Potential Causes of Health Disparities in Cancer-Related Risk Behaviors of Sexual-Minority and Heterosexual Youths
Margaret Rosario, PhD and Jack E. Burkhalter, PhD
Sexual orientation group disparities in cancer-related risk behaviors are now well documented, with sexual minorities reporting more substance use and eating disordered and related behaviors. Little is known about the reasons underlying such higher risk behaviors between sexual minorities and heterosexuals. We propose to investigate potential pathways for the disparities. Our theoretical framework focuses on the experiences of sexual identity development as sexual minority, gay-related stress, family and social relationships, coping strategies used to deal with sexual identity development and stress, and psychological distress as potential determinants of cancer-related risk behaviors. The internal and external demands of sexual identity development and gay-related stress may challenge the individual, offering opportunities for growth as the individual effectively deals with the challenges; thus, we will focus on the resilience or thriving that may result from overcoming the challenges that sexual-minority youths experience. Specifically, our proposed research will address the impact of gay-related stress on disparities between sexual-minority and heterosexual youths and across sexual-minority youths in cancer-related risk behaviors directly and indirectly by means of psychological distress. It will examine moderators, such as the effect of parent-child relationships on the relations between sexual orientation and gay-related stress. It will examine the extent to which sexual identity development mediates the relations between gay-related stress and psychological distress, as well as the extent to which gay-related stress and sexual identity development influence thriving, and how thriving is related to less psychological distress and fewer cancer-related risk behaviors. Our research will be sensitive to important precursors of gay-related stress, such as gender-atypical behavior in childhood and adolescence. It will also examine how gender, sexual minority status, ethnicity/race, and age vary with sexual identity development, gay-related stress, family and social relationships, coping, psychological distress, cancer-related risk behaviors, and thriving. We will collect self-report survey data to investigate these critical issues from 200 sexual-minority and 200 heterosexual youths recruited online. In addition, we will conduct in-depth, qualitative interviews with 85 sexual-minority youths in order to deeply explore their cancer-related risk behaviors, potential facilitators and barriers of those behaviors, and the causal patterns of relations that occur in this process. Together, our quantitative and qualitative data will provide critically important and necessary insights into the elevated cancer-related risk behaviors of sexual-minority youths relative to heterosexuals and across sexual-minority youths.