Addressing Alcohol Use Health Disparities in Latinx Sexual Minorities: A Culturally Congruent Motivational Intervention Targeting Intersectional Forms of Discrimination

项目总结 生活在美国国立卫生研究院确认的两个健康差距群体交界处的拉丁裔少数性群体 酗酒行为和酒精相关问题的风险增加，这与 他们经历的各种形式的歧视--种族主义和异性恋主义。目前没有 酒精滥用行为健康干预措施，解决独特的需求和身份的交集 拉丁裔的性少数群体。有一种很有希望的干预措施，即适应文化的动机访谈 (CAMI)，这在减少拉丁裔个人酒精滥用方面显示出有效性。具体地说，卡米是一个 针对拉丁裔个人的量身定做的干预措施，目标是适应文化压力，并在 它减少了酒精滥用。然而，CAMI只处理单数形式的歧视，而不使用 交叉性和LGBTQ肯定的观点，以解决多种形式的歧视。因此，卡米 将采用LGBTQ干预适应的肯定模式，由少数群体压力告知，以 制定干预措施，解决交叉形式的歧视，以打击酗酒行为 拉丁裔少数性别者称为拉丁裔酷儿改编动机访谈(LaQAMI)。拉卡米将成为 通过远程医疗提供，将有英语和西班牙语版本，以及传统的励志访谈 将被用作受控条件。这项研究将在新英格兰(NE)和 西南部(亚利桑那州西南部)，考虑到拉丁裔性别的多样性，考虑到地理差异 少数族裔。这项研究将分三个阶段进行：对Latinx Sexual进行深入的定性访谈 来自东北部和西南部的少数民族(n=20)和临床利益相关者(n=10；目标1)，以捕捉横断面形式的 歧视和与酒精滥用的联系，并收到对手册改编的反馈；第二 阶段将是开放式系列，重点是审查干预措施的可行性和可接受性，并 将对16个拉丁裔少数性群体(东北地区8人，西南地区8人)进行测试，并将纳入反馈 进入治疗方案(目标2)；第三阶段将是试验性随机对照试验(RCT)，60 来自东北的30名参与者和来自西南部的30名参与者(15名获得新的 干预和接受来自每个地区的15名MI；目的3)。当前研究的目标与 NIAAA确定了特殊人群和战略计划。此外，目前的K23将建立在 申请者在健康差异、少数民族压力和量化技能方面的专业知识，它将为申请者提供 接受文化适应、社区参与研究、构思和执行方面的高级培训 RCT的研究，以及定性和混合方法研究。K23训练期将为申请者提供 需要有保护的时间和培训才能成为领先的健康差距研究人员，专注于多样性和 上瘾科学。

PROJECT SUMMARY Latinx sexual minorities, who are living at the intersection of two NIH identified health disparities groups, are at increased risk for binge drinking behavior and alcohol-related problems which has been linked to the intersectional forms of discrimination they experience – racism and heterosexism. Currently there are no alcohol misuse behavioral health interventions that address the unique need and intersection of identities for Latinx sexual minorities. There is one promising intervention, Culturally Adapted Motivational Interviewing (CAMI), that has shown efficacy in decreasing alcohol misuse within Latinx individuals. Specifically, CAMI is a tailored intervention for Latinx individuals which targets acculturative stress and has shown strong promise in its reduction of alcohol misuse. Yet, CAMI only address singular forms of discrimination and does not use an intersectionality and LGBTQ affirming perspective to address multiple forms of discrimination. Therefore, CAMI will be adapted using an LGBTQ affirmative model of intervention adaptation, informed by minority stress, to develop an intervention that addresses intersectional forms of discrimination to target alcohol misuse among Latinx sexual minorities called- Latinx Queer Adapted Motivational Interviewing (LaQAMI). LaQAMI will be delivered via telehealth, it will be available in English and in Spanish, and traditional motivational interviewing will be used as the controlled condition. The study will be conducted in New England (NE) and in the Southwest (SW in Arizona) to account for geographical differences given the diversity of Latinx sexual minorities. The study will be conducted in three phases: in-depth qualitative interviews with Latinx sexual minorities (n=20) and clinic stakeholders from NE and the SW (n=10; aim 1) to capture intersectional forms of discrimination and links to alcohol misuse and receive feedback on the adaptation of the manual; the second phase will be open series where it will focus on examining feasibility and acceptability of the intervention and it will be tested with 16 Latinx sexual minorities (n= 8 from NE; n= 8 from SW) and feedback will be incorporated into the treatment protocol (aim 2); the third phase will be a pilot randomized controlled trial (RCT) with 60 Latinx sexual minorities with 30 participants from NE and 30 participants from the SW (15 receiving the new intervention and 15 receiving MI from each region; aim 3). The goals of the current study are consistent with NIAAA’s identified special populations and strategic plan. Additionally, the current K23 will build on the applicant’s expertise in health disparities, minority stress, and quantitative skills and it will provide the applicant with advanced training in cultural adaptation, community-engaged research, conceptualizing and executing RCT’s, and qualitative and mixed methods research. The K23 training period will provide the applicant with the needed protected time and training to become a leading health disparities researcher focusing on diversity and addiction science.