Sexual orientation and prevalence of body dissatisfaction and eating disordered behaviors: a population-based study of adolescents

Health equity in pediatrics: Current concepts for the care of children in the 21st century (Dis Mon)

This is an analysis of important aspects of health equity in caring for children and adolescents written by a multidisciplinary team from different medical centers. In this discussion for clinicians, we look at definitions of pediatric health equity and the enormous impact of social determinants of health in this area. Factors involved with pediatric healthcare disparities that are considered include race, ethnicity, gender, age, poverty, socioeconomic status, LGBT status, living in rural communities, housing instability, food insecurity, access to transportation, availability of healthcare professionals, the status of education, and employment as well as immigration. Additional issues involved with health equity in pediatrics that are reviewed will include the impact of the COVID-19 pandemic, behavioral health concepts, and the negative health effects of climate change. Recommendations that are presented include reflection of one's own attitudes on as well as an understanding of these topics, consideration of the role of various healthcare providers (i.e., community health workers, peer health navigators, others), the impact of behavioral health integration, and the need for well-conceived curricula as well as multi-faceted training programs in pediatric health equity at the undergraduate and postgraduate medical education levels. Furthermore, ongoing research in pediatric health equity is needed to scrutinize current concepts and stimulate the development of ideas with an ever-greater positive influence on the health of our beloved children. Clinicians caring for children can serve as champions for the optimal health of children and their families; in addition, these healthcare professionals are uniquely positioned in their daily work to understand the drivers of health inequities and to be advocates for optimal health equity in the 21st century for all children and adolescents.

Body Uneasiness and Dissatisfaction Among Lesbian, Gay, Bisexual, and Heterosexual Persons

Introduction

While sexual minority people have been widely considered at risk for developing a range of body image concerns, evidence of body dissatisfaction and shame amongst LGB (lesbian, gay, and bisexual) individuals is mixed. This study investigated differences in body uneasiness, body dissatisfaction, and self-blaming/attacking attitudes between LGB and heterosexual individuals, as well as within LGB groups, while also examining the predictive role of body mass index (BMI).

Methods

A sample of cisgender lesbian women (n = 163), gay men (n = 277), bisexual women (n = 135), bisexual men (n = 39), heterosexual women (n = 398), and heterosexual men (n = 219) completed an online survey assessing different aspects of body image between May and July 2020.

Results

Gay and bisexual men reported greater body image disturbance and self-blaming attitudes relative to heterosexual men. In contrast, lesbian women reported lower body uneasiness than their bisexual and heterosexual counterparts, but greater self-hate. Moreover, lesbian and bisexual women showed more body dissatisfaction than gay men, and bisexual individuals reported more body uneasiness than individuals in other sexual minority subgroups. Higher BMI emerged as a significant predictor of body image concerns and dissatisfaction.

Conclusions

Body image dimensions showed sexual identity-based differences. Determining the specific nuances of body image in LGB individuals can provide important information on potential risk factors that may impact mental health outcomes.

Policy Implications

In-depth knowledge of body dissatisfaction and uneasiness in individuals with LGB identities may have critical implications for the development of personalized prevention and treatment strategies.

Anonymous Online Survey on Disordered Eating, Drive for Muscularity, Sexual Orientation, and Satisfaction with Life in Young Swedish Males

Psychiatric conditions in general, including eating disorders, are stigmatizing conditions. The stigma of eating disorders is even more pronounced among males. We conducted an anonymous, online survey to explore the feasibility of recruiting participants for collecting sensitive information, and the relation among eating disorders, drive for muscularity, satisfaction with life, and sexual preference in males (N = 824) aged 15-30 years in Sweden. Internet survey method was a feasible way of recruiting males and obtaining sensitive information. Drive for muscularity was positively related to eating psychopathology. Interestingly, only the attitudinal aspect of the drive for muscularity was negatively related to satisfaction with life, whereas the behavioral component of the drive for muscularity was unrelated to quality of life. Drive for muscularity and disordered eating were not significantly different across participants with various sexual orientations. Our findings corroborate and extend previous research by using an anonymous Internet-based survey that may be less contaminated by social desirability or reporting bias due to the sensitivity of some of the questions.

Psychosocial correlates of body esteem and disordered eating among sexual minority adolescent girls

The present study examined whether body esteem mediates the associations between psychosocial factors, including peer victimization and parent-adolescent relationship quality, and multiple categories of disordered eating (DE) within a diverse sample of adolescent sexual minority (SM) girls. Participants were 528 girls, aged 14-18 years, recruited as part of a larger online study on LGBTQ + adolescent health. Participants anonymously completed self-report measures of parent-adolescent relationship quality, sexual orientation-based victimization, body esteem, and DE behaviors, including binge eating, purging, and caloric restriction. Parent-adolescent relationship quality was positively associated with SM adolescent girls' body esteem, and some aspects of body esteem subsequently mediated the associations between parent-adolescent relationship quality and DE behaviors. Experiences of sexual orientation-related victimization were also positively related to endorsement of caloric restriction. However, no significant indirect effects were observed between sexual orientation-related victimization and DE via body esteem. These results suggest parents could influence their SM daughters' DE behaviors via body esteem, and SM girls may be engaging in caloric restriction if they experience victimization, regardless of their body esteem.

Disordered Eating, Body Image Dissatisfaction, and Associated Healthcare Utilization Patterns for Sexual Minority Youth

PURPOSE

To determine the prevalence of disordered eating behaviors (DEBs) and body image dissatisfaction (BID) according to sexual minority youth (SMY) status and describe healthcare utilization patterns by SMY status.

METHODS

Retrospective data from 107,528 adolescents, who had a Well Check in Kaiser Permanente Northern California in 2016, were used to compare DEB and BID by SMY status. Multivariate logistic models were used to examine the associations of SMY, birth-assigned sex, age, race/ethnicity, and body mass index on DEB and BID. The utilization of specialized eating disorder (ED) medical and mental health services and general mental health services was described at one Kaiser Permanente Northern California facility.

RESULTS

BID was reported in 20,763 (19.3%) adolescents, DEB in 1,458 (1.7%) adolescents, and 5,363 (5%) adolescents identified as SMY. SMY had higher odds of having DEB and BID than non-SMY, respectively (adjusted odds ratio 2.0 95% confidence interval [1.9-2.2] and adjusted odds ratio 3.8 [3.4-4.2]). Regardless of SMY status, adolescents with older age, female sex, nonwhite race, and elevated body mass index had higher odds of ED risk factors. SMY with ED risk factors had higher ED medical utilization than non-SMY with ED risk factors (4.6% vs. 1.6%). However, SMY status was not associated with utilization of specialized ED mental health services.

CONCLUSIONS

SMY had increased rates of DEB and BID but had underutilization of specialized ED mental health services. Future targeted efforts to prevent eating disorder-related mortality and morbidity for SMY should include targeted eating disorder screening and referral to specialized ED medical and mental health services.

