Contextual Determinants of Sexual Minority Health in the United States

美国性少数群体健康的背景决定因素 R 01应用摘要/摘要 Kara Joyner（PI）和Wendy Manning（Co-I） 研究人员长期以来一直记录性少数人群（或性多样化人群）的健康差异 人口），他们开始记录他们的性别少数群体（或性别多样性 人口）。这些健康差异在很大程度上仍然难以解决，因为研究人员还没有能够 严格捕捉其背后的假定机制：污名。少数派压力观点认为， 性少数人群，如种族/少数民族人群，经历了更高的不良反应发生率， 健康结果比异性恋人群，由于他们在社会上的耻辱地位。研究人员测试 这种观点越来越多地衡量社会层面的耻辱或“结构性耻辱”，这一概念 同时反映社会气候（公众对性/性别少数群体的态度）和法律的气候（法律和 与性/性别少数群体有关的政策）。研究人员在充分研究 由于大多数基于人口的调查的设计，包括问题， 性少数群体的地位和健康。这些调查中很少有允许研究人员在多个不同的时间测量耻辱感。 程度.这些调查的另一个局限性是，它们是横截面的，排除了如何考虑 在一生中，遭受结构性污名的情况会发生变化。全国青少年纵向研究， 成人健康（添加健康）有必要的标准，严格调查结构性耻辱的影响， 性少数受访者的健康结果，包括一个正式和规范的机制， 和传播上下文数据。添加对测试少数群体压力和交叉性感兴趣的健康用户 观点将有前所未有的机会来研究各种结果如何与 性少数受访者的结构性耻辱，以及不同亚组之间的关联如何不同。目标1 这个项目是为了创建一个上下文数据库，研究人员可以使用它来更好地研究结构性的影响。 耻辱具体地说，该数据库将包括与性少数群体有关的社会和法律的气候措施 对应于第3、4和5波之前或前后的区域、县和州级别。这 数据库还将包括结构性种族主义的措施，因为许多性少数群体也是种族/族裔 少数群体我们将召集一个咨询小组，以确保我们有最好的措施，结构性的耻辱， 种族主义目标2将用这个上下文数据库来检查州一级的法律的气候措施是如何 与健康和健康生物标志物的自我评价有关，并考虑这些 关联因关键因素而不同（例如，性别、社会经济地位和种族/民族）。这个数据库将 促进对性别和种族少数群体健康差异的研究， 新颖啊通过创建这个上下文数据库，研究成为可能， 改善性少数群体和种族少数群体，包括亚群体健康的政策和干预措施 确保所有人都有平等的机会过上长寿、健康和富有成效的生活。

Contextual Determinants of Sexual Minority Health in the United States R01 Application Summary/Abstract Kara Joyner (PI) and Wendy Manning (Co-I) Researchers have long documented health disparities for sexual minority populations (or sexual diverse populations) and they are beginning to document them for gender minority populations (or gender diverse populations). These health disparities remain largely intractable because researchers have not been able to rigorously capture the putative mechanism behind them: stigma. The minority stress perspective posits that sexual minority populations, like racial/ethnic minority populations, experience a higher prevalence of adverse health outcomes than heterosexual populations due to their stigmatized status in society. Researchers testing this perspective have increasingly measured stigma at the societal level or “structural stigma,” a concept that captures both social climate (public attitudes towards sexual/gender minorities) and legal climate (laws and policies relevant to sexual/gender minorities). Researchers have been hampered in their ability to adequately assess the effects of structural stigma due to the design of most population-based surveys that include questions on sexual minority status and health. Few of these surveys permit researchers to measure stigma at multiple levels. Another limitation of these surveys is that they are cross-sectional, precluding a consideration of how exposure to structural stigma changes over the life course. The National Longitudinal Study of Adolescent to Adult Health (Add Health) has the necessary criteria to rigorously investigate the effects of structural stigma on the health outcomes of sexual minority respondents, including a formal and regulated mechanism for producing and disseminating contextual data. Add Health users interested in testing minority stress and intersectionality perspectives will have unprecedented opportunities to examine how various outcomes are associated with structural stigma for sexual minority respondents and how the associations differ across subgroups. Aim 1 of this project is to create a contextual database that researchers can use to better study the effects of structural stigma. Specifically, this database will include measures of social and legal climate relevant to sexual minorities that correspond to the tract, county, and state levels before or around the time of Waves 3, 4, and 5. This database will also include measures of structural racism since many sexual minorities are also racial/ethnic minorities. We will convene an advisory team to ensure we have the best measures of structural stigma and racism. Aim 2 will examine with this contextual database how state-level measures of legal climate are associated with self-rated health and health biomarkers among Add Health respondents and consider how these associations differ by key factors (e.g., gender, socioeconomic status, and race/ethnicity). This database will promote research on health disparities for sexual and racial minority populations that is both rigorous and innovative. Research made possible by the creation of this contextual database has the potential to inform policies and interventions that improve the health of sexual and racial minority populations, including subgroups of these populations, ensuring all populations have equal opportunities for long, healthy, and productive lives.