The Role of Local Structural Stigma in Alcohol Related Inequities among SGM Young Adults

Sexual minority groups (SMGs) have among the highest rates of alcohol use, hazardous drinking, and use disorders in the United States. A large body of literature suggests that selective social and interpersonal challenges are primary factors driving these differences. These selective challenges operate at three levels: (1) Societal norms and policies and practices that limit the resources of SMGs; (2) Unbalanced interpersonal treatment towards SMGs; and (3) Internalized negative perceptions of their own social identity. Crucial gaps remain in the literature of SMG alcohol use. First, research about policies and practices that limit important resources for SMGs has largely focused on those at the national or state level. Yet, local policies and resources may be crucial in understanding SMG health. Second, studies have yet to examine how local SMG policies and resources are associated with experiences of unbalanced interpersonal treatment and internalized negative perceptions among SMGs. Third, scant research has examined how these three levels of selective challenges together impact high rates of alcohol use in SMGs. We therefore propose to investigate the relationships of selective social, interpersonal, and individual challenges with SMG young adults’ alcohol use and related problems. The study will be conducted in 33 midsized cities in California. Local SMG policies and practices will be assessed. Fourteen consecutive daily surveys with 792 SMG young adults (ages 18-29, 24 per city, for a total of 7,084 estimated data points) will be used to assess participants’ day-to-day experiences with selective challenges at the different levels and alcohol use outcomes. A baseline survey will assess demographics, alcohol use, and experiences with unbalanced interpersonal treatment and resources. Since some SMGs may experience higher levels of challenges, it is necessary to consider differences within groups. The specific aims are to: (1) Assess associations of local SMG policies and practices and experiences of selective interpersonal challenges with alcohol use, hazardous drinking, and alcohol-related problems (e.g., alcohol use disorder symptoms), (2) Examine the mechanisms through which local policies, interpersonal, and individual selective challenges are associated with alcohol use, hazardous drinking, and alcohol-related problems, and (3) Explore whether the results for Aim 1 differ by individual-level characteristics.