Youth-led Participatory Action Research (YPAR) is an approach that engages young people and academic researchers as equitable partners in each phase of the research process. YPAR positions youth as experts and aims to increase the power of marginalized groups in advocating for change to address issues that youth want to change. Key principles for YPAR include that it is 1) inquiry-based and topics selected are relevant to youths’ lived experiences and concerns, 2) participatory, which means youth are collaborators across research phases and methods, and 3) transformative, which means the purpose of YPAR is to change knowledge and practices through social action to improve the lives of youth and their communities. Engaging youth in participatory research can help address gaps between adolescent developmental needs and traditional school environments, such as increasing self-efficacy, establishing a sense of purpose, and creating supportive social relationships with peers and trusted adults. The continued emergent growth of the YPAR literature provides insights about study methodology, YPAR project characteristics, and the potential for youth and environmental outcomes from participation in YPAR.In this body of work, I apply frameworks from the fields of psychological empowerment, transformative social and emotional learning, and the use of research evidence. In the first paper, I conduct a systematic review of the recent YPAR literature published between 2015 and 2022, and report findings related to study methodology, YPAR principles and project characteristics, and youth outcomes. I contribute a unique, theoretically-driven analysis of youth empowerment outcomes with respect to the intrapersonal, interactional, and behavioral components of psychological empowerment. In the second paper, I extend the systematic review by applying a unique, theoretically-driven analysis of transformative social and emotional learning outcomes with respect to the transformative focal constructs of agency, belonging, collaborative problem solving, curiosity, and identity. In the third paper, I describe two YPAR project focal cases in which youth-generated evidence and youth recommendations were utilized in the development and implementation of mental health policies and practices in school settings. Further, I report conditions that facilitate and limit use of YPAR evidence addressing mental health issues in school settings. These findings will be of interest to key stakeholders including school administrators, teachers, and mental health professionals given the importance of theoretical insights and recommendations into the use of YPAR as an approach for promoting positive youth mental health, psychological empowerment, and transformative social and emotional learning outcomes in community and school settings.

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This study examines how minority adolescents actively work to stay safe and to improve their life chances within urban neighborhoods marked by high rates of crime, violence, and physical disorder. Often, these youth are seen as resilient by others; however, the work that goes into building resilience is often overlooked. This study provides a deeper understanding of the ongoing processes of resilience that occur over the course of adolescence. Ethnographic approaches and participatory narrative analyses reveal that urban minority adolescents make strategic choices about where they will spend their time and the relationships they invest in, and they develop an internal set of beliefs about faith. Building on empirical studies examining adolescents' resilience in their family and school settings, these results detail how youth strategically avoid unsafe spaces and people and seek out safe spaces and people within their neighborhoods. Once young people find a safe space, such as a neighborhood youth center, they seek out adult mentors there who will help them access educational and professional opportunities. The relationships that develop in safe spaces help to provide social mobility for the youth. Despite these efforts, youth are routinely exposed to violence, stress, and trauma. In these situations, youth harness spiritual beliefs and practices that shore them up when all else fails. These strategies work together to magnify the effect of resilience in the lives of urban minority adolescents. This study's findings have implications for research and practice related to the mechanisms of positive youth development. Youth's own narratives of resilience add rich detail to this work. Further interdisciplinary inquiry into the external and internal factors at play in the processes of resilience can reinforce the linkages between youth development, neighborhood ecology, and public health.

This dissertation investigated the role of youth-led participatory action research (YPAR) in influencing decision-making in five California public health departments. To my knowledge, this is the first systematic study of the utilization of YPAR for decision-making in public health, or in any other field. The present study employs qualitative methods, using a case study approach in multiple sites. Data sources include in-depth interviews, document review and participant observation. The two conceptual frameworks within the research utilization literature that guide this study are the decision-making model and frames of reference. I examined how YPAR projects fit existing models of research utilization and compared the utilization of YPAR compared to traditional research across all five departments in public health department decision-making. I found that the utilization of YPAR in the decision-making of the public health departments fit the political, problem-solving and interactive models. A key finding is the utility of YPAR to decision-makers. Decision-makers are more likely to use YPAR when it is action oriented and relevant to their work. There is also evidence that departments who do not traditionally use research are utilizing YPAR to drive policy change in their communities on issues that impact young people. It appears to provide additional utility to public health department decision-making that traditional research may not provide. Strengths, limitations and implications of this study for future study of YPAR and decision-making are also presented.

