Project Summary/Abstract Women disproportionately experience violence compared to men;21-23 however, violence against women is not distributed randomly. Due, in part, to their stigmatized identity, sexual minority women (SMW) are 2-3 times more likely to face violence than heterosexual women.21, 24-26 Many women use alcohol to cope with the negative sequelae of violence (e.g., PTSD).28 This comorbidity may be exacerbated among SMW given their experiences of psychosocial stressors (i.e., violence and minority stressors such as discrimination).11 Despite the public health necessity of developing targeted alcohol treatment approaches for victimized SMW, current alcohol treatment models do not specify unique stressors and clinical needs of this population. Consistent with the NIAAA’s research priorities,11, 14 the K01 will provide major advances in understanding biopsychosocial mechanisms (e.g., minority stressors, physiological reactivity, PTSD) and moderators (e.g., race/ethnicity) influencing the heterogeneity in hazardous drinking among SMW as well as the role that these core factors play in SMW’s differential need for and response to treatment. The project will include: 1) an epidemiologic assessment that uncovers distinct combinations of psychosocial stressors among SMW, identifies racial/ethnic differences in classes of psychosocial stressors, and determines how these patterns of psychosocial stressors predict comorbid PTSD and hazardous drinking over 11 years (n = 450-600); 2) a lab-based study that advances knowledge of the influence of minority stressors on allostatic load (e.g., salivary cortisol, heart rate, heart rate variability, and skin conductance) among victimized SMW (n = 125); and, 3) a once-daily ecological momentary assessment (EMA) approach over 21 days that determines the role of minority stressors as antecedents to daily fluctuations in PTSD and hazardous drinking using the same sample of SMW from the lab-based study. The proposed training plan in this K01 application will provide essential knowledge and skills that the principal investigator, Jillian R. Scheer, PhD, needs to become an independent, interdisciplinary alcohol scientist. The advanced training acquired by Dr. Scheer via this timely and innovative project will target 3 objectives: (1) rigorous alcohol research methodology and its application to studying determinants of hazardous drinking patterns; (2) physiological measurement of stress reactivity as a tool to assess biological mechanisms underlying the influence of minority stressors on comorbid PTSD and hazardous drinking; and, (3) EMA approaches to assess the proximal effects of minority stressors on daily comorbid PTSD and hazardous drinking among racially diverse SMW. Dr. Scheer will be primarily mentored by John Pachankis, PhD, at Yale University, with additional mentoring from Tonda Hughes, PhD (Columbia University), Rajita Sinha, PhD (Yale University), Tami Sullivan, PhD (Yale University), Joshua Warren, PhD (Yale University), and Robert Pietrzak, PhD, MPH (Yale University). Dr. Scheer’s training through the K01 award will ensure her success as an independent scientist whose work informs public health and clinical efforts to reduce alcohol use among SMW.

Project Narrative Sexual minority women (SMW) are at increased risk of engaging in hazardous drinking compared to heterosexual women because of their disproportionate risk of psychosocial stressors, including violence exposure (eg, sexual assault) and sexual orientation-specific minority stressors (eg, homophobic discrimination). Despite the public health necessity of developing effective alcohol treatments for SMW, current alcohol treatment models do not consider unique mental health needs or psychosocial stressors facing this racially diverse, at-risk population. This proposed research aims to use epidemiologic, lab-based, and multi- method longitudinal approaches to develop and test a biopsychosocial model that can both identify SMW subgroups such as SMW of color for targeted prevention efforts and inform effective alcohol interventions for diverse victimized SMW at greatest risk for alcohol use disorders (eg, those engaging in hazardous drinking).