An intersectional approach linking Minority Stressors Experienced by Transgender and Gender Diverse Adults to Alcohol and Drug Use and comorbid Mental and Physical Health Outcomes

一种交叉方法，将跨性别和性别多样化成年人经历的少数压力源与酒精和毒品使用以及共病心理和身体健康结果联系起来

• 批准号: 10503449
• 负责人: LAURA F SALAZAR
• 金额: $ 48.97万
• 依托单位: GEORGIA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10503449
• 关键词: Acute; Adult; Advertisements; Affect; Age; Alcohol abuse; Alcohol consumption; Alcohols; Anxiety; Behavior; Biological Markers; Blood Pressure; Body mass index; Buffers; Cardiovascular Diseases; Cheek structure; Chronic; Chronic stress; Clip; Communities; Data; Diabetes Mellitus; Discrimination; Distal; Drug Use Disorder; Drug usage; Ecological momentary assessment; Ethnic Origin; Etiology; Evidence based treatment; Frequencies; Gender; Gender Identity; Goals; Gonadal Steroid Hormones; Hair; Health; Health Status; Health behavior; Heterogeneity; High Prevalence; Individual; Individual Differences; Inequity; Infrastructure; Interpersonal Violence; Intervention; Knowledge; Link; Measurement; Measures; Mental Depression; Mental Health; Methodology; Modeling; Obesity; Observational Study; Online Systems; Outcome; Participant; Pathway interactions; Patient Self-Report; Physiological; Policies; Population; Post-Traumatic Stress Disorders; Prevention; Prevention program; Prevention strategy; Process; Prospective, cohort study; Race; Reduce health disparities; Research; Resources; Risk; Risk Factors; Role; Saliva; Sampling; Shapes; Sleep; Social Identification; Social support; Stigmatization; Stress; Subgroup; Surveys; Swab; Victimization; Violence; Waist-Hip Ratio; acute stress; alcohol abuse therapy; alcohol use disorder; cisgender; community organizations; community-level factor; comorbidity; contextual factors; design; ethnic identity; evidence base; experience; follow-up; gender affirmation; gender affirming therapy; gender diversity; health care service utilization; health difference; health disparity; individual variation; intersectionality; marginalization; meetings; microaggression; minority stress; minority stressor; nonbinary; outcome disparities; peer; physical conditioning; prospective; racial diversity; racial identity; recruit; resilience factor; sex assigned at birth; sexual violence; social; social stigma; sociodemographics; stressor; suicidal; theories; transfeminine; transgender; transmasculine; treatment program

Abstract Transgender, and gender diverse adults (TGDAs) experience severe inequities rooted in and reflective of historical stigmatization due to their gender status and resulting in significant health disparities. In accordance with minority stress theory, systematic oppression, discrimination, and stigma are distal stressors that manifest through experiences of interpersonal violence and microaggressions. These experiences can lead to increased levels of stress and, in turn, alcohol abuse and drug use. Consequently, TGDAs experience high prevalence of adverse mental health and physical health outcomes in comparison to their cisgender counterparts. These risk factors and experiences of stress may increase the likelihood of TGDAs’ experiencing and/or perpetrating interpersonal violence. Unfortunately, few efficacious, comprehensive strategies for prevention and treatment of alcohol abuse, drug use, interpersonal violence, mental health and physical health have been specifically designed for TGDAs. The primary goal of this proposal is to use minority stress model and intersectionality to examine a host of stressors that contribute to inequities in alcohol abuse and drug use, cross-reciprocal interpersonal violence, and subsequent physical and mental health outcomes among TGDAs. The goal will be achieved by conducting a 12-month prospective cohort study with a racially and gender diverse sample of 400 TGDAs, ages 18-55. The following aims will be fulfilled: Aim 1:Identify the structural/community factors and proximal/distal minority stressors most strongly predictive of alcohol abuse and drug use as intermediary outcomes to mental health outcomes (i.e., depression, PTSD, etc.) and physical health outcomes (i.e., cardiovascular disease, sleep, etc.) for TGDAs; Aim 2: Evaluate if differences in Aim 1 direct and indirect effects are evident by TGD subgroup (i.e., gender diverse, transfeminine, transmasculine) and across intersecting identities of race/ethnicity; Aim 3: Examine whether Aim 1 associations are moderated by resilience factors (i.e., healthcare utilization, social support), and Aim 4: Explore the mechanistic roles of acute and chronic daily stresses (assessed by biomarkers), controlling for sex hormones, in associations examined for Aim 1. Another subaim will be to examine the intraindividual variability in the momentary cross-reciprocal relationship between interpersonal violence and alcohol abuse. Multiple forms of data will be collected to assess these goals: 1) self- reported survey data collected at baseline, 6- and 12-months, 2) ecological momentary assessments administered, and 3) saliva, hair clippings, and cheek swabs, in addition to BMI, blood pressure, and waist-to-hip ratio. Our expected outcomes are to provide evidence regarding modifiable factors associated with alcohol use and drug use as well as the pathways by which interpersonal violence and physical and mental health outcomes occur,and to identify priorities in treatment and prevention designed for TGDAs.

抽象的 跨性别者和性别多样化的成年人（TGDA）经历了根源并反映的严重不平等现象 历史污名化是由于其性别状况而引起的，导致了重大的健康差异。在 根据少数族裔压力理论，系统的压迫，歧视和污名是二心音 通过人际关系暴力和微攻击经验而表现出来的压力源。这些 经验会导致压力水平增加，进而导致酗酒和吸毒。最后， 相比之下 与他们的cisgender同行。这些危险因素和压力的经历可能会增加 TGDA的经验和/或进行人际关系暴力。不幸的是，效率很少， 预防和治疗酒精滥用，吸毒，人际暴力的综合策略， 精神健康和身体健康是专门为TGDA设计的。这个主要目标 建议是使用少数族裔压力模型和交叉性来检查许多有助于的压力源 酗酒和吸毒的不平等，跨亲红细胞界面暴力以及随后的序列 TGDA中的身心健康结果。目标将通过12个月来实现 前瞻性队列研究，大致和性别潜水员样本为400 tGDA，年龄在18-55岁。这 将实现以下目的：目标1：确定结构/社区因素和近端/远端少数民族 提高最有力地预测酒精滥用和吸毒作为心理健康的中间结果 结果（即抑郁症，PTSD等）和身体健康结果（即心血管疾病，睡眠， 等）对于TGDA； AIM 2：评估目标1是否有直接和间接效应在TGD中证明 亚组（即性别多样，跨性别，跨性质）以及跨越相交的身份 种族/种族；目标3：检查目标1是否由弹性因素调节（即， 医疗保健利用，社会支持）和目标4：探索急性和慢性每日的机械作用 在检查目标1的协会中，应力（由生物标志物评估），控制性激素。 另一个Subaim将是检查瞬时横向重点的个体内变异性 人际暴力与酗酒之间的关系。多种形式的数据将被收集到 评估以下目标：1）在基线，6个月和12个月收集的自我报告的调查数据，2）生态学 进行的瞬时评估以及3）唾液，脱发和脸颊拭子，除了BMI之外 血压和腰围比。我们的预期结果是提供有关可修改的证据 与饮酒和吸毒以及人际暴力的途径相关的因素 以及身体和心理健康的结果，并确定治疗和预防的优先级 为TGDA设计。