Causes and Impact of Minority Stress on Health and Development in Youth

描述（由申请人提供）：性取向群体在几个关键健康领域的差异现在有据可查，性少数群体报告更多的心理困扰，物质使用和依赖，以及饮食失调症状。相对于异性恋者，性少数群体的风险行为更高的潜在原因知之甚少。在此，我们建议通过测试我们的性少数压力理论（SMST）来解释这些性取向差异。SMST基于社会对同性恋的污名化。与同性恋有关的压力，即性少数个体对社会污名化的体验，包括由社区中已知的个人（如亲属、异性恋朋友）和陌生人施加的外部压力源（如偏见、歧视、言语虐待、身体暴力）。同性恋相关的压力也包括内部压力，其中性少数个体内化社会的污名化，如对同性恋持负面态度。我们建议的研究将解决同性恋相关的压力之间的差异和性取向亚组的心理困扰，生理困扰，（皮质醇，脱氢表雄酮），健康行为，慢性疼痛，适应和调整，在新兴的成年，并检查主持人，比如亲子关系对性取向和同性恋关系的影响，相关压力和应对方式对同性恋相关压力与心理和生理困扰之间关系的影响。同性恋相关的压力可能是特别重要的，在影响性少数青年的发展和心理社会调整的成年期。我们的研究将对同性恋相关压力的重要前兆敏感，例如性别不一致。它还将研究如何性别，年龄在经历同性恋相关的压力，性少数群体的地位和地位的转变，一致与不一致的取向模式之间的性少数群体，和性身份的发展与同性恋相关的压力，健康，适应和调整的结果不同。我们将收集新的自我报告调查和生物学数据，以调查今日成长研究（GUTS）中的这些关键问题，GUTS是一项对16，882名美国青少年和新兴成年人的纵向队列研究，始于1996年并持续进行。具体而言，我们将在从GUTS收集的10多年数据中增加3个数据收集阶段，并将青少年的数据与其母亲的数据联系起来，后者构成了护士健康研究II。我们将研究儿童和青少年时期暴力受害的差异以及其他形式的同性恋相关压力，以及这些压力随着时间的推移对随后的心理和生理困扰，物质使用和饮食失调行为，慢性疼痛，适应和调整的影响。公共卫生相关性：令人不安的证据表明，与异性恋青年相比，性少数青年在烟草、酒精和其他物质使用和依赖、饮食失调症状以及其他一些重要健康指标方面存在差异，这些差异对性少数青年产生不利影响。我们拟议的研究将解决新的流行病学调查的迫切需要，以了解暴力受害，骚扰和其他同性恋相关的压力源对这一服务不足和研究不足的人群的健康的影响，为致力于改善所有青年健康的研究人员和临床医生提供有价值的数据。

DESCRIPTION (provided by applicant): Sexual orientation group disparities in several critical health domains are now well documented, with sexual minorities reporting more psychological distress, substance use and dependence, and eating disorders symptoms. Little is known about the reasons underlying higher risk behaviors among sexual minorities relative to heterosexuals. Herein, we propose to explain these sexual orientation disparities by testing our Sexual Minority Stress Theory (SMST). SMST is based on society's stigmatization of homosexuality. Gay-related stress, the experience by a sexual-minority individual of society's stigmatization, consists of external stressors (such as prejudice, discrimination, verbal abuse, physical violence) perpetrated by known individuals (such as kin, heterosexual friends) and strangers in the community. Gay-related stress also consists of internal stress, in which the sexual-minority individual internalizes society's stigmatization, such as possessing negative attitudes toward homosexuality. Our proposed research will address the impact of gay-related stress on disparities between and among sexual orientation subgroups in psychological distress, physiological distress (cortisol, DHEA), health behaviors, chronic pain, adaptation, and adjustment in emerging adulthood, and examine moderators, such as the effect of parent-child relationships on the relations between sexual orientation and gay-related stress and the effect of coping on the relations between gay-related stress and both psychological and physiological distress. Gay-related stress may be particularly important in influencing a sexual minority youth's development and psychosocial adjustment in emerging adulthood. Our research will be sensitive to important precursors of gay-related stress, such as gender nonconformity. It will also examine how sex, age at experiencing gay-related stress, sexual minority status and transitions in status, concordant vs. nonconcordant orientation patterns among sexual minorities, and sexual identity development vary with gay-related stress, health, adaptation, and adjustment outcomes. We will collect new self-report survey and biological data to investigate these critical issues in the Growing Up Today Study (GUTS), a longitudinal cohort study of 16,882 U.S. adolescents and emerging adults begun in 1996 and ongoing. Specifically, we will add 3 data collection phases to more than 10 years of data collected from GUTS and link the youths' data with those of their mothers, who comprise the Nurses' Health Study II. We will examine disparities in violence victimization in childhood and adolescence and other forms of gay-related stress and the impact of these over time on subsequent psychological and physiological distress, substance use and eating disordered behaviors, chronic pain, adaptation, and adjustment in emerging adulthood. PUBLIC HEALTH RELEVANCE: Disturbing evidence exists of disparities in tobacco, alcohol, and other substance use and dependence, eating disorder symptoms, and a number of other important health indicators adversely affecting sexual-minority youth relative to heterosexual peers. Our proposed research will address the critical need for new epidemiologic investigations into the impact of violence victimization, harassment, and other gay- related stressors on the health of this underserved and understudied population, providing valuable data to researchers and clinicians working to improve the health of all youth.