School-based gay-affirmative interventions: first amendment and ethical concerns

The Development of Proud & Empowered: An Intervention for Promoting LGBTQ Adolescent Mental Health

Sexual and gender minority adolescents (SGMA) experience higher rates of internalizing psychopathology, including depression, anxiety, self-harm, and posttraumatic stress disorder. The primary explanation for these mental health disparities is minority stress theory, which suggests that discrimination, violence, and victimization are key drivers of chronic minority stress and place SGMA at higher risk of mental health concerns. To help address these concerns, the authors undertook a nearly 8-year process of developing Proud & Empowered, a school-based intervention to help SGMA cope with minority stress experiences. This manuscript details the intervention development process, including: (a) identifying the mechanisms of change (Stage 0), (b) building the intervention (Stage 1A, Part 1), (c) acceptability testing and program revision (Stage 1A, Part 2), (d) feasibility and pilot testing (Stage 1B, Part 1), (e) modification of the intervention to improve implementability (Stage 1B, Part 2), and (f) the final intervention.

What triggers depressive symptoms among gay and bisexual men? A sequential mediation model of sexual minority-related stigma and self-criticism

A growing number of studies has shown that gay and bisexual men are more likely to experience adverse mental health status than their heterosexual counterparts. Stigma-related stress and self-criticism are believed likely to exacerbate depressive symptoms among gay and bisexual men. This research used cross-sectional findings to illustrate the mediating role of internalized self-stigma and self-criticism in the association between perceived public stigma and depressive symptoms. A total of 317 Chinese gay and bisexual men (267 gays and 50 bisexuals with a mean age of 25.29) were invited to participate in this study from October to November 2021. Sociodemographic characteristics, perceived public stigma, internalized self-stigma, self-criticism and depressive symptoms were measured through self-reported online questionnaires. The results indicated that the association between perceived public stigma and depressive symptoms was sequentially mediated by internalized self-stigma and self-criticism. The findings indicated that public stigma, as a distal stressor, was perceived and internalized as self-stigma by gay and bisexual men. This self-stigma may pose a risk for depressive symptoms via self-criticism (a maladaptive consequence of their attempts to reduce cognitive dissonance). These results highlight the necessity of reducing sexual minority-related stigma and self-criticism to reduce depressive symptoms. Our findings appeal to society to further decrease prejudice and stigma, increase tolerance, and focus on the negative mental health status of gay and bisexual men.

Confirming the Reliability and Validity of the Sexual Minority Adolescent Stress Inventory in a National Sample of Sexual Minority Adolescents

Objective: Sexual minority adolescents (SMA) experience numerous behavioral health disparities, including depression, anxiety, substance use, non-suicidal self-injury, and suicidality. The primary framework to understand these disparities is minority stress theory, which frames this disproportionate burden as the result of discrimination, violence, and victimization in a homophobic culture. Empirical examinations of minority stress among SMA have been limited by lack of diverse samples or validated measures. This study engaged a national community sample of SMA to confirm reliability and validity of the Sexual Minority Adolescent Stress Inventory (SMASI). Method: A national sample of 2,310 SMA aged 14-17 was recruited in the United States through a hybrid social media and respondent-driven sampling approach. Item response theory and confirmatory factor analysis established the psychometric properties of the SMASI in this sample; minority stress was modeled as a latent variable in several regression models to verify criterion and divergent validity. Results: In this national sample (M age = 15.9; 64% female and 60% White), the factor structure of the SMASI and its 11 subscales was confirmed and shown to be invariant by demographic characteristics. Minority stress as measured by the SMASI was significantly associated with all mental and behavioral health outcomes. Conclusions: This study provides evidence that SMASI is a reliable, valid, and important tool for better understanding minority stress and subsequent health and mental health consequences among SMA.

Homophobic Bullying and Suicidal Behavior Among US Heterosexual Youth

Homophobic bullying is pervasive in schools, and has been linked with suicidality among sexual minority youth. In prior studies, heterosexual adolescents have typically served as the reference group to understand disparities facing sexual minority youth. Yet, heterosexual adolescents may also face homophobic bullying. We assessed the associations between homophobic bullying and risk factors for suicide (sadness/hopelessness, considering suicide, planning suicide, and attempting suicide) among youth who identify as heterosexual.

Stigma reduction in relation to HIV test uptake in low- and middle-income countries: a realist review

Background

This realist review was conducted to understand how stigma is reduced in relation to HIV test uptake in low- and middle-income countries (LMICs).

