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得到了很好的记录，性少数群体报告了更多的心理困扰、物质使用和依赖以及进食障碍症状。相对于异性恋者，性少数群体的高风险行为背后的原因知之甚少。在这里，我们建议通过检验我们的性少数压力理论(SMST)来解释这些性取向差异。SMST是基于社会对同性恋的污名化。同性恋相关压力是性少数群体个人对社会污名化的体验，由社区中已知的个人(如亲戚、异性恋朋友)和陌生人造成的外部应激源(如偏见、歧视、言语虐待、身体暴力)组成。与同性恋相关的压力还包括内部压力，在这种压力中，性少数群体将社会的污名化内化，例如对同性恋持负面态度。我们建议的研究将讨论同性恋相关压力对性取向亚群之间差异的影响，包括心理困扰、生理痛苦(皮质醇，DHEA)、健康行为、慢性疼痛、适应和成年初期的适应，并考察调节因素，例如亲子关系对性取向和同性恋相关压力之间关系的影响，以及应对对同性恋相关压力与心理和生理痛苦之间关系的影响。与同性恋有关的压力可能在影响性少数群体青年在成年初期的发展和心理社会适应方面特别重要。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。它还将研究性别、经历同性恋相关压力的年龄、性少数地位和地位转变、性少数群体中和谐与不和谐的取向模式，以及性认同发展与同性恋相关压力、健康、适应和适应结果之间的差异。我们将收集新的自我报告调查和生物学数据，以在今日成长研究(GUTS)中调查这些关键问题，这是一项始于1996年并正在进行的针对16,882名美国青少年和初出茅庐的成年人的纵向队列研究。具体地说，我们将在10多年来从内脏收集的数据中增加3个数据收集阶段，并将青少年的数据与他们的母亲的数据联系起来，这些母亲的数据构成了护士健康研究II。我们将检查儿童和青少年遭受暴力侵害和其他形式的同性恋相关压力的差异，以及这些随着时间的推移对随后的心理和生理痛苦、药物使用和饮食失调行为、慢性疼痛、适应和成年初期适应的影响。公共卫生相关性：存在令人不安的证据表明，与异性恋同龄人相比，在吸烟、酒精和其他物质使用和依赖、进食障碍症状以及其他一些重要健康指标方面存在差异，对性少数群体青年产生不利影响。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、骚扰和其他与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，为致力于改善所有年轻人健康的研究人员和临床医生提供宝贵的数据。

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.