This dissertation examines the influences of LGBTQ positive school climate and state-level anti-bullying policy with sexual and gender minority (SGM) identity enumeration on weight and victimization disparities among sexual minority adolescents. Compared to their heterosexual peers, sexual minority adolescents (those who identify as gay/lesbian or bisexual, or who are unsure of their sexual identity) have higher odds of having obesity and experiencing school violence victimization. The effects of school climate and anti-bullying policy that seek to specifically provide protections for LGBTQ adolescents on the health outcomes of obesity and school violence have rarely been examined, and especially in tandem. Decreasing disparities in both these outcomes would help improve quality of life and decrease morbidity. Therefore, the overall objective of this dissertation is to help fill several gaps in the literature related to obesity, school violence, school climate, and state-level anti-bullying policy with SGM identity enumeration. An adapted Social Ecological Model guided conceptualization and design of the three studies included. Chapter 1 introduces the current state of adolescent obesity, including trends in obesity over time, contextual influences on obesity, and obesity disparities among sexual minority adolescents. Existing research on school violence victimization, school climate, and SGM enumerated policy are also introduced and described. Chapter 2, a systematic review, aimed to systematically search and review the literature on the effects of positive school climate on weight-related health behaviors and risk factors for obesity. Overall, we found that LGBTQ adolescents in more positive school climates reported lower levels of bullying victimization, depressive and suicidal feelings, and sexual orientation-based harassment than those in less positive school climates. Results were more mixed for studies examining the effects of positive school climate on alcohol, tobacco, and other drug use. Chapter 3, a cross-sectional analysis of the Center for Disease Control and Prevention’s (CDC’s) Youth Risk Behavior Surveys (YRBS) and School Health Profiles (SHP) from 2010–2019, examined and compared the associations among sexual identity, school violence victimization, and obesity across varying levels of LGBTQ school climate in ten United States school districts. We found that for both female and male adolescents, regardless of sexual identity, those who reported two or more counts of school violence victimization had significantly higher odds of obesity compared to those who reported no violence victimization experienced in the last 12 months (1.33 and 1.24 greater odds, respectively). We also found that in the presence of more positive LGBTQ school climates, adolescents had 0.85 lower odds of obesity compared to those in the presence of less positive LGBTQ school climates. Chapter 4, a quasi-experimental difference-in-differences analysis of state-level anti-bullying policies and state-level CDC YRBS data from 1999–2019, examined the causal effect of anti-bullying policies with SGM identity enumeration on bullying and obesity trends over time. We found that adolescent girls had a significant 1.0 percentage point decrease in the probability of bullying victimization in the period post SGM enumeration enactment. For boys, this association was slightly stronger with a 3.2 percentage point decrease in the probability of bullying victimization in the post-period. However, when we examined subgroups of sexual minority adolescents specifically, we found the average treatment effects for SGM enumeration were even stronger for sexual minority girls and boys—with a 6.4 percentage point decrease in the probability of being bullied for sexual minority girls and a 6.0 percentage point decrease for sexual minority boys. Results for the obesity outcome showed that in the post-period, obesity rates increased for sexual minority girls and boys, an unintended effect that should be explored in future research that considers temporality of relationships among these outcome variables. Finally, Chapter 5 summarizes the studies included in the dissertation, identifies strengths and limitations, reviews key findings, and discusses implications for policy, practice, and future research. Using strong quantitative statistical methods, our primary contribution to the public health literature is that LGBTQ positive school climates and inclusive, SGM enumerated anti-bullying policies work to help decrease odds of obesity and rates of bullying victimization, respectively, for both heterosexual and sexual minority adolescents—highlighting how specific protections for one group of adolescents can extend benefits to all adolescents.

