Effects of Marriage Recognition on Substance Abuse and Health for Women

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Project Summary/Abstract Sexual minority women (SMW; lesbian, bisexual) experience substantial health disparities, including significantly higher rates of hazardous drinking, depression, and poor self-reported health compared to heterosexual women. However, there is a dearth of research examining resiliency factors and how these factors might vary by race/ethnicity among SMW. The Institute of Medicine (IOM) challenged researchers to examine factors that foster resilience among SMW including examining differences by race and ethnicity and exploring the positive impact on sexual minority (SM) health of the legal recognition of same-sex marriage. Studies have found strong associations between supportive policies, such as marriage recognition, and improved health outcomes among sexual minorities. However, there are gaps in understanding specific psycho-social factors may explain the impact of policies on SM health outcomes. To address these gaps in knowledge, we will draw on minority stress, intersectionality, and social-ecological frameworks and a mixed-methods research design to identify and assess factors that underlie the effect of marriage recognition on health and to examine relationships between these factors and three health outcomes among SMW: hazardous drinking, depression, and poor general health. Several key innovations ensure the success and high impact of this project. First, the proposed project leverages innovative methods from a currently funded project (R01 DA036606; Drabble & Trocki, multiple-PIs), which uses respondent-driven sampling (RDS) based on population-based "seeds" from the National Alcohol Survey (NAS) to collect data nationwide from a large and diverse population of approximately 1000 SMW. Second, by creating measures to describe how marriage recognition may influence health, our study contributes to the sparse but urgently needed research on resiliency among SMW. Third, the study contributes to emerging understanding of the impact of marriage recognition on health outcomes, with a special focus on differences in risk by race/ethnicity and how such risks may be attenuated by other risk/protective factors at individual, interpersonal, community, and sociopolitical levels. Finally, the study capitalizes on the recent historic national change in laws that now recognize same-sex marriage in all states, affording a timely opportunity to develop and test new scales designed to investigate how marriage recognition influences health outcomes among racially and ethnically diverse SMW. To do so, we will test the following aims: 1) Develop new measures to assess factors that underlie the impact of marriage recognition, using in-depth qualitative interviews with approximately 32 diverse SMW. 2) Assess the psychometric properties of the new measures among approximately 500-600 SMW, using item analysis and confirmatory factor analysis. 3) Examine the predictive value of these novel SMW-specific measures on hazardous drinking, depression and self-reported health, with specific focus on racial/ethnic differences. We will merge new data with previously collected data, which include rich demographic, risk and resiliency data from the same participants. Findings will be used in future studies with population-based and volunteer samples to inform prevention and intervention strategies aimed and building resiliency and reducing health disparities among SMW.