California Healthy Kids Survey Research Articles

109 Flavored tobacco sales restrictions and e-cigarette use among high school students in California

OBJECTIVES/GOALS: Flavored tobacco sales restrictions (FTSRs) are implemented to reduce access to flavored tobacco products. We examined the association between seven local FTSRs implemented in 2018/2019 and e-cigarette use among high school students in the Bay Area region of California. METHODS/STUDY POPULATION: We analyzed data from the California Healthy Kids Survey using a difference-in-differences (D-I-D) strategy. We compared pre- and post-policy changes one year after implementation in current tobacco use (e-cigarettes and cigarettes) among students exposed (n=20,832) versus unexposed (n=66,126) to a FTSR. Exposed students attended school in a city with a FTSR. Other outcomes included ever use of e-cigarettes, ever marijuana use in an e-cigarette, and ease of access to e-cigarettes. RESULTS/ANTICIPATED RESULTS: Pre- to post-policy, current tobacco use did not change in exposed students (e-cigarette: 10.5% to 11.1%; cigarette 2.6% to 2.5%) and decreased in unexposed students (e-cigarette: 12.8% to 11.4%; cigarette: 2.2% to 1.7%). FTSRs were not associated with a change in odds of current e-cigarette (adjusted D-I-D OR: 1.25, 95% CI: 0.95, 1.65) or cigarette use (adjusted D-I-D OR: 1.24, 95% CI: 0.94, 1.63), relative to unexposed students. For both exposed and unexposed groups, there was a 54-57% increased odds of reporting ease of access to e-cigarettes and a 29-35% increased odds of ever using marijuana in an e-cigarette. No change was detected for ever e-cigarette use. DISCUSSION/SIGNIFICANCE: Local FTSRs in California were not associated with a decrease in e-cigarette or cigarette use one-year post-implementation. Increased ease of access and marijuana use may be explanatory factors.

Substance use among transgender youth: associations with school-based victimization and school protective factors

This paper examines the extent to which transgender students’ experiences with school-based victimization and school protective factors contribute to or reduce substance use. We conducted secondary analyses of school-based victimization, school protective factors, and substance use of a subsample of transgender students from the 2013–2015 California Healthy Kids Survey. Results indicate that among transgender students, school-based victimization is a risk factor for substance use. School protective factors, including school connectedness and school adult support, were associated with a decreased likelihood of substance use among transgender students; for instance, higher levels of school connection were associated with a 30% decreased odds of past 30-day cigarette use (AOR = .70; 95% CI = .60–.82), above and beyond the key risk factor of school-based victimization. This study’s findings suggest that school educators, staff, and administration should receive training around transgender-inclusive practices, and schools should implement transgender-affirming education, programming, and services to improve school connection and school adult support for transgender students.

Adolescents' Perceptions of Substance Use Harms are Contingent on Mode of Administration and Type of Substance.

Early vaping research often did not differentiate between substances vaped. The present study investigates risk perceptions for vaped nicotine and vaped cannabis. A school-based census of 9th and 11th graders yielded 431 responses to the California Healthy Kids Survey. Differences in harm perceptions were evaluated using multilevel mixed-effects models. Students were more likely to report nicotine vaping as great-moderate risk in comparison to cannabis vaping. Additionally, vaped cannabis was viewed as riskier than traditional administration. These results indicate that differences in harm perceptions may need to be addressed when targeting specific classes of substance use in investigations and interventions.

School Health Predictors of the School-to-Prison Pipeline: Substance Use and Developmental Risk and Resilience Factors

PurposeThe purpose of the study is to establish prospective relationships among school mean levels of substance use, developmental risk and resilience factors, and school discipline. MethodsWe linked 2003–2014 data from the California Healthy Kids Survey and the Civil Rights Data Collection, from more than 4,800 schools and 4,950,000 students. With lagged multilevel linear models, we estimated relationships among standardized school average levels of six substance use measures; eight developmental risk and resilience factors; and the prevalence of total discipline, out-of-school discipline, and police-involved discipline. ResultsSchool mean substance use and risk/resilience factors predicted subsequent prevalence of discipline. For example, a one–standard deviation higher school mean level of smoking, binge drinking, and cannabis use was associated, respectively, with 16% (95% confidence interval [CI]: 14%, 18%), 18% (95% CI: 16%, 20%), and 21% (95% CI: 19%, 23%) higher subsequent prevalence of total discipline. A one–standard deviation higher mean level of community support and feeling safe in school was associated, respectively, with 21% (95% CI: 18%, 23%) and 9% (95% CI: 7%, 11%) lower total discipline. Higher violence/harassment was associated with 5% (95% CI: 4%, 7%) higher total discipline. Peer and home support, student resilience, and neighborhood safety were not associated with total discipline. Nearly all associations remained, attenuated, when we restricted to out-of-school and police-involved discipline. ConclusionsSchools with students who, on average, have higher substance use, less school and community support, and feel less safe in schools have a higher prevalence of school discipline and police contact. The public health implications of mass criminalization extend beyond criminal legal system settings and into schools.

