High School FLASH Sexual Health Education Curriculum: LGBTQ Inclusivity Strategies Reduce Homophobia and Transphobia

Homophobic and transphobic beliefs that lead to bias-based harassment remain a critical concern for young people in the USA. The aim of the present study was to examine the impact of an inclusive comprehensive sex education program (High School FLASH) on homophobic and transphobic beliefs. Data from this study come from a randomized controlled trial that evaluated the impact of High School FLASH on students' sexual behaviors and related outcomes with 20 schools in two U.S. regions (Midwest and South). Following the baseline survey, the 20 schools were randomly assigned to receive FLASH or a comparison curriculum. Ninth and 10th grade students completed follow-up surveys 3 and 12 months after the instructional period. We examined changes in homophobic beliefs using multilevel linear regression models in the full sample and two sub-groups: straight cisgender young people versus those who identified as not straight or cisgender. Mean scores on the homophobic and transphobic beliefs scale were statistically significantly lower among young people receiving FLASH relative to the comparison at both the 3- and 12-month timepoints (p-values for adjusted mean differences were < 0.01, n = 1357 and 1275, respectively). Specifically, FLASH's positive impact on reducing homophobic and transphobic beliefs was statistically significant for straight and cisgender youth at both survey follow-ups (p < 0.01, n = 1144 and p = 0.05, n = 1078, respectively); the effects for the LGBTQ sub-group reached statistical significance at only the final follow-up (p = 0.01, n = 197). Our results show that carefully designed, inclusive comprehensive sexual health education programs like High School FLASH can play a role in promoting better school climates for all youth by reducing beliefs that may lead to bullying, violence, and victimization.

Equity on the frontlines of trauma surgery: An #EAST4ALL roundtable

BACKGROUND

Inequity exists in surgical training and the workplace. The Eastern Association for the Surgery of Trauma (EAST) Equity, Quality, and Inclusion in Trauma Surgery Ad Hoc Task Force (EAST4ALL) sought to raise awareness and provide resources to combat these inequities.

METHODS

A study was conducted of EAST members to ascertain areas of inequity and lack of inclusion. Specific problems and barriers were identified that hindered inclusion. Toolkits were developed as resources for individuals and institutions to address and overcome these barriers.

RESULTS

Four key areas were identified: (1) harassment and discrimination, (2) gender pay gap or parity, (3) implicit bias and microaggressions, and (4) call-out culture. A diverse panel of seven surgeons with experience in overcoming these barriers either on a personal level or as a chief or chair of surgery was formed. Four scenarios based on these key areas were proposed to the panelists, who then modeled responses as allies.

CONCLUSION

Despite perceived progress in addressing discrimination and inequity, residents and faculty continue to encounter barriers at the workplace at levels today similar to those decades ago. Action is needed to address inequities and lack of inclusion in acute care surgery. The EAST is working on fostering a culture that minimizes bias and recognizes and addresses systemic inequities, and has provided toolkits to support these goals. Together, we can create a better future for all of us.

Using Electronic Contact to Reduce Homonegative Attitudes, Emotions, and Behavioral Intentions Among Heterosexual Women and Men: A Contemporary Extension of the Contact Hypothesis

The current study experimentally examined the potential for a contemporary extension of the contact hypothesis, known as electronic contact, or E-contact, to reduce sexual prejudice, intergroup anxiety, and avoidant behavioral intentions among heterosexuals. It also extended the sexual minority contact literature by examining the role of participant and interaction partner sex as a possible boundary condition of this contact-prejudice relationship. To test our hypotheses, 140 heterosexual female and male university students were randomly allocated to interact with a homosexual or heterosexual, female or male E-contact partner, in a collaborative and text-only online interaction before completing the outcome measures. Overall, the results demonstrated that interacting online with a female, as opposed to a male, homosexual E-contact partner reduced heterosexual men's feelings of intergroup anxiety, which in turn was associated with lower sexual prejudice and outgroup avoidance. For heterosexual women, however, E-contact did not influence the outcome variables. In the context of sexual prejudice, these results suggest that E-contact may be particularly useful as a prejudice-reduction strategy among individuals who typically require it most: heterosexual men.

Training to reduce LGBTQ-related bias among medical, nursing, and dental students and providers: a systematic review

BACKGROUND

Lesbian, gay, bisexual, transgender and questioning (LGBTQ) individuals experience higher rates of health disparities. These disparities may be driven, in part, by biases of medical providers encountered in health care settings. Little is known about how medical, nursing, or dental students are trained to identify and reduce the effects of their own biases toward LGBTQ individuals. Therefore, a systematic review was conducted to determine the effectiveness of programs to reduce health care student or provider bias towards these LGBTQ patients.

