Understanding Disparities in Obesity and Weight Behaviors by Sexual Identity

描述(由申请人提供)：以前的研究表明，女同性恋者、男同性恋者、双性恋者和变性人(LGBT)成年人比他们的同龄人经历更多的不利健康后果。少数几项调查成年人体重差异的研究结果表明，与异性恋同龄人相比，女同性恋者更有可能超重或肥胖，尽管对男同性恋者和双性恋者的了解较少。鉴于到目前为止在这一领域的研究很少，医学研究所(IOM)最近呼吁对LGBT健康进行更多的研究。此外，移徙组织强调，在按性别特征审查健康差距时，需要利用生命历程框架，承认不同生命阶段对健康的独特影响。成年初期(即18-25岁)是出现健康差距的重要年龄，也是体重、饮食质量和体力活动出现不利变化的年龄。初出茅庐的成年人在过渡到成年的过程中会经历脆弱，因为他们找到了独立，并协商了新的责任、生活技能和身份认同。为 对于LGBT年轻人来说，这些转变可能会有许多额外的复杂性。由于24岁以下的美国高中毕业生有一半都在接受高等教育，因此高等教育机构可能是检查和解决新出现的成年人健康差距的重要场所，包括LGBT群体之间的差距。在这里，我们有一个独特的机会来分析2007-2011年间近30,000名大专学生的国家监测数据，其中包括近2,000名女同性恋、男同性恋、双性恋和质疑(LGB)年轻人的大样本，他们就读于一系列2年制和4年制学院和大学。我们的目标是：(1)量化LGB和异性恋学生在肥胖、饮食摄入量、体力活动、不健康的体重控制行为、身体满意度和其他与体重相关的健康结果方面的差异；(2)确定主要的与体重相关的健康行为模式，以及这些行为模式在性别认同和性别上的差异程度；以及(3)通过人口统计因素和健康结果(例如，年龄、社会经济状况、医疗保健覆盖范围、肥胖和健康状况)来表征这些行为模式。我们假设LGB学生比他们的异性恋同龄人从事更多的不良行为，并表现出不同的行为模式。例如，根据之前的研究，我们假设男同性恋者更有可能表现出不健康的体重控制和身体不满的模式，而女同性恋者更有可能从事以高体力活动为特征的模式，加上更多的酒精和烟草使用以及其他不利行为。鉴于对LGB体重相关健康的了解有限，尤其是新兴成年人，这项研究将填补国际移民组织和其他人确定的文献中的重要空白。此外，来自R21的发现将作为关键的形成性研究，为R01提供信息，该R01将定制和测试LGB特定的肥胖干预。 公共卫生相关性：(1)使用来自一系列2年制和4年制大学的近30,000名学生的国家监测数据，量化女同性恋者、男同性恋者、双性恋者、质疑者(LGB)和异性恋新兴成年人在肥胖、体重行为和相关结果方面的差异；(2)确定与体重相关的主要健康行为模式，以及这些行为模式由性认同和性别差异的程度；以及(3)根据人口统计因素和健康结果描述这些行为模式。这项研究将填补LGB健康差异文献中的重要空白，并为这些服务不足的群体中未来肥胖干预的发展和定制提供信息。

DESCRIPTION (provided by applicant): Previous research indicates that lesbian, gay, bisexual and transgender (LGBT) adults experience more adverse health outcomes than their peers. Findings from the few studies examining weight disparities among adults suggest that lesbian women are more likely to be overweight or obese compared to their heterosexual peers, though less is known about gay men and bisexuals. Given the scant research to date in this area, the Institute of Medicine (IOM) recently issued a call for additional research on LGBT health. Furthermore, IOM highlighted the need to utilize a life-course framework when examining health disparities by sexual identity, acknowledging the unique influence of various life stages on health. Emerging adulthood (i.e., ages 18-25) is an important age at which health disparities emerge, and an age characterized by adverse changes in weight, dietary quality, and physical activity. Emerging adults experience vulnerabilities as they find independence and negotiate new responsibilities, life skills, and identities during the transition to adulthood. For LGBT youth, these transitions may be layered with many additional complexities. In that half of US high school graduates up to age 24 are enrolled in post-secondary education, post-secondary institutions may be important arenas for examining and addressing emerging adult health disparities, including those among LGBT groups. We have the unique opportunity here to analyze 2007-2011 state surveillance data of nearly 30,000 post-secondary students, including a large sub-sample of nearly 2,000 lesbian, gay, bisexual and questioning (LGB) young people, attending an array of 2- and 4-year colleges and universities. Our aims are to: (1) Quantify disparities in obesity, dietary intake, physical activity, unhealthy weight control behavior, body satisfaction and other weight-related health outcomes among LGB and heterosexual students; (2) Identify major weight-related health behavioral patterns, or profiles, and the extent to which these behavioral profiles differ by sexual identity and gender; and (3) Characterize these behavioral profiles by demographic factors and health outcomes (e.g., age, socioeconomic status, health care coverage, obesity, and health status). We hypothesize that LGB students engage in more adverse behaviors than their heterosexual peers and exhibit differential behavioral patterning. For example, based on previous research, we hypothesize that gay men are more likely to exhibit a pattern of unhealthy weight control and body dissatisfaction, whereas lesbians are more likely to engage in a pattern characterized by high physical activity coupled with higher alcohol and tobacco use and other adverse behaviors. Given the limited understanding of LGB weight-related health, particularly emerging adults, this study will fill important gaps in the literature identified by IOM and others. Furthermore, the findings from this R21 will serve as critical formative research needed to inform an R01 that will tailor and test an LGB-specific obesity intervention. PUBLIC HEALTH RELEVANCE: (1) quantify disparities in obesity, weight behaviors and related outcomes among lesbian, gay, bisexual, questioning (LGB) and heterosexual emerging adults using state surveillance data from nearly 30,000 students attending an array of 2- and 4-year colleges and universities; (2) identify major weight- related health behavioral patterns, or profiles, and the extent to which these behavioral profiles differ by sexual identity and gender; and (3) characterize these behavioral profiles by demographic factors and health outcomes. This study will fill important gaps in the LGB heath disparities literature and inform the development and tailoring of a future obesity intervention among these underserved groups.