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

了解性少数女性肥胖风险的混合方法

• 批准号: 10507447
• 负责人: Lauren Alina Fowler
• 金额: $ 14.91万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-06 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10507447
• 关键词: Address; Adult; Affect; Age; American; Area; Behavior; Behavioral; Bisexual; Cause of Death; Chronic Disease; Cognition; Communities; Data; Data Analyses; Data Collection; Development; Diabetes Mellitus; Diet; Dietary intake; Discrimination; Ecological momentary assessment; Energy Intake; Ensure; Environment; Ethnic group; Exposure to; Foundations; Funding; Gays; Generations; Health; Health Disparities Research; Health behavior; Heart Diseases; Heterosexuals; Individual; Institute of Medicine (U.S.); Intervention; Interview; Knowledge; Lesbian; Lesbian Gay Bisexual Transgender; Literature; Mentorship; Methods; Modeling; National Institute on Minority Health and Health Disparities; Obesity; Outcome; Overweight; Pathway interactions; Patient Self-Report; Phase; Physical activity; Population; Populations at Risk; Predictive Factor; Prevalence; Prevention; Qualitative Research; Research; Research Personnel; Research Support; Risk; Risk Factors; Sampling; Sex Orientation; Strategic Planning; Stress; Stroke; Subgroup; Testing; Time; Training; United States; United States National Institutes of Health; Variant; Weight; Weight Gain; Woman; Work; asexual; behavioral health; cancer type; career development; disease disparity; energy balance; ethnic minority; experience; health disparity; health disparity populations; intersectionality; large scale data; life history; longitudinal design; marginalized population; men; minority health disparity; minority stress; minority stressor; obesity risk; pansexual; programs; queer; racial and ethnic; resilience; sedentary activity; sexual minority; sexual minority health; sexual minority women; skills; social; social stigma; statistics; theories; weight maintenance

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.

项目摘要/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。 美国和世界各地。自认为是性少数群体的妇女(SMW；即有性取向的妇女 除异性恋外)患肥胖症的可能性是男性和异性恋女性的两倍， 然而，人们对导致这些社区面临更高风险的机制知之甚少。小众压力 模型，该模型假设历史上被边缘化的人群，如SMW，面临着更大的压力风险 在结构、人际和个人层面上暴露于更多的耻辱和歧视，可能是 应用于帮助描述将SMW置于更大超重和肥胖风险中的潜在因素。然而， 文献中的局限性阻碍了我们解决肥胖差异的能力。首先，SMW通常被视为 同质性群体，因此我们对未被研究的SMW亚群的风险因素知之甚少(例如，双性恋， 无性恋、同性恋、泛性恋、质疑)。第二，在有限的关于肥胖或初级肥胖的研究中 超重和肥胖的行为驱动因素(即能量平衡行为，如饮食、体力活动和 久坐活动)在SMW中，过度依赖横断面、回溯性自我报告或半 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 通过确定肥胖的时间近端风险因素(例如，预测因素)来加深我们的理解 体力活动或高卡路里摄入量)，并将危险因素与相关因素分开。我将进行一场混合的 方法研究描述可能与SMW肥胖风险相关的因素和机制， 这与NIMHD对寻找健康背后的机制和途径的研究的关注高度一致 在健康差距人群中导致更糟糕结果的决定因素。首先，我将利用一段定性的生活史 确定与体重相关的发展和维持相关的初步因素的方法 认知和行为(目标1)。其次，我将使用ESM测试目标1中确定的初步模型和 在自然环境中实时检查少数民族应激源与体重相关行为之间的关系 来自不同性取向身份的SMW的环境(目标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的计划：对SMW肥胖结果的多层次影响 (培训目标1)；定性数据收集和分析(培训目标2)；环境监测和高级统计 ESM数据(培训目标3)；职业发展(培训目标4)。结果将被用来通知模型 在SMW中的少数民族压力和肥胖，然后我将在一项严格的、大规模的纵向试验中进行测试 (R01)。这款K01将使我具备成为一名促进SMW行为健康的领导者的技能。