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BACKGROUND: Sexual and gender minority (SGM) people are more likely than their cisgender, heterosexual counterparts to report negative alcohol-related outcomes. Although the association between individual- and interpersonal-level minority stressors and negative alcohol-related outcomes among SGM people is well-established, structural-level minority stressors are understudied. This systematic review examined structural-level stigma and alcohol-related outcomes among SGM people to inform future research, interventions, and policy. METHODS: We used five electronic databases to search for studies published between January 2010 and May 2022 that examined associations between structural stigma and alcohol use among SGM adults in the United States. Peer-reviewed, quantitative studies available in English were included. We conducted quality appraisal using the Joanna Briggs Institute checklist. RESULTS: The final sample included 11 studies. Overall, there was moderate to strong support for a positive association between structural stigma and negative alcohol-related outcomes among SGM people, with differences by gender, sexual identity, race, and ethnicity. All studies used cross-sectional designs, and nearly half utilized non-probability samples. Transgender and nonbinary people, SGM people of color, and sexual identity subgroups beyond gay, lesbian, and heterosexual were underrepresented. Structural stigma was most commonly measured as a state-level index. Alcohol measures were heterogeneous. Multilevel stigma and resiliency factors were understudied. CONCLUSIONS: Addressing structural stigma is critical in reducing negative alcohol-related outcomes and inequities among SGM people. Research is needed that includes probability samples, longitudinal designs, and samples that reflect the diversity of SGM people. Future studies should examine the influence of multilevel stigma and resiliency factors on alcohol-related outcomes.

The current study explored how religiosity and spirituality may differentially influence substance use by sexual identity based on a sample of adult sexual minority women (SMW; n = 437 lesbian; n = 323 bisexual) relative to a heterosexual comparison sample (n = 636). We examined three questions: (1) whether spirituality was differentially associated with alcohol and marijuana use by sexual identity; (2) whether religiosity was differentially associated with alcohol and marijuana use by sexual identity; (3) whether observed differences between spirituality or religiosity and substance use by sexual identity persisted after adjusting for religious environment. Measures included spirituality (importance of spirituality), religiosity (importance of religion, attending religious services), and past year substance use (alcohol use disorder [AUD], any marijuana use, and regular marijuana use). Higher levels of spirituality were associated with increased odds of AUD among both lesbian and bisexual respondents relative to heterosexuals. Higher levels of religiosity among lesbian participants were associated with increased odds of AUD relative to heterosexuals with higher levels of religiosity. Consistent with theories of minority stress, findings suggest that spirituality and religiosity are less protective for SMW than heterosexual women and, in some cases, may contribute to greater risk of substance use.

AimsAlcohol consumption during pregnancy remains a public health problem despite >40 years of attention. Little is known about how state policies have evolved and whether policies represent public health goals or efforts to restrict women's reproductive rights.MethodsOur data set includes US state policies from 1970 through 2013 obtained through original legal research and from the National Institute for Alcohol Abuse and Alcoholism's (NIAAA)'s Alcohol Policy Information System. Policies were classified as punitive to women or supportive of them. The association between numbers of punitive policies and supportive policies in 2013 with a measure of state restrictions on reproductive rights and Alcohol Policy Effectiveness Scores (APS) was estimated using a Pearson's correlation.ResultsThe number of states with alcohol and pregnancy policies has increased from 1 in 1974 to 43 in 2013. Through the 1980s, state policy environments were either punitive or supportive. In the 1990s, mixed punitive and supportive policy environments began to be the norm, with punitive policies added to supportive ones. No association was found between the number of supportive policies in 2013 and a measure of reproductive rights policies or the APS, nor was there an association between the number of punitive policies and the APS. The number of punitive policies was positively associated, however, with restrictions on reproductive rights.ConclusionPunitive alcohol and pregnancy policies are associated with efforts to restrict women's reproductive rights rather than effective efforts to curb public health harms due to alcohol use in the general population. Future research should explore the effects of alcohol and pregnancy policies.Short summaryThe number of states with alcohol and pregnancy policies has increased since 1970 (1 in 1974 and 43 in 2013). Alcohol and pregnancy policies are becoming increasingly punitive. These punitive policies are associated with efforts to restrict women's reproductive rights rather than policies that effectively curb alcohol-related public health harms.

This article describes U.S. state policies related to alcohol use during pregnancy, using data from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Alcohol Policy Information System (APIS). Specifically, this study examines trends in policies enacted by states over time and types of policies enacted across states in the U.S., with a focus on whether laws were supportive or punitive toward women. Findings revealed substantial variability in characteristics of policies (19 primarily supportive, 12 primarily punitive, 12 with a mixed approach, and 8 with no policies). Findings underscore the need to examine possible consequences of policies, especially of punitive policies and "mixed" approaches.

