摘要：Objectives. To examine trends in the percentage of US secondary schools that implemented practices related to the support of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) students. Methods. This analysis used data from 4 cycles (2008–2014) of School Health Profiles, a surveillance system that provides results representative of secondary schools in each state. Each school completed 2 self-administered questionnaires (principal and teacher) per cycle. We used logistic regression models to examine linear trends. Results. Of 8 examined practices to support LGBTQ youths, only 1—identifying safe spaces for LGBTQ youths—increased in most states (72%) from 2010 to 2014. Among the remaining 7, only 1—prohibiting harassment based on a student’s perceived or actual sexual orientation or gender identity—had relatively high rates of adoption (a median of 90.3% of schools in 2014) across states. Conclusions. Many states have seen no change in the implementation of school practices associated with LGBTQ students’ health and well-being. Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youths are at disproportionate risk for negative health and other social and educational outcomes that affect well-being. The first national prevalence estimates of health risk behaviors among lesbian, gay, and bisexual (LGB) high school students provided in 2015 Youth Risk Behavior Survey data demonstrated that these students are at significantly higher risk than their heterosexual peers for various negative behaviors, such as substance use, poor nutrition habits, lack of physical activity, sexual risk behaviors, bullying, dating violence, and suicide attempts. 1 For example, in 2015, 42.8% of LGB high school students seriously considered suicide during the 12 months before the survey, compared with 14.8% of heterosexual students, and 29.4% of LGB students attempted suicide during the 12 months before the survey, compared with 6.4% of heterosexual students. 1 Although substantially less data are available on transgender youths, the existing evidence suggests that these youths are also at disproportionate risk for poor mental health outcomes, 2 substance use, 3 HIV, 4 bullying, 5 and suicide. 5 Such alarming statistics push health professionals to better understand factors contributing to these disparities and develop strategies for addressing them. A growing body of literature points to social and structural factors, such as discrimination, stigma, and victimization—including in the school environment—as underlying causes. 6–8 For LGBT youths, school victimization has been associated with risk for HIV and other sexually transmitted diseases (STDs), depression, and suicidal ideation. 8 Given that sexual orientation disparities in school safety persist, 9 national education organizations have recently committed to protecting LGBTQ students. 10,11 Policies that prohibit bullying and harassment in schools have been linked to positive student outcomes, such as less bullying 12 and fewer suicide attempts. 13 The importance of providing a safe and supportive school climate and supportive policies for LGBTQ youths is highlighted in a new adolescent health objective in Healthy People 2020 to “Increase the proportion of middle and high schools that prohibit harassment based on a student’s sexual orientation or gender identity,” 14 and a number of states specify sexual orientation as a protected characteristic in state-level antibullying laws and policies. 15 Studies have investigated promising school-based policies and practices to prevent victimization and related health consequences among this population. 15 Specific practices to support LGBTQ youths include gay–straight alliances (GSAs) and safe spaces, both of which are associated with reduced risk of suicide ideation, alcohol and other drug use, prescription drug misuse, and poor academic outcomes. 16–22 Support for LGBTQ students also involves providing or linking to services that are LGBTQ-friendly and providing education, including sexual health education, in a manner that is inclusive of and relevant for these youths. 23 To date, it is unclear to what extent these school policies and practices have been implemented. Accordingly, we sought to examine trends from 2008 to 2014 in the percentage of secondary schools across states implementing policies and practices to support LGBTQ students. Given changing norms related to sexual orientation and gender identity, greater attention to the LGBTQ population, 6 and increased public support for state- and local-level policies that support and protect LGBT individuals, 24 we hypothesized there would be increases in schools’ implementation of supportive policies and practices.
