Interpersonal- and Community-Level Risk Factors for Adolescent Obesity: An Examination of Sexual Identity, School Violence, and School Climate in a Large Sample of Urban Adolescents

项目摘要/摘要 青少年肥胖，这是一种可预防的慢性疾病，影响到年内超过五分之一的青少年(12-19岁) 在美国，它与心血管疾病、糖尿病和高胆固醇有关。成本 青少年肥胖每年约为140亿美元，肥胖症使预期寿命缩短 最高可达八年。性少数群体青少年(SMA；那些认为自己是男/女同性恋或双性恋的人，或 不确定自己的性别身份)的人明显更有可能肥胖，体检比率较低 与他们的异性恋同龄人相比，他们的活动和久坐行为的比率更高。校园暴力(例如， 欺凌和其他暴力行为)与肥胖有关，因此肥胖风险因负面因素而增加 应对暴力事件的健康行为参与。鉴于SMA在学校发生暴力事件 与异性恋同龄人相比，校园暴力的发生率高得不成比例，校园暴力可能会有所帮助 这是他们患肥胖症风险较高的原因。保护性的学校氛围(即，有政策和做法的学校 (保护性少数群体)是社区一级的一个重要决定因素，现已显示出减少 与性少数群体有关的校园暴力。尽管有这些已知的联系，但很少有调查研究 学校暴力和肥胖之间的关系在SMA中，没有人研究过学校是如何 气候可能会影响这种关系。拟议的研究将通过次级方案解决这些差距。 来自疾病控制和预防中心的横断面、地区级汇集数据的分析 (CDC的)青少年危险行为调查(从中我们将获得个人层面的健康行为和 人际层面的校园暴力数据)与疾控中心的学校健康档案相关联(我们将从该档案中 获取社区层面的学校气候数据)。在适应的社会生态模型的指导下，具体目标 以下是：(1)研究校园暴力和肥胖之间的联系，以及SMA和SMA之间的关系是否不同 他们的异性恋同龄人，以及(2)检查性身份、校园暴力和 以及肥胖是否会因学校氛围的不同而有所不同。建议的目标与 国家护理研究所的目标并与其支持科学的战略计划保持一致 调查促进长期健康的关键社会和环境因素，防止 在不同环境和寿命范围内发展疾病，以消除健康差距为目标。至 促进此类研究，申请者将建立她在青少年性少数群体健康方面的知识和技能 慢性病，以及多层次建模和适度分析。在一位敬业的和 国家卫生研究院资助的跨学科研究团队，以及资源丰富的环境 在哥伦比亚大学，申请者将建立一个坚实的基础，从那里走向她的长期目标 成为一名独立的护士科学家，在SMA中与肥胖相关的健康差距方面拥有专业知识。

PROJECT SUMMARY/ABSTRACT Adolescent obesity, a preventable chronic condition that affects over 1 in 5 adolescents (ages 12-19 years) in the United States, has been linked to cardiovascular disease, diabetes, and high cholesterol. The cost attributed to adolescent obesity is approximately $14 billion annually, and obesity shortens life expectancy by up to eight years. Sexual minority adolescents (SMA; those who identify as gay/lesbian or bisexual, or who are unsure of their sexual identity) are significantly more likely to be obese and to have lower rates of physical activity and higher rates of sedentary behavior compared to their heterosexual peers. School violence (e.g., bullying and other violent acts) is associated with obesity, such that obesity risk is increased due to negative health behavior engagement in response to violent events. Given that SMA experience school violence at disproportionately high rates compared to their heterosexual peers, it is possible that school violence helps account for their higher risk of obesity. A protective school climate (i.e., a school with policies and practices that protect sexual minorities) is an important community-level determinant that has been shown to decrease sexual-minority-related school violence. Despite these known associations, few investigations have examined the relationship between school violence and obesity among SMA, and none have examined how school climate may influence this relationship. The proposed study will address these gaps through secondary analysis of cross-sectional, district-level pooled data from the Centers for Disease Control and Prevention's (CDC's) Youth Risk Behavior Surveys (from which we will obtain individual-level health behaviors and interpersonal-level school violence data) linked with the CDC's School Health Profiles (from which we will obtain community-level school climate data). Guided by an adapted Social Ecological Model, the specific aims are: (1) to examine the association between school violence and obesity and whether it differs for SMA and their heterosexual peers, and (2) to examine the association among sexual identity, school violence, and obesity and whether it differs across different levels of school climate. The proposed aims are consistent with the goals of the National Institute of Nursing Research and align with its strategic plan to support science that investigates key social and environmental factors that promote long-term wellness and prevent the development of disease across settings and the lifespan, with the goal of eliminating health disparities. To facilitate such research, the applicant will build her knowledge and skills in sexual minority health, adolescent chronic disease, and multilevel modeling and moderation analysis. With the mentorship of a dedicated and National Institutes of Health-funded interdisciplinary research team, and the resource-rich environment of Columbia University, the applicant will build a strong foundation from which to move toward her long-term goal of becoming an independent nurse scientist with expertise in obesity-related health disparities among SMA.