LGBTQ Student Health: A Mixed-Methods Study of Unmet Needs in Massachusetts Schools

Using youth participatory action research to explore the impacts of structural violence on LGBTQIA + youth health

Queerphobia is defined as society's negative attitude towards LGBTQIA + people, translating into structures that marginalise LGBTQIA + people and contribute to health inequities that cause real harm and can be understood as structural violence. The purpose of this article is to explore what historically marginalised youth in a youth participatory action research (YPAR) project characterise as the big picture issues affecting the lives of LGBTQIA + youth. We used participatory arts-based methods to conduct community and identity building, define research questions and photo prompts, conduct data collection, engage in group thematic analysis, and make recommendations at the state policy level. We also conducted individual semi-structured interviews with participants. Our findings can be grouped into three main themes: LGBTQIA + youth may feel it is safer to remain closeted; queerphobia perpetuates housing instability; and queerphobia functions as a structural barrier to social services. Youth also developed state level policy recommendations to address the structural issues causing harm to LGBTQIA + youth health. Recommendations included increasing access to affordable housing and LGBTQIA + inclusive foster and group homes, and advocating for government-funded LGBTQIA + specific healthcare practices for LGBTQIA + youth. More youth-driven data are needed that centre those directly impacted by structural violence and associated health outcomes.

LGBTQ+ Population Well-Being: Health Equity Implementation Science in Action

AIMS

Health equity is actualized when all individuals can attain the highest level of health. Youth who identify as LGBTQ+ experience health disparities and scarce access to culturally congruent mental healthcare. Our nurse-led research team recognized evidence-based practice guidance gaps and prioritized a systematic inquiry into the lived experiences of LGBTQ+ identifying youth who needed emergency care for suicidality. Concurrently, we translated new findings into practice. The purpose of this endeavor is to implement a nimble evidence-based practice adoption process for nursing staff to effectively address LGBTQ+ population health needs.

METHODS

Informed by Purnell's Cultural Competence Theory, qualitative findings from a prospective study and available literature, we developed an LGBTQ+ sensitive care curriculum for nursing staff using the American Nurses Credentialing Center's (ANCC) Nursing Continuing Education Professional Development (NCPD) Framework to address the intersectionality of cultural awareness and care provision. The curriculum was delivered and formally evaluated longitudinally with a focus on communication confidence and knowledge.

RESULT

The curriculum was delivered in one session to nursing staff during a 6-month period. Program evaluations indicated curriculum acceptability and effectiveness. Participants reported improved ability to use appropriate language when communicating with patients who identify as LGBTQ+ and their families and a moderate to high change in confidence when providing care to LGBTQ+ identifying patients.

CONCLUSION

Concurrent, evidence-based efforts to uncover and apply new knowledge relevant to nursing communication with youth who identify as LGBTQ+ is possible and yield effective, positive change in nursing knowledge and confidence in providing care for these youth. Implementation science is essential to advance evidence-based nursing practice or the full positive impact of research on patient outcomes is not likely. When the implementation science program is not incorporated early in the research process, research excellence is at risk. Evolving evidence-based practices that enhance individualized holistic patient care delivery for LGBTQ+ individuals are strengthened when primary research, implementation science, and scaling research co-occurrence is achievable.

IMPLICATIONS FOR THE PROFESSION

This implementation strategy demonstrates that early translation of health equity research on culturally congruent care for individuals identifying as LGBTQ+ can be done effectively and replicated across practice settings. Further, this work validates the importance of the relationship between nurse scientists, translational scientists, and clinical practice and education experts in the early dissemination and adoption of new knowledge. Evidence-based practice adoption improves healthcare professionals' propensity to positively impact public health patient care outcomes.

IMPACT

Nursing staff are equipped with the knowledge and skills to deliver equitable care. Dissemination of early research findings as an implementation science strategy supports concurrent adoption in clinical practice to advance health equity outcomes with urgency.

PATIENT AND PUBLIC CONTRIBUTION

No patient or public contribution.

