Homophobic Bullying in Positive and Negative School Climates: The Moderating Role of Gender Sexuality Alliances

Adverse Childhood Experiences, Perceived Discrimination, and Mental Health in Sexual and Gender Minoritized Adults: Comparing Stress Accumulation and Stress Sensitization Models

Purpose: The purpose of this study was to assess the relationship between adverse childhood experiences (ACEs) exposure, perceived discrimination, and anxiety and depressive symptoms in sexual and gender minoritized (SGM) adults in the United States. Methods: Respondents (n = 4445) from a national Qualtrics research panel completed a web-based survey. Guided by the stress proliferation (mediation model) and stress sensitization (moderation model) models, we examined the relationships between ACEs and perceived discrimination and the severity of anxiety and depressive symptoms in adulthood. Results: Cumulative ACEs exposure was positively associated with everyday discrimination scale (EDS) scores. ACEs and EDS scores had a significant direct association with anxiety and depressive symptoms. We found support for EDS as a mediator for anxiety (β = 0.12, p < 0.001) and depressive symptoms (β = 0.14, p < 0.001) and for ACEs as a moderator of the relationship between EDS and anxiety (β = -0.04, p = 0.004) and depressive (β = -0.05, p = 0.001) symptoms. Conclusions: These findings suggest that both stress proliferation and stress sensitization likely contribute to disparities in anxiety and depressive symptoms in SGM adults. This finding supports the integration of social safety and minority stress perspectives regarding health disparities in SGM populations. Exposure to early life adversity likely alters neurodevelopment, which in turn increases awareness of the lack of social safety in adulthood, reduces capacity to cope with minority stress exposure, and ultimately contributes to increased anxiety and depressive symptoms. Prevention efforts should focus on building positive and compensatory childhood experiences.

Inclusion Goals: What Sex Education for LGBTQIA+ Adolescents?

According to the World Health Organization and the World Association for Sexual Health (WAS) Declaration of Sexual Rights, sex education aims to provide children and adolescents with comprehensive knowledge, skills, attitudes, and values, promoting equality and nondiscrimination while upholding freedom of thought and expression. However, current school curricula often focus on dichotomous sexual identity and hetero-cis-normative prevention strategies, neglecting the needs of gender minority (GM) and sexual minority (SM) youths. In family settings, discussions typically revolve around sexual risk reduction and basic contraception, omitting relational aspects and components of sexual identity such as orientations and gender expressions. This discrepancy highlights a gap between the official goals of sex education and its practical implementation, reflecting a cultural deficit in familial sex education. This study reviews the scientific literature on sexual health promotion interventions from 2015 to 2024 to identify inclusive approaches that enhance the participation of all youths, not just hetero-cis-normative individuals. The hypothesis is that most interventions primarily serve heterosexual and cisgender youths, indicating a need for more inclusive strategies to achieve better sexual health and educational outcomes. The study also suggests expanding curricula to align with recognized guidelines and the diverse needs of youth.

Body Mass Index Categories of Transgender and Gender Diverse Youth: Clinical Associations and Predictors

Background: Transgender/gender diverse (TGD) youth are at risk for weight-related problems. We describe factors associated with their body mass index (BMI) category. Methods: Chart review of 228 TGD patients, 12-20 years (u = 15.7, standard deviation 1.3), 72% female assigned at birth. BMI percentile was calculated using CDC growth charts. We examined bivariate relationships of 18 clinically derived factors, utilizing analysis of variance (ANOVA) for continuous variables and chi-squared/Fisher's exact test for categorical variables. Nonparametric Classification and Regression Tree (CART) analyses were used to predict BMI category. Results: Almost half (49.6%) of TGD youth presenting for their initial visit for pediatric gender-affirming care fell in the healthy weight range, 4.4% in the underweight range, 16.7% in the overweight range, and 29.4% in the obese range. Self-described weight, weight management intentions, unhealthy weight management, prescription of psychiatric medications, and medications associated with weight gain were associated with BMI category. Use of psychiatric medications (54.8%) and medications associated with weight gain (39.5%) was associated with BMI in the overweight/obese categories. Youth with obesity most often reported unhealthy weight management. In CART models, self-described weight was the strongest predictor of BMI category. Conclusion: TGD youth have high rates of underweight and overweight/obesity. Unhealthy BMI should be treated as part of gender-affirming care. Self-described body weight is associated with weight category. More than half of TGD youth were prescribed psychiatric medications; those with overweight and obesity were more likely prescribed psychiatric and medications with associated weight gain. Youth with obesity were most likely to use unhealthy weight management.

