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Coulter RW, Mahal IK, Lin CA, Schneider SK, Mathias AS, Baral K, Miller E, Abebe KZ. Providing Lesbian, Gay, Bisexual, Transgender, Nonbinary, and Queer Adolescents With Nurturance, Trustworthiness, and Safety: Protocol for Pilot Cluster Randomized Controlled Trial Design. JMIR Res Protoc 2024; 13:e55210. [PMID: 38502156 PMCID: PMC10988370 DOI: 10.2196/55210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Sexual and gender minority youths (lesbian, gay, bisexual, transgender, nonbinary, and queer individuals) face elevated risks of substance use (eg, alcohol and tobacco) and mental health issues (eg, depressive symptoms and suicidality) compared to their cisgender heterosexual peers. These inequities are hypothesized to be reduced by building supportive high school environments via the training of school staff. An intervention that trains school staff to better understand and support sexual and gender minority youths and engage in positive bystander behaviors that protect them from bullying exposure may reduce disparities in drug and alcohol use among them. Experts, school staff, and sexual and gender minority youths developed Providing LGBTQ+ Adolescents with Nurturance, Trustworthiness, and Safety (PLANTS), a web-based intervention to train school staff on how to support, affirm, and protect sexual and gender minority youths. OBJECTIVE This paper describes the design of the PLANTS pilot trial primarily aimed at assessing its acceptability, usability, appropriateness, and feasibility. We hypothesize PLANTS will have high acceptability, usability, appropriateness, and feasibility as rated by the school staff. Secondary objectives focus on implementation, safety, and pre-post changes in high school staff outcomes, including self-efficacy and skills (eg, active-empathic listening and bullying intervention). Exploratory objectives focus on the impact of PLANTS on student health outcomes. METHODS In a 2-arm cluster randomized controlled trial, high schools in Massachusetts are allocated to PLANTS or an active comparator group (publicly available sexual and gender minority youths resources or training). High school staff complete pretest and posttest surveys containing validated scales. Primary outcomes are validated measures of acceptability, usability, appropriateness, and feasibility of the intervention completed by staff during posttest surveys. To test our primary hypotheses for each outcome, we will calculate means and 95% CIs and P values using 1-sample 2-sided t tests against a priori thresholds or benchmarks of success. Secondary outcomes include staff's active-empathetic listening skills, self-efficacy for working with sexual and gender minority youths, bystander intervention behaviors for bullying and cyberbullying, and self-efficacy for PLANTS' change objectives completed during pretest and posttest staff surveys. Staff can also complete a posttest interview guided by the Information-Motivation-Behavior model and Consolidated Framework for Implementation Research. Exploratory outcomes include student-level data collected via the 2021 and 2023 MetroWest Adolescent Health Surveys, a health behavior surveillance system in 30 Massachusetts schools. RESULTS School enrollment began in May 2023 and participant enrollment began in June 2023. Data collection is expected to be completed by February 2024. CONCLUSIONS This pilot trial will yield important information about the PLANTS intervention and provide necessary information to conduct a fully powered trial of the efficacy of PLANTS for reducing the deleterious health inequities experienced by sexual and gender minority youths. TRIAL REGISTRATION ClinicalTrials.gov NCT05897827; https://clinicaltrials.gov/study/NCT05897827. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55210.
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Affiliation(s)
- Robert Ws Coulter
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Isabella Kaur Mahal
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Clarisse A Lin
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Aaryn S Mathias
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Karuna Baral
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Elizabeth Miller
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Kaleab Z Abebe
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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Cruz TH, Ross-Reed DE, FitzGerald CA, Overton K, Landrau-Cribbs E, Schiff M. Effects of School Policies and Programs on Violence Among All High School Students and Sexual and Gender Minority Students. THE JOURNAL OF SCHOOL HEALTH 2023; 93:679-689. [PMID: 37408512 DOI: 10.1111/josh.13297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/08/2022] [Accepted: 02/05/2023] [Indexed: 07/07/2023]
Abstract
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.
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Affiliation(s)
- Theresa H Cruz
- Research Associate Professor, , Department of Pediatrics, Division of Prevention and Population Sciences, Deputy Director, UNM Prevention Research Center, University of New Mexico, MSC 11 61451, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Danielle E Ross-Reed
- Evaluation Consultant, , Department of Pediatrics, Division of Prevention and Population Sciences, University of New Mexico, MSC 11 6145, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Courtney A FitzGerald
- Sr. Research Scientist 2, , Department of Pediatrics, UNM Prevention Research Center, MSC 11 6145, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Kathryn Overton
- Doctoral Student, , Department of Political Science, MSC 05-3070, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA
| | - Erica Landrau-Cribbs
- Associate Scientist 2, , Department of Pediatrics, UNM Prevention Research Center, MSC 11 6145, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Melissa Schiff
- Professor Emerita, , Department of Internal Medicine, Division of Epidemiology, Biostats, and Preventive Medicine, MSC10 5550, 1 University of New Mexico, Albuquerque, NM, 87131, USA
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Coulter RWS, Colvin S, Onufer LR, Arnold G, Akiva T, D’Ambrogi E, Davis V. Training Pre-Service Teachers to Better Serve LGBTQ High School Students. JOURNAL OF EDUCATION FOR TEACHING : INTERNATIONAL RESEARCH AND PEDAGOGY 2020; 47:234-254. [PMID: 33986557 PMCID: PMC8112552 DOI: 10.1080/02607476.2020.1851137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 11/11/2020] [Indexed: 06/12/2023]
Abstract
Pre-service teachers rarely receive training on how best to serve lesbian, gay, bisexual, transgender, and queer (LGBTQ) high school students. We tested whether participating in LGBTQ-focused service-based learning or LGBTQ-focused didactic training improved pre-service teachers' knowledge, attitudes, self-efficacy, and skills for serving LGBTQ high school students more than a control group. A non-randomised pre-test-post-test design with eighty-eight participants tested these differences. At post-test, the service-based learning group had significantly higher active-empathic listening and self-efficacy for working with LGBTQ high school students than the control group. There were no differences for didactic versus control groups. Overall, service-based learning may better prepare pre-service teachers to serve LGBTQ high school students.
