While most researchers agree that there is nothing inherently pathological about a sexual minority orientation (Savin-Willimas, 2005), sexual minority youth often face additional mental health challenges. Among the specific challenges experienced by sexual minority youth are increased rates of depression (D'Augelli, 2002; Galiher, Rostosky, & Hughes, 2004; Russell & Joyner, 2001), suicidal ideation (Balsam, Beauchaine, Mickey, & Rothblum, 2005; Russell & Joyner, 2001), substance abuse (Garofalo, Wolf, Kessel, Palfrey, & DuRant, 1998), and victimization (D'Augelli, Pilkington, & Hershberger, 2002; Elze, 2003; Russell, Franz, & Driscoll, 2001). Although research is beginning to address protective factors, we do not yet have a complete understanding of specific protective factors, particularly within the school, that promote resiliency within this group. The current study utilized a correlational design to evaluate the experiences of 377 sexual minority youth and examine the link between social support and specific mental health indicators (depression, suicidal ideation, substance use, and victimization). The youth in this study were drawn from community drop-in centers for sexual minority youth. Participants completed questionnaires and participated in a face-to-face interview to provide information regarding depression, suicidal ideation, substance use, victimization. Additionally, participants provided information regarding their feelings of being supported by their friends, whether or not their school had a support/discussion group for sexual minority youth, and if so, whether they attended the group. No significant relationships were found between the social support factors (social support from friends, presence of support group in school) and decreased substance use or suicidal ideation. Contrary to research indicating positive outcomes for students who attend schools with a Gay-Straight Alliance (GSA; GLSEN, 2011), youth in the current study whose school had a support group reported increased depression when compared to youth whose school did not have a support group. However, a significant relationship was found between increased perceived social support from friends and decreased depression scores. These findings suggest the need for advocacy within schools to create supportive environments that are accessible to all sexual minority youth and that provide the opportunity to increase social networks and access to supportive peers. / School Psychology

The current study investigated eating attitudes and depressive symptoms in a sexual minority sample from Turkey who identify themselves as LGBTIQ and explored the role of sexual minority stressors beyond the potential predictors of eating attitudes and depressive symptoms in this population.

This study sought to investigate the effect of state-level policies, pertaining to hate crimes and mental health care, on the association between sexual orientation and the prevalence of depression, suicidal ideation, suicide attempt, and bullying amongst adolescents. State-level policies included whether hate crime laws included sexual orientation as a protected category, and rates of follow-up care after hospital discharge amongst acutely mentally ill youth covered by public health insurance (Medicaid or the Children's Health Insurance Program; CHIP). Data were from the 2019 State-Level Youth Risk Behavior Survey (YRBS), completed by a representative sample (N = 153,215) of U.S. students in grades 9-12 across 44 states. The YRBS is one of the few population-based studies to gather sexual orientation data in a youth sample. Compared with living in states with hate crime laws extending protections to lesbian, gay, and bisexual (LGB) people, living in states without inclusive hate crime laws did not predict a significantly stronger association between LGB status and mental health. However, the association between LGB status and electronic (i.e., cyber) bullying was significantly greater in states with hate crime laws that excluded sexual orientation as a protected category than in states with inclusive hate crime laws. The association between LGB status and suicide attempt was significantly greater in states with lower rates of follow-up mental health care for acutely ill youth than in states with higher rates of follow-up care. This is the first known study to find an association between residing in a state with higher quality government-funded mental health care for acutely ill youth and reduced suicide attempt among LGB youth. These findings underscore the urgent need for state-level policies that increase legal protections and improve access to mental health care for sexual minority youth. / Doctor of Philosophy / This study investigated the relationship between state-level policies, mental health, and bullying among lesbian, gay, and bisexual (LGB) high school students. State-level policies included whether hate crime laws included sexual orientation as a protected category, and rates of follow-up care after hospital discharge amongst severely mentally ill youth enrolled in Medicaid or the Children's Health Insurance Program (CHIP). Data were from the 2019 State-Level Youth Risk Behavior Survey (YRBS), completed by 153,215 U.S. students in grades 9-12 across 44 states. The YRBS is one of the few large studies to gather information about sexual orientation in a youth sample. Participants were more likely to be cyber-bullied if they lived in states that didn't include sexual orientation as a protected category. LGB high school students living in these states were at even greater risk of being cyber-bullied than their heterosexual peers. Youth residing in states with better follow-up care were less likely to attempt suicide. LGB youth living in states with worse follow-up care were at even greater risk of attempting suicide than their heterosexual peers. This is the first known study to find a relationship between residing in a state with higher quality government-funded mental health care and reduced suicide attempt among LGB youth. These findings underscore the urgent need for state-level policies that increase legal protections and improve access to mental health care for sexual minority youth.