Sexual orientation and disordered eating in women: a meta-analysis

PURPOSE

Homosexuality is a clear risk factor for disordered eating in men; however, for women, research has yielded contradictory results. We conducted a meta-analysis to examine the association between sexual orientation and disordered eating in women.

METHODS

PRISMA guidelines were used. Studies comparing disordered eating between lesbians and heterosexual women were identified using PsycNet database and Google Scholar. Twenty-one studies met inclusion criteria. Overall disordered eating, restricting, binging and purging were examined for heterosexual, lesbian, bisexual and 'mostly heterosexual' women.

RESULTS

Whereas there was no significant difference in overall disordered eating between lesbians and heterosexual women, lesbians reported restricting less and binging more than heterosexual women. Bisexual women were more likely than lesbian women to restrict food intake and purge, and more likely than heterosexual women to have overall disordered eating and restrict food intake. "Mostly heterosexual" women were more likely than heterosexual women to restrict food intake, binge and purge.

CONCLUSIONS

Women of different sexual orientations show distinct patterns of disordered eating. Bisexual and "mostly heterosexual" women appear to be particularly at risk. Stress resulting from binegativity and rigid views of sexuality in a dichotomous society, rather than sexual orientation itself, may be associated with disordered eating in women. Findings should be viewed with caution because there were few studies with bisexual and "mostly heterosexual" women. This study elucidates the nature of the association between disordered eating and sexual orientation. Findings provide a possible explanation for previous inconsistencies, since opposing trends for different behaviors cancel each other out.

LEVEL OF EVIDENCE

Level I, systematic review and meta-analysis.

Revisiting the relationship between body dissatisfaction and eating disorder symptoms in Chinese adolescents: the mediating roles of regulatory emotional self-efficacy and depression symptoms

PURPOSE

Even though many studies have investigated the relationship between body dissatisfaction and eating disorder symptoms, the relationship is still far from being clear, especially about what factors that could potentially mediate such relationship. This study aimed to examine the direct pathway in the relationship between body dissatisfaction and eating disorder symptoms, and possible mediation pathways between the two via regulatory emotional self-efficacy and depression symptoms.

METHODS

A sample of 654 adolescents from central China completed questionnaires for a set of study variables. Modeling analysis was conducted that examined the direct pathway between body dissatisfaction and eating disorder symptoms, and the mediating roles of regulatory emotional self-efficacy and depression symptoms between these two constructs. Multi-group modeling analysis was conducted to assess model invariance across gender and age groups.

RESULTS

The results showed that, in addition to the direct pathway between body dissatisfaction and eating disturbances, regulatory emotional self-efficacy and depression symptoms partially mediated the relationship between these two constructs. Results of multi-group invariance analysis showed that the mediation model was consistent across gender and age groups.

DISCUSSION

These results indicated that management of regulatory emotional self-efficacy and appropriate intervention for depression could potentially buffer against the negative impact of body dissatisfaction on eating disorder symptoms. Finally, some potential clinical implications are discussed, and possible preventions for eating disorder symptoms are suggested.

LEVEL OF EVIDENCE

V, Cross-sectional descriptive study.

The Health Challenges of Emerging Adult Gay Men: Effecting Change in Health Care

This article focuses on the health and health care challenges experienced by young and emerging adult gay men. Evidence is provided on the extent to which young and emerging adult gay men are disproportionally burdened by multidimensional health disparities, barriers to health care access, and inadequate provider-patient interactions. Recommendations are provided for health care providers and public health officials working with populations of emerging adult gay men that might have the greatest overall impact on improving this population's well-being and access to competent health care by increasing providers' awareness of the unique needs of young and emerging adult gay men.

Sexual and gender minority individuals report higher rates of abuse and more severe eating disorder symptoms than cisgender heterosexual individuals at admission to eating disorder treatment

Eating disorders (EDs) occur at higher rates among sexual/gender minorities (SGMs). We currently know little about the risk factor profile of SGMs entering ED specialty care.

OBJECTIVE

To (a) compare history of abuse-related risk in SGMs to cisgender heterosexuals (CHs) when entering treatment, (b) determine if SGMs enter and exit treatment with more severe ED symptoms than CHs, and (c) determine if SGMs have different rates of improvement in ED symptoms during treatment compared to CHs.

METHOD

We analyzed data from 2,818 individuals treated at a large, US-based, ED center, 471 (17%) of whom identified as SGM. Objective 1 was tested using logistic regression and Objectives 2 and 3 used mixed-effects models.

RESULTS

SGMs had higher prevalence of sexual abuse (OR = 2.10, 95% CI = 1.71, 2.58), other trauma (e.g., verbal/physical/emotional abuse; OR = 2.07, 95% CI = 1.68, 2.54), and bullying (OR = 2.13, 95% CI = 1.73, 2.62) histories. SGMs had higher global EDE-Q scores than CHs at admission (γ = 0.42, SE = 0.08, p < .001) but improved faster early in treatment (γ = 0.316, SE = 0.12, p = .008). By discharge, EDE-Q scores did not differ between SGMs and CHs.

DISCUSSION

Our main hypothesis of greater abuse histories among SGMs was supported and could be one explanation of their more severe ED symptoms at treatment admission compared to CHs. In addition, elevated symptom severity in SGMs at admission coincides with greater delay between ED onset and treatment initiation among SGMs-possibly a consequence of difficulties with ED recognition in SGMs by healthcare providers. We recommend increased training for providers on identifying EDs in SGMs to reduce barriers to early intervention.

Disparities in DSM-5 defined eating disorders by sexual orientation among U.S. adults

OBJECTIVE

The increased occurrence of disordered eating behaviors among sexual minorities is well established; however, few studies have examined disparities in eating disorder diagnoses among this population. This study sought to examine lifetime prevalence estimates of DSM-5 defined EDs, including anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) as a function of sexual orientation. We then compared prevalence of EDs based on experiences with perceived discrimination.

METHOD

A nationally representative sample of U.S. adults (N = 35,995) participating in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III completed structured diagnostic interviews.

RESULTS

Prevalence rates were significantly higher among sexual minorities than heterosexual respondents for all EDs: AN = 1.71% (SE = 0.50) versus 0.77% (SE = 0.07), BN = 1.25% (SE = 0.37) versus 0.24% (SE = 0.03), BED = 2.17% (SE = 0.52) versus 0.81% (SE = 0.05). Odds of lifetime diagnosis were significantly greater among sexual minorities for AN (adjusted odds ratio [AOR] = 1.93), BN (AOR = 3.69), and BED (AOR = 2.32), after adjusting for sociodemographic variables. Sexual minorities reporting experiences with perceived discrimination had significantly higher prevalence of AN than those not endorsing perceived discrimination: 3.78% (SE = 1.43) versus 0.82% (SE = 0.33); AOR = 5.06. There were no significant differences in prevalence of BN or BED by perceived discrimination.

DISCUSSION

Findings indicate that sexual minorities are disproportionately affected by EDs. Further research is needed to better understand mechanisms contributing to these disparities and heightened risk for EDs.

