Promoting the Health of Gender and Sexual Minorities _ ____________________________________________
When discrepancy between attitudes and behaviors exists, the attitude will most likely change to accommodate the behavior [58; 59]. Using data collected through interviews and focus groups, one study analyzed the coming-out narratives of 20 transgender people [60]. The analysis revealed that coming out requires navigating others’ gender expectations, others’ reactions, and the threat of violence. Transgender individuals do not simply decide to “come out” and then stay out. Rather, they make strategic decisions about gender and gender identify disclosure based on specific social contexts. Coming out is an ongoing, socially embedded, skilled management of one’s gender identity [60]. Common health problems associated with the stages of a four-stage model of the sexual identity (coming-out) process have been identified. For example, during the identification stage, the health picture has been described as “rather gloomy” and includes feelings of severe guilt, reduced self-esteem, overwhelming aloneness, and physical manifestations, such as ulcers and other health problems [61; 62]. More recently, LGBTQ identity formation and the implications for healthcare practice have been addressed [63]. Healthcare professionals must understand the importance of demonstrating aware- ness of gay or lesbian existence through, for example, the use of inclusive interviewing techniques. Antigay attitudes and stereotypes may hinder the healthy development of a child at the respective stages [64]. For example, positively managing the developmental task of industry versus inferiority may be impaired when youth experience a sense of little or no worth as a result of rejection.
language and experience victimization and discrimination at school. As a result, many LGBTQ+ students avoid school activi- ties or miss school entirely [66]. The 2021 Survey found [66]: • 81.8% of LGBTQ+ students reported feeling unsafe in school because of at least one of their actual or per- ceived personal characteristics. • 68.0% of LGBTQ+ students felt unsafe at school because of their sexual orientation, gender identity, and/or gender expression characteristics. • Overall, LGBTQ+ students in online-only learning environments were least likely to feel unsafe at school due to a personal characteristic; those in in-person only learning environments were most likely to feel unsafe. • LGBTQ+ students most commonly avoided school bathrooms (45.1%), locker rooms (42.6%), and physi- cal education or gym classes (39.4%) because they felt unsafe or uncomfortable. • 78.8% of LGBTQ+ students reported avoiding school functions or extra-curricular activities because they felt unsafe or uncomfortable. • LGBTQ+ students who had been only in in-person learning environments did not differ from those who had been in hybrid learning environments with regard to avoiding spaces at school. • 32.2% of LGBTQ+ students missed at least one entire day of school in the past month because they felt unsafe or uncomfortable; 11.3% missed four or more days in the past month. • 16.2% of LGBTQ+ students reported having ever changed schools due to feeling unsafe or uncomfortable at school. • Nearly all LGBTQ+ students (97.0%) heard “gay” used in a negative way (e.g., “that’s so gay”) at school; 68.0% heard these remarks frequently or often, and 93.7% reported that they felt distressed because of this language. • 95.1% of LGBTQ+ students heard the phrase “no homo” at school; 63.3% heard this phrase frequently or often. • 89.9% of LGBTQ+ students heard other types of homophobic remarks or slurs; 44.2% heard this type of language frequently or often. • 91.8% of LGBTQ+ students heard negative remarks about gender expression (e.g., not acting masculine or feminine enough); 56.2% heard these remarks fre- quently or often. • 83.4% of LGBTQ+ students heard negative remarks specifically about transgender people; 39.5% heard them frequently or often. • 58.0% of students reported hearing homophobic remarks, and 72.0% of students reported hearing nega- tive remarks about gender expression from teachers or other school staff.
UNIQUE HEALTH AND SAFETY CONCERNS
Many similarities exist between the LGBTQIA population and the general population related to health and safety con- cerns. For example, all individuals of any age should feel safe, which is a foundational need [64]. Yet, differences between the populations do exist. Heterosexism and homophobia may create environments that place LGBTQIA individuals of any age at increased risk for safety and health concerns [30; 65]. YOUTH Results from the 2021 National School Climate Survey, which included 22,298 LGBT student participants, have illustrated this risk [66]. A note about the 2021 Survey: Because of the COVID pandemic, the authors had to adapt and modify some survey questions according to changes in school structures and instructional methods. The report continues to include findings about LGBTQ+ students’ school experiences overall, but also discusses key findings about the differences between students in online only, in-person only, and hybrid learning environments [66]. Schools nationwide are hostile environ- ments for a distressing number of LGBTQ+ students, the overwhelming majority of whom routinely hear anti-LGBTQ+
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MDDC1026
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