LGBTQ Youth Part 1

Abstract

In order to provide holistic care, school nurses must be culturally competent by being sensitive to health disparities experienced by students in at-risk populations. Despite the growing acceptance toward gender and sexual minorities, LGBTQ youth remain an at-risk population in our communities and our schools. School nurses as well as school counselors, social workers, and psychologists can increase their cultural competence in caring for this group of students by increasing their understanding of appropriate terminology and risks associated with this vulnerable group. This article is Part 1 of a two-article series designed to increase school nurses’ abilities to advocate and care for LGBTQ youth in school settings. This first article provides information regarding proper terminology and current percentages of youth who identify as LGBTQ and concludes with implications for school nurses, including resources for nurses, school staff, and families.

Keywords

LGBTQ youth bullying depression suicide school nurse role professional issues

Introduction

While school nurses are well aware that culturally competent care is an essential component of caring for children from a wide variety of geographic locations or religious identities, they may not routinely consider the need for cultural competence in caring for youth who identify as lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ). The same principles of cultural competence apply to this group of students and require school nurses to understand and use appropriate terminology describing these students as well as learn how the social environment these students live in impacts their health and well-being (Betancourt, Green, Carrillo, & Ananeh-Firempong, 2003). The purpose of this article is to provide nurses with epidemiologic data and terminology that describes the LGBTQ youth community, review the current legal and cultural environment for these students, and discuss implications of this information for school nurses.

The most recent Youth Risk Behavior Survey (Kann et al., 2016) indicates that 11.2% of high school students self-report being gay or lesbian (2%), bisexual (6%), or unsure of their own sexual identity (3.2%). In some urban areas, as few as 77.6% of students report identifying as heterosexual. Thus, school nurses are likely to encounter students who identify as LGBTQ. Data indicate that this group experiences multiple health disparities, including higher rates of depression, suicidal ideation, and suicidal attempts (Kann et al., 2016). One way to begin avoiding stereotyping this group and improving health outcomes is to understand and thus use appropriate identifying language.

LGBTQ Concepts, Terms, and Definitions

Understanding and use of appropriate terminology for LGBTQ youth is important so that school nurses communicate in a consistent and professional manner to students, faculty, and administration. This section expands on the context of the terms found in Table 1 that are acceptable to use when working with LGBTQ youth. In order to reflect the diversity of identities that exists within the LGBTQ community, this article uses the terms gender and sexual minorities, LGBTQ, and queer interchangeably. For clarification purposes, sexual minority denotes individuals who may harbor same-sex attractions, engage in same-sex sexual behaviors, or identify as lesbian, gay, bisexual, queer, or questioning (Kann et al., 2016). On the other hand, gender minority refers to individuals whose gender identity or expression does not conform to the cultural norms associated with their sex at birth (Collier, van Beusekom, Bos, & Sandfort, 2013; National Institutes of Health [NIH], 2013). Finally, the term queer is largely used as an umbrella term as it aptly demonstrates the diversity and fluidity of sexual orientation and gender identity (Human Rights Campaign, 2016). Although sexuality and gender identity are frequently conflated, they are actually two separate, unrelated topics that are unpredictive of each other (American Psychological Association [APA], 2014).

Table 1.

LGBTQ Concepts, Terms, and Definitions

Term	Definitions	Citations
Biological sex	Refers to whether a person is male or female, depending on their chromosomes, reproductive organs, and hormones	APA (2011), Lehmiller (2014)
Intersex	Refers to individuals whose chromosomes, reproductive organs, or hormones differ from typical patterns found in males or females	APA (2006), Lehmiller (2014)
Gender	Refers to the roles, behaviors, and traits that society considers appropriate for men and women or boys and girls	APA (2011), Lehmiller (2014)
Gender identity	Refers to a person’s internal sense of being male, female, or another gender entirely	APA (2011), Lehmiller (2014)
Gender expression	How a person communicates their gender to others through behaviors and physical traits	APA (2014), HRC (2016)
Cisgender	Describes people whose gender identity matches their physical body and biological sex	HRC (2016)
Transgender	An umbrella term that describes people who feel that their gender identity does not match their physical body and conflicts with their biological sex	APA (2014)
Gender nonconforming	Describes a person whose gender expression differs from how their family, culture, or society expects them to act in accordance with their biological sex	Bradford & Makadon (2011), Gender Diversity (2016)
Genderqueer	A term used by people who identify as neither male or female or even a combination of both genders; their gender expression may fluctuate or be androgynous; genderqueer people may or may not identify as transgender	Gender Diversity (2016), APA (2014)
Androgynous	Describes people whose gender expression is both masculine and feminine	Lehmiller (2014)

Note: APA = American Psychological Association; HRC = Human Rights Campaign.