Eating disorders and disordered eating behaviors in the LGBT population: a review of the literature

BACKGROUND

According to past research, lesbian, gay, bisexual, and transgender (LGBT) individuals experience a higher prevalence of psychopathology, which is attributable to the increased stress (i.e., stigma and prejudice) that they experience, as detailed by the minority stress model (MSM).

MAIN

This current literature review examined the empirical literature regarding the rates and types of, and risk factors for eating disorders and disordered eating behaviors in LGBT adults and adolescents, in addition to each individual subgroup (i.e., lesbians, gay males, bisexuals, transgender and gender-nonconforming individuals).

CONCLUSION

LGBT adults and adolescents experience greater incidence of eating disorders and disordered eating behaviors than their heterosexual and cisgender counterparts. Additionally, gay, bisexual, and transgender adults and adolescents were all at increased risk for eating disorders and disordered eating behaviors. Mixed results were found for lesbian adults and adolescents. Results are discussed within the framework of the MSM.

Eating Disorders in Males

Eating disorders are serious psychiatric disorders, associated with significant psychiatric and medical consequences. Although traditionally considered a female disorder, more recent evidence has determined that EDs among males are not uncommon and are equally severe in symptom presentation. Among youth and adolescent males, certain factors increase the risk for ED, including muscularity-focused body image concerns and sexual orientation. Future study of these and other factors that may increase the risk for or maintain EDs among adolescent males is critical to improving screening, assessment, and precision treatment efforts.

A Systematic Review of Sexual Orientation Disparities in Disordered Eating and Weight-Related Behaviors among Adolescents and Young Adults: Toward a Developmental Model

Adolescence is a sensitive period for the development of disordered eating and weight-related behaviors, and sexual minorities may be particularly at risk due to heightened minority stress and challenges related to sexual identity development. This review synthesized findings from 32 articles that examined sexual orientation disparities (each with a heterosexual referent group) in four disordered eating behaviors (binging, purging, restrictive dieting, diet pill use) and four weight-related behaviors (eating behaviors, physical activity, body image, and Body Mass Index [BMI]). Potential variations by outcome, sex, race/ethnicity, and developmental stage were systematically reviewed. Evidence supporting sexual orientation disparities in disordered eating and weight-related behaviors was more consistent among males than females. Among females, sexual orientation disparities in disordered eating behaviors appeared to be more pronounced during adolescence than in young adulthood. Sexual minority females generally reported more positive body image than heterosexual females but experienced disparities in BMI. Sexual orientation differences in eating behaviors and physical activity were especially understudied. Incorporating objectification and minority stress theory, a developmental model was devised where body image was conceptualized as a key mechanism leading to disordered eating behaviors. To advance understanding of sexual orientation disparities and tailor intervention efforts, research in this field should utilize longitudinal study designs to examine developmental variations and incorporate multi-dimensional measurements of sexual orientation and body image.

Relationship between disordered eating and self-identified sexual minority youth in a sample of public high school adolescents

PURPOSE

To investigate the relationship between selected disordered eating behaviors and self-reported sexual minority status (gay/lesbian, bisexual, and unsure) among a representative sample of high school adolescents.

METHODS

The 2013 Centers for Disease Control and Prevention (CDC)-sponsored Connecticut Youth Risk Behavior Survey was utilized (N = 2242). Unadjusted and adjusted logistic regression analyses, separated by gender, examined sexual minority adolescents (gay/lesbian, bisexual, and unsure) and selected eating behaviors. Analyses adjusted for race, age, cigarette use, binge drinking, organized school activity participation, body mass index (BMI), and depression.

RESULTS

Gay males were significantly more likely to report exercising or eating less to lose weight in the unadjusted models (p < 0.05) and fasting, vomiting, and taking diet pills in both adjusted (p < 0.05) and unadjusted models (p < 0.01) when compared to the referent heterosexual males. Bisexual females were significantly more likely to report fasting, vomiting, and taking diet pills in the unadjusted model (p < 0.05) when compared to the referent heterosexual females and significantly less likely to report exercising or eating less to lose weight in the adjusted models (p < 0.05).

CONCLUSIONS

Although additional studies are needed owing to small sample sizes, preliminary findings support previous research suggesting that high school-aged sexual minority youth subgroups are a priority target population for increased efforts to prevent disordered eating.

The role of peer victimization, sexual identity, and gender on unhealthy weight control behaviors in a representative sample of Texas youth

OBJECTIVE

The aim of the study is to examine the association between victimization and unhealthy weight control behaviors (UWCB), accounting for other key correlates of UWCB while considering the moderating role of sexual identity and gender.

METHOD

This study used data from the 2017 Texas Youth Risk Behavior Survey (YRBS), a representative sample of students in grades 9-12 in the U.S. state of Texas, including 2,067 students (1,754 heterosexuals and 313 sexual minorities). We used survey-weighted logistic regression to examine the association of sexual identity, gender, and victimization (dating violence, cyberbullying, and school bullying) with UWCB, after adjusting for demographic information and indicators of weight, physical activity, and support from adults.

RESULTS

Unhealthy weight control behaviors were associated with older age, being obese, lack of support from adults, low physical activity, and cyberbullying. A significant three-way interaction between gender, sexual identity and bullying showed that bullying was associated with high levels of UWCB among sexual minority males.

DISCUSSION

Our study highlights the role of victimization in health behaviors for stigmatized groups, and the importance of school efforts to implement an equitable and safe learning environment for all students.

A longitudinal investigation of perceived weight status as a mediator of sexual orientation disparities in maladaptive eating behaviors

Sexual minority adolescents are more likely than heterosexual peers to engage in maladaptive eating behaviors such as restrictive dieting. However, prior studies relied on cross-sectional data and did not test potential mechanisms. This study examined longitudinal associations between adolescent sexual minority status and three maladaptive eating behaviors (restrictive dieting, diet pill use, and drug-related dieting) in young adulthood and tested higher perceived weight status as a mediator of observed disparities. Data were drawn from Waves 2 (11th grade in 2010/2011) to 7 (4 years post high school in 2015/2016) of the NEXT Generation Health Study, a U.S. national longitudinal cohort of adolescents (n = 1925). Logistic regression analyses revealed that, relative to heterosexual females, sexual minority females were more likely to report any restrictive dieting (extreme food intake restriction) in the past year (62.9% vs. 37.0%; Adjusted Odds Ratio = 2.26, 95% CI = 1.07, 4.76). Associations between sexual minority status and diet pills use or drug-related dieting were not found. Results from structural equation modeling indicated that higher perceived weight status was a significant mediator of the association between sexual minority status and restrictive dieting among females. These findings highlight higher perceived weight status as an important cognitive mechanism explaining why sexual minority females are at heightened risk for restrictive dieting in young adulthood. To optimally inform prevention efforts, additional research is needed to test the extent to which minority stressors may shape weight perceptions and their contribution to maladaptive and disordered eating behaviors among sexual minority adolescents.

