Sexual-orientation disparities in school: the mediational role of indicators of victimization in achievement and truancy because of feeling unsafe

Examination of the "model minority" stereotype through ethnicity and sexual orientation heterogeneity among Asian American youth

INTRODUCTION

The "model minority" stereotype disguises heterogeneity among Asian American youth, many of whom are harmed by policies and attitudes that assume this population to be uniformly high achieving and "problem free." The current study uses an intersectional lens to disaggregate this population by ethnicity and sexual orientation subgroups to demonstrate differences in academic performance and substance use behavior among Asian American youth. This study also investigates the extent to which racial/ethnicity and sexual orientation-based bullying may explain such links.

METHODS

Participants included 65,091 Asian American youth (46.41% Southeast Asian; 37.01% East Asian; 16.58% South Asian) in grades 6-12, who were part of the California Healthy Kids Survey (2015-2017). Participants were 49.4% female and about a third each were in grades 6-8, grades 9-10, and grades 11-12. School-based surveys were administered. Youth reported on substance use, grades, and bias-based bullying experiences in the past 12 months.

RESULTS

Generalized linear mixed-effects model results showed that outcomes varied widely across youth ethnicity and sexual orientation subgroups. Inclusion of racial/ethnic and sexual orientation bullying in these models attenuated the direct effects between ethnic and sexual identities and academic performance and substance use outcomes.

CONCLUSIONS

Implications of this work suggest that research and policy should not treat Asian American students as uniformly high-performing and low-risk, because the experiences of those who deviate from these assumptions will be left undetected. Interventions targeting bias-based bullying may be able to reduce disparities in academic and substance use outcomes among Asian American youth.

State-Level Policies and Health Outcomes in U.S. Transgender Adolescents: Findings from the 2019 Youth Risk Behavior Survey

Purpose: Policies have been shown to bear a considerable influence on transgender health. The few studies that have examined policy-related health outcomes in adolescent transgender populations have rarely included policies that directly affect them. Our study explores associations between four state-level policies and six health outcomes in a sample of transgender adolescents. Methods: Our analytic sample consisted of adolescents residing in 14 states that used the 2019 Youth Risk Behavior Survey's optional gender identity question in their surveys (n = 107,558). Chi-square analyses were performed to examine differences between transgender and cisgender adolescents in demographic variables and suicidal ideation, depression status, cigarette use, binge drinking, grades in school, and perceptions of school safety. Multivariable logistic regression models were run for transgender adolescents only to examine associations between policies and health outcomes, adjusting for demographics. Results: Transgender adolescents comprised 1.7% (n = 1790) of our sample. Compared with cisgender adolescents, transgender adolescents were more likely to experience adverse health outcomes in chi-square analyses. Multivariable models indicated that transgender adolescents who lived in a state that had explicit transgender guidance in their antidiscrimination laws were less likely to experience depressive symptoms, and those who lived in a state with positive or neutral athlete guidance were less likely to report past 30-day cigarette use. Conclusion: Our study is one of the first to show protective associations between affirming transgender-specific policies and health outcomes in transgender adolescents. Findings could have important implications for policymakers and school administrators.

The Association Between Dating Violence and Student Absenteeism Among a Representative Sample of U.S. High School Students: Findings From the 2019 Youth Risk Behavior Survey Survey

Student absenteeism affects students' engagement in school and academic and professional success. While research documents a significant association between school bullying/fighting and student absenteeism due to fear of being at school or getting to school, little research has examined the association of adolescent dating violence (ADV) victimization with this type of absenteeism. This study examined the relationship between physical and/or sexual ADV victimization in the past year (dichotomized as yes or no), and number of days of student absenteeism due to feeling unsafe at school or on the way to school in the past month (dichotomized as any vs. none). We analyzed cross-sectional data from the 2019 Youth Risk Behavior Survey (YRBS), a nationally representative survey of U.S. high school students (n = 9507). We conducted crude and multivariate regression models for the total sample and stratified by sex to assess our hypothesized association of ADV victimization and absenteeism; sex, grade, race/ethnicity, and sexual identity were included as covariates in adjusted models. Findings demonstrate that students reporting past year ADV victimization had 3.69 times the odds of student absenteeism due to feeling unsafe, when compared to students who did not report ADV victimization (95% CI: 3.06-4.45, p < 0.001). Sex-stratified models reveal that this effect is significantly stronger for males than for females, as indicated by non-overlapping confidence intervals (male AOR: 5.67, 95% CI: 4.18-7.68; female AOR: 2.95, 95% CI: 2.32-3.74). The multivariate models also show that Black and Latinx compared with White students, and lesbian/gay/bisexual/unsure compared with heterosexual students, had higher odds of student absenteeism due to feeling unsafe. Findings indicate the need to address ADV victimization and student absenteeism with integrated and gender-tailored responses, and with consideration of greater vulnerabilities for queer students and students of color.

