Testing associations among sexual identity, race/ethnicity, relationship characteristics, and hazardous drinking

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Abstract Sexual minority women (SMW; lesbian, bisexual) are 11 times as likely as heterosexual women to meet criteria for alcohol dependence, and 8 times as likely to report seeking help for alcohol-related problems, indicating a disproportionately high risk of hazardous drinking (HD) and associated health risks. HD is operationalized as an index that includes heavy episodic drinking, intoxication, adverse drinking consequences, and symptoms of alcohol dependence. SMW's high risk for HD has been linked to lifetime exposure to multiple and chronic stressors. Although the association between stress and alcohol use is well-established, little is known about the association between relationships, stress, and alcohol use among same-sex female couples. Intimate relationships confer many benefits, and are protective against stress-related negative health outcomes. Conversely, relationship stress may lead to unhealthy coping behaviors, such as HD. Although more than half of SMW in the United States are married or cohabiting, and estimates suggest that up to 50% of same-sex couples will marry within three years of the Supreme Court decision on marriage equality, there is a paucity of research on SMW's intimate relationships and health, and even less research on these associations among SMW of color. Given that hazardous drinking is among the most prominent sexual-orientation-related health disparities in women, there is a critical need to understand the role of alcohol in SMW's intimate relationships. This National Service Research Award (F32) application integrates training and research designed to develop the applicant's expertise in alcohol research and sexual-orientation-related health disparities, with the overarching aim of supporting the candidate in becoming an independent researcher with the ultimate goal of obtaining a faculty position at a major research university and conducting research on sexual-orientation-related health disparities. To accomplish her career and research goals, the applicant requires training in: (1) SMW's health with a focus on hazardous drinking, (2) racial/ethnic disparities and intersectionality, (3) complex data analysis, and (4) professional development, including competitive grant application and manuscript writing. This training program combines mentorship with coursework, seminars, and conferences to enable the applicant to build a strong and impactful program of research addressing critical interpersonal and contextual factors that contribute to SMW's hazardous drinking. In the proposed research, we will examine relationship characteristics and hazardous drinking by taking into account the larger context in which SMW relationships exist, including racial/ethnic and sexual identity differences in the potential effects of multiple stressors on drinking and drinking-related outcomes. We will use a rich dataset to address the following research aims: (1) Using a large, diverse sample of SMW, we will test two competing models—whether the effects of sexual identity and race/ethnicity are: a) additive or b) multiplicative in the associations between relationship status and hazardous drinking. (2). Cross-sectionally and longitudinally examine associations among relationship status, race/ethnicity, stress, and hazardous drinking.