Examining Daily Self-Efficacy, Minority Stressors, and Alcohol and Other Drug Use Among Trauma-Exposed Sexual Minority Women and Transgender and Gender-Diverse People

• Published in: Annals of behavioral medicine 2024-11, Vol.58 (12), p.832-844
• Main Authors: Scheer, Jillian R, Mereish, Ethan H, Gilmore, Amanda K, Cascalheira, Cory J, Helminen, Emily C, Dobani, Fatima, Behari, Kriti, Pirog, Sophia, Jackson, Skyler D, Sullivan, Tami P, Batchelder, Abigail W
• Format: Article
• Language: English
• Subjects: Adult; Alcohol Drinking - epidemiology; Alcohol Drinking - psychology; Female; Humans; Male; Middle Aged; Psychological Trauma - psychology; Self Efficacy; Sexual and Gender Minorities - psychology; Stress, Psychological - psychology; Substance-Related Disorders - epidemiology; Substance-Related Disorders - psychology; Transgender persons; Transgender Persons - psychology; Young Adult
• ISSN: 0883-6612; 1532-4796; 1532-4796
• DOI: 10.1093/abm/kaae065

Abstract Background and Purpose This study aimed to develop and test a novel model integrating social-learning and self-medication frameworks by examining the association between self-efficacy to resist alcohol and other drug (AOD) use and daily AOD use and unhealthy drinking risk among trauma-exposed sexual minority women (SMW) and transgender and gender-diverse (TGD) people. We examined whether minority stressors moderated these associations. Methods Data were from 57 trauma-exposed SMW and TGD people who participated in a 14-day daily diary study. Multilevel binary logistic models and ordinal logistic models were employed to examine associations between self-efficacy to resist AOD use and daily AOD use and unhealthy drinking risk at within- and between-person levels. We assessed same- and cross-level interactions between daily self-efficacy to resist AOD use and minority stressors in predicting AOD use and unhealthy drinking risk within the same 24-hour period (i.e., standardized as 6 pm to 6 pm; hereafter referred to as “same-day”). Results Self-efficacy to resist AOD use was associated with lower AOD use and unhealthy drinking risk. Minority stressors were associated with daily AOD use. Among those who experienced higher (vs. lower) average sexual minority stressors over the 2-week daily diary period, higher-than-usual self-efficacy to resist AOD use was less protective in decreasing risk of same-day unhealthy drinking. Conclusions Interventions aiming to mitigate AOD use and unhealthy drinking risk by bolstering self-efficacy to resist AOD use should consider the impact of recent cumulative exposure to sexual minority stressors in this population. Further, policy efforts are needed to reduce perpetuation of stigma. Due to stigma, self-efficacy is less effective in reducing daily substance use among sexual minority women and transgender and nonbinary people who have experienced trauma. Interventions aiming to strengthen self-efficacy as a mechanism of behavior change to reduce unhealthy substance use should consider the impact of chronic exposure to stigma in these populations. Lay Summary This study explored how confidence in resisting alcohol and other drug (AOD) use relates to daily AOD use and unhealthy drinking risk among trauma-exposed sexual minority women (SMW) and transgender and gender-diverse (TGD) people. We also assessed whether experiences of minority stress, such as discrimination or stigma, influenced these relationships. Fifty-seven S