Tobacco Use Trajectories And Disparities Among Sexual Minorities In U.S Adolescents And Adults

项目总结/摘要 在美国，烟草使用造成了巨大的健康和财务成本，其中包括超过48万美元。 每年因吸烟导致的死亡人数超过1930亿美元，每年的医疗费用和损失超过1930亿美元。 生产力性少数个体在烟草使用和烟草使用方面的风险要大得多 在美国，与异性恋者相比，烟草相关疾病（TUD）和烟草相关健康结果 需要纵向数据来了解烟草使用在不同时间的差异，以及由此产生的烟草- 性少数群体之间的相关健康差距。这些信息是必要的，以告知烟草监管 减少这些健康差距的政策战略。我们利用少数民族压力的概念， 了解这些烟草使用轨迹和相关的健康差异， 导向本提案是对RFA-OD-19 - 022的直接响应，使用次级数据检查 烟草使用轨迹及其对脆弱人群健康的长期影响，重点关注新烟草 产品.烟草与健康的国家和纵向人口评估（PATH）研究提供了 这是一个前所未有的机会，可以确定烟草使用轨迹的差异，相关的健康差异， 以及这些差异背后的机制。使用PATH数据，我们将能够检查详细的烟草使用情况 四个浪潮的轨迹，四个浪潮的性身份转变，以及与健康的潜在联系 结果。此外，我们对自我报告和压力与健康的生物数据进行了三角测量。使用PATH 本研究的目的是：（1）研究烟草制品， 按性取向分列的吸烟开始和使用轨迹及其与定期吸烟和TUD的关系 （2）通过性取向和与自我的不同关联来识别烟草使用轨迹 报告和成人的生物健康结果;（3）检查生物和心理的作用 强调成人烟草使用轨迹、戒烟和与烟草有关的健康结果， 这是如何通过性取向和性身份的转变而有所不同的。我们将评估烟草轨迹， 强调具有关键公共卫生重要性的具体变化，包括：（1）开始使用烟草，（2） 所使用的烟草产品数量的进展（即，单一产品使用到双重/多种烟草使用）， 重点关注包括电子烟和没有电子烟的轨迹，以及（3）烟草的增加和减少 频率.目标2和3将创新地利用这两个调查的财富自我报告措施的压力 （心理困扰）和健康结果（呼吸系统疾病，癌症，心血管疾病）以及 应激的生物标记（例如，C-反应蛋白、白细胞介素-6）和烟草特异性标记物与 癌症风险（NNAL，NNN，TNE 2）。我们将检查重要的主持人，包括年龄，性别，种族和民族 在所有的目标。该项目将为烟草监管政策提供大量信息，并最大限度地提高其效力。 特别是那些旨在减少性少数群体烟草使用的健康负担的方案。

Project Summary/Abstract Tobacco use is responsible for enormous health and financial costs in the U.S. including more than 480,000 deaths per year due to cigarette use and more than $193 billion annually in health care costs and loss of productivity. Sexual minority individuals are at substantially greater risk for tobacco use and tobacco use disorder (TUD) and tobacco-related health outcomes compared to heterosexual individuals in the U.S. Longitudinal data is needed to understand differences in tobacco use across time and resultant tobacco- related health disparities among sexual minorities. This information is necessary to inform tobacco regulatory policy strategies to reduce these health disparities. We draw on concepts of minority stress and intersectionality to understand these tobacco use trajectories and related health disparities by sexual orientation. This proposal is in direct response to RFA-OD-19-022 by using secondary data to examine tobacco use trajectories and its health effects over time in a vulnerable population, focusing on new tobacco products. The national and longitudinal Population Assessment of Tobacco and Health (PATH) study provides an unprecedented opportunity to identify differences in tobacco use trajectories, associated health disparities, and mechanisms behind these differences. Using PATH data we will be able to examine detailed tobacco use trajectories across four waves, sexual identity transitions across four waves, and prospective links to health outcomes. In addition we triangulate both self-report and biological data on stress and health. Using PATH’s large nationally representative dataset of youth and adults, this study aims to: (1) To examine tobacco product initiation and use trajectories by sexual orientation and their associations with regular tobacco use and TUD symptoms; (2) To identify tobacco use trajectories by sexual orientation and differential associations with self report and biological health outcomes among adults; (3) To examine the role of biological and psychological stress on tobacco use trajectories, tobacco cessation and tobacco-related health outcomes among adults and how this differs by sexual orientation and transitions in sexual identity. We will assess tobacco trajectories, with emphasis on specific changes of critical public health importance including: (1) tobacco use initiation, (2) progression in the number of tobacco products used (i.e., single product use to dual/polytobacco use) with a focus on trajectories including e-cigarettes and those without and (3) increases and decreases in tobacco frequency. Aims 2 and 3 will innovatively make use of the wealth of both survey self-report measures of stress (psychological distress) and health outcomes (respiratory illness, cancer, cardiovascular disease) alongside biological markers of stress (e.g., C-reactive protein, interleukin-6) and tobacco-specific markers linked to cancer risk (NNAL, NNN, TNE2). We will examine important moderators including age, sex, race, and ethnicity throughout all aims. This project will greatly inform and maximize effectiveness of tobacco regulatory policies particularly those aimed at reducing the health burden of tobacco use among sexual minorities.