METHODS

The authors performed searches of online databases (MEDLINE/PubMed, PsycINFO, Web of Science, Scopus, Ingenta, Science Direct, and Google Scholar) for original articles, published in English, between March 2005 and February 2017, describing intervention studies focused on reducing health care student or provider bias towards LGBTQ individuals. Data extracted included sample characteristics (i.e., medical, nursing, or dental students or providers), study design (i.e., pre-post intervention tests, qualitative), program format, program target (i.e., knowledge, comfort level, attitudes, implicit bias), and relevant outcomes. Study quality was assessed using a five-point scale.

RESULTS

The search identified 639 abstracts addressing bias among medical, nursing, and dental students or providers; from these abstracts, 60 articles were identified as medical education programs to reduce bias; of these articles, 13 described programs to reduce bias towards LGBTQ patients. Bias-focused educational interventions were effective at increasing knowledge of LGBTQ health care issues. Experiential learning interventions were effective at increasing comfort levels working with LGBTQ patients. Intergroup contact was effective at promoting more tolerant attitudes toward LGBTQ patients. Despite promising support for bias education in increasing knowledge and comfort levels among medical, nursing, and dental students or providers towards LGBTQ persons, this systematic review did not identify any interventions that assessed changes in implicit bias among students or providers.

CONCLUSIONS

Strategies for assessing and mitigating implicit bias towards LGBTQ patients are discussed and recommendations for medical, nursing, and dental school curricula are presented.

Negotiating Theory When Doing Practice: A Systematic Review of Qualitative Research on Interventions to Reduce Homophobia

We performed a systematic review of qualitative research on interventions to reduce homophobia. Specifically, we conducted a thematic analysis of participant feedback given in 30 qualitative and mixed-methods studies. Participants often described interventions as "eye-opening." However, they also criticized many interventions for their mismatch with the social, historical, or institutional context in which they were conducted. Some participants rejected the interventions altogether, describing them as offensive or disgusting. We drew three conclusions. First, participants not only were actively making sense of the interventions but also were often aware of philosophical and political tensions (especially liberal vs. queer approaches). Second, participants sometimes used the perceived inadequacy of the intervention for the local context as an argument to resist change. Finally, tensions in participant feedback (eye-opening vs. disgusting) can be read as evidence that reducing homophobia is "dirty work": such work is both vital for society and despised by many.

Subverting Heteronormativity: An Intervention to Foster Positive Attitudes Toward Homosexuality Among Indian College Students

Prejudice against gay and lesbian persons remains largely an unaddressed issue in India. This experimental study involved designing, implementing, and assessing the effectiveness of an intervention to foster positive attitudes toward the homosexual community among Indian college students. The experimental group (n = 60) received a three-component module including perspective taking, education, and direct contact with gay and lesbian persons. Attitudes toward homosexuals, empathy, and self-esteem were measured using standardized questionnaires 15 days before the intervention and immediately following the intervention. No intervention was carried out with the control group (n = 55). Their attitudes were measured 15 days apart, parallel to the experimental group. Results showed that attitudes toward homosexuality improved significantly in the experimental group. The control group also showed a significant, but small, improvement in attitudes. Further, levels of empathy were found to increase only in the experimental group. Limitations, future directions, and implications of the study are discussed.

When "They" Become "Us": The Effect of Time and Ingroup Identity on Perceptions of Gay and Lesbian Group Members

Prejudice change manipulations rarely produce the expected attitude change effects. Our research suggests that attitude change depends on time-dependent memory consolidation processes. This study tested the effects of group information and time on perceptions of gays and lesbians. Heterosexual participants (N = 90) were randomly assigned to a condition where their ingroup, or an outgroup, included gay and lesbian individuals. We measured participants' gay and lesbian political attitudes and evaluations of the groups' members at a short or long delay. Results showed no effect of our manipulations on political attitudes, F(1, 86) = 0.14, p = .72. Contrary to predictions, participants evaluated gay and lesbian ingroup members less positively at the long versus short delay, t(49) = 3.72, p = .0004, d = 1.01. Results suggest that members of stigmatized groups are perceived more negatively when associated with one's ingroup.