Methods

A systematic search of eight databases resulted in 34 articles considered for synthesis. Data synthesis was guided by a preliminary programme theory and included coding the meaning units to develop themes or intervention pathways that corresponded to context-mechanism-outcome configurations.

Results

We found that the interventions produced an effect through two pathways: (a) knowledge leads to changes in stigmatizing attitudes and increases in HIV test uptake and (b) knowledge and attitudes lead to changes in stigmatizing behaviours and lead to HIV test uptake. We also found one competing pathway that illustrated the direct impact of knowledge on HIV test uptake without changing stigmatizing attitudes and behaviour. The identified pathways were found to be influenced by some structural factors (e.g., anti-homosexuality laws, country-specific HIV testing programmes and policies), community factors (e.g., traditional beliefs and practices, sexual taboos and prevalence of intimate partner violence) and target-population characteristics (e.g., age, income and urban-rural residence).

Conclusions

The pathways and underlying mechanisms support the adaptation of intervention strategies in terms of social context and the target population in LMICs.

Gay-Straight Alliance Involvement and Youths' Participation in Civic Engagement, Advocacy, and Awareness-Raising

Civic engagement among lesbian, gay, bisexual, transgender, or questioning (LGBTQ) youth and heterosexual cisgender allies can challenge oppressive systems. Among 295 youth in 33 Gay-Straight Alliances (GSAs; 69% LGBQ, 68% cisgender female, 68% white, M_age = 16.07), we examined whether greater GSA involvement was associated with greater general civic engagement, as well as participation in greater LGBTQ-specific advocacy and awareness-raising efforts. Further, we tested whether these associations were partly mediated through members' sense of agency. Greater GSA involvement was associated with greater civic engagement, advocacy, and awareness-raising; associations did not differ based on sexual orientation or gender identity. Finally, the association between GSA involvement and civic engagement was partially mediated through youths' greater sense of agency. Agency did not mediate the association between GSA involvement and engagement in advocacy or awareness-raising efforts. The results suggest GSAs are settings with potential to foster students' capacity to be active and engaged citizens.

LGBTQ Bullying: Translating Research to Action in Pediatrics

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth experience significant bullying that undermines their mental and physical health. National health organizations have called for the development of innovative strategies to address LGBTQ bullying. Pediatricians and other clinicians, medical and public health students, interdisciplinary researchers, government officials, school leaders, community members, parents, and youth from around the country came together at a national symposium entitled "LGBTQ Bullying: Translating Research to Action to Improve the Health of All Youth" in May 2016 to generate strategies to prevent LGBTQ bullying and meet the needs of LGBTQ youth experiencing bullying. This article describes key scientific findings on bullying, LGBTQ stigma, and LGBTQ bullying interventions that were shared at the symposium and provides recommendations for pediatricians to address LGBTQ bullying via clinical care, research, interventions, and policy. Symposium participants recommended that pediatricians engage in efforts to foster inclusive and affirming health care environments wherein LGBTQ youth feel comfortable discussing their identities and experiences, identify youth experiencing LGBTQ bullying, and prevent the negative health consequences of bullying among youth. Moreover, pediatricians can attend to how multiple identities (eg, sexual orientation, gender identity, race and/or ethnicity, disability, and others) shape youth experiences of bullying and expand intervention efforts to address LGBTQ bullying in health care settings. Pediatricians can further advocate for evidence-based, antibullying policies prohibiting bullying on the basis of sexual orientation and gender identity. Collaboration between pediatricians and diverse stakeholders can contribute to the development and implementation of lasting change in all forms of bullying, including LGBTQ bullying.

Promising Pedagogy: Advancing the Educational Experience of Queer Students Through Transformative Leadership

The school experience for queer youth is often quite different from that of their heterosexual and gender-conforming peers; yet it is often the c ase that little attention is given to the disparate and inequitable educational and social conditions under which lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth must learn. In fact, the entirety of pedagogical structures in many schools creates milieus where queer youth, those who have loved ones who are queer, and those who are merely perceived to be queer are systematically marginalized and deprived of their right to a safe, supportive, and equitable educational experience. Transformative leadership theory (TLT) inspires educational leaders to create inclusive and excellent schools for all youth. Neither a prescriptive model nor a process-oriented theory, TLT offers eight tenets that operate in concert to form an authentic way of being informing and guiding leaders' decisions and actions toward the goal of individual, organizational, and societal change.

