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. General Scientific SummaryReservation-area AI and non-AI adolescents' family structure, peer substance use, and school bonding, and the composition of those variables among their fellow students, impact their BD differently depending on their AI identity and sex. These findings can inform adaptations of school-based alcohol use prevention programs accommodating the diverse experiences of reservation-area adolescents.