Rafael Velasquez1
Mary E. Moore2Gabrielle Sheets3Christian Nieves-Rivera3,4Sonya Van Nuland5Martha Cuccia6
Fern Tsien3,5†
Andrew D. Hollenbach3,5*†- 1Ochsner Medical Center, New Orleans, LA, United States
- 2Stritch School of Medicine, Loyola University Chicago, Chicago, IL, United States
- 3School of Graduate Studies, Louisiana State University Health Sciences Center, New Orleans, LA, United States
- 4Children’s Hospital of New Orleans, New Orleans, LA, United States
- 5School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, United States
- 6School of Public Health, LSU Health Sciences Center, New Orleans, LA, United States
Despite improvements in the awareness and acceptance of lesbian, gay, bisexual, transgender, queer, and other sexual and gender diverse (LGBTQ+) individuals, the LGBTQ+ community continues to experience discrimination, which can result in adverse health outcomes. In particular, LGBTQ+ youth have an increased risk of experiencing depression, substance abuse, and suicide. Societal stigma and rejection, bullying, and familial disapproval all contribute to these health disparities. In recognition of these inequities, an interprofessional team of biomedical faculty members, staff, and trainees from the Louisiana State University Health Science Center (LSUHSC) in New Orleans developed the needs-assessment evaluation, the Gender and Sexual Minority Youth Outreach Survey (GSMYO) for high school students. Health science centers have access to resources and experienced personnel who can provide support and education to high school students, teachers, and administrative staff. However, it is important to first determine the high schools’ specific needs, attitudes towards LGBTQ+ acceptance, and their current resources. Faculty, staff, and trainees from the LSUHSC Science Youth Initiative (SYI) and the LSUHSC LGBTQ+ Organization, Tiger Pride, administered the short, anonymous survey to adolescents attending Southeast Louisiana high schools. English Language Learner (ELL) students received the survey in Spanish. Results from the GSMYO needs-assessment survey are presented. Other health science centers may adapt the presented survey to develop needs-based LGBTQ+ high school programs to address the educational and health inequities in their own communities, regardless of location or demographic region.
1 Introduction
The National Institutes of Health officially recently designated lesbian, gay, bisexual, transgender, queer and other sexual and gender diverse (LGBTQ+) individuals as a health disparity population (National Heart, Lung, and Blood Institute & National Institutes of Health, 2014; Dankwa-Mullan and Ṕerez-Stable, 2016; Eliscu et al., 2023). Compared to heterosexual and gender binary peers, LGBTQ+ individuals are more than 2.5 times more likely to experience anxiety, depression, higher rates of suicidal thoughts, negative health behaviors (e.g., alcohol and tobacco use, physical inactivity, obesity), and sexually transmitted infections (Cochran et al., 2003; Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities, and Board of the Health of Select Populations, 2011; Buchting et al., 2018; Shover et al., 2018; Herman et al., 2019; Eliscu et al., 2023). Recent reports state that 81% of transgender adults in the U.S. have thought about suicide, 42% of transgender adults have attempted it, and 56% have engaged in non-suicidal self-injury over their lifetimes (Kidd et al., 2023).
LGBTQ+ youth, in particular, face discrimination, harassment, family & social rejection, or violence, which lead to an increased risk of depression, substance abuse, and suicide (McConnell et al., 2015; Mustanski et al., 2015; Gonzales and Rendon-Garcia, 2016; Hatzenbuehler and Pachankis, 2016; Gonzales and Henning-Smith, 2017; Centers for Disease Control and Prevention National Center, 2021). The Centers for Disease Control and Prevention (CDC)’s Youth Risk Behavior Surveillance System (YRBSS) monitors health among 9th through 12th grade students in the U.S. (Kann et al., 2018; Center for Disease Control and Prevention, 2019). The YRBSS reports that 69% of LGBQ+ youth feel persistently depressed and hopeless, compared to 35% of heterosexual youth (Center for Disease Control and Prevention, 2019; Szucs et al., 2022). LGBQ+ youth consistently report higher rates of bullying, being threatened or injured with a weapon, and dating violence (Center for Disease Control and Prevention, 2019; Szucs et al., 2022). During the COVID-19 pandemic, LGBQ+ students were four times more likely to attempt suicide, and 20% of LGBQ+ students said they had been physically abused by a parent or other adult at home compared to 10% of heterosexual students (Szucs et al., 2022). Data indicate that 82% of transgender and gender nonconforming (TGNC) individuals have considered killing themselves and 40% have attempted suicide, compared to the U.S. frequencies of 12.1 and 4.1%, respectively (Grossman et al., 2016; Austin et al., 2022).
