Multilevel Protective Factors For LGB Youth In North America

描述：越来越多的文献表明，女同性恋、男同性恋和双性恋（LGB）青年与异性恋青年在健康方面存在巨大差异，包括问题药物使用、艾滋病毒风险行为和自杀。2011年，医学研究所呼吁对这一人群进行更多的研究，优先考虑健康差异研究，认为这是在LGB健康方面“建立坚实证据基础的必要条件”。国际移民组织的报告强调了多重社会影响对同性恋、双性恋和变性者生活的重要性，明确指出家庭、学校、工作场所、宗教机构和社区组织等社会结构的作用是重要的研究主题，以扩大我们对这一人群健康决定因素的理解。提议的R01由一名新的调查员领导，以回应PA-12-111，直接解决了这一需求。这项研究的目的是拓宽和加深我们对家庭、同伴、学校和社区环境的理解，这些环境保护年轻的LGB人群不参与高风险健康行为，包括物质使用、艾滋病毒风险行为和自杀行为。本研究旨在1)在深入了解LGB青少年社区和学校环境的基础上，发展一种理论基础的方法来促进LGB青少年的健康；2)将使用该量表收集的环境数据与现有的基于人群的学生数据联系起来，以确定个人、家庭、同伴、学校和社区层面上保护LGB青少年不参与健康风险行为的因素。对72名来自不同地区的青年进行“随缘”访谈，以深入了解LGB青少年对学校和社区中支持因素的看法；这些信息，结合已发表的文献、专家评论和心理测量测试，将用于创建LGB环境清单，以描述这些环境中存在的LGB青年的政策、计划、资源和其他支持。然后，该清单将用于衡量明尼苏达州、不列颠哥伦比亚省和马萨诸塞州120个社区的支持指标，使用可公开获得的材料（例如网站）和与关键举报人的简短联系（目标1）。然后，这些社区一级的数据将与来自这些社区约3 600名LGB青少年的现有学生调查数据联系起来，其中将包括关于家庭、同伴和个人支持的信息，以及健康行为和人口信息（目标2）。以下假设将被检验：a)较高的社区和学校LGB环境得分将对LGB青年的健康风险行为有保护作用；b)更多的家庭联系和支持以及更支持性的同伴环境将对LGB青年的健康风险行为起保护作用；c)家庭、同伴和个人层面的因素将调节LGB环境（社区和学校）与感兴趣的健康风险行为之间的关联。

DESCRIPTION: A growing body of literature demonstrates dramatic disparities in health between lesbian, gay and bisexual (LGB) and heterosexual youth, including problem substance use, HIV risk behaviors and suicide. In 2011 the Institute of Medicine called for additional research with this population, prioritizing health disparities research as "essential for building solid evidence base" in LGB heath. The IOM report highlights the importance of multilevel social influences on the lives of LGB people, specifying the role of social structures such as families, schools, workplaces, religious institutions and community organizations as critical subjects of study to expand our understanding of the determinants of health in this population. The proposed R01 led by a new investigator in response to PA-12-111, directly addresses this need. The goal of this study is to broaden and deepen our understanding of the family, peer, school and community environments that protect young LGB people from involvement in high risk health behaviors, including substance use, HIV risk behaviors and suicide behaviors. This research aims to 1) develop a theoretically grounded approach to promoting health among LGB adolescents based on in-depth knowledge of their community and school environments, and 2) link environmental data, collected using the Inventory, with existing population-based student data to identify factors at the individual, family, peer, school and community levels that protect LGB youth from involvement in health risk behaviors. "Go-along" interviews with 72 youth in diverse locations will be used to elicit in-depth information on LGB adolescents' perceptions of supportive elements in their schools and communities; this information, in conjunction with published literature, expert review, and psychometric testing, will be used to create an LGB Environment Inventory to characterize policies, programs, resources and other supports for LGB youth that exist in these settings. The Inventory will then be used to measure indicators of support in 120 communities in Minnesota, British Columbia and Massachusetts, using publicly available materials (e.g. websites) and brief contacts with key informants (Aim 1). These community-level data will then be linked with existing student survey data from approximately 3,600 LGB adolescents in these same communities, which will include information about family, peer and individual supports, as well as health behaviors and demographic information (Aim 2). The following hypotheses will be tested: a) higher LGB environment scores for the community and school will be protective against health risk behaviors among LGB youth; b) greater family connectedness and support and a more supportive peer environment will be protective against health risk behaviors among LGB youth, and c) family, peer and individual-level factors will moderate the associations between the LGB environment (community and school) and the health risk behaviors of interest.