Cardiovascular Health Associations with Minority stress: Biobehavioral Evaluations and self-Reported Sociopsychological outcomes by SOGI status (CHAMBERS)

项目总结 性少数群体和性别少数群体(SGM)个人经历了各种各样的健康差距 与他们的非SGM同行相比。这些差异包括心血管疾病的较高患病率。 (心血管疾病)与心理困扰有关的风险因素(如抑郁、压力)、行为方面的心血管疾病风险因素 (吸烟、缺乏运动、饮食)和临床心血管疾病危险因素(如糖尿病、肥胖症、高血压、高 胆固醇)。现有的SGM人群健康研究主要依赖于自我报告的措施来记录 心血管疾病危险因素和疾病患病率，因此忽略了下列未诊断的临床心血管疾病危险因素 更年轻的人群。尽管这些研究为证明SGM的存在奠定了重要的基础 心血管疾病的差异，缺乏对心血管疾病风险因素和结果的客观衡量，因此仍然是一个 SGM健康文献中的关键差距。少数应激理论(MST)是提出的主要框架 解释在边缘化人群中观察到的广泛的健康差距。在MST模型中， 结构性污名(例如，反SGM法)被视为导致和加剧远端(歧视)和 近端应激源(内在化耻辱、感知耻辱)。这些与污名相关的压力源可能会导致 SGM健康状况不佳，表现为心理社会苦恼和心血管疾病危险行为增加。这些途径增加了 更高的慢性应激负担与临床心血管疾病危险因素的发展相关。MST越来越多- 派生框架还反映了在多个层面上促进复原力的因素(例如，身份确认， 社会支持)可以减少污名对人口健康的有害影响。应用理论驱动的 交叉镜头，我们建议建立在描述SGM CVD差异存在的研究基础上，通过 将这些跨人、跨地点、跨时间的差异与社会权力系统联系起来。我们 建议对CARDIA进行一项辅助研究，以收集性取向和性别认同(SOGI)数据以及 第35年CARDIA考试中SGM污名和韧性促进因素的测量。通过一个 创新协作，我们还建议将CARDIA数据与西班牙裔社区健康数据结合起来 研究/研究拉丁裔(HCHS/SOL)群体，以解决以下引人注目和及时的具体目标：目标 1：评估行为和临床CVD危险因素在生命过程中随SGM状态的变化。目标2：在 SGM参与者(n=734)，调查耻辱和韧性促进因素如何内化和 与行为和临床心血管疾病危险因素相关的人际关系水平。目标3：确定 SGM结构性污名对行为和临床CVD危险因素的影响。总体而言，这些研究的影响将是 推进心血管疾病流行病学研究，加强改善SGM心血管疾病健康差距的证据基础 并在多个边缘化身份的交汇点促进SGM CVD卫生公平。

PROJECT SUMMARY Sexual minority and gender minority (SGM) individuals experience a wide variety of health disparities compared to their non-SGM peers. These disparities include higher prevalence of cardiovascular disease (CVD) risk factors tied to psychological distress (e.g., depression, stress), behavioral CVD risk factors (smoking, physical inactivity, diet), and clinical CVD risk factors (e.g., diabetes, obesity, hypertension, high cholesterol). Existing SGM population health studies rely primarily on self-reported measures to document CVD risk factors and disease prevalence, thus ignoring undiagnosed clinical CVD risk factors present among younger populations. Though these studies have laid important groundwork to document the existence of SGM CVD disparities, the absence of objective measures of CVD risk factors and outcomes therefore remains a critical gap in the SGM health literature. Minority stress theory (MST) is the leading framework proposed to explain the wide-ranging health disparities observed among marginalized populations. In MST models, structural stigma (e.g., anti-SGM laws) is viewed as leading to and exacerbating distal (discrimination) and proximal stressors (internalized stigma, perceived stigma). These stigma-related stressors can contribute to poor SGM health via enhanced psychosocial distress and CVD risk behaviors. These pathways add to the higher chronic stress burden associated with the development of clinical CVD risk factors. Increasingly, MST- derived frameworks also reflect that resilience promoting factors at multiple levels (e.g., identity affirmation, social support) can decrease the harmful population health effects of stigma. Applying a theoretically-driven intersectional lens, we propose to build on studies describing the existence of SGM CVD disparities by contextualizing these disparities across person, place, and time in relation to social power systems. We propose an ancillary study to CARDIA to collect sexual orientation and gender identity (SOGI) data as well as measures of SGM stigma and resilience promoting factors in the Year 35 CARDIA exam. Through an innovative collaboration, we also propose to pool CARDIA data with data from the Hispanic Community Health Study/Study on Latinos (HCHS/SOL) cohort to address the following compelling and timely Specific Aims: Aim 1: Assess how behavioral and clinical CVD risk factors vary by SGM status over the life course. Aim 2: Among SGM participants (n=734), investigate how stigma and resilience promoting factors at the internalized and interpersonal levels associated with behavioral and clinical CVD risk factors. Aim 3: Determine the influence of SGM structural stigma on behavioral and clinical CVD risk factors. Overall, the impact of these studies will be to advance CVD epidemiology and to enhance the evidence base to ameliorate SGM CVD health disparities and promote SGM CVD health equity at the intersections of multiple marginalized identities.