Changes in the Social and Policy Environment as Predictors of Substance Use and Health-Related Quality of Life Among Sexual Minorities

社会和政策环境的变化作为性少数群体药物使用和健康相关生活质量的预测因素

• 批准号: 9529635
• 负责人: Allegra Raboff Gordon
• 金额: $ 6.57万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-01 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9529635
• 关键词: 14 year old; Address; Adolescent Development; Adolescent and Young Adult; Adverse effects; Affect; Age; Alcohol or Other Drugs use; Appearance; Attention; Behavior; Bisexual; Buffers; Child; Chronic Disease; Civil Rights; Data; Databases; Development; Discrimination; Economics; Enrollment; Environment; Equation; Ethnic Origin; Event; Exposure to; Fellowship; Feminine; Future; Gays; Gender; Generations; Goals; Health; Health Status; Healthy People 2020; Heterogeneity; Heterosexuals; Individual; Injury; Intervention; Latino; Laws; Lesbian; Lesbian Gay Bisexual; Lesbian Gay Bisexual Transgender; Life; Longitudinal cohort; Masculine; Mediating; Mental Health; Mentors; Methods; Minority; Modeling; Modification; Nurses' Health Study; Outcome; Patient Self-Report; Pattern; Policies; Policy Analysis; Population; Population Heterogeneity; Probability Samples; Productivity; Public Health; Quality of life; Race; Research; Risk; Role; Sampling; Sex Orientation; Social Environment; Social Policies; Social support; Statistical Methods; Stress; Substance Addiction; Testing; Time; Training; United States Dept. of Health and Human Services; Violence; Woman; Youth; adolescent substance use; bullying; cohort; experience; gender nonconforming; health equity; health related quality of life; improved; innovation; peer; protective factors; recruit; reduced substance use; resilience; response; self esteem; sexual minority; skills; social; social stigma; stress resilience; stressor

Project Summary/Abstract Sexual minority (i.e., lesbian, gay, bisexual, and mostly heterosexual) young people in the U.S. have elevated risk of substance use and adverse mental health outcomes compared to their heterosexual peers. These health inequities may be the result of social stressors such as stigma and discrimination that can influence health at multiple levels, including individual (e.g., interpersonal discrimination) and structural levels (e.g., discriminatory state policies). Yet little is known about how these individual- and structural-level social stressors or resilience factors (e.g., social support) contribute to health inequities in substance use and how they affect health-related quality of life (HRQOL). There is a pressing need to understand (i) how changes over time in structural discrimination (e.g., law and policy) may relate to substance use and HRQOL across sexual orientation groups and (ii) heterogeneity within sexual minorities, such as patterning of multi-level stressors across race/ethnicity, gender (including gender nonconformity, which can be a target for discrimination), and age cohort. To address these research imperatives, this project will focus on the following aims: (1) Examine the interplay between structural-level stressors and sexual orientation in the development of substance use and HRQOL. Using longitudinal cohort data and a state-level database of changes in laws and policies relevant to sexual minority civil rights, analyses will examine effect modification of the association between sexual orientation and substance use and HRQOL by state-level structural discrimination over the course of adolescent development. (2) Elucidate the relationships between structural- and individual-level stressors and substance use and HRQOL among diverse sexual minorities, using data from two complementary national cohorts of sexual minorities. Analyses will compare associations between state-level structural discrimination, self- reported experiences of discrimination, resilience factors, and risk of substance use and poor HRQOL and will examine differential patterning of social stressors by race/ethnicity, gender nonconformity, and age cohort. To achieve these aims the research will utilize data from (i) the Growing Up Today Study, a longitudinal cohort of 27,000 youth who were recruited when they were ages 9-14 and are now in their 20s-to-30s, and (ii) the Generations Study, a national probability sample of 676 U.S. Black, Latino and White sexual minorities in three age cohorts, representing generations that came of age in disparate social and policy environments with regards to sexual orientation. Longitudinal statistical methods and structural equation modeling will be used to examine the above aims. The proposed research will be among the first to examine multilevel U.S. social and policy contexts in relation to sexual orientation inequities in substance use and HRQOL. Findings will enhance understanding of key mechanisms in the development of sexual orientation-related health inequities and will inform interventions to mitigate stressors and strengthen protective factors for sexual minority youth.