Evaluating Litigation as a Structural Strategy for Addressing Bias-Based Bullying Among Youth

Homophobic bullying-which is motivated by actual or perceived sexual orientation-is a common experience among youth and is more strongly associated with adverse outcomes than bullying unrelated to bias. Yet current approaches to reducing homophobic bullying either lack empirical evidence or encounter significant obstacles. Thus, the field requires the identification of strategies that hold promise for reducing homophobic bullying. To examine whether litigation is associated with reductions in homophobic bullying. In this quasi-experimental study, difference-in-difference analysis was used to estimate the association between litigation and homophobic bullying, comparing students in schools that experienced litigation with students in schools that did not experience litigation, controlling for individual and school characteristics, study year, and county. Survey responses came from high school students from 499 schools participating in the California Healthy Kids Survey, the largest statewide survey of youth risk behaviors and protective factors, between 2001 and 2016. Legal data were collected from September 2018 to September 2019, and data were analyzed from February 2020 to April 2021. Outcomes of litigation related to sexual orientation-based harassment and discrimination in California schools occurring after 2000. Student reports of homophobic bullying. Of 1 448 778 included participants, 706 258 (48.7%) were male, 563 973 (38.9%) were White, and the mean (SD) age was 14.6 (1.7) years. For cases where the plaintiff (student) secured monetary and/or injunctive relief through settlement or court decision, there was a 23% reduction in the ratio of odds ratios (ROR) of homophobic bullying in schools directly involved in the litigation relative to schools that did not experience litigation (ROR, 0.77; 95% CI, 0.68-0.86). These benefits of litigation spilled over into schools in the same district as the schools experiencing litigation (ROR, 0.76; 95% CI, 0.70-0.81). However, homophobic bullying slightly increased in the school and district where the defendant (school) avoided adverse legal consequences, suggesting potential backlash. Litigation seeking to address alleged violations of the rights of students who are (or are perceived to be) lesbian, gay, bisexual, or transgender under laws prohibiting harassment or discrimination may lead to reductions in rates of homophobic bullying, with effect sizes comparable with that of resource-intensive school-based bullying interventions. These findings set the stage for future studies to evaluate the consequences of different litigation efforts aimed at redressing stigma-based harms among youth.

Teen, Queer, and Asian: Lesbian, Gay, Bisexual, Transgender, Queer, Plus Asian American Students' Experiences in Schools.

The experiences of youth with intersecting LGBTQ+ and Asian American (AA) identities have been largely unexplored. This study explored these experiences of LGBTQ+ AA California youth with mental health, school climate, and school victimization. Drawing from the 2016-2017 California Healthy Kids Survey (N=326,124), this study utilized secondary data analyses to examine mental health, school climate, and school victimization among students of specific AA ethnicities (eg, Cambodian, Hmong, Vietnamese) and LGBTQ+ identities. The participants in this study included 7th, 9th, and 11th graders from California public schools, with subsamples of lesbian or gay students (N=13,291), bisexual students (N=30,127), and transgender students (N=7916). The results indicated that Asian Indian, Cambodian, Hmong, Japanese, Korean, Laotian, and Other Asian LGBTQ+ students experienced more negative school climate and victimization compared to their Chinese, Filipino, Vietnamese, and white LGBTQ+ peers. For instance, 41.1% of Cambodian transgender students reported they were beaten up compared to 27.1% of white transgender students. Mental health differences between LGBTQ+ AA and LGBTQ+ white students were also found. This study's findings can inform school administrators and teachers how to best support LGBTQ+ AA populations.

