Healthy Young Men's Study

Research Overview

The Healthy Young Men’s Study (HYM) is a five-year longitudinal research project of the Community, Health Outcomes and Intervention Research Program (CHOIR) of The Saban Research Institute of Childrens Hospital Los Angeles.  Funded in May 2003 by the National Institute of Drug Abuse (RO1 DA015638), the study utilizes longitudinal quantitative and qualitative research methods with a cohort of young men who have sex with men (YMSM), ages 18 to 24 years, to explore the individual, familial, interpersonal, and community factors that may influence drug use, HIV risk, and mental health. 

Materials Resulting from the Study

Healthy Young Men's Study Video (Feature Length: 9:10) Source: Healthy Young Men's Study  Provides an overview of the methods and the data resulting from the HYM Study.

Ask About hym! (Booklet) This 13-page booklet answers questions about the study and includes resources young people might reference.  Download Now

Healthy Young Men's Study (Book) This 44-page book offers information that may help providers improve interventions for young men.  Download Now

Research Topics

The HYM study seeks to contribute to a fuller understanding of the factors that may affect YMSM's use of alcohol and other substances, risk behavior for HIV and other sexually transmitted infections, and mental health, including depression and suicidality.  The study focuses on a number of domains that may influence these types of health outcomes among YMSM, including:

• Individual experiences (e.g., sexual identity and “coming out” experiences; racial/ethnic identity; ethnic community ties; acculturation)
• Personality factors (e.g. sensation seeking, proactive coping, emotion regulation)
• The family (e.g., family composition and environment; familial support and/or rejection; “friends as family”)
• Social networks and sexual partners (e.g., number and nature of intimate relationships; size and contact frequency of social networks; norms and support)
• Community and social institutions (e.g., engagement with and influence of racial/ethnic community, gay community, religious organizations and leaders, school, workplace, and social service agencies)
• Stressful life events, including rejection, violence, victimization, and discrimination, particularly as they play a role within the four prior domains (i.e., as an individual experience, within families and sexual partners, and in the community)

Purpose of the Study

The HYM study is designed to fill important gaps in our knowledge about the lives of young men who have sex with men (YMSM), and in so doing to support improved health and well-being within this population.  Currently, one fo the most critical health concerns facing YMSM is their risk for HIV.  Although significant advances have been made in reducing adult gay men’s involvement in HIV risk behaviors, there has been little progress in reducing young gay men’s risk for HIV infection.  Prevention efforts have been limited in part because significant gaps exist in our understanding of the broad array of individual, familial, social, and community characteristics that influence YMSM to engage in both risk and protective behaviors.  For example, preliminary research suggests that social support can play a positive role in reducing one’s risk for HIV by increasing condom use, and that many YMSM receive less support during adolescence than their heterosexual peers.  However, little is understood about how this social environment is related to risk for HIV, drug use, or other health concerns in this population.  We know very little about the value of social support in YMSM’s lives, what types of support are most important, and how the presence of social support from one area of their life might compensate for a lack of support in other areas.  Social support is therefore one of several aspects of YMSM’s lives that is being explored as part of the Healthy Young Men’s Study.

One reason the factors that influence risk are poorly understood is that previous research on YMSM has been limited in a number of ways.  To date, much of our current understanding of YMSM’s health and risk behaviors has been based on cross-sectional studies—surveys that are administered at only one point in time.  Cross-sectional surveys are limited in their ability to capture changes over time, or to indicate which factors in a person’s life are most likely to lead to positive or negative health outcomes.   In addition, most surveys of YMSM to date have used non-probability sampling methods, meaning that research participants were selected in a non-random manner, such as volunteer participants recruited at a conference for lesbian and gay youth.  While such studies have provided much valuable information, their findings cannot be generalized to broader populations of YMSM (such as those identifying as bisexual or unsure of their identity).  Finally, most large studies of YMSM have employed little or no qualitative research, while the qualitative studies that have been conducted have been based on small, non-representative samples of convenience.

