Sexual Orientation and Health Disparities in Adolescence

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DESCRIPTION (provided by applicant): Healthy People 2010, the nation's essential document for setting the national agenda for health, identifies the persistence of health disparities across communities to be among the leading health challenges of our era. Recent studies suggest that the health of the nation's adolescent population may be patterned in important ways by sexual orientation group disparities. Depressive symptoms and low self-esteem have been proposed as underlying vulnerabilities driving elevated rates of risk behaviors in sexual minority adolescents. Rosario et al. propose a psychosocial Coming Out Process (COP) Model for adolescents in which dimensions of the process are linked with health behaviors. Additionally, drawing on Bandura's Social Cognitive Theory (SCT), we propose that social norms in lesbian/bisexual female (LB) and gay/bisexual male (GB) communities also influence both positively and negatively health behaviors of sexual minority youth through processes of social learning. Family environment, an adolescent's age at the time of coming out, and presence or absence of preexisting psychosocial distress may be important factors influencing a young person's resiliency or risk and their experience with the coming out process. Research is needed to explore important predictors of the process of coming out and how this process relates to health behavior. We will examine sexual orientation in association with weight concerns, disordered weight control behaviors, binge eating, and tobacco and alcohol use in adolescent girls and boys in the Growing Up Today Study (GUTS), a longitudinal cohort study of 16,882 adolescents living across the U.S. In addition, we will examine factors that underlie the coming out process in adolescence, leading some to be more resilient while others have greater difficulties. Our specific aims are to compare the prevalence and severity over 4 years of follow-up of weight concerns and tobacco and alcohol use across sexual orientation groups among adolescent girls and boys and to empirically test the application of the COP Model and SCT to understand sexual orientation group disparities in health. We will examine prospectively the contribution of components of the COP Model and SCT in their relation to psychological distress and factors linked with LB and GB community social norms and orientation group differences in health outcomes.