A mixed-methods approach to understanding stress and hazardous drinking among same-sex female couples

Sexual minority women (SMW; e.g., lesbian, bisexual) are 6-7 times as likely as heterosexual women to meet criteria for alcohol use disorder, indicating a disproportionately high risk of heavy drinking (HD) and associated negative health outcomes. SMW’s elevated HD risk is believed to be caused, in large part, by lifetime exposure to multiple and chronic stressors. Although the association between stress and HD is well-established, little is known about how relationship characteristics influence stress and HD among SMW. Intimate relationships confer many benefits and are protective against stress-related negative health outcomes. Conversely, relationship stress may lead to unhealthy coping behaviors, such as HD. The proposed study aims to understand the role of HD within same-sex female couples using and quantitative data at both the individual- and couple-levels. The specific aims for the K99 phase were to: 1) Explore associations among couple-level relationship factors, stressors, and HD; and 2) Identify individual-level experiences within same-sex female couples that influence drinking behaviors. K99 results: The linked K99 award has provided preliminary findings into associations between relationship stages, alcohol use, and stress and has identified key stressors across women’s same-gender couple relationships. These findings supported the creation of a testable model for the R00. R00 research question: The critical next step in this program of research is to understand the mechanisms underlying SMW’s high risks for HD within the relationship context. Specifically, data collected during the R00 phase will support an examination of individual-level and couple-level stressors and mechanisms that may increase HD risks. R00 Design: I will be working with Gallup to recruit a representative sample of women in same-gender couple relationships (N = 300 couples) to complete a survey about their stressors, coping, relationships, and their health behaviors. Specific aims. Each of the aims tests a portion of the overarching conceptual model which is informed by ecological theory, minority stress theory, and the psychological mediation framework, as well as findings from both my NIH F32 and my K99. AIM 1. Test individual-level mechanisms theorized to increase risk of HD. AIM 2. Test relationship-level mechanisms theorized to increase risk of HD. AIM 3. Test whether couple-level stressors moderate the associations between individual-level stressors and relationship quality and with heavy drinking. The overarching goals of the R00 are to: 1) recruit a geographically and demographically diverse national sample of same-sex female couples (N = 300 couples); and 2) test a theoretical framework informed by the K99 findings using empirically validated individual- and couple-level measures. The proposed study extends findings from Dr. Veldhuis’ F32 and the K99 phase of this grant to understand how individual- and couple-level characteristics of same-sex relationships influence HD and will provide preliminary data for her R01 application. Future Directions and Public Health Relevance: The proposed project represents an innovative approach to understanding SMW’s elevated risk for HD. Considering both partners’ perspectives will provide much needed information about influences beyond the individual that affect drinking behaviors of SMW. Findings will support an NIH R01 application to test temporality and causality in the associations between relationships and HD.

Sexual minority women (SMW; e.g., lesbian, bisexual) are 6-7 times as likely as heterosexual women to meet criteria for alcohol use disorder, indicating a disproportionately high risk of heavy drinking (HD) and associated negative health outcomes. SMW’s elevated HD risk is believed to be caused, in large part, by lifetime exposure to multiple and chronic stressors. Although the association between stress and HD is well-established, little is known about how relationship characteristics influence stress and HD among SMW. Intimate relationships confer many benefits and are protective against stress-related negative health outcomes. Conversely, relationship stress may lead to unhealthy coping behaviors, such as HD. The proposed study aims to understand the role of HD within same-sex female couples using and quantitative data at both the individual- and couple-levels. The specific aims for the K99 phase were to: 1) Explore associations among couple-level relationship factors, stressors, and HD; and 2) Identify individual-level experiences within same-sex female couples that influence drinking behaviors. K99 results: The linked K99 award has provided preliminary findings into associations between relationship stages, alcohol use, and stress and has identified key stressors across women’s same-gender couple relationships. These findings supported the creation of a testable model for the R00. R00 research question: The critical next step in this program of research is to understand the mechanisms underlying SMW’s high risks for HD within the relationship context. Specifically, data collected during the R00 phase will support an examination of individual-level and couple-level stressors and mechanisms that may increase HD risks. R00 Design: I will be working with Gallup to recruit a representative sample of women in same-gender couple relationships (N = 300 couples) to complete a survey about their stressors, coping, relationships, and their health behaviors. Specific aims. Each of the aims tests a portion of the overarching conceptual model which is informed by ecological theory, minority stress theory, and the psychological mediation framework, as well as findings from both my NIH F32 and my K99. AIM 1. Test individual-level mechanisms theorized to increase risk of HD. AIM 2. Test relationship-level mechanisms theorized to increase risk of HD. AIM 3. Test whether couple-level stressors moderate the associations between individual-level stressors and relationship quality and with heavy drinking. The overarching goals of the R00 are to: 1) recruit a geographically and demographically diverse national sample of same-sex female couples (N = 300 couples); and 2) test a theoretical framework informed by the K99 findings using empirically validated individual- and couple-level measures. The proposed study extends findings from Dr. Veldhuis’ F32 and the K99 phase of this grant to understand how individual- and couple-level characteristics of same-sex relationships influence HD and will provide preliminary data for her R01 application. Future Directions and Public Health Relevance: The proposed project represents an innovative approach to understanding SMW’s elevated risk for HD. Considering both partners’ perspectives will provide much needed information about influences beyond the individual that affect drinking behaviors of SMW. Findings will support an NIH R01 application to test temporality and causality in the associations between relationships and HD.