Changes in the Social and Policy Environment as Predictors of Substance Use and Health-Related Quality of Life Among Sexual Minorities

项目摘要/摘要 美国的性少数(即女同性恋者、男同性恋者、双性恋者和大部分是异性恋者)年轻人有 与他们的异性恋同龄人相比，使用药物的风险和不利的心理健康结果更高。 这些健康不平等可能是社会压力的结果，例如耻辱和歧视 在多个层面上影响健康，包括个人(例如，人际歧视)和结构层面 (例如，歧视性的国家政策)。然而，关于这些个人和结构层面的社会如何 应激源或复原力因素(例如，社会支持)促进物质使用方面的健康不平等，以及如何 它们影响与健康相关的生活质量(HRQOL)。迫切需要了解(I)变化是如何发生的 结构性歧视的时间(例如，法律和政策)可能与物质使用和性别之间的HRQOL有关 取向群体和(2)性少数群体中的异质性，例如多层次应激源的模式 跨种族/族裔、性别(包括性别不一致，这可能成为歧视的目标)；以及 年龄队列。为了解决这些研究任务，本项目将侧重于以下目标： (1)考察结构性应激源与性取向之间的相互作用 物质使用的发展与HRQOL。使用纵向队列数据和州一级数据库 与性少数民事权利相关的法律和政策的变化，分析将审查修改的效果 性取向、物质使用与HRQOL的关系 在青少年发展过程中的歧视。 (2)阐明结构性应激源和个体应激源与物质的关系 使用来自两个互补的国家队列的数据，在不同的性少数群体中使用和HRQOL 性少数群体。分析将比较州级结构性歧视、自我歧视和 报告的歧视、复原力因素和使用药物的风险以及不良的HRQOL和意志的经历 按种族/民族、性别不一致和年龄队列检查社会压力源的不同模式。 为了实现这些目标，这项研究将利用(I)今日成长研究的数据，这是一项纵向研究 27,000名青年，他们在9至14岁时被招募，现在20多岁至30多岁，以及(Ii) 世代研究是对美国676名黑人、拉丁裔和白人性少数群体的全国概率样本 三个年龄组，代表在不同的社会和政策环境中成长的几代人 关于性取向的问题。将使用纵向统计方法和结构方程建模 审视上述目标。这项拟议的研究将是第一批检查美国多层次社会和 与性取向、物质使用不平等和人权生活质量有关的政策背景。调查结果将增强 了解与性取向有关的健康不平等和意愿形成的关键机制 告知干预措施，以减轻压力并加强对性少数群体青年的保护因素。

Project Summary/Abstract Sexual minority (i.e., lesbian, gay, bisexual, and mostly heterosexual) young people in the U.S. have elevated risk of substance use and adverse mental health outcomes compared to their heterosexual peers. These health inequities may be the result of social stressors such as stigma and discrimination that can influence health at multiple levels, including individual (e.g., interpersonal discrimination) and structural levels (e.g., discriminatory state policies). Yet little is known about how these individual- and structural-level social stressors or resilience factors (e.g., social support) contribute to health inequities in substance use and how they affect health-related quality of life (HRQOL). There is a pressing need to understand (i) how changes over time in structural discrimination (e.g., law and policy) may relate to substance use and HRQOL across sexual orientation groups and (ii) heterogeneity within sexual minorities, such as patterning of multi-level stressors across race/ethnicity, gender (including gender nonconformity, which can be a target for discrimination), and age cohort. To address these research imperatives, this project will focus on the following aims: (1) Examine the interplay between structural-level stressors and sexual orientation in the development of substance use and HRQOL. Using longitudinal cohort data and a state-level database of changes in laws and policies relevant to sexual minority civil rights, analyses will examine effect modification of the association between sexual orientation and substance use and HRQOL by state-level structural discrimination over the course of adolescent development. (2) Elucidate the relationships between structural- and individual-level stressors and substance use and HRQOL among diverse sexual minorities, using data from two complementary national cohorts of sexual minorities. Analyses will compare associations between state-level structural discrimination, self- reported experiences of discrimination, resilience factors, and risk of substance use and poor HRQOL and will examine differential patterning of social stressors by race/ethnicity, gender nonconformity, and age cohort. To achieve these aims the research will utilize data from (i) the Growing Up Today Study, a longitudinal cohort of 27,000 youth who were recruited when they were ages 9-14 and are now in their 20s-to-30s, and (ii) the Generations Study, a national probability sample of 676 U.S. Black, Latino and White sexual minorities in three age cohorts, representing generations that came of age in disparate social and policy environments with regards to sexual orientation. Longitudinal statistical methods and structural equation modeling will be used to examine the above aims. The proposed research will be among the first to examine multilevel U.S. social and policy contexts in relation to sexual orientation inequities in substance use and HRQOL. Findings will enhance understanding of key mechanisms in the development of sexual orientation-related health inequities and will inform interventions to mitigate stressors and strengthen protective factors for sexual minority youth.