It is known that mothers’ child-feeding behaviors are associated with their children’s weight status, but this is only one familial factor. There is a dearth of research on the associations of both mothers’ and fathers’ child-feeding behaviors and their children’s weight status in Mexican American families. In 2009-2010, 22% of Mexican American children aged 6 to 11 years had a body mass index (BMI) greater than or equal to the 95th percentile and were considered obese compared to 14% of non-Latino White children of similar ages. This disparity was also seen among children under age 6. In the same period, 16% of Mexican American children aged 2 to 5 years were considered obese compared to 9% of non-Latino White children. Obesity during these early years is associated with increased risk of obesity later in life. In Mexican families, where fathers often influence family decisions, it is important to understand how they may also influence decisions around child feeding. Parental child-feeding behaviors are a major focus of my research because they are modifiable risk factors in children’s weight status, particularly when compared to other predictors, such as parental weight status, parental education level and ethnicity. Using the conceptual framework from Davison and Birch’s (2001) ecological model, which identifies individual, family and sociocultural influences on children’s weight status, this dissertation applies quantitative and qualitative methods to examine parental and sociocultural associations with child-feeding behaviors in Mexican American families.

This dissertation research examines the associations of parental feeding behaviors and child weight status in Mexican American families, with a special focus on the role of fathers. I apply a three-pronged approach to the study of childhood obesity that includes a family, environmental, and nutrition policy component. At the family level, I demonstrate in my quantitative study (paper 1) that fathers’ child-feeding practices, such as pressure to eat and use of food to control behavior are equally as significant as mothers’ child-feeding practices in their associations with child weight status. For example, findings indicate that fathers’ higher use of pressure to eat and use of food to control behavior were significantly related to children’s lower weight status, after accounting for mothers’ feeding practices and other covariates. At the environmental level, I demonstrate in my qualitative study (paper 2) that both mothers and fathers experience structural and environmental obstacles, such as a lack of social support among neighbors and dirty, under-policed streets in urban neighborhoods, which negatively influences their ability to leave the house and makes it difficult to feed their children healthful foods. Specifically, I examine how these obstacles in turn influence the development of overweight and obesity in children aged 2 to 5 years. I have integrated the results of my first two studies with the existing literature on obesity in Latino children to inform the third component of my dissertation, a health policy brief. In this brief, I ask the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to take steps and develop procedures to encourage full access to their services by Latino fathers and encourage their participation and, by so doing, support WIC goals for the nutrition of low-income children and their families. Overall, my findings suggest that in order to effectively intervene in the development of childhood obesity, community stakeholders, scholars and policymakers need a better understanding of how structural and environmental obstacles, and parents’ resources, culture, gender and ethnicity intersect and impact child weight.

A substantial body of empirical evidence has found a connection between education and health. An emerging area of research interest is links between characteristics of school settings and health. An inductive case can be made: characteristics of the school setting, including school inputs, student body demographics, and school culture, are associated with educational attainment, which is, in turn, a key social determinant of health. This dissertation assesses the links between characteristics of the school setting and health outcomes directly.

The existing small evidence base assessing the association between class size reduction and student health outcomes is inconclusive. I conducted a quasi-experimental analysis to evaluate the impact of North Carolina’s elementary class size reduction policy on student sedentary behavior, using an instrumental variables approach. I observed no association between class size and screen time (recreational television and/or electronic device use), after accounting for grade size and school size, year fixed effects, and clustering at the school and district level. These findings suggest that, in state-wide policy implementation settings, there do not appear to be any immediate spillover benefits of class size reduction policies on student health.

Little is known about the extent to which characteristics of the school setting are associated with health outcomes in adulthood, especially in recent decades. I analyzed data from a recent, nationally representative American cohort, the National Longitudinal Survey of Youth 1979 cohort, to explore this question. After adjusting for confounders, high school socioeconomic composition, but not racial/ethnic composition or dropout prevalence, was weakly associated with both obesity and poor self-rated health at age 40. However, after adding adult educational attainment to the model, only the weak association between high school socioeconomic composition and obesity remained statistically significant. Future research should explore possible mechanisms, and also if findings are similar for elementary and middle school composition. These results suggest that policies that seek to break the link between socioeconomic composition and negative outcomes, like Title I, remain important but may have few spillover effects onto health.