Body Dissatisfaction, Importance of Appearance, and Body Appreciation in Men and Women Over the Lifespan

Body image disturbance is associated with several mental disorders. Previous research on body image has focused mostly on women, largely neglecting body image in men. Moreover, only a small number of studies have conducted gender comparisons of body image over the lifespan and included participants aged 50 years and older. With regard to measurement, body image has often been assessed only in terms of body dissatisfaction, disregarding further aspects such as body appreciation or the importance of appearance. The aim of this cross-sectional study was to explore different aspects of body image in the general German-speaking population and to compare men and women of various ages. Participants completed an online survey comprising questionnaires about body image. Body dissatisfaction, importance of appearance, the number of hours per day participants would invest and the number of years they would sacrifice to achieve their ideal appearance, and body appreciation were assessed and analyzed with respect to gender and age differences. We hypothesized that body dissatisfaction and importance of appearance would be higher in women than in men, that body dissatisfaction would remain stable across age in women, and that importance of appearance would be lower in older women compared to younger women. Body appreciation was predicted to be higher in men than in women. General and generalized linear models were used to examine the impact of age and gender. In line with our hypotheses, body dissatisfaction was higher in women than in men and was unaffected by age in women, and importance of appearance was higher in women than in men. However, only in men did age predict a lower level of the importance of appearance. Compared to men, women stated that they would invest more hours of their lives to achieve their ideal appearance. For both genders, age was a predictor of the number of years participants would sacrifice to achieve their ideal appearance. Contrary to our assumption, body appreciation improved and was higher in women across all ages than in men. The results seem to suggest that men's and women's body image are dissimilar and appear to vary across different ages.

A systematic review of the roles of body image flexibility as correlate, moderator, mediator, and in intervention science (2011-2018)

The emergence of body image flexibility into the positive body image nomenclature has innovatively expanded the conceptualization of how individuals may adaptively respond to body image threats. Given the notable growth of interest in researching this construct over nearly the past decade, the present analysis provides a systematic and critical review of evidence examining the roles of body image flexibility as correlate, mediator, moderator, and in intervention research. Results indicated that body image flexibility tended to demonstrate a pattern of relationships with correlates in directions predicted by its conceptualization and showed promise in functioning as both effect modifier and as an explanatory variable in the associations evaluated. Multiple studies demonstrated susceptibility to change following intervention. Although the current state of the literature is bound by notable limitations, the results of this review point to pertinent future steps in advancing the theory and application of body image flexibility scholarship.

Pluralistic Ignorance of Physical Attractiveness in the Gay Male Community

Researchers have found that a disproportionate percentage of men diagnosed with eating disorders identify as gay, and there is extensive evidence that gay men have significantly more body image concerns than heterosexual men (Bosley, 2011). The current studies investigated whether pluralistic ignorance exists about what is considered attractive in the gay community. It was hypothesized that gay males would privately reject the notion that only a mesomorphic (thin and muscular) body type is attractive, yet incorrectly assume that their peers are attracted primarily to a mesomorphic body type. The studies found evidence for the existence of pluralistic ignorance about what is considered attractive in the gay community. Further, there was evidence for a significant association between pluralistic ignorance and body image concerns, particularly among men who were not in committed romantic relationships.

Unhealthy weight control behaviors among youth: Sex of sexual partner is linked to important differences

Unhealthy weight control behaviors (UWCBs) have been decreasing for most youth over time, yet little is known whether these behaviors have changed for sexual minority (e.g., non-heterosexual) youth. This is important because many studies have found that sexual minorities report some of the highest rates of UWCBs. To determine whether or not these behaviors have changed over time, given the extreme changes in social contexts over the past two decades, we utilised three waves of the Minnesota Student Survey (N = 55,597, M_age = 17). In doing so, we report trends, disparities, and changes in disparities of UWCBs. Overall, the prevalence of UWCBs has declined from 1999 to 2010 for all youth, but there are alarming disparities by sex of sexual partner. We found that both- and same-sex partnered male youth were more likely to fast, use diet pills, and vomit on purpose to lose weight compared to their opposite-sex partnered counterparts in all three survey years; specifically, both-sex partnered boys were up to 5.5× as likely to vomit on purpose compared to their opposite-sex partnered counterparts. Likewise, both-sex partnered girls were more likely to use diet pills and vomit on purpose to lose weight compared to opposite-sex partnered girls in all three survey years. Additionally, the disparity in fasting to lose weight widened for the same-sex partnered females compared to the opposite-sex partnered females from 1998 to 2004. This has implications for UWCB interventions and preventions targeted specifically towards sexual minorities.

Biological origins of sexual orientation and gender identity: Impact on health

Gynecologic Oncologists are sometimes consulted to care for patients who present with diverse gender identities or sexual orientations. Clinicians can create more helpful relationships with their patients if they understand the etiologies of these diverse expressions of sexual humanity. Multidisciplinary evidence reveals that a sexually dimorphic spectrum of somatic and neurologic anatomy, traits and abilities, including sexual orientation and gender identity, are conferred together during the first half of pregnancy due to genetics, epigenetics and the diversity of timing and function of sex chromosomes, sex-determining protein secretion, gonadal hormone secretion, receptor levels, adrenal function, maternally ingested dietary hormones, fetal health, and many other factors. Multiple layers of evidence confirm that sexual orientation and gender identity are as biological, innate and immutable as the other traits conferred during that critical time in gestation. Negative social responses to diverse orientations or gender identities have caused marginalization of these individuals with resultant alienation from medical care, reduced self-care and reduced access to medical care. The increased risks for many diseases, including gynecologic cancers are reviewed. Gynecologic Oncologists can potentially create more effective healthcare relationships with their patients if they have this information.

Viewing Sexually Explicit Media and Its Association with Mental Health Among Gay and Bisexual Men Across the U.S

Gay and bisexual men (GBM) have reported viewing significantly more sexually explicit media (SEM) than heterosexual men. There is evidence that viewing greater amounts of SEM may result in more negative body attitude and negative affect. However, no studies have examined these variables within the same model. A national sample of 1071 HIV-negative GBM in the U.S. participating in a larger study completed an online survey, which included measures of SEM consumption, male body attitudes, anxiety, and depression. Participants reported viewing 3 h of SEM per week, on average, and 96% of participants reported recently viewing at least some SEM. Greater consumption of SEM was directly related to more negative body attitude and both depressive and anxious symptomology. There was also a significant indirect effect of SEM consumption on depressive and anxious symptomology through body attitude. These findings highlight the relevance of both SEM on body image and negative affect along with the role body image plays in anxiety and depression outcomes for GBM. They also indicate a potential role for body image in explaining the co-occurrence of SEM consumption and negative affect. For interventions looking to alleviate negative affect for GBM, it may be important to address SEM consumption and body image as they are shown to be associated with both anxious and depressive symptomology.

