Purpose: Health disparities between sexual minority (SM) adolescents and heterosexual adolescents have been identified for risky behaviors such as substance use and risky sexual practice. Yet, few studies have looked at disordered eating (e.g., binge-eating and self-induced vomiting) which may cause serious health consequences. SM youth may be at higher risk for disordered eating, in part because of stress and trauma experiences. Additionally, prevalence of disordered eating within the same sexual orientation group may change over time, as seen in general adolescent samples. We thus examined (a) trends in disordered eating within each orientation group and (b) disparities between SM and heterosexual adolescents in western Canada.
Methods: Data were from the British Columbia Adolescent Health Survey of 1998, 2003, and 2008, a province-wide, school-based, cluster-stratified random survey of students in grades 7-12. We included students from school districts participating in at least 2 of 3 survey years (weighted N’s > 210,000), with 91% heterosexual (HET), 7% mostly heterosexual (MH), 3% lesbian, gay, and bisexual (LGB). Measures included binge eating (twice a month or more) and vomiting on purpose after eating (at least one time for boys; twice a month or more for girls).Trends in prevalence across survey years were tested by contingency tables with z tests. Age-adjusted odds ratios assessed differences in disordered eating between SM groups and HET groups in each year. All analyses were stratified by gender and adjusted for complex sampling.
Results: Binge-eating rates declined between 1998 and 2008 among HET boys (8.4% to 6.4%) and HET girls (14.5% to 12.9%) and between 2003 and 2008 among MH girls (23.7% to 19.3%). Among LGB boys, the rates declined from 30.2% in 1998 to 14.8% in 2003, then increased (but not significantly) to 24.2% in 2008. A significant decrease in vomiting was found among HET boys (from 3.8% in 1998 to 2.5% in 2008). Among LGB boys, the rates declined from 19.4% in 1998 to 4.5% in 2003, followed by an increase to 18.5% in 2008. LGB girls had increasing rates from 9.3% in 2003 to 16.2% in 2008. MH boys and MH girls had 1.5-2 times odds of binge eating and vomiting compared to their HET peers. Orientation differences between LGB and HET were narrower in 2003 than in 1998 (AOR of binge eating for boys 4.7 to 2.1; for girls 2.6 to 1.8; AOR of vomiting for boys 6.3 to 2.1; for girls 4.1 to 3.8), followed by a widening gap in 2008 (AOR of binge eating for boys 4.5; for girls 2.4; AOR of vomiting for boys 9.3; for girls 6.4).
Conclusions: A declining trend in disordered eating was observed for heterosexual youth and a V-shaped trend for LGB youth. Sexual minority youth were at higher risk across all years. Findings suggest the need to continue monitoring trends by orientation and explore factors that may influence the trends.
Sources of Support: Grants #CPP86374 & #MOP 119472, Canadian Institutes for Health Research; McCreary Centre Society’s BC Adolescent Health Survey.
