Cardiovascular Health Associations with Minority stress: Biobehavioral Evaluations and self-Reported Sociopsychological outcomes by SOGI status (CHAMBERS)

心血管健康与少数群体压力的关联：生物行为评估和按 SOGI 状态自我报告的社会心理学结果 (CHAMBERS)

• 批准号: 10663927
• 负责人: Lauren Brittany Beach
• 金额: $ 73.61万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-09 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10663927
• 关键词: Address; Adult; Ancillary Study; Behavior assessment; Behavioral; Black race; Cardiovascular Diseases; Cholesterol; Chronic stress; Clinical; Collaborations; Communities; Coronary artery; County; Data; Development; Diabetes Mellitus; Diet; Discrimination; Disease; Disease Outcome; Disparity; Distal; Distress; Ethnic Origin; Evaluation Reports; Funding; Gender Identity; Goals; Health; Health Promotion; High Prevalence; Hispanic; Hispanic Community Health Study; Household; Hypertension; Incidence; Individual; Investigation; Latino; Latino Population; Laws; Life Cycle Stages; Link; Literature; Longitudinal cohort study; Measures; Mediating; Mental Depression; Modeling; National Heart, Lung, and Blood Institute; Obesity; Outcome; Participant; Pathway interactions; Patient Self-Report; Persons; Policy Maker; Population; Population Heterogeneity; Prevalence; Race; Research Personnel; Resources; Risk; Risk Behaviors; Risk Factors; Same-sex; Sex Orientation; Sexual and Gender Minorities; Smoking; Social Power; Social support; Socioeconomic Status; Stigmatization; Stress; System; Testing; Time; adjudication; aged; behavior measurement; biobehavior; cardiovascular disorder epidemiology; cardiovascular disorder risk; cardiovascular health; clinical development; clinical risk; cohort; community center; disease disparity; enhancing factor; evidence base; experience; gender minority; gender minority community; gender minority group; gender minority health; health disparity; health equity; improved; innovation; internalized stigma; lens; marginalization; marginalized population; minority disparity; minority health disparity; minority stress; peer; physical conditioning; physical inactivity; population health; promote resilience; psychological distress; psychological outcomes; psychosocial; sex; social stigma; stressor; theories; young adult

PROJECT SUMMARY Sexual minority and gender minority (SGM) individuals experience a wide variety of health disparities compared to their non-SGM peers. These disparities include higher prevalence of cardiovascular disease (CVD) risk factors tied to psychological distress (e.g., depression, stress), behavioral CVD risk factors (smoking, physical inactivity, diet), and clinical CVD risk factors (e.g., diabetes, obesity, hypertension, high cholesterol). Existing SGM population health studies rely primarily on self-reported measures to document CVD risk factors and disease prevalence, thus ignoring undiagnosed clinical CVD risk factors present among younger populations. Though these studies have laid important groundwork to document the existence of SGM CVD disparities, the absence of objective measures of CVD risk factors and outcomes therefore remains a critical gap in the SGM health literature. Minority stress theory (MST) is the leading framework proposed to explain the wide-ranging health disparities observed among marginalized populations. In MST models, structural stigma (e.g., anti-SGM laws) is viewed as leading to and exacerbating distal (discrimination) and proximal stressors (internalized stigma, perceived stigma). These stigma-related stressors can contribute to poor SGM health via enhanced psychosocial distress and CVD risk behaviors. These pathways add to the higher chronic stress burden associated with the development of clinical CVD risk factors. Increasingly, MST- derived frameworks also reflect that resilience promoting factors at multiple levels (e.g., identity affirmation, social support) can decrease the harmful population health effects of stigma. Applying a theoretically-driven intersectional lens, we propose to build on studies describing the existence of SGM CVD disparities by contextualizing these disparities across person, place, and time in relation to social power systems. We propose an ancillary study to CARDIA to collect sexual orientation and gender identity (SOGI) data as well as measures of SGM stigma and resilience promoting factors in the Year 35 CARDIA exam. Through an innovative collaboration, we also propose to pool CARDIA data with data from the Hispanic Community Health Study/Study on Latinos (HCHS/SOL) cohort to address the following compelling and timely Specific Aims: Aim 1: Assess how behavioral and clinical CVD risk factors vary by SGM status over the life course. Aim 2: Among SGM participants (n=734), investigate how stigma and resilience promoting factors at the internalized and interpersonal levels associated with behavioral and clinical CVD risk factors. Aim 3: Determine the influence of SGM structural stigma on behavioral and clinical CVD risk factors. Overall, the impact of these studies will be to advance CVD epidemiology and to enhance the evidence base to ameliorate SGM CVD health disparities and promote SGM CVD health equity at the intersections of multiple marginalized identities.

项目概要 性少数群体和性别少数群体 (SGM) 个体经历着各种各样的健康差异 与非 SGM 同行相比。这些差异包括心血管疾病的患病率较高 (CVD) 与心理困扰相关的风险因素（例如抑郁、压力）、行为 CVD 风险因素 （吸烟、缺乏运动、饮食）和临床 CVD 危险因素（例如糖尿病、肥胖、高血压、高血压） 胆固醇）。现有的 SGM 人口健康研究主要依靠自我报告的措施来记录 CVD 危险因素和疾病患病率，因此忽略了人群中存在的未确诊的临床 CVD 危险因素 年轻的人群。尽管这些研究为记录 SGM 的存在奠定了重要的基础 因此，CVD 差异、缺乏 CVD 危险因素和结果的客观衡量标准仍然是一个问题 SGM 健康文献中的关键空白。少数派压力理论 (MST) 是提出的领先框架 解释边缘化人群中观察到的广泛健康差异。在 MST 模型中， 结构性耻辱（例如，反 SGM 法律）被视为导致并加剧远端（歧视）和 近端压力源（内在耻辱、感知耻辱）。这些与耻辱相关的压力源可能会导致 由于社会心理困扰和心血管疾病风险行为增加，导致 SGM 健康状况不佳。这些途径增加了 较高的慢性压力负担与临床心血管疾病危险因素的发展相关。越来越多的 MST- 衍生框架还反映了多个层面的复原力促进因素（例如身份确认、 社会支持）可以减少耻辱对人口健康的有害影响。应用理论驱动 交叉透镜，我们建议以描述 SGM CVD 差异存在的研究为基础 将这些不同人、不同地点和不同时间的差异与社会权力系统联系起来。我们 向 CARDIA 提出一项辅助研究，收集性取向和性别认同 (SOGI) 数据以及 在 35 年级 CARDIA 考试中衡量 SGM 耻辱感和复原力促进因素。通过一个 创新合作，我们还建议将 CARDIA 数据与西班牙社区健康中心的数据汇集起来 研究/拉丁裔研究 (HCHS/SOL) 队列旨在解决以下令人信服且及时的具体目标： 目标 1：评估生命历程中行为和临床 CVD 危险因素如何因 SGM 状态而变化。目标 2：其中 SGM参与者（n = 734），调查耻辱感和复原力促进因素如何内化和 与行为和临床心血管疾病危险因素相关的人际关系水平。目标 3：确定影响 SGM 对行为和临床 CVD 危险因素的结构耻辱。总体而言，这些研究的影响将是 推进CVD流行病学并增强改善SGM CVD健康差距的证据基础 促进SGM CVD在多重边缘化身份交叉点的健康公平。