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?

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.