项目总结/摘要 性少数群体（即，女同性恋、男同性恋、双性恋和大多数异性恋）的年轻人在美国有 与异性恋同龄人相比，他们使用药物的风险更高，心理健康结果也更差。 这些卫生不公平现象可能是社会压力因素的结果，如耻辱和歧视， 在多个层面上影响健康，包括个人（例如，人际歧视）和结构层面 (e.g.,歧视性政策）。然而，人们对这些个体和结构层面的社会 压力源或弹性因素（例如，社会支持）在药物使用方面造成卫生不公平现象， 影响健康相关生活质量（HRQOL）。有一个迫切需要了解（i）如何改变 结构性歧视的时间（例如，法律和政策）可能与药物使用和HRQOL有关， 取向群体和（ii）性少数群体内的异质性，如多层次压力源的模式 跨种族/民族、性别（包括性别不一致，这可能成为歧视的目标），以及 年龄组为了解决这些研究需要，该项目将侧重于以下目标： (1)研究结构层面的压力源和性取向之间的相互作用， 物质使用和HRQOL的发展。使用纵向队列数据和国家级数据库， 与性少数群体公民权利有关的法律和政策的变化，分析将审查 性取向与物质使用和HRQOL之间的关联 在青少年发展过程中的歧视。 (2)阐明结构和个人层面的压力源与物质之间的关系 使用来自两个互补的国家队列的数据， 性少数分析将比较国家一级的结构性歧视，自我， 报告的歧视经历、弹性因素、药物使用风险和HRQOL差， 研究种族/民族，性别不一致性和年龄组的社会压力源的差异模式。 为了实现这些目标，研究将利用来自以下方面的数据：（一）《今日成长研究》，一项纵向研究， 27，000名9-14岁的年轻人被招募，现在他们20多岁到30多岁，以及（ii） 世代研究，一个全国性的概率样本676美国黑人，拉丁美洲人和白色性少数民族， 三个年龄组，代表了在不同的社会和政策环境中成长的几代人， 关于性取向。纵向统计方法和结构方程模型将用于 查看上述目标。这项拟议中的研究将是第一个研究美国多层次社会和 政策背景与物质使用和HRQOL中的性取向不平等有关。调查结果将提高 了解与性取向有关的健康不公平现象发展的关键机制， 采取知情干预措施，减轻性少数青年的压力，加强保护性因素。

项目成果

Sexual orientation-related disparities in healthcare access in three cohorts of U.S. adults.

• DOI: 10.1016/j.ypmed.2020.105999
• 发表时间: 2020-03
• 期刊: Preventive medicine
• 影响因子: 5.1
• 作者: Tabaac AR;Solazzo AL;Gordon AR;Austin SB;Guss C;Charlton BM
• 通讯作者: Charlton BM

Childhood Gender Nonconformity and Intimate Partner Violence in Adolescence and Young Adulthood.

• DOI: 10.1177/0886260518770643
• 发表时间: 2021-03
• 期刊: JOURNAL OF INTERPERSONAL VIOLENCE
• 影响因子: 2.5
• 作者: Adhia, Avanti;Gordon, Allegra R.;Roberts, Andrea L.;Fitzmaurice, Garrett M.;Hemenway, David;Austin, S. Bryn
• 通讯作者: Austin, S. Bryn

Gender Expression, Peer Victimization, and Disordered Weight-Control Behaviors Among U.S. High School Students.

• DOI: 10.1016/j.jadohealth.2020.08.032
• 发表时间: 2021-06
• 期刊: The Journal of adolescent health : official publication of the Society for Adolescent Medicine
• 作者: Gordon AR;Austin SB;Schultz J;Guss CE;Calzo JP;Wang ML
• 通讯作者: Wang ML