Bakgrund   Ätstörningar påverkar ungefär nio procent av världens befolkning. De definieras som allvarliga och tvångsmässiga beteenden med potentiellt livsfarliga konsekvenser. Sexuella-och könsminoriteter är sårbara och marginaliserade grupper med hög risk för att lida av psykisk ohälsa. Deras upplevelser och erfarenheter som marginaliserade samhällsgrupper påverkar deras interaktion med vården. Syfte Att beskriva prevalensen och lidandet av ätstörningar hos sexuella-och könsminoriteter. Metod Studien är en icke-systematisk litteraturstudie. För att söka ut de 17 originalartiklar som inkluderades i studien användes tre separata databaser och manuell sökning. Alla artiklar har kvalitetsgranskats enligt Sophiahemmets Högskolas bedömningsunderlag. Därefter lästes materialet igenom och en integrerad dataanalys användes för att analysera det syntetiserade resultatet. Resultat Sexuella-och könsminoriteter påvisade en högre risk för att lida av ätstörningar än ciskönade heterosexuella individer. Helt homosexuella deltagare hade ofta en officiell ätstörningsdiagnos medan bisexuella deltagare rapporterade höga resultat på bedömningar om ätstörningar. Ätstörningar och ätstörningsbeteende var ofta förekommande hos könsminoriteter med motiveringen att framhäva eller förtrycka könskaraktärer. Deltagare rapporterade upplevt lidande på grund av en bristande kunskap eller möjlighet till vård. Slutsats Det finns ett behov av ett empatiskt förhållningssätt gentemot målgrupperna samt utbildning i att förstå minoritetsperspektivet för att minska lidandet bland sexuella-och könsminoriteter som lider av ätstörningar. Minoritetsstress måste tas i beaktning när man hanterar minoriteter då de löper hög risk för fysiska och psykiska sjukdomar. Resultaten illustrerade skillnader mellan grupperna vilket lyfte fram vikten av att se individen holistiskt. Genom att arbeta för att förstå minoritetsperspektivet kan vårdgivare bidra till globala mål samt lindra lidande för individen. / Background Feeding and eating disorders affect about nine percent of the human population. They are defined as serious and compulsory behaviours with potentially life-threatening consequences. Sexual and gender minorities are vulnerable and marginalised groups who are at risk of suffering psychological illnesses. Their experiences as marginalised groups of society affect their interaction with the healthcare system.  Aim To describe the prevalence and suffering of feeding and eating disorders amongst sexual and gender minorities. Method The study is a non-systematic literature review. Three separate databases along with manual search were used to find the 17 primary articles included in the study. All articles have been reviewed as per Sophiahemmet University’s assessment instruments. Thereafter, the source material was examined, and an integrated analysis was used to analyse the synthesised results.  Results Sexual and gender minorities exhibited a high risk for suffering feeding and eating disorders than cisgendered heterosexual individuals. Completely homosexual participants were more likely to have an official feeding and eating disorder diagnosis whilst bisexual participants reported high scores on feeding and eating disorder questionnaires. Feeding and eating disorders and disturbed eating behaviours were frequent amongst gender minorities with the motivation of accentuating or repressing sex characteristics. Participants reported further suffering due to lack of knowledge or care amongst healthcare providers.  Conclusions There is a need for an empathic attitude and education in understanding the minority perspective to reduce the suffering amongst sexual and gender minorities suffering feeding and eating disorders. Minority stress needs to be taken into consideration when dealing with minorities as they are at high risk of physical and mental illnesses. The results illustrated various differences between the subgroups which highlighted the importance of viewing the individual holistically. By working to understand the minority perspective, healthcare providers can contribute to global goals as well as alleviate suffering for the individual.

The minority stress model provides context to understand the mechanisms by which prejudicial experiences contribute to the disproportionate prevalence of adverse physical and mental health outcomes among LGBT people. The transactional model of stress and coping explains the appraisal processes through which people identify stigma-related stimuli as threatening and how they assess available coping resources to counteract these threats. The Connor-Davidson Resilience Scale (CD-RISC) and the Perceived Stress Scale (PSS) were used in this study to measure resilience and stress in a sample of 99 lesbian and gay older adults. Women reported statistically significantly higher levels of resilience and lower levels of perceived stress compared to older gay men. An analysis of covariance (ANCOVA) revealed statistically significant main effects for gender (Cohen's d = .51; ηp2 = .056; F(1,98) = 5.488, p = .021) while controlling for perceived stress (Cohen's d = 1.62; ηp2 = .375; F(1,98) = 55.840, p < .001). An interaction effect between gender and perceived stress was also statistically significant (Cohen's d = .72; ηp2 = .115; F(1,98) = 12.40, p < .001) indicating that the negative relationship between stress and resilience is stronger for older gay men. Clinical implications and relevance to future research are discussed.

