Examining differential effects of state equality-promoting policies on harmful alcohol use among sexual and gender minority adults in the U.S.: an econometrics approach for causal inference

摘要/摘要 危险饮酒和酗酒是过量饮酒的最致命形式1-3。 与顺性直人相比，在性和性别少数的成年人中更普遍4-11。 来自结构性污名的少数民族压力驱使性和性别少数民族健康差异12-16，但其潜力 对酗酒和危险饮酒的影响还有待严格审查。 结构性污名可能会受到州一级促进平等政策的干预，这些政策 明确将性少数群体和性别少数群体列为就业、住房、公共部门的受保护阶层 住宿和其他基本服务17。在促进国家平等方面的变化程度 政策涉及改变性和性别少数民族成年人的酗酒和危险饮酒 与他们的顺性别相比，异性恋的对应者是未知的，也是拟议研究的重点。 本研究旨在评估国家促进平等政策(目标1)和关键政策的不同效果 关于性和性别少数群体成年人酗酒和危险饮酒的领域(目标2)。非- 国家促进平等政策的随机变化需要应用先进的 计量经济学方法。为了严格估计影响并做出因果推断，三重差异模型 并将指定可识别性假设，以分析72,000多个具有全国代表性的数据18 2014-2022年，性和性别少数群体成年人与国家促进平等政策指数挂钩19。 针对性少数群体和性别少数群体的促进平等政策的格局正在不断演变。本研究 将提供及时的证据基础，为减少与酒精有关的发病率所需的结构性干预提供信息 性少数群体和性别少数群体的死亡率。在一流导师团队的支持下， 申请人将具备(1)用于因果推断的高级计量经济学方法，(2)酒精研究方面的技能。 和有害饮酒的社会决定因素，以及(3)确定相关和可采取行动的社会政策 这影响了性和性别少数群体的健康。这些培训目标的实现将启动 申请人作为一名成功的独立研究人员的职业生涯。

ABSTRACT/SUMMARY Hazardous alcohol use and binge drinking, the deadliest form of excessive alcohol use1-3, are substantially more prevalent among sexual and gender minority adults compared to their cisgender straight counterparts4-11. Minority stress from structural stigma drives sexual and gender minority health disparities12-16, but its potential effect on binge drinking and hazardous alcohol use has yet to be rigorously examined. Structural stigma is potentially amenable to intervention by equality-promoting policies at the state level that explicitly name sexual and gender minority people as protected classes in employment, housing, public accommodations, and other essential services17. The extent to which changes in state equality-promoting policies relate to changes in binge drinking and hazardous alcohol use for sexual and gender minority adults compared to their cisgender straight counterparts is unknown and the focus of the proposed study. This study aims to evaluate differential effects of state equality-promoting policies (Aim 1) and key policy domains (Aim 2) on binge drinking and hazardous alcohol use among sexual and gender minority adults. Non- randomized variation in state equality-promoting policies necessitates the application of advanced econometrics methods. To rigorously estimate effects and make causal inferences, triple differences models and identifiability assumptions will be specified to analyze nationally representative data18 on over 72,000 sexual and gender minority adults linked with indices of state equality-promoting policies19 from 2014-2022. The landscape of equality-promoting policies for sexual and gender minority people is ever evolving. This study will offer a timely evidence base to inform needed structural interventions that reduce alcohol-related morbidity and mortality among sexual and gender minority populations. With support from a premier mentorship team, the applicant will build skills in (1) advanced econometrics methods for causal inference, (2) alcohol research and social determinants of harmful alcohol use, and (3) identification of relevant and actionable social policies that influence sexual and gender minority health. Achievement of these training goals will launch the applicant’s career as a successful, independent researcher.