The terms in the table are not meant to be exhaustive lists, and in many cases, individuals’ gender identities and sexual orientations will not easily fit into the prescribed categories. Moreover, youths—just like adults—have varying perspectives on the centrality of their gender and sexual orientation to their identity. Each individual uniquely experiences their gender and sexuality in ways that cannot always be perfectly described through labels. School nurses can help ease the social burden on queer youths by helping them identify their feelings, using language that affirms their identity and creates an environment where queer youths can safely express themselves without fear of judgment or retribution.

Correctly using these terms not only requires practice but also patience and empathy toward queer children and adolescents. School nurses can best serve these youths by asking which terms feel most comfortable to them and which ones they should eschew in order to avoid unintentional misunderstanding and degradation. Misuses of these terms, even if done so accidentally, can recreate prejudices and invalidate the experiences of gender and sexual minority youths, who may already be feeling isolated as a result of their identity. Proper usage of these terms coupled with compassion reaffirms children’s experiences and can leave an indelible mark on youths who merely seek understanding and acceptance.

Sexuality Concepts and Terms

Children, long before they identify with a particular sexual orientation, have sexual feelings (Kellogg, 2010; National Child Traumatic Stress Network, 2009). Often, gender nonconformity in childhood is seen as a harbinger of future homosexual feelings and attraction. However, childhood gender nonconformity may be related or unrelated to one’s sexual identity later in life (American Academy of Pediatrics, 2015). Moreover, the growing liberalization of gender norms and repudiation of gender stereotypes have enabled children to express themselves in ways that may have once been seen as incongruent with their assigned gender at birth. One’s sexuality is separate from one’s gender identity and expression. Sexual orientation refers to one’s physical, emotional, and romantic attraction to others, which can include people of the opposite sex, same sex, or both sexes (APA, 2008; Lehmiller, 2014). In comparison, gender identity refers to a person’s internal sense of being male, female, or another gender entirely (APA, 2014; Lehmiller, 2014).

In general, many people are uncomfortable with ambiguity and naturally sort things into recognizable categories that have distinct patterns. However, sexuality is fluid, overflowing categories and transcending cultural norms. For example, the Youth Risk Behavior Surveillance Survey found that both hetero- and homosexual youth report sexual encounters with both same and opposite gender individuals (Kann et al., 2016). Instances such as these should not be perceived as an inability of others to firmly state an attraction or as evidence that queer individuals can somehow be “converted” to heterosexuality. Rather, they should serve as reminders that a single label cannot possibly encapsulate a person’s entire sexual experience. Indeed, 9.2% of youth self-identify as bisexual or unsure of their sexual identity (Kann et al., 2016). Ultimately, identities mean different things to different people, and in the tumultuous development phases of childhood, it is normal for youths to question their sexuality and explore their sexual feelings.

Gender Identity Concepts and Terms

As soon as they are born, children are automatically categorized as either male or female based on their physical characteristics, specifically their genitalia and chromosomes. These innate markers determine an individual’s biological sex (APA, 2011; Lehmiller, 2014). For approximately 1 in 2,000 newborns, over 60 different conditions may make this question of boy or girl difficult to answer. In these infants, chromosomes, gonads, internal sex organs, genitals, or some combination thereof differs from the prescribed patterns of male or female (American Academy of Pediatrics, 2014; APA, 2006; Lehmiller, 2014). The complex treatments and ethical issues related to care of these children are beyond the scope of this article, but school nurses should note the existence of these children and follow the same respectful guidance in care for LGBTQ individuals.