Sexual minority youth continue to smoke cigarettes earlier and more often than heterosexuals: Findings from population-based data

BACKGROUND

An established body of research documents that sexual minority (i.e., lesbian, gay, and bisexual) populations are at higher risk for several adverse health behaviors and outcomes compared to their heterosexual counterparts. Smoking is one behavior where the gap is especially large, particularly among youth. Researchers have increasingly drawn attention to contextual determinants of health behaviors affecting sexual minority youth.

PURPOSE

Although these factors have evolved over time, few scholars have examined time as a contextual factor that affects sexual minority health behaviors or the level of inequality with heterosexual populations. We aimed to fill this gap.

PROCEDURES

We used eight years of data from the Massachusetts Youth Risk Behavior Survey (MYRBS), pooled into four waves, to determine whether gaps between sexual minority and heterosexual youth have widened or narrowed for three different indicators of smoking: having ever smoked, early onset smoking, and daily cigarette smoking in the past 30 days.

RESULTS

We find that, though rates of smoking for all youth in Massachusetts have declined since the late 1990s, significant disparities remain between sexual minority and heterosexual youth.

CONCLUSIONS

Findings may suggest that targeted tobacco control programs in Massachusetts are needed; perhaps shifts in social attitudes toward smoking have affected smoking behaviors in diverse segments of society.

Disparities in Body Mass Index Trajectories From Adolescence to Early Adulthood for Sexual Minority Women

PURPOSE

We aimed to estimate group-based trajectories of body mass index (BMI) in a longitudinal cohort of young women and determine the association between sexual identity and BMI trajectory group, adjusting for obesity risk factors.

METHODS

We analyzed data from females in waves I-IV of the National Longitudinal Study of Adolescent to Adult Health. Sexual identity was categorized as heterosexual, mostly heterosexual, bisexual, or lesbian (homosexual/mostly homosexual). We conducted group-based trajectory modeling of BMI with a censored normal distribution and a cubic relationship with age to identify three BMI trajectory groups. Multinomial logit regressions predicted the risk of trajectory membership associated with sexual identity, adjusting for background characteristics.

RESULTS

At wave I, the mean (n = 7,801) age was 15.9 years (95% confidence interval: 15.6-16.1). Subjects were 16.3% African-American; and 80.0% heterosexual, 15.9% mostly heterosexual, 2.5% bisexual, and 1.7% lesbian. Group-based trajectory modeling identified three BMI trajectory groups characterized as (1) minimal obesity (62.2%), (2) developing obesity (29.9%), and (3) progressive obesity (8.0%). In multinomial logit regressions adjusted for age, race, parental obesity and education, sexual abuse, household income, screen time, depressive symptoms, and rural residence, lesbian women had a nearly two-fold higher relative risk of being in the developing obesity trajectory group (relative risk ratio = 1.91, 95% confidence interval: 1.10-3.32) relative to the minimal obesity group, compared with heterosexual women.

CONCLUSIONS

Lesbian women were at increased risk of membership in the developing obesity trajectory group compared with heterosexual women. Adjusting for obesity risk factors had minimal impact on the point estimates for this association.

The Science Behind the Academy for Eating Disorders' Nine Truths About Eating Disorders

OBJECTIVE

In 2015, the Academy for Eating Disorders collaborated with international patient, advocacy, and parent organizations to craft the 'Nine Truths About Eating Disorders'. This document has been translated into over 30 languages and has been distributed globally to replace outdated and erroneous stereotypes about eating disorders with factual information. In this paper, we review the state of the science supporting the 'Nine Truths'.

METHODS

The literature supporting each of the 'Nine Truths' was reviewed, summarized and richly annotated.

RESULTS

Most of the 'Nine Truths' arise from well-established foundations in the scientific literature. Additional evidence is required to further substantiate some of the assertions in the document. Future investigations are needed in all areas to deepen our understanding of eating disorders, their causes and their treatments.

CONCLUSIONS

The 'Nine Truths About Eating Disorders' is a guiding document to accelerate global dissemination of accurate and evidence-informed information about eating disorders. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Peer Victimization and Unhealthy Weight Control Behaviors-the Role of Intersecting Identities among New York City Youth

We investigated the intersection of sexual minority, gender, and Hispanic identities, and their interaction with peer victimization in predicting unhealthy weight control behaviors (UWCB) among New York City (NYC) youths. Using logistic regression with data from the 2011 NYC Youth Risk Behavior Survey, we examined the association of sexual identity, gender, ethnicity, and peer victimization (dating violence, bullying at school, electronic bullying) in predicting UWCB. Sexual minority youths, dating violence victims, and youths bullied at school had 1.97, 3.32, and 1.74 times higher odds of UWCB than their counterparts, respectively (P < 0.001). The three-way interaction terms between (i) dating violence, gender, and sexual identity and (ii) electronic bullying, gender, and sexual identity were statistically significant. The effect of dating violence on unhealthy weight control practices was strongest among sexual minority males (OR = 4.9), and the effect of electronic bullying on unhealthy weight control practices was strongest among non-sexual minority males (OR = 2.9). Sexual minority and gender identities interact with peer victimization in predicting unhealthy weight control practices among NYC youths. To limit the prevalence and effect of dating violence and electronic bullying among youths, interventions should consider that an individual's experiences are based on multiple identities that can be linked to more than one ground of discrimination.

Body image and sexual orientation: The experiences of lesbian and bisexual women

Western cultures promote a thin and curvaceous ideal body size that most women find difficult to achieve by healthy measures, resulting in poor body image and increased risk for eating pathology. Research focusing on body image in lesbian and bisexual women has yielded inconsistent results. In total, 11 lesbian and bisexual women were interviewed regarding their experiences with body image. Interpretative phenomenological analysis revealed that these women experienced similar mainstream pressures to conform to a thin body ideal. Furthermore, participants perceived additional pressure to conform to heteronormative standards of beauty since the normalisation of homosexuality and the increase in Lesbian, Gay, Bisexual and Transgender representation in mainstream media.

Prevalence of binge and loss of control eating among children and adolescents with overweight and obesity: An exploratory meta-analysis

OBJECTIVE

Due to the inconsistency of the research findings in the current literature, the prevalence of binge and loss of control (LOC) eating among children and adolescents with overweight and obesity remains unclear. By using the meta-analytic approach, this article aimed at exploring the prevalence of binge/LOC eating among children and adolescents with overweight and obesity, and at identifying potential moderators, which may have contributed to the heterogeneity of the existing research findings.

METHOD

Four electronic databases (PubMed, Web of Science, EBSCOhost, and ProQuest Dissertations & Theses Global) were searched. The search period covered the research literature up to April 2016. A random-effects meta-analysis model was used to estimate the overall prevalence. Weighted random-effects model ANOVAs and univariate random-effects meta-regression were applied for the analysis of categorical moderators and continuous moderators, respectively.

RESULTS

Thirty-six studies were identified. The overall prevalence of binge/LOC eating was estimated to be 26.3% (95% CI: 23.1-29.7%), with 22.2% (95% CI: 18.6-26.3%) and 31.2% (95% CI: 26.1-36.9%) for binge eating and LOC eating, respectively. Treatment status, binge eating vs. LOC eating and assessment methods appeared to be associated with the inconsistencies of the prevalence rates across the studies.

