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

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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.