Examining biomarkers and mechanisms of health disparities in sexual minority women

项目摘要 重要性：与异性恋女性相比，女同性恋/男同性恋和双性恋（LGB）女性的身体健康率更高 问题目前的证据，主要是基于自我报告，表明重要的健康差异存在的条件， 具有高发病率和死亡率（例如，糖尿病、心脏病）。然而，到目前为止，还没有研究测试了 在年轻成年人的代表性样本中，客观衡量LGB和异性恋妇女之间的健康风险。我们的目标是 通过使用严格的客观健康生物标志物（即心脏代谢功能）检查推定的健康差异来填补这一空白 和炎症）在年轻的成年人中的代表性，种族多样性的年轻女性样本， 正在进行的纵向研究，匹兹堡女孩研究（PGS）（目标1）。我们将把前瞻性收集的歧视数据 压力和童年逆境，以确定压力暴露在性少数地位和 早期成人健康（目标2）。最后，我们将测试青春期的健康促进是否会减弱 男女同性恋、双性恋和变性妇女的歧视压力和健康风险（目标3）。方法：我们的计划是利用全面的， 从PGS前瞻性收集数据，并测量PGS中LGB妇女（n=230）的当前健康指标， 人口统计学频率匹配样本的异性恋妇女（n=230）在成年早期（年龄22-25岁）。评估 健康将包括：腰围，血压，血脂，胆固醇，脂肪酸，葡萄糖，胰岛素，促炎细胞因子 (IL-6 TNF-α）和C-反应蛋白。我们建议通过皮质醇和心率对实验室的反应来评估歧视压力- 基于歧视压力源和感知的歧视经历，每年和前瞻性地从15岁到21岁进行测量 年儿童逆境（家庭压力、创伤、虐待和同伴伤害）每年在PGS中进行评估， 青少年和看护者报告。在青春期的身心健康促进已在一些评估， PGS中的方式，包括疫苗摄取，安全的性行为，和身体活动，支持性的成人存在，并将 并辅以关于学校气氛和出柜经历的访谈。研究人员：Kathryn Keenan博士是负责人 研究者Alison Hipwell、Stephanie Stepp、Karen马修斯、Alicia马修斯和Alida Bouris博士是合作研究者， 女士Kristen Wroblewski是生物统计学家。康斯坦斯·哈曼博士是顾问调查人员已经导致许多 成功的NIH资助的研究，并代表在发展精神病理学，妇女的心理健康，性 少数民族身心健康、健康心理学和生物统计学。总的来说，调查人员在以下方面有经验： 对易感人群进行TSST管理，测量皮质醇反应性，并检验涉及心脏代谢的假设。 和炎症功能。环境：该提案建立在以下各方长期、富有成效的合作基础之上： 芝加哥大学、伊利诺斯大学和匹兹堡大学的研究人员。创新/影响：拟议的研究提供了一个 这是一个前所未有的机会，以严格的方式探索LGB妇女的健康差异， 哪些性取向会带来健康风险，并在一个有代表性的和种族多样的样本中确定保护因素， LGB和异性恋女性

Project Summary Significance: Compared to heterosexual women, lesbian/gay and bisexual (LGB) women report higher rates of physical health problems. Current evidence, which is largely based on self-report, suggests that important health disparities exist in conditions with high rates of morbidity and mortality (e.g., diabetes, heart disease). To date, however, no study has tested differences in objective measures of health risks between LGB and heterosexual women in a representative sample of young adults. We aim to fill this gap by examining putative health disparities using rigorous objective biomarkers of health (i.e. cardiometabolic functioning and inflammation) in young adulthood in a representative, racially diverse sample of young women who are participating in an ongoing longitudinal study, the Pittsburgh Girls Study (PGS) (Aim 1). We will link prospectively gathered data on discrimination stress and childhood adversity to determine the role of stress exposure in the association between sexual minority status and early adult health (Aim 2). Finally, we will test whether health promotion during adolescence attenuates the association between discrimination stress and health risks among LGB women (Aim 3). Approach: Our plan is to leverage comprehensive, prospectively collected data from the PGS and measure current health indicators among LGB women in the PGS (n=230) and a demographic frequency matched sample of heterosexual women (n=230) in early adulthood (ages 22-25 years). Assessments of health will include: waist circumference, blood pressure, lipids, cholesterol, fatty acids, glucose, insulin, proinflammatory cytokines (IL-6; TNF-α), and C-reactive protein. We propose to assess discrimination stress via cortisol and heart rate reactivity to a lab- based discrimination stressor and perceived discrimination experiences measured annually and prospectively from ages 15 to 21 years. Childhood adversity (family stress, trauma, abuse, and peer victimization) has been assessed annually for in the PGS from youth and caregiver reports. Physical and emotional health promotion during adolescence has been assessed in a number of ways in the PGS including vaccine uptake, safe sexual practices, and physical activity, supportive adult presence, and will be complemented by interviews on school climate and coming out experiences. Investigators: Dr. Kathryn Keenan is the Principal Investigator, Drs. Alison Hipwell, Stephanie Stepp, Karen Matthews, Alicia Matthews and Alida Bouris are Co-Investigators, and Ms. Kristen Wroblewski is the biostatistician. Dr. Constance Hammen is the consultant. The investigators have led many successful NIH-funded studies and represent expertise in developmental psychopathology, women's mental health, sexual minority physical and mental health, health psychology, and biostatistics. Collectively, the investigators have experience in administering the TSST to vulnerable populations, measuring cortisol reactivity, and testing hypotheses involving cardiometabolic and inflammatory functioning. Environment: This proposal builds on long-standing, productive collaborations among investigators at the Universities of Chicago, Illinois, and Pittsburgh. Innovation/Impact: The proposed study provides an unprecedented opportunity to explore health disparities in LGB women in a rigorous manner, examine potential mechanisms by which sexual orientation confers health risks, and identify protective factors in a representative and racially diverse sample of LGB and heterosexual women.