Recreational Marijuana Legalization and Co-use With Alcohol Among Adolescents

Little is known about the possible impacts of recreational marijuana legalization on alcohol and marijuana co-use among underage youth. This study examines the association between recreational marijuana legalization in California in 2016 and alcohol and marijuana co-use among adolescents. Additional analyses investigate the associations between recreational marijuana legalization and co-use among past 30-day drinkers and marijuana users and the frequency of alcohol and marijuana use among co-users. This study used annual cross-sectional data from 7th, 9th, and 11th graders (N=3,319,329) who participated in the California Healthy Kids Survey from 2010-2011 to 2018-2019. Measures included past 30-day alcohol and marijuana use and student demographic characteristics, survey year, pre-post recreational marijuana legalization, and urbanicity. Multilevel regression analyses were conducted in 2021. Recreational marijuana legalization was associated with greater odds of past 30-day alcohol and marijuana co-use in the total sample (OR=1.06, 95% CI=1.05, 1.07). Recreational marijuana legalization was more strongly associated with co-use among adolescents who reported past 30-day alcohol use (OR=1.58, 95% CI=1.52, 1.62) and heavy drinking (OR=1.25, 95% CI=1.21, 1.29) but was inversely related to co-use among past 30-day marijuana users (OR=0.76, 95% CI=0.74, 0.78). Among past 30-day co-users, there was a positive association with the frequency of marijuana use (β=0.36, SE=0.07). Recreational marijuana legalization may increase the risk of alcohol and marijuana co-use among adolescents. Greater restrictions on the numbers of alcohol and marijuana retail outlets and hours of operation and advertising and higher taxes on alcohol and marijuana products may help reduce the availability of these substances to adolescents.

Vaping Disparities at the Intersection of Gender Identity and Race/Ethnicity in a Population-Based Sample of Adolescents.

Transgender adolescents use vape products (eg, e-cigarettes) at higher rates than cisgender adolescents. Little is known about how these disparities differ from the intersectional perspective of both gender identity and race/ethnicity. We examined disparities in past 30-day vaping frequency at the intersection of gender identity and race/ethnicity among adolescents participating in two pooled waves of the population-based California Healthy Kids Survey (N = 953 445; 2017-2019). Generalized linear mixed models included gender identity-by-race/ethnicity interactions and adjusted for potential confounders. Stratified models quantified relationships between gender identity and vaping within race/ethnicity strata and between race/ethnicity and vaping within gender identity strata. Transgender adolescents of color were more likely to report a higher frequency of vaping than cisgender white adolescents. In models stratified by race/ethnicity, transgender adolescents evidenced greater odds of more frequent vaping than cisgender adolescents of the same race/ethnicity; disparities were greatest between transgender and cisgender Black adolescents (adjusted odds ratio [AOR]: 6.05, 95% CI: 4.76-7.68) and smallest between transgender and cisgender white adolescents (AOR: 1.20, 95% CI: 1.06-1.35). In models stratified by gender identity, disparities were greatest between transgender Black and transgender white adolescents (AOR: 2.85, 95% CI: 2.20-3.70) and smallest between transgender multiracial and transgender white adolescents (AOR: 1.28, 95% CI: 1.05-1.58). Similar, though less consistent, patterns emerged for adolescents of color unsure of their gender identity relative to cisgender white adolescents. Transgender adolescents of color may be especially vulnerable to vaping disparities. Future research should identify and intervene on causal mechanisms undergirding disparities. Research finds that transgender adolescents use vape products at higher rates than their cisgender peers, however, little is known about how patterns of adolescent vaping may differ by both gender identity and race/ethnicity, information needed to inform culturally tailored prevention and control initiatives to decrease adolescent vaping disparities. Our analysis of data from a population-based adolescent health survey finds evidence of magnified disparities in vaping frequency among transgender adolescents of color.

California’s tobacco 21 minimum sales age law and adolescents’ tobacco and nicotine use: differential associations among racial and ethnic groups

ObjectiveA California, USA, law raised the minimum tobacco sales age to 21 (T21) on 9 June 2016. We investigated whether T21 was associated with reductions adolescents’ use of tobacco cigarettes,...

School- and Student-Level Prevalence and Predictors of Weapon-Related Behaviors and Experiences among Secondary Schools in California

ABSTRACT This study assessed the prevalence of weapon-related behaviors and experiences in secondary schools in California, their intercorrelations, and predictors at the individual and school levels. This study is based on a representative sample of 889,726 secondary school students in California based on the California Healthy Kids Survey. Prevalence ranged from 3.1% of students carrying gun to 17.9% who saw another student with a weapon. In 3.3% of schools, more than 15% of students carried a weapon and in 5.8% of schools, 15% or more were injured or threatened with weapons. The strongest predictors were the number of transgender students, gang members, and victimized students, particularly those victimized because of their disability. A public-health approach is advocated.

