Health, Stress, and Tobacco Use Disparities among Sexual Minority Populations

项目摘要/摘要 为响应PA-15-261：性少数群体和性别少数群体的健康，该项目“健康， 性少数人群中的压力和烟草使用差异“建议使用现有的 具有全国代表性的数据集，用于评估性取向、歧视、压力、 烟草/尼古丁使用行为和DSM-5烟草使用障碍在美国烟草使用中仍处于领先地位 可预防的死因；吸烟每年导致超过48万人死亡 美国过去的研究普遍发现，性少数群体吸烟和其他疾病的风险更高 烟草/尼古丁的使用。然而，这些研究中的许多都受到方法学局限性的困扰，包括 样本少、没有代表性、缺乏异性比较群体和/或性取向有限 措施。到目前为止，还没有全国性的代表性研究检查dsm-5烟草使用障碍。 性少数群体之间存在差异，关于严重程度、共病、残疾、寻求帮助和 性少数群体中与DSM-5烟草使用障碍相关的康复。因此，我们建议在此基础上 2012-2013年全国白酒流行病学调查前期工作及二次分析 和相关条件(NESARC-III)，对36,309名18岁和18岁的美国成年人进行的具有全国代表性的调查 NESARC-III研究代表了唯一具有全国代表性的研究， 测试潜在年龄、性别、种族/民族和社会经济地位的措施和样本量 我们的研究目的是：(1)检查(A)香烟的流行率 吸烟、电子烟使用和其他烟草/尼古丁使用，(B)DSM-5烟草使用障碍严重程度(包括 烟草和/或尼古丁产品)，以及(C)DSM-5烟草使用障碍和精神健康的共病 基于性取向的主要维度(吸引力、行为和认同感)的障碍；(2)评估 残疾(例如，一般健康、身体功能和社会功能)、寻求帮助(例如，咨询， 尼古丁替代疗法和药物)与康复(例如，早期和持续缓解)相关 与烟草/尼古丁使用和DSM-5烟草使用障碍基于性取向；以及(3)确定 应激事件、性取向歧视(个人层面和机构层面)、 烟草/尼古丁使用和DSM-5烟草使用障碍综合发展和 少数应激模型。该项目将利用2012-2013年提供的独特机会 NESARC-III：提供具有大量性少数群体的族裔/种族多样性样本； 纳入基于吸引力、行为和身份的多种性取向衡量标准；以及 关于吸烟、其他烟草/尼古丁使用、DSM-5烟草使用障碍和DSM-5的大量数据 精神健康障碍。衡量有压力的生活事件和性取向歧视将使 评估被推定为导致性少数群体健康差异的两个主要因素。

PROJECT SUMMARY/ABSTRACT In response to PA-15-261: The Health of Sexual and Gender Minority Populations, this project “Health, Stress, and Tobacco Use Disparities among Sexual Minority Populations” proposes to use an existing nationally representative dataset to assess the relationships among sexual orientation, discrimination, stress, tobacco/nicotine use behaviors, and DSM-5 tobacco use disorder in the U.S. Tobacco use remains the leading preventable cause of death; cigarette smoking is responsible for more than 480,000 deaths per year in the U.S. Past research has generally found sexual minorities are at heightened risk for cigarette smoking and other tobacco/nicotine use. However, many of these studies are plagued by methodological limitations including small, non-representative samples, lack of heterosexual comparison groups and/or limited sexual orientation measures. To date, no nationally representative studies have examined the DSM-5 tobacco use disorder disparities among sexual minorities and few data exists on severity, comorbidity, disability, help seeking, and recovery associated with DSM-5 tobacco use disorder among sexual minorities. Thus, we propose to build on our prior work and conduct secondary analyses of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III), a nationally representative survey of 36,309 U.S. adults 18 years and older in the U.S. The NESARC-III study represents the only nationally representative study that has sufficient measures and sample size to test for potential age, gender, racial/ethnic, and socioeconomic status differences and to meet the objectives of our study, which aims to: (1) examine the prevalence of (a) cigarette smoking, e-cigarette use, and other tobacco/nicotine use, (b) DSM-5 tobacco use disorder severity (includes tobacco and/or nicotine products), and (c) comorbidity of DSM-5 tobacco use disorder and mental health disorders based on major dimensions of sexual orientation (attraction, behavior, and identity); (2) assess the disability (e.g., general health, physical functioning, and social functioning), help seeking (e.g., counseling, nicotine replacement therapy, and medication), and recovery (e.g., early and sustained remission) associated with tobacco/nicotine use and DSM-5 tobacco use disorder based on sexual orientation; and (3) determine the relationships among stressful events, sexual orientation discrimination (individual-level and institutional-level), tobacco/nicotine use and DSM-5 tobacco use disorder based on the Comprehensive Developmental and Minority Stress Model. This project will take advantage of the unique opportunities afforded by the 2012-2013 NESARC-III: the availability of an ethnically / racially diverse sample with large numbers of sexual minorities; the inclusion of multiple measures of sexual orientation based on attraction, behavior and identity; and the wealth of data on cigarette smoking, other tobacco/nicotine use, DSM-5 tobacco use disorder, and DSM-5 mental health disorders. Measures of stressful life events and sexual orientation discrimination will enable assessment of two of the major factors presumed to account for health disparities among sexual minorities.