Social institutions in rural communities tend to be highly interrelated and social ties tend to be dense and multiplex. Human ecological theoretical models posit that all institutions in which an individual is embedded interact in complex ways. As such, this dissertation examines the influences of school, faith, family, and risk contexts on the grade point averages of students who attended school in nonmetropolitan counties in Appalachian Kentucky. Using data disaggregated by gender from nearly 5,000 adolescents, I identified risk and protective factors on grade point averages by attraction type (exclusively opposite-sex attracted, same-sex attracted, and unsure of attraction), identified differences in grade point averages between attraction types, and identified mediators and moderators of the relationship between attraction type and grade point average. School belonging positively influenced the grade point averages of unsure males and religious belief negatively influenced the grade point averages of same-sex attracted males. In general, sexual minority students reported lower grade point averages than their exclusively opposite-sex attracted peers. Among same-sex attracted males and females, this disparity in grade point average was mediated by school belonging. Among unsure males the variation in grade point average was largely explained by engagement in risk behaviors. The relationship between sexual attraction and grade point average was moderated by religiosity, marijuana use, and labor market optimism.

ABSTRACT Background: Sexual orientation is comprised of distinct components, including sexual identity, sexual attraction and sexual behavior. Lesbian, gay and bisexual adolescents are at an increased risk of experiencing poor health outcomes compared to non-sexual minority youth. Health care professional organizations recommend that health care providers discuss each component of sexual orientation at every adolescent health supervision visits in order to best assess the adolescent's health risks and needs for intervention and education. Objective: This survey assessed the frequency with which nurse practitioners (NPs) in the state of Vermont discussed sexual identity, attraction and behavior with adolescents during annual health supervision visits. Design: A cross sectional study that analyzed descriptive statistics of a small convenience sample of Vermont NPs. Setting and Participants: Attendees of the Vermont Nurse Practitioner Association 2015 annual conference. Participants in the study were licensed, practicing NPs in the state of Vermont responsible for the health supervision of adolescents. Results: Participants were overwhelmingly female (93%), with a median age between 40-49 years old, and a median length of years in practice of six to ten years. Sixty-two percent of respondents specialized in family practice. Respondents reported that they always asked adolescents about the sex of sexual partners at 49% of health supervision visits. Respondents always discussed sexual attraction and sexual identity at 31% and 24% of health supervision visits, respectively. Twenty percent of respondents reported rarely or never discussing sexual attraction, and 38% reported rarely or never discussing sexual identity. Conclusions: The Vermont NPs who participated in this survey were demographically similar to national NP cohorts. Vermont NPs discussed the adolescent's sexual behavior at health supervision visits as frequently as health care providers nationally, and Vermont NPs discussed sexual attraction and sexual identity more frequently than providers nationally. However, Vermont NPs discussed sexual attraction and identity much less frequently than they discussed sexual behavior. Results of this survey illustrate that there is substantial room for improvement regarding the frequency with which Vermont NPs discuss the three components of sexual orientation with adolescents, particularly the components of sexual identity and attraction.

Death by suicide, and suicidal behaviors, are a significant public mental health problem, and individuals who are lesbian, gay, bisexual, transgendered and questioning (LGBTQ), may be at increased risk. Potential underlying mechanisms of this association are unknown, but may involve the impact of LGBTQ status on future orientation and mood. Our purpose was to determine the influence of sexual identity, sequentially, on cognitive and emotional functioning, and consequent relation to suicidal behavior. In a sample of 349 college students, we used serial mediation models to investigate the relation between self-identification as LGBTQ and suicidal behavior, with hope and hopelessness as first-order mediators and depression as a second order mediator. Supporting hypotheses, we found that LGBTQ status was related to less hope and greater hopelessness and, in serial fashion, to depressive symptoms and consequent suicidal behavior. Our findings may have clinical implications. Resolution of hopelessness and depression, and promotion of hopefulness, perhaps via Motivational Interviewing and Cognitive Behavioral Therapy strategies, such as goal-setting, may reduce suicidal risk in LGBTQ young adults.

