Poteat Tonia, Gallo Linda C, Harkness Audrey, Isasi Carmen R, Matthews Phoenix, Schneiderman Neil, Thyagarajan Bharat, Daviglus Martha L, Sotres-Alvarez Daniela, Perreira Krista M
Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States.
Department of Psychology, San Diego State University, San Diego, CA, United States.
JMIR Res Protoc. 2021 May 6;10(5):e28997. doi: 10.2196/28997.
Hispanic/Latino sexual and gender minorities (SGM) are the fastest growing ethnic group of SGM in the United States. Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among Hispanics/Latinos. SGM inequities in CVD risk have been identified as early as young adulthood, and minority stress has been identified as a potential mediator. Yet, the small number of ethnic or racial minority participants in SGM studies have precluded the examination of the intersections of sexual orientation, gender identity, and race and ethnicity.
Minority stress models conceptualize relationships between stressors in minority groups and health outcomes. In this study, we will (1) examine the influence of sexual orientation and gender identity on CVD risk among all Hispanic Community Health Study/Study of Latinos (HCHS/SOL) participants at visit 3 (2021-2024; N9300); (2) model pathways from sexual orientation and gender identity to CVD risk through stigma, discrimination, and stress in a 1:2 matched subcohort of SGM and non-SGM participants at visit 3 (n1680); and (3) examine the influence of resilience factors on sexual orientation or gender identity and CVD risk relationships among subcohort participants at visit 3 (n~1680).
This study will leverage existing data from the parent HCHS/SOL study (collected since 2008) while collecting new data on sexual orientation, gender identity, stigma, discrimination, stress, coping, social support, and CVD risk. Data analysis will follow the SGM minority stress model, which states that excess stigma against SGM populations leads to minority stress that increases CVD risk. In this model, coping and social support serve as resilience factors that can mitigate the impact of minority stress on CVD risk. Cross-sectional and longitudinal regression models as well as structural equation models will be used to test these relationships.
This study was funded by the National Heart, Lung, and Blood Institute in March 2020. Recruitment is scheduled to begin in the first quarter of 2021 and continue through 2024.
Understanding the influence of stigma-induced stress on CVD risk among Hispanic/Latino SGM has significant implications for the development of culturally specific CVD risk reduction strategies. Study findings will be used to build on identified Hispanic/Latino cultural strengths to inform adaptation and testing of family and community acceptance interventions.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/28997.
西班牙裔/拉丁裔性取向和性别少数群体（SGM）是美国增长最快的SGM族裔群体。心血管疾病（CVD）是西班牙裔/拉丁裔发病和死亡的主要原因。早在青年时期就已发现SGM在CVD风险方面存在不平等现象，且少数群体压力被认为是一个潜在的中介因素。然而，SGM研究中少数族裔或种族参与者数量较少，妨碍了对性取向、性别认同与种族和族裔交叉点的研究。
少数群体压力模型将少数群体中的压力源与健康结果之间的关系概念化。在本研究中，我们将：（1）在第三次访视（2021 - 2024年；N≈9300）时，研究性取向和性别认同对所有西班牙裔社区健康研究/拉丁裔研究（HCHS/SOL）参与者CVD风险的影响；（2）在第三次访视时，对1:2匹配的SGM和非SGM参与者亚队列（n≈1680），构建从性取向和性别认同通过耻辱感、歧视和压力到CVD风险的路径模型；（3）在第三次访视时，研究复原力因素对亚队列参与者中性取向或性别认同与CVD风险关系的影响。
本研究将利用母本HCHS/SOL研究（自2008年起收集）的现有数据，同时收集关于性取向、性别认同、耻辱感、歧视、压力、应对方式、社会支持和CVD风险的新数据。数据分析将遵循SGM少数群体压力模型，该模型指出对SGM群体的过度耻辱感会导致少数群体压力增加，进而增加CVD风险。在该模型中，应对方式和社会支持作为复原力因素，可以减轻少数群体压力对CVD风险的影响。将使用横断面和纵向回归模型以及结构方程模型来检验这些关系。
本研究于2020年3月获得美国国立心肺血液研究所资助。招募计划于2021年第一季度开始，并持续至2024年。
了解耻辱感引发的压力对西班牙裔/拉丁裔SGM群体CVD风险的影响，对于制定具有文化特异性的CVD风险降低策略具有重要意义。研究结果将用于依托已确定的西班牙裔/拉丁裔文化优势，为家庭和社区接纳干预措施的调整和测试提供参考。
国际注册报告识别码（IRRID）：PRR1 - 10.2196/28997
