Healthy Environments for Vulnerable Youth

Background: Bias-based bullying, or bullying based on personal characteristics such as race/ethnicity, sexual orientation, gender identity, or body weight, has been identified as a key contributor to health disparities among youth of color; lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth; and youth who are overweight or obese. Students who are the targets of bias-based bullying may not only experience emotional distress and physical health consequences associated with this type of bullying victimization, but they may also be less academically engaged and more likely to skip classes or full school days. As a result, bias-based bullying during adolescence can have life-long impacts on children’s healthy development, including physical health, social and emotional well-being, academic achievement, and employment. Although well-placed to intervene, educate, and prevent bias-based bullying, schools are struggling with a lack of clear guidelines and evidence-based practices that effectively reduce bias-based bullying. Given schools’ limited time and monetary resources, specific school practices that are responsive to the needs of both schools and youth most affected by bias-based bullying are critically needed. 

This study: This study had two parts – a qualitative and a quantitative component.

Qualitative research: The aim of this component was to describe bias-based bullying experiences from the perspectives of youth, parents, and school personnel in Minnesota, focusing on youth of color, LGBTQ youth, and those who are overweight. We conducted 13 dyadic interviews (n=26 youth and parents), four focus groups (n=24 youth), and 7 school team interviews (n=19 staff members). Key findings include the following:

• While there were some experiences of “traditional” bullying, the majority of experiences included being the target of or overhearing slurs, name calling, and microaggressions that happened frequently but were not perpetrated by the same actor;
• Experiences of microaggressions (direct and overheard) were very common among students;
• Schools have policies and protocols in place to deal with bullying, but the experiences described by our participants typically did not meet the school’s formal definition of bullying (i.e. intention to harm, repeated action, power imbalance between actor and target), so often went unaddressed;
• Bias-based bullying adversely affected school climate and the health and wellbeing of vulnerable youth.

Quantitative research: The aim of this component was to explore whether schools that offer diversity education activities have lower rates of bias-based bullying among students compared to schools that do not offer these activities. Data came from two sources: the 2018 CDC School Profiles Survey (N=216 schools) and the 2019 Minnesota Student Survey (N=64,510 students). Multilevel logistic regression tested associations between diversity education activities (diversity clubs, lessons, or special events) and eight types of bias-based bullying among students (e.g. based on race/ethnicity/national origin, sexual orientation), with attention to differences across relevant demographic characteristics. Key findings include:

• Prevalence of bias-based bullying ranged from 7% reporting bullying due to religion, gender, and sexual orientation, to approximately 25% (due to weight and appearance);
• Experiences of bias-based bullying were significantly more common among youth with the relevant characteristic (e.g. students of color were more likely than white students to be bullied about race/ethnicity/national origin);
• Diversity education activities were common, with almost half offering all three types;
• Schools that offer a wider variety of diversity education opportunities had significantly lower odds of bullying about race, ethnicity, or national origin among boys of color, about sexual orientation for gay, bisexual and questioning boys, and about disability for boys with a physical health problem (similar findings were not found for girls).

Sharing findings: A brief summary of this work is available here (factsheet). Please contact Dr. Eisenberg (eisen012@umn.edu) if you are interested in having a team member present findings to school personnel in your organization.

This research includes extensive analysis of a large, population-based sample of gender diverse youth (N=2168), takes a broad view of health influences and health care, and pairs this information with qualitative data from adolescent health care providers and youth.  The goal of this mixed-methods study is to understand the health needs of gender diverse youth in order to develop and test training modules to be used in medical and nursing education in a future R01 application. The study has two specific aims: 1) Analyze data from the Minnesota Student Survey (MSS), a statewide surveillance system of adolescents’ health and related behaviors, which has recently been revised to include three measures regarding gender (biological sex, transgender identity, gender presentation).  Analyses will focus on high risk health behaviors (i.e. substance use, sex behaviors, suicide involvement, bullying and prejudiced-based victimization), protective factors (i.e. internal assets, family support, school connection), health and health care utilization of gender variant youth, with comparisons to straight cisgender youth and youth who are diverse and lesbian, gay, bisexual and questioning (LGBQ, with whom transgender youth are often grouped for services and resources).  2) Conduct interviews with health care providers working with adolescents and with gender diverse youth to understand health care practices and needs of this population.  Interviews with health care providers will include questions about their professional training regarding gender diverse youth, need for resources, and comfort and competence with this topic. Interviews with gender diverse youth will include questions regarding their experiences with health care professionals, information they would share with providers about their health needs, and feedback on findings from health care provider interviews.

Learn more about Adolescent Gender Diversity and Health (AGenDAH)

This study: This University of Minnesota Medical School’s Department of Pediatrics research project, continues to identify significant disparities among youth at the intersections of sexual orientation, gender identity, and race/ethnicity in emotional distress, substance use, sexual and HIV-prevention behaviors, experiences of bias-based bullying, interpersonal protective factors, and numerous additional health concerns and experiences.

Our work is informed by intersectional factors that build our framework: we look closely at how young individuals experience power (or lack of) and privilege (or lack of), based on their interrelated social identities, in order to understand how these intersections confer risk and resilience to LGBTQ+ youth of color. 

Eventually, we hope to recommend specific interventions and guidelines that center, support, and protect LGBTQ+ youth, particularly trans and gender-diverse (TGD) youth of color.

Background: Research shows that LGBTQ+ adolescents are at disproportionately high risk of poor health experiences, health outcomes, and health behaviors compared to their straight, cisgender peers. 

In the field of healthy youth development, we see a gap in knowledge of how or if individuals’ intersectional identities (related to race, sexual orientation, gender identity, disability status, etc., e.g. TGD youth of color, youth who identify as TGD and also pansexual/queer) correspond to the health and behavioral risks and protections they experience. 

Because individual and social identities are experienced simultaneously (e.g. as a person who is both Black and trans), various forms of social oppression (e.g. racism and transphobia) may work together to differentially affect the health of LGBTQ+ people with multiple marginalized social identities. 

We further hypothesized that living within these intersecting social identities may create unique challenges to – and strengths that promote – healthy development among youth.

We pose these specific research questions:

• What differences exist in bullying, risk behaviors, emotional distress, and protective factors among youth with different social identities?
• How do differing protective factors and other characteristics explain the above outcomes among youth with different social identities?
• What positive and negative experiences are uniquely relevant to the overlapping, simultaneous production of inequalities by LGBTQ+ identity, race/ethnicity, and other social identities?
• With which intersecting social identities do we see individual LGBTQ+ youth of color facing the greatest struggles?

The research: Our quantitative work builds on existing surveillance data from three adolescent health data sets: the Minnesota Student Survey (N ~122,000) and California Healthy Kids Survey (N ~1,042,000); plus the LGBTQ National Teen Survey (N ~17,000). Together, these provide us with very large samples of diverse populations and appropriate questions about social experiences.

Our qualitative research, in the form of interviews with over 65 LGBTQ+ youth, gives us detailed context on individual, interpersonal and community assets that informs our quantitative findings. 

Since 2021, we have used these quantitative and qualitative methods to:

• Analyze combinations and intersections of social positions for LGBTQ+ adolescents.
• Analyze risk factors (e.g. bullying victimization) and protective factors (e.g. family support, inclusive sex education).
• Look at specific co-existing behaviors, experiences, and health conditions; emotional distress, substance use, sexual behaviors, HIV prevention behaviors, school absence, disordered eating, asthma, sports involvement, healthy youth development opportunities, sleep, and housing stability.

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.