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

项目总结 酒精是美国年轻人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)比他们的异性恋同龄人高得不成比例，尤其是 在那些处于多个边缘化身份交叉点的人中。酒精的使用和滥用与 多种短期和长期负面健康后果，包括艾滋病毒脆弱性、酒精和其他 物质使用依赖、神经认知缺陷和心理困扰。尽管事实是 青春期饮酒和滥用酒精对下游健康结果和 成人药物使用模式，迄今为止在性少数群体中的大多数研究都集中在 处于大学年龄的人口。与SMY在研究方面的差距对于纠正这一差距至关重要，特别是对SMY来说 经历基于性别、种族/民族和性取向的多种交叉形式的边缘化。 基于我们团队在这一领域的先前工作，我们建议使用来自当地青年风险中心的汇集数据 行为调查(YRBS)，一项针对高中生的两年一度的全国性调查，旨在评估性认同和 行为，以及包括饮酒、艾滋病毒易感性和精神健康在内的健康行为。我们独特的 大数据集，目前包含2005-2019年(253个管辖年限)和950,295个高位的数据 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 关于居住在美国的SMY的性、心理和身体健康，以及存在的差距 使边缘化的SMY和他们的同龄人成倍增长。这项建议是我们先前工作(R01)的自然延伸 AA024409)，导致在高影响力的同行评议期刊(例如，儿科学， 美国公共卫生杂志)和各种跨学科合作。目前的提案 将继续这些成功，结合交叉镜头以及其他先进的方法 调查，包括使用多层次模型来确定与酒精的司法和时间关联 HIV风险的使用和差异；描述酒精使用类别的潜在类别分析及其与 少数群体地位；以及影响酒精使用及其影响的地区、学校和结构层面因素的影响 在不同的SMY中艾滋病毒易感性增加方面的作用。这些方法将使我们能够继续确定 干预的关键途径，以确保公平的健康结果并最大限度地减少与以下疾病相关的风险 在明显易受伤害的青年人群中酗酒和酗酒。

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.