Physical Health Variability Among Gang-Involved Youth: Addressing Health Promotion Needs to Reduce Disparities

Background and Purpose: Gang-involved youth disproportionately experience social, cultural, and economic marginalization and are members of communities experiencing significant health disparities (e.g., youth of color, poor). Yet, research and policy narratives routinely center delinquency and legal system intervention with limited attention to health and well-being. Health promoting behaviors (e.g., physical activity, healthy diet, sleep) during adolescence are critical for short- and long-term health and are also interrelated (Xiao et al., 2019). Research on how and why these health behaviors cluster together for gang-involved youth is virtually nonexistent. We aim to address this gap by testing for distinct profiles of health behavior, including how profiles differ according to social identity and living context factors. We add to the dearth of research on youth gangs and physical health to support a more comprehensive portrait of the health challenges and subsequent needs of this population.

Methods: Data come from a state-wide survey of self-identified, gang-involved students in the 8^th, 10^th, and 12^th grades (N=3,849). The sample was ethnoracially diverse, 63% male, 15% lesbian/gay, bisexual, or questioning (LGBQ), and on average 15 years old. Latent class analysis using indicators of physical activity, diet, sleep duration, and media use-- tested for distinct classes of youth relative to their health decision-making profiles. Guided by health lifestyle and social determinants of health frameworks (Viner et al., 2012; Cockerham, 2017), chi-square tests examined overall and between-class differences by social identity (gender, ethnoracial, sexual identity) and proximal and macrosocial factors that shape youth’s living contexts (e.g., family relations, violence exposure, health care access, socioeconomic instability).

Results: A 4-class solution emerged based on model fit (AIC, BIC) and interpretability: Healthy Balanced (25%); Healthy with Heavier Exercise (37%); Inconsistent Towards Unhealthy (16%); and Unhealthy (22%). We found a pattern whereby females, youth of color, and LGBQ youth were disproportionately represented in the classes with fewer health promoting behaviors (Inconsistent and Unhealthy classes). The Healthy Balanced and Heavier Exercise youth had lower asthma, better mental health, and less structural adversity compared to the Inconsistent and Unhealthy youth. Inconsistent and Unhealthy youth were burdened with both health compromising behaviors as well as poorer mental health and greater environmental adversity compared to the other classes, with Inconsistent youth experiencing the greatest adversity.

Conclusions and Implications: Our study is the first to test for, and find, distinct patterns of health behavior among gang-involved youth. Latinx, female, and LGBQ youth were disproportionately represented in profiles characterized by fewer health promoting behaviors and greater environmental adversities. These differences reflect meaningful within-gang disparities, and our sample as a whole fared worse across certain health indicators compared to the general adolescent population. Youth gang membership in the U.S. is highly racialized, and research suggests that gang culture is gendered and heteronormative (e.g., Panfil, 2017). Failure to attend to the health challenges of, and within, this population is an issue of injustice. Addressing health disparities for gang-involved youth will require a focus on healthy development, issues of intersectionality, and the structural and environmental drivers of adverse health.