Predicting adverse outcomes among sexual minorities and heterosexuals from a prospective study of adolescent health and wellbeing

项目总结 性少数群体(女同性恋者、男同性恋者、双性恋者和其他非异性恋者)患癌症的风险增加 许多不利的身心健康后果，包括焦虑、抑郁、自杀、物质 使用、艾滋病毒/艾滋病、哮喘、心血管疾病和某些形式的癌症。尽管有明确的文档和 这些健康差距的复制，相对较少知道他们从青春期到 成人期。两种理论主要主导了文学作品。少数民族压力模型描述了独特的生活压力源 只有性少数群体(例如，基于性取向的受害和歧视)才有这种经历 造成健康差距的主要因素。其他模型既涉及少数群体压力，也涉及规范 心理社会过程共同造成了健康差距。一些这样的规范性进程包括 (1)心理适应和特征(如情绪调节/调节失调、物质使用 期望)，(2)破坏的社会制度(例如，家庭、同龄人、学校)，以及(3)个人差异(例如， 种族/民族、社会经济地位、性情)。到目前为止，大多数关于少数族裔压力和 规范程序受到主要是高加索成年人的横断面样本的使用的限制。虽然 从这些研究中学到了很多东西，但它们不能分析整个地区出现的健康差距 发展。因此，现有研究在对不同人群的普适性方面是有限的，而且 观察到的“预测者”和“结果”之间的方向性推论的有效性。我的长期职业目标 确定导致性少数群体差异的机制，目的是改善 治疗这些差异，并开发筛查工具，以确定将受益的高危青年 从预防项目中受益。为了达到这个目标，在这个项目中，我使用 基线年龄在14-19岁并跟踪超过4年的个人的预期样本。我的 目标是描述性行为健康差距发展的发展轨迹和机制 在跨越14岁的10年发展窗口中，少数民族青年与异性恋青年相比-- 23年。纵向结果包括抑郁/焦虑、自杀、犯罪、睡眠、一般身体状况 健康、饮食紊乱和物质使用。这些成果的发展轨迹将由 性别和性取向。基于现有文献的验证性分析将被用来检验 少数民族应激与不良后果之间的关系。然后，我将使用机器学习来识别到目前为止 不良后果和健康差距的未知预测因素，并表征预测中的任何变化 跨越时间。最后，我将使用最先进的介入性变量分析(中介、调节)来评估 出现健康差距的纵向机制。调查结果应该为我们提供对 发展和维持差距的机制，为预防和干预战略提供信息。

PROJECT SUMMARY Sexual minorities (lesbian, gay, bisexual and other non-heterosexual individuals) are at increased risk for numerous adverse physical and mental health outcomes, including anxiety, depression, suicidality, substance use, HIV/AIDS, asthma, cardiovascular disease, and certain forms of cancer. Despite clear documentation and replication of these health disparities, relatively little is known about their development from adolescence into adulthood. Two theories primarily dominate the literature. Minority stress models describe unique life stressors experienced only by sexual minorities (e.g., victimization and discrimination based on sexual orientation) as primary contributors to health disparities. Other models implicate both minority stress and normative psychosocial processes together as contributors to health disparities. Some such normative processes include (1) psychological adjustment and characteristics (e.g., emotion regulation/dysregulation, substance use expectancies), (2) disrupted social systems (e.g., family, peers, school), and (3) individual differences (e.g., race/ethnicity, socioeconomic status, temperament). To date, most studies of both minority stress and normative processes are limited by use of cross-sectional samples of primarily Caucasian adults. Although much has been learned from these studies, they do not permit analysis of emerging health disparities across development. Existing research is therefore limited in terms of both generalizability to diverse populations, and validity of directionality inferences between observed ‘predictors’ and ‘outcomes’. My long-term career goals are to identify mechanisms leading to disparities among sexual minorities, with the goal of improving treatments for these disparities, and to develop screening tools to identify high-risk youth who would benefit from prevention programs. To reach this goal, in this project, I address existing limitations to the literature using a prospective sample of individuals who were 14-19 years old at baseline and followed for over 4 years. My goal is to describe developmental trajectories and mechanisms of health disparity development for sexual minority youth compared with heterosexual youth across a 10-year developmental window spanning ages 14- 23 years. Longitudinal outcomes include depression/anxiety, suicidality, delinquency, sleep, general physical health, disordered eating and substance use. Developmental trajectories for these outcomes will be charted by gender and sexual orientation. Confirmatory analyses based on existing literature will be conducted to examine relations between minority stress and adverse outcomes. Then, I will use machine learning to identify as-yet unknown predictors of adverse outcomes and health disparities and characterize any changes in prediction across time. Finally, I will use state-of-the art intervening variable analyses (mediation, moderation) to evaluate longitudinal mechanisms through which health disparities emerge. Findings should provide insight into mechanisms of disparity development and maintenance, informing prevention and intervention strategies.