Researchers consider positive school climate to be multidimensional and essential for a supportive school setting. I systematically review the relationship between school climate and students’ mental health in the K-12 grades. I identified 40 studies that examined the association between school climate and psychological functioning and met the eligibility criteria. The majority of studies used internalizing and/or externalizing symptoms as the outcome(s) of interest; measures of school climate were more heterogeneous. U.S. middle and high school populations were most frequently studied. Ninety percent of studies found an association between at least one measure of school climate and at least one domain of psychological outcomes. However, there was also room for potential single source bias, since most articles used student reports of both school climate and mental health, and potential residual confounding, since results sometimes differed depending on if the study was cross-sectional or longitudinal in nature.

In conclusion, it appears that some characteristics of the school setting are associated with some health outcomes, although it depends on the specific school setting constructs and health outcomes and the time point at which the health outcomes are measured.

For more than a century, the question of how adolescents should be taught about their emerging sexuality and sexual health has been debated in schools, within communities, and across the public sphere. Today, most efforts to provide formal sexuality education fall under two models: abstinence-only programs, which promote the benefits of restraint from sexual activity, or abstinence-plus programs, which encourage abstinence and offer lessons on safer sexual practices. The lack of consistent, compelling evidence for these widely used approaches has reinforced the need, among some leaders in the field, to reconsider the paradigm as a whole. They advocate for a shift from a narrow emphasis on reducing the risks of adolescent sexual activity toward a positive, holistic emphasis on the healthy sexual development of young people. The term "rights-based" has become increasingly linked to this concept of a more comprehensive approach to sexuality education.

Discussions of a rights-based approach to sexuality education have become increasingly common in both international and U.S. contexts over the past decade. Among a small but growing group of program developers, funders, health educators, and scholars, the idea of addressing contextual factors such as gender norms, power differentials, and sexual rights within sexuality education has gained enthusiastic backing. While preliminary evidence from basic science and theoretical guidance lend support to this interest, there is little direct evidence for concluding that that this new approach is preferable to existing models. This dissertation was developed to offer a critical exploration of this new paradigm for sexuality education.

In the first paper, "A Rights-Based Approach to Sexuality Education: Conceptualization, Clarification and Challenges," I present a conceptual definition for a rights-based approach to sexuality education that is consistent with and gives structure for understanding the guidelines, curricula, research, and theory that have been cited as informing the approach. Based on in-depth qualitative interviews with experts, I propose a rights-based approach as the intersection of four elements: 1) an underlying principle guiding the provision of sexuality education to youth as holders of sexual rights and responsibilities; 2) an expansion of programmatic goals beyond reducing unintended pregnancy and sexually transmitted infections; 3) a broadening of curriculum content to include issues such as gender norms, sexual orientation, sexual expression and pleasure, violence, and individual rights and responsibilities in relationships; and 4) a participatory teaching strategy that engages youth in critical thinking about their sexuality and sexual choices.

In the second and third papers, I focus on one construct - adolescents' underlying attitudes about their sexual rights in relationships - of particular importance for the development, implementation, and evaluation of future rights-based sexuality education programs. In "Adolescents' Attitudes about Rights in Sexual Relationships: Measure Development and Psychometric Assessment," I describe the development of self-report survey measures that address adolescents' attitudes about their rights in steady and casual sexual relationships, and assess their psychometric properties using both classical test theory (CTT) and item response modeling (IRM) approaches. The final measures show evidence of psychometric soundness, including reliability and validity, which encourages their use in both epidemiological studies of adolescent sexual behavior and evaluations of rights-based sexuality education programs.

In the third paper, "Understanding Adolescents' Attitudes about Rights in Sexual Relationships," I examine how adolescents' attitudes about their sexual relationship rights vary by demographic and behavioral characteristics, in contexts with a steady or casual sexual partner, and across the different dimensions of sexual relationship rights. Adolescents report strong support for sexual relationship rights across complex hypothetical situations, with some notable differences by individual characteristics and relationship contexts. I also investigate a theorized causal connection between attitudes about their sexual relationship rights and communication with sexual partners using a series of regression models. These analyses support a causal relationship between attitudes about rights to express sexual engagement needs and partner communication, net of plausible alternative explanations and partially mediated by comfort communicating with sexual partners. In contrast, there was no evidence to support an association between adolescents' attitudes about their rights to refuse sexual activity or rights to establish relationship autonomy and their communication with sexual partners.

As a whole, this dissertation provides a critical examination of the rights-based approach to sexuality education, asking research questions not previously addressed in the literature and suggesting a number of avenues for future sexual health promotion efforts.