Once a child’s biological sex is determined, gender stereotypes are instantly applied and expected to come to fruition. According to cultural norms, only two genders exist, specifically boy and girl, which correspond to one’s biological sex, respectively, male or female. In turn, this division causes certain characteristics to be prescribed as either masculine or feminine. Subsequently, most parents envision their child’s future in gendered ways. For instance, while boys are expected to thrive in rough-and-tumble play, girls are pressured to engage in sophisticated pursuits, such as the arts and humanities. This socialization is reinforced throughout early childhood as youths continue to gravitate toward gender-specific clothing, toys, and activities. In sum, these observable mannerisms and preferences form an individual’s gender expression, or the way in which one presents their gender through their physical appearance and outward behaviors (APA, 2014; Human Rights Campaign, 2016).

Traditionally, one’s gender expression has been constrained by culturally acceptable traits for males and females; however, attitudes have shifted toward recognizing gender roles as inaccurate and constricting as most individuals display a range of historically masculine and feminine behaviors. Similarly, just because some characteristics are considered to be masculine or feminine does not mean that they are mutually exclusive. As such, instead of imagining gender roles on a spectrum, with one end designating masculine expressions and the opposite end representing feminine expressions, it is useful to imagine the concept of gender as either a galaxy or a universe; just as there are an infinite number of stars in space, there are also an infinite number of ways in which one can express their gender identity. Questioning one’s gender and changing one’s gender expression is also quite common. As with sexual identity, it is perfectly normal for a child to frequently change their gender presentation as the concept of gender is more fluid than society typically recognizes (American Academy of Pediatrics, 2015).

Most people’s gender identity correlates with their biological sex (APA, 2014; Lehmiller, 2014). These individuals may be described as being cisgender, meaning that the gender they feel they are on the inside overlaps with their gender expression and their assigned sex at birth (Human Rights Campaign, 2016). Nevertheless, some individuals feel a dissonance between the gender they truly are on the inside and the gender others perceive them to be based on the body they were born into. These individuals may identify as transgender, genderqueer, or gender nonconforming (APA, 2014). Identification as transgender is more common in young adults than in older adults, with approximately 0.7% of 18- to 24-year-olds self-reporting this identity (Flores, Herman, Gates, & Brown, 2016). Although these identities may seem abstract at first, there has been a growing acceptance within the medical and psychological communities of gender dysphoria as a normal variation in how some people experience their bodies and gender (NIH, 2013).

While the term transgender may be the most recognizable and the term used in national survey data, just as there are many different ways of being a man or a woman, there are also many different ways of being transgender. For example, some transgender individuals seek to find a balance between the gender they really are on the inside and the gender the world perceives them to be by socially transitioning. For some, this may mean changing their pronouns, names, and physiognomy through nonmedical means. Meanwhile, others may opt for medical treatments such as hormone therapy or surgery.

In comparison, the term genderqueer describes a person whose gender identity and expression do not neatly fit into the narrow, easily defined categories of male or female. Genderqueer individuals may identify as neither female nor male or even a combination of both genders. Their gender expression may fluctuate often, or they may choose more androgynous presentations. Typically, genderqueer individuals reject the dichotomy of male and female and in doing so take a political stance against society’s rigid gender binary definitions (APA, 2014; Gender Diversity, 2016).

Thus, as transgender and gender-nonconforming children age and as their feelings about their identity become more acute, navigating their schools and communities can become progressively harder as they are continually forced to reconcile who they really are on the inside with how others perceive them. Transgender and gender-nonconforming youths and their families face unique challenges, such as transitioning socially, explaining themselves to others, and living as authentically as possible in environments that may be inhospitable toward their true identity. See Table 2 for a synopsis of the gender identity terminology.

Table 2.