The HYM Study was thus developed as a large-scale longitudinal multi-method study with a random sample of YMSM who attend gay-identified venues.  The study is designed to provide much-needed insights into the lives and behaviors of YMSM, with the hope that such knowledge that could contribute to improved HIV prevention efforts, better tailoring of youth programs to the specific needs of YMSM, and greater understanding and acceptance of YMSM.

Study Design

The HYM study used a combination of the best research methods to gain a more complete understanding of the lives and experiences of YMSM.  A longitudinal survey was developed to provide the “big picture,” and make valid claims based on a representative sample of YMSM who visit gay-identified venues.  The sample was ethnically stratified to include substantial numbers of African Americans, Caucasians, and Latinos of Mexican descent.  By interviewing each respondent five times over two years, the study provided new insights into how these young men’s lives change during the critical developmental period of emerging adulthood.  In addition, this longitudinal approach allowed us to explore which factors in the lives of YMSM are most likely to lead to a variety of health outcomes.  A series of in-depth qualitative interviews with several subsets of respondents offered additional context for accurate interpretation of the survey results, as well as discovery of new themes and concerns that have rarely been addressed in previous research.  Ongoing communication between qualitative and quantitative staff ensured that both types of findings influenced the design and analysis of every aspect of the research project.

Formative Phase

Prior to launching the HYM study, six focus groups and 82 in-depth interviews were conducted with an ethnically-diverse sample of YMSM to ensure that the survey and study design were relevant and appropriate for the target population.  Interviews and focus groups were designed to provide context regarding several key topics, including family, social support, community, discrimination, gender roles, and sexual relationships.  The HYM survey was developed based on this formative work, and pilot tested with 51 YMSM.  Early in the formative phase, the HYM Community Advisory Board was convened to provide input and perspective on the study design. This group included members representing youth, club promoters, YMSM service providers, and individuals from City and County HIV planning offices.

Recruiting the Sample

Recruitment for the HYM Study utilized venue-based probability sampling, a method that combines standard outreach techniques with survey methods to systematically recruit random samples of hard-to-reach populations, such as YMSM. 

A total of 526 subjects were recruited into the study between February 2005 and January 2006.  Youth were recruited from gay-identified venues throughout Los Angeles County, including bars, coffee houses, parks, beaches, and high-traffic street locations; social events, such as a picnic or baseball game sponsored by an agency or organization that serves YMSM; and special events such as gay pride festivals. 

Young men were eligible if they were:

• 18-24 years old
• Self-identified as other than straight, or had sex with a male 
• African American, Caucasian, or Latino of Mexican descent
• Living in Los Angeles County

Survey

Each respondent completed an extensive 1-1½ hour survey every six months for two years, for a total of five surveys.  The retention rate over the five waves of the survey was 92.5%.  The survey was available in both English and Spanish, and utilized Audio Computer Assisted Self-Interviewing (ACASI) technology.  This technology allowed the respondents to enter their own responses to survey questions, and has been found to improve both the quality of the data being collected and the validity of subjects’ responses, particularly to questions of a sensitive nature, such as drug use and sexual behavior.  The survey included measures for a wide range of constructs, including:

The survey consisted of validated measures and new measures specifically designed from the study’s formative findings. 

Surveys were conducted in the HYM project offices or at one of a number of coffee shops located throughout Los Angeles County.

Qualitative Interviews

In-depth interviews were conducted with several subsets of respondents in order to capture the full context of these young men’s experiences in their own words.  Separate sets of interviews addressed four topics over the course of the study: substance use, sexuality, religion/spirituality, and discrimination.  Focusing on a single construct in each interview yielded particularly rich and depthful descriptions of respondents’ experiences.  

In order to obtain random samples and a diversity of perspectives, each subset of 24–36 respondents was systematically selected from the larger HYM sample based on responses to key items in the survey.  For example, in order to ensure that the interviews on religion/spirituality included a full spectrum of views and experiences, we generated lists of respondents whose survey responses identified them as “very religious,” “spiritual but not religious,” or “neither religious nor spiritual.”  These groups were further stratified by ethnicity, yielding a total of nine groups.  An equal number of respondents was randomly selected from each group. 

