showed good model fit, with resilience mediating the relationship between acculturative stress and binge drinking in the conceptual model. Conclusions: Behavioral health problems and needs of international students are prevalent themes in social work practice; this study, therefore, has practical implications for U.S. colleges and universities as they make decisions about programs and services.

U.S. adolescent alcohol use by race/ethnicity: Consumption and perceived need to reduce/stop use.

Understanding racial/ethnic drinking patterns and service provision preferences is critical for deciding how best to use limited alcohol prevention, intervention, and treatment resources. We used nationally representative data from 150,727 U.S. high school seniors from 2005 to 2016 to examine differences in a range of alcohol use behaviors and the felt need to reduce or stop alcohol use based on detailed racial/ethnic categories, both before and after controlling for key risk/protective factors. Native students reported particularly high use but corresponding high felt need to reduce/stop use. White and dual-endorsement students reported high use but low felt need to stop/reduce alcohol use.

The Co-occurrence of Daily Smoking, Binge Drinking and IPV Among Latino Expectant Fathers.

Many Latino men have multiple risk factors that predispose them to chronic disease morbidity and mortality, yet few have examined patterns in this population. We describe the co-occurrence of daily smoking, binge drinking, and intimate partner violence (IPV) behaviors among Latino expectant fathers and examine factors associated with the co-occurrence of these behaviors. We conducted a secondary analysis of baseline data from the Parejas Trial, a randomized controlled trial testing a culturally tailored couples-based smoking cessation intervention. We used Kruskal-Wallis test statistics to explore the relationship of the co-occurring behavior and demographic and cultural factors. All participants smoked as was a requirement of being in the trial, but only 39% smoked daily. Forty three percent of the participants engaged in one behavior, 32% engaged in two behaviors, and 5% engaged in three behaviors, with binge drinking being the most common co-occurring behavior. In the bivariate analysis, higher stress (p = 0.01) and having more children (p = 0.003) were found to be positively significantly associated with the number of behaviors. Helping Latino expectant fathers manage with their stress may serve as tailoring points for future interventions to reduce risk behaviors.

A Comparison of Excessive Drinking, Binge Drinking and Alcohol Dependence in Ethnic Minority Groups in the Netherlands: The HELIUS Study.

BACKGROUND: The Dutch multi-ethnic Healthy Life in an Urban Setting study recently showed that alcohol consumption was lower in ethnic minority groups than those of Dutch origin, but that binge drinking in drinkers of Turkish and Moroccan origin was relatively high. The aim of the current study is to examine factors that may contribute to the differences in drinking patterns and how they relate to the relationship between drinking patterns and alcohol dependence (AD) across ethnic groups. METHODS: The rate of last year alcohol use, alcohol use patterns and AD was assessed in 4,635 Dutch, 4,317 Moroccan, 4,036 Turkish, 2,459 Ghanaian, 4,426 African Surinamese and 3,357 South-Asian Surinamese participants (both men and women) born in Amsterdam, the Netherlands. RESULTS: Compared to the Dutch, the prevalence of (regular) drinking is substantially lower in all ethnic minority groups and regular drinkers among most ethnic minority groups have a lower adjusted risk to develop binge drinking and AD than the Dutch. For the prevalence of regular drinking, the ethnic differences are bigger than for the prevalence of current drinking. However, regular drinkers of Moroccan origin have a risk similar to the Dutch to develop binge drinking and AD; a finding that could not be explained by group differences in age, sex, religiosity, perceived discrimination, depression or guilt feelings about drinking. DISCUSSION: The prevalence data show that current drinking is lower and that regular drinking is much lower in ethnic minorities and - with the exception of those of Moroccan origin - ethnic minority regular drinkers also have a significant lower risk to develop binge drinking or AD than regular drinkers of Dutch origin. This implies that the magnitude of problematic alcohol use is substantially smaller in ethnic minorities than in the ethnic Dutch population of Amsterdam. Unfortunately, no explanation was found for the special risk situation of regular drinkers of Moroccan origin.

Alcohol consumption patterns in young adults with type 1 diabetes: The SEARCH for diabetes in youth study.

