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

社会和政策环境的变化作为性少数群体药物使用和健康相关生活质量的预测因素

• 批准号: 9529635
• 负责人: Allegra Raboff Gordon
• 金额: $ 6.57万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-01 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9529635
• 关键词: 14 year old; Address; Adolescent Development; Adolescent and Young Adult; Adverse effects; Affect; Age; Alcohol or Other Drugs use; Appearance; Attention; Behavior; Bisexual; Buffers; Child; Chronic Disease; Civil Rights; Data; Databases; Development; Discrimination; Economics; Enrollment; Environment; Equation; Ethnic Origin; Event; Exposure to; Fellowship; Feminine; Future; Gays; Gender; Generations; Goals; Health; Health Status; Healthy People 2020; Heterogeneity; Heterosexuals; Individual; Injury; Intervention; Latino; Laws; Lesbian; Lesbian Gay Bisexual; Lesbian Gay Bisexual Transgender; Life; Longitudinal cohort; Masculine; Mediating; Mental Health; Mentors; Methods; Minority; Modeling; Modification; Nurses' Health Study; Outcome; Patient Self-Report; Pattern; Policies; Policy Analysis; Population; Population Heterogeneity; Probability Samples; Productivity; Public Health; Quality of life; Race; Research; Risk; Role; Sampling; Sex Orientation; Social Environment; Social Policies; Social support; Statistical Methods; Stress; Substance Addiction; Testing; Time; Training; United States Dept. of Health and Human Services; Violence; Woman; Youth; adolescent substance use; bullying; cohort; experience; gender nonconforming; health equity; health related quality of life; improved; innovation; peer; protective factors; recruit; reduced substance use; resilience; response; self esteem; sexual minority; skills; social; social stigma; stress resilience; stressor

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.

项目概要/摘要 美国的性少数群体（即女同性恋、男同性恋、双性恋和大多数异性恋）年轻人 与异性恋同龄人相比，物质使用和不良心理健康结果的风险更高。 这些健康不平等可能是耻辱和歧视等社会压力的结果 在多个层面影响健康，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，人们对这些个人和结构层面的社会如何 压力源或复原力因素（例如社会支持）导致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）如何改变 结构性歧视（例如法律和政策）的时间可能与跨性别的物质使用和 HRQOL 相关 取向群体和（ii）性少数群体内的异质性，例如多层次压力源的模式 跨种族/民族、性别（包括性别不一致，这可能成为歧视的目标），以及 年龄组。为了解决这些研究当务之急，该项目将重点实现以下目标： (1) 检查结构层面的压力源与性取向之间的相互作用 物质使用和 HRQOL 的发展。使用纵向队列数据和州级数据库 与性少数公民权利相关的法律和政策的变化，分析将考察修改的影响 州级结构性取向和物质使用与 HRQOL 之间的关联 青少年发展过程中的歧视。 (2) 阐明结构和个体层面的压力源与物质之间的关系 使用来自两个互补的国家队列的数据，研究不同性少数群体的使用情况和 HRQOL 性少数群体。分析将比较州级结构性歧视、自我歧视之间的关联 报告的歧视经历、复原力因素、药物使用风险以及较差的 HRQOL 和意愿 检查按种族/族裔、性别不一致和年龄组划分的社会压力源的差异模式。 为了实现这些目标，该研究将利用来自 (i) 《今日成长研究》的数据，这是一项纵向研究 由 27,000 名 9 至 14 岁青少年组成的队列，现在年龄在 20 至 30 多岁，以及 (ii) 世代研究，对 676 名美国黑人、拉丁裔和白人性少数群体进行的全国概率样本 三个年龄段，代表在不同的社会和政策环境中长大的几代人 关于性取向。纵向统计方法和结构方程模型将用于 检查上述目标。拟议的研究将是第一个研究多层次的美国社会和 与物质使用和 HRQOL 中的性取向不平等相关的政策背景。研究结果将增强 了解与性取向相关的健康不平等和意愿发展的关键机制 为缓解压力源和加强性少数青少年的保护因素的干预措施提供信息。

项目成果

Sexual orientation-related disparities in healthcare access in three cohorts of U.S. adults.

• DOI: 10.1016/j.ypmed.2020.105999
• 发表时间: 2020-03
• 期刊: Preventive medicine
• 影响因子: 5.1
• 作者: Tabaac AR;Solazzo AL;Gordon AR;Austin SB;Guss C;Charlton BM
• 通讯作者: Charlton BM

Childhood Gender Nonconformity and Intimate Partner Violence in Adolescence and Young Adulthood.

• DOI: 10.1177/0886260518770643
• 发表时间: 2021-03
• 期刊: JOURNAL OF INTERPERSONAL VIOLENCE
• 影响因子: 2.5
• 作者: Adhia, Avanti;Gordon, Allegra R.;Roberts, Andrea L.;Fitzmaurice, Garrett M.;Hemenway, David;Austin, S. Bryn
• 通讯作者: Austin, S. Bryn

Gender Expression, Peer Victimization, and Disordered Weight-Control Behaviors Among U.S. High School Students.

• DOI: 10.1016/j.jadohealth.2020.08.032
• 发表时间: 2021-06
• 期刊: The Journal of adolescent health : official publication of the Society for Adolescent Medicine
• 作者: Gordon AR;Austin SB;Schultz J;Guss CE;Calzo JP;Wang ML
• 通讯作者: Wang ML