PROJECT SUMMARY/ABSTRACT For transgender and nonbinary (TNB) people, anti-TNB stigma is a risk factor for adverse alcohol outcomes, often co-occurring with depression and anxiety. Stigma’s impact on alcohol use and mental health is of particular concern in TNB young adults (YA; 21-30 years old), who report more adverse alcohol and mental health outcomes than older TNB adults. For these YA, favorable romantic relationship experiences may attenuate the mental health impact of anti-TNB stigma, yet stigma may contribute to adverse relationship experiences (e.g., intimate partner violence; IPV) linked to adverse alcohol and mental health outcomes. Accordingly, relationship-focused interventions have the potential to improve alcohol and mental health outcomes in TNB YA. However, targets for such interventions remain unclear—first, because the mechanisms by which stigma affects relationship experiences have not been identified, and second, because it is not clear what kinds of general or TNB-specific relationship experiences should be addressed. This project responds to these gaps, culminating in development of a relationship-focused intervention for alcohol use and co-occurring depression/anxiety in TNB YA. In Aim 1, I will collect survey data from 200 TNB YA in romantic relationships to revise and validate a new measure of TNB-specific relationship experiences. In Aim 2, I will use the new measure in a 2-month weekly diary study of stigma, relationship experiences, alcohol use, and depression/anxiety (n=250 TNB YA in romantic relationships). I will use these data to (1) assess weekly associations of stigma and relationship experiences with alcohol use and depression/anxiety, and (2) identify mechanisms by which stigma may affect relationship experiences. In Aim 3, I will adapt an existing type of online alcohol intervention—technology-adapted motivational interviewing with personalized feedback—by tailoring content for TNB YA and (if supported by Aim 2 findings) adding components to address relationship experiences in the context of anti-TNB stigma. The intervention, Whole Selves, will be developed through a multi-phase co-design process with 8 TNB YA, followed by evaluation of acceptability, usability, and engagement in user-testing interviews (n=5 TNB YA in romantic relationships) and a single-arm feasibility study (n=107 TNB YA in romantic relationships). In the K99 phase, this work will be coordinated with training in psychometrics/scale development, diary methods, and community-engaged intervention development, with mentorship from senior scholars known for applying these methods to research on stigma, alcohol use, mental health, and romantic relationships. This training and mentorship will prepare me to develop and evaluate Whole Selves in the R00 phase, producing preliminary data for an R01 efficacy trial proposal. Thus, the project and associated training will allow me to launch an independent research career with the goals of (1) identifying the mechanisms by which stigma affects young people’s alcohol use and mental health, and (2) partnering with affected communities to mitigate these effects through scalable interventions.

PROJECT NARRATIVE Excessive alcohol use contributes to a wide range of negative health outcomes, including accidents, violence, alcohol dependence, and cardiovascular disease. Existing interventions to reduce alcohol use may not be appropriate for TNB people, both due to inapplicable and potentially unacceptable content (e.g., gender- specific drinking guidelines) and because they do not address anti-TNB stigma as a key determinant of alcohol use in this population. Relationship-focused interventions have the potential to jointly address alcohol use and co-occurring depression/anxiety symptoms in TNB people by reducing adverse relationship experiences (e.g., intimate partner violence) that result from stigma—and leveraging supportive romantic relationships as a buffer against the effects of stigma.