Improving Sexual Minority Health: Differences in Substance Use, Substance Use Treatment, and Associated Chronic Diseases among Rural versus Urban Populations

项目摘要 性少数群体表现出明显更高的物质使用(SU)和物质使用障碍 (Sud)与他们的异性恋同龄人相比。SU研究中的绝大多数是性行为 然而，少数民族关注的是城市人口，很少有工作比较农村和农村之间的SU模式 和城市居住性少数群体。过去对异性恋人群的研究观察到了强烈的差异 在基于都市性的SU模式中。SU治疗计划的使用和成功也被发现 根据居住的城市化程度差异很大，农村环境缺乏治疗选择 以及增加的SUD负担。此外，慢性SU与许多慢性生理疾病有关 健康问题(例如心血管疾病)。与他们较高的苏族比例一致，都是性少数 人群和农村异性恋人群经历了与苏相关的慢性疾病不成比例的负担 疾病。因此，SU和慢性病的发病率很可能在 对农村性少数群体的研究不足，使他们成为极高风险群体。考虑到他们的潜在风险，这是 对更好地了解SU、未得到满足的治疗需求和SU相关的慢性病至关重要 区别于农村和城市居住的性别少数群体。 建议的R03小额研究资助计划将利用来自全国代表的数据 研究，即全国药物使用与健康调查。这项调查是一项年度横断面调查 对居住在美国的非制度化个人进行的家庭调查，包括衡量 酒精、烟草和药物使用，药物使用治疗，以及一些与苏有关的慢性病 (例如心血管疾病、癌症)。我们将分析NSDUH所有年份的数据，其中有性行为的数据 并在分析开始时(2015-2020年)提供。数据将被用来评估差异 焦点变量的总流行率和这些差异按年的变化(通过时间变化 影响)在所有三个具体目标中：1)评估城乡性别之间的SU和SUD差异 少数民族，并确定苏州的性取向差异是否因城市化而异；2)描绘 农村和城市性少数群体治疗利用和未满足治疗需求的差异 确定异性恋和性少数群体之间的待遇差异是否因 城市化；以及3)确定城乡之间是否存在与SU相关的慢性病差异 性少数群体以及慢性病中的性取向差异是否因城市化而异。这 提案是研究计划的第一步，该计划最终旨在发展行为和生物医学 针对农村和城市性少数群体的具体需要而制定的干预措施。

Project Summary Sexual minorities exhibit significantly higher rates of substance use (SU) and substance use disorders (SUD) compared to their heterosexual counterparts. The vast majority of SU research among sexual minorities, however, has focused on urban populations with little work comparing patterns of SU between rural and urban dwelling sexual minorities. Past work with heterosexual populations has observed strong differences in SU patterns based on urbanicity. Utilization and success of SU treatment programs have also been found to vary widely based on urbanicity of residence, with rural environments suffering from a lack of treatment options and an increased burden of SUD. Additionally, chronic SU has been linked to a number of chronic physical health problems (e.g. cardiovascular disease). Consistent with their higher rates of SU, both sexual minority populations and rural heterosexual populations experience a disproportionate burden of SU-associated chronic diseases. It is therefore likely that SU and chronic disease rates will be even further elevated among understudied rural sexual minorities, making them an extremely high-risk group. Given their potential risk, it is vital to develop a better understanding of how SU, unmet treatment need, and SU-associated chronic diseases differ between rural and urban dwelling sexual minority. The proposed R03 Small Research Grant Program will utilize data from a nationally representative study, namely the National Survey on Drug Use and Health (NSDUH). This survey is an annual cross-sectional household survey of non-institutionalized individuals living in the United States and includes measures of alcohol, tobacco, and drug use, substance use treatment, and a number of SU-associated chronic diseases (e.g. cardiovascular disease, cancer). We will analyze data from all years of NSDUH that have data on sexual identity and are available at commencement of analyses (2015-2020). Data will be used to assess disparities in the aggregate prevalence of focal variables and variations in these disparities by year (via time-varying effects) in all three specific aims: 1) assess disparities in SU and SUD between rural and urban sexual minorities and determine whether sexual orientation disparities in SU vary by urbanicity; 2) delineate differences in treatment utilization and unmet treatment need among rural versus urban sexual minorities and determine whether disparities in treatment between heterosexual and sexual minority populations vary by urbanicity; and 3) determine whether SU-associated chronic disease disparities exist between rural and urban sexual minorities and whether sexual orientation disparities in chronic diseases vary by urbanicity. This proposal is the first step in a program of research which ultimately aims to develop behavioral and biomedical interventions tailored to the specific needs of rural and urban sexual minority populations.