Research shows that students who feel supported by their school community do better socially, emotionally, and academically (Ybarra et al., 2015; Gegenfurtner and Gebhardt, 2017; Center for Disease Control and Prevention, 2019; Wilkins et al., 2019). When schools implement LGBTQ+-supportive policies and practices, all students experience less emotional distress, violence, harassment, and suicidal behaviors (Gegenfurtner and Gebhardt, 2017; Center for Disease Control and Prevention, 2019; Lessard et al., 2020; Kaczkowski et al., 2022). The CDC’s “What Works in Schools” program has identified inclusive practices that benefit both LGBTQ+ students and their heterosexual peers (Centers for Disease Control and Prevention, 2023). However, some schools are resistant to these implementations, so students may not have allies or adults they can trust (Kaczkowski et al., 2022; Shattuck et al., 2022). In fact, LGBTQ+ youth are more likely to miss school because of safety concerns (Gegenfurtner and Gebhardt, 2017; Center for Disease Control and Prevention, 2019; Szucs et al., 2022). Studies recommend training of teachers, counselors, social workers, and mental health practitioners to systematically incorporate knowledge and evidence-based practices to enable them to become culturally and clinically skilled in working with LGBTQ+ and TGNC youth and their families (Grossman et al., 2016; Gegenfurtner and Gebhardt, 2017; Phelan et al., 2017).
Since the NIH designated LGBTQ+ as a health disparity population, health care organizations and academic institutions have created guidelines to reduce these inequalities (Dankwa-Mullan and Ṕerez-Stable, 2016; Phelan et al., 2017; Rafferty and AAP Committee on Psychosocial Aspects of Child and Family Health, AAP Committee on Adolescence, AAP Section on Lesbian, Gay Bisexual, and Transgender Health and Wellness, 2018; Cronin and Stockdale, 2021; American Academy of Family Physicians, 2023; Eliscu et al., 2023). The Liaison Committee on Medical Education now includes community service opportunities in their accreditation guidelines, and many graduate programs in the biomedical sciences and public health incorporate service learning as part of their curriculum (Woodhouse et al., 2006; Sabo et al., 2015; Loh et al., 2016; Phelan et al., 2017; Abraham and Torner, 2021). Studies describe a dramatic shift in the medical school curriculum to reduce medical student biases toward LGBTQ+ individuals by increasing opportunities to provide care to sexual minorities, an improved diversity climate, and more favorable interaction with sexual minorities (Phelan et al., 2017). These programs provide valuable opportunities for trainees in health care professions, biomedical research, and public health to strengthen community-campus partnerships and address health disparities in vulnerable populations (Seifer, 1998; Blue et al., 2006; Woodhouse et al., 2006; Sheridan et al., 2010; Brazeau et al., 2011; Sabo et al., 2015; Loh et al., 2016; Phelan et al., 2017; Abraham and Torner, 2021).
The goal of the present study is to conduct a needs-assessment among high school students residing in Southeastern Louisiana. Results of the survey will be used to develop needs-based LGBTQ+ health equity initiatives that improve LGBTQ+ education, improve training of emerging health care and public health professionals, increase accessibility to preventative health services, and reduce LGBTQ+ health disparities.
2 The interprofessional team
The Louisiana State University Health Sciences Center (LSUHSC) in New Orleans, LA is comprised of six schools (Medicine, Graduate Studies, Public Health, Nursing, Allied Health Professions, and Dentistry). In keeping with national guidelines, LSUHSC provides health education service learning to high schools while allowing future health care professionals and academic trainees to develop a sense of commitment to their communities (Gunaldo et al., 2018, 2020). For more than 20 years, LSUHSC in New Orleans has received federal, local, and foundational funding to support educational pipeline/pathway programs including the Science Youth Initiative (SYI) (Erickson et al., 2022; Sims et al., 2022; Hess et al., 2023; Moore et al., 2024). During the academic year (August–May), an interprofessional team of LSUHSC faculty, staff, and trainees teach high school students via practical experiments to enhance their science curriculum, improve classroom/standardized test scores, and provide career guidance. The curricula were developed in partnership with teachers from more than 50 schools throughout Southeastern Louisiana. Anonymous formative and summative evaluations by participants have measured satisfaction of the program, demographics, learning gains, topic retention, and long-term tracking of career plans (Erickson et al., 2022; Sims et al., 2022; Hess et al., 2023; Moore et al., 2024).
All LSUHSC faculty, trainees, and staff are required to complete yearly online training covering how to prevent harassment and discrimination. These topics are reinforced during in-person training which includes workshops on microaggressions, implicit bias, and SafeZone Training (Bolger and Killerman, 2018; Harrison-Bernard et al., 2020; Shattuck et al., 2022). SafeZone Training develops, enhances and maintains safe environments in workplaces, schools and other social settings that support LGBTQ+ individuals, as well as straight, cisgender people (Bolger and Killerman, 2018; Harrison-Bernard et al., 2020; Shattuck et al., 2022). Workshops include videos, seminars, interactive activities, and panel discussions, and are facilitated by diversity education experts at the institutional, state, and national level. Additionally, all LSUHSC adults teaching students under the age of 18 require a criminal background check, fingerprinting, and the completion of an online training module by the Louisiana Department of Children and Family Services.
