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

本研究旨在探讨性少数青少年的行为健康是如何形成的 他们的多重、交叉和相互构成的身份经历及其与 更大的社会结构体系的特权和劣势。本研究的核心是关注 发展对社会生态风险和保护环境的交叉理解，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，因为它将提供经验性的 研究结果，提高我们对SM BH差异景观的理解，从而更好地装备 我们要解决这些差距。拟议的项目将促进NIMHD传播有效的 * 采取多层次干预措施，通过明确如何最好地发展和 实施针对这些成果的干预措施。为了实现这些目标，本项目将分析定量 和定性二手数据使用混合方法的方法，强调特定的优势， 每个数据源。定量分析将包括结构方程模型（SEM）和分层线性模型。 模型（HLM）技术，以调查在调节BH结果的SM生态背景的作用 新墨西哥州青年风险和复原力调查（YRRS）所捕获的青年人口。这些分析 技术可以提供一个不同的社会地位交叉的方式，以形成理解， 青少年心理健康（MH）和物质使用（SU）。将为每个性别的年轻人创建模型 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结果如何不同 基于他们的性身份，性别，性别，社会经济地位（SES），种族和民族。这些 定量分析将克服这一领域以往研究的局限性， YRRS样本的大而多样的性质，以调查内部MH和SU途径的差异 SM人群。定性数据将包括96个深入的，半结构化的采访，学校 在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和玛丽拉莫斯）。这些采访探讨了 工作人员和教师对SM学生的态度，对SM学生如何对待的看法， 保护SM学生的地方，以及学校如何更好地为SM学生服务。工作人员和教师访谈 数据将被用于情境化，并为定量结果添加描述性细节，以及扩展我们的 了解学校教师、管理人员和护士如何感知情境支持， SM学生面临的障碍。这些人的独特地位不仅分享他们自己的作用， 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人 和工作人员以及学生与机构及其 社区.

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.