Racial/Ethnic and Sexual Identity Differences in Unhealthy Weight Control Behaviors

Background Literature on unhealthy weight control behavior (WCB) in sexual minority youth (SMY: gay, lesbian, and bisexual youth) is remarkably limited. Some studies have found higher rates of diet pill use and purging among SMY, and higher rates of steroid use among sexual minority males. However, there is very little data on steroid use among females at all, or differences in unhealthy WCB by sexual identity sub-group and race/ethnicity, often due to small sample sizes. Using our pooled Youth Risk Behavior Survey (YRBS) dataset, we will be able to analyze the usage of diet pills, steroids, purging, and fasting among subsets of SMY by both gender and race/ethnicity, identifying disparities and populations most at risk. Methods We pooled data from the 2013 and 2015 YRBS for jurisdictions that included questions on sexual minority status, creating a sample of 226,858 individuals and 35 jurisdictions. Outcome variables included fasting, diet pill use, steroid use, and purging or laxative use. Prevalence of these behaviors was compared between SMY and non-SMY, and stratified by both gender and race/ethnicity. Significant associations were assessed with weighted chi-squared tests. Preliminary Results Preliminary weighted results found significant differences for all four WCBs by both sexual identity and race/ethnicity. For example, rates of steroid use for female Latina adolescents ranged from 2.1% for heterosexual youth to 14.8% for lesbian youth; for male African-American adolescents, rates ranged from 2.9% for heterosexual youth to 28.2% for gay youth. Additional analyses will control for survey year and age and assess significant differences between subgroups. We will also explore the association between WCBs and obesity and self-perceived weight. Discussion A more accurate understanding of unhealthy WCB in adolescents can inform prevention curricula in schools and enhance screening of at-risk youth. These practices must consider unhealthy WCB that may not fit stereotypical risk (e.g., steroid use among females), as well as significant differences between racial/ethnic groups. Further research is needed to explore the mechanisms of these disparities and appropriate interventions based on the unique risks and needs of SMY of varying races/ethnicities.