Social stress and substance abuse disparities in sexual minority youth

描述(申请人提供)：最近的数据表明，在女同性恋、男同性恋和双性恋(LGB)人群中存在着巨大的健康差距，其中LGB青年使用药物的风险几乎是他们的异性恋同龄人的两倍。此外，年轻的男同性恋者/双性恋者已经不成比例地背负着艾滋病毒发病率的负担，他们是新艾滋病毒感染率正在上升的仅有的风险群体之一。医学研究所(IOM)2011年发布的一份关于LGB健康的报告指出，对导致这些差异的因素缺乏研究。本报告将社会生态影响的研究确定为优先研究领域，并强调需要采用少数群体压力和生命历程的观点进行研究，以确定LGB人群面临的独特问题如何增加他们产生不利健康后果的风险。该指导研究科学家发展奖(K01)将为候选人提供必要的保护时间、培训和资源，以执行国际移民组织报告中确定的这些研究优先事项。该奖项的目标是开发一项跨学科研究计划，重点是确定可以解释和解决LGB青年健康差距的可改变的社会生态因素。为了实现他的职业目标和研究目标，应聘者需要社会流行病学、生命历程研究的生物统计学方法和压力生物学方面的培训和指导。这种培训将通过指导研究项目、课程、研讨会和会议相结合的方式完成。获得的新技能将使应聘者能够进行创新的、高影响力的研究，研究LGB青年周围的社会环境如何以及为什么导致他们使用药物和相关问题的风险增加。这项研究的总体目标是：(1)评估性少数群体压力是否可以预测LGB青少年中的物质使用和HIV危险行为，并解释这些结果中与性取向相关的差异；(2)确定保护LGB青年不参与物质使用和HIV危险行为的可改变的背景因素；以及(3)阐明调节性少数群体应激、物质使用和HIV危险行为之间关系的生物学途径。这项建议使用了一个多方法框架，借鉴了两项前瞻性队列研究(今日成长研究和国家青少年健康纵向研究)的优势，这两项研究跟踪LGB和异性恋青少年超过15年。这些流行病学研究将得到两项研究的数据收集的补充，这两项研究利用了实验和经验抽样设计。这项研究将解决有关LGB健康的社会决定因素、它们与个人生物因素的相互作用以及这些过程如何在生命过程中出现的新问题。此外，这些结果将有助于制定结构性、政策性和社区一级的干预措施，减少与性取向有关的物质使用和艾滋病毒危险行为方面的差异，这是NIDA的一个重要优先事项。

DESCRIPTION (provided by applicant): Recent data indicate substantial health disparities in lesbian, gay, and bisexual (LGB) populations, including nearly twice the risk of substance use among LGB youths compared to their heterosexual peers. Additionally, young gay/bisexual men, already disproportionately burdened with HIV morbidity, are one of the only risk groups in which new HIV infection rates are increasing. A 2011 report on LGB health released by the Institute of Medicine (IOM) noted the dearth of research on the factors responsible for these disparities. This report identified the study of social ecological influences as a priority researc area, and emphasized the need for studies that adopt minority stress and life course perspectives in order to determine how the unique issues confronting LGB populations increase their risk for adverse health outcomes. This Mentored Research Scientist Development Award (K01) will provide the candidate with the protected time, training, and resources necessary to carry out these research priorities established in the IOM report. The goal of the Award is to develop an interdisciplinary research program focused on identifying modifiable social ecological factors that can explain and address health disparities among LGB youth. To accomplish his career goals and research objectives, the candidate requires training and mentorship in social epidemiology, biostatistical approaches to life course studies, and stress biology. This training will be accomplished through a combination of mentored research projects, courses, seminars, and conferences. The new skills that are acquired will enable the candidate to conduct innovative, high-impact research examining how and why the social environment surrounding LGB youth contributes to their increased risk for substance use and associated problems. The over-arching objectives of this research are: (1) to evaluate whether sexual minority stress measured at the social ecological level predicts substance use and HIV risk behaviors within LGB youth and explains sexual orientation-related disparities in these outcomes; (2) to identify modifiable contextual factors that protect LGB youth from engaging in substance use and HIV risk behaviors; and (3) to elucidate biological pathways that mediate the relationship between sexual minority stress, substance use, and HIV risk behaviors. This proposal uses a multi-method framework that draws on the strengths of two prospective cohort studies (the Growing Up Today Study and the National Longitudinal Study of Adolescent Health) that have followed LGB and heterosexual adolescents for over 15 years. These epidemiologic studies will be complemented by data collection in two studies that utilize experimental and experience-sampling designs. This research will address novel questions about social determinants of LGB health, their interplay with individual biological factors, and how these processes emerge over the life course. Moreover, the results will facilitate the development of structural, policy, and community-level interventions that reduce sexual orientation-related disparities in substance use and HIV risk behaviors, an important priority at NIDA.