Adolescent Loneliness during the COVID-19 Pandemic: The Role of Pre-Pandemic Risk Factors

The COVID-19 pandemic is a global mental health crisis that disproportionately impacts adolescents. Loneliness is a particularly salient pandemic psychosocial outcome to understand; however, research to date on this outcome is sparse and largely cross-sectional. In response, we examined pre-pandemic risk factors for pandemic loneliness. Further, we examined how risk may differ based on key demographics, and whether mediation or moderation models best explained potential disparities in experiencing loneliness. Self-reported, pre-pandemic mental health, trauma exposure, and family conflict survey data were collected at Wave 1 in a diverse sample of 369 adolescents (54.5% female, 45.5% male; 30.1% White; 30.9% Black; 18.4% Hispanic; M_age = 15.04; SD _age  = 1.10). Subsequently, self-reported experiences of loneliness during the pandemic were collected 6 months (April-June 2020) and 12 months (October-December 2020) later. Using a regression-based framework (i.e., PROCESS), we tested (a) which pre-pandemic risks uniquely predicted prospective loneliness and (b) whether loneliness risk was elevated for certain identities (i.e., mediation models) or whether certain identities were more sensitive to specific risks (i.e., moderation models). Overall, pre-pandemic depressive and aggression symptoms predicted early pandemic loneliness (6-month follow-up), whereas anxiety symptoms specifically predicted mid-pandemic loneliness (12-month follow-up). Environmental stressors were moderated by gender, such that females with pre-pandemic trauma exposure were more likely to report pandemic loneliness. Further, pre-pandemic internalizing distress for girls and externalizing symptoms for boys, reflected gender-specific pathways for loneliness. Implications for mental health prevention in the wake of national disasters are discussed.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12187-022-09984-8.

LGBTQ+ Students' Peer Victimization and Mental Health before and during the COVID-19 Pandemic

Given the well-established health disparities between lesbian, gay, bisexual, transgender, queer, and gender-expansive (LGBTQ+) and cisgender, straight youth, scholars predicted the COVID-19 pandemic would disproportionately impact LGBTQ+ students. Yet, few studies have described changes in LGBTQ+ students' school experiences and well-being during the pandemic. Using survey data from 40,904 middle and high school students, we examined changes from before (2018) to during (2021) the pandemic in peer victimization, anxiety, and suicide attempts. We conducted bivariate and multivariate regression analyses to assess changes between the two time points among LGBTQ+ and cisgender, straight students. We found LGBTQ+ students experienced more peer victimization, anxiety, and suicide attempts at both points, before and during the pandemic, than cisgender, straight youth. However, LGBTQ+ students reported increased anxiety, decreased peer victimization, and decreased suicide attempts in 2021, during the pandemic, compared to pre-pandemic 2018 reports. These findings suggest pandemic-related school disruptions may have provided LGBTQ+ students some relief from the harmful effects of poor, in-person school climates.

Safety and Predictors of Sexual Minority Youth Carrying Weapons

Prior research has revealed sexual minority youth are more likely to carry weapons both outside of and within school. However, to date, no study has examined the degree to which bullying and harassment is associated with weapon carrying among sexual minority youth. We utilized the Youth Risk Behavior Survey to examine the prevalence and likelihood of carrying weapons by sexual identity, adjusting for adverse experiences. From the Youth Risk Behavior Survey 2009-2015, we examined self-report of adverse experiences (e.g., being bullied, skipping school due to fear for personal safety) and performed Logistic regressions to estimate the odds of carrying a weapon and were adjusted to include demographics and adverse experiences. When surveyed by sexual identity, 14.0% of heterosexual, 21.8% of gay/lesbian, 18.5% of bisexual, and 17.4% of "not sure" students reported carrying a weapon in the past 30 days. Odds of carrying a weapon were significantly increased for youth who skipped school due to feeling unsafe at school, had ever been threatened with a weapon in the past year, and had ever been in a physical fight. Compared to heterosexual female peers, sexual minority women had increased odds of carrying a weapon. Pediatricians should recognize that experiencing bullying and feeling unsafe are associated with weapon carrying, particularly among sexual minorities. Pediatricians and professionals who work with youth should recognize that reported experiences of bullying may not be the most salient indicator of risk for weapon carrying among all youth, and that other fears of or experiences with bullying are crucial to screen for among sexual minorities in particular.

