This competing renewal application will build on the PI's 15-year prospective study, the Chicago Health and Life Experiences of Women (CHLEW) (K01 AA00266 & R01 AA013328-09), which focuses on understanding the mechanisms linking minority sexual orientation and hazardous drinking (HD). HD is operationalized as an index that includes heavy episodic drinking, intoxication, adverse drinking consequences and symptoms of potential alcohol dependence. Participants in the previous phase (W3) of the CHLEW study were 354 sexual minority women (SMW: lesbian, bisexual) from the 3-wave longitudinal sample (79% retention at 10-year follow-up) and 373 new participants including younger (age 18-25), and additional Black, Latina, and bisexual SMW (total N=727). The study has collected rich data on individual and interpersonal (micro-level) risk and protective factors for heavy/hazardous alcohol use and alcohol-related problems and has to date produced more than 50 journal articles and book chapters and 6 completed doctoral dissertations. Building on minority stress theory we propose to expand on our previous work by examining social- contextual (structural-level) risk and protective factors for HD and drinking-related health consequences among SMW. Specifically, we will capitalize on 2 historic opportunities to: 1) conduct a natural experiment to evaluate the impact of the June 1, 2014, Illinois Marriage Fairness Act on SMW's drinking and health; and 2) take advantage of a unique longitudinal dataset-that will include data on SMW's drinking spanning nearly 20 years-to examine the associations of long-term drinking trajectories with SMW's health. We expect that this supportive policy change will have beneficial effects for all SMW and that SMW who choose to marry will demonstrate many of the health benefits of marriage observed among women in the general population. Thus, we plan to use 3 waves of existing data (2000-01, 2004-05, 2010-12) and 2 proposed new waves (2016-17, 2017-18) to (1) examine the overall effect of legal recognition of same-sex marriage on drinking outcomes (volume of alcohol consumption and HD) and potential mediators of such changes among SMW; (2) examine potential moderators of the relationship between legal recognition of same-sex marriage and drinking outcomes; (3) compare drinking outcomes among SMW who marry their same-sex partner and those of SMW in other same-sex relationships (civil unions, cohabiting, committed/not living together); and (4) identify associations between long-term trajectories of alcohol consumption and HD and SMW's physical and mental health, as well as moderators of these associations. The CHLEW is the longest running and most comprehensive study of SMW's drinking and health in the US or elsewhere. Its large subsamples of women under 25 and over 50, and of Black, Latina, and bisexual women, add to its value by providing a rare opportunity to examine age, race/ethnicity and sexual identity differences in the relationships between marriage recognition and drinking, and between drinking and health.
Statement Sexual-orientation-related health disparities are now well recognized, and some of the largest disparities have been documented in comparisons of drinking behaviors among sexual minority and heterosexual women. In this study we capitalize on two historic opportunities to: 1) evaluate the impact on SMW's drinking and health of the June 1, 2014, Illinois Marriage Fairness Act (which provides legal recognition of same-sex marriage); and 2) take advantage of a unique longitudinal dataset (including data on SMW's drinking patterns over a nearly 20-year period) to examine the associations of long-term drinking trajectories with SMW's health. Findings from the study will add significantly to the currently sparse knowledge about individual, interpersonal, and societal factors that contribute to elevated rates of physical and mental health problems (including hazardous drinking and related problems) in SMW, generating information that can guide the development of prevention, treatment, and policy to reduce health disparities in sexual minorities, and potentially other minority groups as well.
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