Impact of supportive policies on minority stress, drinking and health among women

Abstract. The proposed research responds directly to NOT-OD-20-097 by building on the aims of our current R01 study (AA013328-13). Over the past several decades research has clearly demonstrated that compared with their heterosexual counterparts, sexual minority women (SMW; lesbian, bisexual) are at substantially higher risk of hazardous drinking (HD; i.e., heavy average drinking, heavy episodic drinking, intoxication, adverse drinking consequences and alcohol dependence symptoms). HD-related risks among women are associated with stress. Added to the stress experienced by women in the general population are stressors unique to having a minority sexual identity, such as stigma and discrimination. Sexual minority stressors are likely amplified by COVID-19 (C-19). For the past 20 years, the Chicago Health and Life Experiences of Women (CHLEW) study has focused on identifying risk and protective factors and the mechanisms by which these factors influence HD among SMW. The parent grant for this supplement (CHLEW Waves 4 & 5; R01 AA013328) focuses on the impact of an historic structural-level event (i.e., legalization of same-sex marriage) assumed to be supportive of SMW and their health. We are now confronted by another historic macro-level event?the C-19 pandemic. In this case the impact is assumed to be threatening rather than supportive. To rapidly improve understanding of critical social and behavioral aspects of the pandemic relative to HD among SMW, we will add an online C-19 module to W5 of the CHLEW, currently underway. We will compare drinking outcomes in W5 with those assessed in W4 (2018-19), before the pandemic. The online C-19-specific questions will complement the unique and rich data on social and behavioral factors already collected that are highly relevant to the pandemic. Specific aims are to: Aim 1: Examine the impact of the C-19 pandemic on drinking outcomes in a diverse sample of SMW. To gain an understanding of C-19?s impact on drinking among SMW we will compare changes in drinking outcomes in W4 (2018-19) and in W5 (currently in progress). We expect that SMW overall will report higher volumes of alcohol consumption and higher levels of HD indicators following the onset of C-19. Aim 2: Compare drinking outcomes among SMW based on two major C-19- related impacts (isolation and loss of employment) and by race/ethnicity, age, and sexual identity. In general, we expect that SMW who are more isolated (e.g., live alone) and those who experience recent loss of employment will report greater increases in alcohol consumption and in HD than SMW who live with a partner or their families, or SMW who are employed. However, associations between these factors and drinking will vary by living situation (e.g., living with/caring for children or elderly parents) and type of employment (front-line or other high-risk job). We also expect to find subgroup differences in HD based on race/ethnicity, age, and sexual identity. Results of the study will enhance understanding of the pandemic?s personal and economic costs and behavioral outcomes in an already vulnerable population.