3 The gender and sexual minority youth outreach survey
To find out how to help our communities, it was first necessary to evaluate the needs of individual high schools and to determine whether these needs varied depending on the location, nature, and composition of the student population. Therefore, faculty directors of the SYI created the Gender and Sexual Minority Youth Outreach Survey (GSMYOS), modeled after the CDC’s Youth Risk Behavior Surveillance System (YRBSS) high school questionnaire, (Centers for Disease Control and Prevention National Center, 2021). The GSMYOS is a short, simple, anonymous survey asking adolescents to rate their high school’s attitudes towards LGBTQ+ acceptance and available resources with the overall goal of developing needs-based educational and support programs led by health care professional trainees and faculty for LGBTQ+ youth. The survey was approved by the Institutional Review Board and all participants had parent/guardian consent.
3.1 Survey administration
Data were collected from SYI workshop participants enrolled in high schools from Southeastern Louisiana including public (ELL and non-ELL) and private (Catholic and non-Catholic) schools in urban and suburban regions of a wide range of socioeconomic backgrounds and racial and ethnic groups. LSUHSC facilitators supervised the in-person survey, in which students seated themselves separately from their peers to ensure privacy. Upon completion, surveys were collected in an envelope to maintain anonymity. Students were informed that the survey was completely anonymous and voluntary and that a blank (incomplete) survey form would be accepted. Adolescents enrolled in English Language Learner (ELL) programs whose first language was Spanish received the survey translated to their native language.
3.2 Analysis
The data were analyzed using the following methods: For questions using a 5-point Likert scale (i.e., strongly disagree = 1 to strongly agree = 5), the data were grouped according to school type (private Catholic, private non-Catholic, public), if students were enrolled in an ELL program, and by school location (suburban, urban). Mean and standard error were computed for each category, and a two-sample t-test was used to determine significance in answers based on school type and school location. A significance threshold was set at α = 0.05. Since the responses for Statement 2 were not on a scale; responses were analyzed using a Chi-Square test. Significance threshold was set at α = 0.05.
3.3 Demographics
A total of 516 high school students were surveyed from seven different schools; one urban school had both ELL and non-ELL students, but their results were analyzed separately. The demographics regarding race varied, ranging from private Catholic schools with a predominantly White student body to public schools with a more racially diverse population (Figure 1). Furthermore, higher levels of diversity were observed in urban schools relative to suburban schools.
Figure 1. Demographics of high school students who completed the Gender and Sexual Minority Youth Outreach Survey needs-assessment (n = 516).
3.4 Survey question results
Table 1. Summary of high school student responses to the Gender and Sexual Minority Youth Outreach needs-assessment survey.
3.4.1 Question 1: I feel that my campus is an LGBTQ+-friendly environment
Survey question results are summarized in Table 1. Responses to this statement varied significantly by school type:
a. Private non-Catholic schools (n = 110) and non-ELL public schools (n = 180) agreed (53.2, 35% respectively). Using the Likert scale (strongly disagree = 1, strongly agree = 5) their means were similar, 3.78 and 3.88, respectively (p = 1.97).
b. Students from private Catholic schools (n = 162) were the most likely to disagree (36.6%) with this statement. The average response from students in this category (2.6) is significantly lowest, indicating that students in private Catholic schools do not consider their school as LGBTQ+-friendly.
c. The majority of ELL students attending public Schools (public ELL) chose neutral (35.9%), with a mean of 3.39.
d. All schools’ means were significantly higher than private Catholic schools.
Significant differences were seen based on location:
a. Although the majority of students from all tested locations agreed that their school was LGBTQ+ friendly (suburban, urban non-ELL, and urban ELL student average scores were 3.09, 4.08, and 3.39, respectively).
b. Urban non-ELL students (n = 205) were most likely to strongly agree (43.6%).
c. The majority of the students in suburban and urban ELL remained neutral.
3.4.2 Question 2: Do you personally know someone who openly identifies as LGBTQ+?
a. The vast majority of non-ELL public school, private Catholic school, and private non-Catholic school students (92.8, 91.3, and 90.8%) or suburban and non-ELL urban (95.0 and 90.4%) answered that they knew someone who openly identified as LGBTQ+.
b. However, the answers of public ELL students were significantly different from other student types. The majority of ELL students reported that they did not know someone who identified as LGBTQ+ (42.2%).
3.4.3 Statement 3: I have witnessed bullying (verbal, physical, online, etc.) of classmates openly identified or perceived to be LGBTQ+
We observed no statistical difference in the response of students by school type:
a. Average responses ranged from 2.6 to 2.8.
b. Public ELL students had a higher percentage of “neutral” responses (34.9%).
In contrast, statistically significant differences were found when the data were evaluated by location:
a. A larger percentage of students from Suburban schools “agreed” or “strongly agreed” to have witnessed bullying (35.3%) than other locations.
b. Non-ELL urban students reported the least amount of bullying relative to suburban students (non-ELL urban 17.1% strongly disagree, 37.1% disagree; suburban 11.9% strongly disagree, 29.9% disagree).
c. Responses for urban ELL students also differed from suburban schools with the differences approaching statistical significance (p = 0.06).