Outer-context determinants on the implementation of school-based interventions for LGBTQ+ adolescents

Background

Schools are critical venues for supporting LGBTQ+ youth well-being. Implementing LGBTQ-supportive practices can decrease experiences of stigmatization, discrimination, and victimization that lead to adverse mental health outcomes like anxiety, depression, and suicidality. However, schools are also subject to a wide range of outer-context pressures that may influence their priorities and implementation of LGBTQ-supportive practices. We assessed the role of emergent outer-context determinants in the context of a 5-year cluster randomized controlled trial to study the implementation of LGBTQ-supportive evidence-informed practices (EIPs) in New Mexico high schools.

Method

Using an iterative coding approach, we analyzed qualitative data from annual interviews with school professionals involved in EIP implementation efforts.

Results

The analysis yielded three categories of outer-context determinants that created challenges and opportunities for implementation: (a) social barriers related to heterocentrism, cisgenderism, and religious conservatism; (b) local, state, and national policy and political discourse; and (c) crisis events.

Conclusions

By exploring the implications of outer-context determinants for the uptake of LGBTQ-supportive practices, we demonstrate that these elements are dynamic-not simply reducible to barriers or facilitators-and that assessing outer-context determinants shaping implementation environments is crucial for addressing LGBTQ health equity.

Widening, Narrowing, and Persistence of Socioeconomic Gaps Between Sexual Minorities and Heterosexuals Across Adulthood

In socioeconomic attainment, same-sex sexuality (SSS) matters, as well as whether SSS is experienced in adolescence (early) or not until later in adulthood (late). Using data from 8912 participants of the National Longitudinal Study of Adolescent to Adult Health, sexual minorities are identified as the early or late groups. Multilevel regression models were used to compare their income, occupational status, and education separately against heterosexuals, based on repeated measures taken in their 20s, 30s, and 40s. This study found a significant lag in high-school graduation compared to a subgroup of men in the early group that did not express same-sex sexuality in adulthood. Independently, "gay penalty" in income emerged for the late group as they entered their 30s, and persisted into their 40s. No socioeconomic gaps were observed for the women. To serve equity goals for all sexualities, closer attention needs to be given to those with an evolving history of same-sex sexuality.

Effects of School Policies and Programs on Violence Among All High School Students and Sexual and Gender Minority Students

BACKGROUND

Youth identifying as lesbian, gay, bisexual (LGB) and/or transgender/gender nonconforming (TGNC) are at increased risk of violence. School policies and practices may mitigate this risk.

METHODS

Researchers merged data from the 2016 New Mexico School Health Profiles and the 2017 New Mexico Youth Risk and Resiliency Survey. Researchers employed multivariable logistic regression to test the associations between school-level measures and violence outcomes.

RESULTS

Genders and sexualities alliances (GSAs) were associated with reduced odds of lifetime forced sex among all, heterosexual cisgender, and LGB students, reduced odds of sexual violence among heterosexual cisgender students, and reduced odds of dating violence among LGB students. Inclusive sexual health education was associated with reduced odds of lifetime forced sex among LGB and TGNC students, reduced odds of sexual violence among LGB students, and increased odds of dating violence among heterosexual cisgender students. Inclusive teacher training was associated with increased odds of lifetime forced sex among TGNC students.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Inclusive sexual health education and the presence of active GSAs may have the greatest potential for reducing violence, especially among LGB and TGNC students.

