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

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.

Grant Number: 5R01HL149866-05
NIH Institute/Center: NIH
Principal Investigator: Lauren Beach