A Gamified, Social Media-Inspired, Web-Based Personalized Normative Feedback Alcohol Intervention for Lesbian, Bisexual, and Queer-Identified Women: Protocol for a Hybrid Trial

COVID-19 Concerns, Coping and Perceived Peer Norms: Correlates of Increased Alcohol and Marijuana Use Among Sexual Minority Women

This study explored the impact of COVID-related concerns and other characteristics on alcohol and marijuana use among sexual minority women (SMW). Survey data from a racially/ethnically diverse sample of 338 SMW participants in the Chicago Health and Life Experiences of Women (CHLEW) study were used to examine correlates of three substance use outcomes: frequent intoxication (once a month or more), perceived increase in alcohol use, and perceived increase in marijuana use. Coping motives for alcohol use was positively associated with each of the substance use outcomes. Belief that peers (in terms of age, sexual identity, and gender) used alcohol often to cope was associated with higher odds of frequent intoxication. COVID-19 related financial concerns were positively associated with both frequent intoxication and increased marijuana use. Health and mental health concerns were associated with lower odds of frequent intoxication. Findings underscore the importance of enhancing coping skills, addressing perceived peer coping norms, and providing both economic and social support in intervention efforts.

Toward Cognitive-Behavioral Therapy for Sexual Minority Women: Voices From Stakeholders and Community Members

Sexual minority women (SMW) experience an elevated risk of mental health problems compared to heterosexual women. However, knowledge gaps remain regarding whether cognitive-behavioral therapy (CBT) interventions meet SMW's mental health needs. Further, virtually no studies have integrated stakeholder (i.e., researchers with content expertise in SMW's health and clinical providers who work with SMW) and community member (i.e., SMW) perspectives to identify CBT approaches that address SMW-specific issues. This study used qualitative data gathered from 39 SMW who reported depression, anxiety, suicidality, and heavy drinking in the past 3 months and 16 content experts and clinical providers to obtain information relevant to enhancing CBT for SMW. In addition, we used thematic analysis to identify themes related to the adaptation and delivery of CBT for SMW. Building on prior literature, this study's findings revealed seven considerations for delivering mental health services to SMW: (1) attending to SMW's diverse gender identities and expressions; (2) focusing on SMW's nonbinary stressors; (3) formulating SMW's gender-based stressors within a feminist framework; (4) applying intersectionality frameworks; (5) incorporating issues of diversity, multiculturalism, and social justice; (6) addressing the role of trauma exposure; and (7) addressing the role of alcohol use in SMW's lives. These considerations are reviewed in terms of their implications for clinical practice, with a focus on enhancing applications of existing CBT interventions, to best respond to the unique needs of this population.

Facets of Gender Expression and Discrimination in Relation to Alcohol and Other Drug Use Severity Among Sexual Minority Women and Gender Diverse Individuals Assigned Female at Birth

Purpose: Sexual minority women and gender diverse individuals assigned female at birth (SMW+) consistently report more alcohol and other drug (AOD) use severity than heterosexual women, with greater disparities reported among bisexual plus (bi+) SMW (including bisexual, pansexual, queer, and those with attractions to more than one gender regardless of identity). Furthermore, emerging evidence suggests that SMW with masculine gender expression (e.g., SMW with masculine gender appearance) disproportionately experience problematic AOD use compared to those with feminine gender expression. The minority stress model, which has predominantly been investigated in relation to internalized homonegativity and sexuality-based discrimination, may also account for these AOD use disparities. This study examined gender expression, related discrimination, and AOD use severity among SMW+. Methods: In a 2020 sample of SMW+ (n = 236), we investigated AOD use severity in relation to gender expression (appearance, emotional expression, and gender roles) and gender expression-based discrimination after controlling for internalized homonegativity and sexuality-based discrimination through an online survey. Results: Masculine gender roles were associated with AOD use severity, whereas masculine appearance and emotional expression were not. In multivariable models, gender identity was inconsistently associated with alcohol use severity, sexuality-based discrimination was consistently associated with alcohol use severity and inconsistently associated with other drug use severity, and gender expression-based discrimination was associated with neither. Conclusion: This study emphasizes the importance of examining intersecting aspects of minority identity among SMW+, including facets of gender expression, in relation to AOD use severity.

