The Influence of Multilevel Minority Stress on Hazardous Drinking among Sexual Minority Women

性少数妇女（如女同性恋、双性恋）是高危人群之一

Sexual minority women (SMW; e.g., lesbian, bisexual) represent one of the highest-risk groups for hazardous drinking (HD; a quantity or pattern of alcohol consumption that places individuals at risk for harmful consequences that includes heavy episodic drinking, adverse drinking consequences, intoxication, and dependence symptoms). SMW are much more likely than heterosexual women to report indicators of HD; for example, they have 3-7 times higher odds of past-year alcohol dependence symptoms. The major explanation for this disparity is SMW’s exposure to minority stressors (e.g., stigma, discrimination). However, research has been largely focused on individual- (e.g., stigma consciousness) or interpersonal- (e.g., discrimination) level factors. Relatively little research has considered structural-level minority stressors (e.g., discriminatory laws or policies) and even less has simultaneously examined the impact of multiple levels of minority stress on HD in SMW. Greater understanding of the dynamic, contextual, interrelated impact of multiple levels of minority stressors can inform prevention and intervention strategies. In the proposed predoctoral fellowship, I will investigate these relationships by combining data from the 21-year longitudinal Chicago Health and Life Experiences of Women study (CHLEW; R01AA013328-14; T. Hughes, PI [primary mentor]) and publicly available data related to structural level minority stress, using a previously validated index of state LGBT policy environment. Guided by an integration of the Social Ecological and Minority Stress Models, the specific aims are to: (1) Examine the associations of individual-level minority stressors (i.e., stigma consciousness, internalized stigma/homophobia) with past year HD; (2) Examine the associations of interpersonal-level minority stressors (i.e., sexual identity discrimination, family reactions to sexual identity disclosure) with past year HD while accounting for individual-level minority stressors; and (3) Examine the association of structural- level minority stressors (i.e., state LGBT policy environment) with past year HD while accounting for individual and interpersonal-level minority stressors. Recognizing the diversity among SMW, for each of the three aims I will also explore potential differences by sexual identity (i.e., lesbian, bisexual) and race/ethnicity (i.e., Black, White, Latina). The proposed aims align with the National Institute on Alcohol Abuse and Alcoholism (NIAAA) research goals and priorities to inform prevention strategies for alcohol misuse and disorders among individuals across the lifespan and to investigate socio-cultural origins of alcohol use. Working with a mentorship team of prominent researchers, and within the highly resourced environment of Columbia University, I will develop expertise and skills in alcohol epidemiology, multiple levels of minority stress, and advanced quantitative methods. I will gain experience and professional skills in the responsible conduct of research, multidisciplinary collaboration, grantsmanship, and academic writing. This will serve to build a strong foundation for the development of my independent research career focused on reducing HD among SMW.