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.

PROJECT NARRATIVE Sexual minority and gender minority (SGM) individuals are more likely to have poor physical health than their non-SGM peers. In this proposal, we will test if SGM people are more likely to have higher levels of cardiovascular disease (CVD) risk factors than non-SGM people and determine if stigma against SGM people contributes to increased risk for poor CVD outcomes in these populations at the intersections of race/ethnicity, sex, and socioeconomic status. As part of our larger goal to not only decrease SGM CVD but also to enhance SGM cardiovascular health equity, we will investigate if resilience promoting factors can mediate the harmful health effects of stigma to improve the health of diverse SGM populations.