- PI: Eric Buhi
- Funder: Office of Adolescent Health, U.S. Department of Health and Human Services
The Teen Outreach Program (or TOP) is a youth development and service learning program for youth ages 12 to 17 designed to reduce teenage pregnancy and increase school success by helping youth develop a positive self-image, life management skills, and realistic goals. Trained facilitators working for the Florida Department of Health delivered the TOP curriculum in high school classrooms. Following the RE-AIM framework, SASH researchers and a team at the University of South Florida have been evaluating the impact of TOP in 28 public high schools in 12 nonmetropolitan Florida counties. In Fall 2012, a baseline paper-and-pencil survey was administered in classrooms. The first follow-up survey was administered at the end of the school year, immediately following the delivery of the TOP in intervention schools and to youth in comparison schools. The second follow-up survey was administered 10 months after the end of the intervention. Primary research questions include: 1) What is the impact of TOP relative to business as usual on ever having sexual intercourse 10 months after the end of the program? And 2) What is the impact of TOP relative to business as usual on reported pregnancies 10 months after the end of the program? Secondary research questions include: 1) What is the impact of TOP relative to business as usual on ever having sexual intercourse at the end of the program? And 2) What is the impact of TOP relative to business as usual on reported pregnancies at the end of the program? Come see some of our implementation and outcome evaluation findings at our session at the American Public Health Association annual meeting in Chicago: https://apha.confex.com/apha/143am/webprogram/Session43456.html
- PI: Eric Buhi
- Funder: SDSU University Grants Program
Sexual and reproductive health among youth is a critical public health issue. While enrollment in charter schools is increasing nationwide, virtually nothing is known about health, sexuality, and HIV prevention education being implemented, including what content is being delivered (if any) and needs for teacher training and new programming initiatives. In collaboration with SDSU College of Education and School of Journalism and Media Studies researchers, and community leaders, SASH researchers are leading this community-based research project to: 1) assess the current state of health, sexuality, and HIV prevention education in San Diego County charter schools; and 2) among charter school teachers implementing such programming, determine knowledge, comfort, confidence, and training needs regarding delivery of these curricula. With the knowledge gained from this study, we will be able to respond to community needs and may develop innovative health, sexuality, and HIV prevention education interventions.
- PI: Eric Buhi
Genital human papillomavirus (HPV) is the most common sexually transmitted virus in the U.S. HPV vaccines, such as Gardasil and Cervarix, have the potential to either reduce or exacerbate disparities in HPV-related diseases and cervical cancers, depending on the equitability of vaccine uptake. While HPV vaccines have demonstrated positive effects in reducing multiple types of cancer, vaccination remains controversial. Accordingly, vaccine uptake is very low, especially in key priority populations in the U.S. Social media, however, represent a potential vaccine promotion modality, as adolescents and young adults who are within the indicated age-range for receiving the HPV vaccine are heavy users of social media. In this study, SASH researchers are examining Twitter content regarding the HPV vaccine, assessing the general sentiment toward the HPV vaccine, evaluating geographic differences in social media activity with vaccine uptake, and identifying message and source characteristics that may provide insight into how messages diffuse through social networks. If we can understand what is being discussed on Twitter regarding the HPV vaccine, then we can start conceptualizing the development of effective HPV vaccine promotion strategies and messaging for social media.
- PI: Eric Buhi
This project involves the collection, synthesis, and evaluation of sexual and reproductive health data—on sexually transmitted infections (STIs), HIV and AIDS, sexual assault, sexuality education, and sexual behaviors—in California and, specifically, Southern California. SASH researchers are collecting such information to inform strategic planning efforts and to direct future research projects and intervention initiatives.