DISCUSSION

The findings of this meta-analysis indicated that binge/LOC eating was prevalent among more than one quarter of children and adolescents with overweight and obesity. Considering the close relationship between disordered eating behaviors and obesity, future research concerning overweight and obesity among children and adolescents needs to take binge/LOC eating into consideration. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:91-103).

Trends and disparities in disordered eating among heterosexual and sexual minority adolescents

OBJECTIVE

Disordered eating has decreased for all youth over time, but studies have not focused specifically on lesbian, gay, and bisexual (LGB) youth. Research has found that LGB youth report disordered eating behaviors more often compared to their heterosexual counterparts, but no studies have documented trends over time for LGB youth and considered whether these disparities are narrowing or widening across sexual orientation groups.

METHOD

We use pooled data from the 1999 to 2013 Massachusetts Youth Risk Behavior Surveys (N = 26,002) to investigate trends in purging, fasting, and using diet pills to lose or control weight for heterosexual and sexual minority youth. We used crosstabs, logistic regression, and interactions in regression models, stratified by sex.

RESULTS

The prevalence of disordered eating has decreased on all three measures across nearly all groups of heterosexual and sexual minority youth. However, we found disparities in reported disordered eating behaviors for LGB youth persisted across all survey years, with LGB students reporting significantly higher prevalence of disordered eating than heterosexuals. The disparities in fasting to control weight widened between the first and last survey waves between lesbian adolescents and heterosexual females.

DISCUSSION

The significant reductions over time in prevalence of disordered eating among some youth are encouraging, but the disparities remain. Indeed, the increasing prevalence of fasting, diet pill use, and purging to control weight among lesbians may warrant targeted prevention and intervention programs. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:22-31).

Investigating the influence of shame, depression, and distress tolerance on the relationship between internalized homophobia and binge eating in lesbian and bisexual women

There is limited research evidence about the specific factors influencing disordered eating for lesbian and bisexual women. Therefore, this study investigated relationships among binge eating, internalized homophobia, shame, depression, and distress tolerance in a sample of lesbian (n=72) and bisexual women (n=66). Two hypotheses were tested. First, it was hypothesized that shame and depression would mediate the relationship between internalized homophobia and binge eating. Second, it was hypothesized that distress tolerance would moderate the relationship between shame and binge eating and the relationship between depression and binge eating in the mediation relationships proposed in the first hypothesis. Results indicated that shame was a significant mediator for the relationship between internalized homophobia and binge eating, that depression was not a significant mediator, and that distress tolerance did not moderate the significant mediation relationship between shame and binge eating. The data in this study also indicated that the proportions of lesbian and bisexual participants who reported binge eating and compensatory behavior did not differ significantly, but that bisexual participants reported significantly more depression and shame than lesbian participants.

Body Image and Eating Disorders Among Lesbian, Gay, Bisexual, and Transgender Youth

Adolescence is a crucial period for emerging sexual orientation and gender identity and also body image disturbance and disordered eating. Body image distortion and disordered eating are important pediatric problems affecting individuals along the sexual orientation and gender identity spectrum. Lesbian, gay, bisexual, transgender (LGBT) youth are at risk for eating disorders and body dissatisfaction. Disordered eating in LGBT and gender variant youth may be associated with poorer quality of life and mental health outcomes. Pediatricians should know that these problems occur more frequently in LGBT youth. There is evidence that newer treatment paradigms involving family support are more effective than individual models of care.

A New View of Lesbian Subtypes: Stable Versus Fluid Identity Trajectories over an 8-Year Period

Research has increasingly documented that the distinction between lesbian and bisexual women is one of degree rather than kind, and some researchers have therefore argued for an end to sexual categorization altogether. To the contrary, I maintain that researchers should explore alternative criteria for sexual categorization that might allow us to discern novel and meaningful subtypes of same-sex sexuality Toward this end, I explore the usefulness of a typology that focuses on change in lesbian identification over time, using a sample of young sexual-minority women that has been observed longitudinally for a period of 8 years. Specifically, I contrast women who have maintained consistent lesbian identifications over this time period (stable lesbians) to women who have alternated between lesbian and nonlesbian labels (fluid lesbians) and women who never adopted lesbian labels (stable nonlesbians). The pattern of similarities and differences among the groups changes as a function of the specific phenomenon being assessed (e.g., sexual and emotional attractions, sexual contact, developmental histories), suggesting the value of using multiple, alternative sexual typologies as heuristics to guide future research into life span development of sexual orientation and identity.

Body image in transgender young people: Findings from a qualitative, community based study

The goal of this study was to examine the ways in which transgender youth experience their bodies with regard to gender and body size. Ninety transgender youth and young adults completed in-depth interviews in eight metropolitan areas of the United States, Canada, and Ireland. Using a queer perspective, qualitative analyses revealed two broad conceptual categories: body dissatisfaction and body satisfaction. Within these categories, participants focused on body issues related to gender characteristics and body size. Findings revealed evidence of self-criticism and social distress related to body image dissatisfaction and self-acceptance and social acceptance related to body image satisfaction. Data demonstrated how gender, body size, and the intersection of gender and body size influenced personal perceptions of body dissatisfaction and satisfaction. Developmental processes were evident: participants further along in consolidating a gender identity described gaining a sense of social awareness, self-acceptance, and body satisfaction reflecting a sense of resilience.

Examining weight and eating behavior by sexual orientation in a sample of male veterans

OBJECTIVE

Eating disorders are understudied in men and in sexual minority populations; however, extant evidence suggests that gay men have higher rates of disordered eating than heterosexual men. The present study examined the associations between sexual orientation, body mass index (BMI), disordered eating behaviors, and food addiction in a sample of male veterans.

METHOD

Participants included 642 male veterans from the Knowledge Networks-GfK Research Panel. They were randomly selected from a larger study based on previously reported trauma exposure; 96% identified as heterosexual. Measures included the Eating Disorder Diagnostic Scale, the Yale Food Addiction Scale, and self-reported height and weight.

RESULTS

Heterosexual and sexual minority men did not differ significantly in terms of BMI. However, gay and bisexual men (n=24) endorsed significantly greater eating disorder symptoms and food addiction compared to heterosexual men.

CONCLUSIONS

Our findings that sexual minority male veterans may be more likely to experience eating disorder and food addiction symptoms compared to heterosexual male veterans highlight the importance of prevention, assessment, and treatment efforts targeted to this population.

