Sexual Orientation and Health Disparities in Adolescence

描述(由申请者提供)：《2010年健康人》是美国制定国家健康议程的基本文件，它确定了社区之间持续存在的健康差距是我们这个时代的主要健康挑战之一。最近的研究表明，美国青少年人口的健康状况可能在很大程度上受到性取向群体差异的影响。抑郁症状和低自尊被认为是导致性少数族裔青少年危险行为发生率上升的潜在脆弱性。Rosario等人。提出了青少年心理社会出柜过程(COP)模型，该模型将出柜过程的各个维度与健康行为联系起来。此外，借鉴班杜拉的社会认知理论(SCT)，我们认为女同性恋者/双性恋者(LB)和男同性恋者/双性恋者(GB)社区的社会规范也通过社会学习过程对性少数民族青年的健康行为产生积极和消极的影响。家庭环境、青少年出柜时的年龄，以及是否存在先前存在的心理社会困境，可能是影响青少年的复原力或风险及其出柜过程经验的重要因素。需要进行研究，以探索出柜过程的重要预测因素，以及这一过程与健康行为的关系。 在《今日成长研究》(Guts)中，我们将检验性取向与体重担忧、体重控制行为紊乱、暴饮暴食以及烟酒使用有关的青春期女孩和男孩。这是一项对美国16,882名青少年进行的纵向队列研究。此外，我们还将检查青春期出柜过程背后的因素，导致一些人更具韧性，而另一些人则有更大的困难。我们的具体目标是比较青春期女孩和男孩在性取向群体中体重担忧和烟酒使用的患病率和严重程度，并经验性地测试COP模型和SCT的应用，以了解性取向群体在健康方面的差异。我们将前瞻性地考察COP模型和SCT的组成部分对心理困扰的贡献，以及与LB和GB社区社会规范和定向群体在健康结果上的差异有关的因素。

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.