Structural Racism and Its Influence On Sexual and Reproductive Health Inequities Among Immigrant Youth

Using youth participatory action research to explore the impacts of structural violence on LGBTQIA + youth health

Queerphobia is defined as society's negative attitude towards LGBTQIA + people, translating into structures that marginalise LGBTQIA + people and contribute to health inequities that cause real harm and can be understood as structural violence. The purpose of this article is to explore what historically marginalised youth in a youth participatory action research (YPAR) project characterise as the big picture issues affecting the lives of LGBTQIA + youth. We used participatory arts-based methods to conduct community and identity building, define research questions and photo prompts, conduct data collection, engage in group thematic analysis, and make recommendations at the state policy level. We also conducted individual semi-structured interviews with participants. Our findings can be grouped into three main themes: LGBTQIA + youth may feel it is safer to remain closeted; queerphobia perpetuates housing instability; and queerphobia functions as a structural barrier to social services. Youth also developed state level policy recommendations to address the structural issues causing harm to LGBTQIA + youth health. Recommendations included increasing access to affordable housing and LGBTQIA + inclusive foster and group homes, and advocating for government-funded LGBTQIA + specific healthcare practices for LGBTQIA + youth. More youth-driven data are needed that centre those directly impacted by structural violence and associated health outcomes.

Playing for understanding: The impact of interactive gaming on young adults' sexual health education

OBJECTIVES

This study examines the impact of a "choose your own adventure" (CYOA) game on improving understanding and facilitating discussions about dating, sex, and sexual health among immigrant and refugee youth who often face cultural and language barriers.

STUDY DESIGN

A qualitative exploratory design was used to capture participants' experiences with the game.

METHODS

Thirty-two immigrant and refugee youth aged 18-25 participated in semi-structured interviews. Inductive thematic analysis was conducted to explore the perceived effectiveness of the CYOA game, which was accessible via smartphones and desktop devices.

RESULTS

Participants described the CYOA game as an accessible and engaging way to explore sensitive topics, providing a discreet and safe environment for learning and discussion. Cultural and religious backgrounds influenced comfort levels, and culturally sensitive content and non-judgmental delivery were particularly valued. Participants reported that while school-based sexual health education was often insufficient, community programs provided more relevant support.

CONCLUSIONS

CYOA games are perceived to be effective educational tools for sexual health, especially when they incorporate culturally appropriate content. These games foster open discussions and understanding among immigrant and refugee youths, highlighting the need for culturally relevant resources to support traditional approaches to promoting sexual health.

"So, This Is Actually Going to Somebody, Right?": Critical Reflections on Participatory Planning, Implementation, and Evaluation of a Peer Support Group for Parents From Historically Marginalized Communities

Community-engaged, participatory approaches to designing and evaluating public health initiatives center the experiences, perspectives, and knowledge of community members at every stage of the process. A peer support group for racialized and minoritized parents under 25 years of age in the northeastern United States was designed, facilitated, and evaluated with the participation of peer leaders who shared expertise and strategies for navigating complex albeit imperfect bureaucratic systems on which they depend for social services. This paper explores key tensions between the experiences and expectations of peer leaders and the academic researchers involved in the project, and examines the limitations of culturally responsive evaluation to address the structural constraints of the neoliberal university.

Stacked Up Against Us: Using Photovoice and Participatory Methods to Explore Structural Racism's Impact on Adolescent Sexual and Reproductive Health Inequities

While structural racism has profound impacts on adolescent health, little is known about how youth synthesize racialized experiences and work to dismantle systems of oppression. This article provides an overview of a Youth Participatory Action Research study that used Photovoice and community mapping to explore how structural violence, like racism, impacts the sexual and reproductive health of historically excluded youth as they navigate unjust socio-political landscapes. Youth participants used photography and community maps to identify how the experience of bias, profiling, and tokenism impacted their ability to navigate complex social systems. With youth voices prioritized, participants explored ways to address structural racism in their lives. The importance of co-creating opportunities with and for youth in critical reflection of their lived experience is emphasized. Through an Arts and Cultural in Public Health framework, we provide an analysis of the ways structural racism functions as a gendered racial project and fundamental cause of adolescent sexual and reproductive health inequities, while identifying pathways toward liberation in pursuit of health and well-being.

"How to Make it Out Alive": A Strengths-Based Analysis of Latinas' Adolescent Sexual Health Experiences

BACKGROUND

Ample evidence demonstrates Latina adolescents' elevated risk for sexual health disparities, but knowledge of how they manage their sexual health during this critical period of sexual development is limited. Countering the overfocus on Latina adolescents as "at-risk" girls in extant research, this study uses a strengths-based perspective to explore this topic.

METHODS

This study used a narrative research design to gather and analyze the stories of 18 Latina young people who attended school in New York. We employed holistic-content and categorical-content approaches to identify themes and interpret findings through a strengths-based view of sexual health.