3.4.4 Question 4: I have heard others in school speak about LGBTQ+ matters in a negative context
a. Students from private non-Catholic schools and private Catholic schools had heard about LGBTQ+ matters in a negative context (with means of 3.8 and 3.7, respectively; and “agreed” or “strongly agreed” 75 and 67.9% respectively).
b. In contrast, ELL students from public schools had the lowest mean out of all school types (2.7) and the highest percentage (44.5%) of students saying that they had not heard about LGBTQ+ matters being discussed in a negative context. The majority of ELL students stayed neutral (34.9%).
c. These statistics are significantly different when compared to other school categories, and even differs from Non-ELL public school students, whose mean was 3.3.
When the responses for this statement were analyzed by location:
a. Students from suburban schools had the highest average (3.7), followed by non-ELL urban (3.2) and then urban ELL students (2.6).
b. Of note, the responses of suburban students were clustered at the “agree” (50.2%) and “strongly agree” (19.9%), with the majority of ELL students as staying neutral (34.9%).
4 Discussion
Our results provide insights into the environments that LGBTQ+ students encounter at their respective schools in Southeastern Louisiana. We found that schools in suburban areas, although equally as likely as their non-ELL urban counterparts to know an LGBTQ+ person, reported lower levels of LGBTQ+ friendliness in their school and higher levels of negative comments and bullying. This result indicates that although many suburban students are aware of LGBTQ+ individuals, there also exists higher levels of intolerance and hostility towards this population.
The responses of ELL students in public schools differed from non-ELL students. ELL students were unique in that they were less likely than their non-ELL counterparts to report that their school was LGBTQ+ friendly and less likely to know someone who identified as LGBTQ+. They reported, however, fewer incidents of negative remarks and witnessing bullying than non-ELL students. One possible explanation is that many ELL students are raised in cultures and environments in which discussion of LGBTQ+ issues are considered a taboo topic (Dumas, 2008; Witcher, 2014; Gray et al., 2015; Quidley-Rodriguez and Gattamorta, 2019). Furthermore, they may wish to assimilate, in which case their comments may reflect an attempt to fit into their new environment (Gray et al., 2015; Quidley-Rodriguez and Gattamorta, 2019). ELL educators often find themselves not only teaching language, but also American culture, so guidelines have been proposed to embed LGBTQ+ cultural lessons in their classroom environment (Dumas, 2008; Witcher, 2014). ELL teachers are recommended to reframe classroom discussions to include LGBTQ+ content, and in particular acceptance of transgender individuals (Dumas, 2008; Witcher, 2014; Grossman et al., 2016; Shariff-Marco et al., 2017).
Private non-Catholic and non-ELL public school students were the most likely to report that their school is LGBTQ+ friendly, while private Catholic school students were the least likely. Furthermore, while students from all school types were equally likely to have witnessed bullying, students from private Catholic schools and private non-Catholic schools were the most likely to have heard negative remarks about the LGBTQ+ community. According to scholars, the opportunities to include the LGBTQ+ community in Catholic education aligns with tenets of Catholic Social Teaching (the life and dignity of the person, the preference for the vulnerable, and the common good) (United States Conference of Catholic Bishops, 2005; Huchting and Fisher, 2019). However, a hostile climate exists for LGBTQ+ students, and the message of inclusion is contradicted when LGBTQ+ students experience microaggressions (Huchting and Fisher, 2019; Janoski, 2023). Extensive research by Maher et al. demonstrates the connections between religiosity, masculinity, and intolerance in Catholic schools (Maher, 2007; Maher and Sever, 2007; Maher et al., 2008; Maher, 2013). Catholic secondary school staff and administrators’ recommendations for promoting a more inclusive LGBTQ+ environment include (1) exposure to diverse perspectives and world views, (2) a “more personal, socially conscious, socially compassionate” learning environment, (3) professional development, (4) and the creation of ally and affinity groups (Maher, 2007; Maher and Sever, 2007; Maher et al., 2008; Maher, 2013; Callaghan, 2016; Huchting and Fisher, 2019; Parodi-Brown, 2019). Studies report that Catholic students are more accepting towards LGBTQ+ individuals when they had more personal experiences with them (Maher, 2007; Maher and Sever, 2007; Maher et al., 2008; Callegher, 2010; Callaghan, 2016; Huchting and Fisher, 2019). The Catholic Pastoral Committee on Sexual Minorities spearheaded the Safe Schools Initiative, based on a “training the trainer” model implemented in some U.S. Catholic schools (Bayly, 2013; Ratts et al., 2013).
5 Future directions
Our needs-assessment results provide valuable information for the development of health science center-led outreach programs to provide (1) education about LGBTQ+ issues to all high school students, (2) support for students who identify as LGBTQ+, and (3) service learning opportunities for health science center trainees. While all high schools would benefit from a centralized Core Curriculum, each school has its own unique environment that would require specific modules to address their individual needs. Therefore, based on our results, we propose supplementary modules targeting specific school environments. All of these would be led by health science center trainees, faculty, and staff. In addition, there are a variety of online resources that can aid in the development of the overarching program and modules including the Gay, Lesbian & Straight Education Network (GLSEN) Safe Space Kit (GLSEN, 2016), and the U. S. Department of Health and Human Services (Stopbullying.gov, 2021). One limitation of this study includes the lack of sex or gender identity in our participants but will be included in the future.