Pride or Closet? Unpacking Experiences of Minority Stress, Coping, and Resistance among Gender and Sexual Minorities in India

In India, sexuality has long been a silent battleground, which has led to the legal acceptance of non-heteronormative practices in recent years. Given the risk of facing difficulties and social discrimination, questions may arise on the consequences of revealing non-heteronormative gender identity and sexual orientation. Using data from a two-year qualitative immersive study on the queer individuals in India and extant theories on Concealed Stigmatized Identity and Minority Stress, we explore the dynamics of disclosure, or "Coming-out of the closet" and construct a narrative on their lived experiences of stress and coping associated with marginal gender identity. Thematic analysis reveals that informants elaborate, borrow, and adapt perceptions and experiences of denial and loss of agency as queer individuals. Disclosure and Coming-out help them to find the "safe others." The findings indicate that this kinship and entitativity result in measurably higher well-being, happiness, and meaning in life. We conclude that rising above the minority stress can be the beginning of endless possibilities in different spheres of life for gender and sexual minorities. Participants' narratives unpack the embodied and contextual stereotypes and taboos and the precarity of living with non-normative identities. The paper makes a compelling argument that coping with gender marginalization, vulnerability, and loss of dignity can be achieved through a sense of purpose and meaning.

LGBTQ+ Youth's Identity Development in the Context of Peer Victimization: A Mixed Methods Investigation

Research rarely explores LGBTQ+ youth bullying in the context of culture-specific outcomes (e.g., LGBTQ+ identity development) and what can mitigate the impact of peer stressors. This study used a concurrent mixed methods design to explore how experiences of peer victimization predicted LGBTQ+ youth's identity development (i.e., stigma sensitivity, concealment motivation, and difficult process) and whether social support and outness served as protective, moderating factors. The mixed methods approach provides a culture-specific context via qualitative inquiry to inform whether the quantitative findings align with how youth qualitatively discuss their experience of peer victimization, negative outcomes, and social support. Our sample consisted of 349 LGBTQ+ youth 14-17 years old who completed a survey (quantitative sample) and a subset of 39 LGBTQ+ youth who completed a semi-structured interview (qualitative sample). Our quantitative findings indicated that greater overall peer victimization was positively related to LGBIS-revised subscales of stigma sensitivity, concealment motivation, and difficult process, where both outness and social support moderated such relations. Qualitatively, victimized youth also reported stigma sensitivity and concealment motivation while also endorsing how being out and having a support system played a role in their experience of being victimized. These qualitative findings align with our quantitative findings that classmate support mitigated the effects of peer victimization on the difficulty of coming out. Implications for practitioners and researchers are provided.

Sexual Identity Differences in Health Behaviors and Weight Status among Urban High School Students

Although racial/ethnic disparities in childhood obesity are well documented in the United States (U.S.), fewer studies have investigated elevated body mass index (BMI) and related health behaviors among sexual minority youth (SMY; gay/lesbian, bisexual, not sure). We examined pooled data from the 2009-2017 Youth Risk Behavior Surveys, which included high school students from 12 urban U.S. school districts. We used sex-stratified logistic regression models to estimate the association of sexual identity with health behaviors and elevated BMI (reference = heterosexual participants). A total of 133,615 participants were included. Sexual minority boys were more likely to report physical inactivity than heterosexual boys. Gay and not sure boys were also less likely to consume the recommended daily intake of fruit. Bisexual girls were more likely than heterosexual girls to report watching television ≥ 3 hours on a school day and to consume sugar-sweetened beverages (AOR 1.30, 95% CI= 1.18-1.43). All SMY reported higher rates of current tobacco use than their heterosexual peers. Sexual minority girls and bisexual boys had significantly higher rates of obesity than their heterosexual counterparts. These findings can inform tailored health promotion initiatives to reduce obesity risk in SMY.

First- and Second-Hand Experiences of Enacted Stigma Among LGBTQ Youth

Research on enacted stigma, or stigma- and bias-based victimization, including bullying and harassment, among lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth often focuses on one context (e.g., school) or one form (e.g., bullying or microaggressions), which limits our understanding of these experiences. We conducted qualitative go-along interviews with 66 LGBTQ adolescents (14-19 years) in urban, suburban, town, and rural locations in the United States and Canada identified through purposive and snowball sampling. Forty-six participants (70%) described at least one instance of enacted stigma. Three primary themes emerged: (1) enacted stigma occurred in many contexts; (2) enacted stigma restricted movement; and (3) second-hand accounts of enacted stigma shaped perceptions of safety. Efforts to improve well-being among LGBTQ youth must address the diverse forms and contexts of enacted stigma that youth experience, which limit freedom of movement and potential access to opportunities that encourage positive youth development. School nurses can play a critical role in reducing enacted stigma in schools and in collaboration with community partners.