Gender Identity Concepts and Terms

Term	Definition	Citations
Sexual orientation	The enduring emotional, romantic, and physical attraction one experiences toward men, toward women, or toward both men and women	Lehmiller (2014), Bradford & Makadon (2011), APA (2008)
Heterosexual	Describes someone who is emotionally, romantically, and physically attracted to members of the opposite gender	APA (2008), Lehmiller (2014)
Homosexual	Describes someone who is emotionally, romantically, and physically attracted to members of the same gender	APA (2008), Lehmiller (2014)
Gay	Describes men and women who are emotionally, romantically, and physically attracted to members of the same gender	HRC (2016)
Lesbian	A term that solely describes women who are gay	HRC (2016)
Bisexual	Describes someone who is emotionally, romantically, and physically attracted to both men and women, though not necessarily to the same degree	APA (2008), Lehmiller (2014), HRC (2016)
Asexual	Refers to individuals who experience little or no sexual attraction to others	Lehmiller (2014)
Queer	An umbrella term that can be used to describe fluid sexual and gender identities and is often used interchangeably with “LGBTQ”; however, it can still be used as a derogatory term depending on the context in which it is used	HRC (2016)
Questioning	A term used to describe people who are in the process of exploring their sexual orientation or gender identity	HRC (2016)
Sexual fluidity	The ability to adapt one’s sexual and romantic attraction toward a specific person regardless of gender	Lehmiller (2014)

Note: APA = American Psychological Association; HRC = Human Rights Campaign.

Historical Perspective

It is difficult to overstate the progress the LGBTQ community has made toward full political and social equality just within the past decade. As of 2016, 55% of American adults currently support same-sex marriage; comparatively, in 2006, 55% of U.S. adults opposed same-sex marriage (Pew Research Center, 2016). Since 2004, when Massachusetts became the first state to legalize marriage equality, support for same-sex marriage steadily increased until June 2015 when the United States Supreme Court officially legalized marriage equality nationwide.

Legal recognition and social support for the LGBTQ community has not been limited to only lesbian and gay couples. The states of Vermont, California, New Jersey, Illinois, and Oregon, along with the District of Columbia, have banned the use of so-called “conversion therapy” on minors, which the American Psychiatric Association (2000) has attributed to depression, self-harm, and suicide. Moreover, Medicare and certain state and private insurers now cover transgender-specific medical care, including hormone therapy and gender-confirmation surgeries. Finally, although they are still a minority, LGBTQ characters are more common and portrayed more positively than ever before in television shows and movies (Bond, 2015).

LGBTQ youths continue to face stark challenges within their academic and local communities as a result of both verbal and physical harassment (Human Rights Campaign, 2014). It is difficult to overemphasize the profound psychological consequences LGBTQ youths face when they are made to feel ashamed of their identities or are forced to hide who they truly are (Cooper & Blumenfeld, 2011; Hatzenbuehler, 2011; LeVasseur, Kelvin, & Grosskopf, 2013; Robinson & Espelage, 2011). Part 2 of this series explores these consequences in detail. Prior to addressing such consequences, school nurses have the opportunity to create and enhance safe spaces by utilizing appropriate langue for queer youths as they frequently serve as confidants to students and are often confronted with questions pertaining to sexuality.

Role of the School Nurse

Students may view the school nurse’s office as a place of refuge and solace, where they can privately disclose their feelings as well as ask personal questions they may be too fearful or embarrassed to share with another adult. Even if gender and sexual minority youths do not yet possess the language to fully express their identities, they typically have enough self-awareness to know that their feelings and experiences differ from those of their peers. School nurses can provide a nonjudgmental and private place for youth to discuss their thoughts and feelings and ask questions. School nurses should use appropriate language that affirms student identity and creates an environment where queer youths can safely express themselves without fear of judgment or retribution.

Nurses can provide basic information for youth regarding terminology and using national statistics, reassure youth either coming out or questioning that they are indeed not alone. Questioning one’s sexual and gender identity is a normal part of creating an adult identity, and nurses can aid in that process by supportive listening or providing referrals to counseling.

Additional use of correct language involves school nurses empowering queer youths by asking their preferred names, pronouns, and identity markers. Similarly, unless required in a health assessment, school nurses should not ask transgender and gender-nonconforming children whether they have “completely transitioned” or what medical routes they may be pursuing as these questions are invasive, unnecessary, and disrespectful of their right to privacy. School nurses should refrain from making assumptions regarding these youths’ sexual orientation.

Providing thoughtful and respectful book and movie recommendations (Table 3) can provide a way for youth to share in LGBTQ stories and help them build their own sexual and gender identities. As part of working toward cultural competence, nurses can also read and watch these media as a way of increasing understanding of a variety of perspectives for the LGBTQ community. Reading and viewing may provide students, nurses, faculty, and administrators with a platform to discuss issues without having to refer to specific students.

Table 3.

