Sexual identity disparities in binge drinking: A multilevel analysis of the alcohol policy environment and nondiscrimination statutes
| dc.contributor.advisor | Johnson, Renee M | |
| dc.contributor.committeeMember | Cohen, Joanna E | |
| dc.contributor.committeeMember | German, Danielle | |
| dc.contributor.committeeMember | Rosen, Joanne A | |
| dc.creator | Greene, Naomi Kitty | |
| dc.creator.orcid | 0000-0003-4045-7817 | |
| dc.date.accessioned | 2021-06-25T12:55:59Z | |
| dc.date.created | 2021-05 | |
| dc.date.issued | 2021-01-06 | |
| dc.date.submitted | May 2021 | |
| dc.date.updated | 2021-06-25T12:55:59Z | |
| dc.description.abstract | Background: Binge drinking is a major public health issue with individual and societal costs. Substantial evidence exists documenting binge drinking disparities between lesbian, gay, bisexual compared with heterosexual populations in the United States. Most studies examining the causes of these disparities look to individual and interpersonal experiences of discrimination, prejudice, violence, and homophobia directed at sexual minority people. Few studies examine structural factors, such as public policies, as possible causes for binge drinking disparities by sexual orientation despite evidence that alcohol policies may reduce binge drinking in the general population and nondiscrimination policies may improve mental health outcomes among sexual minority populations. To address these gaps, the current dissertation examines how alcohol policy environments and state-level nondiscrimination statutes are associated with binge drinking disparities between lesbian, gay, bisexual and heterosexual adults in the United States. Methods: To answer the research question, this dissertation employs a cross-sectional design with some lagged effects. Data from several publicly available administrative data sources were combined to provide information on several individual and state-level factors known to be associated with individual-level binge drinking. Logistic regression models with interaction terms were used to examine the associations between individual-level binge drinking, the alcohol policy environment and nondiscrimination statutes by sexual identity stratified by sex at birth. Results: Overall, associations between binge drinking and the alcohol policy environment and nondiscrimination statutes were stronger among women than men. Binge drinking disparities between lesbian and bisexual women compared with heterosexual women persisted even in states with stronger alcohol policy environments. However, in the presence of nondiscrimination statutes, disparities disappeared between lesbian and heterosexual women while disparities were much narrower between bisexual and heterosexual women when accounting for the alcohol policy environment. Discussion: This dissertation provides evidence that structural factors, such as the alcohol policy environment and nondiscrimination statutes, can further elucidate binge drinking disparities between sexual minority and heterosexual populations in the United States. Furthermore, a health equity perspective is needed in alcohol policy research to ensure that effective policies are working the same way for all population subgroups, especially those with higher alcohol consumption. | |
| dc.format.mimetype | application/pdf | |
| dc.identifier.uri | http://jhir.library.jhu.edu/handle/1774.2/63948 | |
| dc.language.iso | en_US | |
| dc.publisher | Johns Hopkins University | |
| dc.publisher.country | USA | |
| dc.subject | alcohol policy environment | |
| dc.subject | Behavioral Risk Factor Surveillance System | |
| dc.subject | binge drinking | |
| dc.subject | bisexual | |
| dc.subject | health disparities | |
| dc.subject | legal epidemiology | |
| dc.subject | lesbian | |
| dc.subject | LGB | |
| dc.subject | multilevel models | |
| dc.subject | structural stigma | |
| dc.title | Sexual identity disparities in binge drinking: A multilevel analysis of the alcohol policy environment and nondiscrimination statutes | |
| dc.type | Thesis | |
| dc.type.material | text | |
| local.embargo.lift | 2022-05-01 | |
| local.embargo.terms | 2022-05-01 | |
| thesis.degree.department | Health, Behavior and Society | |
| thesis.degree.discipline | Social & Behavioral Sciences | |
| thesis.degree.grantor | Johns Hopkins University | |
| thesis.degree.grantor | Bloomberg School of Public Health | |
| thesis.degree.level | Doctoral | |
| thesis.degree.name | Ph.D. |