Sexual Fluidity and Longitudinal Changes in Alcohol Misuse and Associated Health Consequences

项目摘要/摘要 回应关于性和性别少数群体健康研究的特别关注的通知 人口(非-MD-19-001)和公共政策对酒精、大麻、烟草和其他毒品的影响- 相关行为和结果(非-AA-21-028)，该项目将通过以下方式确定酒精滥用的轨迹 性取向及其相关的健康后果。我们还将研究风险和保护因素。 跨个人、社会和政策领域。性少数群体酗酒的风险更高； 然而，现有的研究往往是基于静态的和一维的性取向结构 而不是一个流动的、多维的性取向结构，尽管有证据表明有性取向 流动性很普遍，尤其是在性少数群体中。先前的研究表明酒精滥用和酒精使用 精神障碍(AUD)症状在性少数群体中比异性恋者更普遍、更严重。 缺乏以人群为基础的关于酒精滥用轨迹和相关负面影响的纵向研究 基于流动的和多维的性取向结构的健康后果。另外， 关于在性少数人群中滥用酒精的风险和保护因素的研究主要集中在 个人层面的因素和社会和政策层面上被忽视的因素。有必要扩大这一范围 研究和借鉴社会生态模型中的概念，以包括上游风险和保护 因素，如社会和政策层面的因素。为了解决这些差距，该项目将使用纵向 数据来自美国青少年和成年人的样本，基于六波人口评估 烟草与健康研究(n=45,971；2013-2021)。这项研究设计将使我们能够探索 新冠肺炎发作前后基于性取向的酒精滥用。我们的研究目的是：(1)确定 酒精滥用在8年期间的轨迹，并确定这些关联是否因性别而不同 取向(A)和谐与不和谐，以及(B)稳定性与流动性。我们还将研究潜在的 年龄、性别、种族、民族和性别认同的风险异质性，并比较酒精滥用的变化 新冠肺炎发病前后受性取向影响。(2)研究(A)酒精滥用的变化 轨迹塑造了与健康相关的负面后果(例如，AUD症状、其他物质使用障碍 症状、多物质使用和对身体健康的负面影响)和(B)这是否不同 性取向亚组，按性取向不协调与和谐，以及性认同流动性 与稳定性的对比。(3)检查个人(例如，内化症状)、社会-(例如， 社会互动程度)和政策层面(如反歧视法)的保护/风险因素 酒精滥用的轨迹和与酒精相关的负面健康后果，并确定是否存在关联 性取向和谐与不和谐，性认同流动性与稳定性不同。

PROJECT SUMMARY/ABSTRACT In response to the Notices of Special Interest on Research on the Health of Sexual and Gender Minority Populations (NOT-MD-19-001) and Public Policy Effects on Alcohol-, Cannabis-, Tobacco-, and Other Drug- Related Behaviors and Outcomes (NOT-AA-21-028), this project will identify trajectories of alcohol misuse by sexual orientation and their associated health consequences. We will also examine risk and protective factors across individual, social, and policy domains. Sexual minorities are at heightened risk of alcohol misuse; however, existing research is often based on a static and unidimensional construct of sexual orientation rather than a fluid and multidimensional construct of sexual orientation, despite evidence indicating sexual orientation fluidity is common, especially among sexual minorities. Prior work has shown alcohol misuse and alcohol use disorder (AUD) symptoms are more prevalent and more severe among sexual minorities than heterosexuals. There is a lack of population-based longitudinal studies of alcohol misuse trajectories and related negative health consequences based on a fluid and multidimensional construct of sexual orientation. Additionally, studies examining risk and protective factors for alcohol misuse among sexual minorities have largely focused on individual-level factors and neglected factors at the social and policy level. There is a need to expand this research and draw on concepts from the Social Ecological Model to include upstream risk and protective factors, such as those at the social and policy level. To address these gaps, this project will use longitudinal data from a sample of U.S. adolescents and adults based on six waves of the Population Assessment of Tobacco and Health study (n=45,971; 2013-2021). This study design will allow us to explore changes in alcohol misuse based on sexual orientation before and after COVID-19 onset. Our study aims to: (1) Identify alcohol misuse trajectories over an 8-year period and determine if these associations differ by sexual orientation (a) concordance vs. discordance, and (b) stability vs. fluidity. We will also examine potential heterogeneity in risk by age, sex, race, ethnicity, and gender identity and compare changes in alcohol misuse before and after COVID-19 onset by sexual orientation. (2) Examine (a) how variation in alcohol misuse trajectories shape negative health-related consequences (e.g., AUD symptoms, other substance use disorder symptoms, polysubstance use, and negative physical health consequences) and (b) whether this differs across sexual orientation subgroups, by sexual orientation discordance vs. concordance, and sexual identity fluidity vs. stability. (3) Examine longitudinal relationships of individual- (e.g., internalizing symptoms), social- (e.g., degree of social interaction), and policy-level (e.g., antidiscrimination laws) protective/risk factors with trajectories of alcohol misuse and negative alcohol-related health consequences and determine if associations differ by sexual orientation concordance vs. discordance and sexual identity fluidity vs. stability.