ABSTRACT/SUMMARY Hazardous alcohol use and binge drinking, the deadliest form of excessive alcohol use1-3, are substantially more prevalent among sexual and gender minority adults compared to their cisgender straight counterparts4-11. Minority stress from structural stigma drives sexual and gender minority health disparities12-16, but its potential effect on binge drinking and hazardous alcohol use has yet to be rigorously examined. Structural stigma is potentially amenable to intervention by equality-promoting policies at the state level that explicitly name sexual and gender minority people as protected classes in employment, housing, public accommodations, and other essential services17. The extent to which changes in state equality-promoting policies relate to changes in binge drinking and hazardous alcohol use for sexual and gender minority adults compared to their cisgender straight counterparts is unknown and the focus of the proposed study. This study aims to evaluate differential effects of state equality-promoting policies (Aim 1) and key policy domains (Aim 2) on binge drinking and hazardous alcohol use among sexual and gender minority adults. Non- randomized variation in state equality-promoting policies necessitates the application of advanced econometrics methods. To rigorously estimate effects and make causal inferences, triple differences models and identifiability assumptions will be specified to analyze nationally representative data18 on over 72,000 sexual and gender minority adults linked with indices of state equality-promoting policies19 from 2014-2022. The landscape of equality-promoting policies for sexual and gender minority people is ever evolving. This study will offer a timely evidence base to inform needed structural interventions that reduce alcohol-related morbidity and mortality among sexual and gender minority populations. With support from a premier mentorship team, the applicant will build skills in (1) advanced econometrics methods for causal inference, (2) alcohol research and social determinants of harmful alcohol use, and (3) identification of relevant and actionable social policies that influence sexual and gender minority health. Achievement of these training goals will launch the applicant’s career as a successful, independent researcher.

PROJECT NARRATIVE Sexual and gender minority adults bear an excess burden of harmful alcohol use (e.g., binge drinking and hazardous alcohol use), necessitating exploration of underlying causal mechanisms. Structural drivers of harmful alcohol use disparities in the form of state equality-promoting policies are underexplored yet offer an important opportunity for applying advanced econometrics methods to rigorously estimate causal effects. This study proposes a triple differences approach with causal identifiability assumptions to examine potential differential effects of state equality-promoting policies on binge drinking and hazardous alcohol use for U.S. sexual and gender minority adults compared to cisgender straight adults from 2014-2022.