A Dynamical Systems Approach to the Development and Expression of Female Same-Sex Sexuality

Researchers have documented substantial variability in the development and expression of same-sex sexuality, especially among women, posing challenges to traditional linear developmental models. In this article, I argue for a new approach to conceptualizing the development and expression of female same-sex sexuality over the life course, based in dynamical systems theory. Dynamical systems models seek to explain how complex patterns emerge, stabilize, change, and restabilize over time. Although originally developed by mathematicians and physicists to model complex physical phenomena in the natural world, they have increasingly been applied to social-behavioral phenomena, ranging from motor development to cognition to language. I demonstrate the utility of this approach for modeling change over time in female same-sex sexuality, reviewing extant published research and also introducing data collected from an ongoing, 10-year longitudinal study of young nonheterosexual women. I provide evidence that female same-sex sexuality demonstrates the emblematic features of a dynamical system: nonlinear change over time, spontaneous emergence of novel forms, and periodic reorganizations and phase transitions within the overall system. I highlight the specific contribution of a dynamical systems perspective for understanding such phenomena and suggest directions for future study.

Differences in Weight-Related Behavioral Profiles by Sexual Orientation Among College Men: A Latent Class Analysis

PURPOSE

To identify and describe homogenous classes of male college students based on their weight-related behaviors (e.g., eating habits, physical activity, and unhealthy weight control) and to examine differences by sexual orientation.

DESIGN

Study design was a cross-sectional sample of 2- and 4-year college students.

SETTING

Study setting was forty-six 2- and 4-year colleges in Minnesota.

SUBJECTS

Study subjects comprised 10,406 college males.

MEASURES

Measures were five categories of sexual orientation derived from self-reported sexual identity and behavior (heterosexual, discordant heterosexual [identifies as heterosexual and engages in same-sex sexual behavior], gay, bisexual, and unsure) and nine weight-related behaviors (including measures for eating habits, physical activity, and unhealthy weight control).

ANALYSIS

Latent class models were fit for each of the five sexual orientation groups, using the nine weight-related behaviors.

RESULTS

Overall, four classes were identified: "healthier eating habits" (prevalence range, 39.4%-77.3%), "moderate eating habits" (12.0%-30.2%), "unhealthy weight control" (2.6%-30.4%), and "healthier eating habits, more physically active" (35.8%). Heterosexual males exhibited all four patterns, gay and unsure males exhibited four patterns that included variations on the overall classes identified, discordant heterosexual males exhibited two patterns ("healthier eating habits" and "unhealthy weight control"), and bisexual males exhibited three patterns ("healthier eating habits," "moderate eating habits," and "unhealthy weight control").

CONCLUSION

Findings highlight the need for multibehavioral interventions for discordant heterosexual, gay, bisexual, and unsure college males, particularly around encouraging physical activity and reducing unhealthy weight control behaviors.

Disparities by Sexual Orientation in Frequent Engagement in Cancer-Related Risk Behaviors: A 12-Year Follow-Up

OBJECTIVES

We examined sexual-orientation disparities in frequent engagement in cancer-related risk indicators of tobacco, alcohol, diet and physical activity, ultraviolet radiation, and sexually transmitted infections (STIs).

METHODS

We used longitudinal data from the national Growing Up Today Study (1999-2010). Of the analytic sample (n = 9958), 1.8% were lesbian or gay (LG), 1.6% bisexual (BI), 12.1% mostly heterosexual (MH), and 84.5% completely heterosexual (CH).

RESULTS

More sexual minorities (LGs, BIs, and MHs) than CHs frequently engaged in multiple cancer-related risk behaviors (33%, 29%, 28%, and 19%, respectively). Sexual-minority young women, especially BI and MH, more frequently engaged over time in substance use and diet and physical activity risk than CH women. More young gay than CH men frequently engaged over time in vomiting for weight control (odds ratio [OR] = 3.2; 95% confidence interval [CI] = 1.1, 9.4), being physically inactive (OR = 1.7; 95% CI = 1.2, 2.4), and using tanning booths (OR = 4.7; 95% CI = 3.0, 7.4), and had a higher prevalence of ever having an STI (OR = 3.5; 95% CI = 2.0, 6.4). Individual analyses were generally comparable to the group-level analyses.

CONCLUSIONS

Young sexual minorities are at risk for cancer through frequent exposure to cancer-related risk behaviors over time. Long-term, longitudinal studies and surveillance data are essential and warranted to track frequent engagement in the risk behaviors and cancer-related morbidity and mortality.

Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students

PURPOSE

This study examined associations of gender identity and sexual orientation with self-reported eating disorder (SR-ED) diagnosis and compensatory behaviors in transgender and cisgender college students.

METHODS

Data came from 289,024 students from 223 U.S. universities participating in the American College Health Association-National College Health Assessment II (median age, 20 years). Rates of past-year SR-ED diagnosis and past-month use of diet pills and vomiting or laxatives were compared among transgender students (n = 479) and cisgender sexual minority (SM) male (n = 5,977) and female (n = 9,445), unsure male (n = 1,662) and female (n = 3,395), and heterosexual male (n = 91,599) and female (n = 176,467) students using chi-square tests. Logistic regression models were used to estimate the odds of eating-related pathology outcomes after adjusting for covariates.

RESULTS

Rates of past-year SR-ED diagnosis and past-month use of diet pills and vomiting or laxatives were highest among transgender students and lowest among cisgender heterosexual men. Compared to cisgender heterosexual women, transgender students had greater odds of past-year SR-ED diagnosis (odds ratio [OR], 4.62; 95% confidence interval [CI], 3.41-6.26) and past-month use of diet pills (OR, 2.05; 95% CI, 1.48-2.83) and vomiting or laxatives (OR, 2.46; 95% CI, 1.83-3.30). Although cisgender SM men and unsure men and women also had elevated rates of SR-ED diagnosis than heterosexual women, the magnitudes of these associations were lower than those for transgender individuals (ORs; 1.40-1.54).

CONCLUSIONS

Transgender and cisgender SM young adults have elevated rates of compensatory behavior and SR-ED diagnosis. Appropriate interventions for these populations are urgently needed.

Estimating the number of men who have sex with men by race/ethnicity at the county level in Texas

This analysis presents a method for estimating the population of men who have sex with men (MSM) at the county and metropolitan area level in Texas. Surveillance data consistently demonstrate that MSM experience a high burden of HIV and other sexually transmitted infections (STIs). Numerous studies have shown that MSM are also vulnerable to many other health concerns such as suicide, substance abuse, domestic violence and assault, homelessness, and mental illness. However, compilation of rates of HIV, STIs, and other health issues is dependent on estimation of population denominators. In the absence of systematic, consistent, and direct assessment of sexual orientation and gender identity in national surveys, it is difficult to estimate the size of at-risk populations. Previous estimates at the national and state level have been calculated using varied methodologies. However, to date, statewide estimates at the county level have only been produced for the state of Florida. County-level and metropolitan area estimates of MSM population were produced using three modified models developed by Lieb et al. These models used data on population and same-sex households from the US Census, along with estimates of sexual behavior from the National Survey on Family Growth. These models produce an estimate of 599,683 MSM in Texas (6.4 % of the adult male population). Metropolitan areas with the highest percentage of MSM population include Dallas and Austin (10.3 and 9.8 %, respectively). County-level estimates of MSM population range from 1.0 to 12.9 %. These local estimates are critical to targeting vulnerable populations and effective allocation of resources for prevention and treatment programs.