Exposure to interpersonal stigma enhances the effectiveness of a culturally adapted personalized normative feedback alcohol intervention for sexual minority women

Stigma-related stress and inflated perceptions of substance use norms are positioned in the literature as theoretically distinct explanations for disproportionate substance use among sexual minorities. As research has yet to examine how these variables may interact in an intervention context, this study examined the impact of recent experiences with violence and harassment due to sexual minority status (i.e., interpersonal stigma exposure) on the effectiveness of a culturally adapted personalized normative feedback intervention for lesbian, bisexual, and queer (LBQ) women. A sub-sample of 499 moderate-to-heavy drinking LBQ women were randomized to receive personalized normative feedback (PNF) on alcohol use or control topics within a broader digital competition designed to challenge negative LBQ stereotypes. At baseline, recent interpersonal stigma exposure strengthened the relationship between perceived LBQ alcohol-related norms and participants' own alcohol-related behaviors (i.e., consumption and consequences). At follow-up, 3 months later, recent interpersonal stigma exposure moderated the effectiveness of alcohol PNF with substantially less drinking and consequences among participants in the treatment condition reporting recent violence or harassment due to sexual minority status, relative to those reporting no such experiences. Underscoring the utility of PNF for LBQ women and potentially other heavy drinking stigmatized populations, findings suggest that a greater tendency to conform to over-estimated ingroup drinking norms may be another way in which minority status-based violence and harassment contributes to alcohol consumption in stigmatized populations.

Promoting Resilience and Well-being Through Co-design (The PRIDE Project): Protocol for the Development and Preliminary Evaluation of a Prototype Resilience-Based Intervention for Sexual and Gender Minority Youth

BACKGROUND

Sexual and gender minority youth (SGMY) are at an increased risk of a range of mental health problems. However, few evidence-informed interventions have been developed specifically to support their mental well-being. Interventions that are evidence-informed for the general population and are fine-tuned specifically with SGMY in mind proffer considerable potential. A particular opportunity lies in the delivery of engaging interventions on the web, where the focus is on enhancing the coping skills and building the resilience of SGMY, in a way that is directly relevant to their experiences. On the basis of earlier work related to an intervention called Rainbow SPARX (Smart, Positive, Active, Realistic, X-factor thoughts), we seek to create a new resource, especially for SGMY in the United Kingdom.

OBJECTIVE

This project has 3 main objectives. First, together with SGMY as well as key adult experts, we aim to co-design a media-rich evidence-informed web-based SGMY well-being prototype toolkit aimed at those aged between 13 and 19 years. Second, we will explore how the web-based toolkit can be used within public health systems in the United Kingdom by SGMY and potentially other relevant stakeholders. Third, we aim to conduct a preliminary evaluation of the toolkit, which will inform the design of a future effectiveness study.

METHODS

The first objective will be met by conducting the following: approximately 10 interviews with SGMY and 15 interviews with adult experts, a scoping review of studies focused on psychosocial coping strategies for SGMY, and co-design workshops with approximately 20 SGMY, which will inform the creation of the prototype toolkit. The second objective will be met by carrying out interviews with approximately 5 selected adult experts and 10 SGMY to explore how the toolkit can be best used and to determine the parameters and user-generated standards for a future effectiveness trial. The final objective will be met with a small-scale process evaluation, using the think out loud methodology, conducted with approximately 10 SGMY.

RESULTS

The study commenced on September 1, 2021, and data gathering for phase 1 began in October 2021.

CONCLUSIONS

A considerable body of work has described the issues faced by the SGMY. However, there is a dearth of research seeking to develop interventions for SGMY so that they can thrive. This project aims to co-design such an intervention.

TRIAL REGISTRATION

Research Registry Reference researchregistry6815; https://www.researchregistry.com/browse-the-registry#home/registrationdetails/609e81bda4a706001c94b63a/.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/31036.

A Gamified Personalized Normative Feedback App to Reduce Drinking Among Sexual Minority Women: A Randomized Controlled Trial and Feasibility Study (Preprint)

Background

Sexual minority women disproportionately engage in heavy drinking and shoulder the burden of alcohol dependence. Although several intensive interventions are being developed to meet the needs of treatment-seeking sexual minority women, there remains a lack of preventive interventions to reduce drinking and its consequences among women not yet motivated to reduce their alcohol consumption.

