Cardiovascular Health Associations with Minority stress: Biobehavioral Evaluations and self-Reported Sociopsychological outcomes by SOGI status (CHAMBERS)

心血管健康与少数群体压力的关联：生物行为评估和按 SOGI 状态自我报告的社会心理学结果 (CHAMBERS)

• 批准号: 10053165
• 负责人: Lauren Brittany Beach
• 金额: $ 83.5万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-09 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10053165
• 关键词: Address; Adult; Ancillary Study; Behavioral; Cardiovascular Diseases; Cholesterol; Chronic stress; Clinical; Collaborations; Communities; Coronary artery; County; Data; Development; Diabetes Mellitus; Diet; Discrimination; Disease; Disease Outcome; Distal; Distress; Ethnic Origin; Evaluation Reports; Funding; Gender Identity; Goals; Health; High Prevalence; Hispanic Community Health Study; Hispanics; Household; Hypertension; Incidence; Individual; Investigation; Latino; Laws; Life Cycle Stages; Link; Literature; Longitudinal cohort study; Measures; Mediating; Mental Depression; Minority; Modeling; National Heart, Lung, and Blood Institute; Obesity; Outcome; Participant; Pathway interactions; Patient Self-Report; Persons; Population; Population Heterogeneity; Prevalence; Race; Research Personnel; Resources; Risk; Risk Behaviors; Risk Factors; Same-sex; Sex Orientation; Sexual and Gender Minorities; Smoking; Social Power; Social support; Socioeconomic Status; Stigmatization; Stress; Structure; System; Testing; Time; adjudicate; aged; base; behavior measurement; biobehavior; cardiovascular disorder epidemiology; cardiovascular disorder risk; cardiovascular health; clinical development; clinical risk; cohort; community center; enhancing factor; evidence base; experience; gender minority; health disparity; health equity; improved; innovation; lens; minority communities; minority health; multilevel analysis; peer; physical conditioning; physical inactivity; population health; psychological distress; psychosocial; resilience; sex; social stigma; stressor; theories; young adult

PROJECT SUMMARY Sexual minority and gender minority (SGM) individuals experience a wide variety of health disparities compared to their non-SGM peers. These disparities include higher prevalence of cardiovascular disease (CVD) risk factors tied to psychological distress (e.g., depression, stress), behavioral CVD risk factors (smoking, physical inactivity, diet), and clinical CVD risk factors (e.g., diabetes, obesity, hypertension, high cholesterol). Existing SGM population health studies rely primarily on self-reported measures to document CVD risk factors and disease prevalence, thus ignoring undiagnosed clinical CVD risk factors present among younger populations. Though these studies have laid important groundwork to document the existence of SGM CVD disparities, the absence of objective measures of CVD risk factors and outcomes therefore remains a critical gap in the SGM health literature. Minority stress theory (MST) is the leading framework proposed to explain the wide-ranging health disparities observed among marginalized populations. In MST models, structural stigma (e.g., anti-SGM laws) is viewed as leading to and exacerbating distal (discrimination) and proximal stressors (internalized stigma, perceived stigma). These stigma-related stressors can contribute to poor SGM health via enhanced psychosocial distress and CVD risk behaviors. These pathways add to the higher chronic stress burden associated with the development of clinical CVD risk factors. Increasingly, MST- derived frameworks also reflect that resilience promoting factors at multiple levels (e.g., identity affirmation, social support) can decrease the harmful population health effects of stigma. Applying a theoretically-driven intersectional lens, we propose to build on studies describing the existence of SGM CVD disparities by contextualizing these disparities across person, place, and time in relation to social power systems. We propose an ancillary study to CARDIA to collect sexual orientation and gender identity (SOGI) data as well as measures of SGM stigma and resilience promoting factors in the Year 35 CARDIA exam. Through an innovative collaboration, we also propose to pool CARDIA data with data from the Hispanic Community Health Study/Study on Latinos (HCHS/SOL) cohort to address the following compelling and timely Specific Aims: Aim 1: Assess how behavioral and clinical CVD risk factors vary by SGM status over the life course. Aim 2: Among SGM participants (n=734), investigate how stigma and resilience promoting factors at the internalized and interpersonal levels associated with behavioral and clinical CVD risk factors. Aim 3: Determine the influence of SGM structural stigma on behavioral and clinical CVD risk factors. Overall, the impact of these studies will be to advance CVD epidemiology and to enhance the evidence base to ameliorate SGM CVD health disparities and promote SGM CVD health equity at the intersections of multiple marginalized identities.

项目摘要 性少数民族和性别少数民族（SGM）个人经历了各种各样的健康差异 与他们的非SGM同行相比。这些差异包括较高的心血管疾病患病率 （CVD）与心理困扰有关的风险因素（例如抑郁，压力），行为CVD风险因素 （吸烟，身体不活动，饮食）和临床CVD风险因素（例如糖尿病，肥胖，高血压，高 胆固醇）。现有的SGM人口健康研究主要依赖于自我报告的措施来记录 CVD风险因素和疾病患病率，因此忽略了未诊断的临床CVD风险因素 年轻人。尽管这些研究为记录SGM的存在奠定了重要的基础 CVD差异，缺乏CVD风险因素和结果的客观度量仍然是一个 SGM健康文献中的关键差距。少数民族压力理论（MST）是提出的领先框架 解释边缘化人群中观察到的广泛的健康差异。在MST模型中， 结构性污名（例如，反对SGM法律）被视为导致和加剧远端（歧视）和加剧 近端应力源（内部污名，感知的污名）。这些与污名相关的压力源可能有助于 通过增强的社会心理困扰和CVD风险行为，SGM健康状况不佳。这些途径增加了 与临床CVD风险因素的发展有关的慢性应激负担更高。越来越多的MST- 派生的框架还反映了弹性在多个层面上促进因素（例如身份肯定， 社会支持）可以减少污名的有害人口健康影响。应用理论驱动 交叉镜头，我们建议建立在描述SGM CVD差异存在的研究的基础上 将这些差异与社会权力系统有关的各个差异进行情境化。我们 向Cardia提出一项辅助研究，以收集性取向和性别认同（SOGI）数据以及 SGM污名和弹性促进因子的度量35 Cardia考试。通过一个 创新的合作，我们还建议与西班牙裔社区健康的数据一起汇总Cardia数据 拉丁裔研究/研究（HCHS/SOL）群体以解决以下引人注目且及时的特定目的：目标 1：评估行为和临床CVD风险因素如何因SGM状态而变化。目标2：中间 SGM参与者（n = 734），研究内在化和 人际关系水平与行为和临床CVD风险因素有关。目标3：确定 SGM对行为和临床CVD风险因素的结构污名。总体而言，这些研究的影响将是 提高CVD流行病学并增强证据基础，以改善SGM CVD健康差异 并在多个边缘化身份的交集处促进SGM CVD卫生公平。