RESULTS

We identified three major themes across participants' narratives: (1) agency in gaining sexual health information; (2) self-protection; and (3) obtaining sexual healthcare despite barriers.

CONCLUSIONS

Findings underscore the need for more inclusive, culturally relevant sexual health education initiatives, youth-centered services, and interventions that capitalize on the strengths of Latina adolescents.

Improving cervical cancer health literacy in Arabic-speaking immigrant women in the United States through an online patient education tool

BACKGROUND

Low health literacy rates especially among the medically underserved have called for more understandable and actionable resources to involve patients in their health. The online audio-visual Reproductive Health Network (ReproNet) cervical cancer tool was shown to improve cervical cancer health literacy among marginalized English- and Spanish-speaking populations and Arab and Afghan immigrants in a group setting.

OBJECTIVE

This study aimed to determine whether or not the cervical cancer tool positively impacts health literacy for Arabic-speaking Middle Eastern or North African first- and second-generation immigrant women in the United States when self-administered.

DESIGN

In this single-group pre-post interventional study, a convenience sample of 95 Arabic-speaking immigrant women in the United States, ages 18 and over, reviewed an online cervical cancer patient education tool and completed pre- and post-tests.

METHODS

Participants received links to the tool and to pre- and post-tests, using the cervical cancer literacy assessment tool. We conducted McNemar tests and paired t-tests to compare pre- and post-test results in health literacy per participants. A multivariate regression model was fitted to test the association between demographic variables and the change of cervical cancer literacy content domains, controlling for the baseline scores before administering the tool.

RESULTS

Out of 118 participants, 95 participants had complete pre- and post-tests. Health literacy increased overall after self-administration of the tool, specifically in terms of cervical cancer prevention and control (p < 0.01). There were no significant differences in knowledge in U.S.-born versus foreign-born Arabic-speaking women (p = 0.6660).

CONCLUSION

The self-administration of the ReproNet cervical cancer tool most significantly increases awareness and knowledge of cervical cancer prevention in Arabic-speaking first- and second-generation immigrant women, thus pointing to increased quality of the provider-patient relationship.

Participatory Action Research to Explore the Role of Structural Violence on Marginalized and Racialized Young Parents

Structural inequities influence young parents' access to health care, housing, transportation, social support, education, and income. The current study adds to the extant literature by providing data directly obtained in collaboration with young parents to understand how structural violence affects the health and well-being of their families, ultimately resulting in community-driven policy recommendations developed in collaboration with the state health department. We engaged a diverse sample of young people-considered as community researchers in the project-including Black, Latinx, and/or LGBTQ+ pregnant and parenting young parents in a participatory action research (PAR) project in the spring of 2022 to explore their health and material needs while living in Springfield, Massachusetts. Together with young parents, we used participatory arts-based methods to conduct community and identity building, define research questions and photo prompts, conduct data collection (photos), engage in group thematic analysis, and take action at the state policy level. We also conducted individual semi-structured life-history interviews with the young parents. Participatory community-led findings indicate an urgent need for systemic change to increase access to safe and affordable housing; living-wage jobs; safe, high-quality, and affordable child care; and to bolster social support and disabilities services for young parents and their families. This participatory study funded by a state health department demonstrates that participatory community-driven data can have the power to mobilize community members and policy makers for social change if prioritized at the state and local levels. Additional practice-based implications include prioritizing participatory mentorship programs intended to aid young parents in navigating the complex systems that are vital to their survival.

Structural and intermediary determinants in sexual health care access in migrant populations: a scoping review

OBJECTIVES

Addressing migrant population's sexual health needs is essential, given the high vulnerability of this population, especially during migratory trajectories and when accessing health care in destination countries. The aim of this scoping review is to identify and describe the structural and intermediary determinants and their dimensions, which negatively influence sexual healthcare access in migrant population in the world in the last 20 years.

STUDY DESIGN

Scoping review.

METHODS

The search strategy was carried out in the databases PubMed/MEDLINE, Web of Science, EMBASE, and CINAHL. The inclusion criteria were primary studies published in English or Spanish from 2000 to 2022, describing determinants or barriers to access to sexual health for international migrants, refugees, and asylum seekers. The construction of the results was based on the social determinants of health framework.

RESULTS

A total of 44 studies were included. Thirteen categories that negatively affect access to sexual health in migrants were identified-structural determinants: language and communication barriers, religious and cultural values, VIH stigma and discrimination, irregular migration status, financial constraints, racism and discrimination, gender inequalities, and lack of knowledge and awareness about sexuality and sexual health; and intermediary determinants: financial health coverage, privacy and confidentiality, health system navigation; health system and facilities, and psychosocial factors.

CONCLUSION

The most relevant dimensions identified as barriers to access to health services were "culture and societal values" and "health system". Identifying the determinants that affect migrants' access to sexual health is relevant for the formulation of public policies with sociocultural relevance and an intersectional and human rights approach.