Sexual minority women (SMW) demonstrate lower rates of cervical cancer screening than heterosexual women. This is concerning as lesbian and bisexual women tend to engage in higher rates of substance-related cancer risk behaviors, unprotected sex, and tend to have higher body mass indices, all of which are risk factors for cancer development. Another major risk factor, screening avoidance, places SMW at increased risk for the development of high grade cervical lesions in the absence of early detection practices, which is likely to impact overall cervical cancer morbidity in this population. The aim of the present study was to utilize the Health Equity Promotion Model in order to investigate the interplay of medical heterosexism, social and community, behavioral, biological, and social identity/position factors on cervical cancer screening rates in a sample of SMW from a large metro area in the southeastern United States. 145 women who identify as sexual minorities were recruited from local LGBT-friendly venues, events, community organizations, email LISTSERVs, and related social media accounts and were asked to complete a fifteen-minute survey. A series of bivariate correlation, t-test, and multivariate regression analyses were run. Findings from mediation analyses demonstrated that health communication factors mediated the relationship between perceived medical heterosexism and cervical cancer screening outcomes. Further, after accounting for demographic factors, greater provider communication quality, provider trust, eHealth literacy, and ever having an HIV test significantly and differentially predicted cervical cancer screening outcomes in the multivariate models (ps < .05). Findings suggest that health communication factors play an important role in facilitating cervical cancer screenings for SMW, and provider training interventions and policy that focus on reducing medical heterosexism may aid in improving patient-provider relationships in this population.

The purpose of this study was to identify school-based practices that lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth endorse as ways for high schools to provide social, emotional, and academic support to LGBTQ youth. A diverse sample of LGBTQ high school students (N = 18) from one large urban school district in a southeastern state participated in individual semi-structured interviews and/or small group brainstorming sessions. Eleven individual interviews were conducted to gather detailed accounts of a) supportive behaviors and policies that youth had experienced in their schools, as well as b) supportive behaviors and policies that were suggested as desired supports that had not actually been experienced. Participants' sentiments were coded based on the source of support (i.e., teachers, school mental health providers, administrators, policies, resources), nature of support (i.e., proactive, reactive), and social context of the support (i.e., impacting single students through one-on-one setting, impacting more than one student or groups of students). Three brainstorming sessions that included a total of 13 students were conducted to gather additional ideas from youth on ways for schools and school staff to provide support. Frequency counts of individual interview data indicated that teachers provided more experienced and desired supports than any other school-based source of support. Of the desired supports that participants had not actually experienced, Proactive Supports Impacting Groups were the most frequently described Support Type for teachers, school mental health providers, and administrators. Content Themes emerged within Support Types (e.g., Proactive Support Impacting Individuals, Reactive Support Impacting Groups) capture sentiments that were shared across multiple participants' responses. Data from interviews and brainstorming sessions were also analyzed together through a constant-comparative reduction process, resulting in 162 Specific Educator Behaviors/Policies corresponding to 8 Big Ideas of school-based supports for LGBTQ high school students: (1) Using Respectful Language and Interactions with Students; (2) Providing Comfort, Assistance, and Advice Matched to Student Needs; (3) Facilitating Connections with Community Supports; (4) Providing LGBTQ-Related Materials and Information; (5) Allowing and Supporting School-Based GSA and Pride Activities; (6) Addressing Professional Development, Human Resources, and School Culture Related Issues; (7) Implementing Policies that Address Bullying and Harassment of LGBTQ Students; and (8) Implementing Policies that Respectfully Account for Students' Diversity.) Pragmatic implications for teachers, school mental health providers, and administrators are discussed.

Thesis (M.S.W.) -- Ohio State University, 2005. / Includes bibliographical references (leaves 109-114). Available online via OhioLINK's ETD Center

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.