A Conceptual and Large-Scale Empirical Examination of the Welcoming Empowerment Monitoring Approach (WEMA) for School Safety and Substance Use Reduction

Purpose: Research shows that many evidence-based school programs are not sustained after the demonstration period is complete. This article outlines the Welcoming Empowerment Monitoring Approach and builds on data at each school—to address school safety and reduce substance use. Method: The study used California Healthy Kids Survey data across 145 schools in Southern California at five points in time over an 8-year period. Results: From project inception through 3 years after the project completed, all manifestations of school victimization dropped and were sustained. Lifetime alcohol and marijuana use also declined for all students during the overall period assessed. Discussion: Schools, districts, and regions tailored interventions according to each school’s and region’s specific needs. Combinations of ground-up solutions, evidence-based programs, building internal capacity, and connecting the school to resources helped reduce victimization and substance use.

Mental Health and Psychosocial Risk and Protective Factors Among Black and Latinx Transgender Youth Compared With Peers

Black and Latinx transgender youth experience stigma that may increase their susceptibility to mental health symptoms. To compare past-year mental health symptoms and psychosocial factors among Black and Latinx transgender youth, White transgender youth, and Black and Latinx cisgender youth. This survey study used data from the 2015-2017 Biennial California Healthy Kids Survey with a weighted sample (N = 45 269) representative of California's secondary school population. The analytic sample (n = 19 780) included Black and Latinx transgender youth, White transgender youth, and Black and Latinx cisgender youth in the 9th and 11th grades. Data analysis was conducted from July 2020 to February 2021. Outcomes include past-year depressive symptoms and suicidality. Psychosocial risk factors include school-based victimization, gender-based harassment, sexuality-based harassment, and race-based harassment; protective factors include school connectedness and caring adult relationships. The analytic sample of 19 780 participants (in 9th grade: weighted percentage, 51% [95% CI, 50% to 52%]; female participants: weighted percentage, 50% [95% CI, 49% to 51%]) included 252 Black and Latinx transgender youth (weighted percentage, 1.3% [95% CI, 1.1% to 1.5%]), 104 White transgender youth (weighted percentage, 0.7% [95% CI, 0.6% to 0.8%]), and 19 424 Black and Latinx cisgender youth (weighted percentage, 98.0% [95% CI, 97.8% to 98.2%]). For Black and Latinx transgender youth, estimated prevalence of depressive symptoms and suicidality were 50% (95% CI, 44% to 57%) and 46% (95% CI, 39% to 52%), respectively. Logistic regression models adjusted for grade, living arrangement, and reported sex indicated that compared with White transgender youth, Black and Latinx transgender youth had similar odds of depressive symptoms (adjusted odds ratio, 0.6; 95% CI, 0.4 to 1.1) and suicidality (adjusted odds ratio, 1.1; 95% CI, 0.6 to 1.8) and similar odds of all forms of harassment (eg, race-based harassment: adjusted odds ratio, 1.5; 95% CI, 0.8 to 2.6). Regression models indicated that compared with White transgender youth, Black and Latinx transgender youth had similar levels of victimization (adjusted linear regression coefficient, 0.5; 95% CI, -0.3 to 1.3) and caring adult relationships (adjusted linear regression coefficient, -0.6; 95% CI, -1.4 to 0.09) but lower levels of school connectedness (adjusted linear regression coefficient, -1.6; 95% CI, -2.9 to -0.4). With similar analyses, compared with Black and Latinx cisgender youth, Black and Latinx transgender youth had higher odds of depressive symptoms (adjusted odds ratio, 2.7; 95% CI, 2.0 to 3.7) and suicidality (adjusted odds ratio, 5.9; 95% CI, 4.3 to 8.0), higher odds and levels of all forms of harassment and victimization (eg, race-based harassment: adjusted odds ratio, 3.2; 95% CI, 2.4 to 4.5), and lower levels of school connectedness (adjusted linear regression coefficient, -2.6; 95% CI -3.3 to -1.8) and caring adult relationships (adjusted linear regression coefficient, -0.9; 95% CI -1.3 to -0.5). In this study, Black and Latinx transgender youth had high rates of mental health symptoms, with rates comparable with White transgender youth but higher than Black and Latinx cisgender youth. Their unique pattern of psychosocial risk and protective factors for these mental health symptoms should be factored in clinical preventive services and school-based interventions to support them.

Intersectional Differences in Protective School Assets by Sexuality, Gender, Race/Ethnicity, and Socioeconomic Status.

