Abstract
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.
Similar content being viewed by others
References
APHA (2014). Reduction of bullying to address health disparities among LGBT youth. https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2015/01/23/09/31/reduction-of-bullying-to-address-health-disparities-among-lgbt-youth.
Beebe, J. (2001). Rapis assessment process: An introduction. Lanham: Rowman & Littlefield.
Beebe, J. (2014). Rapid qualitative inquiry: A field guide to team-based assessment (2nd ed.). Lanham: Rowman & Littlefield.
Bowleg, L. (2012). The problem with the phrase women and minorities: Intersectionality-an important theoretical framework for public health. American Journal of Public Health, 102(7), 1267–1273. https://doi.org/10.2105/AJPH.2012.300750.
Bronfenbrenner, U. (1986). Ecology of the Family As A Context for Human-Development - Research Perspectives (Vol. 22).
Council on School Health. (2016). Role of the school nurse in providing school health services. Pediatrics, 137(6), e20160852. https://doi.org/10.1542/peds.2016-0852.
Crenshaw, K. (1991). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43(6), 1241–1299. https://doi.org/10.2307/1229039.
Daley, A., Solomon, S., Newman, P. A., & Mishna, F. (2007). Traversing the margins: Intersectionalities in the bullying of lesbian, gay, bisexual and transgender youth AU - Daley, Andrea. Journal of Gay & Lesbian Social Services, 19(3–4), 9–29. https://doi.org/10.1080/10538720802161474.
Davis, C. (2006). School's out for bullying. Nursing Standard, 20(21), 24–25.
DuBois, L. Z., Macapagal, K. R., Rivera, Z., Prescott, T. L., Ybarra, M. L., & Mustanski, B. (2015). To have sex or not to have sex? An online focus group study of sexual decision making among sexually experienced and inexperienced gay and bisexual adolescent men. Archives of Sexual Behavior, 44(7), 2027–2040. https://doi.org/10.1007/s10508-015-0521-5.
Earnshaw, V. A., Rosenthal, L., Carroll-Scott, A., Peters, S. M., McCaslin, C., & Ickovics, J. R. (2014). Teacher involvement as a protective factor from the association between race-based bullying and smoking initiation. Social Psychology of Education, 17(2), 197–209. https://doi.org/10.1007/s11218-014-9250-1.
Earnshaw, V. A., Bogart, L. M., Poteat, V. P., Reisner, S. L., & Schuster, M. A. (2016). Bullying among lesbian, gay, bisexual, and transgender youth. Pediatric Clinics of North America, 63(6), 999–1010. https://doi.org/10.1016/j.pcl.2016.07.004.
Earnshaw, V. A., Reisner, S. L., Juvonen, J., Hatzenbuehler, M. L., Perrotti, J., & Schuster, M. A. (2017). LGBTQ bullying: Translating research to action in pediatrics. Pediatrics, 140(4), e20170432. https://doi.org/10.1542/peds.2017-0432.
Earnshaw, V. A., Reisner, S. L., Menino, D., Poteat, V. P., Bogart, L. M., Barnes, T. N., et al. (2018). Stigma-based bullying interventions: A systematic review. Developmental Review, 48, 178–200. https://doi.org/10.1016/j.dr.2018.02.001.
Espelage, D. L. (2016). Sexual orientation and gender identity in schools: A call for more research in school psychology-no more excuses. Journal of School Psychology, 54, 5–8. https://doi.org/10.1016/j.jsp.2015.11.002.
Friedman, M. S., Koeske, G. F., Silvestre, A. J., Korr, W. S., & Sites, E. W. (2006). The impact of gender-role nonconforming behavior, bullying, and social support on suicidality among gay male youth. The Journal of Adolescent Health, 38(5), 621–623. https://doi.org/10.1016/j.jadohealth.2005.04.014.
Gower, A. L., Forster, M., Gloppen, K., Johnson, A. Z., Eisenberg, M. E., Connett, J. E., et al. (2018). School practices to Foster LGBT-supportive climate: Associations with adolescent bullying involvement. Prevention Science, 19(6), 813–821. https://doi.org/10.1007/s11121-017-0847-4.
Graybill, E. C., & Proctor, S. L. (2016). Lesbian, gay, bisexual, and transgender youth: Limited representation in school support personnel journals. Journal of School Psychology, 54, 9–16. https://doi.org/10.1016/j.jsp.2015.11.001.
Hillard, P., Love, L., Franks, H. M., Laris, B. A., & Coyle, K. K. (2014). "They were only joking": Efforts to decrease LGBTQ bullying and harassment in Seattle public schools. The Journal of School Health, 84(1), 1–9. https://doi.org/10.1111/josh.12120.
IBM. (2015). IBM SPSS Statistics for Windows (23.0 ed.). Armonk: IBM Corp..
Juvonen, J., & Graham, S. (2014). Bullying in schools: The power of bullies and the plight of victims. Annual Review of Psychology, 65, 159–185. https://doi.org/10.1146/annurev-psych-010213-115030.
Kann, L., Olsen, E. O., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., et al. (2016). Sexual identity, sex of sexual contacts, and health-related behaviors among students in grades 9-12 - United States and selected Sites, 2015. MMWR Surveill Summ, 65(9), 1–202. https://doi.org/10.15585/mmwr.ss6509a1.
Kolbert, J. B., Crothers, L. M., Bundick, M. J., Wells, D. S., Buzgon, J., Berbary, C., et al. (2015). Teachers' perceptions of bullying of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) students in a southwestern Pennsylvania sample. Behav Sci (Basel), 5(2), 247–263. https://doi.org/10.3390/bs5020247.
