Understanding the individual and combined impact of childhood sexual abuse and minority stress on hazardous drinking among sexual minority women: Is emotion dysregulation a key factor?

项目总结。危险饮酒(HD)是与性取向有关的主要健康问题之一 影响性少数群体妇女(如女同性恋者、双性恋者)的差异。与异性恋相比 女性，SMW报告酒精依赖的可能性大约是女性的7倍，超过8倍 报告至少两种饮酒的负面社会后果(例如，事故、人际关系问题)。 尽管少数族裔压力(例如，内在化的同性恋恐惧症)已被确定为HD的主要风险因素，但它 并不能完全解释HD中与性取向相关的差异。不良的童年经历，例如 儿童期性虐待(CSA)也被确定为SMW中HD的危险因素。特定的 CSA的特征，表明严重程度(例如，与犯罪者的关系，CSA的类型)，已被发现 增加负面健康后果的风险，如HD。然而，尽管SMW更频繁地报告 经历过CSA和比异性恋女性更严重的CSA经历的研究很少 研究了少数人应激如何与CSA(及其严重程度)相互作用，以加剧SMW患HD的风险。 在普通人群中的研究表明，CSA与情绪调节障碍和 情绪失调和饮酒之间的关系--一项新的文献显示了两者之间的联系 少数族裔压力和情绪失调之间的关系。因此，这项研究将考察情绪的作用 调节失调，精神病理学和物质使用的跨诊断风险因素，影响能力 管理情绪反应。为了进一步阐明情绪失调到HD的途径， 饮酒期望值(例如，忘记烦恼)在这种关系中的作用也将被研究。研究结果 有可能提供重要信息，用于制定更有针对性的预防和 减少SMW患者HD的干预策略。使用来自SMW的大量和不同样本的数据 芝加哥妇女健康与生活经验研究(N~475)，本研究有两个目的：1)考察 先天性巨结肠患者CsA(及其严重程度)与性少数应激的独立和联合关联；以及2)检查 情绪失调与饮酒期望值之间关系的潜在序贯调节 CSA与HD之间以及少数应激与HD之间。在这两个目标中，我将探索性别认同的差异 以及种族/族裔，并找出造成潜在差异的因素。拟议的研究和培训 与国家酒精滥用和酒精中毒研究所的使命以及国家酒精滥用和酒精中毒研究所 对性和性别少数群体健康研究特别感兴趣的健康通告(非-- MD-19-001)，并将帮助我实现以下培训目标：1)增加对CSA的了解 SMW，包括严重程度和SM人群较高的CSA患病率；2)发展病因学和 SMW酒精使用和HD的流行病学；3)加强统计和方法技能，以进行 复杂的定量分析；以及4)提高拨款撰写、研究传播和指导方面的技能。

PROJECT SUMMARY. Hazardous drinking (HD) is among the leading sexual orientation-related health disparities impacting sexual minority women (SMW; e.g., lesbian, bisexual). Compared to heterosexual women, SMW are approximately 7 times as likely to report alcohol dependence and over 8 times as likely to report at least two negative social consequences (e.g., accidents, relationship problems) of alcohol use. Although minority stress (e.g., internalized homophobia) has been identified as a leading risk factor for HD, it does not fully explain sexual orientation-related disparities in HD. Adverse childhood experiences, such as childhood sexual abuse (CSA), have also been identified as risk factors for HD among SMW. Specific characteristics of CSA, indicative of severity (e.g., relationship to perpetrator, type of CSA), have been found to increase risk for negative health outcomes, such as HD. However, although SMW more frequently report having experienced CSA and more severe CSA experiences than heterosexual women, few studies have examined how minority stress interacts with CSA (and its severity) to exacerbate risk of HD among SMW. Research in the general population has demonstrated links between CSA and emotion dysregulation and between emotion dysregulation and alcohol use—and there is an emerging literature showing associations between minority stress and emotion dysregulation. Therefore, this study will examine the role of emotion dysregulation, a transdiagnostic risk factor for psychopathology and substance use that impacts the ability to manage emotional responses. To further clarify the pathway from emotion dysregulation to HD, the mediating role of drinking expectancies (e.g., forgetting worries) in this relationship will also be examined. Study findings have the potential to provide important information that can be used to develop more targeted prevention and intervention strategies to reduce HD in SMW. Using data from a large and diverse sample of SMW in the Chicago Health and Life Experiences of Women study (N~475), this study has two aims: 1) Examine the independent and joint associations of CSA (and its severity) and sexual minority stress on HD; and 2) Examine potential sequential mediation of emotion dysregulation and drinking expectancies in relationships between CSA and HD, as well between minority stress and HD. In both aims, I will explore differences by sexual identity and race/ethnicity and identify factors that account for potential disparities. The proposed research and training are aligned with the National Institute on Alcohol Abuse and Alcoholism’s mission and the National Institutes of Health Notice of Special Interest in Research on the Health of Sexual and Gender Minority Populations (NOT- MD-19-001) and will help me to achieve the following training goals: 1) Increase knowledge of CSA among SMW, including severity and SM people’s higher prevalence of CSA; 2) Develop expertise in the etiology and epidemiology of SMW’s alcohol use and HD; 3) Strengthen statistical and methodological skills to conduct complex quantitative analyses; and 4) Enhance skills in grant writing, research dissemination, and mentorship.