The Unintended Consequences of Rape Disclosure: The Effects of Disclosure Content, Listener Gender, and Year in College on Listener's Reactions

Rape is prevalent on American college campuses. Rape survivors often disclose their experience to their peers in hope of receiving support and obtaining justice (i.e., the intended consequences of disclosure). Yet, rape disclosures may also lead to unintended consequences, such as stigma. How peers react to survivors' disclosures of rape greatly influences survivors' recovery and their decision to press charges against their perpetrators. In this article, we explore gender differences in responses to rape disclosures. Using an experimental design (N = 391), we investigate reactions to stigmatizing (versus nonstigmatizing) rape disclosures. We find that, when controlling for the experimental condition, college men stigmatize the rape survivor more than college women. However, in response to a stigmatizing (versus nonstigmatizing) rape disclosure, college women who have been in college longer, compared with college men, have more stigmatizing reactions toward the person disclosing that information. Their reactions then predict increased social distance between the recipient of the disclosure and rape survivors.

Training Pre-Service Teachers to Better Serve LGBTQ High School Students

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.

Factors Associated with Academic Achievement for Sexual and Gender Minority and Heterosexual Cisgender Students: Implications from a Nationally Representative Study

Research on sexual and gender minority student achievement indicates that such students report lowered achievement relative to other students. Increased victimization and less school belonging, amongst other factors, have been identified as contributing to these inequalities. However, supportive schooling structures and caregiver support may support their achievement. A nationally representative survey of secondary school students was used to identify specific factors that support achievement for sexual minority (n = 485), gender minority (n = 298), and heterosexual cisgender (where one's sex assigned at birth "matches" a binary gender identity, i.e., a male assigned at birth identifies as a boy/man, n = 7064) students in New Zealand. While reported victimization did not affect achievement for sexual and gender minority students, school belonging, and teacher expectations of success, emerged as significant factors. Differences emerged between sexual minority and gender minority achievement factors, suggesting a range of detailed policy implications and recommendations.

Risk Factors for School Absenteeism and Dropout: A Meta-Analytic Review

School absenteeism and dropout are associated with many different life-course problems. To reduce the risk for these problems it is important to gain insight into risk factors for both school absenteeism and permanent school dropout. Until now, no quantitative overview of these risk factors and their effects was available. Therefore, this study was aimed at synthesizing the available evidence on risk factors for school absenteeism and dropout. In total, 75 studies were included that reported on 781 potential risk factors for school absenteeism and 635 potential risk factors for dropout. The risk factors were classified into 44 risk domains for school absenteeism and 42 risk domains for dropout. The results of a series of three-level meta-analyses yielded a significant mean effect for 28 school absenteeism risk domains and 23 dropout risk domains. For school absenteeism, 12 risk domains were found with large effects, including having a negative attitude towards school, substance abuse, externalizing and internalizing problems of the juvenile, and a low parent-school involvement. For dropout, the risk domains having a history of grade retention, having a low IQ or experiencing learning difficulties, and a low academic achievement showed large effects. The findings of the current study contribute to the fundamental knowledge of the etiology of school absenteeism and dropout which in turn contributes to a better understanding of the problematic development of adolescents. Further, more insight into the strength of effects of risk factors on school absenteeism and dropout is important for the development and improvement of both assessment, prevention and intervention strategies.

Reducing Disparities for Women and Minority Business in Public Contracting Work: A Call for Social Virtuousness

Despite government devoting time and resources to ending discrimination, disparities based on gender, race, and disadvantaged business status persist in the area of business development, access to capital, and contracting opportunities. We join with the growing number of scholars that call for the concept of virtuousness to be highly placed on the business and management research agendas. This research utilizes critical participatory action research (CPAR) as a tool for building capacity to define and implement meaningful change that has the potential to correct these persistent disparities. We describe a longitudinal project that uses CPAR for addressing gender and racial disparities in local government contracting opportunities. We developed a collaboration with several community, women and minority-serving and legal partners in order to move beyond documenting the problems and toward advancing corrective social policy changes based on the key principles of the CPAR methodology. We described this work in the context of social virtuousness and discuss the implications for future research and public policy.