Youth-centered Recommendations to Address Social Stigma and Discrimination Against Unhoused Youth: An Integrative Literature Review

Youth between ages 13 and 25 who experience homelessness face numerous barriers to excellent health, including social stigma and discrimination. Applying socio-ecological model and intersectionality theory, an integrative literature review was conducted. Peer-reviewed studies (N = 29) representing 808,296 participants extracted from four databases (CINAHL, MEDLINE, PsychINFO, SocINDEX) were analyzed. The studies included sources of discrimination and stigma from interpersonal interactions with support services staff upwards to policy and systemic levels with housing and justice systems. Health outcomes include poorer physical and behavioral health status from increased likeliness of denied access to support services, prolonged time spent being homeless, and higher incidences of experiencing violence. School nursing has power to push for recommended changes and support unhoused youth towards excellent health. Proposed changes include adapting Housing First framework, engaging with unhoused youth in program planning, policy writing, and public education that address the causes of poverty.

Risk for experiencing psychological and sexual abuse on- and offline: a comparison of bisexual, gay/lesbian, and heterosexual women and men

Dating abuse research on lesbian, gay, and bisexual (LGB) populations tends to aggregate LGB participants for comparisons with heterosexuals and often excludes nonassaultive dating abuse and abuse that takes place on online dating applications. In the present study, we used the Pew Research Center's 2019 American Trends Panel Wave 56 data set (n = 4712) to compare ever experiencing several types of nonassaultive on- and offline dating abuse between bisexual women (n = 402), lesbian women (n = 207), heterosexual women (n = 1802), bisexual men (n = 225), gay men (n = 575), and heterosexual men (n = 1501). We found that gay men and bisexual women generally had the greatest odds of experiencing online dating abuse. Bisexual and heterosexual women had the greatest odds of experiencing some offline abuse (eg, being touched in an uncomfortable way), but gay men, bisexual women, and bisexual men had the greatest odds of experiencing other offline abuse (eg, having their contact information or a sexual image of them shared nonconsensually). Findings highlight how assessments of nonassaultive dating abuse in on- and offline contexts via analyses of more specified gender/sex and sexual identity groups can broaden understandings of dating abuse victimization, especially among sexual minority populations.

Challenges and Opportunities in Transitioning Autistic Individuals Into Adulthood

BACKGROUND AND OBJECTIVES

Approximately 1.2 million autistic youth will reach the legal age of adulthood over the next decade. Given dynamic changes in the socioecological context of the transition to adulthood, we produced an updated transitions research agenda reflecting the perspectives of autistic young adults, care partners (parents), and professionals who use autism research.

METHODS

We conducted 9 focus groups: 4 young adult, 4 care partner, and 1 professional, with 59 total participants. Young adults were grouped by self-reported identity: (1) racial and ethnic minority, (2) lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other identities, and (3) nonspeaking, in addition to a general group. We selected care partners who supported youth with varying intensity of support needs. We used rapid qualitative inquiry methods to extract key points from answers to semistructured interview questions.

RESULTS

Delays in diagnosis and transition processes, and placement on wait lists resulted in significant obstacles to successful transitions. Parents assumed a dominant role by coordinating services, navigating systems and identifying opportunities for community participation, and providing direct supports. There was an overarching need for inclusion of autistic people in transitions research and consideration of cultural differences in priorities and values. Participants prioritized investigation of variation in transitions among autistic youth with intersecting identities, navigation support (eg, peer mentors), efficacy of services and supports (eg, transition and employment services), differences in available services by location, and problems within specific benefits programs.

CONCLUSIONS

Research should focus on understanding population-level factors of system performance on outcomes and support needs, service delivery among marginalized groups, and transformation of complex service ecosystems.

