Identity Stress and Health in Three Cohorts of LGB individuals

描述（由申请人提供）：女同性恋、男同性恋和双性恋（LGB）青年和成年人与异性恋同龄人相比，健康状况存在差异。少数民族压力理论认为，由于社会环境中的偏见和耻辱，LGB人经历过度的压力，导致健康状况不佳和健康差距。由于它的重点是社会环境，少数民族压力理论使我们预测，影响LGBs的压力过程的字符转移沿着改善的社会环境。同样，对男女同性恋、双性恋和变性者身份、与社区的联系以及男女同性恋、双性恋和变性者寻求的社会和保健服务类型的看法也发生了变化。如果我们要实现美国公共卫生服务减少与性取向有关的健康差距的目标，我们需要了解身份变化和少数民族压力对LGB健康的影响，并利用这些知识，为整个生命周期的公共卫生干预提供信息。为了获得这一知识，我们提出了一项纵向研究，使用代表美国人口中LGBT的不同LGBT的概率样本。我们试图比较3组年龄在18 - 25岁、34 - 42岁和48 - 55岁的LGB个体，他们的不同之处在于，他们成年后暴露于显著不同的社会环境。我们感兴趣的是身份和少数民族压力预测整个队列健康的方式。我们将使用混合方法设计，使我们能够从定性和调查数据中获得知识。我们使用一种创新的2阶段程序来招募676名代表美国黑人、拉丁裔和白色LGB人群的LGB个体样本。我们评估受访者的基线，并在此后的3年内每年评估一次。在一项定性研究中，我们使用叙述性生活史来评估纽约、加州和亚利桑那州城乡地区的黑人、拉丁裔、白色和亚洲LGB个体的不同群体。我们假设：1.尽管容易承认LGB的身份，并且比年长的群体更年轻，但年轻群体与年长群体的不同之处在于，他们的LGB身份不那么重要，他们对LGB社区的认同感较低，并且对性取向和身份有不同的含义。2.与年长者相比，年轻群体经历的与接受同性恋身份和出柜有关的少数民族压力较少，但更多的外部压力，包括与偏见有关的压力生活事件，反同性恋暴力和日常形式的歧视。3.较年轻的LGB群体成员比较年长的LGB群体成员利用更少的LGBT社会和保健服务。4.在结构方程中，少数群体压力模型在预测年轻和老年队列的健康结果方面同样有效，但根据目标1和2中的研究结果，队列之间的压力，弹性和健康结果模式不同。

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.