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Affiliation(s)
- Robert W. S. Coulter
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, Pennsylvania, USA 15261
- Division of Adolescent and Young Adult Medicine, Children’s Hospital of Pittsburgh of UPMC, 3414 Fifth Ave, Pittsburgh, Pennsylvania, USA 15213
- Clinical and Translational Science Institute, School of Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, Pennsylvania, USA 15261
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, Pennsylvania, USA 15261
| | - Sharon Colvin
- School of Education, University of Pittsburgh, 5930 Wesley W. Posvar Hall, Pittsburgh, Pennsylvania, USA 15260
| | - Lindsay R. Onufer
- School of Education, University of Pittsburgh, 5930 Wesley W. Posvar Hall, Pittsburgh, Pennsylvania, USA 15260
| | - Glynis Arnold
- THRIVE of Southwest PA, PO Box 10565, Pittsburgh, Pennsylvania, USA 15235
| | - Thomas Akiva
- School of Education, University of Pittsburgh, 5930 Wesley W. Posvar Hall, Pittsburgh, Pennsylvania, USA 15260
| | - Eric D’Ambrogi
- THRIVE of Southwest PA, PO Box 10565, Pittsburgh, Pennsylvania, USA 15235
| | - Vanessa Davis
- THRIVE of Southwest PA, PO Box 10565, Pittsburgh, Pennsylvania, USA 15235
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Coulter RWS, Egan JE, Kinsky S, Friedman MR, Eckstrand KL, Frankeberger J, Folb BL, Mair C, Markovic N, Silvestre A, Stall R, Miller E. Mental Health, Drug, and Violence Interventions for Sexual/Gender Minorities: A Systematic Review. Pediatrics 2019; 144:e20183367. [PMID: 31427462 PMCID: PMC6855817 DOI: 10.1542/peds.2018-3367] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2019] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Compared with cisgender (nontransgender), heterosexual youth, sexual and gender minority youth (SGMY) experience great inequities in substance use, mental health problems, and violence victimization, thereby making them a priority population for interventions. OBJECTIVE To systematically review interventions and their effectiveness in preventing or reducing substance use, mental health problems, and violence victimization among SGMY. DATA SOURCES PubMed, PsycINFO, and Education Resources Information Center. STUDY SELECTION Selected studies were published from January 2000 to 2019, included randomized and nonrandomized designs with pretest and posttest data, and assessed substance use, mental health problems, or violence victimization outcomes among SGMY. DATA EXTRACTION Data extracted were intervention descriptions, sample details, measurements, results, and methodologic rigor. RESULTS With this review, we identified 9 interventions for mental health, 2 for substance use, and 1 for violence victimization. One SGMY-inclusive intervention examined coordinated mental health services. Five sexual minority-specific interventions included multiple state-level policy interventions, a therapist-administered family-based intervention, a computer-based intervention, and an online intervention. Three gender minority-specific interventions included transition-related gender-affirming care interventions. All interventions improved mental health outcomes, 2 reduced substance use, and 1 reduced bullying victimization. One study had strong methodologic quality, but the remaining studies' results must be interpreted cautiously because of suboptimal methodologic quality. LIMITATIONS There exists a small collection of diverse interventions for reducing substance use, mental health problems, and violence victimization among SGMY. CONCLUSIONS The dearth of interventions identified in this review is likely insufficient to mitigate the substantial inequities in substance use, mental health problems, and violence among SGMY.
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Affiliation(s)
- Robert W S Coulter
- Departments of Behavioral and Community Health Sciences and
- Center for LGBT Health Research, Graduate School of Public Health, and
- Department of Medicine, School of Medicine, and
- Department of Pediatrics, School of Medicine, University of Pittsburgh and Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - James E Egan
- Departments of Behavioral and Community Health Sciences and
- Center for LGBT Health Research, Graduate School of Public Health, and
| | - Suzanne Kinsky
- Departments of Behavioral and Community Health Sciences and
- Center for LGBT Health Research, Graduate School of Public Health, and
- Center for High-Value Health Care, UPMC, Pittsburgh, Pennsylvania; and
| | - M Reuel Friedman
- Center for LGBT Health Research, Graduate School of Public Health, and
- Infectious Diseases and Microbiology, and
| | | | | | - Barbara L Folb
- Departments of Behavioral and Community Health Sciences and
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christina Mair
- Departments of Behavioral and Community Health Sciences and
| | - Nina Markovic
- Center for LGBT Health Research, Graduate School of Public Health, and
- Department of Dental Public Health, School of Dental Medicine
| | - Anthony Silvestre
- Center for LGBT Health Research, Graduate School of Public Health, and
| | - Ron Stall
- Departments of Behavioral and Community Health Sciences and
- Center for LGBT Health Research, Graduate School of Public Health, and
| | - Elizabeth Miller
- Departments of Behavioral and Community Health Sciences and
- Department of Pediatrics, School of Medicine, University of Pittsburgh and Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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