ABSTRACT Notice number: NOT-MD-19-001. Sexual and gender minority (SGM) populations have among the highest rates of alcohol use, hazardous drinking, and use disorders in the United States. A large body of literature suggests that stigma and minority stress are primary factors driving SGM inequities. SGM stigma is the social process of labeling, stereotyping, and rejecting human difference as a form of social control and it operates at three levels: (1) Structural stigma (e.g., societal norms and institutional laws and practices that limit the resources of stigmatized people); (2) Interpersonal stigma (e.g., verbal harassment and physical violence); and (3) Individual stigma (e.g., the feelings people hold about themselves or the beliefs they perceive others hold about them that may shape anticipation and avoidance of discrimination). Crucial gaps remain in the literature of SGM stigma and alcohol use. First, structural stigma has largely been measured and examined at the national or state level. Yet, structural stigma experienced at the local level (e.g., city policies) may be crucial in understanding the mechanisms by which stigma influences SGM health. To date, research on the associations between local structural stigma and alcohol use is limited. Second, studies have yet to examine how structural stigma is associated with interpersonal and individual stigmas. Third, scant research has examined how the intersections of these stigmas impact SGM alcohol inequities. We therefore propose to investigate the relationships of local structural stigma and experiences of discrimination with SGM young adults' alcohol use and related problems. The study will be conducted in 33 midsized cities in California that contain significant variation in participants' exposure to local structural sigma. To assess local structural stigma, including its specific components (e.g., law enforcement, municipal benefits and protections to LGBTQ employees), we will use information and ratings assessed by the Human Rights Campaign. Fourteen consecutive daily surveys with 792 SGM 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 stigmas and alcohol use outcomes. A baseline survey will assess demographics, alcohol use, experiences with discrimination, and constructs of minority stress. Since gender minorities (GM), cisgender sexual minorities (SM) women, and young people of different racial/ethnic groups may experience higher levels of stigma than other SGM groups, it is necessary to consider differences within SGM populations. The specific aims are to: (1) Assess associations of local structural SGM stigma and experiences of interpersonal discrimination with alcohol use, hazardous drinking, and alcohol-related problems (e.g., alcohol use disorder symptoms), (2) Examine the mechanisms through which local structural, interpersonal, and individual stigmas are associated with alcohol use, hazardous drinking, and alcohol-related problems, and (3) Explore whether the results for Aim 1 differ by cisgender SM men, cisgender SM women, GM populations, and Latinxs. We focus on Latinx SGMs as the largest racial/ethnic group in California (~40%).

PROJECT NARRATIVE The proposed research will provide important information about local policies and programs that can reduce discrimination and alcohol inequities among sexual and gender minorities (SGMs) and SGM subgroups. Identifying local modifiable structural conditions that contribute to SGM health can better inform the development of effective programs and policies to reduce alcohol inequities for SGM populations because (1) local structural conditions may be more immediate and therefore more important for people's day-to-day experiences and (2) local policies might be easier to implement than national or state-wide policies. Also, by understanding how the three levels of stigma operate together to affect alcohol use and problems, results can inform stigma-reduction interventions in healthcare settings and SGM organizations.