Associations between stigma and alcohol use among women and their offspring

Women are more likely to experience health impacts from risky drinking behaviors than men. One cause of this disparity is stigma, which refers to conditions, norms, and policies, including attitudes about women’s alcohol use, treatment seeking, and prenatal alcohol exposure. Stigma also has intergenerational impacts, evidenced by its adverse effects among children and infants across exposed groups. However, little is known about when stigma is most harmful across the lifecourse for women and the extent to which intergenerational effects impact offspring health behaviors. Further, the mechanisms of these intergenerational effects are underexplored, as are the moderating risk and preventive factors. These knowledge gaps contribute to perpetuating alcohol-related health consequences and limit our understanding of what factors may reduce risk among women and their children. It has not been previously possible to examine these associations because doing so requires a unique data structure with: 1) a large number of women living in different places and measured over their lifecourse; 2) longitudinal stigma measures, which are very limited; and 3) alcohol measures among both parents and offspring. This mentored research proposal will provide the first opportunity to address these questions by pairing training in stigma measurement over time using natural language processing (NLP) with data from two unique, intergenerational cohort studies: the Nurses’ Health Study 2 (N=116,429), and their offspring in the linked Growing Up Today Study (N=27,704). By leveraging NLP on a corpus of >9,000 unique, digitized newspapers from all 50 US states during the lifecourse of respondents in the Nurses’ Health Study 2 (75 years), I will develop and extensively validate a time-varying measure of stigma related to women’s alcohol use (Aim 1). I will then elucidate the association between stigma and alcohol use across the lifecourse among women (Aim 2) and their offspring (Aim 3) and examine which intervenable, modifiable characteristics moderate the effects of stigma. Advanced training in NLP and lifecourse epidemiology will provide the necessary tools to develop a novel stigma measure and test its relationship with alcohol consumption among women and their offspring across the lifecourse, representing a critical next step for understanding and decreasing alcohol-related health outcomes. This award will support essential career development in my path toward independence as an alcohol and stigma researcher and is highly consistent with NIAAA’s strategic plan for reducing stigma and identifying causes of alcohol and prenatal alcohol related stigma. The proposed studies are the essential next step towards identifying modifiable targets for protecting against the impact of stigma on risky drinking and laying the foundation for similar research in other high-risk populations. This work represents an innovative approach to understand the reverberating impact of stigma not only on those who are directly exposed but also across generations.