Reducing Black Men's Drug Use and Co-Occurring Negative Mental and Physical Health Outcomes: Intersectionality, Social-Structural Stressors, and Protective Factors

项目摘要/摘要 美国黑人男性的健康不平等现象十分严重。吸毒占前十名中的六名 18至54岁黑人男性的死因。社会结构性应激源，如歧视，基于 种族或种族和性别认同，以及使用药物来应对压力，都是有据可查的吸毒途径。 在黑人成年人中。经验证据表明，吸毒与其他负面健康后果并存 强调公共卫生迫切需要检查药物使用和其他共同发生的负面健康 与社会结构性应激源相关的结果。单轴视角--无论是种族还是性别认同-- 主导药物使用和健康差距的研究。除了艾滋病毒/艾滋病研究外，还研究了 黑人男性吸毒的社会结构性应激源和共同出现的负面健康后果 性身份(即异性恋、性少数)和社会经济地位(SEP)的交集实际上是 根本不存在。在保护因素(例如，韧性、宗教信仰、积极因素)方面也存在严重差距 种族/性别认同)影响社会结构性应激源对黑人男性吸毒和共同吸毒的影响 出现负面的健康后果。为了解决这些关键差距，纵向交叉滞后的解释- 提出了序贯(QUANT→QUAL)混合方法研究，通过结构方程模型检验 社会结构性应激源、保护性因素和药物使用(酒精、大麻、尼古丁、 非法吸毒)和同时出现的消极心理(如心理困扰)和身体(如血液) 压力)处于性别认同和SEP交叉点的黑人男性的健康结果。目的配额 抽样将用于招募960名黑人男性，年龄在18-54岁之间，按性别认同和SEP分层(240人/组) 在华盛顿特区。第一阶段包括收集自我报告的社会结构性应激源，保护性 因素、药物使用和精神健康数据，以及客观药物使用(如尿毒学)和身体健康 (例如，血压)数据在时间1，以及3个月后在时间2(目标1、2)。将采集血液样本 在时间2仅评估心血管疾病生物标记物(例如总胆固醇)。第二阶段包括4个焦点 有目的地对6-8名第一阶段参与者(总共n=24-32人)进行抽样，以解释第一阶段的结果(目标3)。 第三阶段涉及对定量和定性结果进行综合和有效性评估(目标3)。这个 拟议的研究使用交叉性、社会结构压力和弹性理论框架来 提出关于社会结构性应激源和保护措施的程度的新的重要知识 影响黑人男性吸毒和共同出现的负面健康后果的因素 性别认同和SEP。这一横截面焦点代表了传统单轴的范例转变。 以及一刀切的干预方法。本研究的意义在于预期的 多层次(即个人和社会结构)干预措施的未来发展成果，以减少 毒品使用和促进处于不同风险交叉位置的黑人男性的心理和身体健康。

PROJECT SUMMARY/ABSTRACT Health inequities among Black men in the U.S. are stark. Drug use contributes to six of the top ten leading causes of death among Black men ages 18 to 54. Social-structural stressors such as discrimination, based on race or race and sexual identity, and drug use to cope with stress, are well-documented pathways to drug use among Black adults. Empirical evidence that drug use co-occurs with other negative health outcomes underscores an urgent public health need to examine drug use and other co-occurring negative health outcomes associated with social-structural stressors. Single-axis perspectives—either race or sexual identity— dominate drug use and health disparities research. Apart from HIV/AIDS research, research on the effects of social-structural stressors on Black men’s drug use and co-occurring negative health outcomes at the intersection of sexual identity (i.e., heterosexual, sexual minority) and socioeconomic position (SEP) is virtually nonexistent. Critical gaps also exist about how protective factors (e.g., resilience, religiosity, positive racial/sexual identity) influence the effects of social-structural stressors on Black men’s drug use and co- occurring negative health outcomes. To address these critical gaps, a longitudinal cross-lagged explanatory- sequential (QUANT→qual) mixed methods study is proposed to test, via structural equation modeling, a conceptual model of social-structural stressors, protective factors, and drug use (alcohol, marijuana, nicotine, illicit drug use) and co-occurring negative mental (e.g., psychological distress) and physical (e.g., blood pressure) health outcomes among Black men at the intersection of sexual identity and SEP. Purposive quota sampling will be used to recruit 960 Black men, ages 18-54, stratified by sexual identity and SEP (240/group) in Washington, DC. Phase I includes the collection of self-reported social-structural stressors, protective factors, drug use, and mental health data, and objective drug use (i.e., urine toxicology) and physical health (e.g., blood pressure) data at Time 1, and 3 months later at Time 2 (Aims 1, 2). Blood samples will be collected at Time 2 only to assess cardiovascular disease biomarkers (e.g., total cholesterol). Phase II includes 4 focus groups with 6-8 Phase I participants (total n = 24 to 32) purposively sampled to explain Phase I results (Aim 3). Phase III involves a synthesis and validity assessment of the quantitative and qualitative results (Aim 3). The proposed research uses intersectionality, social-structural stress, and resilience theoretical frameworks to advance new and important knowledge about the extent to which social-structural stressors and protective factors influence drug use and co-occurring negative health outcomes among Black men at the intersection of sexual identity and SEP. This intersectional focus represents a paradigmatic shift from conventional single-axis and one-size-fits-all intervention approaches. The significance of the proposed research lies in the expected outcome of the future development of multi-level (i.e., individual and social-structural) interventions to reduce drug use and promote mental and physical health among Black men at different intersectional positions of risk.