Data availability statement
The original contributions presented in the study are included in the article; further inquiries can be directed to the corresponding author.
Ethics statement
The studies involving humans were approved by LSU School of Medicine Institutional Review Board. The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants’ legal guardians/next of kin.
Author contributions
RV: Investigation, Methodology, Project administration, Supervision, Writing – review & editing. MM: Investigation, Methodology, Project administration, Supervision, Writing – review & editing. GS: Writing – review & editing. CN-R: Writing – review & editing. SN: Writing – review & editing. MC: Conceptualization, Investigation, Project administration, Supervision, Writing – review & editing. FT: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Writing – original draft, Writing – review & editing. AH: Conceptualization, Formal analysis, Writing – original draft, Writing – review & editing.
Funding
The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the NSF REU (Awards # DBI-1359140, 1659752, and 2051440).
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
Abraham, O., and Torner, C. (2021). Preparing graduate students for community engagement in health services research. Innov. Pharm. 12:15. doi: 10.24926/iip.v12i2.3469
American Academy of Family Physicians. (2023). “Care for the transgender and gender nonbinary patient.” Aafp.Org. Available at: https://www.aafp.org/about/policies/all/transgender-nonbinary.html (Accessed May 13, 2024).
Austin, A., Craig, S. L., D'Souza, S., and McInroy, L. B. (2022). Suicidality among transgender youth: elucidating the role of interpersonal risk factors. J. Interpers. Violence 37, NP2696–NP2718. doi: 10.1177/0886260520915554
Bayly, M. J. (2013). Creating safe environments for LGBT students: a catholic schools perspective. New York: Harrington Park Press.
Blue, A. V., Geesey, M. E., Sheridan, M. E. B., and Basco, W. T. (2006). Performance outcomes associated with medical school community service. Acad. Med. 81, S79–S82. doi: 10.1097/00001888-200610001-00020
Bolger, M., and Killerman, S. (2018). “Curriculum: Safe Zone Project.” Thesafezoneproject.Org. Available at: https://thesafezoneproject.com/curriculum/ (Accessed May 13, 2024).
Brazeau, C. M. L. R., Schroeder, R., Rovi, S., and Boyd, L. (2011). Relationship between medical student service and empathy. Acad. Med. J. Assoc. Am. Med. Coll. 86, 42–45. doi: 10.1097/acm.0b013e31822a6ae0
Buchting, F. O., Emory, K. T., Scout, Y. K., Fagan, P., Vera, L. E., and Emery, S. (2018). Transgender use of cigarettes, cigars, and E-cigarettes in a National Study. Am. J. Prev. Med. 53, e1–e7. doi: 10.1016/j.amepre.2016.11.022
Callaghan, T. D. (2016). Young, queer, and Catholic: youth resistance to homophobia in Catholic schools. J. LGBT Youth 13, 270–287. doi: 10.1080/19361653.2016.1185758
Callegher, J. D. (2010). Attitudes toward homosexuality among Catholic-educated university graduates. J. Cathol. Educ. 13, 306–328. doi: 10.15365/joce.1303032013
Center for Disease Control and Prevention. (2019). “Adolescent and school health: YRBSS results.” Cdc.Gov. Available at: https://www.cdc.gov/lgbthealth/youth.htm#print (Accessed May 13, 2024).
Centers for Disease Control and Prevention. (2023). “LGBTQ+ youth: addressing health disparities with a school based approach.” Lesbian, Gay, Bisexual, and Transgender Health Home. Available at: https://www.cdc.gov/lgbthealth/youth.htm#print (Accessed May 13, 2024).
Centers for Disease Control and Prevention National Center (2021). Youth risk behavior surveillance system (YRBSS). Adol. School Health. Available at: https://www.cdc.gov/healthyyouth/data/yrbs/index.htm%0Ahttps://www.cdc.gov/healthyyouth/data/yrbs/overview.htm (Accessed May 13, 2024).
Cochran, S. D., Sullivan, G., and Mays, V. M. (2003). Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. J. Consult. Clin. Psychol. 71, 53–61. doi: 10.1037/0022-006X.71.1.53
Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities, and Board of the Health of Select Populations (2011). The health of lesbian, gay, bisexual, and transgender people: Building a Foundation for Better Understanding. Washington, DC: Insitute of Medicine of the National Academies.