CONCLUSIONS

Findings highlight the important role of school policies and practices in addressing violence.

The roles of non-heterosexuality outside of identity and gender non-conformity in Allostatic Load among young adults

Using the National Longitudinal Study of Adolescent to Adult Health, this study contrasted levels of Allostatic Load at the baseline and change observed between the age 20s and 30s, among self-identified Lesbians/Gays/Bisexuals and heterosexuals with non-heterosexual attraction/behavior (discordant heterosexuals), against heterosexuals without (concordant heterosexuals). In addition, the study tested if Allostatic Load differs for each of the sexual orientation group differs jointly or independently of gender non-conformity. The study found no Allostatic Load elevation for self-identified non-heterosexual men and women. For women only, a significantly greater elevation of Allostatic Load is observed among discordant heterosexuals. Independently, Allostatic Load is found higher for females appearing more androgynous. The findings suggest expanding the current scope of sexual minority research to consider the relevance of minority stress to those without a LGB identity, who may be exposed to stress from disparate sources related to their gender identity.

A Snapshot of Gay-Straight Alliance Clubs and Student Well-Being in Western Canadian High Schools

Gay-Straight Alliance (GSA) clubs promote safer school environments for students. GSAs typically refer to student-led, teacher-supported school clubs that serve youth of diverse gender identities and sexual orientations. This study investigated the relationship between students' awareness of school-based GSAs and their bullying experiences, mental health, self-determination, and relationships at school and home. Findings showed that LGBTQ2S+ students experienced higher rates of bullying and symptoms of depression and scored lower on self-determination subscales than cisgender heterosexual students. Interestingly, students who were aware of their school's GSA club scored higher on the self-determination subscales regarding family relationships and lower on bullying compared to students who were unaware of their school's GSA club. LGBTQ2S+ students had lower rates of comfort with their sexual orientation at home and school than their cisgender heterosexual students. Implications and future directions are discussed.

Gender-Sexuality Alliance Advisors' Self-Efficacy to Address Transgender Issues: An Interpersonal Protective Factor for Transgender Student Depression

Purpose: Our purpose was to assess the association between Gender-Sexuality Alliances (GSAs) advisors' self-efficacy to address transgender issues and their students' depressive symptoms, by students' gender identity (i.e., transgender vs. cisgender). We predict that higher advisor self-efficacy will be associated with decreases in student depressive symptoms for transgender students, though not necessarily for cisgender students. Methods: Data come from surveys of student members (n = 366) and advisors (n = 58) of 38 purposively sampled GSAs in Massachusetts high schools, in 2016-2017 and 2017-2018. We used a linear mixed-effects model to assess the association between advisor self-efficacy to address transgender issues and student change in Center for Epidemiological Studies Depression-10 scores between the beginning and end of the school year by gender identity, adjusting for student covariates. Results: Students were 10-20 years old (mean = 15, standard deviation [SD] = 1.4); 28% were transgender, 28% were students of color, and 86% were lesbian, gay, bisexual, or queer/questioning or other non-heterosexual identity. The GSA advisor self-efficacy scores ranged from 13 to 25 with a mean of 20.4 (SD = 3.0). Greater advisor self-efficacy to address transgender issues was associated with a decrease in depressive symptoms for transgender students (estimate = -0.47, p = 0.01), but not for cisgender students. Conclusions: GSA advisor self-efficacy to address transgender issues could be protective for transgender student depressive symptoms. Thus, increasing advisor self-efficacy to address transgender issues may help decrease depressive symptomatology for transgender youth, and intervention work in this area is needed to bolster this claim.