Kosciw, J. G., Greytak, E. A., Bartkiewicz, M. J., Boesen, M. J., & Palmer, N. A. (2012). The 2011 national school climate survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation's schools. Washington: GLSEN.
Lesesne, C. A., Rasberry, C. N., Kroupa, E., Topete, P., Carver, L. H., Morris, E., et al. (2015). Communicating with school staff about sexual identity, health and safety: An exploratory study of the experiences and preferences of black and Latino teen young men who have sex with men. LGBT health, 2(3), 258–264. https://doi.org/10.1089/lgbt.2014.0087.
Li, M. J., Distefano, A., Mouttapa, M., & Gill, J. K. (2014). Bias-motivated bullying and psychosocial problems: Implications for HIV risk behaviors among young men who have sex with men. AIDS Care, 26(2), 246–256. https://doi.org/10.1080/09540121.2013.811210.
Marshall, A., Yarber, W. L., Sherwood-Laughlin, C. M., Gray, M. L., & Estell, D. B. (2015). Coping and survival skills: The role school personnel play regarding support for bullied sexual minority-oriented youth. The Journal of School Health, 85(5), 334–340. https://doi.org/10.1111/josh.12254.
McMullen, C. K., Ash, J. S., Sittig, D. F., Bunce, A., Guappone, K., Dykstra, R., et al. (2011). Rapid assessment of clinical information systems in the healthcare setting: An efficient method for time-pressed evaluation. Methods of Information in Medicine, 50(4), 299–307. https://doi.org/10.3414/me10-01-0042.
Meezan, W., & Martin, J. L. (2009). Handbook of research with lesbian, gay, bisexual, and transgender populations (1ed.). New York: Routledge.
Menkin, D., & Flores, D. D. (2018). Transgender students: Advocacy, care, and support opportunities for school nurses. NASN School Nurse, 34, 173–177. https://doi.org/10.1177/1942602X18801938.
Nansel, T. R., Overpeck, M., Pilla, R. S., Ruan, W. J., Simons-Morton, B., & Scheidt, P. (2001). Bullying behaviors among US youth: Prevalence and association with psychosocial adjustment. Jama, 285(16), 2094–2100.
Reisner, S. L., Greytak, E. A., Parsons, J. T., & Ybarra, M. L. (2015). Gender minority social stress in adolescence: Disparities in adolescent bullying and substance use by gender identity. Journal of Sex Research, 52(3), 243–256. https://doi.org/10.1080/00224499.2014.886321.
Reisner, S. L., Randazzo, R. K., White Hughto, J. M., Peitzmeier, S., DuBois, L. Z., Pardee, D. J., et al. (2018). Sensitive health topics with underserved patient populations: Methodological considerations for online focus group discussions. Qualitative Health Research, 28(10), 1658–1673. https://doi.org/10.1177/1049732317705355.
Russell, S. T., & Joyner, K. (2001). Adolescent sexual orientation and suicide risk: Evidence from a national study. American Journal of Public Health, 91(8), 1276–1281.
Russell, S. T., Ryan, C., Toomey, R. B., Diaz, R. M., & Sanchez, J. (2011). Lesbian, gay, bisexual, and transgender adolescent school victimization: Implications for young adult health and adjustment. The Journal of School Health, 81(5), 223–230. https://doi.org/10.1111/j.1746-1561.2011.00583.x.
Schuster, M. A., Bogart, L. M., Elliott, M. N., Klein, D. J., Feng, J. Y., Tortolero, S. R., et al. (2015). A longitudinal study of bullying of sexual-minority youth. The New England Journal of Medicine, 372(19), 1872–1874. https://doi.org/10.1056/NEJMc1413064.
Taras, H. L. (2004). School-based mental health services. Pediatrics, 113(6), 1839–1845.
The National Academies of Sciences, Engineering, and Medicine. (2016). Preventing bullying through science, policy, and practice. Washington, DC.
Vessey, J. A., & O'Neill, K. M. (2011). Helping students with disabilities better address teasing and bullying situations: A MASNRN study. The Journal of School Nursing, 27(2), 139–148. https://doi.org/10.1177/1059840510386490.
Williams, S. G. (2017). Mental health issues related to sexual orientation in a high school setting. The Journal of School Nursing, 33(5), 383–392. https://doi.org/10.1177/1059840516686841.
Wolke, D., & Lereya, S. T. (2015). Long-term effects of bullying. Archives of Disease in Childhood, 100(9), 879–885. https://doi.org/10.1136/archdischild-2014-306667.
Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52(1), 30–41. https://doi.org/10.1207/s15327752jpa5201_2.
Acknowledgments
The authors thank Eli Godwin and the youth and community advisory board for their contributions on this study (alphabetical): Landon Callahan, Sonya Epstein, Opal Hines-Fisher, Lee Hoegler, Kira Houston, Karen Jarvis-Vance, Karen Rufo, and Rothsaida Sylviance.
Funding
This study was funded by Harvard Catalyst |The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic healthcare centers. Dr. Valerie A. Earnshaw’s contributions were further supported by the National Institute on Drug Abuse (K01 DA042881). Funders were not involved in the study design; collection, analysis, or interpretation of the data; write up of the report; or decision to submit the article for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic healthcare centers, or the National Institutes of Health.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interests
The authors declare that they have no conflict of interests.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Reisner, S.L., Sava, L.M., Menino, D.D. et al. Addressing LGBTQ Student Bullying in Massachusetts Schools: Perspectives of LGBTQ Students and School Health Professionals. Prev Sci 21, 408–421 (2020). https://doi.org/10.1007/s11121-019-01084-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11121-019-01084-4