Cronin, B., and Stockdale, C. K. (2021). Health Care for Transgender and Gender Diverse Individuals. Obstet. Gynecol. 137, 554–555. doi: 10.1097/aog.0000000000004296
Dankwa-Mullan, I., and Ṕerez-Stable, E. J. (2016). Addressing health disparities is a place-based issue. Am. J. Public Health 106, 637–639. doi: 10.2105/AJPH.2016.303077
Dumas, J. (2008). The ESL classroom and the queerly shifting sands of learner identity. TESL Canada J. 26, 1–10. doi: 10.18806/tesl.v26i1.387
Eliscu, A. H., Jamilkowski, J., Gonzalez, A., Higham, J. M., Kenny, L., and McGovern, M. M. (2023). Results from an LGBTQ+ community health needs assessment in Nassau and Suffolk counties of New York state. Community Ment. Health J. 59, 855–868. doi: 10.1007/s10597-022-01069-8
Erickson, O. A., Cole, R. B., Isaacs, J. M., Alvarez-Clare, S., Arnold, J., Augustus-Wallace, A., et al. (2022). How do we do this at a distance?! A descriptive study of remote undergraduate research programs during COVID-19. CBE life sciences. Education 21, 1–16. Available at: https://www.lifescied.org/doi/pdf/10.1187/cbe.21-05-0125
Gegenfurtner, A., and Gebhardt, M. (2017). Sexuality education including lesbian, gay, bisexual, and transgender (LGBT) issues in schools. Educ. Res. Rev. 22, 215–222. doi: 10.1016/j.edurev.2017.10.002
GLSEN. (2016). Safe space kit: A guide to supporting lesbian, gay, Bisexual and Transgender Students in Your School. New York. Available at: https://www.glsen.org/activity/glsen-safe-space-kit-solidarity-lgbtq-youth (Accessed May 13, 2024).
Gonzales, G., and Henning-Smith, C. (2017). Health disparities by sexual orientation: results and implications from the behavioral risk factor surveillance system. J. Community Health 42, 1163–1172. doi: 10.1007/s10900-017-0366-z
Gonzales, R. G., and Rendon-Garcia, S. A. (2016). Understanding the deferred action for childhood arrivals (DACA) impact on Young adults’ well-being. Am. Psychol. Assoc. 2016, 1–6. Available at: https://www.apa.org/pi/families/resources/newsletter/2016/11/deferred-action (Accessed May 13, 2024).
Gray, N. N., Mendelsohn, D. M., and Omoto, A. M. (2015). Community connectedness, challenges, and resilience among gay Latino immigrants. Am. J. Community Psychol. 55, 202–214. doi: 10.1007/s10464-014-9697-4
Grossman, A. H., Park, J. Y., and Russell, S. T. (2016). Transgender youth and suicidal behaviors: applying the interpersonal psychological theory of suicide. J. Gay Lesbian Ment. Health 20, 329–349. doi: 10.1080/19359705.2016.1207581
Gunaldo, T. P., Augustus-Wallace, A., Goumas, A., Cheramie, T., Brisco, S., and Levitzky, E. (2018). Integrating interprofessional education into an academic enrichment program. Health Interprof. Pract. 3, 1–8. doi: 10.7710/2159-1253.1168
Gunaldo, T. P., Augustus-Wallace, A., Schilling, D., Hicks, M., Goumas, A., and Levitzky, E. (2020). Gaining an understanding of Interprofessional roles and responsibilities among pre-professional health students. Health Interprof. Pract. Educ. 4:1191. doi: 10.7710/1191
Harrison-Bernard, L. M., Augustus-Wallace, A. C., Souza-Smith, F. M., Tsien, F., Casey, G. P., and Gunaldo, T. P. (2020). Knowledge gains in a professional development workshop on diversity, equity, inclusion, and implicit bias in academia. Adv. Physiol. Educ. 44, 286–294. doi: 10.1152/ADVAN.00164.2019
Hatzenbuehler, M. L., and Pachankis, J. E. (2016). Stigma and minority stress as social determinants of health among lesbian, gay, bisexual, and transgender youth research evidence and clinical implications. Pediatr. Clin. N. Am. 63, 985–997. doi: 10.1016/j.pcl.2016.07.003
Herman, J. L., Brown, T. N. T., and Haas, A. P. (2019). “Suicide thoughts and attempts among transgender adults: findings from the 2015 U.S. transgender survey.” The Williams Institute at UCLA School of Law. Available at: https://williamsinstitute.law.ucla.edu/publications/suicidality-transgender-adults/ (Accessed May 13, 2024).
Hess, R. A., Erickson, O. A., Cole, R. B., Isaacs, J. M., Alvarez-Clare, S., Arnold, J., et al. (2023). Virtually the same? Evaluating the effectiveness of remote undergraduate research experiences. CBE Life Sci. Educ. 22, ar25–ar12. doi: 10.1187/cbe.22-01-0001
Huchting, K., and Fisher, E. (2019). Introduction to the special issue: the challenges and opportunities of including the LGBTQ Community in Catholic Education. J. Cathol. Educ. 23, 1–13. doi: 10.15365/joce.2203012019
Janoski, H. K. (2023). “Deconstructing U.S. Catholic schools: Institutions of homogeneity and inequity.” Ohio University. Available at: https://etd.ohiolink.edu/acprod/odb_etd/etd/r/1501/10?clear=10&p10_accession_num=ouhonors1682692162008644 (Accessed May 13, 2024).
