Alcohol Use Among Asian American Sexual and Gender Diverse Youth Enrolled in 9^th, 10^th, 11^th, and 12^th Grades in California: A Decision Tree Analysis

Background: Asian American sexual and gender diverse youth experience bias-based stressors rooted in stereotypes and forms of oppression, which can contribute to coping behaviors like alcohol use. Few studies examine lifetime alcohol use with a focus on understanding heterogeneity within Asian American adolescents. Methods: The analytic sample included Asian American youth in 9^th through 12^th grade (N = 86,799) who completed the 2017-2019 California Healthy Kids Survey, a statewide, school-based survey. Exhaustive Chi-square automatic interaction detection was conducted using SPSS. Variables included exposure to sexual orientation and gender identity-based (SOGI) and race-based bullying and different social identities (ethnic, sexual, and gender identities and sex assigned at birth). Results: Past-year SOGI-based bullying was reported by 11.2% of students and race-based bullying was reported by 18.8% of students. 19.6% of students indicated lifetime alcohol use, with higher rates among those in older grades (13.1% 9^th grade to 31.8% 12^th grade). Lowest lifetime alcohol use prevalence were among monoracial Asian American youth who were not the targets of bias-based bullying, while highest lifetime alcohol use rates were among youth identifying as multiracial and/or with a minoritized sexual orientation and experiencing bias-based bullying. Conclusions: Findings suggest bias-based victimization may lead youth to cope or attempt to fit in through alcohol use. Bisexual and multiracial youth, who are often marginalized from monoracial and monosexual communities also had high lifetime alcohol use prevalence. Future research should identify intersectionality-informed strategies to address the nuanced bias-based bullying experiences of Asian American sexual and gender diverse youth, particularly in school settings.