A National Analysis of State Policies on Lesbian, Gay, Bisexual, Transgender, and Questioning/Queer Inclusive Sex Education

The History of US Menstrual Health, School Nurses, and the Future of Menstrual Health Equity

In the United States, adolescents suffer from inadequate menstrual health, meaning that adolescents are unprepared for menarche, lack the practical resources they need to comfortably and confidently manage menstruation, and receive inadequate health education and care for menstrual pain and disorders. In this article, we provide a historical analysis of the role of school nurses in addressing menstruation from the early 20th century up to the present day. We contextualize the current realities of school nursing and menstrual health education and clinical support. We argue that the decentralized US school system, a cultural aversion to open discussion about menstruation, and the outsized influence of commercial menstrual product manufacturers have hampered the ability of school nurses to deliver menstrual health education along with menstrual health support. Finally, we discuss implications for today's schooling experiences as well as recommendations for how to support school nurses in aligning our national approach to menstrual health toward the public health perspective of menstrual equity. (Am J Public Health. 2024;114(9):903-908. https://doi.org/10.2105/AJPH.2024.307705).

Busting MisconSEXions: evaluation of a social media knowledge translation initiative addressing myths about sex

There is a critical gap in sex education such that many people lack access to evidence-based and accessible information about sexuality, putting them at risk for endorsing myths about sex and in turn having poorer sexual wellbeing. To address this gap, we developed a novel social media knowledge translation initiative-MisconSEXions-to debunk common myths about sexuality. The goal of this study was twofold. First, to examine whether exposure to MisconSEXions is effective for reducing sexuality myth endorsement. Second, to evaluate the acceptability (participants' satisfaction with the content), appropriateness (the perceived fit of the content with participants), adoption (participants' intention to engage with the initiative), and penetration (participants' perception of the content's impact on their lives) of MisconSEXions among study participants. We also examined possible group differences in our observed effects by assigned sex, gender modality, and sexual orientation. A large and diverse sample (N = 2,356) of adults completed an online survey and reported on their demographics, sexuality myth endorsement before and after exposure to MisconSEXions content, and the acceptability, appropriateness, adoption, and penetration of the MisconSEXions content. We found that participants' sexuality myth endorsement was significantly lower following exposure to MisconSEXions content, and this effect held across assigned sex, gender modality, and sexual orientation groups. Regardless of participants' assigned sex, gender modality, or sexual orientation, MisconSEXions content was reported to be both acceptable and appropriate to people's lives. Participants reported relatively low levels of adoption, such that they reported reluctance to engage with the content on social media. Additionally, participants reported mixed feelings regarding the impact of the content on their lives (i.e., penetration). Overall, the findings have implications for how sexuality social media knowledge translation initiatives can fill important gaps in providing inclusive and accessible sex education.

Characterizing Life Stress Exposure Among Sexual Minority Adolescents: Temporality, Content, And Mediating Role in Mental Health Disparities

Though sexual minority adolescents face a wide array of deleterious stressors, few studies have examined the role of specific types of stress exposure (i.e., chronic vs. episodic, interpersonal vs. non-interpersonal) on mental health disparities. This study utilizes a contextual threat-based assessment to (a) compare levels of stress exposure types between sexual minority and non-sexual minority adolescents, and (b) examine stress type as a mediator between sexual orientation and two outcomes: depressive symptoms and emotion dysregulation. Data comes from a longitudinal sample (14-17 years-old, N = 241; 17.6% sexual minority; 54% assigned female at birth; 73.9% White), with two time-points (T1 and T2) utilized. Sexual minority adolescents reported higher chronic interpersonal stress, but no differences in non-interpersonal chronic or episodic stress, relative to non-sexual minority adolescents. Chronic interpersonal stress exposure mediated the link between membership in an oppressed group (i.e., sexual minority teens) and the primary outcomes (emotion dysregulation and depressive symptoms) at both T1 and T2. Findings demonstrate the utility of contextual threat-based assessments within sexual minority research.

The Role of the Athletic Trainer in Providing Care to Transgender and Gender-Diverse Patients: Foundational Knowledge and Disparities-Part I

Transgender and gender-diverse (TGD) patients experience discrimination, harassment, marginalization, and minority stress at greater rates than their cisgender counterparts, leading to numerous health and health care disparities that negatively affect well-being and access to quality health care.1 Despite being in an opportune position to improve health equity for TGD patients under their care, many athletic trainers (ATs) report having little to no formal education on TGD patient care, leading to a reduction in self-reported competence. As such, to fill this knowledge gap, the purposes of the first part of this 2-part narrative literature review are to (1) provide readers with foundational information and terminology, (2) explore relevant health and health care disparities, and (3) identify the role of the AT within an interprofessional care team treating TGD patients.

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.