Objective

We aimed to examine the feasibility and efficacy of reducing alcohol-related risks via personalized normative feedback (PNF) on alcohol use and coping delivered within LezParlay, a social media–inspired digital competition designed to challenge negative stereotypes about lesbian, bisexual, and queer (LBQ)–identified sexual minority women.

Methods

Feasibility was assessed by examining engagement with LezParlay outside the context of an incentivized research study, assessing the characteristics of the LBQ women taking part, and examining the competition’s ability to derive risk-reducing actual norms as well as levels of acceptability and perceived benefits reported by participants. Intervention efficacy was examined by randomizing a subsample of 499 LBQ alcohol consumers (ie, drinkers) already taking part in the competition to receive sexual identity–specific PNF on alcohol use and coping, alcohol use only, or control topics over only 2 rounds of play. Changes in alcohol use and negative consequences were examined 2 and 4 months after the delivery of treatment PNF.

Results

A total of 2667 diverse LBQ women played ≥1 round of LezParlay. The competition attracted large numbers of moderate and heavy drinkers; however, risk-reducing actual norms could still be derived from competition rounds and featured in PNF. Efficacy results revealed that drinkers who received PNF on alcohol use and both alcohol use and coping had similar reductions in their weekly drinks (P=.003; P<.001), peak drinks (P<.001; P<.001), and negative consequences (P<.001; P<.001) relative to those who received PNF on control topics at the 2-month follow-up. However, at the 4-month follow-up, reductions in alcohol consumption outcomes faded among those who received alcohol PNF only (weekly: P=.06; peak: P=.11), whereas they remained relatively robust among those who received PNF on both alcohol use and coping (weekly: P=.02; peak: P=.03). Finally, participants found the competition highly acceptable and psychologically beneficial as a whole.

Conclusions

The LezParlay competition was found to be a feasible and efficacious means of reducing alcohol-related risks in this population. Our findings demonstrate the utility of correcting sexual identity–specific drinking and coping norms to reduce alcohol-related risks among LBQ women and suggest that this approach may also prove fruitful in other stigmatized health disparity populations. To engage these populations in the real world and expand the psychological benefits associated with PNF, our findings also point to packaging PNF within a broader, culturally tailored competition designed to challenge negative group stereotypes.

Trial Registration

ClinicalTrials.gov NCT03884478; https://clinicaltrials.gov/ct2/show/NCT03884478

International Registered Report Identifier (IRRID)

RR2-10.2196/24647

Integrating social media inspired features into a personalized normative feedback intervention combats social media-based alcohol influence

BACKROUND

Research suggests that the social media platforms popular on college campuses may reflect, reinforce, and even exacerbate heavy drinking practices among students. The present study was designed to directly examine: (1) whether exposure to alcohol-related content on social media diminishes the efficacy of a traditional web-based personalized normative feedback (PNF) alcohol intervention among first-year drinkers; and (2) if social media inspired features and digital game mechanics can be integrated into a PNF intervention to combat social media-based alcohol influence and increase efficacy.

METHOD

Alcohol experienced first-year college students (N = 223) completed a pre-survey that assessed exposure to alcohol-related content and social media and were randomized to 1 of 3 web-based alcohol PNF conditions (traditional, gamified only, or social media inspired gamified). One month later, participants' alcohol consumption was reassessed.

RESULTS

Among participants who received traditional PNF, social media-based alcohol exposure interacted with pre-intervention drinking such that traditional PNF was less effective in reducing drinking among heavier drinkers reporting greater exposure to alcohol-related social media content. Further, when regression models compared the efficacy of all three conditions, the social media inspired gamified PNF condition was significantly more effective in reducing drinking than was traditional PNF among moderate and heavy drinkers reporting greater exposure to alcohol on social media.

CONCLUSION

Although additional research is needed, these findings suggest that representing the population of students on whom normative statistics are based with social media-like user avatars and profiles may enhance the degree to which alcohol PNF is relatable and believable among high-risk students.