An ecological framework for sexual minority women's health: factors associated with greater body mass

In recent years, many studies have focused on the body of sexual minority women, particularly emphasizing their larger size. These studies rarely offer theoretically based explanations for the increased weight, nor study the potential consequences (or lack thereof) of being heavier. This article provides a brief overview of the multitude of factors that might cause or contribute to larger size of sexual minority women, using an ecological framework that elucidates upstream social determinants of health as well as individual risk factors. This model is infused with a minority stress model, which hypothesizes excess strain resulting from the stigma associated with oppressed minority identities such as woman, lesbian, bisexual, woman of color, and others. We argue that lack of attention to the upstream social determinants of health may result in individual-level victim blaming and interventions that do not address the root causes of minority stress or increased weight.

Sexual orientation and gender differences in markers of inflammation and immune functioning

BACKGROUND

Sexual minorities have documented elevated risk factors that can lead to inflammation and poor immune functioning.

PURPOSE

This study aims to investigate disparities in C-reactive protein (CRP) and Epstein-Barr virus (EBV) by gender and sexual orientation.

METHODS

We used the National Longitudinal Study of Adolescent Health to examine disparities in CRP (N = 11,462) and EBV (N = 11,812).

RESULTS

Among heterosexuals, women had higher levels of CRP and EBV than men. However, sexual minority men had higher levels of CRP and EBV than heterosexual men and sexual minority women. Lesbians had lower levels of CRP than heterosexual women.

CONCLUSIONS

Gender differences in CRP and EBV found between men and women who identify as 100 % heterosexual were reversed among sexual minorities and not explained by known risk factors (e.g., victimization, alcohol and tobacco use, and body mass index). More nuanced approaches to addressing gender differences in sexual orientation health disparities that include measures of gender nonconformity and minority stress are needed.

Distressing Sexual Difficulties in Heterosexual and Non-Heterosexual Croatian Men: Assessing the Role of Minority Stress

Although research has shown a connection between minority stressors and internalizing mental health problems, the role of minority stress has mainly been neglected in the assessment of sexual problems among non-heterosexual men. Using online samples of heterosexual (n = 933) and non-heterosexual participants (n = 561) aged 18 to 50 years, this study aimed to comparatively assess sexual difficulties and problems and explore the role of minority stress in non-heterosexual men's sexual problems. Although the age-adjusted odds of reporting rapid ejaculation, delayed ejaculation, and sex-related anxiousness significantly differed between the two groups, the overall prevalence of sexual difficulties and the associated levels of distress did not significantly differ between the samples. In multivariate assessment, anxiety and depression significantly increased the odds of reporting distressing sexual difficulties among both heterosexual and non-heterosexual participants. In the non-heterosexual sample, positive body image significantly decreased the odds of experiencing sexual problems. Pointing to a role of minority stress, highest levels of victimization related to sexual orientation increased the risk of sexual problems. This association was partially mediated by negative emotions. Our findings offer some support for a recent call to include sexual orientation among the social determinants of health recognized by the World Health Organization.

Weight misperception and unhealthy weight control behaviors among sexual minorities in the general adolescent population

PURPOSE

Gay, lesbian, and bisexual youth may experience significant body dissatisfaction. We examined sexual orientation differences in self-perceived weight status and the prevalence of potentially dangerous weight control behaviors in a representative sample of adolescents.

METHODS

Data were obtained from 12,984 youth between 2003 and 2009 over four cycles of the Massachusetts Youth Risk Behavior Survey, a statewide survey of ninth- through 12th-grade students. Self-perceived weight status and past-month unhealthy weight control behaviors (fasting >24 hours, using diet pills, and vomiting or using laxatives) were compared among gay/lesbian, bisexual, or self-identified heterosexual youth with same-sex partners, unsure youth, and exclusively heterosexual youth using logistic regression, adjusting for age and race/ethnicity.

RESULTS

Compared with exclusively heterosexual males, heterosexual males with prior same-sex partners and bisexual males were more likely to self-perceive as overweight despite being of healthy weight or underweight (respectively, adjusted odds ratio [AOR], 2.61; 95% confidence interval [CI], 1.68-4.05; and AOR, 2.56; 95% CI, 1.64-4.00). Compared with exclusively heterosexual females, lesbians and bisexual females were more likely to self-perceive as being of healthy weight or underweight despite being overweight or obese (respectively, AOR, 3.17; 95% CI, 1.15-8.71; and AOR, 2.00; 95% CI, 1.20-3.33). Unhealthy weight control behaviors were significantly more prevalent among sexual minority males (32.5%; AOR, 4.38; 95% CI, 3.38-5.67) and females (34.7%; AOR, 2.27; 95% CI, 1.85-2.78) when considered together relative to exclusively heterosexual males (9.7%) and females (18.8%).

CONCLUSIONS

One third of sexual minority youth engage in hazardous weight control behaviors. Future research should investigate underlying mechanisms and determine whether clinicians should routinely screen for these behaviors.

Patterns of disordered eating behavior in women by sexual orientation: a review of the literature

Most disordered eating research has focused on White, heterosexual women. More empirical work is needed to better understand disordered eating among women of diverse backgrounds. Given evidence of disparities between heterosexual and sexual minority (i.e., non-heterosexual) women in other health behaviors (e.g., tobacco use) and outcomes (e.g., cardiovascular disease), it appears important to study disordered eating behaviors among sexual minority women. In this article, we review the extant literature on disordered eating behaviors in women across sexual orientations, with a focus on research examining potential mechanisms of disparities in disordered eating, including awareness and internalization of sociocultural norms.

Sexual orientation disparities in cancer-related risk behaviors of tobacco, alcohol, sexual behaviors, and diet and physical activity: pooled Youth Risk Behavior Surveys

OBJECTIVES

We examined sexual orientation disparities in cancer-related risk behaviors among adolescents.

METHODS

We pooled data from the 2005 and 2007 Youth Risk Behavior Surveys. We classified youths with any same-sex orientation as sexual minority and the remainder as heterosexual. We compared the groups on risk behaviors and stratified by gender, age (< 15 years and > 14 years), and race/ethnicity.

RESULTS

Sexual minorities (7.6% of the sample) reported more risk behaviors than heterosexuals for all 12 behaviors (mean = 5.3 vs 3.8; P < .001) and for each risk behavior: odds ratios (ORs) ranged from 1.3 (95% confidence interval [CI] = 1.2, 1.4) to 4.0 (95% CI = 3.6, 4.7), except for a diet low in fruit and vegetables (OR = 0.7; 95% CI = 0.5, 0.8). We found sexual orientation disparities in analyses by gender, followed by age, and then race/ethnicity; they persisted in analyses by gender, age, and race/ethnicity, although findings were nuanced.

CONCLUSIONS

Data on cancer risk, morbidity, and mortality by sexual orientation are needed to track the potential but unknown burden of cancer among sexual minorities.