An intersectional approach linking Minority Stressors Experienced by Transgender and Gender Diverse Adults to Alcohol and Drug Use and comorbid Mental and Physical Health Outcomes

一种交叉方法，将跨性别和性别多样化成年人经历的少数压力源与酒精和毒品使用以及共病心理和身体健康结果联系起来

• 批准号: 10503449
• 负责人: LAURA F SALAZAR
• 金额: $ 48.97万
• 依托单位: GEORGIA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10503449
• 关键词: Acute; Adult; Advertisements; Affect; Age; Alcohol abuse; Alcohol consumption; Alcohols; Anxiety; Behavior; Biological Markers; Blood Pressure; Body mass index; Buffers; Cardiovascular Diseases; Cheek structure; Chronic; Chronic stress; Clip; Communities; Data; Diabetes Mellitus; Discrimination; Distal; Drug Use Disorder; Drug usage; Ecological momentary assessment; Ethnic Origin; Etiology; Evidence based treatment; Frequencies; Gender; Gender Identity; Goals; Gonadal Steroid Hormones; Hair; Health; Health Status; Health behavior; Heterogeneity; High Prevalence; Individual; Individual Differences; Inequity; Infrastructure; Interpersonal Violence; Intervention; Knowledge; Link; Measurement; Measures; Mental Depression; Mental Health; Methodology; Modeling; Obesity; Observational Study; Online Systems; Outcome; Participant; Pathway interactions; Patient Self-Report; Physiological; Policies; Population; Post-Traumatic Stress Disorders; Prevention; Prevention program; Prevention strategy; Process; Prospective, cohort study; Race; Reduce health disparities; Research; Resources; Risk; Risk Factors; Role; Saliva; Sampling; Shapes; Sleep; Social Identification; Social support; Stigmatization; Stress; Subgroup; Surveys; Swab; Victimization; Violence; Waist-Hip Ratio; acute stress; alcohol abuse therapy; alcohol use disorder; cisgender; community organizations; community-level factor; comorbidity; contextual factors; design; ethnic identity; evidence base; experience; follow-up; gender affirmation; gender affirming therapy; gender diversity; health care service utilization; health difference; health disparity; individual variation; intersectionality; marginalization; meetings; microaggression; minority stress; minority stressor; nonbinary; outcome disparities; peer; physical conditioning; prospective; racial diversity; racial identity; recruit; resilience factor; sex assigned at birth; sexual violence; social; social stigma; sociodemographics; stressor; suicidal; theories; transfeminine; transgender; transmasculine; treatment program

Abstract Transgender, and gender diverse adults (TGDAs) experience severe inequities rooted in and reflective of historical stigmatization due to their gender status and resulting in significant health disparities. In accordance with minority stress theory, systematic oppression, discrimination, and stigma are distal stressors that manifest through experiences of interpersonal violence and microaggressions. These experiences can lead to increased levels of stress and, in turn, alcohol abuse and drug use. Consequently, TGDAs experience high prevalence of adverse mental health and physical health outcomes in comparison to their cisgender counterparts. These risk factors and experiences of stress may increase the likelihood of TGDAs’ experiencing and/or perpetrating interpersonal violence. Unfortunately, few efficacious, comprehensive strategies for prevention and treatment of alcohol abuse, drug use, interpersonal violence, mental health and physical health have been specifically designed for TGDAs. The primary goal of this proposal is to use minority stress model and intersectionality to examine a host of stressors that contribute to inequities in alcohol abuse and drug use, cross-reciprocal interpersonal violence, and subsequent physical and mental health outcomes among TGDAs. The goal will be achieved by conducting a 12-month prospective cohort study with a racially and gender diverse sample of 400 TGDAs, ages 18-55. The following aims will be fulfilled: Aim 1:Identify the structural/community factors and proximal/distal minority stressors most strongly predictive of alcohol abuse and drug use as intermediary outcomes to mental health outcomes (i.e., depression, PTSD, etc.) and physical health outcomes (i.e., cardiovascular disease, sleep, etc.) for TGDAs; Aim 2: Evaluate if differences in Aim 1 direct and indirect effects are evident by TGD subgroup (i.e., gender diverse, transfeminine, transmasculine) and across intersecting identities of race/ethnicity; Aim 3: Examine whether Aim 1 associations are moderated by resilience factors (i.e., healthcare utilization, social support), and Aim 4: Explore the mechanistic roles of acute and chronic daily stresses (assessed by biomarkers), controlling for sex hormones, in associations examined for Aim 1. Another subaim will be to examine the intraindividual variability in the momentary cross-reciprocal relationship between interpersonal violence and alcohol abuse. Multiple forms of data will be collected to assess these goals: 1) self- reported survey data collected at baseline, 6- and 12-months, 2) ecological momentary assessments administered, and 3) saliva, hair clippings, and cheek swabs, in addition to BMI, blood pressure, and waist-to-hip ratio. Our expected outcomes are to provide evidence regarding modifiable factors associated with alcohol use and drug use as well as the pathways by which interpersonal violence and physical and mental health outcomes occur,and to identify priorities in treatment and prevention designed for TGDAs.

摘要 变性人和性别多样化的成年人（TGDAs）经历了严重的不平等，这种不平等根源于并反映了 由于其性别地位而遭受历史性的耻辱，并导致了重大的健康差距。在 根据少数民族压力理论，系统的压迫，歧视和耻辱是远端 通过人际暴力和微攻击的经历表现出来的压力源。这些 这些经历可能导致压力增加，进而导致酗酒和吸毒。因此，委员会认为， 与之相比，TGDAs的不良心理健康和身体健康结果的患病率较高 对他们的顺性别对应者。这些风险因素和压力的经历可能会增加 TGDAs经历和/或实施人际暴力。不幸的是，很少有效， 预防和治疗酗酒、吸毒、人际暴力、 心理健康和身体健康是专门为TGDAs设计的。这个的主要目标 建议是使用少数压力模型和交叉性来检查一系列压力源， 滥用酒精和药物的不平等，交叉互惠的人际暴力，以及随后的 TGDAs之间的身体和心理健康结果。这一目标将通过开展为期12个月的 前瞻性队列研究，400名年龄在18-55岁的TGDAs的种族和性别多样性样本。的 目标1：确定结构/社区因素和近端/远端少数群体 压力源最强烈地预测酒精滥用和药物使用作为心理健康的中介结果 结果（即，抑郁症、创伤后应激障碍等）和身体健康结果（即，心血管疾病，睡眠， 等等）。对于TGDAs;目标2：通过TGD评价目标1的直接和间接效应是否存在明显差异 子组（即，性别多样性，跨女性，跨男性）和交叉的身份， 种族/民族;目标3：检查目标1的关联是否受到弹性因素的调节（即， 医疗保健利用率，社会支持），以及目标4：探索急性和慢性日常 压力（通过生物标志物评估），控制性激素，与目标1相关。 另一个子目标将是检查瞬时交叉倒数的个体内变异性 人际暴力与酗酒的关系。将收集多种形式的数据， 评估这些目标：1）在基线、6个月和12个月收集的自我报告调查数据，2）生态 进行瞬时评估，和3）唾液、毛发剪下物和颊拭子，以及BMI， 血压和腰臀比我们的预期结果是提供证据， 与酒精使用和药物使用相关的因素以及人际暴力的途径 和身心健康的结果，并确定治疗和预防的优先事项 专为TGDA设计。