LGBTQ Themed Children’s Books and Informational Websites

Books	Appropriate for All Ages
The Sissy Duckling by Harvey Fierstein	Elmer is not like the other boy ducklings. While other boy ducklings like to build forts and play baseball, Elmer likes to bake cakes and put on theatrical shows. The other boys think Elmer is a sissy. But when Elmer’s father is wounded by a hunter, Elmer comes to the rescue and proves to all the other ducks that he is a hero. This book helps children understand that we are all unique and that being different is a good thing.
Annie’s Plaid Shirt by Stacy Davids	Anne’s plaid shirt deals with gender identification. This book is all about teaching tolerance and that it is OK to be different.
The Boy in the Dress by David Williams and Quentin Blake	Dennis is a 12-year-old boy who likes football but also is into fashion. He is teased for purchasing a Vogue magazine. Dennis loves the colors and styles of women’s fashion. Dennis becomes friends with Lisa, who is a very pretty and popular girl in school. One day she convinces Dennis to dress up as a girl and pretend he is an exchange student from France. The story is funny and witty and follows Dennis and Lisa as he tries to pull off the ruse. There are also some touching moments between Dennis and his brother and father.
10,000 Dresses by Marcus Ewert	Bailey loves to dream about dresses made of rainbows, sequins, and flowers. When he is awake, he is scolded and mocked when he talks about the dresses in his dreams. One day Bailey meets Laurel, and she befriends him and is inspired by his imagination. The two friends eventually make dresses together, and Bailey’s dreams come true.
All I Want to Be Is Me by Phyllis Rothblatt	All I Want To Be Is Me is a book about how young children experience and express their gender. It is a good book for children who don’t feel like they fit into traditional gender stereotypes.
I am Jaz by Jessica Herthel and Jazz Jennings	The story of a transgender child based on the real-life experience of Jazz Jennings.
Goblinheart by Brett Axel	The author uses fairy and goblin as terms for male and female. This book is written like a fairytale. The main character, Julep, wants to grow up to be a goblin rather than a fairy. The rest of his tribe eventually learns to embrace Julep as a goblin at heart and eventually support his physical transition to goblin.
My Princess Boy by Cheryl Kilodavis	The main character loves the color pink and loves sparkly things. He likes to wear dresses and a princess tiara even when he is climbing trees. This book looks at tolerance and speaks to bullying and being judgmental.
Red: A Crayon’s Story by Michael Hall	This is a story about a blue crayon that is mistakenly labeled red and suffers an identity crisis. Blue wears a bright red label, and everyone tries to change him; his teacher tries to get him to draw strawberries, andhis mother tries to help him be red and sends him on a playdate with a yellow crayon and tells them to draw an orange. He finally meets a friend who helps him show his true color, blue. This book is about being yourself.
Meet Polkadot by Talcott Broadhead	This is the first of a series of books about Polkadot. Polkadot is a nonbinary transgender child. This book is about identity and gender. Polkadot’s sister and best friend experience along with Polkadot what life is like as a trans kid.
Books	Appropriate for Middle School and High School
Totally Joe by James Howe	A sequel to the young adult novel The Misfits, Totally Joe is centered around seventh-grader Joe Bunch, who never quite fit in with other boys his age. In comparison to his other male classmates, Joe prefers baking over shooting hoops and would rather secretly date the school jock, Colin, than attempt to blend in by dating another girl. With the help of his family and friends, Joe survives his first heartbreak and comes to grips with his newfound sexuality all while demonstrating the importance of staying true to yourself. For any kid that feels that they never quite fit in, Totally Joe offers a hopeful, optimistic message of finding friendship, love, and support amid the challenges of middle school.
Gracefully Grayson by Ami Polonsky	The main character, Grayson Sender, struggles with being a girl on the inside and the struggles with being who “he” is. A caring teacher helps Grayson be who “he” was meant to be.
Better Nate Than Ever by Tim Federle	This is a story about 13-year-old Nate Foster. He and his best friend Libby sneak off to New York City to try and get a part on ET the musical on Broadway. The story is upbeat and suspenseful; you have to wait and see if Nate get the part.
Kiss by Jacqueline Wilson	Sylvie and Carl are best friends. Sylvie thinks she will someday marry Carl. But when Carl has a new friend named Paul, Sylvie realizes that things may be changing. The friends play a game of hide and seek in which Carl kisses Paul. The feelings are not mutual, and the results are devastating to Carl. Sylvie and Miranda’s quick thinking help Carl in more ways than one.
Ask the Passengers by A.S. King	Transplanted from New York City to a small-minded suburb in Pennsylvania, Astrid Jones feels isolated in her family, pressured by her friends, and overwhelmed by falling in love with another girl. The only people Astrid can confide in are her imaginary friend “Frank” Socrates and the unknown people flying in airplanes above her backyard. However, as her relationship intensifies, Astrid realizes that she can find support in unexpected places on the ground and that she doesn’t have to accept society’s pressure to conform to labels.
