7. PROJECT SUMMARY/ABSTRACT This project is responsive to NOT-MD-19-001 Notice of Special Interest in Research on the Health of Sexual and Gender Minority (SGM) Populations. Gender minority populations are at increased risk for cardiovascular disease (CVD) morbidity and mortality. Specifically, Behavioral Risk Factor Surveillance System data suggest that, compared to cisgender people, gender minorities are at more than double the risk for myocardial infarction and report greater depression, physical inactivity, and elevated body mass index (BMI), as well as poorer access to healthcare, all of which increase CVD risk. Further, many gender minority individuals take hormones, which may further increase their risk of CVD. According to minority stress theory, the negative impact of prejudice and discrimination is one contributor to CVD risk disparities. Although previous studies have found associations between gender minority stress and poorer self-reported mental health, the impact of minority stress on physical health outcomes, including CVD risk, has not been examined in gender minority populations. The goal of this study is to advance our understanding of how minority stress and resilience affect CVD risk. In an established longitudinal, multisite cohort of gender minority individuals in three U.S. cities (N=390), we aim to: (1) determine the association of minority stress with mental health and CVD risk; (2) determine the impact of social support, access to care, and identity development on mental health and CVD risk; and (3) identify modifiable resilience factors that may influence the relationship of minority stress to mental health and CVD risk in this health disparity population. In addition to structured interviews and Ecological Momentary Assessments (EMA) of stress and resilience at baseline and 2-year follow-up, we will collect 2-week bursts of objective measurements of blood pressure, sleep and physical activity. The proposed research will provide the best evidence to date to guide researchers and clinicians working to develop interventions to reduce CVD disparities in gender minority populations, and promote their long-term health and wellbeing.

8. Project Narrative Research to date has found inequities in cardiovascular disease and related health behaviors in the U.S. gender minority population. This study will be the first to determine the relationship between minority stress, resilience, mental health, and cardiovascular disease (CVD) risk factors (blood pressure, sleep and physical activity, tobacco use, and BMI) in a diverse sample of the U.S. gender minority population, using both self-report and objectively measured data. Findings will inform the development and testing of future intervention strategies aimed at reducing CVD risk and promoting the health and wellbeing of this and other vulnerable populations.