The Family Environment, Social Support, and Health in Transgender Youth

 描述(由申请人提供)：变性青年认同的性别不同于他们出生时指定的性别，部分由于污名化和家庭排斥，他们面临更大的负面健康后果风险。对非跨性别性少数群体的研究表明，家庭支持对青少年的健康和福祉至关重要，家庭排斥可能会导致负面结果，如青少年无家可归。然而，关于变性人青年的具体情况以及他们的经历如何与他们现在或过去的家庭环境(原籍家庭、选定家庭、寄养家庭、团体照料)联系在一起，人们知之甚少。在有变性人青年的家庭中，变性人身份的发展和从指定性别向确定性别转变的过程可能是青年和更大的家庭系统的压力来源。响应医学研究所和国立卫生研究院LGBT研究协调委员会关于研究变性人特有的健康需求的呼吁，这项研究的具体目的是：1)纵向调查家庭环境如何影响变性人青年的健康结果；2)检查来自家庭内外的哪些类型的社会支持是否可以改善家庭功能并保护变性人青年的健康；以及3)开发基于叙事的干预措施，以改善变性人青年家庭的家庭功能和寻求社会支持的行为。将少数群体压力模型和家庭系统理论结合起来，为研究1和研究2提供了一个框架。研究1将调查家庭环境如何与变性人青年的健康结果(药物使用、性风险、自残、自杀、抑郁、焦虑)纵向相关。为了向未来的干预措施提供信息，研究1还将审查来自家庭内外的社会支持是否以及哪些类型可以改善家庭功能并保护变性人青年的健康。我将使用基于社区的参与性研究(CBPR)原则和混合方法(定性访谈和定量调查)来研究家庭环境、感知的压力、健康结果和社会支持的多个方面，使用24个月的五次浪潮收集的数据，这些数据来自40名13至17岁的变性人青年及其父母/监护人和兄弟姐妹(总N=80-160)。参与者将从多个来源招募，以获取家庭功能方面的各种经验和变异性。先前的研究表明，社会支持可能会减少变性人青年家庭中与压力相关的负面后果。需要强调社会支持的干预措施，以改善压力源的影响，改善这一边缘化人口的家庭环境。研究2将根据社会认知和运输理论开发和试验一种创新的基于叙事的干预措施，以改善变性人青年的家庭环境，包括减少家庭内公开的污名(公开的反变性人态度和行为)，并改善家庭功能和寻求社会支持的技能。基于叙事的干预措施使用讲故事的方式，通过运输机制(融入故事并认同人物)、说服和自我效能来促进健康行为的改变。研究2中开发的干预措施将使用数字讲故事，这是一种特定的基于叙事的干预方法，从变性人青年那里制作关于他们家庭环境的多媒体视觉叙事。基于叙述的干预措施已成功地用于改变边缘人群的健康行为和减少耻辱，使其成为改善变性人青年家庭环境的一种创新和有前途的方法。这项计划中的研究将首次利用多个家庭成员的视角纵向调查家庭环境对变性人青年健康结果的影响，并开发和试点以叙事为基础的干预措施，以改善变性人青年的家庭环境。最终，这项工作将改善变性人青年和家庭的健康和福祉，并为今后与其他边缘化人口开展的工作提供信息。

 DESCRIPTION (provided by applicant): Transgender youth, who identify with a gender that is different from their sex assigned at birth, are at increased risk for negative health outcomes due in part to stigmatization and family rejection. Research with non- transgender sexual minorities suggests that family support is crucial to youths' health and well-being and that family rejection may lead to negative outcomes, such as youth homelessness. Yet little is known about transgender youth specifically and how their experiences are linked to their current or past family environment (family of origin, chosen family, foster family, group care). In families with transgender youth, development of a transgender identity and the process of transitioning from assigned sex to identified gender may represent a source of stress for both the youth and the larger family system. Responding to the Institute of Medicine's and NIH LGBT Research Coordinating Committee's call for research on transgender-specific health needs, the specific aims of this research are to: 1) longitudinally investigate how the family environment affects health outcomes among transgender youth, 2) examine whether and what types of social support from within and outside of the family can improve family functioning and be protective for transgender youths' health, and 3) develop a narrative-based intervention to improve family functioning and social support-seeking behaviors in families with transgender youth. The Minority Stress Model and Family Systems Theory are integrated to provide a framework for Studies 1 and 2. Study 1 will investigate how the family environment is longitudinally associated with health outcomes (substance use, sexual risk, self-harm, suicidality, depression, anxiety) among transgender youth. With the goal of informing future interventions, Study 1 will also examine whether and what types of social support from within and outside of the family can improve family functioning and be protective for transgender youth's health. I will use community-based participatory research (CBPR) principles with mixed methods (qualitative interviews and quantitative surveys) to examine multiple aspects of the family environment, perceived stress, health outcomes, and social support using data collected at five waves across 24 months from 40 transgender youth ages 13 to 17 years and their parents/guardians and siblings (Total N = 80-160). Participants will be recruited from multiple sources to capture a diverse range of experiences and variability in family functioning. Previous research has indicated that social support may reduce negative stress-related outcomes in families with transgender youth. Interventions emphasizing social support are needed to ameliorate the effects of stressors and improve the family environment in this marginalized population. Study 2 will develop and pilot an innovative narrative-based intervention based on Social Cognitive and Transportation Theories to improve the family environment for transgender youth, including decreasing enacted stigma (overt anti-transgender attitudes and behaviors) within the family, and improving family functioning and social support-seeking skills. Narrative-based interventions use storytelling to promote health behavior change through mechanisms of transportation (absorption into the story and identification with characters), persuasion, and self-efficacy. The intervention developed in Study 2 will use digital storytelling, a specific narrative-based intervention method, to produce multimedia visual narratives from transgender youth about their family environment. Narrative-based interventions have been used successfully to change health behaviors and reduce stigma in marginalized populations, making this an innovative and promising approach to improve the family environment in families with transgender youth. The planned research will, for the first time, longitudinally investigate effects of the family environment on health outcomes among transgender youth using multiple family member perspectives and develop and pilot test a narrative-based intervention to improve the family environment for transgender youth. Ultimately this work will improve the health and well-being of transgender youth and families and inform future work with other marginalized populations.