Novel Approaches to Population-Level Health Research: Role of HIV Risk and Mental Health in Alcohol Use among High School-Aged Youth

Alcohol is the most commonly used and abused drug among youth in the US with differences in prevalence of alcohol use among youth. Alcohol use and abuse are associated with a multiplicity of short and long-term negative health outcomes, including HIV risk behavior, alcohol and other substance use dependence, neurocognitive deficiencies, and psychological distress. Despite the fact that alcohol use and abuse during adolescence has important consequences for downstream health outcomes and adult patterns of substance use, the majority of research on the matter has focused on college-aged populations. This gap in research with youth is critical to rectify, particularly for high schoolers. Building on our team’s prior work in this area, we propose to use pooled data from the Local Youth Risk Behavior Survey (YRBS), a national biennial survey of high school students that assesses alcohol use, HIV risk, and other health outcomes. Our uniquely large dataset, which currently contains data from 2005 to 2019 (253 jurisdiction-years) and 950,295 high school youth, will expand to include 2021, 2023, and 2025 data, resulting in an estimated 1,668,078 youth. This will allow us to apply an array of complex epidemiologic approaches to assess the impact of alcohol use on the HIV risk behaviors of youth living in the US, and the factors associated with differential magnitudes of association. This proposal is a natural extension of our prior work (R01 AA024409) that resulted in numerous publications in high-impact peer-reviewed journals (e.g., Pediatrics, American Journal of Public Health) and a multitude of collaborations. The current proposal will continue these successes, incorporating additional advanced methods of inquiry, including use of multilevel modeling to determine jurisdictional and temporal associations with alcohol use and differences in HIV risk; latent class analysis to describe alcohol use classes and their association with demographic factors; and the impact of regional, school, and structural level factors that influence alcohol use and its role in increased HIV risk among high schoolers. These approaches will allow us to continue identifying critical pathways for intervention to ensure favorable health outcomes and minimize the risks associated with alcohol use and abuse among high school aged youth.