Addressing LGBTQ Student Bullying in Massachusetts Schools: Perspectives of LGBTQ Students and School Health Professionals.

Lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) youth face disparities in bullying victimization are associated with higher rates of physical injury, psychological distress, and even suicide. Innovative strategies to address bullying victimization are needed to prevent adverse physical and mental health outcomes, including those engaging school health professionals (SHPs; school nurses, psychologists). This mixed-methods study sought to identify factors that facilitate or impede SHPs' reporting and responding to LGBTQ bullying in Massachusetts from the perspectives of LGBTQ students and SHPs. Between August 2017 and July 2018, asynchronous online focus group discussions and a brief survey were conducted separately for 28 LGBTQ students and 19 SHPs in Massachusetts (9-12 participants per group; n = 47 enrolled). Focus groups probed on bullying experiences. Rapid qualitative inquiry was used for thematic coding of facilitators and barriers to address LGBTQ student bullying described by youth and SHPs. Facilitators and barriers largely coalesced around the social ecological model. Youth and SHPs identified factors at multiple levels of the social ecological model: (1) individual (knowledge, skills, attitudes); (2) interpersonal (trust and follow-through, confidentiality and fear of being "outed," close relationships, champion SHPs); and (3) structural (school buy-in, time, reporting and protocols, staff roles, resources, and school culture of inclusivity). LGBTQ students expressed a need for an intersectional lens for SHPs when addressing LGBTQ student bullying. Interventions that help SHPs overcome multilevel barriers and leverage facilitators are needed. Consideration of intersectionality will better equip SHPs to support LGBTQ students and address disparities in LGBTQ student bullying that confer health risks.

Contextualizing gay-straight alliances: student, advisor, and structural factors related to positive youth development among members.

Gay-straight alliances (GSAs) may promote resilience. Yet, what GSA components predict well-being? Among 146 youth and advisors in 13 GSAs (58% lesbian, gay, bisexual, or questioning; 64% White; 38% received free/reduced-cost lunch), student (demographics, victimization, attendance frequency, leadership, support, control), advisor (years served, training, control), and contextual factors (overall support or advocacy, outside support for the GSA) that predicted purpose, mastery, and self-esteem were tested. In multilevel models, GSA support predicted all outcomes. Racial/ethnic minority youth reported greater well-being, yet lower support. Youth in GSAs whose advisors served longer and perceived more control and were in more supportive school contexts reported healthier outcomes. GSA advocacy also predicted purpose. Ethnographic notes elucidated complex associations and variability as to how GSAs operated.

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

BACKGROUND: Lesbian, gay, bisexual, transgender, and queer and questioning (LGBTQ) youth experience poor physical and mental health outcomes relative to their non-LGBTQ peers. School health professionals (SHPs), such as school nurses, play a key role in addressing LGBTQ student health needs. However, few studies examine school health needs of LGBTQ students from both the youth and SHP perspective. METHODS: From August 2017 to July 2018, 28 LGBTQ youth and 19 SHPs (N = 47) in Massachusetts participated in online focus groups and a brief survey on school health needs and experiences. Qualitative themes were coded using Rapid Qualitative Inquiry principles and NVIVO. RESULTS: Both LGBTQ students and SHPs identified an urgent need for inclusive sexual education and mental health services. LGBTQ students raised access to safer bathrooms, information, and guidance on gender transitioning, and access to safe spaces as school-based needs. Missing from SHPs' perspectives, students also discussed sexual violence/harassment of transgender students and racism impacting youth of color. CONCLUSIONS: LGBTQ students, especially transgender students and LGBTQ youth of color, have unmet health needs that need to be addressed. Recognizing these needs is the first step towards inclusive health services and support for all students in schools. Next, interventions to increase the capacity of SHPs to address LGBTQ student health are necessary.

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.