Ethical and methodological challenges conducting participative research with transgender and gender-diverse young people: a systematic review

Introduction

Research with transgender and gender-diverse (TGD) young people is essential to understand their experiences and to be able to propose, implement and adapt 'services' in the broadest sense to meet their needs. However, research outside clinical settings on current experiences and needs of youth under the age of 18 is limited which hinders the development of knowledge on TGD, as well as the development of research informed support practices. Acquiring parental consent for participatory research may present ethical and logistical difficulties, as it could jeopardize the safety, well-being, or confidentiality of adolescent participants. This creates a tension between the adolescent's right to autonomy, privacy, freedom, and all aspects related to the consent of the underage on the one hand, and the parents' right to protect their child on the other hand. This review aims to identify the methodological and ethical challenges associated with participatory research with transgender and gender-diverse young people.

Methods

We systematically searched bibliometric databases for studies published between 2006 and 2022 and included 4 main conceptual groups: transgender and gender non-conforming, adolescence, qualitative research (including participatory research) and consent. This review was registered in PROSPERO (CRD42022368360) in November 2022.

Results

Of the 3,794 articles initially identified, 291 met the inclusion criteria and 48 were examined. The selected studies were analyzed in the light of four main ethical tensions: involving parents or a trusted person in the consent gathering process, ensuring the protection and safety of young people while respecting confidentiality, and ensuring that spaces are created for transgender and gender-diverse young people to express themselves freely as part of an empowering research process. At the same time, several methodological challenges concerning public and stakeholder participation and recruitment, data collection and analysis as well as research integrity emerged from the selected studies.

Conclusion & implications

The existing literature of participatory research involving young transgender and gender-diverse individuals underscores the intricate and conflicting aspects, especially concerning power dynamics, empowerment, and the researcher's role. The relevance of these findings extends across various legal frameworks and is applicable to multiple contexts and countries.

School health-care team members' reflections of their promotion of sexual and reproductive health and rights (SRHR): Important but neglected

OBJECTIVE

Young people are prioritized regarding the promotion and safeguarding of sexual and reproductive health and rights - SRHR. In Sweden, the school is seen as an important arena with members of the school health-care or SHC team as vital actors in this work. This study explored SRHR-related work in SHC teams in Sweden.

METHODS

Within an explorative qualitative design, structured interviews were conducted with 33 nurses, counsellors, SHC unit managers and headmasters. Reflexive thematic analysis was applied, and two main themes found.

RESULTS

SHC team members see SRHR as an urgent topic, but address it only 'when necessary', not systematically - and they experience a shortage of guidance and cooperation regarding SRHR-related work. Even in a country with agreement on the importance of SRHR for all and on providing holistic comprehensive sex education in schools, young people are left to chance - i.e., to the SRHR competence in the professionals they meet.

CONCLUSION

SHC team members in Sweden see SRHR as an urgent topic but do not address it systematically. Moreover, they experience a shortage of guidance for their work. To avoid any professional stress of conscience and for equitable school health care regarding SRHR to be realized, research-informed policy needs to underline systematic, comparable and proactive practice.

Exploring the Mental Health Challenges and Coping Behaviour of Lesbian, Gay, and Bisexual Students at an Institution of Higher Learning

The South African university community is predominantly heterosexual, which fosters stigmatisation and discrimination against LGBTQI students despite the efforts to create conditions where LGBTQI students can succeed academically, socially, and personally. The study aimed to explore and describe the challenges experienced by LGBTQI students and their mental well-being as well as the coping behaviours adopted in a university in South Africa. This was accomplished using a descriptive phenomenological approach. A snowballing sampling method was used to select ten students who identified themselves as gay, lesbian, and bisexual (LGB). Semi-structured one-on-one interviews were conducted, and data were analysed thematically. The students perceived character defects stigma from fellow students and lecturers in and out of class. The mental health challenges experienced included a diminished sense of safety, lack of a sense of belonging, low self-esteem, and acting out of character. As a result, confrontation, passive withdrawal, and active dependent behaviour were utilised as different types of coping behaviour. The LGB students were subjected to stigma that negatively affected their mental health. Therefore, creating awareness about the rights of LGBTQI students to education, safety, and self-determination is recommended.