Minority Stress and Cigarette Smoking among Sexual Minority Youth

项目总结/摘要 性少数群体之间在烟草和其他物质使用方面的健康差异有据可查 (e.g.,女同性恋、男同性恋、双性恋或酷儿）和异性恋个体的寿命。特别是性 少数民族青年（SMY）开始使用烟草的年龄更小，吸烟率高于其 异性恋同行。与少数群体性行为有关的耻辱和歧视 取向（即，少数压力源）有助于我们理解SMY之间的健康差异。少数 SMY经常每天都经历压力。因此，SMY可能会吸烟，以科普 这些基于污名的压力源引发的负面影响。事实上，横向研究表明，少数民族 SMY的压力源与吸烟和其他物质使用有关。重要限制 然而，现存文献包括过度依赖横截面和回顾性自我报告数据，失败 解释少数民族压力源和吸烟行为的个体内和个体间差异， 少数压力源对吸烟的独特贡献超出了日常生活中的个体差异， 一般压力源、终生累积压力和心理健康。此外，我们对 少数民族压力源和吸烟之间的中介机制。与医学研究所一致 以及NIH性和性别少数研究协调委员会呼吁扩大我们的 了解导致SMY烟草和其他物质使用水平较高的因素， 响应NIH PA-15-263对性少数群体健康研究的关注，我们提出了一个创新的探索性研究。 研究（R21）。我们建议严格检查少数民族压力源对吸烟的影响， 真实的时间在自然环境当中SMY采用电子经验采样方法，具体 生态瞬时评价（EMA）。我们的主要目的是研究：a）之间的关系 60名SMY自然环境中少数应激源和真实的吸烟时间的近端变化 在30天内使用EMA的经常吸烟者; B）少数压力源对近端 影响和渴望的变化;以及，c）影响和渴望对之间关系的中介作用 少数压力源和吸烟。我们这项研究的第二个目的是检查 少数压力因素对其他物质使用的近端变化以及测试弹性资源， 可能与吸烟有关的背景风险因素。这项探索性研究的结果将 少数民族压力理论的重要理论意义，并告知文化敏感的发展 针对SMY的吸烟预防和戒烟干预措施，针对特定的个体内机制， 以及背景因素。拟议中的R21还将为大规模研究提供试点数据， 严格测试与SMY吸烟相关的精细心理社会弹性和风险机制。

PROJECT SUMMARY/ABSTRACT Health disparities in tobacco and other substance use are well documented between sexual minorities (e.g., lesbian, gay, bisexual, or queer) and heterosexual individuals across the lifespan. In particular, sexual minority youth (SMY) initiate tobacco use at younger ages and smoke cigarettes at higher rates than their heterosexual counterparts. Stigma and discrimination-related stressors specific to their minority sexual orientation (i.e., minority stressors) contribute to our understanding of health disparities among SMY. Minority stressors are often experienced daily by SMY. As such, SMY may smoke cigarettes as a way to cope with negative affect elicited by these stigma-based stressors. In fact, cross-sectional research shows that minority stressors are correlated with cigarette smoking and other substance use among SMY. Important limitations of the extant literature, however, include overreliance on cross-sectional and retrospective self-report data, failure to account for within- and between-individual differences in minority stressors and smoking behaviors, and lack of discernment of unique contributions of minority stressors on smoking beyond individual differences in daily general stressors, lifetime cumulative stress, and mental health. In addition, we know very little about the mediating mechanisms between minority stressors and cigarette smoking. Consistent with Institute of Medicine and the NIH Sexual and Gender Minority Research Coordinating Committee's call to expand our understanding of factors contributing to SMY’s higher levels of tobacco and other substance use, and in response to NIH PA-15-263’s focus on sexual minority health research, we propose an innovative exploratory study (R21). We propose a rigorous examination of the effects of minority stressors on cigarette smoking in real time in the natural environment among SMY using electronic experience sampling methods, specifically ecological momentary assessment (EMA). Our primary aims are to examine: a) the relationship between minority stressors and proximal changes in smoking in real time in the natural environment among 60 SMY who are regular smokers using EMA over a 30-day period; b) the effects of minority stressors on proximal changes in affect and craving; and, c) the mediating effects of affect and craving on the relationship between minority stressors and cigarette smoking. Our secondary aims of this study are to examine the effects of minority stressors on proximal changes in other substance use as well as to test resilience resources and contextual risk factors that might be associated with smoking. Findings from this exploratory study would have important theoretical implications for minority stress theory and inform the development of culturally sensitive smoking prevention and cessation interventions for SMY, targeting specific within-individual mechanisms as well as contextual factors. The proposed R21 will also provide pilot data for large scale research to more rigorously test the fine-grained psychosocial resilience and risk mechanisms associated with SMY’s smoking.