Exploring health equity for Asian American, Native Hawaiian, and Pacific Islander Adolescents in a large epidemiologic study: Intersections of ethnicity, sexual orientation, and gender identity

项目摘要/总结 亚裔美国人、夏威夷原住民和太平洋岛民（AANHPI）性和性别少数群体（SGM）青年 与顺性别者和异性恋者相比，他们面临着巨大的健康差距。他们还必须应对 陈规定型观念，如模范少数民族神话，助长了误解和不准确/不充分 指导干预战略的信息。AANHPI青年不是一个整体;然而，他们往往聚集在 研究，掩盖了AANHPI亚群之间的重要健康差异。交叉性是一个关键的 一个分析框架，描述了权力和特权的复杂结构， 构成性的社会地位以及赋予特权和劣势的过程如何影响人们的生活。 暴露于重叠的并发形式的社会压迫（例如，同性恋和种族主义） 可能对AANHPI青年亚组的治疗产生不同影响，从而产生长期健康问题。AANHPI 面临多重边缘化的青年可能会遇到影响健康发展的挑战， 独特的优势AANHPI青年是一个快速增长，了解甚少的人群，特别是AANHPI SGM 青年及其风险和支助需求是关键的公共卫生问题。这项发展研究 响应NOT-HL-23-001，是受资助R 01（MD 015722）的辅助研究。我们将使用 交叉透镜和顺序解释性设计，以回答AANHPI SGM青年特有的问题 （13-19岁），这超出了我们现有的研究范围：1）在欺负，风险， 行为，心理健康，和不同社会地位的AANHPI青少年的保护因素（例如， AANHPI性和/或性别少数青年、各族裔群体）？2)如何在保护性差异 因素和其他特征解释了欺负，风险行为和心理健康的变化， 不同社会地位的AANHPI青年（和族裔群体）？（3）积极和消极 经验与AANHPI族裔之间重叠、同时产生的不平等有关， SGM身份？我们将通过两个研究目标探索这些新领域：第一，进行交叉性知情， 对三个青少年数据集进行统一和平行的定量分析，以审查风险和保护措施 AANHPI青年处于交叉社会地位的因素。我们将使用加州健康儿童调查 （N~ 1，042，000），明尼苏达州学生调查（N~ 122，000）和LGBTQ全国青少年调查（N~ 17，000）。 其次，我们将与15名AANHPI SGM青年进行访谈，以深入了解目标1的发现和15 与AANHPI SGM青年合作的专业人员，以了解培训/资源需求和人际关系， 社区特有的资产。调查结果将产生具体的建议，以加强护理和服务 AANHPI SGM青年的系统。这项研究，利用现有的协议，资源和指导， 我们资助的R 01，预计将提供初步数据，以开发和测试教育工作者的培训计划， 卫生专业人员和服务提供者在不同的设置，以改善AANHPI青年的福祉。

PROJECT ABSTRACT/SUMMARY Asian American, Native Hawaiian, and Pacific Islander (AANHPI) sexual and gender minority (SGM) youth face substantial health disparities compared to their cisgender and straight peers. They must also contend with stereotypes, such as the model minority myth, contributing to misconceptions and inaccurate/insufficient information to guide intervention strategies. AANHPI youth are not a monolith; yet, they are often aggregated in studies, masking important health disparities across AANHPI subpopulations. Intersectionality is a critical analysis framework describing complex ways that power and privilege are structured based on mutually constitutive social positions and how processes that confer privilege and disadvantage impact people’s lives. Exposure to overlapping concurrent forms of social oppression (e.g., homophobia and racism simultaneously) may differentially affect treatment of AANHPI youth subgroups, yielding longer-term health concerns. AANHPI youth facing multiple marginalization may experience challenges that affect healthy development, but also unique strengths. AANHPI youth are a fast-growing, poorly understood population, especially AANHPI SGM youth, and their risks and support needs are critical public health issues. This proposed developmental study responds to NOT-HL-23-001 and is an ancillary study to a funded R01 (MD015722). We will use an intersectional lens and a sequential explanatory design to answer questions specific to AANHPI SGM youth (13-19 years old), which are beyond the scope of our existing study: 1) What are differences in bullying, risk behaviors, mental health, and protective factors among AANHPI youth with different social positions (e.g. AANHPI sexual and/or gender minority youth, various ethnic groups)? 2) How do differences in protective factors and other characteristics explain variations in bullying, risk behaviors, and mental health among AANHPI youth (and ethnic groups) with different social positions? and 3) What positive and negative experiences are relevant to the overlapping, simultaneous production of inequalities by AANHPI ethnicity and SGM identity? We will explore these new areas using two study aims: first, conduct intersectionality-informed, harmonized and parallel quantitative analyses of three adolescent datasets to examine risk and protective factors for AANHPI youth at intersecting social positions. We will use the California Healthy Kids Survey (N~1,042,000), Minnesota Student Survey (N~122,000), and LGBTQ National Teen Survey (N~17,000). Second, we will conduct interviews with 15 AANHPI SGM youth to gain rich insight into Aim 1 findings and 15 professionals who work with AANHPI SGM youth to understand training/resource needs and interpersonal and community-specific assets. Findings will generate concrete recommendations to bolster care and service systems for AANHPI SGM youth. This study, capitalizing on existing protocols, resources and mentorship of our funded R01, is expected to provide preliminary data to develop and test training programs for educators, health professionals and service providers in various settings to improve the wellbeing of AANHPI youth.