School assets-such as connectedness, caring relationships with adults, high behavioral expectations from adults, and meaningful participation-are associated with positive outcomes for adolescents. However, little is known about how school assets differ among adolescents with intersecting marginalized identities. We used the 2013-2014 California Healthy Kids Survey (N=320,462 students) to examine differences in school assets with respect to sexuality, gender, race/ethnicity, and socioeconomic status using adjusted multilevel linear regression models. Sexual minority, gender minority, racial/ethnic minority, and low socioeconomic status adolescents had significantly lower protective school assets. For all outcomes, the differences between sexual minority and heterosexual adolescents were more pronounced among nontransgender girls than nontransgender boys; however, these differences were not consistently present among racial/ethnic minority students. For school connectedness and meaningful participation, differences for racial/ethnic minorities versus white adolescents were more pronounced among nontransgender girls than nontransgender boys. Differences between transgender adolescents and nontransgender boys were more pronounced for white adolescents compared to some other racial/ethnic minority students. Overall, adolescents with certain multiple marginalized identities had lower school assets. Interventions are needed to strengthen school assets among marginalized students, thereby helping mitigate health and education inequities.

Developmental Differences in Sexual Orientation and Gender Identity–Related Substance Use Disparities: Findings From Population-Based Data

PurposeDespite well-established substance use disparities between sexual and gender minority adolescents and their heterosexual, cisgender peers, there remain questions about whether there are developmental differences in the onset and progression of these disparities across adolescence. These perspectives are critical for prevention efforts. We therefore estimate age-based patterns of five substance use behaviors across groups of adolescents defined by sexual orientation and gender identity (SOGI). MethodsData are from the 2013–2015 cycles of the California Healthy Kids Survey (N = 634,454). Substance use was assessed with past 30-day e-cigarette use, combustible cigarette use, alcohol use, heavy episodic drinking, and marijuana use. Two- and three-way interactions were used to assess differences in age-specific prevalence rates of each substance by (1) sex and sexual identity; and (2) gender identity. ResultsAcross all substances, SOGI differences in past 30-day use were present by age 12 years. Most disparities persisted to age 18 years and older. SOGI disparities in combustible and e-cigarette use were wider in late adolescence. Analyses by sexual identity show that sexual minority girls reported the highest rates of substance use across age, followed by sexual minority boys. ConclusionsSOGI differences in substance use emerged in early adolescence and appeared to persist and accelerate by late adolescence. Sexual minority girls had the highest rates of substance use across all ages. The findings underscore the urgent need for screening and prevention strategies to reduce substance use for sexual and gender minority youth.

Correction to: Associations Between Student Engagement and Drug Use: Age and Gender Comparisons Using the California Healthy Kids Survey

Correction to: Associations Between Student Engagement and Drug Use: Age and Gender Comparisons Using the California Healthy Kids Survey

Adolescents’ use of school-based health centers and receipt of mental health supports

• School-based health centers (SBHCs) increase youth’s receipt of mental health care. • Youth who use SBHCs are more likely to talk to health providers about mental health. • Female SBHC users are more likely than male SBHC users to receive mental health care. School-based health centers (SBHCs) are well situated to support students’ mental health needs because they provide crisis intervention, mental health care, and broader interventions to improve school climate. This study examined the association between urban adolescents’ use of SBHCs and their receipt of mental health supports. Data were analyzed from 3,909 high school students attending 10 urban schools with SBHCs in one California county using the 2016–2017 California Healthy Kids Survey. Chi-square tests and multivariate logistic regression were used to measure associations. Effect modification by student gender and race/ethnicity was examined. Female SBHC users were significantly more likely to report receiving mental health counseling when needed (Adjusted Odds Ratio/AOR 1.86; 95% Confidence Interval/CI: 1.55, 2.23) and to report having a caring relationship with an adult at school (AOR 1.66; 95% CI: 1.47, 1.89) compared to female non-users. Differences were not found between male users and non-users. SBHC users were more likely than non-users to report having talked to a doctor or nurse about their moods and feelings (AOR 1.65; 95% CI: 1.19, 2.27) and about how school is going (AOR 1.76; 95% CI: 1.30, 2.38). Findings suggest that SBHCs may be an important place to address students’ mental health needs.

