Project Recognize: Improving Measurement of Alcohol Use and Other Disparities by Sex, Sexual Orientation, and Gender Identity through Community Engagement

项目摘要 研究人员和健康从业者使用来自联邦健康调查、电子健康记录（EHR）、 和研究，以监测性和性别少数群体（SGM）的健康。相比 非SGM人群，SGM人群不成比例地受到健康状况不佳的影响，包括 酒精使用，物质使用，和精神疾病。大量的前期工作支持了少数民族的压力 将SGM的健康差异纳入背景的框架;与歧视和受害有关的压力源， SGM状态与不平等密切相关。准确识别这种差异的能力， 潜在的因果途径是至关重要的，以确保公共卫生和卫生保健研究，政策和实践， 适当配备，以满足边缘化群体的健康需求，如SGM个人。这 酒精仍然是最常用和滥用的药物之一， 在全国范围内，特别是在青少年和成人SGM中。然而，人口统计数据 与SGM身份和污名化相关的特征-例如，性、性取向和性别 身份（SSOGI）-在卫生研究和实践中仍然定义不清，使用不一致 设置.例如，尽管存在明显的局限性，但大多数研究、提供者和国家调查继续 使用二元框架（男性与女性）评估出生时的性别分配。这种方法无法捕捉到 大量的双性个体（估计患病率为每1 000例活产1 - 2例）。此外，大多数 调查继续使用不推荐的做法，将性和性别认同混为一谈， 只有这些结构之一，从而不能适当地识别或表征变性，非二元， 和性别歧视的个体。虽然越来越多的调查询问性取向， 经常没有说明其多维性质：许多项目合并了身份（例如，同性恋，双性恋），与 行为（例如，仅与同性伴侣发生性关系）和吸引力（例如，只被男性的外表所吸引 个人）。这一点尤其令人担忧，因为研究表明， 只会被归类为基于一个类别的性少数，而不是另一个（例如，的人 同性恋者，但与同性伴侣发生性关系）。此外，目前的措施往往不是 全面，排除研究不足或新兴的方向（例如，无性恋，泛性恋，同性恋），缺乏 选择多个选项的能力，并且无法考虑随着时间的推移身份的变化。如果没有全面的， 评估SSOGI的有效措施，了解SGM差异的程度或如何最好地 对促进SGM健康公平的干预是有限的。因此，制定标准化、灵活化、 在不同的人口统计和地区使用的措施。该项目将通过以下方式弥补这些差距： 迭代，社区参与新的SSOGI措施的发展，并将评估新的有效性， vs.先前的措施，以表征SGM之间的酒精使用，物质使用和心理健康的差异。

PROJECT SUMMARY Researchers and health practitioners use data from federal health surveys, electronic health records (EHRs), and research studies to monitor the health of sexual and gender minority (SGM) populations. Compared to non-SGM populations, SGM populations are disproportionately affected by poor health, including disparities in alcohol use, substance use, and mental illness. Substantial prior work has supported the minority stress framework to contextualize SGM health disparities; stressors related to discrimination and victimization tied to SGM status are strongly associated with disparities. The ability to accurately identify such disparities and potential causal pathways is vital to ensure that public health and health care research, policy, and practice are appropriately equipped to address the health needs of marginalized populations such as SGM individuals. This is particularly true in the case of alcohol, which remains one of the most commonly used and abused drugs nationwide, particularly among both adolescent and adult SGM. However, measurement of demographic characteristics associated with SGM identity and stigmatization – e.g., sex, sexual orientation, and gender identity (SSOGI) – remains poorly defined and inconsistently used across health research and practice settings. For example, despite evident limitations, most studies, providers, and national surveys continue to use a binary framework (male vs. female) to assess sex assigned at birth. This approach fails to capture a substantial population of intersex individuals (estimated prevalence of 1-2 per 1,000 live births). Further, most surveys continue to use the non-recommended practice of conflating sex and gender identity by asking about only one of these constructs, thereby failing to appropriately identify or characterize transgender, non-binary, and gender nonconforming individuals. While a growing number of surveys ask about sexual orientation, they frequently do not account for its multidimensional nature: many items conflate identity (e.g., gay, bisexual), with behavior (e.g., sex with only same-sex partners) and attraction (e.g., only attracted to male-presenting individuals). This is especially concerning as research has shown that a substantial number of individuals would only be classified as a sexual minority based on one category, but not another (e.g., a person who identifies as heterosexual but has sex with same-sex partners). Furthermore, current measures often are not comprehensive, exclude understudied or emerging orientations (e.g., asexual, pansexual, queer), lack the ability to select multiple options, and fail to account for changes in identity over time. Without comprehensive, validated measures to assess SSOGI, the ability to understand the magnitude of SGM disparities or how best to intervene to promote SGM health equity is limited. Therefore, it is vital to develop standardized, flexible measures for use across diverse demographics and regions. This project will address these gaps through iterative, community-engaged development of new SSOGI measures, and will assess the effectiveness of new vs. prior measures to characterize disparities in alcohol use, substance use, and mental health among SGM.