Classroom Voices: Youth Perspectives to Direct School-based Sexual Health Education

Sexual health education is a well-known, evidence-based intervention that can improve adolescent health outcomes, increase protective health behaviours, and decrease risky health behaviours. Providing sexual health education in school settings offers opportunities for discussion of critical health topics and can improve the school environment for all students. However, not all sexual health education is taught equitably across classroom environments. As part of a mixed-methods study to describe school-based sexual health education, we conducted focus groups and interviews with recently graduated high school students in New Mexico, a geographically and ethnically diverse state in the US Southwest. Thirty-one young people shared their experiences, explored the sexual health education content they had been taught, and offered recommendations to improve sexual health education. Three key themes were developed: young people wanted and needed sexual health education taught in school settings; the sexual health education currently taught in school is not helpful and sometimes harmful; and the individuals who teach sexual health education are critically important. These findings can inform and support school staff and administrators addressing barriers to school-based sexual health education delivery, particularly in schools within marginalised communities with limited resources. The results support including youth as stakeholders in the planning, delivery and evaluation of school-based sexual health education; and the development of sexual health education training for teachers, with the goal of improving health outcomes for all youth populations.

"I wish I actually had known what the heck sex was:" What adolescent sexual minority males knew and wish they knew prior to sexual debut with a male partner

Introduction

Understanding the sexual health needs of adolescent sexual minority males (ASMM) at the time of sexual debut will inform programs seeking to decrease sexual health inequities experienced by ASMM.

Methods

In 2020, sexually active, cisgender ASMM (n=102, age 14-17) in the United States completed the baseline assessment of an online sexual health intervention pilot trial. Participants responded to closed- and open-ended questions about their sexual debut with a male partner, including sexual behavior, skills and knowledge they knew and wish they knew at the time of their debut, and sources of said skills and knowledge.

Results

On average, participants were 14.5 years old (SD=1.4) at their debut. Participants reported knowing how to say no to sex (80%) and wishing they knew how to talk with partners about what they would (50%) and would not (52%) like to do sexually. Open-ended responses indicated that participants desired sexual communication skills at sexual debut. Personal research (67%) was the most common knowledge source prior to debut, and open-ended responses suggest that Google, pornography, and social media were the most frequently used websites and phone applications to find information about sex.

Conclusions

Results suggest sexual health programs for ASMM should occur prior to sexual debut, teach sexual communication skills, and teach media literacy skills to help youth deduce credible sexual health resources.

Policy Implications

Incorporating the sexual health needs and wants of ASMM into sexual health programs will likely improve acceptability and efficacy, and ultimately decrease sexual health inequities experienced by ASMM.

Dispersion of contraceptive access policies across the United States from 2006 to 2021

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We surveil and present patterns in contraceptive policies across states and time.

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States commonly increased Advanced Practice Registered Nurses’ practice authority.

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Medicaid expansion policies were also common during the study period.

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More expansive contraceptive policies were enacted in West and Northeast regions.

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We provide contraceptive access policy data by state and year for future research.

Person-centered contraceptive access benefits reproductive autonomy, sexual wellbeing, menstrual regulation, and other preventive health. However, contraceptive access varies by social and geographic position, with policies either perpetuating or alleviating health inequities. We describe geographic and time-trend variation in an index from fewer (less expansive) to greater (more expansive) aggregation of U.S. state-level contraceptive access policies across 50 states and Washington, D.C. (collectively, states) from 2006 to 2021. We collected data from primary and secondary sources on 23 policies regulating contraceptive education, insurance coverage, minor’s rights, provider authority, and more. As of 2021, the most enacted policies expanded contraceptive access through: 1) prescribing authority for nurse practitioners, certified nurse-midwives (n = 50, 98 % of states), and clinical nurse specialists (n = 38, 75 %); 2) Medicaid expansion (n = 38, 75 %); 3) prescription method insurance coverage (n = 30, 59 %); and 4) dispensing authority for nurse practitioners and certified nurse-midwives (n = 29, 57 %). The average overall U.S. policy index value increased in expansiveness from 6.9 in 2006 to 8.6 in 2021. States in the West and Northeast regions had the most expansive contraceptive access landscapes (average index values of 9.0 and 8.2, respectively) and grew more expansive over time (increased by 4–5 policies). The Midwest and South had least expansive landscapes (average index values of 5.0 and 6.1, respectively). Regions with more expansive sexual and reproductive health policy environments further expanded access, whereas least expansive environments were maintained. More nuanced understanding of how contraceptive policy diffusion affects health outcomes and equity is needed to inform public health advocacy and law making.

