An Intersectional Mixed-Method Examination of Multi-Level Determinants of Adolescent Sexual Minority Health and Substance Use

青少年性少数群体健康和物质使用多层次决定因素的交叉混合方法检验

• 批准号: 10017064
• 负责人: Alena A. Kuhlemeier
• 金额: $ 3.73万
• 依托单位: UNIVERSITY OF NEW MEXICO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-08 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10017064
• 关键词: Address; Administrator; Adolescence; Adolescent; Alcohol or Other Drugs use; Area; Attenuated; Attitude; Award; Bisexual; Brain; Categories; Characteristics; Climate; Communities; County; Data; Data Collection; Data Sources; Development; Disadvantaged; Discrimination; Disease; Empirical Research; Environment; Equation; Ethnic Origin; Event; Family; Foundations; Funding; Gays; Gender; Gender Identity; Goals; Health; Heterogeneity; High School Student; Individual; Institution; Intervention; Intervention Studies; Interview; Investigation; Knowledge; Lesbian; Lesbian Gay Bisexual; Lesbian Gay Bisexual Transgender; Life Cycle Stages; Linear Models; Link; Mediating; Mental Health; Mental disorders; Methods; Modeling; National Institute of Child Health and Human Development; Nature; New Mexico; Nurses; Outcome; Pathway interactions; Perception; Policies; Population; Public Health; Qualitative Methods; Race; Reporting; Research; Research Personnel; Research Training; Resources; Risk; Risk Factors; Role; Sampling; School Teachers; Schools; Shapes; Site; Social Change; Social Environment; Social status; Social support; Socioeconomic Status; Structure; Students; Suicide; Surveys; System; Techniques; Testing; Victimization; Vision; Woman; Youth; adolescent suicide; base; behavioral health; career; contextual factors; critical period; design; disparity reduction; ethnic identity; experience; health disparity; high school; improved; men; minority communities; minority health; minority student; multilevel analysis; population based; protective factors; psychological distress; racial and ethnic; resilience; sex; sexual identity; sexual minority; skills; social; social determinants; social stigma; social structure; substance misuse; substance using adolescents; teacher

The goal of this study is to investigate how sexual minority (SM) adolescents’ behavioral health (BH) is shaped by their experience of multiple, intersecting and mutually constitutive identities and their interactions with larger, social-structural systems of privilege and disadvantage. At its core, this study is concerned with developing an intersectional understanding of the socio-ecological risk and protective environments1 in which SM adolescents live. This research is of urgent relevance to public health because it will provide empirical research findings that improve our understanding of the landscape of SM BH disparities and thus better equip us to address these disparities. The proposed project will facilitate NIMHD’s vision of disseminating effective multi-level interventions to reduce and eliminate BH disparities by making clear how best to develop and implement interventions targeting these outcomes. To achieve these goals, this project will analyze quantitative and qualitative secondary data using a mixed-method approach that emphasizes the particular strengths of each data source. Quantitative analyses will include structural equation modeling (SEM) and hierarchical linear modeling (HLM) techniques to investigate the role of ecological context in moderating BH outcomes of SM youth populations as captured by the New Mexico Youth Risk and Resiliency Survey (YRRS). These analytic techniques can provide an understanding of the ways in which different social statuses intersect to shape adolescents’ mental health (MH) and substance use (SU). Models will be created for youth of each sexual identity category (lesbian/gay, bisexual, and questioning/not sure) in order to examine how BH outcomes differ based on their sexual identity, sex, gender, socioeconomic status (SES), race, and ethnicity. These quantitative analyses will overcome limitations of previous research in this area by capitalizing on the strengths of the large and diverse nature of the YRRS sample to investigate differences in MH and SU pathways within SM populations. Qualitative data will be comprised of 96 in-depth, semi-structured interviews with school professionals that were conducted in the course of baseline data collection for the NICHD-funded Reducing LGBT Adolescent Suicide (RLAS) trial (PIs: Cathleen Willging and Mary Ramos). These interviews explored staff and teacher attitudes toward SM students, perceptions about how SM students are treated, policies in place to protect SM students, and how schools could better serve SM students. Staff and teacher interview data will be used to contextualize and add descriptive detail to quantitative results, as well as to expand our understanding of how school teachers, administrators, and nurses perceive the contextual supports and barriers faced by SM students. These individuals are uniquely situated to not only share their own role in shaping adolescents’ experiences at school, but also to be witnesses of the micro-level interactions of students and staff and the impact of macro- and meso-level interactions that students have with the institution and their communities.

本研究的目的是调查性少数 (SM) 青少年的行为健康 (BH) 是如何形成的 通过他们对多重、交叉和相互构成的身份的体验以及他们与他人的互动 更大的、特权和劣势的社会结构体系。这项研究的核心是 形成对社会生态风险和保护环境的交叉理解1，其中 SM青少年生活。这项研究与公共卫生具有紧迫的相关性，因为它将提供实证 研究结果提高了我们对 SM BH 差异状况的理解，从而更好地装备 我们来解决这些差异。拟议的项目将促进 NIMHD 传播有效信息的愿景 多层次干预措施，通过明确如何最好地制定和消除 BH 差异来减少和消除 BH 差异。 实施针对这些结果的干预措施。为了实现这些目标，该项目将进行定量分析 和使用混合方法方法的定性二手数据，强调了特定的优势 每个数据源。定量分析将包括结构方程模型 (SEM) 和分层线性 建模 (HLM) 技术来研究生态环境在调节 SM 的 BH 结果中的作用 新墨西哥州青年风险和复原力调查 (YRRS) 捕获的青年人口。这些解析 技术可以提供对不同社会地位交叉塑造的方式的理解 青少年的心理健康（MH）和物质使用（SU）。将为每个性别的青少年创建模型 身份类别（女同性恋/男同性恋、双性恋和质疑/不确定），以检查 BH 结果有何不同 基于他们的性别认同、生理性别、社会经济地位 (SES)、种族和民族。这些 定量分析将利用优势克服该领域先前研究的局限性 利用 YRRS 样本的庞大且多样化的性质来研究 MH 和 SU 途径的差异 SM 人群。定性数据将由 96 次对学校的深入、半结构化访谈组成 NICHD 资助的减少基线数据收集过程中进行的专业人员 LGBT 青少年自杀 (RLAS) 试验（PI：Cathleen Willging 和 Mary Ramos）。这些采访探讨了 教职员工和教师对 SM 学生的态度、对 SM 学生待遇的看法、SM 学生的政策 保护 SM 学生的场所，以及学校如何更好地为 SM 学生服务。工作人员和老师访谈 数据将用于对定量结果进行背景化和添加描述性细节，以及扩展我们的研究 了解学校教师、管理人员和护士如何看待情境支持和 SM 学生面临的障碍。这些人处于独特的位置，不仅在其中分享自己的角色 塑造青少年在学校的经历，同时也是学生微观层面互动的见证者 和工作人员以及学生与机构及其他们的宏观和中观层面互动的影响 社区。