Methods: Organizations were sampled that served primarily 1) youth of color, 2) immigrant or refugee youth, and 3) youth with trans- or non-binary gender identities. Fifteen youth ages 13-19 were recruited to attend three focus groups. 66% of participants were youth of color, 66% identified as trans or a non-binary gender, and 40% were immigrants or refugees. A semi-structured interview protocol was used in all focus groups. Focus groups were recorded and transcribed and analyzed using deductive thematic content analysis.
Results: Identity development was critical for all participants, but youths' own identities had a large influence on how they define and prioritize racial, ethnic, cultural and gender identity. For racial identity, youth discussed the salience of race to inequality and how society treats them as a result. Immigrant and refugee youth discussed the importance of cultural identity, yet did not relate to racial or ethnic identity. Gender diverse youth reported that their experience of their gender identity was a choice that could change moment to moment. For all youth, the way that programs fostered their identity development was central to how they perceived programs supported their well-being
Conclusions: Youth perspectives are critical to develop measurement tools that are attuned to cultural differences and experiences of systemic oppression. Youth conceptualizations of social identity, in particular racial, ethnic and gender identity are especially important for evaluating culturally-responsive health and education programs. Implications for setting up big data systems that aim to measure a set of intermediate outcomes related to behavioral health equity in a highly diverse population of youth and programs are discussed.