Trans and queer children are experiencing discrimination starting in the earliest years of schooling. In a paradoxical era of increased support for transgender and queer children on the one hand, and persistent gender violence on the other, this study examines how the New York City Department of Education (NYCDOE) gender policy is taken up in Early Childhood Education practice. In particular, I ask: (a) What are early childhood teachers’ understanding of NYCDOE’s policy? (b) How do the larger social and material contexts, shape teachers’ enactments of the policy? (c) What do teachers’ understandings and enactments of NYC gender policy look like in their everyday classroom practices? I use a critical policy-as-practice conceptual framework that does not take policy for granted but understands that embedded in all the policy processes, there is always a great deal of negotiation of power, where some stakeholders are empowered and other perspectives are silenced. Through semi-structured interviews with district policymakers, school administrators, and early childhood teachers, this study unveils how different actors took up NYCDOE’s gender policy in their practice, in accordance with their own ideas, motivations, and broader social and material contexts. Findings indicate that the policy formation processes excluded the knowledge and perspectives of school communities and grassroots trans activist movements. Principals and teachers had little knowledge of the Guidelines on Gender and resources available, while several policy content and procedures reproduced gender and racial violence. Moreover, the sediment construct of childhood innocence shaped early childhood teachers’ gender-justice practices. Shifting understandings of gender, without revising understandings of childhood, this study concludes, hinders the possibility of transformative change.

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Background: Previous research has shown that sexual minority individuals (SM) are twice as likely to smoke, twice as likely to be overweight or obese, and less likely to be physically active than heterosexual persons; all of which place SMs at an increased risk for cardiovascular disease (CVD). While information on CVD risk by race/ethnicity and socioeconomic status is well documented, there is scant literature examining race, gender, and the potential CVD risk in SMs. The purpose of this study was to examine CVD risk in sexual minorities. Method: The current study used data from the National Longitudinal Study of Adolescent Health (Add Health). The Framingham multiple-risk assessment, which uses a calculation of age, smoking, BMI, and blood pressure, was used to predict vascular age and the risk of experiencing CVD event in the next 10 years. 54% of the sample was male, 62% white, and 4% identified as a SM. The sample was split into three groups: 1) 100% heterosexual (N=4363); 2) mostly heterosexual (N=509); and 3) SM (N=188). Results: There was a trend towards significance, p = .056, for mean differences in vascular age/actual age, for SM participants (M=10.07), compared to 100% heterosexual (M=9.1) and mostly heterosexual (M=8.66) participants. Mostly heterosexual participants were 1.62 times more likely, and SM participants were 1.97 times more likely to be current smokers when compared to 100% heterosexual participants. SM participants endorsed having significantly more drinks (M = 4.50) when compared to both 100% heterosexual (M = 3.80) and mostly heterosexual (M = 3.38) participants. SM participants were 1.7 times more likely to endorse having 5 or more drinks on one occasion. SM participants also reported significantly higher stress levels than the other two groups Conclusion: While the data for the current study did not provide sufficient evidence to suggest sexual orientation differences in Framingham risk scores, the findings remain noteworthy. SM showed increased risk in smoking and stress levels. Additionally, the Population-based longitudinal studies and surveillance data are essential and necessary in order to minimize disparities in risk factors and to reduce the likelihood of subsequent disease in SM population.

This thesis describes the organization of two waves of pride parades in the city of Dallas, Texas. Using more than 40 sources, this work details how LGBT organizers have used pride parades to create a more established place for the LGBT community in greater Dallas culture. This works adds to the study of LGBT history by focusing on an understudied region, the South; as well as focusing on an important symbolic event in LGBT communities, pride parades.

Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2008. / Typescript. Includes bibliographical references (leaves 65-69).