Tobacco Use Trajectories And Disparities Among Sexual Minorities In U.S Adolescents And Adults

项目摘要/摘要 烟草的使用在美国造成了巨大的健康和经济成本，其中包括超过48万 每年因吸烟而死亡以及每年超过1,930亿美元的医疗费用和 生产力。性少数群体使用烟草和使用烟草的风险要大得多 在美国，与异性恋个人相比，与烟草相关的疾病(TUD)和健康结果。 需要纵向数据来了解烟草使用在不同时间和结果烟草使用的差异- 性少数群体之间的相关健康差距。此信息对于告知烟草监管部门是必要的 减少这些健康差距的政策战略。我们借鉴了少数族裔压力和 按性别理解这些烟草使用轨迹和相关健康差异的交叉性 定位。该建议是对RFA-OD-19-022的直接回应，使用二次数据来检查 在弱势人群中烟草使用轨迹及其随时间的健康影响，重点是新烟草 产品。国家和纵向人口烟草与健康评估(PATH)研究提供 这是一个前所未有的机会，可以确定烟草使用轨迹的差异，相关的健康差异， 以及这些差异背后的机制。使用路径数据，我们将能够检查详细的烟草使用情况 四次浪潮中的轨迹，四次浪潮中的性身份转变，以及未来与健康的联系 结果。此外，我们还对压力和健康方面的自我报告和生物数据进行三角测量。使用路径的 本研究的目的是：(1)检测烟草产品 性取向的启动和使用轨迹及其与常规烟草使用和TUD的关联 症状；(2)通过性取向和与自我的不同联系来识别烟草使用轨迹 报告和成人的生物健康结果；(3)检查生物和心理的作用 成年人对烟草使用轨迹、戒烟和与烟草相关的健康结果的压力以及 这在性取向和性认同的转变上有何不同。我们将评估烟草的轨迹， 强调关键公共卫生重要性的具体变化，包括：(1)开始使用烟草；(2) 使用的烟草产品数量(即单一产品使用向双重/多种烟草使用)的进展 重点关注包括电子烟和没有电子烟的轨迹，以及(3)烟草的增加和减少 频率目标2和目标3将创新性地利用这两项调查的丰富自我报告压力测量方法 (心理困扰)和健康结果(呼吸系统疾病、癌症、心血管疾病)以及 应激的生物标记物(如C-反应蛋白、白介素6)和烟草特异性标记物 癌症风险(NNAL、NNN、TNE2)。我们将检查重要的主持人，包括年龄、性别、种族和民族 在所有的目标中。该项目将极大地为烟草监管政策提供信息并使其发挥最大效力。 特别是那些旨在减少性少数群体使用烟草造成的健康负担的措施。

Project Summary/Abstract Tobacco use is responsible for enormous health and financial costs in the U.S. including more than 480,000 deaths per year due to cigarette use and more than $193 billion annually in health care costs and loss of productivity. Sexual minority individuals are at substantially greater risk for tobacco use and tobacco use disorder (TUD) and tobacco-related health outcomes compared to heterosexual individuals in the U.S. Longitudinal data is needed to understand differences in tobacco use across time and resultant tobacco- related health disparities among sexual minorities. This information is necessary to inform tobacco regulatory policy strategies to reduce these health disparities. We draw on concepts of minority stress and intersectionality to understand these tobacco use trajectories and related health disparities by sexual orientation. This proposal is in direct response to RFA-OD-19-022 by using secondary data to examine tobacco use trajectories and its health effects over time in a vulnerable population, focusing on new tobacco products. The national and longitudinal Population Assessment of Tobacco and Health (PATH) study provides an unprecedented opportunity to identify differences in tobacco use trajectories, associated health disparities, and mechanisms behind these differences. Using PATH data we will be able to examine detailed tobacco use trajectories across four waves, sexual identity transitions across four waves, and prospective links to health outcomes. In addition we triangulate both self-report and biological data on stress and health. Using PATH’s large nationally representative dataset of youth and adults, this study aims to: (1) To examine tobacco product initiation and use trajectories by sexual orientation and their associations with regular tobacco use and TUD symptoms; (2) To identify tobacco use trajectories by sexual orientation and differential associations with self report and biological health outcomes among adults; (3) To examine the role of biological and psychological stress on tobacco use trajectories, tobacco cessation and tobacco-related health outcomes among adults and how this differs by sexual orientation and transitions in sexual identity. We will assess tobacco trajectories, with emphasis on specific changes of critical public health importance including: (1) tobacco use initiation, (2) progression in the number of tobacco products used (i.e., single product use to dual/polytobacco use) with a focus on trajectories including e-cigarettes and those without and (3) increases and decreases in tobacco frequency. Aims 2 and 3 will innovatively make use of the wealth of both survey self-report measures of stress (psychological distress) and health outcomes (respiratory illness, cancer, cardiovascular disease) alongside biological markers of stress (e.g., C-reactive protein, interleukin-6) and tobacco-specific markers linked to cancer risk (NNAL, NNN, TNE2). We will examine important moderators including age, sex, race, and ethnicity throughout all aims. This project will greatly inform and maximize effectiveness of tobacco regulatory policies particularly those aimed at reducing the health burden of tobacco use among sexual minorities.