Simon vs. the Homo Sapiens Agenda by Becky Albertalli	Simon is a junior in high school, and he falls for an online pen pal. Unfortunately for Simon, Martin, the school goof-off, finds out about the emails and blackmails Simon. Simon eventually learns to accept himself and find true love.
Beyond Magenta: Transgender Teens Speak Out by Susan Kuklin	In a moving portrayal of photojournalism, Beyond Magenta presents a series of young adult voices and faces from a segment of the queer community that is frequently marginalized and misunderstand. In this book, six transgender and gender-nonconforming young adults share their stories on accepting themselves, coming out, forming connections, and overcoming adversity. Beyond Magenta is an immersive read on the complexity, diversity, and beauty within the trans community.
Websites	Appropriate for all Ages
Gay, Lesbian, & Straight Education Network: glsen.org	GLSEN, the Gay, Lesbian & Straight Education Network, believes that all students deserve a safe and affirming school environment where they can learn and grow. GLSEN conducts research to develop appropriate resources for educators.
Safe Schools Coalition: safeschoolscoalition.org	The Safe Schools Coalition (SSC) is an international public-private partnership that supports queer and questioning youths as well as their caregivers and allies. Although it is headquartered in Washington state, the SSC also provides a comprehensive list of nationwide hotlines and organizations dedicated to protecting both queer and straights youths from bullying, harassment, and violence. The SSC also provides skill-based training to educators and faculty who want to make their schools more accepting of all individuals.
It Gets Better Project: itgetsbetter.org	Founded in the aftermath of a spate of LGBTQ youth suicides, the It Gets Better Project delivers a simple yet powerful message to queer and questioning youths: Despite the challenges of being bullied and harassed, life does get better. Through its online community, the It Gets Better Project invites youths and adults to share their stories and features videos by politicians, activists, and celebrities that stand with the LGBTQ community. Ultimately, the Project provides hope and optimism to youths who are being bullied for who they are by showing them the possibilities for happiness and love in the future.
GLBT National Help Center: glnh.org	The GLBT National Help Center offers free, confidential, and diverse types of support to LGBTQ individuals and their families through two national hotlines, private peer-to-peer instant messaging, and email services. The Center’s website also provides referrals to local organizations as well as advice and information on coming out, relationships, family issues, school problems, and safe sex.
The Trevor Project: thetrevorproject.org	Since its founding, the Trevor Project has helped save the lives of countless queer and questioning youths through its national hotline, peer-to-peer online chat, and text messaging supports. These services are free, confidential, and available to young people who are in crisis, feeling suicidal, or just need a safe space to talk.
Crisis Text Line: crisistextline.org	While not specifically targeted at LGBTQ youths, the Crisis Text Line is available 24/7 to anyone facing psychological or emotional distress. Users from anywhere in the United States can begin by texting “START” to 741-741. Messages are received by live, trained volunteers who respond by actively listening and working with senders to create an immediate plan for crisis management. Text messages are kept confidential and are typically available free of charge on most major U.S. carriers and regional carriers. However, shortcodes (like 741-741) may not be allowed on many prepaid plans, such as T-Mobile’s, and standard messaging rates may apply on certain carriers. In this situation, users can also access the service for free via Facebook messenger.
Parents & Friends of Lesbians and Gays (PFLAG): pflag.org	PFLAG is the nation’s largest family-based organization that is committed to advocating for full equality for the LGBTQ community. With 400 chapters across the United States, PFLAG provides support for families of the LGBTQ community through grassroots activism, anti-bullying workshops, and local chapter meetings that allow families to share their concerns and questions with others who are facing similar challenges. Local chapters also offer support groups for caregivers, siblings, and queer individuals as well as workshops based around issues specific to the LGBTQ community.
Websites	Appropriate for Middle School and High School
Everyone Is Gay: everyoneisgay.com	As stated in its name, Everyone Is Gay is truly an organization for anyone, from straight individuals to LGBTQ youths, their families, and allies. Besides touring high schools and colleges, the site’s founders and staffers provide heartwarming, humorous advice to kids and adults on topics ranging from gender, sexuality, relationships, well-being, and everything in between. This site may be inappropriate for younger children due to language and mature content.

