Advancing novel methods to measure and analyze multiple types of discrimination for population health research

项目摘要 我们的研究旨在提出测量和分析多种类型的人口歧视的方法 健康研究。我们将比较新的隐式和传统的显式(自我报告)暴露措施， 调查不同的方法来模拟暴露在多种类型的歧视中，并测试新的 使用因果调解分析的假设。我们的动机是对当前广泛存在的- 以往的做法低估了歧视对人口健康的影响。 我们以人口为基础的研究直接解决了这些问题，并专注于与以下两个健康结果相关的问题 当前和终身的歧视，损害生活质量，增加慢性病和 药物滥用：心理困扰和睡眠障碍。我们将采用第一个的精炼版本- 我们最近开发的用于区分的曾经内隐联想测试(IAT)，以及我们之前验证的 自我报告措施是卫生研究中关于歧视的最广泛使用的措施之一。 为了确保每个对照小组有350名参与者，我们将招募1092名成年患者成员和工作人员 从两个不同的社区卫生中心中随机挑选，以满足以下具体目标： 目标1.使用隐性和显性(自我报告)措施评估遭受歧视的风险，使用 经过验证的简要IAT格式，以实现对美国终身暴露的时间效率评估，以 基于以下方面的歧视：种族/族裔、性别认同、年龄、性取向和体重，以及评估 以不同的方式将个人暴露在多种类型的歧视中。 目标2.测试关于单身人士和单身人士遭受歧视对健康影响的假设 社会比较群体(即有色人种与白人；性别少数群体)的综合衡量标准 [GM/TGNC(变性人/不符合性别)]vs.顺式性别女性vs.顺式性别男性vs.；老年人vs. 年轻；性少数[LGBQ(女同性恋者/男同性恋者/双性恋者/酷儿)/SM]对异性恋；肥胖者与非肥胖者) 目标2.1。检验内隐和外显区别测量将独立的假设 与心理困扰和睡眠障碍有关(睡眠不足；睡眠呼吸障碍)。 目标2.2。使用因果调解技术，量化歧视作为健康调解人的影响 这将有助于消除不平等现象，并确定哪种类型和组合的歧视措施产生的影响最大。 影响：如果我们的假设得到支持，结果将表明主要措施和 方法低估了歧视对健康的影响，而更好的方法将需要使用 多重歧视的内隐和外显测量与反事实因果调解 技巧。我们期待我们的研究，为高内部效度而设计，将极大地推进 在大规模人群研究中，对多种类型的暴露进行可行的测量和严格的分析 消除歧视，这一知识对于促进健康公平的证据至关重要，这是美国卫生机构的优先事项。

Project Summary Our study seeks to advance methods to measure and analyze multiple types of discrimination for population health research. We will compare novel implicit vs. conventional explicit (self-report) measures of exposure, investigate different approaches to modeling exposure to multiple types of discrimination, and test novel hypotheses using causal mediation analyses. We are motivated by profound concerns that current widely- used approaches are underestimating the impact of discrimination on population health. Our population-based study directly tackles these issues, and focuses on two health outcomes linked to current and lifetime discrimination that harm quality of life and increase risk of both chronic disease and substance abuse: psychological distress and sleep disorders. We will employ a refined version of the first- ever implicit association test (IAT) for discrimination we recently developed, along with our prior validated self-report measure that is among the most widely-used measures in health research on discrimination. To ensure 350 participants per comparison group, we will recruit 1092 adult patient members and staff randomly selected from two diverse community health centers to address the following specific aims: Aim 1. Assess exposure to discrimination using implicit and explicit (self-report) measures, using the validated brief IAT format, to enable time-efficient assessment of lifetime exposure in the US to discrimination based on: race/ethnicity, gender identity, age, sexual orientation, and weight, and assess different ways to combine individuals’ exposure to multiple types of discrimination. Aim 2. Test hypotheses about the health impact of exposure to discrimination, for single and combined measures across the social comparison groups (i.e., people of color vs. white; gender minority [GM/TGNC (transgender/non-conforming)] vs. cis-gender women vs. cis-gender men vs.; older vs. younger; sexual minority [LGBQ (lesbian/gay/bisexual/queer)/SM] vs. heterosexual; obese vs. non-obese) Aim 2.1. Test the hypotheses that the implicit and explicit discrimination measures will be independently associated with psychological distress and sleep disorders (insufficient sleep; sleep disordered breathing). Aim 2.2. Using causal mediation techniques, quantify the effects for discrimination as mediator of health inequities and determine which type and combination of discrimination measures yields the largest effects. Impact: If our hypotheses are supported, results would demonstrate that predominant measures and methods underestimate the health impacts of discrimination, and that better methods would entail use of implicit and explicit measures of multiple types of discrimination and counterfactual causal mediation techniques. We expect our study, designed for high internal validity, will significantly advance methods for feasibly measuring and rigorously analyzing, in large population-based studies, exposure to multiple types of discrimination, knowledge crucial for evidence to promote health equity, a priority for US health agencies.