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

项目概要/摘要 美国黑人男性的健康不平等是显而易见的。毒品使用占前十名中的六个 18至54岁黑人男性的死亡原因。歧视等社会结构性压力因素， 种族或种族和性身份，以及使用药物来科普压力，都是有据可查的吸毒途径 黑人成年人。经验证据表明，吸毒与其他负面健康结果同时发生 强调了迫切的公共卫生需要检查药物使用和其他共同发生的负面健康 与社会结构性压力源相关的结果。单轴视角--种族或性别认同-- 在药物使用和健康差异研究中占主导地位。除了艾滋病毒/艾滋病研究外， 黑人男性吸毒的社会结构性压力因素和同时发生的负面健康结果 性别认同的交叉点（即，异性恋者、性少数）和社会经济地位（SEP）实际上是 根本不存在在保护性因素（例如，韧性，宗教信仰，积极 种族/性别认同）影响社会结构压力对黑人男性吸毒的影响， 产生负面的健康后果。为了解决这些关键差距，纵向交叉滞后解释- 序贯（QUANT→QUAL）混合方法研究提出了测试，通过结构方程模型， 社会结构压力源、保护因素和药物使用（酒精、大麻、尼古丁、 非法药物使用）和同时发生的消极心理（例如，心理困扰）和身体（例如，血液 压力）的健康结果在黑人男性的交叉点的性别认同和SEP。 将采用抽样方法招募960名黑人男性，年龄18-54岁，按性别和SEP分层（240人/组） 在华盛顿第一阶段包括收集自我报告的社会结构压力源，保护性 因素、药物使用和心理健康数据，以及客观药物使用（即，尿液毒理学）和身体健康 (e.g.,血压）数据，3个月后的时间2（目的1，2）。将采集血样 仅在时间2评估心血管疾病生物标志物（例如，总胆固醇）。第二阶段包括4个重点 6-8名I期受试者（总人数n = 24 - 32），有目的地抽样解释I期结果（目标3）。 第三阶段涉及定量和定性结果的综合和有效性评估（目标3）。的 拟议的研究使用交叉性，社会结构压力和弹性理论框架， 推进新的和重要的知识，在多大程度上，社会结构的压力和保护 影响黑人男性吸毒和共同发生的负面健康结果的因素 这种交叉的焦点代表了从传统的单轴范式转变， 和“一刀切”的干预方法。本研究的意义在于， 多级的未来发展的结果（即，个人和社会结构）的干预措施， 毒品使用和促进精神和身体健康的黑人男子在不同的交叉位置的风险。

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.