- PI: Heather Corliss
- Funder: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH)
Type 2 diabetes (T2D) is a critical public health problem affecting the U.S. because it causes enormous morbidity, disability, premature mortality, and financial and social costs to society. Lesbian and bisexual (LB) women may be at elevated risk for developing T2D because they are more likely than heterosexual women to experience obesity and other risk factors linked with T2D such as cigarette smoking, violence victimization, and depressive distress. Nonetheless, knowledge of T2D and how it may disproportionately affect LB women is severely limited. Studies using longitudinal designs that have comprehensively examined how lifestyle, diet, and psychosocial risk factors for T2D may differ between LB and heterosexual women across the life course are virtually nonexistent. In addition, evidence to understand how risk for developing T2D may differ between LB and heterosexual women is inconclusive and limited to four cross-sectional health surveys. To our knowledge, no studies with longitudinal designs have investigated how incidence of T2D may differ between LB and heterosexual women. Furthermore, analytic epidemiological studies examining how sexual-orientation disparities in risk factors for T2D may contribute to LB women’s disparities in occurrence of T2D are nonexistent. Consequently, huge knowledge gaps exist in understanding the extent to which T2D and related risk factors may disproportionately affect LB women. According to the IOM report The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding, LB women face large health disparities, and understanding these disparities and how to eliminate them is hampered by methodological complexities involving research with this population. To address these problems and gaps in the literature, SASH researchers are carrying out a rigorous quantitative study using prospectively collected data spanning more than 20 years (1989 through 2011) from nearly 100,000 women participating in the Nurses’ Health Study II. This study will compare incidence of developing T2D among LB women to that among heterosexual women, compare risk factors for T2D in multiple domains (e.g., diet, lifestyle, psychosocial) and over the life course (i.e., from childhood through age 65 years) among LB women to that among heterosexual women, and examine how lesbian and bisexual women’s disparities in risk factors for T2D prospectively explain their disparities in risk for developing T2D. Our study has high potential for public health impact because findings will increase understanding of: 1) the extent to which risk factors for T2D disproportionately affect LB women over a substantial portion of the life course, 2) the extent to which incidence of T2D disproportionately impacts LB women, and 3) potential social and behavioral factors that explain sexual-orientation-based disparities.
- PI: Heather Corliss
- Funder: National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH)
- see video – Identifying risk factors for substance use disparities with LGBT youth – Brigham & Women’s Hospital
Substance abuse and dependence are critical public health problems affecting the U.S. and they cause enormous financial and social burden, morbidity, and mortality. Sexual-minority populations (e.g., lesbian, gay, bisexual [LGB]) are disproportionately affected by substance use, substance use disorders, and co-occurring mental health problems. However, there are almost no empirical investigations among youth that would enable researchers and clinicians to: 1) understand patterns and causes of sexual-orientation disparities in risk for substance use disorders, and 2) elucidate sexual minorities’ barriers to receiving needed substance use treatment and their treatment experiences. Consequently, huge knowledge gaps exist in understanding which subpopulations of sexual-minority youths are most at risk for substance use disorders, their barriers to receiving needed treatment, and effective treatment approaches. The recent Institute of Medicine (IOM) report, The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding, identifies large health disparities in the LGB population, extensive gaps in understanding LGB health, and methodological complexities in conducting LGB research. To address these problems, SASH researchers are carrying out a mixed methods study with the Growing Up Today Study, two ongoing longitudinal cohorts of 27,324 youth begun in 1996 and 2004. This project will focus on a range of substance disorders including alcohol abuse and dependence, drug abuse and dependence, and nicotine dependence. In order to develop targeted, effective, evidence-based preventive and treatment interventions for sexual-minority youth, it is necessary first to: 1) understand the extent to which substance disorders disproportionately impact this population, 2) identify subpopulations at greatest risk, 3) understand causal mechanisms contributing to sexual-orientation-based disparities, 4) identify specific barriers sexual minorities face receiving needed treatment, and 5) identify effective treatment strategies. Our study has high potential for public health impact, as we propose to contribute essential knowledge to all 5 of these critical areas, with a focus on the developmental periods of adolescence and emerging adulthood.
- Co-I: Heather Corliss
- Funder: National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH)
- see video – Identifying Multilevel Protective Factors for LGBT Youth in North America
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. This research 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.