UCSF

Emerging adulthood is an ideal development period to target for substance use interventions, as it is a period of immense transition in which individuals confront heightened stressors in many domains, including education, career, and relationships, rendering them to be more susceptible to tobacco and alcohol use. Notably, those initiating substance use during this period often develop enduring usage patterns. Therefore, directing prevention efforts towards emerging adulthood holds significant promise in mitigating future substance use trends. Moreover, we recognize that tobacco and alcohol use patterns are not evenly distributed among different demographic groups. For instance, research indicates that lesbian, gay, and bisexual (LGB) individuals exhibit higher rates of cigarette smoking and binge drinking compared to their heterosexual counterparts, reflecting potential effects of structural discrimination. Theoretical frameworks such as Link and Phelan's fundamental cause theory, Meyer's minority stress model, and Hatzenbuehler's work on LGB structural stigma provide a conceptual basis for understanding how structural discrimination manifests in substance use behaviors. Structural discrimination, such as the absence of comprehensive nondiscrimination policies, creates legal and institutional barriers for LGB individuals, restricting their employment opportunities, housing access, and healthcare services. These structural constraints exacerbate economic burdens and contribute to heightened levels of stress and anxiety among LGB individuals. Consequently, many may resort to maladaptive coping mechanisms, including substance use, to manage these stressors. Recognizing the significance of emerging adulthood, my dissertation focuses on understanding substance use within this population. In my first paper, I explore whether exposure to LGB state policy protections during emerging adulthood constitutes a critical period of policy exposure. However, heterosexism is not the only form of structural discrimination and does not operate alone in society, I was interested in exploring how multiple forms of structural discrimination coalesce and shape substance use behaviors using quantitative intersectionality methods. So, in my second paper, I presented a systematic review of quantitative intersectionality methods that have been employed to investigate intersectional hypotheses. Finally, in my third paper, I applied quantitative intersectionality methods to examine the interplay between heterosexism, racism, and economic marginalization in shaping patterns in tobacco use and binge drinking.