Identity Stress and Health in Three Cohorts of LGB individuals

描述(由申请人提供)：女同性恋者、男同性恋者和双性恋者(LGB)青年和成年人与他们的异性恋同龄人相比，健康结果存在差异。少数群体压力理论认为，由于社会环境中的偏见和耻辱，LGB人经历了过度的压力，导致了糟糕的健康结果和健康差距。由于少数群体应激理论关注的是社会环境，它引导我们预测，随着社会环境的改善，影响LGB的应激过程的特征也会发生变化。LGB身份、与社区的联系以及LGB人寻求的社会和健康服务的类型也发生了类似的变化。如果我们要实现美国公共卫生服务机构减少与性取向相关的健康差距的目标，我们需要了解身份变化和少数族裔压力对LGB健康的影响，并利用这些知识为终身公共卫生干预提供信息。为了获得这一知识，我们建议进行一项纵向研究，使用美国人口中代表LGB的不同LGB的概率样本。我们试图比较三组LGB人群--18-25岁、34-42岁和48-55岁--他们的不同之处在于，当他们成年时，他们暴露在显著不同的社会环境中。我们感兴趣的是，身份认同和少数族裔压力如何预测队列中的健康。我们将使用混合方法设计，使我们能够从定性数据和调查数据中获得知识。我们使用创新的两阶段程序招募了代表美国黑人、拉丁裔和白人LGB人群的676名LGB个人样本。我们对受访者进行基线评估，并在此后3年内每年评估一次。在一项定性研究中，我们使用叙事生活史来评估纽约、加利福尼亚州和亚利桑那州城市和农村地区的黑人、拉丁裔、白人和亚裔LGB人的不同群体。我们的假设是：1.尽管年轻人很容易承认LGB的身份，并且出柜的年龄比年长的人更早，但年轻的人与年长的人不同，因为他们的LGB身份不是那么核心，他们对LGB社区的认同感不那么强烈，对性取向和身份认同的含义也不同。2.与年长的人相比，年轻的同龄人在接受同性恋身份和出柜方面感受到的少数群体压力较少，但感受到的外部压力更多，包括与偏见相关的应激生活事件、反同性恋暴力和日常形式的歧视。3.较年轻的LGB群体的成员比较年长的LGB群体的成员使用LGB确定的社会和保健服务较少。4.在结构方程中，少数群体压力模型在预测年轻群体和老年群体的健康结果方面发挥了同样好的作用，但根据目标1和目标2的研究结果，各群体的压力、复原力和健康结果的模式不同。

DESCRIPTION (provided by applicant): Lesbian, gay, and bisexual (LGB) youth and adults suffer disparities in health outcomes compared with their heterosexual peers. Minority stress theory suggests that because of prejudice and stigma in the social environment, LGB people experience excess stress that leads to poor health outcomes and health disparities. Because of its focus on the social environment, minority stress theory leads us to predict that the character of stress processes affecting LGBs shift along with improvement in the social environment. Similarly shifting are notions of LGB identity, connection with the community, and the types of social and health services LGB people seek. If we are to achieve the U.S. Public Health Services' goal of reducing health disparities related to sexual orientation, we need to understand the impact of changes in identity and minority stress on LGB health and, using this knowledge, inform public health interventions across the lifespan. To gain this knowledge, we propose a longitudinal study using a probability sample of diverse LGBs representative of LGBs in the U.S. population. We seek to compare 3 cohorts of LGB individuals-aged 18 - 25, 34 - 42, and 48 - 55 years old-who are distinct in that they were exposed to significantly different social environments when they came of age. We are interested in ways that identity and minority stress predict health across the cohorts. We will use a mixed method design that allows us to gain knowledge from both qualitative and survey data. We use an innovative 2-stage procedure to recruit a sample of 676 LGB individuals representative of U.S. Black, Latino, and White LGB populations. We assess respondents baseline and annually for 3 years thereafter. In a qualitative study, we use a narrative life history to assess a diverse group of Black, Latino, White, and Asian LGB individuals in urban and rural regions of New York, California, and Arizona. We hypothesize that: 1. Despite readily acknowledging an LGB identity and coming out at a younger age than did older cohorts, the younger cohorts differ from older cohorts in that their LGB identity is less central, they are less strongly identified with the LGB community, and have different meanings of sexual orientation and identity. 2. Compared with older, the younger cohort experience less minority stress related to their own acceptance of a gay identity and coming out, but more external stress, including prejudice-related stressful life events, antigay violence, and everyday forms of discrimination. 3. Members of younger LGB cohorts utilize fewer LGB-identified social and health services than do members of older LGB cohorts. 4. In structural equations, the minority stress model functions equally well in predicting health outcomes in the younger and older cohorts, but patterns of stress, resilience, and health outcomes differ among the cohorts in accordance with findings in Aims 1 and 2.