Intersectional Approaches to Population-Level Health Research: Role of HIV Risk and Mental Health in Alcohol Use Disparities among Diverse Sexual Minority Youth

项目摘要 酒精是美国青少年中最常用和滥用的药物;酒精使用的流行率是 性少数青年（SMY）的比例高于异性恋青年，特别是 处于多重边缘化身份交叉点的人。酒精的使用和滥用与 多种短期和长期的负面健康结果，包括艾滋病毒脆弱性，酒精和其他 物质依赖、神经认知缺陷和心理困扰。尽管事实上 青春期的酒精使用和滥用对下游健康结果有重要影响， 成年人的物质使用模式，迄今为止，对性少数群体的大多数研究都集中在 大学年龄人口。与SMY的研究差距至关重要，尤其是对于SMY， 经历基于性别、种族/族裔和性取向的多重交叉形式的边缘化。 基于我们团队在这一领域的前期工作，我们建议使用本地青年风险的汇总数据， 行为调查（YRBS）是一项两年一度的全国性高中生调查，评估高中生的性别认同， 行为，以及健康行为，包括饮酒，艾滋病毒脆弱性和心理健康。我们独特 大型数据集，目前包含2005年至2019年的数据（253个司法管辖区年）和950，295个高 学校青年，将扩大到包括2021年，2023年和2025年的数据，估计有1，668，078名青年。 这将使我们能够应用一系列复杂的流行病学方法来评估酒精使用的影响 关于生活在美国的SMY的性、心理和身体健康，以及 被边缘化的SMY和他们的同龄人。该建议是我们先前工作（R 01）的自然延伸 AA 024409），在高影响力的同行评审期刊上发表了大量文章（例如，儿科， 美国公共卫生杂志）和各种各样的跨学科合作。现时的建议 将继续这些成功，结合交叉透镜以及其他先进的方法， 调查，包括使用多层次建模来确定与酒精的管辖和时间关联 使用和艾滋病毒风险的差异;潜在类别分析，以描述酒精使用类别及其与 少数民族地位;以及影响酒精使用及其 在不同的SMY之间增加艾滋病毒脆弱性的作用。这些方法将使我们能够继续识别 关键的干预途径，以确保公平的健康结果，并尽量减少与 特别脆弱的青年群体中的酒精使用和滥用。

PROJECT SUMMARY Alcohol is the most commonly used and abused drug among youth in the US; prevalence of alcohol use is disproportionately higher among sexual minority youth (SMY) than among their heterosexual peers, especially among those at the intersections of multiple marginalized identities. Alcohol use and abuse are associated with a multiplicity of short and long-term negative health outcomes, including HIV vulnerabilities, alcohol and other substance use dependence, neurocognitive deficiencies, and psychological distress. Despite the fact that alcohol use and abuse during adolescence has important consequences for downstream health outcomes and adult patterns of substance use, the majority of research among sexual minorities to date has focused on college-aged populations. This gap in research with SMY is critical to rectify, particularly for SMY who experience multiple, intersecting forms of marginalization based on sex, race/ethnicity, and sexual orientation. Building on our team’s prior work in this area, we propose to use pooled data from the Local Youth Risk Behavior Survey (YRBS), a national biennial survey of high school students that assesses sexual identity and behavior, as well as health behaviors including alcohol use, HIV vulnerability, and mental health. Our uniquely large dataset, which currently contains data from 2005 to 2019 (253 jurisdiction-years) and 950,295 high school youth, will expand to include 2021, 2023, and 2025 data, resulting in an estimated 1,668,078 youth. This will allow us to apply an array of complex epidemiologic approaches to assess the impact of alcohol use on the sexual, mental, and physical health of SMY living in the US, and the disparities that exist between multiply marginalized SMY and their peers. This proposal is a natural extension of our prior work (R01 AA024409) that resulted in numerous publications in high-impact peer-reviewed journals (e.g., Pediatrics, American Journal of Public Health) and a diverse array of interdisciplinary collaborations. The current proposal will continue these successes, incorporating an intersectional lens as well as additional advanced methods of inquiry, including use of multilevel modeling to determine jurisdictional and temporal associations with alcohol use and disparities in HIV risk; latent class analysis to describe alcohol use classes and their association with minority status; and the impact of regional, school, and structural level factors that influence alcohol use and its role in increased HIV vulnerability among diverse SMY. These approaches will allow us to continue identifying critical pathways for intervention to ensure equitable health outcomes and minimize the risks associated with alcohol use and abuse among notably vulnerable populations of youth.