Reducing Black Men's Drug Use and Co-Occurring Negative Mental and Physical Health Outcomes: Intersectionality, Social-Structural Stressors, and Protective Factors

减少黑人吸毒和同时发生的负面身心健康结果：交叉性、社会结构压力源和保护因素

• 批准号: 9906886
• 负责人: Ingrid Alisa Bowleg
• 金额: $ 63.48万
• 依托单位: GEORGE WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9906886
• 关键词: AIDS/HIV problem; Accidental Injury; Address; Adult; Affect; Age; Alcohol consumption; Alcohols; Area; Biological Markers; Bisexual; Blood Pressure; Blood specimen; Cardiovascular Diseases; Cause of Death; Cholesterol; Collection; Data; Dependence; Development; Discrimination; Drug usage; Economic Factors; Environmental Risk Factor; Epidemiology; Equation; Focus Groups; Future; Gays; Gender; Health; Heart Diseases; Heterosexuals; Homicide; Imprisonment; Individual; Inequality; Intervention; Knowledge; Malignant Neoplasms; Marijuana; Mental Health; Methods; Mission; Modeling; Morbidity - disease rate; National Institute of Drug Abuse; Nicotine; Outcome; Participant; Pathway interactions; Patient Self-Report; Pattern; Pharmaceutical Preparations; Phase; Police; Political Factor; Population; Positioning Attribute; Process; Psyche structure; Public Health; Race; Reporting; Research; Research Design; Research Support; Risk; Sampling; Social status; Socioeconomic Status; Stress; Structure; Suicide; Testing; Time; Toxicology; Urine; Washington; base; epidemiology study; experience; health data; health disparity; illicit drug use; intersectionality; low socioeconomic status; male health; men; men who have sex with men; mortality; multidisciplinary; physical conditioning; protective factors; psychological distress; racial identity; recruit; resilience; sexual identity; sexual minority; social factors; social structure; stress resilience; stressor; therapy design; virtual

PROJECT SUMMARY/ABSTRACT Health inequities among Black men in the U.S. are stark. Drug use contributes to six of the top ten leading causes of death among Black men ages 18 to 54. Social-structural stressors such as discrimination, based on race or race and sexual identity, and drug use to cope with stress, are well-documented pathways to drug use among Black adults. Empirical evidence that drug use co-occurs with other negative health outcomes underscores an urgent public health need to examine drug use and other co-occurring negative health outcomes associated with social-structural stressors. Single-axis perspectives—either race or sexual identity— dominate drug use and health disparities research. Apart from HIV/AIDS research, research on the effects of social-structural stressors on Black men’s drug use and co-occurring negative health outcomes at the intersection of sexual identity (i.e., heterosexual, sexual minority) and socioeconomic position (SEP) is virtually nonexistent. Critical gaps also exist about how protective factors (e.g., resilience, religiosity, positive racial/sexual identity) influence the effects of social-structural stressors on Black men’s drug use and co- occurring negative health outcomes. To address these critical gaps, a longitudinal cross-lagged explanatory- sequential (QUANT→qual) mixed methods study is proposed to test, via structural equation modeling, a conceptual model of social-structural stressors, protective factors, and drug use (alcohol, marijuana, nicotine, illicit drug use) and co-occurring negative mental (e.g., psychological distress) and physical (e.g., blood pressure) health outcomes among Black men at the intersection of sexual identity and SEP. Purposive quota sampling will be used to recruit 960 Black men, ages 18-54, stratified by sexual identity and SEP (240/group) in Washington, DC. Phase I includes the collection of self-reported social-structural stressors, protective factors, drug use, and mental health data, and objective drug use (i.e., urine toxicology) and physical health (e.g., blood pressure) data at Time 1, and 3 months later at Time 2 (Aims 1, 2). Blood samples will be collected at Time 2 only to assess cardiovascular disease biomarkers (e.g., total cholesterol). Phase II includes 4 focus groups with 6-8 Phase I participants (total n = 24 to 32) purposively sampled to explain Phase I results (Aim 3). Phase III involves a synthesis and validity assessment of the quantitative and qualitative results (Aim 3). The proposed research uses intersectionality, social-structural stress, and resilience theoretical frameworks to advance new and important knowledge about the extent to which social-structural stressors and protective factors influence drug use and co-occurring negative health outcomes among Black men at the intersection of sexual identity and SEP. This intersectional focus represents a paradigmatic shift from conventional single-axis and one-size-fits-all intervention approaches. The significance of the proposed research lies in the expected outcome of the future development of multi-level (i.e., individual and social-structural) interventions to reduce drug use and promote mental and physical health among Black men at different intersectional positions of risk.

项目摘要/摘要 美国黑人男性的健康不平等是鲜明的。毒品使用贡献了前十名领先的六个 18至54岁的黑人死亡原因。基于歧视等社会结构压力源 种族，种族和性认同以及用于应对压力的药物使用是有据可查的毒品使用的途径 在黑人成年人中。经验证据表明，使用药物与其他负面健康结果共同占领 强调了紧急公共卫生需要检查药物使用和其他同时发生的负面健康 与社会结构压力源相关的结果。单轴观点 - 种族或性认同 - 主导使用药物使用和健康差异研究。除了艾滋病毒/艾滋病研究，研究 社会结构压力源对黑人药物使用和同时发生的负面健康结果 性认同（即异性恋，性少数群体）和社会经济地位（SEP）的交集实际上是 不存在。关于受保护因素的方式（例如，韧性，宗教，积极的）也存在关键差距 种族/性认同）影响社会结构压力源对黑人药物使用和共同使用的影响 发生负面健康结果。为了解决这些关键的差距，纵向交叉隔断的挖掘 - 顺序（Quant→Qual）混合方法研究建议通过结构方程建模A测试A 社会结构压力源，受保护因素和吸毒的概念模型（酒精，大麻，尼古丁， 非法药物使用）和同时发生的负面心理（例如心理困扰）和身体（例如，血液 压力）黑人在性认同与SEP的交集中的健康状况。目的配额 抽样将用于招募960名黑人，年龄在18-54岁，按性认同和SEP分层（240/组） 在华盛顿特区。第一阶段包括收集自我报告的社会结构压力源，受到保护 因素，药物使用和心理健康数据以及客观的药物使用（即尿液毒理学）和身体健康 （例如，血压）时间1和3个月后的数据（目标1，2）。将收集血液样本 在时间2上仅评估心血管疾病生物标志物（例如总胆固醇）。第二阶段包括4个焦点 具有6-8阶段参与者的组（总n = 24至32）通常被采样以解释I期结果（AIM 3）。 第三阶段涉及对定量和定性结果的合成和有效性评估（AIM 3）。 拟议的研究使用交叉性，社会结构压力和弹性理论框架 促进有关社会结构压力源和保护性多大程度的新重要知识 因素会影响黑人在黑人中的药物使用和同时发生的负面健康结果 性认同和七个。这种交叉焦点代表了从常规单轴的范式转移 和一定大小的干预方法。拟议的研究的意义在于预期 多层次（即个人和社会结构）干预措施的未来发展的结果 在不同风险的交叉位置，黑人使用药物并促进精神和身体健康。