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

项目摘要 性少数和性别少数（SGM）个体经历了各种各样的健康差异 与非SGM同行相比。这些差异包括心血管疾病的患病率较高 (CVD)与心理困扰相关的风险因素（例如，抑郁症，压力），行为CVD危险因素 （吸烟、缺乏身体活动、饮食）和临床CVD风险因素（例如，糖尿病、肥胖、高血压、高 胆固醇）。现有的SGM人群健康研究主要依靠自我报告的措施来记录 CVD危险因素和疾病患病率，因此忽略了未诊断的临床CVD危险因素， 年轻的人口。虽然这些研究为证明SGM的存在奠定了重要的基础 心血管疾病的差异，心血管疾病的危险因素和结果的客观措施的缺乏，因此仍然是一个问题。 SGM健康文献中的关键空白。少数压力理论（Minority Stress Theory，MST）是一个主要的理论框架， 解释在边缘化人群中观察到的广泛的健康差异。在MST模型中， 结构性污名（例如，反SGM法律）被视为导致和加剧远端（歧视）， 近端压力源（内化污名，感知污名）。这些与污名相关的压力源可能会导致 通过增强的心理社会困扰和CVD风险行为，SGM健康状况较差。这些途径增加了 较高的慢性压力负担与临床CVD危险因素的发展相关。越来越多的，MST- 衍生框架还反映了多个层面的抗御力促进因素（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 交叉透镜，我们建议建立在研究描述SGM CVD差异的存在， 将这些人、地、时的差异与社会权力系统联系起来。我们 向CARDIA提出一项辅助研究，以收集性取向和性别认同（SOGI）数据，以及 SGM耻辱和弹性促进因素的措施在35年CARDIA考试。通过一个 创新合作，我们还建议将CARDIA数据与西班牙裔社区健康数据相结合 研究/研究拉丁美洲人（HCHS/SOL）队列，以解决以下令人信服的和及时的具体目标： 1：评估行为和临床CVD风险因素如何随生命过程中SGM状态而变化。目标2： SGM参与者（n=734），调查如何耻辱和弹性促进因素在内化和 与行为和临床CVD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危险因素的影响总的来说，这些研究的影响将是 推进心血管疾病流行病学，增强证据基础，改善SGM心血管疾病健康差异 在多重边缘化身份的交叉点促进SGM CVD健康公平。

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.