Inclusive National Educational Policies as Protective Factors for LGBTI Youth Adjustment: An European Cross-National Study

PURPOSE

To evaluate whether the presence of inclusive national educational policies is associated with more positive adjustment, better school experiences, and less harassment among lesbian, gay, bisexual, transgender, and intersex (LGBTI) youth.

METHODS

A total of 66,851 LGBTI youth aged 15-24 from 30 EU countries completed the EU-LGBTI II survey in 2019. Participants reported on feelings of sadness/depression, life satisfaction, lack of safety at school, being out at school as LGBTI, experiences of bias-based school violence, and experiences of general and bias-based harassment. Individual-level data were linked to country-level data on the presence of LGBTI-inclusive school policies obtained from the International Lesbian, Gay, Bisexual, Transgender, Queer & Intersex Youth and Student Organisation report which reviewed existing European educational measures. The inclusiveness of each policy was assessed by the inclusion of the following grounds as protected: Variation in sexual characteristics, gender identity or expression, and sexual orientation. National policies were categorized into (1) antidiscrimination laws; (2) policies and action plans; (3) inclusive curricula; (4) teacher training; and (5) government support.

RESULTS

LGBTI youth with more inclusive school policies in their countries had lower odds of lack of school safety, and concealment, and higher odds of life satisfaction. Inclusive teacher training and curricula were associated with less lack of safety and depression/sadness, and less school bias-based violence. Moreover, whereas teacher training was associated with more visibility and less concealment among LGBTI youth, inclusive curricula were linked to less general and bias-based harassment experiences.

DISCUSSION

A multipronged national approach that includes teacher training and inclusive curricula is needed to better support LGBTI youth.

School Bullying Victimization and Associated Factors Among School-Aged Adolescents in China

There has been a significant amount of research on correlates of bullying victimization, but most prior studies are descriptive and do not distinguish between different types of bullying. The current study used a case-control study design to explore factors related to different types of bullying victimization, including physical, relational, verbal, sexual, property, and poly-bullying victimization. This study was conducted in a southern city in China, including 3054 cases who self-reported being victims of school bullying and 3054 controls who reported not being involved in any school bullying in the past 12 months. Each victim case was matched with a control on gender, school, and grade level. Univariate logistic analyses and multivariate conditional logistic regression analyses were used to identify factors associated with being a victim of school bullying. Results suggest physical bullying victimization was only associated with a family-level characteristic (parenting style) while the other four types of bullying victimization (relational, verbal, sexual, and property bullying) and poly-bullying victimization were associated with multiple social domain variables at individual, family, and school levels. Findings from this study provide evidence of factors for different types of bullying victimization and have implications for potential measures to prevent bullying. Measures from multiple social domains, including individual, family and school (e.g., developing healthy behaviors, improving social skills, positive parent-child interactions, building trust between teachers and peers, and forming strong friendships), should be considered in order to effectively prevent adolescent victimization from bullying.

Engagement in Gender-Sexuality Alliances Predicts Youth's Positive and Negative Affect: An 8-Week Weekly Diary Study

Gender-Sexuality Alliances (GSAs) are school clubs for LGBTQ + youth and peer allies to support one another. This 8-week weekly diary study considered whether a youth's positive and negative affect during a given week could be predicted by experiences in their most recently attended GSA meeting. Ninety-nine GSA members (M_age = 15.90, SD = 1.33; 79% LGBQ + ; 41% trans/non-binary; 59% youth of color) in 11 states completed weekly surveys between January and May 2021. On average, some youth reported higher positive and negative affect than others. Youth also varied notably in their own positive and negative affect from week to week. Youth reported relatively higher positive affect on days following GSA meetings where they were more engaged than in other meetings and had spent time socializing in the meeting. Youth reported relatively higher negative affect on days following GSA meetings where they had discussed personal concerns, and relatively lower negative affect on days following meetings where they were more engaged and perceived greater advisor responsiveness. These findings offer a dynamic portrayal of youth's varied experiences across GSA meetings and the more immediate predictive effects of GSA experiences.

