A Mixed-Method Study on Transgender and Gender Diverse Adults’ Alcohol Use

项目总结/摘要 跨性别和性别多样性（TGD）成年人在酒精使用，酒精相关问题和酒精使用方面的风险更大 与顺性成年人相关的疾病。因此，具有文化能力的酒精使用评估和干预措施， 从公共卫生的角度来看，有效地针对这一人群中的突出风险至关重要。然而，尽管增长 关注这一弱势群体，现存的理论，酒精风险和弹性内TGD人口 存在许多理论和方法上的局限性。这包括（a）对风险的狭隘看法， 考虑TGD成年人面临的不同压力源的增量有效性，（B）风险的操作化， 种族同质的白色样本，可能无法捕获种族、人种和 （c）依赖定量方法，无法促进对性别多样性指数的转换， TGD社区内的酒精使用纳入临床协议。解决这些局限性是奠定 为更多的文化肯定和临床有用的模型解释和干预酒精使用的基础， TGD人群。我们的研究与NOT-MD-19-001“关于研究的特别兴趣的通知”一致。 性和性别少数群体（SGM）的健康。 拟议的研究旨在通过一种新颖的混合方法研究方法来解决这些目标。第一阶段 在这项研究中，我们将对大量不同的TGD成年人样本（N= 27，715;美国变性人）进行二次数据分析。 调查），以检验经验文献中哪些少数人的压力经历是酒精使用的可靠预测因素 跨性别身份（例如，非二元、跨性别男性、跨性别女性）和交叉身份（例如，种族、民族、性 方向）。我们的分析计划将使用多层次建模方法（即，MAIHDA模型），以更好地捕捉 交叉身份对风险的影响，以及循证医学（EBM）方法来证明 TGD成年人的少数压力理论所告知的酒精使用风险算法的临床效用和统计公平性。 在研究的第二阶段，将对60名TGD饮酒成年人进行定性访谈， 第一阶段测试的自上而下的少数民族压力理论的观点，以及其他突出的风险，需求和优势 在TGD社区内，目前对酒精使用的概念化中缺失。样本将按以下因素分层： 性别认同，种族和民族，以确保对环境事件和动态的代表性观点 过程最突出的TGD成年人的观点有问题的酒精使用。我们的研究结果将 告知R34应用程序，该应用程序专注于开发TGD确认酒精干预。

Project Summary/Abstract Transgender and gender diverse (TGD) adults are at greater risk for alcohol use, alcohol-related problems, and alcohol use disorders relative to cisgender adults. Thus, having culturally-competent alcohol use assessments and interventions that effectively target salient risks within this population is critical from a public health perspective. Yet, despite increased attention on this vulnerable population, extant theory concerning alcohol risk and resilience within TGD populations suffers from numerous theoretical and methodological limitations. This includes (a) a narrow perspective of risk that fails to consider the incremental validity of different stressors facing TGD adults, (b) the operationalization of risk within racially homogeneous, White samples that may not capture risks and strengths relevant in racially, ethnically, and sexually diverse samples, and (c) reliance on quantitative approaches that fail to facilitate the translation of indices of alcohol use within TGD communities into clinical protocols. Addressing these limitations is the answer to laying the foundation for more culturally affirming and clinically useful models for explaining and intervening with alcohol use in TGD populations. Our study is consistent with NOT-MD-19-001, “Notice of Special Interest in Research on the Health of Sexual and Gender Minority (SGM) Populations.” The proposed study seeks to address these aims via a novel, mixed method research approach. In the first phase of the study, we will conduct secondary data analyses on a large, diverse sample of TGD adults (N=27,715; U.S. Transgender Survey) to examine which minority stress experiences in the empirical literature are robust predictors of alcohol use across gender identities (e.g., non-binary, trans men, trans women) and intersecting identities (e.g., race, ethnicity, sexual orientation). Our analytic plan will use a multi-level modeling approach (i.e., MAIHDA models) to better capture the influence of intersecting identities on risk, as well as an evidence-based medicine (EBM) approach to demonstrate the clinical utility and statistical fairness of an alcohol use risk algorithm informed by minority stress theory for TGD adults. In the second phase of the study, qualitative interviews will be conducted with 60 TGD, drinking adults, to gain perspectives on top-down minority stress theories tested in Phase I, as well as other salient risks, needs, and strengths missing from current conceptualizations of alcohol use within the TGD community. The sample will be stratified by gender identity, race, and ethnicity to ensure a representative perspective on the environmental events and dynamic processes most salient to TGD adults’ perspectives on problematic alcohol use. Collective findings from our study will inform an R34 application that focuses on developing a TGD-affirming alcohol intervention.