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.

Evaluating Litigation as a Structural Strategy for Addressing Bias-Based Bullying Among Youth.

Importance: Homophobic bullying-which is motivated by actual or perceived sexual orientation-is a common experience among youth and is more strongly associated with adverse outcomes than bullying unrelated to bias. Yet current approaches to reducing homophobic bullying either lack empirical evidence or encounter significant obstacles. Thus, the field requires the identification of strategies that hold promise for reducing homophobic bullying. Objective: To examine whether litigation is associated with reductions in homophobic bullying. Design, Setting, and Participants: In this quasi-experimental study, difference-in-difference analysis was used to estimate the association between litigation and homophobic bullying, comparing students in schools that experienced litigation with students in schools that did not experience litigation, controlling for individual and school characteristics, study year, and county. Survey responses came from high school students from 499 schools participating in the California Healthy Kids Survey, the largest statewide survey of youth risk behaviors and protective factors, between 2001 and 2016. Legal data were collected from September 2018 to September 2019, and data were analyzed from February 2020 to April 2021. Exposures: Outcomes of litigation related to sexual orientation-based harassment and discrimination in California schools occurring after 2000. Main Outcomes and Measures: Student reports of homophobic bullying. Results: Of 1 448 778 included participants, 706 258 (48.7%) were male, 563 973 (38.9%) were White, and the mean (SD) age was 14.6 (1.7) years. For cases where the plaintiff (student) secured monetary and/or injunctive relief through settlement or court decision, there was a 23% reduction in the ratio of odds ratios (ROR) of homophobic bullying in schools directly involved in the litigation relative to schools that did not experience litigation (ROR, 0.77; 95% CI, 0.68-0.86). These benefits of litigation spilled over into schools in the same district as the schools experiencing litigation (ROR, 0.76; 95% CI, 0.70-0.81). However, homophobic bullying slightly increased in the school and district where the defendant (school) avoided adverse legal consequences, suggesting potential backlash. Conclusions and Relevance: Litigation seeking to address alleged violations of the rights of students who are (or are perceived to be) lesbian, gay, bisexual, or transgender under laws prohibiting harassment or discrimination may lead to reductions in rates of homophobic bullying, with effect sizes comparable with that of resource-intensive school-based bullying interventions. These findings set the stage for future studies to evaluate the consequences of different litigation efforts aimed at redressing stigma-based harms among youth.

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.

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.

Faculty Perceptions of Engaging Students in Active Learning to Address Implicit Bias Using Videos Exemplifying the Prenatal Visit of a Lesbian Couple.

Introduction: Implicit bias affects patient-nurse interactions and care management decisions. The purpose of this educational project was to explore faculty perceptions of engaging students in active learning to address implicit bias using videos vignettes. Method: Three videos were created with a corresponding instructor guide. The vignettes depicted insensitive behaviors, best practice clinical interactions, and a reflection about bias in health care. Faculty who implemented the active learning strategy were invited to complete an online, confidential survey regarding their perceptions. Results: Most faculty (83%) agreed that students benefit from discussing implicit bias using an active learning approach. All faculty (N = 12) believed the videos and instructor guide to be effective tools in creating meaningful discussion. Discussion: Video vignettes illustrating insensitive behaviors and demonstrating best practice enable faculty to actively engage students in addressing the impact of implicit bias. Educational strategies intended to ensure equitable care are indicated to support positive patient outcomes.

Preventing Transphobic Bullying and Promoting Inclusive Educational Environments: Literature Review and Implementing Recommendations.

