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/总结 危险的酒精使用和酗酒，过量饮酒最致命的形式1 -3， 在性取向和性别少数的成年人中比顺性别的异性恋者更普遍4 -11。 结构性耻辱感造成的少数群体压力推动了性和性别少数群体的健康问题12 -16，但其潜力 对酗酒和危险酒精使用的影响尚待严格审查。 结构性成见可能会受到州一级促进平等政策的干预， 明确将性和性别少数群体列为就业、住房、公共服务和社会保障方面的受保护阶层。 住宿和其他基本服务17.在多大程度上改变国家平等促进 有关改变性和性别少数成年人酗酒和危险酒精使用的政策 与他们的顺性异性恋者相比，异性恋者是未知的，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）和关键政策的差异效应 在性和性别少数成年人中，对酗酒和危险酒精使用领域（目标2）进行研究。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效应并进行因果推断，三重差异模型 和可识别性假设将被指定用于分析超过72，000个国家的全国代表性数据18。 2014-2022年性和性别少数成年人与国家促进平等政策指数19相关联。 促进性和性别少数群体平等的政策环境不断变化。本研究 将提供及时的证据基础，为减少酒精相关发病率所需的结构性干预提供信息 性和性别少数群体的死亡率。在一流导师团队的支持下， 申请人将建立技能（1）先进的计量经济学方法的因果推理，（2）酒精研究 有害酒精使用的社会决定因素，以及（3）确定相关和可操作的社会政策 影响性和性别少数群体的健康。实现这些培训目标将启动 申请人的职业生涯作为一个成功的，独立的研究人员。

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.