Understanding and Reducing Sexual Prejudice in Jamaica: Theoretical and Practical Insights From a Severely Anti-Gay Society

Jamaica has earned an international reputation for severe sexual prejudice-perhaps disproportionately so compared to other severely anti-LGBT (lesbian, gay, bisexual, and transgender) societies. Until recently, however, no quantitative empirical research had investigated Jamaica's sexual prejudice, leaving the prejudice poorly understood and methods of reducing it unclear. This article reviews empirical research on Jamaican anti-LGBT prejudice from the past 15 years. It situates Jamaica within the global context, explains the current understanding of the severity and nature of the problem, evaluates solutions currently being explored, and suggests promising strategies based on available evidence. Importantly, this article also reflects on lessons learned from Jamaica that are relevant for other severely anti-LGBT societies.

Beyond Men, Women, or Both: A Comprehensive, LGBTQ-Inclusive, Implicit-Bias-Aware, Standardized-Patient-Based Sexual History Taking Curriculum

Introduction

This standardized-patient-based module prepares medical students to take inclusive, comprehensive sexual histories from patients of all sexual orientations and gender identities. Health disparities faced by lesbian, gay, bisexual, transgender, and queer (LGBTQ) people are at least partially the result of inadequate access to health care and insufficient provider training. This module incorporates implicit bias activities to emphasize the important role providers can play in mitigating these disparities through compassionate, competent care. Furthermore, two of the three included cases highlight the negative impact sexual dysfunction can have on emotional well-being.

Methods

Over 3 hours, students participate in a 30-minute large-group lecture and three 40-minute small-group standardized patient encounters with debrief. Prework consists of a short video on sexual history taking, assigned readings, and an implicit bias activity. These materials are included in this resource, along with lecture slides, facilitator guide, and standardized patient cases. Though the cases are adaptable to all levels of medical education, this module is designed for second-year and early third-year medical students.

Results

Qualitative student evaluations were positive, and postparticipation surveys revealed statistically significant improvement in comfort with their ability to take a sexual history in general, and take one from patients with a differing sexual orientation. Deployed in the second year of our Doctoring curriculum, this module continues to receive positive evaluations.

Discussion

Introducing these skills begins to address the curricular deficiencies seen across medical education and lays the foundation for a more competent health care workforce to address the needs of LGBTQ patients.

Gay-Straight Alliances are Associated with Lower Levels of School-Based Victimization of LGBTQ+ Youth: A Systematic Review and Meta-analysis

Gay-straight alliances (GSAs) are school-based organizations for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) youth and their allies that often attempt to improve school climate for sexual and gender minority youth. This meta-analysis evaluates the association between school GSA presence and youth's self-reports of school-based victimization by quantitatively synthesizing 15 primary studies with 62,923 participants. Findings indicate GSA presence is associated with significantly lower levels of youth's self-reports of homophobic victimization, fear for safety, and hearing homophobic remarks, and these results are robust, controlling for a variety of study-level factors. The findings of this meta-analysis provide evidence to support GSAs as a means of protecting LGTBQ+ youth from school-based victimization.

Understanding antigay bias from a cognitive-affective-behavioral perspective

In general, United States citizens have become increasingly more accepting of lesbians and gay men over the past few decades. Despite this shift in public attitudes, antigay bias remains openly tolerated, accepted, practiced, and even defended by a substantial portion of the population. This article reviews why and how antigay bias persists using a cognitive-affective-behavioral perspective that touches on sociocognitive factors such as prejudice and stereotyping, as well as features unique to antigay bias, such as its concealable nature. The article concludes with a discussion of how understanding modern antigay bias through a cognitive-affective-behavioral lens can be applied to reduce discrimination against gays and lesbians.

[Discrimination and homophobia associated to the human immunodeficiency virus epidemic]

OBJECTIVE

To describe a political mapping on discrimination and homophobia associated to human immunodeficiency virus (HIV) in the context of public institutions in Mexico.

MATERIALS AND METHODS

The political mapping was conducted in six Mexican states. Stakeholders who were involved in HIV actions from public and private sectors were included. Semistructured interviews were applied to explore homophobia and discrimination associated with HIV. Information was systematized using the Policy Maker software, which is a good support for analyzing health policies.

RESULTS

Discriminatory and homophobic practices in the public domain occurred, damaging people´s integrity via insults, derision and hate crimes. Most stakeholders expressed a supportive position to prevent discrimination and homophobia and some of them had great influence on policy-making decisions. It was found that state policy frameworks are less specific in addressing these issues.

