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?

项目摘要。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的不平等（法定最低工资;例如，女同性恋、双性恋）。与异性恋相比 女性，SMW报告酒精依赖的可能性约为7倍， 报告至少两个负面社会后果（例如，事故，关系问题）。 虽然少数人强调（例如，内化的同性恋恐惧症）已被确定为HD的主要风险因素， 不能完全解释HD中与性取向相关的差异。不良的童年经历，如 儿童期性虐待，亦被确定为法定最低工资中发生亨廷顿病的风险因素。具体 CSA的特征，指示严重程度（例如，与犯罪者的关系，CSA类型），已被发现， 增加负面健康结果的风险，如HD。然而，虽然法定最低工资更经常报告， 经历过CSA和比异性恋女性更严重的CSA经历，很少有研究 研究了少数族裔压力如何与CSA（及其严重程度）相互作用，以加剧法定最低工资中的HD风险。 对普通人群的研究表明，CSA和情绪失调之间存在联系， 情绪失调和饮酒之间的联系，有一个新兴的文献显示， 少数族裔压力和情绪失调之间的联系因此，本研究将探讨情绪的作用 调节障碍是精神病理学和物质使用的跨诊断风险因素， 管理情绪反应。为了进一步阐明从情绪失调到HD的通路， 饮酒预期的作用（例如，忘记烦恼）在这种关系中也将被审查。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措施， 干预策略，以减少法定最低工资中的高血压。使用从一个大型和多样化的样本的数据， 芝加哥妇女健康和生活经验研究（N~475），本研究有两个目的：1）检查 CSA（及其严重程度）和性少数对HD压力的独立和联合关联;以及2）检查 情绪失调和饮酒预期之间关系的潜在顺序中介 CSA和HD，以及少数民族压力和HD之间。在这两个目标中，我将探讨性别认同的差异 和种族/民族，并确定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和国家酒精研究所保持一致。 性和性别少数人群健康研究特别关注的健康通知（非- MD-19-001），并将帮助我实现以下培训目标：1）增加CSA的知识， SMW，包括严重程度和SM人群CSA的较高患病率; 2）发展病因学和 （3）加强统计及方法学技巧， 复杂的定量分析;和4）提高赠款写作，研究传播和指导的技能。

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.