Disaggregating Asian Americans and Pacific Islanders to identify mechanisms of adolescent suicide risk: The role of school stressors, alcohol, sleep, and school/community contexts

摘要 青少年自杀是一个值得立即关注的关键问题，因为它是导致死亡的主要原因 在15-19岁的AAPI青少年中。作为美国最多样化的种族/少数民族群体之一，AAPI是 他们往往被忽视，因为作为一个整体，他们的比率似乎低于其他种族/族裔群体。 当分解时，一些AAPI群体的自杀率显着高于非西班牙裔白人。 继续聚集AAPI只会使青少年自杀的隐藏问题永久化， 不同的民族历史，定居经历，社会经济地位和健康行为， 可能导致更高的自杀风险。认识到非洲土著人民的异质性及其不同的社会文化 本研究旨在探讨个人和背景水平的风险和保护因素，可能影响 并有助于解释八个AAPI群体青少年自杀风险的变化：亚洲印度人，中国人，菲律宾人， 日本人、韩国人、太平洋岛民、东南亚人（即，苗族人、老挝人和越南人。 在这方面，我们注意到NIMH和NIMHD的研究呼吁，以确定心理健康差异的驱动因素， 多层次的透镜，将个人与社会文化环境和宏观影响联系起来。应用社会 生态模型和少数和压力过程理论的通知，我们的研究调查了显着的学校， 与学业成绩和种族相关的欺凌有关的压力。我们将研究酒精使用的作用， 大麻使用和睡眠不足-后两种流行率上升-作为潜在的可改变的反应， 这些压力源，也在不同的流行AAPI亚组和性别。利用调查数据 来自美国最大的学校系统和最大的AAPI学生人口，这项研究将涉及中学 青少年调查数据分析与学校管理人员对教师/工作人员对 学校气氛、学生组成和学习成绩的学校行政数据以及社区 AAPI人口和社会经济状况数据。对于按性别划分的每个AAPI亚组，本研究将 解决三个目标：（1）检查与学校有关的压力源之间的关系（即，成绩差，欺凌） 和自杀风险，并评估这些关系如何因学校和社区环境而异（即，学校氛围， 同种族密度，劣势），（2）评估酒精使用，大麻使用和睡眠单独的程度 修改和调解这些关联与自杀风险，（3）阐明干预杠杆，通过估计 与压力源和风险行为变化相关的人群自杀风险降低， 与加强保护环境相关的进一步减少。这项研究将解决新的问题， 种族相关的压力源和自杀风险的风险行为，以及这些机制如何在八个不同的 土著人民群体和性别。调查结果将告知混合方法R 01建议将这些压力源和风险联系起来 行为与精神病理因素，以获得更丰富的理解风险和弹性 在学校和社区建立机制，以最好地指导对亚太裔青少年的自杀干预。

Abstract Adolescent suicide is a critical issue that warrants immediate attention since it is the leading cause of death among AAPI adolescents ages 15-19. As one of the most diverse U.S. racial/ethnic minority groups, AAPIs are often overlooked because as an aggregate, they appear to have lower rates than other racial/ethnic groups. When disaggregated, some AAPI groups show significantly higher suicide rates than non-Hispanic whites. Continuing to aggregate AAPIs will only perpetuate the hidden problems of adolescent suicide and mask AAPI's different ethnic group histories, settlement experiences, socioeconomic positions, and health behaviors, which may contribute to higher suicide risk. Recognizing the heterogeneity in AAPIs and their diverse sociocultural contexts, this study aims to examine individual- and contextual-level risk and protective factors that may influence and help explain variations in adolescent suicide risk in eight AAPI groups: Asian Indians, Chinese, Filipinos, Japanese, Koreans, Pacific Islanders, Southeast Asians (i.e., Hmong, Cambodians, Laotians), and Vietnamese. In this, we heed the NIMH and NIMHD's call for research to identify drivers of mental health disparities using a multilevel lens that links individuals to sociocultural environments and macrolevel influences. Applying the Social Ecological Model and informed by minority and stress process theories, our study investigates salient school- related stressors of academic performance and race-relevant bullying. We will examine the roles of alcohol use, marijuana use and insufficient sleep – the latter two rising in prevalence – as potentially modifiable responses to these stressors, that also vary in prevalence across AAPI subgroups and gender. Capitalizing on survey data from the largest U.S. school system and with the largest AAPI student population, this study will entail secondary data analysis of adolescent surveys linked with school administrator surveys of teacher/staff perceptions of school climate, school administrative data of student composition and academic performance, and community data of AAPI demographic and socioeconomic conditions. For each AAPI subgroup-by-gender, this study will address three aims: (1) examine the relationships between school-related stressors (i.e., poor grades, bullying) and suicide risk, and assess how these relationships vary by school and community contexts (i.e., school climate, co-ethnic density, disadvantage), (2) assess the extent to which alcohol use, marijuana use and sleep individually modify and mediate these associations with suicide risk, and (3) illuminate intervention levers by estimating the reduction in suicide risk at the population level associated with changes in stressors and risk behaviors, and the added reduction associated with enhanced protective contexts. This research will address novel questions about race-relevant stressors and risk behaviors on suicide risk, and how these mechanisms vary across the eight AAPI groups and gender. Findings will inform a mixed-methods R01 proposal to link these stressors and risk behaviors with psychopathological factors in order to gain a richer understanding of risk and resiliency mechanisms within schools and communities to best guide suicide interventions for AAPI adolescents.