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

This study examines sexual minority structural stigma in relation to drinking to cope and negative consequences in a diverse sample of sexual minority women (SMW). As previous work with this population has exclusively assessed structural stigma via state policies unsupportive to sexual minorities, we also examine whether other measures of structural stigma assessed at the county-level contribute to the prediction of outcomes beyond the variability accounted for by state policies. Further, this study examines whether relationships between measures of structural stigma and alcohol outcomes are stronger among Black, Indigenous, and SMW of color relative to non-Hispanic white SMW. Participants were 499 diverse adult SMW taking part in a larger study in which state and county of residence, drinking to cope, and negative consequences were assessed. Secondary data indicative of state policies, public opinion, population densities of same-sex couples, and presence of LGBTQ community resources were merged into the baseline dataset. Hierarchical regression models revealed that residing in a state with unsupportive policies was positively associated with drinking to cope but not negative consequences. Further, after controlling for state policies, county-level structural stigma interacted with racial/ethnic minority status such that there were significant positive relationships between county-level structural stigma and both outcomes among BIPOC SMW, but not among non-Hispanic white SMW. These findings demonstrate the importance of examining racial and ethnic minority status in structural stigma research and underscore the utility of considering county-level measures, which can vary greatly within state, in addition to state policies in health research with sexual and gender minority populations.