Bullying Victimization among LGBTQ Youth: Current and Future Directions

PURPOSE OF REVIEW

This paper examines recent research on bullying victimization among lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth to identify critical issues and advocate for future research priorities.

RECENT FINDINGS

Recent studies have begun to document the importance of bullying in general, and bias-based bullying (rooted in stigma) in particular, on the health and wellbeing of this vulnerable subgroup of adolescents, as well as drivers of disparities. Current research demonstrates the role of multiple identities for and important differences among LGBTQ youth and has begun to identify protective factors for youth who are the targets of bullying.

SUMMARY

Researchers, clinicians, and those working with and on behalf of LGBTQ youth must measure and acknowledge the multiple reasons for which LGBTQ youth are the targets of bullying. Intervention and prevention efforts should focus on improving the supportiveness of the climates within which LGBTQ youth live.

Sexual minority status and suicidal behaviour among Chinese adolescents: a nationally representative cross-sectional study

OBJECTIVES

Suicidality among sexual minority adolescents has generated worldwide concern in recent decades, and previous Western studies have demonstrated that sexual minority status is associated with adolescent suicidality. However, whether this association exists in Chinese adolescents remains largely unknown. This study aimed to estimate the associations between sexual minority status and suicidal behaviour among Chinese adolescents.

DESIGN

Cross-sectional survey.

SETTING

A total of 506 high schools in 7 provinces of China.

PARTICIPANTS

A total of 150 822 students in grades 7-12 who completed the questionnaires (response rate of 95.9%) were included.

MAIN OUTCOME MEASURES

Suicidal ideation and suicide attempts were used to measure suicidal behaviour, and sexual attraction (opposite sex, same sex or both sex) was used as a measure for sexual minority status.

RESULTS

Of the 150 822 adolescents analysed, 4.1% self-reported as sexual minorities and 17.3% were unsure. Compared with heterosexual and unsure adolescents, same-sex romantic attraction (SSA) and both-sex romantic attraction (BSA) adolescents reported a higher prevalence of past-year suicidal ideation (SSA: 21.6% for males and 30.4% for females; BSA: 34.7% for males and 42.3% for females) and suicide attempts (SSA: 6.9% for males and 8.9% for females; BSA: 12.2% for males and 10.9% for females). After adjustment for covariates, SSA and BSA adolescents were more likely to have past-year suicidal ideation and suicide attempts than their heterosexual and unsure peers. BSA adolescents reported the highest risk of suicidal ideation (males: adjusted OR (AOR) 2.42, 95% CI 2.03 to 2.88; females: AOR 2.61, 95% CI 2.41 to 2.82) and suicide attempts (males: AOR 3.83, 95% CI 2.85 to 5.14; females: AOR 2.59, 95% CI 2.19 to 3.06).

CONCLUSIONS

Our study suggested that Chinese sexual minority adolescents were at increased risk of suicidality, and those with BSA had an especially high risk in this population. These findings emphasised the urgent need to develop targeted interventions to effectively address suicide-related problems among Chinese sexual minority adolescents.

LGBT people and suicidality in youth: A qualitative study of perceptions of risk and protective circumstances

Evidence suggests that lesbian, gay, bisexual and trans (LGBT) people are more likely to attempt to take their own lives in their youth when compared to heterosexual and/or cisgender people. This study draws on in-depth interviews with 17 LGBT individuals living in England, and explores the narratives used by participants to better understand their perceptions of risk and protective circumstances to explain suicide attempts in youth. Using a Goffman-informed thematic analysis, results identified three key themes that were linked to attempts to end life in youth. The first theme considers the conflicts resulting from first disclosure of sexual orientation and/or gender identity/trans status and being 'out' to others. The second theme explores participants' accounts of their concurrent mental health issues and how diagnoses of the mental health issues helped them make sense of their own experiences of attempted suicide. The final theme explores the experience of grieving over lost relationships and how that grief is received by others, including health professionals. Our results indicate that some LGBT individuals have effectively, although often arduously, navigated suicidal crises by utilising various approaches to coping. We provide a rich and layered picture of LGBT suicide risk in youth and potential resilience scenarios, although these are a reflection of our specific group of participants' experiences and realities. We argue that it is important to understand how LGBT individuals with a history of suicide attempts narrate and make sense of their experiences in early life and we suggest that the early negative experiences continue to have an effect on LGBT adults today.

