A mixed methods approach to understanding obesity risk among sexual minority women

项目总结/摘要 肥胖是一种可以预防和治疗的疾病，与美国的主要死亡原因有关。 国家和全世界。认定为性少数的妇女（法定最低工资;即，有性取向的女性 异性恋者以外的其他人）患肥胖症的可能性是男性和异性恋女性的两倍， 然而，人们对这些社区面临更大风险的机制知之甚少。少数民族的压力 模型，该模型假定历史上被边缘化的人群，如SMW，由于压力的增加， 在结构、人际关系和个人层面上遭受耻辱和歧视的风险增加， 应用于帮助描述潜在因素，使SMW处于超重和肥胖的更大风险。但是，在这方面， 文献中的局限性阻碍了我们解决肥胖差异的能力。首先，法定最低工资往往被视为 同质组，所以我们对SMW研究不足的亚组的风险因素知之甚少（例如，双性恋， 无性恋，酷儿，泛性恋，质疑）。第二，在对肥胖或主要疾病的有限研究中， 超重和肥胖的行为驱动因素（即，能量平衡行为，如饮食，体力活动， 在法定最低工资中，过度依赖横断面、回顾性自我报告或半 年度纵向设计。虽然这些研究为理解行为风险因素提供了基础 在SMW中，这些方法所能提供的数据有限。经验抽样方法（ESM）可以 通过识别肥胖的时间上接近的风险因素来推进我们的理解（例如，因素预测 体力活动或高热量摄入），并从相关因素中分离出风险因素。我将指挥一个混合的 方法研究描述可能与SMW中肥胖风险相关的因素和机制， 这与NIMHD的研究重点是寻求健康背后的机制和途径高度一致 在健康差距人群中造成更差结果的决定因素。首先，我将利用定性的生活史 方法，以确定与发展和维持体重相关的初步因素， 认知和行为（目标1）。其次，我将使用ESM来测试目标1中确定的初步模型， 在自然环境中，在真实的时间内检查少数压力源和体重相关行为之间的关系 不同性取向认同的法定最低工资的环境（目的2）。这些目标支持我的训练 我将在以下方面接受专家指导和培训：对法定最低工资肥胖结果的多层面影响 （培训目标1）;定性数据收集和分析（培训目标2）;无害环境管理和高级统计 无害环境管理数据（培训目标3）;职业发展（培训目标4）。结果将用于通知模型 我将在一项严格的、大规模的纵向试验中进行测试， （R01）。这个K 01将使我具备成为促进SMW行为健康的领导者的技能。

PROJECT SUMMARY/ABSTRACT Obesity, a preventable and treatable condition, is associated with the leading causes of death in the United States and worldwide. Women who identify as sexual minorities (SMW; i.e., women with sexual orientations other than heterosexual) are up to twice as likely to have obesity compared to men and heterosexual women, yet little is known about the mechanisms that confer heightened risk for these communities. The minority stress model, which posits that historically marginalized populations, such as SMW, are at increased risk for stress due to increased exposure to stigma and discrimination at the structural, interpersonal, and individual levels, can be applied to help delineate potential factors that place SMW at greater risk for overweight and obesity. However, limitations in the literature hinder our ability to address obesity disparities. First, SMW are often treated as a homogeneous group, so we know little about risk factors for understudied subgroups of SMW (e.g., bisexual, asexual, queer, pansexual, questioning). Second, among the limited research on obesity or the primary behavioral drivers of overweight and obesity (i.e., energy-balance behaviors such as diet, physical activity, and sedentary activity) among SMW, there is an overreliance on cross-sectional, retrospective self-report, or semi- annual longitudinal designs. While these studies provide a foundation for understanding behavioral risk factors among SMW, these methods are limited in the data they can provide. Experience sampling methods (ESM) can advance our understanding by identifying temporally proximal risk factors for obesity (e.g., factors predicting physical activity or high caloric intake) and disentangling risk factors from correlates. I will conduct a mixed methods study to delineate factors and mechanisms that may be associated with obesity risk among SMW, which is highly aligned with NIMHD’s focus on research that seeks mechanisms and pathways behind health determinants that confer worse outcomes in health disparity populations. First, I will utilize a qualitative life history approach to identify preliminary factors associated with the development and maintenance of weight-related cognitions and behaviors (Aim 1). Second, I will use ESM to test the preliminary model identified in Aim 1 and examine relationships between minority stressors and weight-related behaviors in real time in the natural environment among SMW from diverse sexual orientation identities (Aim 2). These aims support my training plan in which I will receive expert mentorship and training in: multi-level influences on SMW obesity outcomes (Training Aim 1); qualitative data collection and analysis (Training Aim 2); ESM and advanced statistics for ESM data (Training Aim 3); and career development (Training Aim 4). Results will be used to inform a model of minority stress and obesity among SMW, which I will then test in a rigorous, large-scale, longitudinal trial (R01). This K01 will equip me with the skills to become a leader in promoting SMW behavioral health.