Exploring health equity for Asian American, Native Hawaiian, and Pacific Islander Adolescents in a large epidemiologic study: Intersections of ethnicity, sexual orientation, and gender identity

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PROJECT ABSTRACT/SUMMARY Asian American, Native Hawaiian, and Pacific Islander (AANHPI) sexual and gender minority (SGM) youth face substantial health disparities compared to their cisgender and straight peers. They must also contend with stereotypes, such as the model minority myth, contributing to misconceptions and inaccurate/insufficient information to guide intervention strategies. AANHPI youth are not a monolith; yet, they are often aggregated in studies, masking important health disparities across AANHPI subpopulations. Intersectionality is a critical analysis framework describing complex ways that power and privilege are structured based on mutually constitutive social positions and how processes that confer privilege and disadvantage impact people’s lives. Exposure to overlapping concurrent forms of social oppression (e.g., homophobia and racism simultaneously) may differentially affect treatment of AANHPI youth subgroups, yielding longer-term health concerns. AANHPI youth facing multiple marginalization may experience challenges that affect healthy development, but also unique strengths. AANHPI youth are a fast-growing, poorly understood population, especially AANHPI SGM youth, and their risks and support needs are critical public health issues. This proposed developmental study responds to NOT-HL-23-001 and is an ancillary study to a funded R01 (MD015722). We will use an intersectional lens and a sequential explanatory design to answer questions specific to AANHPI SGM youth (13-19 years old), which are beyond the scope of our existing study: 1) What are differences in bullying, risk behaviors, mental health, and protective factors among AANHPI youth with different social positions (e.g. AANHPI sexual and/or gender minority youth, various ethnic groups)? 2) How do differences in protective factors and other characteristics explain variations in bullying, risk behaviors, and mental health among AANHPI youth (and ethnic groups) with different social positions? and 3) What positive and negative experiences are relevant to the overlapping, simultaneous production of inequalities by AANHPI ethnicity and SGM identity? We will explore these new areas using two study aims: first, conduct intersectionality-informed, harmonized and parallel quantitative analyses of three adolescent datasets to examine risk and protective factors for AANHPI youth at intersecting social positions. We will use the California Healthy Kids Survey (N~1,042,000), Minnesota Student Survey (N~122,000), and LGBTQ National Teen Survey (N~17,000). Second, we will conduct interviews with 15 AANHPI SGM youth to gain rich insight into Aim 1 findings and 15 professionals who work with AANHPI SGM youth to understand training/resource needs and interpersonal and community-specific assets. Findings will generate concrete recommendations to bolster care and service systems for AANHPI SGM youth. This study, capitalizing on existing protocols, resources and mentorship of our funded R01, is expected to provide preliminary data to develop and test training programs for educators, health professionals and service providers in various settings to improve the wellbeing of AANHPI youth.