Impact of the policy environment on substance use among sexual minority women

Associations between structural stigma, drinking to cope, and consequences among sexual minority women as a function of racial and ethnic minority status.

“…This study is the first to examine multiple components of sexual minority stigma at state and county levels in relation to alcohol outcomes among LBQ-identified SMW, a subpopulation of women who disproportionately experience alcohol use disorders. Consistent with previous findings (e.g., Hughes et al, 2020;Schuler et al, 2020) relative to non-Hispanic white SMW, BIPOC SMW reported drinking to cope more often and experiencing more negative alcohol- Consistent with the link between heavy episodic drinking and unsupportive state legislature reported by Drabble et al (2022), overall, there was a significant positive relationship between residence in a state with more legislature unsupportive to sexual minorities and drinking to cope more often when experiencing negative emotions, stress, and sexual minority stigma. However, no such significant relationship was observed in the model predicting negative consequences.…”

“…Illumination of these linkages are important in the context of the broader sexual minority stigma literature in which maladaptive coping behaviors are proposed mediating mechanisms linking stigma experiences to poor mental health and increased health-risk behaviors among sexual minorities (e.g., Hatzenbuehler, 2009). In addition, given that previous structural stigma work with SMW in the alcohol use context has been narrowly focused on state-level policies (Drabble et al, 2022;Everett et al, 2016;Greene et al, 2021), findings demonstrate the utility of examining more proximal indices of structural stigma at the county level in relation to drinking to cope and the experience of negative alcohol-related consequences among SMW. Furthermore, although health research with sexual minority men has examined attitudinal and population density markers of structural stigma at the county level (Lattanner et al, 2021) and work with sexual minority youth has considered lacking school-based LGBTQ ally programs in measures of structural stigma (Hatzenbuehler et al, , 2015Woodford et al, 2018), to our knowledge this is the first study with a sexual minority population to utilize publicly available republican-democratic presidential voting differentials or lacking LGBTQ community in county-level measures of structural stigma.…”

“…focused on the state policy environment (Drabble et al, 2022;Everett et al, 2016;Greene et al, 2021) and little is known about associations between alcohol outcomes and more proximal attitudinal, population, and community resource components of structural stigma. As such, this research aims to provide a full, multidimensional examination of structural stigma in relation to drinking to cope and negative alcohol-related consequences among lesbian, bisexual, and queer (LBQ) identified SMW diverse in geographic location, race, and ethnicity.…”

“…Although it is assumed that higher structural stigma is also associated with hazardous drinking and alcohol problems among SMW, only a single component of structural stigma has been studied in relation to these variables in this population. Most recently, Drabble et al (2022) cross-sectionally linked state policies unsupportive to sexual minorities to increased incidence of heavy episodic drinking in a national convenience sample of SMW. Similarly, Greene et al (2021) found that binge drinking disparities comparing lesbian/bisexual women with heterosexual women were narrower in states with inclusive nondiscrimination laws.…”

“…In contrast to the study by Everett et al (2016), the broader literature has rarely examined potential demographic moderators of relationships between structural stigma and health behaviors, assuming instead that associations are consistent across racial and ethnic subgroups (e.g., Drabble et al, 2022;Hatzenbuehler, 2016;Hatzenbuehler et al, 2015Hatzenbuehler et al, , 2020van der Star et al, 2020). However, a recent review of alcohol research investigating structural stigma among sexual and gender minority populations (Zollweg et al, 2023) has called this assumption into question, highlighting a problematic lack of diversity in the demographics of sexual minority samples (e.g., greater than 70% white) and a need to better understand if and how relationships between structural stigma and alcohol outcomes differ as a function of racial/ethnic minority status and other demographic characteristics.…”