AIMS: The objective of this study is to describe alcohol consumption behaviors of young adults with T1D and to examine associations between alcohol consumption and diabetes-related clinical markers. METHODS: Data from 602 SEARCH for Diabetes in Youth Study participants age ≥ 18 yrs. with T1D were collected from 12/2011 to 6/2015 (50% female, mean age 21.3(SD 2.4), 22% race/ethnic minority). Participants were characterized as alcohol non-drinkers (n = 269), drinkers but non-binge drinkers (n = 167), or binge drinkers (n = 166) based on reported consumption in the past 30 days. Analyses were conducted using one-way ANOVAs, chi-square tests, and logistic regression modeling to examine associations between drinking and clinical markers. RESULTS: Fifty-five percent of participants reported alcohol consumption; 27.6% of participants reported binge drinking. After adjusting for demographic characteristics, neither binge drinking nor non-binge drinking were associated with HbA1c or severe hypoglycemic events relative to non-drinkers. Binge drinking was associated with higher HDL (p = 0.008), lower systolic blood pressure (p = 0.011), and a lower waist:height ratio compared to non-drinkers (p = 0.013). CONCLUSIONS: Young adults with T1D in the SEARCH cohort reported similar alcohol use but higher rates of binge drinking compared to the general United States population and previously reported rates in adults with T1D.

Relevance of the "Immigrant Health Paradox" for the Health of Arab Americans in California.

Objectives. To assess the validity of the immigrant health paradox among Arab Americans in California.Methods. We used data from the 2003 to 2017 California Health Interview Survey (n = 1425). We used survey-weighted χ2 and logistic regression analyses to compare Arabs by immigrant generation on socioeconomic indicators, health behaviors, and health outcomes.Results. Second-generation Arab Americans had higher odds of binge drinking (adjusted odds ratio [AOR] = 3.26; 95% confidence interval [CI] = 1.53, 6.94) in the past year than did first-generation Arab Americans. Third-generation Arab Americans had greater odds of receiving the influenza vaccine in the past year (AOR = 3.29; 95% CI = 1.09, 9.98) than did second-generation Arab Americans. Third-generation Arab Americans had increased odds of being overweight or obese when compared with first- (AOR = 2.59; 95% CI = 1.02, 6.58) and second-generation Arab Americans (AOR = 3.22; 95% CI = 1.25, 8.29), respectively.Conclusions. Alcohol use increased across immigrant generations, and we observed no differences in health outcomes, other than obesity. The immigrant health paradox does not appear to apply to Arab Americans in California; mechanisms that generate health in this population should be studied further.

Trends in Alcohol Use Behaviors by Sexual Identity and Behavior Among High School Students, 2007-2017.

PURPOSE: Certain groups, particularly sexual minority youth, demonstrate notable disparities in alcohol use risk. Assessing trends in alcohol use behaviors by sexual orientation over time is therefore important to the epidemiologic study of adolescent health equity. METHODS: We analyzed age at first drink, lifetime drinking behavior, current drinking, and binge drinking in a large, national sample of high school youth across six time points, beginning in 2007 and biennially through 2017. We assessed trends by sex, sexual identity, and sexual behavior, controlling for race/ethnicity and age. RESULTS: Our results demonstrated that, although overall alcohol use is decreasing among youth, disparities between heterosexual and sexual minority youth remain significant. The largest decreases were seen in current alcohol use among lesbian youth, which fell from a prevalence of 56.1% in 2007 to 38.9% in 2017, and among bisexual females (64.3% in 2007 to 41.1% in 2017). Despite this, alcohol use behaviors were still elevated among lesbian and bisexual female youth compared with heterosexual sex-matched counterparts. Heterosexual-identified male students saw significant decreases in alcohol use, whereas most alcohol use behaviors among sexual minority males decreased but not to a statistically significant degree, with the exception of binge drinking among those who identified as gay (2007: 36.0% to 2017: 12.6%) and bisexual (2007: 24.7% to 2017: 11.6%). Results by sexual behavior are presented within. CONCLUSIONS: Sexual minority youth continued to demonstrate markedly high prevalence of alcohol use behaviors compared with heterosexual peers across all time points. Downward trends in alcohol use may thus mask serious population health risks if not adequately explored. Research and health promotion efforts must consider sexual minority orientation to avoid incomplete or inaccurate representation of findings.