Examining biomarkers and mechanisms of health disparities in sexual minority women

项目摘要 意义：与异性恋女性相比，女同性恋者/男同性恋者和双性恋者(LGB)女性的身体健康比率更高 有问题。目前的证据主要基于自我报告，表明在不同的条件下存在着重要的健康差距 发病率和死亡率高(如糖尿病、心脏病)。然而，到目前为止，还没有研究测试在 在具有代表性的年轻人样本中，客观衡量LGB和异性恋女性之间的健康风险。我们的目标是 通过使用严格的健康客观生物标记物(即心脏代谢功能)检查假定的健康差异来填补这一空白 和炎症)在一项具有代表性的、不同种族的年轻女性样本中进行 正在进行的纵向研究，匹兹堡女孩研究(PGS)(目标1)。我们将把预期收集到的有关歧视的数据联系起来 压力和童年逆境，以确定压力暴露在性少数群体地位和儿童逆境之间的关系中的作用 成人早期健康(目标2)。最后，我们将测试青春期的健康促进是否减弱了 男女同性恋妇女中的歧视、压力和健康风险(目标3)。方法：我们的计划是利用全面、 前瞻性地从PGS收集数据，并测量PGS中LGB妇女的当前健康指标(n=230)和 人口统计频率与成年早期(22-25岁)的异性恋女性样本(n=230)相匹配。对以下方面的评估 健康包括：腰围、血压、血脂、胆固醇、脂肪酸、葡萄糖、胰岛素、促炎细胞因子 (IL-6；肿瘤坏死因子-α)和C反应蛋白。我们建议通过实验室的皮质醇和心率反应来评估歧视压力- 基于歧视压力源和感知的歧视经历，每年测量，并预期从15岁到21岁 好几年了。儿童时期的逆境(家庭压力、创伤、虐待和同伴伤害)在PGS中每年都会进行评估，从 《青年与照顾者》报道。在青春期促进身体和情绪健康已经在许多方面进行了评估 PGS的方法包括接种疫苗，安全的性行为，和身体活动，支持成年人的存在，并将是 辅以关于学校氛围和出柜经历的采访。调查人员：凯瑟琳·基南博士是校长 调查员艾莉森·希普韦尔博士、斯蒂芬妮·斯特普博士、凯伦·马修斯、艾丽西亚·马修斯和艾莉达·布里斯是联合调查员，以及 克里斯汀·罗布列夫斯基是生物统计学家。康斯坦斯·哈曼博士是顾问。调查人员已经带领许多人 NIH资助的成功研究，代表了发展精神病理学、妇女心理健康、性健康、 少数民族身心健康、健康心理学、生物统计学。总的来说，调查人员在以下方面有经验 对脆弱人群实施TSST，测量皮质醇反应性，并测试涉及心脏代谢的假设 和炎症功能。环境：该建议建立在长期的、富有成效的合作基础上 芝加哥大学、伊利诺伊大学和匹兹堡大学的研究人员。创新/影响：拟议的研究提供了 前所未有的机会，以严格的方式探索LGB妇女的健康差距，通过以下方式检查潜在的机制 哪些性取向会带来健康风险，并在具有代表性和种族多样性的 LGB和异性恋女性。

Project Summary Significance: Compared to heterosexual women, lesbian/gay and bisexual (LGB) women report higher rates of physical health problems. Current evidence, which is largely based on self-report, suggests that important health disparities exist in conditions with high rates of morbidity and mortality (e.g., diabetes, heart disease). To date, however, no study has tested differences in objective measures of health risks between LGB and heterosexual women in a representative sample of young adults. We aim to fill this gap by examining putative health disparities using rigorous objective biomarkers of health (i.e. cardiometabolic functioning and inflammation) in young adulthood in a representative, racially diverse sample of young women who are participating in an ongoing longitudinal study, the Pittsburgh Girls Study (PGS) (Aim 1). We will link prospectively gathered data on discrimination stress and childhood adversity to determine the role of stress exposure in the association between sexual minority status and early adult health (Aim 2). Finally, we will test whether health promotion during adolescence attenuates the association between discrimination stress and health risks among LGB women (Aim 3). Approach: Our plan is to leverage comprehensive, prospectively collected data from the PGS and measure current health indicators among LGB women in the PGS (n=230) and a demographic frequency matched sample of heterosexual women (n=230) in early adulthood (ages 22-25 years). Assessments of health will include: waist circumference, blood pressure, lipids, cholesterol, fatty acids, glucose, insulin, proinflammatory cytokines (IL-6; TNF-α), and C-reactive protein. We propose to assess discrimination stress via cortisol and heart rate reactivity to a lab- based discrimination stressor and perceived discrimination experiences measured annually and prospectively from ages 15 to 21 years. Childhood adversity (family stress, trauma, abuse, and peer victimization) has been assessed annually for in the PGS from youth and caregiver reports. Physical and emotional health promotion during adolescence has been assessed in a number of ways in the PGS including vaccine uptake, safe sexual practices, and physical activity, supportive adult presence, and will be complemented by interviews on school climate and coming out experiences. Investigators: Dr. Kathryn Keenan is the Principal Investigator, Drs. Alison Hipwell, Stephanie Stepp, Karen Matthews, Alicia Matthews and Alida Bouris are Co-Investigators, and Ms. Kristen Wroblewski is the biostatistician. Dr. Constance Hammen is the consultant. The investigators have led many successful NIH-funded studies and represent expertise in developmental psychopathology, women's mental health, sexual minority physical and mental health, health psychology, and biostatistics. Collectively, the investigators have experience in administering the TSST to vulnerable populations, measuring cortisol reactivity, and testing hypotheses involving cardiometabolic and inflammatory functioning. Environment: This proposal builds on long-standing, productive collaborations among investigators at the Universities of Chicago, Illinois, and Pittsburgh. Innovation/Impact: The proposed study provides an unprecedented opportunity to explore health disparities in LGB women in a rigorous manner, examine potential mechanisms by which sexual orientation confers health risks, and identify protective factors in a representative and racially diverse sample of LGB and heterosexual women.