Stigma, Romantic Relationships, and Alcohol Use Among Transgender and Nonbinary Young Adults

项目摘要/摘要 对于变性人和非双性人(TNB)来说，抗TNB污名是不良酒精的危险因素 结果，通常与抑郁和焦虑同时发生。耻辱对饮酒和心理健康的影响是 尤其令人担忧的是TNB的年轻人(YA；21-30岁)，他们报告的不良酒精和精神疾病更多 健康结果比年龄较大的TNB成年人更高。对于这些YA来说，良好的恋爱经历可能会 减轻反对TNB污名对心理健康的影响，但污名可能会导致不良关系 与不良酒精和精神健康后果有关的经历(例如，亲密伴侣暴力；IPV)。 因此，以关系为重点的干预有可能改善酒精和精神健康 TNB YA的结果。然而，此类干预的目标仍然不清楚--首先，因为机制 第一，污名影响恋爱经历的方式尚未确定；第二，因为尚不清楚 应解决哪种一般性或特定于TNB的关系体验。该项目响应于 这些差距最终导致制定了以关系为重点的酒精使用和共生干预措施 TNB YA中的抑郁/焦虑。在目标1中，我将收集200名恋爱中的TNB YA的调查数据，以 修订和验证TNB特定关系体验的新衡量标准。在《目标2》中，我将使用新的 在为期两个月的每周日记研究中测量污名、恋爱经历、饮酒和 抑郁/焦虑(恋爱关系中的250 TNB YA)。我将使用这些数据来(1)每周评估 耻辱和关系经历与饮酒和抑郁/焦虑的关系，以及(2)确定 耻辱可能影响人际关系体验的机制。在目标3中，我将改编现有类型的 在线酒精干预.具有个性化反馈的技术适应的激励性访谈 为TNB YA定制内容，并(如果得到Aim 2调查结果的支持)添加组件以解决关系 在反对TNB耻辱的背景下的经验。干预，整个自我，将通过一个 具有8个TNB YA的多阶段合作设计流程，然后评估可接受性、可用性和 参与用户测试面试(n=5个恋爱关系中的TNB YA)和单臂可行性 研究(n=107名恋爱中的TNB YA)。在K99阶段，这项工作将与 心理测量学/量表开发、日记方法和社区参与干预开发 来自资深学者的指导，以将这些方法应用于耻辱、酒精使用、精神疾病的研究而闻名 健康，和浪漫的关系。这一培训和指导将为我的发展和评估做好准备 整体处于R00阶段，为R01疗效试验提案提供初步数据。因此，该项目 相关培训将使我能够开始独立的研究生涯，目标是(1)确定 污名影响年轻人饮酒和心理健康的机制，以及(2)与 受影响的社区通过可扩展的干预措施减轻这些影响。

PROJECT SUMMARY/ABSTRACT For transgender and nonbinary (TNB) people, anti-TNB stigma is a risk factor for adverse alcohol outcomes, often co-occurring with depression and anxiety. Stigma’s impact on alcohol use and mental health is of particular concern in TNB young adults (YA; 21-30 years old), who report more adverse alcohol and mental health outcomes than older TNB adults. For these YA, favorable romantic relationship experiences may attenuate the mental health impact of anti-TNB stigma, yet stigma may contribute to adverse relationship experiences (e.g., intimate partner violence; IPV) linked to adverse alcohol and mental health outcomes. Accordingly, relationship-focused interventions have the potential to improve alcohol and mental health outcomes in TNB YA. However, targets for such interventions remain unclear—first, because the mechanisms by which stigma affects relationship experiences have not been identified, and second, because it is not clear what kinds of general or TNB-specific relationship experiences should be addressed. This project responds to these gaps, culminating in development of a relationship-focused intervention for alcohol use and co-occurring depression/anxiety in TNB YA. In Aim 1, I will collect survey data from 200 TNB YA in romantic relationships to revise and validate a new measure of TNB-specific relationship experiences. In Aim 2, I will use the new measure in a 2-month weekly diary study of stigma, relationship experiences, alcohol use, and depression/anxiety (n=250 TNB YA in romantic relationships). I will use these data to (1) assess weekly associations of stigma and relationship experiences with alcohol use and depression/anxiety, and (2) identify mechanisms by which stigma may affect relationship experiences. In Aim 3, I will adapt an existing type of online alcohol intervention—technology-adapted motivational interviewing with personalized feedback—by tailoring content for TNB YA and (if supported by Aim 2 findings) adding components to address relationship experiences in the context of anti-TNB stigma. The intervention, Whole Selves, will be developed through a multi-phase co-design process with 8 TNB YA, followed by evaluation of acceptability, usability, and engagement in user-testing interviews (n=5 TNB YA in romantic relationships) and a single-arm feasibility study (n=107 TNB YA in romantic relationships). In the K99 phase, this work will be coordinated with training in psychometrics/scale development, diary methods, and community-engaged intervention development, with mentorship from senior scholars known for applying these methods to research on stigma, alcohol use, mental health, and romantic relationships. This training and mentorship will prepare me to develop and evaluate Whole Selves in the R00 phase, producing preliminary data for an R01 efficacy trial proposal. Thus, the project and associated training will allow me to launch an independent research career with the goals of (1) identifying the mechanisms by which stigma affects young people’s alcohol use and mental health, and (2) partnering with affected communities to mitigate these effects through scalable interventions.