Testing a Biopsychosocial Model of Violence Exposure, Minority Stressors, and Hazardous Drinking among Sexual Minority Women

项目摘要/摘要 与男性相比，女性遭受暴力的比例更高；21-23然而，对妇女的暴力并不是 随机分配。部分由于她们的耻辱身份，性少数群体妇女(SMW)是2-3倍 比起异性恋女性更有可能面临暴力。许多女性饮酒是为了应对 暴力的负面后遗症(例如，创伤后应激障碍)。28这一共病在SMW中可能会加剧，因为他们 心理社会压力源(即暴力和歧视等少数群体压力源)的经历。11尽管 为受害SMW制定针对性酒精治疗方法的公共卫生必要性，当前 酒精治疗模式没有具体说明这一人群的独特应激源和临床需求。与一致 NIAAA的研究重点，11，14 K01将在理解生物心理社会方面取得重大进展 机制(例如，少数民族应激源、生理反应、创伤后应激障碍)和调节因素(例如，种族/民族) 影响SMW人群危险饮酒异质性及其核心因素的作用 在SMW对治疗的不同需求和反应中发挥作用。该项目将包括：1)流行病学 评估揭示了SMW之间不同的心理社会压力源组合，确定了种族/民族 心理社会应激源类别的差异，并决定这些心理社会应激源的模式 预测11年后共患创伤后应激障碍和危险饮酒(n=450-600)；2)一项基于实验室的研究 了解少数应激源对不平衡负荷的影响(如唾液皮质醇、心率、心率 变异性和皮肤传导性)；和，3)每日一次的生态 21天的瞬时评估(EMA)方法，确定少数族裔应激源的作用 使用相同的SMW样本对创伤后应激障碍和危险饮酒的每日波动的影响 基于实验室的研究。此K01应用程序中建议的培训计划将提供基本的知识和技能 首席研究员Jillian R.Scheer博士需要成为一名独立的、跨学科的 酒精科学家。舍尔博士通过这个及时和创新的项目获得的高级培训将针对 3目标：(1)严谨的酒精研究方法学及其在研究高血压的决定因素中的应用 危险饮酒模式；(2)作为评估生物学工具的应激反应的生理学测量 少数人应激源对共病的创伤后应激障碍和危险饮酒影响的潜在机制；以及，(3) EMA方法评估少数民族应激源对日常共病的创伤后应激障碍和危险因素的近期影响 在不同种族的SMW中饮酒。舍尔博士将主要由耶鲁大学的约翰·帕钱基斯博士指导 大学，由Tonda Hughes博士(哥伦比亚大学)、Rajita Sinha博士(耶鲁大学)提供额外指导 Tami Sullivan博士(耶鲁大学)、Joshua Warren博士(耶鲁大学)和Robert Pietrzak， 博士、公共卫生硕士(耶鲁大学)舍尔博士通过K01奖项接受的培训将确保她作为一名 独立科学家，他的工作为公众健康和临床减少SMW中的酒精使用提供了信息。

Project Summary/Abstract Women disproportionately experience violence compared to men;21-23 however, violence against women is not distributed randomly. Due, in part, to their stigmatized identity, sexual minority women (SMW) are 2-3 times more likely to face violence than heterosexual women.21, 24-26 Many women use alcohol to cope with the negative sequelae of violence (e.g., PTSD).28 This comorbidity may be exacerbated among SMW given their experiences of psychosocial stressors (i.e., violence and minority stressors such as discrimination).11 Despite the public health necessity of developing targeted alcohol treatment approaches for victimized SMW, current alcohol treatment models do not specify unique stressors and clinical needs of this population. Consistent with the NIAAA’s research priorities,11, 14 the K01 will provide major advances in understanding biopsychosocial mechanisms (e.g., minority stressors, physiological reactivity, PTSD) and moderators (e.g., race/ethnicity) influencing the heterogeneity in hazardous drinking among SMW as well as the role that these core factors play in SMW’s differential need for and response to treatment. The project will include: 1) an epidemiologic assessment that uncovers distinct combinations of psychosocial stressors among SMW, identifies racial/ethnic differences in classes of psychosocial stressors, and determines how these patterns of psychosocial stressors predict comorbid PTSD and hazardous drinking over 11 years (n = 450-600); 2) a lab-based study that advances knowledge of the influence of minority stressors on allostatic load (e.g., salivary cortisol, heart rate, heart rate variability, and skin conductance) among victimized SMW (n = 125); and, 3) a once-daily ecological momentary assessment (EMA) approach over 21 days that determines the role of minority stressors as antecedents to daily fluctuations in PTSD and hazardous drinking using the same sample of SMW from the lab-based study. The proposed training plan in this K01 application will provide essential knowledge and skills that the principal investigator, Jillian R. Scheer, PhD, needs to become an independent, interdisciplinary alcohol scientist. The advanced training acquired by Dr. Scheer via this timely and innovative project will target 3 objectives: (1) rigorous alcohol research methodology and its application to studying determinants of hazardous drinking patterns; (2) physiological measurement of stress reactivity as a tool to assess biological mechanisms underlying the influence of minority stressors on comorbid PTSD and hazardous drinking; and, (3) EMA approaches to assess the proximal effects of minority stressors on daily comorbid PTSD and hazardous drinking among racially diverse SMW. Dr. Scheer will be primarily mentored by John Pachankis, PhD, at Yale University, with additional mentoring from Tonda Hughes, PhD (Columbia University), Rajita Sinha, PhD (Yale University), Tami Sullivan, PhD (Yale University), Joshua Warren, PhD (Yale University), and Robert Pietrzak, PhD, MPH (Yale University). Dr. Scheer’s training through the K01 award will ensure her success as an independent scientist whose work informs public health and clinical efforts to reduce alcohol use among SMW.