Sexual minority (e.g., lesbian, gay, and bisexual) and gender minority (e.g., transgender and gender nonbinary) individuals – or SGM individuals collectively – 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, anxiety, stigma, stress), adverse health behaviors (smoking, alcohol, physical inactivity, diet), and clinical factors (e.g., diabetes, obesity, hypertension). Existing SGM population health studies rely primarily on self-reported measures to document CVD risk factors and disease prevalence. 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 is 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, policies, and attitudes) is viewed as leading to and exacerbating distal (discrimination, community-level prejudice) and proximal stressors (internalized stigma, perceived stigma). These stigma-related stressors are thought to contribute to poor SGM health via enhanced psychosocial distress and adverse health behaviors. Together, these pathways add to the higher chronic stress burden associated with the development of poor CVH, clinical CVD risk factors and CVD events. Though a growing number of studies support the existence of SGM CVD disparities, little is known about which 1) SGM stigma levels or 2) CVD risk factors most contribute to the CVD disparities between SGM and non-SGM populations. We propose an ancillary study to CARDIA to collect sexual orientation and gender identity (SOGI) as well as measures of health behaviors and SGM stigma and resilience in the Year 35 CARDIA exam. Of note, through an innovative collaboration, we also propose to pool CARDIA data from this ancillary study 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: In CARDIA & CARDIA/SOL data, assess whether SGM participants have worse CVH and more CVD compared to their non-SGM counterparts. Aim 2: Determine if internalized and interpersonal SGM stigmas are associated with poor CVH, CVD risk factors, and CVD events and if resilience mediates these associations among SGM participants. Aim 3: Determine if higher levels of SGM structural stigma are associated with worse CVH and with a higher burden of CVD risk factors and events. This study will determine the psychosocial, behavioral, and clinical minority stress pathways that drive SGM CVD risk factors, outcomes, and disparities. The impact will be to advance CVD epidemiology and enhance the evidence base to improve SGM health and ameliorate SGM health disparities.
|Effective start/end date||7/9/20 → 6/30/25|
- National Heart, Lung, and Blood Institute (1R01HL149866-01A1)