Raising Sexual Minority Youths’ Health Levels by Incorporating Resiliencies Into Health Promotion Efforts

摘要

Myriad health inequities that sexual minority youths (SMYs) experience have been documented over the past several decades. Evidence demonstrates that these are not a result of intrinsic characteristics; rather, they result from high levels of adversity that SMYs experience. Despite the pervasive marginalization that SMYs face, there is also evidence of great resilience within this population. It seems likely that if a culture of marginalization produces health inequities in SMYs, a culture of acceptance and integration can work to produce resiliencies. We have described how promoting forms of acceptance and integration could work to promote resilient SMYs despite an overarching culture of marginalization. Building on SMYs’ resiliencies may potentiate the effectiveness of health promotion interventions to reduce health disparities within this population. OVER THE PAST SEVERAL DE cades, researchers and public health practitioners have documented myriad health inequities that sexual minority youths (SMYs) experience. SMYs are individuals who identify as lesbian, gay, or bisexual (LGB) or who are attracted to or engage in sexual behaviors with individuals of the same gender. Male and transgender SMYs disproportionately bear the burden of HIV. 1 SMYs are also at increased risk for psychological distress, including depression, self-harm, and suicidality. 2–8 SMYs experience higher rates of substance use and abuse 9,10 and violence victimization than do their heterosexual peers. 11–13 Health inequities experienced during childhood or adolescence are irrefutably harmful to the well-being of SMYs and have continuing deleterious effects as these individuals achieve adulthood. 14–17 Research on SMYs’ health inequities has progressed from exploratory work to methodologically rigorous population-based designs. This development parallels the progression toward achieving greater scientific rigor in the larger field of LGB health research, permitting stronger conclusions about their health inequities. To give an example of this process from the substance abuse field, a set of early studies reported rates of alcohol abuse among sexual minority adults that, if true, would be among the highest in the world. 18,19 However, by oversampling bar patrons and relying on convenience samples, these studies had a high probability of selection bias. Later work, incorporating population-based sampling methods, found that although sexual minorities are unlikely to abuse alcohol at rates as high as previously thought, rates of substance abuse in this population are higher than those among heterosexuals. 20–22 Initial studies with nonprobability samples have, despite their limitations, inspired the field of sexual minority health by providing a foundation of evidence for health inequities, thereby justifying the support of more rigorous research efforts to measure their extent. The articles in this section represent a culmination of decades-long documentation of SMYs’ health inequities. The scientific rigor of these analyses from the population-based Youths Risk Behavior Surveillance System allows researchers to build on existing literature to make two strong assertions. First, SMYs experience numerous significant and life-threatening health inequities. Second, the era in which descriptive studies of SMYs’ health risks have had their greatest impact is drawing to a close. It is time to develop and test interventions to raise health levels. We have proposed a research agenda for developing resiliency-based interventions to achieve this goal.