Power and resistance in schools: Implementing institutional change to promote health equity for sexual and gender minority youth

Introduction

Schools in the United States are hierarchical institutions that actively (re)produce the power relations of the wider social world, including those associated with heteronormativity. Structural stigma, informed by heteronormativity and perpetuated through schools, contributes to the production of academic and health disparities among youth who are lesbian, gay, bisexual, transgender, queer, or of other gender and sexual identities (LGBTQ+). We draw upon 5 years of qualitative data from a cluster randomized controlled trial conducted in New Mexico that used implementation science frameworks to promote the uptake and sustainment of evidence-informed practices (EIPs) to examine how power operates to hinder or promote the ability of school staff to change school environments, disrupt structural stigma, and increase safety and support for LGBTQ+ youth.

Methods

Data sources included annual individual and small group qualitative interviews with school professionals (e.g., administrators, school nurses, teachers, and other staff), several of whom took part in Implementation Resource Teams (IRTs) charged with applying the EIPs. Other data sources included bi-weekly periodic reflections with implementation coaches and technical assistance experts. Data were recorded, transcribed, and analyzed using deductive and inductive coding techniques.

Results

The IRTs experienced variable success in implementing EIPs. Their efforts were influenced by: (1) constraining school characteristics, including staff turnover and resource scarcity; (2) community-based opposition to change and concerns about community backlash; (3) the presence or absence of supportive school leadership; and (4) variations in school, district, and state policies affecting LGBTQ+ students and attitudes about their importance. Findings illustrate how diverse power structures operated in and across outer and inner contexts to bound, shift, amplify, and otherwise shape how new practices were received and implemented.

Conclusion

Findings indicate that the efforts of IRTs were often a form of resistant power that operated within and against school hierarchies to leverage epistemic, discursive, and material power toward implementation. To improve health equity, implementation scientists must attend to the multiple real and perceived power structures that shape implementation environments and influence organizational readiness and individual motivation. Implementers must also work to leverage resistant power to counter the institutional structures and social norms that perpetuate inequities, like heteronormativity and structural stigma.

Student Intervention Against Homophobic Name-Calling: The Role of Peers, Teachers, and Inclusive Curricula

Encouraging bystander intervention is an effective strategy to prevent episodes of bullying victimization at school. Yet there remains a paucity of evidence on this behavior in situations of homophobic name-calling, a form of peer victimization aimed at mocking individuals based on their actual or perceived sexual orientation. The existing research has focused on intentionality rather than actual student intervention behaviors, and, of note, no previous studies have taken into consideration contextual factors at the classroom and school levels. The present study examined whether students' observations of teacher and peer interventions against homophobic name-calling and perceptions of the representation of lesbian, gay, bisexual, and transgender (LGBT) issues in class are associated with student intervention behaviors against homophobic name-calling. A three-level multilevel approach was used to account for the nested nature of students' experiences in classrooms and schools. The sample included 1,296 students (43.57% girls) recruited from 84 classrooms of 22 Italian public high schools. Preliminary analyses showed that the variability in students' reports had more to do with which classrooms versus which schools students attend. Results from multilevel regressions indicated that students who observe teachers intervening during episodes of homophobic name-calling, and who perceive the representation of LGBT issues in class as positive, were more likely to intervene against homophobic name-calling and to observe other classmates intervene as well. Also, participants who observed other students intervening were more likely to intervene. These findings highlight the importance of the role of teachers in modeling classroom norms to encourage bystander interventions. Teachers can do so indirectly such as when providing a positive representation of LGBT issues in class, or directly when intervening to condemn episodes of homophobic name-calling. In addition, our results affirm the importance of peer influence in encouraging bystander interventions during episodes of homophobic name-calling.