Kaczkowski, W., Cooper, A. C., Li, J., and Robin, L. (2022). The association of LGBTQ-supportive school health policies and practices with sexual health outcomes. LGBT Health 9, 384–392. doi: 10.1089/lgbt.2021.0132
Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Hawkins, J., et al. (2018). Youth risk behavior surveillance – United States, 2015. MMWR Surveill. Summ. 67, 1–114. doi: 10.15585/mmwr.ss6708a1
Kidd, J., Tettamanti, N., Kaczmarkiewicz, R., Corbeil, T., Dworkin, J., Jackman, K., et al. (2023). Prevalence of substance use and mental health problems among transgender and cisgender U.S. adults: results from a national probability sample. Psychiatry Res. 326:115339. doi: 10.1016/j.psychres.2023.115339
Lessard, L. M., Puhl, R. M., and Watson, R. J. (2020). Gay-straight alliances: A mechanism of health risk reduction among LGBTQ adolescents. Am. J. Prev. Med. 59, 196–203. doi: 10.1016/j.amepre.2020.02.020
Loh, A. Z., Hui, J. S., Tan, Y., Lee, J. J. M., and Koh, G. C. H. (2016). Voluntary Community Service in Medical School: A qualitative study on student leaders’ motivations, experiences, and outcomes. Med. Teach. 38, 683–690. doi: 10.3109/0142159X.2016.1150985
Maher, M. J. (2007). Gay and lesbian students in Catholic high schools: A qualitative study of alumni narratives. J. Cathol. Educ. 10, 79–111. doi: 10.15365/joce.1004052013
Maher, M. J. (2013). “Homophobic bullying in Catholic high schools: five us studies in heterosexism, authority, masculinity, and religion” in Gender, religion and education in a chaotic postmodern world. eds. Z. Gross, L. Davies, and A-K. Diab (Netherlands: Springer), 271–284.
Maher, M. J., and Sever, L. M. (2007). What educators in Catholic schools might expect when addressing gay and lesbian issues: a study of needs and barriers. J. Gay Lesbian Issues Educ. 4, 79–111. doi: 10.1300/J367v04n03_06
Maher, M. J., Sever, L. M., and Pichler, S. (2008). How Catholic College students think about homosexuality: the connection between authority and sexuality. J. Homosex. 55, 325–349. doi: 10.1080/00918360802345065
McConnell, E. A., Birkett, M. A., and Mustanski, B. (2015). Typologies of social support and associations with mental health outcomes among LGBT youth. LGBT Health 2, 55–61. doi: 10.1089/lgbt.2014.0051
Moore, M., Cuccia, M., Edwards, A., Hicks, C., McLean, A., Nieves-Rivera, C., et al. (2024). How can academic health science centers help to increase diversity in the STEM professions? Front. Educ. 9, 1–7. doi: 10.3389/feduc.2024.1357946
Mustanski, B., Greene, G. J., Ryan, D., and Whitton, S. W. (2015). Feasibility, acceptability, and initial efficacy of an online sexual health promotion program for LGBT youth: the queer sex Ed intervention. J. Sex Res. 52, 220–230. doi: 10.1080/00224499.2013.867924
National Heart, Lung, and Blood Institute & National Institutes of Health. (2014). About health disparities. Available at: https://www.nhlbi.nih.gov/health/educational/healthdisp/about-health-disparities.htm (Accessed April 2, 2024)
Parodi-Brown, J. A. (2019). “Being LGBTQ in Catholic school: understanding students’s lived experience to influence school leadership practice.” Graduate School of Creighton University. Available at: https://revistas.ufrj.br/index.php/rce/article/download/1659/1508%0Ahttp://hipatiapress.com/hpjournals/index.php/qre/article/view/1348%5Cnhttp://www.tandfonline.com/doi/abs/10.1080/09500799708666915%5Cnhttps://mckinseyonsociety.com/downloads/reports/Educa (Accessed May 13, 2024).