Lesbian, gay, and bisexual (LGB) youth within in welfare: Prevalence, risk and outcomes

The purpose of this study was to estimate the population of sexual minority or LGB (lesbian, gay and bisexual) children and youth involved with the child welfare system, and to compare their health, mental health, placement and permanency outcomes to those of non-LGB youth. Data were drawn from the Second National Survey of Child and Adolescent Well-Being (NSCAW-II), a nationally representative sample of children who were referred to child welfare due to a report of abuse or neglect over a fifteen month period. This sample included youth ages eleven and older who self-identified their sexual orientation (n = 1095). Results indicate that approximately 15.5% of all system involved youth identified as lesbian, gay or bisexual, and that lesbian and bisexual females, and LGB youth of color are both overrepresented within child welfare systems. Although no substantive difference in risk factors, permanency and placement were found between LGB and Non-LGB youth, LGB youth were significantly more likely to meet the criteria for adverse mental health outcomes. Implications for child welfare practice and policy are presented, along with recommendations for future research in this area.

Have Mischievous Responders Misidentified Sexual Minority Youth Disparities in the National Longitudinal Study of Adolescent to Adult Health?

The National Longitudinal Study of Adolescent to Adult Health (Add Health) has been instrumental in identifying sexual minority youth health disparities. Recent commentary suggested that some Wave 1 youth responders, especially males, intentionally mismarked same-sex attraction and, as a result, published reports of health disparities from these data may be suspect. We use two recently developed approaches to identify "jokesters" and mischievous responding and apply them to the Add Health data. First, we show that Wave 1 same-sex attracted youth, including those who later reported completely heterosexual identities in adulthood, were no more likely than different-sex attracted youth and consistently heterosexual participants to be "jokesters." Second, after accounting for mischievous responses, we replicated six previously established disparities: depressive symptoms, suicidal ideation and behaviors, alcohol use, cocaine use, parental satisfaction, and school connectedness. Accounting for mischievousness resulted in the elimination of one observed disparity between heterosexual and sexual minority youth: suicidal ideation for males who reported romantic attraction to both sexes. Results also showed that accounting for mischievous responding may underestimate disparities for sexual minority youth, particularly females. Overall, results presented here support previous studies that identified health disparities among sexual minority youth using these data.

Gender Expression, Violence, and Bullying Victimization: Findings From Probability Samples of High School Students in 4 US School Districts

BACKGROUND

Young people may experience school-based violence and bullying victimization related to their gender expression, independent of sexual orientation identity. However, the associations between gender expression and bullying and violence have not been examined in racially and ethnically diverse population-based samples of high school students.

METHODS

This study includes 5469 students (13-18 years) from the 2013 Youth Risk Behavior Surveys conducted in 4 urban school districts. Respondents were 51% Hispanic/Latino, 21% black/African American, 14% white. Generalized additive models were used to examine the functional form of relationships between self-reported gender expression (range: 1 = Most gender conforming, 7 = Most gender nonconforming) and 5 indicators of violence and bullying victimization. We estimated predicted probabilities across gender expression by sex, adjusting for sexual orientation identity and potential confounders.

RESULTS

Statistically significant quadratic associations indicated that girls and boys at the most gender conforming and nonconforming ends of the scale had elevated probabilities of fighting and fighting-related injury, compared to those in the middle of the scale (p < .05). There was a significant linear relationship between gender expression and bullying victimization; every unit increase in gender nonconformity was associated with 15% greater odds of experiencing bullying (p < .0001).

CONCLUSIONS

School-based victimization is associated with conformity and nonconformity to gender norms. School violence prevention programs should include gender diversity education.

Sexual attraction and the nonmedical use of opioids and sedative drugs among Chinese adolescents

OBJECTIVE

The nonmedical use of prescription drugs (NMUPD) is attracting public attention. We aimed to explore the association between sexual attraction and NMUPD among Chinese adolescents.

METHOD

A school-based survey was conducted in seven Chinese provinces, and a multi-stage stratified cluster sampling method was used in this study. A total of 150,822 students from seven Chinese provinces completed the questionnaire; the response rate was 95.93%. All data were collected between November 2014 and January 2015.

RESULTS

Overall, 8.8%, 4.4%, and 2.2% of the students reported lifetime, past-year, and past-month NMUPD, respectively. Compared with heterosexual students (8.2%), sexual minority and unsure students were more likely to report lifetime NMUPD (14.4% and 10.0%, respectively; χ² = 244.34, P < 0.001). In addition, sexual minority and unsure students were more likely to admit past-year and past-month use of NMUPD. After adjusting for social demographics and lifestyle covariates, sexual minority and unsure students were at an increased risk of lifetime NMUPD (adjusted odds ratio [AOR] = 1.68, 95% confidence interval [CI] = 1.54-1.83 and AOR = 1.33, 95% CI = 1.26-1.41, respectively).