In partnership with community stakeholders, the present study aimed to gather descriptive data on pandemic-related stress and its association with mental health outcomes among a community sample of self-identified sexual minority women (SMW) in Los Angeles County (N = 84; Mage = 35.61). The sample was comprised solely of women (i.e. self-identified gender identity as woman, including cisgender and transgender women). Data were collected in April 2021, the 'third wave' of the COVID-19 global pandemic. Los Angeles experienced some of the highest COVID-19 incidence rates in the United States. Yet, there was a significant lack of COVID-19 data on SMW, thus making it difficult to address the specific needs of this community. Background data were collected on pre-existing health conditions and COVID-19 infection history. Data were specific to COVID-19 stressors in the areas of mental health, financial strain, social isolation and health and discrimination concerns. Findings revealed that mental health concern was strongly associated with financial strain (r =.63, p <.01), social isolation (r =.62, p <.01) and health and discrimination concerns (r =.63, p <.01), thus demonstrating the wide-ranging negative impact of pandemic stressors on the mental health of SMW in Los Angeles during the third wave of COVID-19. Recommendations for future research, practice and policy implications are discussed. [ABSTRACT FROM AUTHOR]

This paper describes a transcultural perspective, employed by one social work program, as an integrative framework for addressing diversity throughout the curriculum. The transcultural perspective incorporates five interrelated but distinct dimensions: (1) culture (recognizing the importance of culture at all levels of practice); (2) understanding dynamics of power, privilege, and oppression; (3) positionality and self-reflexivity; (4) respectful partnership; and (5) cultural competence (translating principles into culturally responsive practice). Also presented are findings from a study assessing student understanding after delivery of educational modules introducing the transcultural perspective. (Contains 1 table.)

Objective: Extensive use of specific social contexts (bars and parties, for instance) by homosexuals and bisexuals is thought to be a factor in the higher rates of drinking among these groups. However, much of the empirical evidence behind these assumptions has been based on studies with methodological or sampling shortcomings. This article examines the epidemiological patterns of alcohol contexts in relation to sexual identity, using a large, national, probability population survey. Method: We used the 2000 National Alcohol Survey for these analyses. The prevalence of spending leisure time in each of two social contexts (bars and parties) that are associated with heavier drinking is examined by sexual orientation (heterosexual, homosexual, bisexual and self-identified heterosexuals with same sex partners). In addition, we compare levels of drinking within these contexts by sexual orientation within these groups. Results: Exclusively heterosexual women spent less time in these two contexts relative to all other groups of women. Gay men spent considerably more time in bars compared with the other groups of men. Heterosexual women who reported same sex partners drink more at bars, and bisexual women drink more alcohol at both bars and parties than exclusively heterosexual women. For men, there were no significant differences for average consumption in any of these contexts. Entry of background and demographic variables into logistic regression analyses did little to modify these associations. Conclusions: There is empirical evidence that some groups of homosexual and bisexual women and men spend more time than heterosexual individuals in heavier drinking contexts. The frequency of being in these two social contexts does not appear to be associated with heavier drinking within these contexts for men, but it may be related to heavier drinking in those places among some groups of women. (J Stud. Alcohol 66:105-110, 2005), IT HAS BEEN argued that excessive alcohol use by gay and lesbian individuals is due to their use of bars as their primary social institution (Israelstam and Lambert, 1984; Rotello, [...]

Objective: Few population-based studies have explored differences in alcohol consumption by sexual orientation. This study examined the prevalence of abstinence, drinking, heavier drinking, alcohol-related problems, alcohol dependence and help-seeking among homosexual and bisexual women and men compared with heterosexuals. Method: Data are from the 2000 National Alcohol Survey, a national population-based survey of adults (N = 7,612), a Random Digit Dialing telephone survey of all 50 states of the United States and Washington, DC. Four categories of sexual orientation were created using questions on both sexual orientation self-identification and behavior: homosexual identified, bisexual identified, heterosexual identified with same sex partners and exclusively heterosexual. Five alcohol measures (past year) were used in the analyses: (1) mean number of drinks, (2) days consuming five or more drinks on a single occasion, (3) drunkenness, (4) negative social consequences (2 or more) and (5) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, alcohol dependence. A lifetime measure of help-seeking for an alcohol problem was also analyzed. Results: Few significant differences were found among men by sexual orientation. By contrast, both lesbians and bisexual women had lower abstention rates and significantly greater odds of reporting alcohol-related social consequences, alcohol dependence and past help-seeking for an alcohol problem. Conclusions: These findings suggest that alcohol dependence and alcohol-related consequences differ by sexual orientation, particularly among women. These findings also emphasize the need for the inclusion of sexual-orientation items in population-based surveys so that prevalence rates within these subgroups can be effectively monitored., IN SPITE OF PROGRESS in research on alcohol use and alcohol-related problems among lesbians, gay men and bisexuals, few national population-based studies have included questions related to sexual orientation (Boehmer, [...]

Respondent-driven sampling (RDS) is an approach commonly used to recruit nonprobability samples of rare and hard-to-find populations. The purpose of this study was to explore the utility of phone- and web-based RDS methodology to sample sexual minority women (SMW) for participation in a telephone survey. Key features included (i) utilizing a national probability survey sample to select seeds; (ii) web-based recruitment with emailed coupons; and (iii) virtual processes for orienting, screening, and scheduling potential participants for computer-assisted telephone interviews. Rather than resulting in a large diverse sample of SMW, only a small group of randomly selected women completed the survey and agreed to recruit their peers, and very few women recruited even one participant. Only seeds from the most recent of two waves of the probability study generated new SMW recruits. Three RDS attempts to recruit SMW over several years and findings from brief qualitative interviews revealed four key challenges to successful phone- and web-based RDS with this population. First, population-based sampling precludes sampling based on participant characteristics that are often used in RDS. Second, methods that distance prospective participants from the research team may impede development of relationships, investment in the study, and motivation to participate. Third, recruitment for telephone surveys may be impeded by multiple burdens on seeds and recruits (e.g. survey length, understanding the study and RDS process). Finally, many seeds from a population-based sample may be needed, which is not generally feasible when working with a limited pool of potential seeds. This method may yield short recruitment chains, which would not meet key RDS assumptions for approximation of a probability sample. In conclusion, potential challenges to using RDS in studies with SMW, particularly those using virtual approaches, should be considered. [ABSTRACT FROM AUTHOR]