As youths are especially vulnerable to anti-LGBTQ messages in school environments, student feelings may also come to include loneliness, self-hatred, and a diminished sense of self-worth (Vaccaro, August, & Kennedy, 2012). Subsequently, these attitudes can become manifested in reactive behaviors, such as chronic absenteeism, psychosomatic symptoms, substance abuse, and acute anxiety and depression (NIH, 2013). Part 2 of this series addresses these health disparities and provides further implications for the role of the school nurse in reducing these disparities.

Finally, although this article largely aims to assist nurses in their interactions with gender and sexual minority youths, nurses can also use this newfound knowledge to educate not only their colleagues but also students and their families. The keywords, phrases, and resources enumerated in this article can and should be shared with youths and their caregivers to encourage discussions, clarify misinformation, and provide support in times that can be both confusing and isolating. Doing so can help children and their families embrace identity exploration and find solidarity in local and national organizations.

Conclusion

To create a healthier, safer environment for all students, school nurses can shape attitudes and ideologies, ameliorate prejudices, dissuade or embrace differences, and create negative or positive spaces for the entire school community. Using appropriate terminology and following anti-discrimination laws reduces stereotyping and use of potentially hurtful slang terms. Throughout these challenges, school nurses can play a multifaceted role by acting as advocates for gender and sexual minority youths as well as educators in promoting practices that affirm the experiences of LGBTQ children and their families. In doing so, nurses will have the profound opportunity to leave an indelible mark on countless youths and contribute to the establishment of a more just and safe school environment. ■

Footnotes

Acknowledgements

The Authors thank Carole Kenner for her guidance and support in the development of this article.

Dr. Tracy Perron is a registered nurse with over 25 years of experience. She has extensive experience in community health, school health, and public health. Dr. Perron has done research on bullying in school age children and is a Johnson and Johnson School Nurse Fellow.

Dr. Connie is a certified family nurse practitioner with experience in primary care, rheumatology, care of older adults, adherence, and intergenerational relationships.

Chaya is currently a third-year nursing student at the College of New Jersey.

References

American Academy of Pediatrics. (2014). Explaining disorders of sex development and intersexuality. Retrieved from https://www.healthychildren.org/English/health-issues/conditions/genitourinary-tract/Pages/Explaining-Disorders-of-Sex-Development-Intersexuality.aspx

American Academy of Pediatrics. (2015). Gender identity development in children. Retrieved from https://www.healthychildren.org/English/ages-stages/gradeschool/Pages/Gender-Identity-and-Gender-Confusion-In-Children.aspx

American Psychiatric Association. (2000). Position statement on therapies focused on attempts to change sexual orientation [Press release]. Retrieved from https://www.psychiatry.org/file%20library/about-apa/organizationdocuments-policies/policies/position-2000-therapies-change-sexualorientation.pdf

American Psychological Association. (2006). Answers to your questions about individuals with intersex conditions [Pamphlet]. Retrieved from http://www.apa.org/topics/lgbt/intersex.pdf

American Psychological Association. (2008). Answers to your questions: For a better understanding of sexual orientation and homosexuality [Pamphlet]. Retrieved from http://www.apa.org/topics/lgbt/orientation.pdf

American Psychological Association. (2011). Guidelines for psychological practice for lesbian, gay, and bisexual clients. American Psychologist, 67(1), 10-42. Retrieved from http://www.apa.org/pubs/journals/features/amp-a0024659.pdf

American Psychological Association. (2014). Answers to your questions about transgender people, gender identity, and gender expression [Pamphlet]. Retrieved from http://www.apa.org/topics/lgbt/transgender.pdf

Betancourt

J. R.

Green

A.R.

