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

 描述（由申请人提供）：跨性别青年，谁确定的性别是从他们出生时分配的性别不同，是在增加风险的负面健康结果，部分原因是耻辱和家庭拒绝。对非变性性少数群体的研究表明，家庭的支持对青年的健康和福祉至关重要，家庭的排斥可能导致负面结果，如青年无家可归。然而，人们对变性青年的具体情况知之甚少，也不知道他们的经历如何与他们目前或过去的家庭环境（原籍家庭、选择的家庭、寄养家庭、集体照顾）联系在一起。在有变性青年的家庭中，变性人身份的形成以及从指定性别向确定性别过渡的过程可能是青年和大家庭系统的压力来源。为了响应医学研究所和NIH LGBT研究协调委员会对跨性别特定健康需求研究的呼吁，本研究的具体目标是：1）纵向调查家庭环境如何影响跨性别青年的健康结果，（二）研究来自家庭内外的社会支持是否以及哪些类型的社会支持可以改善家庭功能并保护变性人青少年的健康，以及3）发展基于叙事的干预，以改善家庭功能和社会支持寻求行为的跨性别青年的家庭。少数民族压力模型和家庭系统理论相结合，为研究1和2提供了一个框架。研究1将调查家庭环境如何与跨性别青年的健康结果（物质使用，性风险，自我伤害，自杀，抑郁，焦虑）纵向相关。研究1的目标是为今后的干预措施提供信息，研究还将探讨家庭内外的社会支持是否以及何种类型的社会支持可以改善家庭功能，并保护变性青年的健康。我将使用基于社区的参与式研究（CBPR）原则与混合方法（定性访谈和定量调查），以检查家庭环境，感知压力，健康结果和社会支持的多个方面，使用从40名13至17岁的跨性别青少年及其父母/监护人和兄弟姐妹（总N = 80-160）中收集的数据在24个月内的五波。参与者将从多个来源招募，以捕捉家庭功能的各种经验和变化。先前的研究表明，社会支持可能会减少跨性别青年家庭中与压力相关的负面结果。需要强调社会支持的干预措施，以减轻压力的影响，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点一种创新的基于叙事的干预措施，以改善跨性别青年的家庭环境，包括减少家庭内的歧视（公开的反跨性别态度和行为），并改善家庭功能和社会支持寻求技能。基于叙事的干预措施使用讲故事，通过运输机制（吸收到故事中，并与人物认同），说服和自我效能来促进健康行为的改变。在研究2中开发的干预将使用数字讲故事，一个特定的叙事为基础的干预方法，从跨性别青年对他们的家庭环境产生多媒体视觉叙事。基于叙述的干预措施已成功地用于改变健康行为，减少边缘化人群的耻辱感，使其成为改善跨性别青年家庭环境的创新和有前途的方法。计划中的研究将首次纵向调查家庭环境对跨性别青年健康结果的影响，使用多个家庭成员的观点，并开发和试点测试基于叙事的干预措施，以改善跨性别青年的家庭环境。最终，这项工作将改善跨性别青年和家庭的健康和福祉，并为未来与其他边缘化群体的工作提供信息。

 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.