CONCLUSIONS

Our study suggested that sexual minority and unsure adolescents have a higher risk of NMUPD. Moreover, our study suggested that sexual minority and unsure students are more likely to both try and continue to use prescription drugs. Further studies focusing on the mechanism of substance abuse and appropriate interventions among sexual minority and unsure adolescents are warranted.

Sexual Orientation Trends and Disparities in School Bullying and Violence-Related Experiences, 1999-2013

Numerous recent studies have demonstrated that schools are often unsafe for lesbian, gay, and bisexual (LGB) adolescents, who are more likely than heterosexual peers to be bullied, harassed, or victimized in school contexts. Virtually all of these studies call for change, yet none investigate whether or not it has occurred. Using repeated waves of a population-based high school survey, we examine (1) the extent to which sexual orientation differences in school bullying and violence-related experiences are reported by lesbian/gay, bisexual, and heterosexual male and female adolescents; (2) trends in school bullying and violence-related experiences for each gender/orientation group, and (3) whether disparities have changed over time. Data were drawn from eight Massachusetts biennial Youth Risk Behavior Surveys from 1999 to 2013, grouped into 4 waves totaling 24,845 self-identified heterosexual, 270 lesbian/gay, and 857 bisexual youth. Disparities between LGB and heterosexual peers were found in all indicators. Heterosexual youth and gay males saw significant reductions in every outcome between the first and last waves. Among bisexual males, skipping school due to feeling unsafe, carrying weapons in school, and being bullied all decreased, but among lesbians and bisexual females only fighting in school declined significantly. Improvement trends in school safety were more consistent for heterosexual youth and gay males than for bisexual or lesbian females. Notably, despite these improvements, almost no reduction was seen in sexual orientation disparities. Future research should identify influences leading to reduced school victimization, especially focusing on ways of eliminating persistent sexual orientation disparities. Future research should identify influences leading to reduced school victimization, especially focusing on ways of eliminating persistent sexual orientation disparities.

The Whole Family Serves: Supporting Sexual Minority Youth in Military Families

Sexual minority youth in military families have a unique set of stressors that affect their mental, emotional, and physical health. There is a pronounced gap in data addressing the specific stressors of this population and how they interact to impact the health of the adolescent. The culture of the United States military has historically been heterosexist and homophobic, propelled primarily by policies that restricted the recruitment and service of lesbian, gay, bisexual, or transgender individuals, leading to a continued secrecy around sexual orientation that may affect how sexual minority youth within the community view themselves. Homophobia, social stigma, and victimization lead to significant health disparities among sexual minority youth, and youth connected to the military have additional stressors as a result of frequent moves, parental deployment, and general military culture. Primary care providers must be aware of these stressors to provide a safe environment, thorough screening, and competent care for these adolescents.

Racial/Ethnic Disparities in Influenza Vaccination of Chronically Ill US Adults: The Mediating Role of Perceived Discrimination in Health Care

BACKGROUND

Despite well-established programs, influenza vaccination rates in US adults are well below federal benchmarks and exhibit well-documented, persistent racial and ethnic disparities. The causes of these disparities are multifactorial and complex, though perceived racial/ethnic discrimination in health care is 1 hypothesized mechanism.

OBJECTIVES

To assess the role of perceived discrimination in health care in mediating influenza vaccination RACIAL/ETHNIC disparities in chronically ill US adults (at high risk for influenza-related complications).

RESEARCH DESIGN

We utilized 2011-2012 data from the Aligning Forces for Quality Consumer Survey on health and health care (n=8127), nationally representative of chronically ill US adults. Logistic regression marginal effects examined the relationship between race/ethnicity and influenza vaccination, both unadjusted and in multivariate models adjusted for determinants of health service use. We then used binary mediation analysis to calculate and test the significance of the percentage of this relationship mediated by perceived discrimination in health care.

RESULTS

Respondents reporting perceived discrimination in health care had half the uptake as those without discrimination (32% vs. 60%, P=0.009). The change in predicted probability of vaccination given perceived discrimination experiences (vs. none) was large but not significant in the fully adjusted model (-0.185; 95% CI, -0.385, 0.014). Perceived discrimination significantly mediated 16% of the unadjusted association between race/ethnicity and influenza vaccination, though this dropped to 6% and lost statistical significance in multivariate models.

CONCLUSIONS

The causes of persistent racial/ethnic disparities are complex and a single explanation is unlikely to be sufficient. We suggest reevaluation in a larger cohort as well as potential directions for future research.