BACKGROUND: Transgender individuals are often targets of abuse, bullying, harassment, discrimination and violence at school, which causes significant personal suffering and serious consequences for their education process. Research suggests that structural interventions and changes are needed to reduce these phenomena and ensure that schools function as protective and secure learning environments for sexual minorities. AIM: This study presents a review of international interventions/programs focused on reducing bullying and promoting inclusive educational environments for transgender youths. METHODS: An extensive literature search in English and Spanish was undertaken using the electronic database of MEDLINE, PsycINFO, SCOPUS, SciELO and LILACS (1990-2018). RESULTS: Several international programs, guidelines and projects aimed at preventing bullying against sexual minorities (including the transgender population) in school environments were described. Recommendations and barriers to consider in the development and implementation of bullying prevention interventions in a range of school settings are discussed. CONCLUSIONS: Evidence suggest important positive benefits associated with attending schools that have anti-bullying or inclusive policies for gender minorities, such as the improvement of school wellbeing, more positive school climate, decreasing truancy, lower levels of victimization, decreased school harassment and increased feelings of safety. However, more research is needed to follow up on the various programs and interventions described in this study, to determine whether they have been implemented and what their actual long-term impact has been. The normalization of transphobia and tolerance for sexual minorities requires the attention of public policies in education strategies designed to deconstruct gender stereotypes and eradicate transphobia among adolescents.

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.

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.

"It's not my business": Exploring heteronormativity in young people's discourses about lesbian, gay, bisexual, transgender, and queer issues and their implications for youth health and wellbeing.

In Canada, the issue of creating safe and inclusive school environments for lesbian, gay, bisexual, transgender, and queer students has been in the spotlight. Several researchers and advocates have pointed out the positive effects of lesbian, gay, bisexual, transgender, and queer-positive policy frameworks on the health and wellbeing of all young people. In this article, we take a critical approach to analyzing narrative findings from qualitative interviews conducted with youth in three communities in British Columbia, Canada: "the North," Vancouver, and Abbotsford. Using a Foucauldian Discourse Analytic Approach and Butler's concept of Citationality, our analysis suggested that although explicit homophobia was largely absent from youth discussions, young people discursively constructed lesbian, gay, bisexual, transgender, and queer identities and "communities" in ways that reified heteronormativity. Youth made references to sociopolitical discourses of libertarianism and liberalism and to homonormative stereotypes regarding gay masculinity. A few young people also alluded to egalitarian, queer-positive discourses, which appeared to interrogate structures of heteronormativity. Since studies suggest a connection between the existence of institutional supports for lesbian, gay, bisexual, transgender, and queer students in schools and their mental and physical wellbeing, we conclude by considering the limitations and possibilities of these sociopolitical discourses in the struggle for sexual and gender equity, and how they might help frame future health-related, anti-homophobia policy frameworks in educational settings.

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.

Enhancing Cultural Sensitivity in a Community Health Care Setting for LGBTQ Patients.

Lesbian, gay, bisexual, transgender, or queer (LGBTQ)-identified individuals, particularly transgender individuals, experience significant health inequities such as increased risk for chronic health conditions and mental health concerns. Discrimination by health care professionals is a major deterrent for LGBTQ individuals to seek health care. The purpose of the article is to offer practice recommendations using targeted community actions to enhance LGBTQ cultural sensitivity in community health care settings. Strategic planning, assessment for readiness to change, environmental strengths, weaknesses, opportunities, and threats analysis, and use of community resources are recommended as part of a basic model for change in a community setting. Outcomes are measured using a cultural competency tool.

Longitudinal Examination of the Bullying-Sexual Violence Pathway across Early to Late Adolescence: Implicating Homophobic Name-Calling.

The Bully-Sexual Violence Pathway theory has indicated that bullying perpetration predicts sexual violence perpetration among males and females over time in middle school, and that homophobic name-calling perpetration moderates that association among males. In this study, the Bully-Sexual Violence Pathway theory was tested across early to late adolescence. Participants included 3549 students from four Midwestern middle schools and six high schools. Surveys were administered across six time points from Spring 2008 to Spring 2013. At baseline, the sample was 32.2% White, 46.2% African American, 5.4% Hispanic, and 10.2% other. The sample was 50.2% female. The findings reveal that late middle school homophobic name-calling perpetration increased the odds of perpetrating sexual violence in high school among early middle school bullying male and female perpetrators, while homophobic name-calling victimization decreased the odds of high school sexual violence perpetration among females. The prevention of bullying and homophobic name-calling in middle school may prevent later sexual violence perpetration.

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.