Understanding the Service Needs of Gang-Involved Youth: Social Identity and Ecological Influences on Health Decision-Making

Abstract

Gang-involved youth experience multiple forms of marginalization and are members of communities experiencing significant health disparities (e.g., youth of color, poor). Yet, research and policy narratives routinely center delinquency, violence, and legal system intervention with limited attention to health and well-being. To develop relevant and responsive service approaches to address needs and reduce disparities, research is needed to examine how and why health varies within the youth gang population. Broadly informed by social ecological, social determinants of health, and health lifestyle frameworks, this dissertation used multiple methodologies to examine health experiences among gang-involved youth. Methods: Paper 1 was a scoping review of 65 studies to understand how researchers are currently approaching the gang-health link. A thematic analysis was undertaken to explore how and why health variation might emerge within the gang context. Papers 2 and 3 utilized latent class analysis to test for unobserved health decision-making profiles among a statewide, school-based sample of self-identified youth gang members. Quantitative analyses also examined how emerging health profiles differentiated according to youths’ social identities and living contexts. Results: The review illuminated key gaps in our current understanding of the influence of gangs and gang membership on adolescent health. Authors of the reviewed studies theorized that gangs represent social-cultural contexts where norms and values shape health behavior, and that these norms and behaviors may often be gendered in nature. Despite this theorizing, few studies operationalized gang context measures beyond individual membership. Additionally, authors frequently took an ecological approach in their theorizing, citing neighborhood and family influences as important for youth gang members’ health. Yet, the potential mediating role of gang membership in the environment-health link was neglected in analyses, and few studies examined how ecological factors help explain health variation within gangs. The quantitative analyses of this dissertation tested for, and found, distinct profiles of sexual and physical health decision-making. For both sexual and physical health, a pattern emerged whereby youth of color and those identifying as LGBQ were disproportionately represented in profiles characterized by fewer health promoting behaviors and greater environmental adversities (e.g., poverty, housing instability, limited health care access, violence exposure). Gender varied, with males represented in riskier sex profiles and females in poorer physical health profiles. Discussion: Findings suggest that health disparities exist among gang-involved youth, and that these disparities may be attributable to youths’ ecological contexts. Findings have several implications for research and practice. First, gang-involved youth are a heterogeneous group with respect to health, and flexible service approaches are needed. Second, heterosexuality within youth gangs is not universal and those who identify otherwise may be at heightened vulnerability for adverse health, highlighting the need for intersectional approaches to research and practice. Third, the structural and environmental drivers of gang membership (e.g., racism, poverty, neighborhood violence) are also undermining health for these youth, indicating the need for an intentional research and policy focus on macro- and meso-level factors. Conclusion: Youth gang membership in the U.S. is highly racialized, and emerging research suggests that youth gangs are gendered and heteronormative. Failing to attend to the health challenges of, and within, this population represents a complex, yet pressing social justice issue. Addressing health disparities for gang-involved youth will require research and practice frameworks with a multilevel focus on healthy development, issues of intersectionality, and the structural and environmental drivers of adverse health.