CONCLUSIONS

Homophobia and discrimination associated to HIV are still considered problematic in Mexico. Homophobia is a very sensitive issue that requires further attention. Also, an actual execution of governmental authority requires greater enforcement of laws against discrimination and homophobia.

"Honk against homophobia": rethinking relations between media and sexual minorities

The theory of "symbolic annihilation" or "symbolic violence" has been used in academic literature to describe the way in which sexual minorities have been ignored, trivialized, or condemned by the media. This article aims to de-center research from issues of media representation to consider the capacity for minority groups to proactively use new media and its various avenues for interactivity, social networking, and feedback to fight social exclusion. This work suggests that new media has become a space in which the nominally marginal in society may acquire "social artillery"-a term used to describe how sexual minorities utilize their expanding and more readily accessible social connections in digital space to combat instances of homophobia. The research draws on the results of an inquiry into the relation between media and a regional youth social justice group in Australia tackling homophobia. The research demonstrates that the group is becoming increasingly adept and comfortable with using a cross-section of media platforms to fulfill their own objectives, rather than seeing themselves as passive subjects of media representation. This article argues that this sets an example for other socially excluded groups looking to renegotiate their relation with the media in regional areas.

"There aren't any gays here": encountering heteroprofessionalism in an international development workplace

Western-oriented workplaces use professionalism as a normative value to sustain and promote a cohesive work environment. Yet, through this qualitative study, the author points out some implications of using professionalism to manage staff relationships and behaviors. Using post-conflict Kosovo as the context, the author examined (a) the work experiences of 8 gay male aid workers and (b) the attitudes toward homosexuality of foreign staff members in 2 international aid agencies. The author introduces and suggests heteroprofessionalism as a root to homophobic and heterosexist behaviors present in the study. Heteroprofessionalism is defined as a professional value that screens out homosexuality.

A network evaluation of attitudes toward gays and lesbians among U.S. military cadets

The U.S. military's ban on open homosexuality has become an increasingly salient issue since its implementation in 1993 and its repeal in 2011. The military is an organization with a unique professional and social organization. Evaluating military attitudes from a network perspective may offer insight into the role of formal and informal leadership in engendering attitudinal change and cultural tolerance around homosexuality. This study evaluates the role of network centrality and network exposure across formal (command networks) and informal (friendship and perceived leadership networks) structures on attitudes toward homosexuality in the military. This work analyzes survey data from a single cadet company within the U.S. Military Academy (n = 139) prior to the repeal of Don't Ask, Don't Tell. Results indicate that popular students tend to show tolerance toward homosexuality, whereas those who hold command leadership positions are more likely to have personal and professional opposition to homosexuality. In addition, formal superior-subordinate relationships are somewhat more likely to suggest social contagion compared to informal leadership and friendship relationships. Recommendations offer guidance for training strategies particularly with respect to a military leaders and socialization. Future research should monitor these issues relative to the post-DADT environment.

Prevalence of internalized homophobia and HIV associated risks among men who have sex with men in Nigeria

This study assessed the level of internalized homophobia and associated factors among men who have sex with men (MSM) in Nigeria. Using respondent driven sampling, MSM were recruited in Lagos and Ibadan between July and September, 2006. Internalized homophobia was assessed as a negative composite score using an 11-item scale. A total of 1,125 MSM were interviewed. About 44.4% self-identified as homosexual or gay while 55% regarded themselves as bisexual. About a third of the respondents reported internalized homophobia. With homosexual/gay men as reference, respondents who self-identified as bisexual were two times more likely [AOR 2.1; 95 CI: 1.6 - 2.9, p < 0.001] to report internalized homophobia. Those who were HIV positive were also twice as likely to report internalized homophobia compared to those who were HIV negative [AOR 1.8; 95% CI: 1.2 - 2.7, p = 0.004]. As internalized homophobia impedes acceptance of HIV prevention programming, identifying MSM who experience internalized homophobia is integral to the success of HIV prevention programming in Nigeria.

Confronting hate: heterosexuals' responses to anti-gay comments

An online diary study was used to examine the individual and situational variables that influence non-targets' verbal and nonverbal reactions and responses to sexually prejudiced remarks. Results indicated that anti-gay comments were extremely prevalent in a college setting and resulted in a range of reactions and behaviors. Confrontation of the perpetrator was predicted by the perceived offensiveness of the comment, perceived social pressure to confront, and the number of close same-sex attracted friends. Additionally, those who confronted felt more satisfied with their responses than those who did not confront. Implications for future research and prejudice reduction strategies are discussed.