Structural anti-Asian racism, structural cisheterosexism, and psychological, behavioral, and sleep health among Asian American sexual and gender minority adolescents

Abstract Background Since the COVID-19 pandemic began, a dramatic rise in anti-Asian sentiment as well as cissemxism and heterosexism (hereafter, cisheterosexism) has been documented, particularly affecting Asian American (AA) sexual and gender minority (SGM) adolescents who face intersecting oppressions. Purpose We investigated the associations between state-level structural anti-Asian racism, structural cisheterosexism, and psychological, behavioral, and sleep health outcomes among AA SGM adolescents. Methods This study analyzed a subsample of AA SGM adolescents (N = 980) from a US cross-sectional national survey of 17 578 SGM adolescents aged 13-18 years old conducted in 2022. To quantify state-level structural anti-Asian racism and structural cisheterosexism, we utilized data from multiple sources including Project Implicit (implicit and explicit prejudiced attitudes), Education Week (critical race theory legislation), and Movement Advancement Project (anti-SGM laws and policies). Multivariate regression analyses examined associations between structural oppression and health outcomes, adjusting for individual demographics and state-level covariates (poverty, income inequality, conservatism, and population density). Results Higher levels of structural anti-Asian racism were associated with greater psychological distress (adjusted b = 0.58, robust SE = 0.21) and higher odds of recent vape use (adjusted odds ratio = 2.56, 95% CI: 1.77-3.70). Structural cisheterosexism was associated with greater odds of past-year alcohol use (adjusted OR = 2.07, 95% CI: 1.27-3.38), but less sleep trouble (adjusted b = −0.31, robust SE = 0.08). The adverse effects of structural anti-Asian racism on psychological distress were amplified for AA SGM adolescents living in states with higher structural cisheterosexism. Conclusions These findings demonstrate how intersecting structural oppressions shape health outcomes among multiply marginalized youth, highlighting the urgent need for comprehensive policies addressing multiple forms of structural oppressions.