Healthy Environments for Vulnerable Youth

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)

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 ([email protected]) if you are interested in having a team member present findings to school personnel in your organization.

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: 

• Develop a theoretically grounded approach to promoting health among LGB adolescents based on in-depth knowledge of their community and school environments
• 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: 

• Higher LGB environment scores for the community and school will be protective against health risk behaviors among LGB youth;
• Greater family connectedness and support and a more supportive peer environment will be protective against health risk behaviors among LGB youth;
• Family, peer and individual-level factors will moderate the associations between the LGB environment (community and school) and the health risk behaviors of interest.