Associations Between Student Engagement and Drug Use: Age and Gender Comparisons Using the California Healthy Kids Survey

This study examined relations between student engagement and drug use using data obtained from the statewide biennial California Healthy Kids Survey. Latent variable modeling with confirmatory factor analysis indicated four conceptually distinct and psychometrically sound factors capturing academic motivation, school connectedness, caring relations, and meaningful participation. Further tests indicated relative invariance of the measurement models across grade (7th, 9th, and 11th) and gender. Structural equation models indicated unique prediction of drug use from the four engagement factors with academic motivation providing the largest magnitude of effect. Evidence of suppression was corrected statistically to show consistent prediction across the four constructs. The relative magnitude of regression coefficients diminished considerably with the introduction of relevant covariates. Results are discussed in terms of designing educational programs that emphasize multiple facets of engagement while at the same time also addressing pedagogical means to boost student academic motivation.

School and Student Level Prevalence and Predictors of Weapon-Related Behaviors and Experiences Among Secondary Schools in California

Importance: The first study to examine prevalence and correlates of weapon-related behaviors on school ground both on student- and school levels on a large and representative sample of a whole state. Objective: To assess the prevalence of weapon-related behaviors in secondary schools in California, their intercorrelations and predictors on the individual and school levels. Design: Secondary analysis of the California Healthy Kids survey among secondary school students in California in 2013-2015. Setting: Survey conducted in grades 7,9,11 in public schools. Participants: 889,726 students (50.5% females), from 2,641 schools. Outcome(s) and Measure(s): Dependent variables (last year): Carrying a gun in school; carrying another weapon; threatened/injured with weapon; seeing students carrying weapons. Predictors include socio-demographic characteristics of the student and family, school violence involvement (victimization, gang affiliation), and school climate. Results: Prevalence ranged from 3.1% of students carrying gun to 17.9% saw another student with a weapon. In 3.3% of schools i more than 15% of students carry a weapon and in 5.8% of schools, 15% or more were injured/threatened with weapons. Weapon-related behaviors were inter-correlated: proportion of students in school who reported carrying a gun was r=.71 (p<.001) with both the proportion of students who carried other weapons and were threatened/injured. Both student- and school level prevalence were predictable. For students, R2 ranged from 36.9%, threatened/injured to 24.5% seeing a weapon. For schools, R2 ranged from 56.3%, carrying another weapon to 45.7%, seeing a student with a weapon. The strongest predictors are the number of transgender students, gang members, and victimized students, and particularly victimized because of their disability. Conclusions and Relevance: Tens of thousands of students are involved in weapon-related behaviors in schools. Many schools have only few involved students, while few schools have large numbers of students carrying weapons. This is important for prevention public health policies and practices. Funding Statement: None to declare Declaration of Interests: None to declare

Proximity of Gun Stores to High Schools and Student Gun Carrying

Although research has examined various correlates of weapon and gun carrying at school and among adolescents, it has yet to consider the relationship between gun stores around schools and the carrying of guns at school. This study uses data from the 2015–2016 California Healthy Kids Survey, the California Department of Education, and geocoded data on public high schools and gun stores in Orange County, California, to examine the association between proximity of gun stores to schools and the carrying of guns by high school students. Using geographic information system analysis and hierarchical logistic regression, results indicate that the proximity of gun stores to schools is significantly associated with self-reported gun carrying at school. Implications for policy and practice are discussed.

Differences in Prevalence Rates of Hopelessness and Suicidal Ideation Among Adolescents by Gang Membership and Latinx Identity

Despite the ongoing challenge of preventing youth gang membership in diverse communities across the United States, and increasing recognition of associations between trauma and gang involvement, the nexus between hopelessness, suicide, and gang membership has largely been ignored. We created two random samples of 1000 participants, with 50% identifying as non-Latinx White, and 50% identifying as Latinx of any race from 91,265 participants of the 2014–2015 California Healthy Kids Survey. Four Chi square tests of independence tested differences in prevalence rates of chronic hopelessness and suicidal ideation for self-identified Latinx and non-Latinx White gang and non-gang member youth. Grounded in a systems responsiveness framework, we predicted that hopelessness and suicidal ideation would be higher for groups that are more marginalized, which was supported by our findings. Specifically, gang membership and ethnicity were both associated with suicide and hopelessness. An unexpected finding, not related to the research questions, was the high prevalence of gender and sexual minority (GSM) youth who identified as gang members. This study represents a unique contribution to the adolescent suicidal ideation literature base, as most studies focus on race or ethnicity and neglect gang membership when identifying disproportionalities in suicidal ideation. Implications for practitioners, researchers, and schools and communities are discussed.