Carrillo

J. E.

Ananeh-Firempong

II . (2003). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118(4), 293-302.

Bond

B. J.

(2015). The mediating role of self-discrepancies in the relationship between media exposure and well-being among lesbian, gay, and bisexual adolescents. Media Psychology, 18(1), 51-73.

10.

Bradford Makadon . (2011, March 31). IOM LGBT Health Report. Retrieved January 04, 2017, from http://thefenwayinstitute.org/research/iom-report/

11.

Collier

K. L.

van Beusekom

Bos

H. M. W.

Sandfort

T. G. M.

(2013). Sexual orientation and gender identity/expression related peer victimization in adolescence: A systematic review of associated psychosocial and health outcomes. Journal of Sex Research, 50(3-4), 299-317. doi:10.1080/00224499.2012.750639

12.

Cooper

R. M.

Blumenfeld

W. J.

(2011). Responses to cyberbullying: A descriptive analysis of the frequency of and impact on LGBT and allied youth. Journal of LGBT Youth, 9(2), 153-177.

13.

Flores

A. R.

Herman

J. L.

Gates

G. J.

Brown

T. N.

(2016). How many adults identify as transgender in the United States. Retrieved from http://williamsinstitute.law.ucla.edu/wp-content/uploads/How-Many-Adults-Identify-as-Transgender-in-the-United-States.pdf

14.

Gender Diversity. (2016). Terminology. Retrieved from http://www.genderdiversity.org/resources/terminology/

15.

Hatzenbuehler

M. L.

(2011). The social environment and suicide attempts in lesbian, gay, and bisexual youth. Pediatrics, 127(5), 896-903.

16.

Human Rights Campaign. (2014). Growing up LGBT in America [Pamphlet]. Retrieved from http://hrc-assets.s3-website-us-east-1.amazonaws.com//files/assets/resources/Growing-Up-LGBT-in-America_Report.pdf

17.

Human Rights Campaign. (2016). Glossary of terms. Retrieved from http://www.hrc.org/resources/glossary-of-terms

18.

Kann

McManus

Harris

W. A.

Shanklin

S. L.

Flint

K. H.

Hawkins

… Zaza

. (2016). Youth risk behavior surveillance—United States, 2015. Morbidity and Mortality Weekly Report, 65(6), 1-174.

19.

Kellogg

N. D.

(2010). Sexual behaviors in children: Evaluation and management. American Family Physician, 82(10). Retrieved from http://www.aafp.org/afp/2010/1115/p1233.pdf

20.

Lehmiller

(2014). The psychology of human sexuality. Chichester, UK: John Wiley & Sons.

21.

LeVasseur

M. T.

Kelvin

E. A.

Grosskopf

N. A.

(2013). Intersecting identities and the association between bullying and suicide attempt among New York City youths: Results from the 2009 New York City youth risk behavior survey. American Journal of Public Health, 103(6), 1082-1089. doi:10.2105/AJPH.2012.300994

22.

National Child Traumatic Stress Network. (2009). Sexual development and behavior in children [Pamphlet]. Retrieved from http://nctsn.org/nctsn_assets/pdfs/caring/sexualdevelopmentandbehavior.pdf

23.

National Institutes of Health. NIH LGBT Research Coordinating Committee. (2013). Consideration of the Institute of Medicine (IOM) report on the health of lesbian, gay, bisexual and transgender (LGBT) individuals. Retrieved from https://report.nih.gov/UploadDocs/LGBT%20Health%20Report_FINAL_2013-01-03-508%20compliant.pdf.

24.

Pew Research Center. (2016). Changing attitudes on gay marriage. Retrieved from http://www.pewforum.org/2016/05/12/changing-attitudeson-gay-marriage/

25.

Robinson

J. P.

Espelage

D. L.

(2011). Bullying explains only part of LGBTQ-heterosexual risk disparities implications for policy and practice. Educational Researcher, 41(8), 309-319. doi:10.3102/0013189X12457023

26.

Vaccaro

August

Kennedy

M. S.

(2012). Safe spaces: Making schools and communities welcoming to LGBT youth. Santa Barbara, CA: Praeger.

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