A Right to Disclose: LGBTQ Youth Representation in Data, Science, and Policy

There has been growing attention to sexual orientation and gender identity (SOGI) in child and adolescent development, public discourse, and research. A strong tension is clear: The right for participation, and thus representation in data, science, and policy, is often understood as conflicting with the right for protection, that is, safety from disclosure of a marginalized orientation or identity. Both participation and protection rights are also closely tied to young people's rights to privacy (or lack thereof). We review recent scholarship on SOGI in developmental sciences in light of this tension. We focus on schooling as a salient developmental context for all youth, a place that is historically unsafe for lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth, and a context where researchers have identified gaps of knowledge as well as strategies for improvement. Our review focuses on the politics and processes of SOGI inclusion in education data collection efforts in the United States, an area where SOGI data collection is scarce in comparison to other systems of care, such as health. We suggest that one solution to the dilemma would be that youth have the right to disclose their SOGI information to whom and when they choose. We offer strategies on how to hold these tensions in balance and move toward SOGI-inclusive research and data collection so that LGBTQ youth can be represented in data, science, and policy.

The Schooling Experience of Lesbian, Gay, and Bisexual Youth in lsrael: Falling Below and Rising Above as a Matter of Social Ecology

Research on the schooling experience of lesbian, gay, and bisexual (LGB) youth in Israel and in other Western countries has been largely risk-focused, whereas extrinsic and intrinsic protective factors, which enable LGB adolescent students to cope with school homophobic bullying, are often overlooked. To address this shortcoming, the researchers conducted a qualitative study based on semistructured interviews with 20 LGB-identified secondary school students. The findings and implications emphasized the key role of adequate ecological protective factors for LGB youth in enhancing effective coping mechanisms in response to school homophobic bullying.

Addressing the Social Determinants of Suicidal Behaviors and Poor Mental Health in LGBTI Populations in Australia

The purpose of this article is to describe and assess-as well as identify and rectify gaps in-intervention and prevention initiatives that specifically address poor mental health outcomes and suicidal behaviors in lesbian, gay, bisexual, transgender, and intersex (LGBTI) populations in Australia. It begins with an overview of the evidence base for heightened vulnerability to suicidal behaviors among LGBTI people in Australia. It then provides a discussion on the public health implications for LGBTI-targeted mental health initiatives and the prevention of and timely intervention in LGBTI suicidal behaviors. We conclude that the literature supports an increased risk for poorer mental health outcomes and suicidal behaviors in LGBTI populations in the Australian context. Psychological distress and suicidal behaviors in LGBTI people in Australia have social determinants that can and have been addressed through the provision of interventions with a strong evidence base in reducing these outcomes, implemented at a nationwide level, including training of health professionals and gatekeepers to mental health services and the general public. We conclude that the current Australian focus appears to address many of the social determinants of suicidal behaviors and poor mental health in LGBTI people but requires sustained and uniform government support if it is to continue and to produce measurable results.

Reducing risk for illicit drug use and prescription drug misuse: High school gay-straight alliances and lesbian, gay, bisexual, and transgender youth

Previous research suggests that lesbian, gay, bisexual, and transgender (LGBT) youth are at elevated risk for using illicit drugs and misusing prescription drugs relative to heterosexual youth. Previous research also indicates that LGBT youth who attend high schools with a gay-straight alliance (GSA) report having fewer alcohol problems and lower levels of cigarette smoking. The present study investigates whether the absence of a GSA is associated with risk for illicit drug use and prescription drug misuse in a sample of 475 LGBT high school students (M age=16.79) who completed an online survey. After controlling for demographic variables and risk factors associated with illicit drug use, the results of 12 logistic regression analyses revealed that LGBT youth attending a high school without a GSA evidenced increased risk for using cocaine (adjusted odds ratio [adjOR]=3.11; 95% confidence interval [95% CI]=1.23-7.86), hallucinogens (adjOR=2.59; 95% CI=1.18-5.70), and marijuana (adjOR=2.22; 95% CI=1.37-3.59) relative to peers attending a high school with a GSA. Youth without a GSA also evidenced increased risk for the misuse of ADHD medication (adjOR=2.00; 95% CI=1.02-3.92) and prescription pain medication (adjOR=2.00; 95% CI=1.10-3.65). These findings extend the research base related to GSAs and further demonstrate the importance of providing LGBT youth with opportunities for socialization and support within the school setting. Important limitations of the present study are reviewed.