Phelan, S. M., Burke, S. E., Hardeman, R. R., White, R. O., Przedworski, J., Dovidio, J. F., et al. (2017). Medical school factors associated with changes in implicit and explicit bias against gay and lesbian people among 3492 graduating medical students. J. Gen. Intern. Med. 32, 1193–1201. doi: 10.1007/s11606-017-4127-6
Quidley-Rodriguez, N., and Gattamorta, K. (2019). Constructing interventions for Hispanic sexual minority youth. J. LGBT Youth 16, 278–299. doi: 10.1080/19361653.2019.1573712
Rafferty, J.AAP Committee on Psychosocial Aspects of Child and Family Health, AAP Committee on Adolescence, AAP Section on Lesbian, Gay Bisexual, and Transgender Health and Wellness. (2018). “Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents.” American Academy of Pediatrics. doi: 10.1542/peds.2018-2162
Ratts, M. J., Kaloper, M., McReady, C., Loni Tighe, S., Butler, K., Dempsey, K., et al. (2013). Safe space programs in K-12 schools: creating a visible presence of LGBTQ allies. J. LGBT Issues Couns. 7, 387–404. doi: 10.1080/15538605.2013.839344
Sabo, S., De Zapien, J., Teufel-Shone, N., Rosales, C., Bergsma, L., and Taren, D. (2015). Service learning: A vehicle for building health equity and eliminating health disparities. Am. J. Public Health 105, S38–S43. doi: 10.2105/AJPH.2014.302364
Seifer, S. D. (1998). Service-learning community-campus partnerships for health professions education. Acad. Med. 73, 273–277. doi: 10.1097/00001888-199803000-00015
Shariff-Marco, S., Von Behren, J., Reynolds, P., Keegan, T. H. M., Hertz, A., Kwan, M. L., et al. (2017). Impact of social and built environment factors on body size among breast cancer survivors: the pathways study. Cancer Epidemiol. Biomarkers Prev. 26, 505–515. doi: 10.1158/1055-9965.EPI-16-0932
Shattuck, D., Richard, B. O., Jaramillo, E. T., Byrd, E., and Willging, C. E. (2022). Power and resistance in schools: implementing institutional change to promote health equity for sexual and gender minority youth. Front. Health Serv. 2, 1–16. doi: 10.3389/frhs.2022.920790
Sheridan, M. E. B., Blue, A. V., and Basco, W. T. (2010). Promoting students’ community service during medical school: the MUSC gives back office. Teach. Learn. Med. 22, 214–218. doi: 10.1080/10401334.2010.488449
Shover, C. L., DeVost, M. A., Beymer, M. R., Gorbach, P. M., Flynn, R. P., and Bolan, R. K. (2018). Using sexual orientation and gender identity to monitor disparities in HIV, sexually transmitted infections, and viral hepatitis. Am. J. Public Health 108, S277–S283. doi: 10.2105/AJPH.2018.304751
Sims, Z. K., Cousin, L., Suppiah, V., Stanley, N., Li, J., Quinn, G., et al. (2022). Improving multi-site interaction through remote learning technology: report from a training program to increase underrepresented undergraduate and medical students in health disparities research. J. Cancer Educ. 37, 1466–1471. doi: 10.1007/s13187-021-01985-5
Stopbullying.gov. (2021). “Stop bullying: LGBTQI + youth.” Available at: https://www.stopbullying.gov/bullying/lgbtq (Accessed May 13, 2024).
Szucs, L. E., Barrios, L. C., Young, E., Robin, L., Hunt, P., and Jayne, P. E. (2022). The CDC’s division of adolescent and school health approach to sexual health education in schools: 3 decades in review*. J. Sch. Health 92, 223–234. doi: 10.1111/josh.13115
United States Conference of Catholic Bishops (2005). Renewing our commitment to Catholic elementary and secondary schools in the third millennium. J. Cathol. Educ. 9, 266–277. doi: 10.15365/joce.0903022013
Wilkins, N. J., Rasberry, C., Liddon, N., Szucs, L. E., Johns, M., Leonard, S., et al. (2019). Addressing HIV/sexually transmitted diseases and pregnancy prevention through schools: an approach for strengthening education, health services, and school environments that promote adolescent sexual health and well-being. J. Adolesc. Health 70, 540–549. doi: 10.1016/j.jadohealth.2021.05.017
Witcher, T. L. (2014). “Finding the ‘T’ in LGBTQ: ESL educator perceptions of transgender and non-binary gender topics in the language classroom.” Western Kentucky University. Available at: http://digitalcommons.wku.edu/cgi/viewcontent.cgi?article=2439&context=theses (Accessed May 13, 2024).
Woodhouse, L. D., Cardelle, A. C., Godin, S. W., Shive, S. E., Williams, T. L., Brensinger, E. A., et al. (2006). Transforming a master of public health program to address public health practice needs. Prev. Chronic Dis. 3:A22.
Keywords: LGBTQ+, LGBTQ+ advocacy, LGBTQ+ school environment, high school, outreach, LGBTQ+ mental health, school health, adolescent health
Citation: Velasquez R, Moore ME, Sheets G, Nieves-Rivera C, Van Nuland S, Cuccia M, Tsien F and Hollenbach AD (2024) A needs-assessment survey of the high school LGBTQ+ environment by a health science center interprofessional team. Front. Sociol. 9:1356007. doi: 10.3389/fsoc.2024.1356007
Edited by:
Marta Evelia Aparicio-Garcįa, Complutense University of Madrid, SpainReviewed by:
Miguel Ángel López-Sáez, Rey Juan Carlos University, SpainKillian Kinney, Pacific University, United States
Copyright © 2024 Velasquez, Moore, Sheets, Nieves-Rivera, Van Nuland, Cuccia, Tsien and Hollenbach. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Andrew D. Hollenbach, aholle@lsuhsc.edu
†These authors have contributed equally to this work and share senior authorship