PROJECT SUMMARY Heavy drinking and sexual assault co-occur, and bisexual women are at elevated risk for both. Approximately 25% of bisexual women relative to 11% of heterosexual women report engaging in heavy episodic drinking (HED; 4+ drinks on one occasion). Bisexual women’s elevated risk for HED is believed to be driven largely by lifetime exposure to multiple and chronic stressors, including sexual assault. Further, bisexual women’s elevated risk for sexual assault is in part driven by alcohol use, making it even more critical to understand and ultimately intervene upon heavy drinking in this group. Despite that bisexual women have the highest rates of heavy drinking and lifetime sexual assault, there is no published research on event-level antecedents of heavy drinking among bisexual women. Theoretically important antecedents of heavy drinking among bisexual women with sexual assault histories include psychological distress, coping motives, and microaggressions. To examine event-level influences of these constructs, a mixed-methods approach will be employed across four aims. The specific aims of the K99 phase of this MOSAIC K99/R00 are to 1) gain an in-depth understanding of antecedents of heavy drinking and how they differ between bisexual and heterosexual women who have been sexually assaulted and 2) refine measures and methods for studying event-level predictors of heavy drinking among bisexual and heterosexual women. To accomplish these aims, a qualitative approach (individual interviews with 40 either bisexual or heterosexual women; exit interviews with 16 women who complete a pilot ecological momentary assessment (EMA) study) will be used to develop and refine a full EMA study. The R00 phase will include a larger-scale EMA study that will assess heavy drinking antecedents among bisexual women with (n = 50) and without (n = 50) histories of sexual assault and heterosexual women with (n = 50) and without (n = 50) histories of sexual assault. The specific aims of the R00 phase include to 3) characterize the extent to which heavier event-level drinking occurs as a result of psychological distress, coping motives, and microaggression among bisexual versus heterosexual women and 4) examine how SA history further increases risk of heavier drinking at the event level for bisexual women. The PI, Dr. López, will work with an experienced and knowledgeable team of mentors (Drs. Jennifer Merrill, Kristina Jackson, Lindsay Orchowski) to develop expertise in five areas of training: (1) EMA methods, (2) longitudinal data analysis, (3) qualitative methods (4) intervention development, and (5) professional development skills. Successful completion of the research and training detailed in this proposal will prepare the PI to become an independent clinical scientist and develop a program of research on alcohol use disparities among bisexual women with histories of sexual assault. Findings will inform an understanding of the most proximal risk factors for heavy drinking at the event- level among bisexual and heterosexual women. Identifying risk factors will be the first step in the development of just-in-time intervention to decrease heavy drinking.

PROJECT NARRATIVE This study involves identifying antecedents (i.e., psychological distress, drinking motives, and microaggressions) of heavy drinking in real-time among bisexual and heterosexual women with and without histories of sexual assault. Investigation of antecedents of heavy drinking is of immediate public health importance due to the very high rates of heavy drinking and sexual assault among bisexual women, particularly those with histories of sexual assault. Identifying event-level antecedents will aid in the development of ecological momentary and/or just-in-time interventions to decrease heavy drinking among bisexual women.