Considering "Spheres of Influence" in the Care of Lesbian, Gay, Bisexual Transgender, and Queer-Identified Youth

Working with lesbian, gay, bisexual transgender, and queer-identified (LGBTQ) youth can present a uniquely challenging opportunity for clinicians given the rapidly changing landscapes of gender and sexuality and deficits in training and education. The goal of this article is to provide the most up-to-date trends and advances in the mental health care of LGBTQ youth to empower clinicians in delivering evidence-based care. We adapt the "Spheres of Influence" model to challenge the clinician to think more globally about our interventions. When LGBTQ youth are supported at every sphere, we give them the best chance to survive and thrive into adulthood.

Social support in schools and related outcomes for LGBTQ youth: a scoping review

Recent research has increasingly focused on positive factors and supports for LGBTQ youth. This scoping review explores existing social support for LGBTQ youth in schools through the Ecological Systems Theory to respond to the following four objectives: (1) define social support systems in schools, (2) identify current research on outcomes for LGBTQ youth, (3) identify barriers to support LGBTQ youth in schools, and (4) identify areas for future research for LGBTQ youth and social support in schools. A systematic search (Arksey and O'Malley in Int J Soc Res Methodol 8(1):19-32, 2005) between 2007 through 2021 resulted in 94 articles. This review gave rise to an organizational framework to consolidate various systems of social support for LGBTQ youth in schools. Social support consisted of seven social support systems (family, curriculum, family, peers, school policies, GSAs and programs, and school climate) that are positively associated with the promotion of positive socioemotional, behavioural, and educational outcomes for LGBTQ youth. Though the literature has been clear surrounding the risks associated with LGBTQ youth, this scoping review provides a positive outlook on LGBTQ youth's school experiences and how these systems of social support allow for LGBTQ youth to act as active participants to foster a positive school climate and sense of safety.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44217-022-00016-9.

Does a Decade of School Administrator Support for Educator Training on Students' Sexual and Gender Identity Make a Difference for Students' Victimization and Perceptions of School Climate?

Professional development training for school personnel on issues related to sexual and gender identity (i.e., SOGI training) is a school strategy designed to prevent health and educational disparities for lesbian, gay, bisexual, and transgender (LGBT) youth at school. Yet we know surprisingly little about how the presence of this practice at school affects students' experience. This study explores whether students' experiences of victimization and school climate vary as a function of school administrator support for SOGI training at two time points (2004 and 2014). We combined multiple independent databases: students' reports on victimization and school climate in 2013-2015 (n = 55,158), and school (n = 152) and school district data (n = 67) on support for SOGI training in 2004 and 2014. More positive school climates were found in schools with support for SOGI training in 2004 only and both 2004 and 2014 compared to schools with SOGI training support in 2014 only. In schools with support for SOGI training in both 2004 and 2014, LGBT students reported the lowest rates of victimization. Findings from this study provide evidence that support for SOGI training by school administration is an effective way to improve school contexts for LGBT and all students. School administrators who aim to reduce victimization disparities for LGBT students and improve school climates should support the implementation of SOGI training, and sustain such training over time.

Bullying victimization, psychosocial functioning, and protective factors: Comparing African American heterosexual and sexual minority adolescents in Chicago's Southside

African American heterosexual and sexual minority (SM) adolescents report widespread bullying victimization (BV), which is associated with poorer psychosocial functioning. However, studies examining potential protective factors that moderate this association are limited. Using data from a cross-sectional study conducted in Chicago, we examined the association between BV and psychosocial functioning among a sample of heterosexual (n = 475) and SM (n = 105) African American adolescents and examined whether four empirically-supported protective factors moderated these associations. Among SM adolescents, having close parents was protective against psychosomatic symptoms for those who reported high BV and having caring teachers was protective against substance use for those who reported both high and low BV. Among heterosexual adolescents, having close parents was protective against substance use for those who reported high BV but having high neighborhood support exacerbated the risk of developing psychosomatic symptoms for those who reported high BV. Implications for school and parental-based interventions are discussed.