Reproductive health disparities and sexual orientation in girls and women

 说明(申请人提供)：与异性恋同龄人相比，性少数(即女同性恋和双性恋)女青年特别容易健康状况不佳，特别是生殖健康状况不佳。新出现的研究表明，州一级的歧视性法律可能会对性少数群体的健康产生不利影响。这种歧视可能发生在未能就仇恨犯罪、工作歧视或同性婚姻制定保护措施的州。然而，人们对这些类型的公共政策与生殖健康之间的联系知之甚少。政策环境在美国各州也是高度可变的，随着时间的推移而变化，美国最高法院在2013年推翻了《婚姻保护法》就证明了这一点。因此，这项研究对于理解快速变化的政策环境可能如何影响性少数群体至关重要。需要经验证据来为新的公共政策制定和公共卫生战略提供信息，以改善生殖健康，但很少有研究人员接受过探索这种差异并将调查结果转化为行动所需的培训。在这项拟议的项目中，查尔顿博士认为，公共政策可能与性少数族裔女孩和妇女的生殖健康有关。她将通过以下目标探讨这一问题：(1)确定公共政策如何与性少数群体女孩和妇女的生殖健康有关；(2)阐明在性少数群体女孩和妇女中，哪些不利的生殖健康结果可能与公共政策有关，以及这些生殖健康结果发生在哪里；(3)审查不良生殖健康结果给性少数群体女孩和妇女带来不成比例负担的潜在原因。为了实现这些目标，将对青少年和年轻人的两个纵向队列(今日成长研究I/II)以及他们的母亲队列(护士健康研究II)的国家数据进行分析。为了完成这项拟议中的研究，查尔顿博士必须在流行病学技能的基础上，接受与健康相关的公共政策方面的正式培训。因此，她 导师们制定了一项计划，以推进她在政策分析和计量经济学等领域的培训。这项培训将使她能够创建一个全面的数据库，代表美国各州的各种政策环境，并分析这种环境如何与性少数族裔女孩和妇女的生殖健康有关。这项拟议的研究符合NICHD保健公平办公室的倡议，并将是首次审查公共政策和性少数群体女孩和妇女中的一系列生殖健康问题。查尔顿博士将能够获得独特的详细数据，她的发现将进一步了解性取向健康差异，并促进在不同人群中的研究。这项培训和研究将为查尔顿博士在与健康相关的公共政策方面奠定坚实的基础，再加上她的流行病学背景，将使她能够作为一名独立研究科学家建立自己的职业生涯。

 DESCRIPTION (provided by applicant): Compared to their heterosexual peers, sexual minority (i.e., lesbian and bisexual) female youth are particularly vulnerable to having poor health, especially poor reproductive health. Emerging research shows that the health of sexual minorities can be adversely affected by state-level discriminatory laws. This discrimination can occur in states that have failed to enact protections around hate crimes, job discrimination, or same-sex marriage. However, little is known about the association of these types of public policies with reproductive health. Policy environments are also highly variable across U.S. states and dynamic across time, as demonstrated by the U.S. Supreme Court overturning the Defense of Marriage Act in 2013. Therefore, this research is vital for understanding how the rapidly shifting policy environment may affect sexual minorities. Empirical evidence is needed to inform new public policy development and public health strategies to improve reproductive health, but few researchers have the training needed to explore such disparities and translate findings into action. In the proposed project, Dr. Charlton argues that public policy may be associated with the reproductive health of sexual minority girls and women. She will explore this through the following aims: (1) Identify how public policy may be associated with the reproductive health of sexual minority girls and women; (2) Elucidate what adverse reproductive health outcomes may be associated with public policy among sexual minority girls and women and where these reproductive health outcomes occur; and (3) Examine potential reasons why adverse reproductive health outcomes disproportionately burden sexual minority girls and women. To fulfill these aims, national data will be analyzed from two longitudinal cohorts of adolescents and young adults (Growing Up Today Study I/II) along with a cohort of their mothers (Nurses' Health Study II). In order complete the proposed research, Dr. Charlton must build on her epidemiology skills with formal training in health-related public policy. As such, her mentors have developed a plan to advance her training in areas such as policy analysis and econometrics. This training will enable her to create a comprehensive database representing the various policy environments in every U.S. state and analyze how this environment is associated with the reproductive health of sexual minority girls and women. The proposed research is in line with the NICHD Office of Health Equity's initiatives and will be among the firs to examine public policy and a range of reproductive health issues among sexual minority girls and women. Dr. Charlton will have access is to uniquely detailed data and her findings will further the understanding of sexual orientation health disparities and promote research in diverse populations. This training and research will give Dr. Charlton a solid foundation in health-related public policy, which, combined with her epidemiology background, will enable her to build a career as an independent research scientist.