Current Publications

The following is a list of manuscripts that are currently available through PubMed.  This list will be regularly updated as additional papers are published.

Kipke MD, Kubicek K, Weiss G, Wong CF, Lopez D, Iverson E, Ford W. (2007) The health and health behaviors of YMSM.  Journal of Adolescent Health, 40, 342-350.

Kipke MD, Weiss G, Ramirez M, Dorey F, Ritt-Olson A, Iverson E, Ford W. Club drug use among YMSM in Los Angeles. Substance Use and Misuse, 42 (11),1723-43.

Kipke MD, Weiss G, Wong CF. Residential status as a risk factor for drug use and HIV risk among YMSM.  AIDS and Behavior. 11(6 Suppl), 56-69.

In Gratitude

We would like to acknowledge the many people who have made this unique and important research project possible.  We are especially grateful to the young men who participated in this study for their commitment and willingness to share their diverse and often profound personal experiences.  Many thanks to our Community Advisory Board whose members remained consistently engaged, thoughtful, and supportive throughout the duration of the study.  Their guidance strengthened both the methodology of the study and the analysis of the findings.  The tireless HYM staff stayed out until late at night recruiting respondents, demonstrated an impressive level of enthusiasm and creative involvement, and established the strong rapport that made possible a longitudinal study of this scale.  Finally, we thank the National Institute on Drug Abuse for funding this project, and Macy's West G.I.F.T. for providing additional support to more broadly disseminate findings from this study.

Community Advisory Board
Noel Alumit, Asian Pacific AIDS Intervention Team, Chi-Wai Au, LA County Department of Health Services; Ivan Daniels III, LA Black Pride, Ray Fernandez, AIDS Project Los Angeles, Trent Jackson, Youth/Trent Jackson Media Group, Dustin Kerrone, LA Gay and Lesbian Cetner, Miguel Martinez, Childrens Hospital Los Angeles, Division of Adolescent Medicine; Ariel Prodigy, West Coast Ballroom Scene, Brion Ramses, West Coast Ballroom Scene, Ricki Rosales, City of LA, AIDS Coordinator’s Office, Haquami Sharpe, Minority AIDS Project, Pedro Garcia, Bienestar,  Carlos Ruiz, St. Mary's Medical Center Long Beach, Ramy Eletreby, IN Magazine; Kevin Williams, Minority AIDS Project, Rev. Charles E. Bowen, Minority AIDS Project, Tom Freese, UCLA Integrated Substance Abuse Programs

Principal Investigator
Michele D. Kipke, PhD

Co-Investigators
Robert Appleby, PhD; George Ayala PsyD; Wesley Ford, MPH; Ellen Iverson, MPH; Jennifer Unger PhD

Project Coordinator
George Weiss

Data Collection Team
Francisca Angulo-Olaiz, PhD; Cesar Arauz-Cuadra; Marianne Burns; Julie Carpineto,MFA; Peter Cruz; Donna Lopez; MSW; Larkin Mackey; Miles McNeeley; Diane Preciado; Talia Rubin; Conor Schaye, MPH; David Sheski; Meghan Treese; Kevin Willaims; David Zucker

Quantitative Analysis and Survey Development Team
Fred Dorey, PhD; Jennifer Jackson-Bloom MPH; Xiaowei Liu, MS; Anamara Ritt-Olson, PhD; Carolyn F. Wong, PhD; Joseph Zhou

Qualitative Research Team
Eduardo Contreras, PhD; Katrina Kubicek, PhDc; Bryce McDavitt

Tracking Team
Marcia Reyes; Maral Shahanian; Alex Tapia

Transcription Team
Randi Aichel; Shalondra Henry; Sophia Lorente; Donna Luebbe; Heather Reyes; Eunice Villatoro

Administrative Team
Judith Grout; Griselda Monroy 

Interns
Neda Bogsara; Jacquelyn Manougian; Megha Mehta; Leah Molaiepour; Katherine Riberal; Siavoche Siassi; Amy Tung; Vicki Yu