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

项目总结 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)、 以及监控性和性别少数群体(SGM)健康的研究。与.相比 非SGM人群，SGM人群受到健康状况不佳的影响不成比例，包括 酗酒、吸毒和精神疾病。之前的大量工作支持了少数族裔的压力 确定特别机制健康差距的框架；与歧视和受害有关的压力源 SGM地位与差异密切相关。准确识别这种差异的能力和 潜在的因果路径对于确保公共卫生和卫生保健研究、政策和实践 具备适当的能力，以满足边缘人群的健康需求，如SGM个人。这 尤其是酒精，它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特别报告员中。然而，对人口统计的衡量 与性别歧视身份和污名化有关的特征--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明确，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、提供者和国家调查仍在继续 使用二元框架(男性和女性)来评估出生时分配的性别。此方法无法捕获 相当多的双性人(估计每1000名活产中有1-2名)。更进一步说，大多数 调查继续使用不推荐的做法，将性别和性别认同混为一谈，询问 只有这些结构中的一个，因此无法适当地识别或表征变性人，非二元， 和性别不一致的人。虽然越来越多的调查问及性取向，但他们 往往无法解释其多维性质：许多物品将身份(例如，同性恋、双性恋)与 行为(例如，只与同性伴侣发生性关系)和吸引力(例如，只被呈现男性的人吸引 个人)。这一点尤其令人担忧，因为研究表明，相当数量的个人 只会根据一个类别被归类为性少数，而不是另一个类别(例如， 认为自己是异性恋，但与同性伴侣发生了性关系)。此外，目前的措施往往不是 全面的，排除未被研究的或正在出现的取向(例如，无性恋、泛性恋、同性恋)，缺乏 能够选择多个选项，而不考虑身份随时间的变化。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 为促进SGM健康公平而进行的干预是有限的。因此，制定规范、灵活的 跨不同人口统计和地区使用的措施。该项目将通过以下方式解决这些差距 迭代、社区参与开发新的SSOGI措施，并将评估新的 对比以前的方法来表征SGM在酒精使用、物质使用和精神健康方面的差异。

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.