Enfermeiros diante do cuidado à saúde de adolescentes gays

Resumo Objetivo: analisar narrativas de enfermeiros sobre o cuidado à saúde de adolescentes gays. Método: estudo qualitativo, ancorado na Análise Temática de Clarke e Braun, adotando como referencial teórico o Interacionismo Simbólico, uma vez que ele favorece a apreensão da relação de comportamentos, interações e significados sociais. Foram entrevistados remotamente 12 enfermeiros, recrutados a partir da técnica de bola de neve, por meio da plataforma de vídeo Google Meet ® . Resultados: ao longo do processo compreensivo-interpretativo, foram elaborados quatro temas: “Adolescente gay, pautas e relação com a saúde”; “A família do adolescente gay e o cuidado”; “Relação com adolescente gay no cuidado” e “Limites para o cuidar de enfermagem ao adolescente gay”. Conclusão: as narrativas denunciam estigmas e símbolos derivados da cisheteronormatividade como intervenientes da relação e indicam premência de apostas no encontro intersubjetivo com os adolescentes gays e seus familiares em relação horizontal, afetiva e empática, com chances de favorecer defesa pública do direito à saúde. Há apontamentos para a atitude dos enfermeiros e qualificação do cuidado a essa população.

Los enfermeros frente al cuidado de la salud de los adolescentes gays

Resumen Objetivo: analizar los relatos de los enfermeros sobre el cuidado de la salud de los adolescentes gays. Método: estudio cualitativo, anclado en el Análisis Temático de Clarke y Braun, adoptando el Interaccionismo Simbólico como marco teórico, ya que favorece la aprehensión de la relación de comportamientos, interacciones y significados sociales. Fueron entrevistados remotamente 12 enfermeros, reclutados a partir de la técnica de bola de nieve, por medio de la plataforma de video Google Meet ® . Resultados: a lo largo del proceso comprensivo-interpretativo, se elaboraron cuatro temas: “Adolescente gay, pautas y relación con la salud”; “La familia del adolescente gay y el cuidado”; “Relación con adolescente gay en el cuidado” y “Límites para el cuidado de enfermería al adolescente gay”. Conclusión: las narrativas denuncian los estigmas y símbolos derivados de la cisheteronormatividad como intervinientes de la relación e indican la urgencia de apuestas en el encuentro intersubjetivo con los adolescentes gays y sus familiares en relación horizontal, afectiva y empática, con posibilidades de favorecer la defensa pública del derecho a la salud. Hay apuntes para la actitud de los enfermeros y calificación del cuidado a esa población.

Nurses and health care for gay adolescents

Objective:

to analyze nurses’ statements about health care for gay adolescents.

Method:

qualitative study, anchored on the Thematic Analysis of Clarke and Braun, with adoption of Symbolic Interactionism as a theoretical framework, since it favors the understanding of the relationship between behaviors, interactions, and social meanings. Twelve nurses recruited using the snowball sampling technique were remotely interviewed via the Google Meet^® video-conferencing app.

Results:

four themes were elaborated throughout the comprehensive-interpretative process: “Gay adolescents, agendas, and relation with health;” “The gay adolescent’s family and care;” “Relationship with gay adolescents in care,” and “Limits to nursing care for gay adolescents.”

Conclusion:

the statements denounce stigmas and symbols derived from cisheteronormativity as intervening in the relationship and indicate the urgency of investing in the intersubjective encounter with gay adolescents and their families in a horizontal, affective, and empathic relationship, with chances of favoring public defense of the right to health. There are comments on the nurses’ attitude and qualification of care for this population.

Examining LGBTI+ inclusive sexual health education from the perspective of both youth and facilitators: a systematic review

OBJECTIVES

To critically appraise and synthesise the evidence in relation to both the receipt and delivery of LGBTI+ (Lesbian, Gay, Bisexual, Transgender, Intersex) inclusive sexual health education.

DESIGN

A systematic review and narrative synthesis.

DATA SOURCES

A systematic search of three online databases (EMBASE, PsychINFO and SocINDEX) from January 1990 to May 2021 was conducted.

ELIGIBILITY CRITERIA

Studies included were (1) peer-reviewed; (2) English; (3) quantitative, qualitative and mixed methods; that evaluated (4) inclusive sexual health in an educational or online setting and (5) focused on training or educating. Studies were excluded if (1) the population was not LGBTI+ inclusive; (2) the studies did not focus on original data or (3) the study was not available in full text.

DATA EXTRACTION AND SYNTHESIS

The studies that met the inclusion criteria were assessed using the Critical Appraisal Skills Programme tool. A narrative synthesis was then completed employing content analysis focusing on the results section of each article.

RESULTS

Of the 5656 records retrieved, 24 studies met the inclusion criteria. The majority of studies noted that both LGBTI+ youth and those who facilitate sexual health education are turning to online sources of information. Current sexual health education programmes operate mainly from a heterosexual perspective, creating a sense of exclusion for LGBTI+ youth. This is compounded by a lack of training, or provision of an inclusive curricula, resulting in facilitators feeling ill equipped or inhibited by their personal biases.

CONCLUSIONS

LGBTI+ youth are not experiencing inclusive and comprehensive sexual health education. In parallel, educators report poor access to information, training and resources remain the primary reasons. There is a need to standardise sexual health curricula, making them LGBTI+ inclusive and incorporate holistic aspects of health such as pleasure and healthy relationships. Online approaches should be considered in the future, as they represent equality of access for both sexual health education professionals and LGBTI+ youth alike.