Associations between LGBTQ-affirmative school climate and adolescent drinking behaviors

BACKGROUND

We investigated whether adolescents drank alcohol less frequently if they lived in jurisdictions with school climates that were more affirmative of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) individuals.

METHODS

Data from the 2010 School Health Profile survey, which measured LGBTQ school climate (e.g., percentage of schools with safe spaces and gay-straight alliances), were linked with pooled data from the 2005 and 2007 Youth Risk Behavior Survey, which measured sexual orientation identity, demographics, and alcohol use (number of drinking days, drinking days at school, and heavy episodic drinking days) in 8 jurisdictions. Two-level Poisson models tested the associations between school climate and alcohol use for each sexual-orientation subgroup.

RESULTS

Living in jurisdictions with more (versus less) affirmative LGBTQ school climates was significantly associated with: fewer heavy episodic drinking days for gay/lesbian (incidence-rate ratio [IRR]=0.70; 95% confidence interval [CI]: 0.56, 0.87; p=0.001) and heterosexual (IRR=0.80; 95% CI: 0.76, 0.83; p<0.001) adolescents; and fewer drinking days at school for adolescents unsure of their sexual orientation (IRR=0.57; 95% CI: 0.35, 0.93; p=0.024).

CONCLUSIONS

Fostering LGBTQ-affirmative school climates may reduce certain drinking behaviors for gay/lesbian adolescents, heterosexual adolescents, and adolescents unsure of their sexual orientation.

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.

Sexual-Orientation Differences in Positive Youth Development: The Mediational Role of Bullying Victimization

OBJECTIVES

To examine sexual-orientation differences in positive youth development, and how bullying victimization mediated these differences in a sample of adolescents.

METHODS

In 2007 to 2008, positive youth development was measured in 1870 adolescents from US schools and after-school programs in 45 states by using the validated Five Cs model of competence, confidence, connection, character, and caring/compassion. Sexual-minority youths (6.8%) reported having same- or both-gender sexual attractions. Nonattracted youths (4.2%) reported having no sexual attractions.

RESULTS

Compared with sexual-minority youths, heterosexual and nonattracted youths had lower odds of being a victim of bullying. Heterosexual and nonattracted youths also had higher average scores in competence, confidence, and connection, but these associations between sexual orientation and positive youth development scores were partly attributable to lack of bullying victimization.

CONCLUSIONS

Designing, implementing, and evaluating interventions that reduce bullying can give sexual-minority youths access to several building blocks of health and well-being.

Who intervenes against homophobic behavior? Attributes that distinguish active bystanders

Research on homophobic behavior has focused on students engaging in this behavior or students toward whom this behavior is directed. There has been little attention to the large segment of students who observe this behavior, including active bystanders who defend or support students when homophobic behavior occurs. Among 722 high school students (55% female, 87% white, 86% heterosexual), 66.8% had observed at least one instance of homophobic behavior in the past 30 days. Gender (in this case, girls more so than boys), leadership, courage, altruism, justice sensitivity, and number of LGBT friends were associated with engagement in more active bystander behavior in response to observing homophobic behavior. Further, gender, courage, altruism, and number of LGBT friends each made unique contributions in accounting for variability in students' defending behavior in a comprehensive regression model. Findings highlight qualities that interventionists should cultivate in students that could lead to more active bystander engagement against homophobic behavior.

Gay-Straight Alliances vary on dimensions of youth socializing and advocacy: factors accounting for individual and setting-level differences

Gay-Straight Alliances (GSAs) are school-based youth settings that could promote health. Yet, GSAs have been treated as homogenous without attention to variability in how they operate or to how youth are involved in different capacities. Using a systems perspective, we considered two primary dimensions along which GSAs function to promote health: providing socializing and advocacy opportunities. Among 448 students in 48 GSAs who attended six regional conferences in Massachusetts (59.8 % LGBQ; 69.9 % White; 70.1 % cisgender female), we found substantial variation among GSAs and youth in levels of socializing and advocacy. GSAs were more distinct from one another on advocacy than socializing. Using multilevel modeling, we identified group and individual factors accounting for this variability. In the socializing model, youth and GSAs that did more socializing activities did more advocacy. In the advocacy model, youth who were more actively engaged in the GSA as well as GSAs whose youth collectively perceived greater school hostility and reported greater social justice efficacy did more advocacy. Findings suggest potential reasons why GSAs vary in how they function in ways ranging from internal provisions of support, to visibility raising, to collective social change. The findings are further relevant for settings supporting youth from other marginalized backgrounds and that include advocacy in their mission.