Contextual Determinants of Sexual Minority Health in the United States

美国性少数人群健康的环境决定因素 R01申请摘要/摘要 卡拉·乔伊纳(PI)和温迪·曼宁(Co-I) 长期以来，研究人员一直在记录性别少数人群(或性别多样化)的健康差异 人口)，并开始为性别少数民族人口(或性别多样化)记录这些数据 种群)。这些健康差距在很大程度上仍然难以解决，因为研究人员尚未能够 严格地捕捉到它们背后的假定机制：耻辱。少数派压力观点认为 性少数群体，如种族/少数民族人口，经历了更高的不良行为发生率 由于异性恋人口在社会中的污名化地位，他们的健康结果比异性恋人口更严重。研究人员测试 这一视角越来越多地衡量了社会层面的污名，或称“结构性污名”，这是一个 捕捉社会风气(公众对性/性别少数群体的态度)和法律风气(法律和 与性/性别少数群体有关的政策)。研究人员一直受到阻碍，他们无法充分 评估由于设计了包含问题的大多数基于人群的调查而造成的结构性污名的影响 关于性少数群体的地位和健康。在这些调查中，很少有研究人员能够对污名进行多次测量 级别。这些调查的另一个局限性是它们是横截面的，不能考虑如何 暴露在结构性污名下会在一生中发生变化。全国青少年到青少年的纵向研究 成人健康(Add Health)有必要的标准来严格调查结构性污名对 性少数受访者的健康结果，包括正式和规范的生产机制 以及传播上下文数据。增加对测试少数族裔压力和交叉性感兴趣的健康用户 视角将有前所未有的机会来研究各种结果是如何与 对性少数受访者的结构性污名，以及不同亚群之间的关联有何不同。目标1 这个项目是为了创建一个背景数据库，研究人员可以使用它来更好地研究结构的影响 耻辱。具体地说，该数据库将包括有关性少数群体的社会和法律氛围的衡量标准。 与第3、4和5波之前或前后的地区、县和州级别相对应。这 数据库还将包括结构性种族主义的衡量标准，因为许多性少数群体也是种族/族裔。 少数族裔。我们将召集一个咨询团队，以确保我们有最好的结构性污名措施和 种族主义。目标2将用这个背景数据库检查州一级的法律环境措施是如何 在Add Health受访者中与自我评估的健康和健康生物标记物相关联，并考虑如何 关联因关键因素而异(例如，性别、社会经济地位和种族/族裔)。该数据库将 促进对性别和种族少数群体健康差距的研究，既要严格，又要 创新。这个背景数据库的创建使研究成为可能，它有可能为 改善包括亚群在内的性少数群体和种族少数群体健康的政策和干预措施 确保所有人口都有平等的机会长寿、健康和富有成效。

Contextual Determinants of Sexual Minority Health in the United States R01 Application Summary/Abstract Kara Joyner (PI) and Wendy Manning (Co-I) Researchers have long documented health disparities for sexual minority populations (or sexual diverse populations) and they are beginning to document them for gender minority populations (or gender diverse populations). These health disparities remain largely intractable because researchers have not been able to rigorously capture the putative mechanism behind them: stigma. The minority stress perspective posits that sexual minority populations, like racial/ethnic minority populations, experience a higher prevalence of adverse health outcomes than heterosexual populations due to their stigmatized status in society. Researchers testing this perspective have increasingly measured stigma at the societal level or “structural stigma,” a concept that captures both social climate (public attitudes towards sexual/gender minorities) and legal climate (laws and policies relevant to sexual/gender minorities). Researchers have been hampered in their ability to adequately assess the effects of structural stigma due to the design of most population-based surveys that include questions on sexual minority status and health. Few of these surveys permit researchers to measure stigma at multiple levels. Another limitation of these surveys is that they are cross-sectional, precluding a consideration of how exposure to structural stigma changes over the life course. The National Longitudinal Study of Adolescent to Adult Health (Add Health) has the necessary criteria to rigorously investigate the effects of structural stigma on the health outcomes of sexual minority respondents, including a formal and regulated mechanism for producing and disseminating contextual data. Add Health users interested in testing minority stress and intersectionality perspectives will have unprecedented opportunities to examine how various outcomes are associated with structural stigma for sexual minority respondents and how the associations differ across subgroups. Aim 1 of this project is to create a contextual database that researchers can use to better study the effects of structural stigma. Specifically, this database will include measures of social and legal climate relevant to sexual minorities that correspond to the tract, county, and state levels before or around the time of Waves 3, 4, and 5. This database will also include measures of structural racism since many sexual minorities are also racial/ethnic minorities. We will convene an advisory team to ensure we have the best measures of structural stigma and racism. Aim 2 will examine with this contextual database how state-level measures of legal climate are associated with self-rated health and health biomarkers among Add Health respondents and consider how these associations differ by key factors (e.g., gender, socioeconomic status, and race/ethnicity). This database will promote research on health disparities for sexual and racial minority populations that is both rigorous and innovative. Research made possible by the creation of this contextual database has the potential to inform policies and interventions that improve the health of sexual and racial minority populations, including subgroups of these populations, ensuring all populations have equal opportunities for long, healthy, and productive lives.