LGBTQ College Students’ Experiences With University Health Services: An Exploratory Study

ABSTRACT

Access to inclusive, equitable health care is central to the wellbeing of all college students yet little is known about LGBTQ students’ experiences with university health services. In this article, individual interviews with a convenience sample of 14 LGBTQ students at a large public university were analyzed to explore their perceptions of and experiences with the university’s health center and its services. Our findings demonstrate that the university is not adequately meeting their health care needs. Participants’ narratives offer insights into how to improve campus-based health services for LGBTQ students.     

Advancing Research on LGBTQ Microaggressions: A Psychometric Scoping Review of Measures

ABSTRACT

Understanding the nature and consequences of LGBTQ microaggressions is critical to fostering equity and wellbeing among sexual and gender minorities. Yet little guidance is available for researchers seeking psychometrically robust measures of subtle LGBTQ slights, invalidations, and insults. To address this gap, we conducted a scoping review of multi-item quantitative measures that included at least one question addressing LGBTQ microaggressions. This article reports the study characteristics and psychometric properties of 27 original measures we identified and their subsequent adaptations. The article concludes with an assessment of strengths and limitations of LGBTQ microaggression measurement, highlighting aspects of measurement innovation on which future researchers can build. As microaggressions remain a powerful and underexplored mechanism of sexual and gender minority oppression, this review will help to both advance methodological quality in this critical research area and enhance our understanding of how microaggressions manifest in the lives of LGBTQ individuals.     

Identifying the Needs of LGBTQ Immigrants and Refugees in Southern Arizona

This article reports on the results of a needs assessment conducted for lesbian, gay, bisexual, transgender, and queer (LGBTQ) immigrants, asylees, refugees, and their allies in Southern Arizona, and it is the first study of its kind in the United States. Utilizing interview data collected with migrants, allies, and service providers in Tucson, Arizona, this article presents findings on the quality of service provision provided to this very underserved community pertaining to health care, housing, and legal services. The assessment shows that no services are provided specifically for LGBTQ migrants, and most LGBTQ migrants turn to family and friends when they have needs. The most significant result of this study pertains to the lack of cultural competence and an overall deficiency in terms of cultural awareness when it comes to the specific needs of LGBTQ migrants.     

Identifying the needs of LGBTQ immigrants and refugees in Southern Arizona

This article reports on the results of a needs assessment conducted for lesbian, gay, bisexual, transgender, and queer (LGBTQ) immigrants, asylees, refugees, and their allies in Southern Arizona, and it is the first study of its kind in the United States. Utilizing interview data collected with migrants, allies, and service providers in Tucson, Arizona, this article presents findings on the quality of service provision provided to this very underserved community pertaining to health care, housing, and legal services. The assessment shows that no services are provided specifically for LGBTQ migrants, and most LGBTQ migrants turn to family and friends when they have needs. The most significant result of this study pertains to the lack of cultural competence and an overall deficiency in terms of cultural awareness when it comes to the specific needs of LGBTQ migrants.     

Coping With Stress as an LGBTQ+ Health Care Professional

Lesbian, gay, bisexual, transgender, queer, and other sexual/gender minority (LGBTQ+) health care providers face both general work-related stresses and working in heteronormative settings with ill-informed or hostile coworkers and patients, yet there has been little study of whether the coping strategies are specific to LGBTQ+ stress. We analyzed qualitative data from 277 health care professionals. Sources of stress included religiously and politically conservative coworkers, coworker/patient lack of knowledge, stresses of being closeted, and concerns about being out to patients. Consequences of being out as LGBTQ+ included lack of promotions, gossip, refusals of tenure, and anti-LGBTQ+ comments and behaviors in the workplace. Respondents showed mostly positive coping strategies to deal with stress, including becoming educators/advocates and self-care activities. Self-care options were common in rural areas with few LGBTQ+ social resources. Negative coping strategies were reported by 18% of respondents. The study highlights the extra burden of stress on LGBTQ+ health care providers.     

Primary Care Providers’ Attitudes,Practices, and Knowledge in Treating LGBTQ Communities

ABSTRACT

Cultural competency in lesbian, gay, bisexual, transgender, and queer (LGBTQ) health care has been found to be lacking within various medical specialties, but no studies have compared competency among primary care providers. The authors compared 127 primary care providers’ cultural competency regarding LGBTQ health using a survey that assessed providers’ attitudes, practices, and knowledge. Overall, 78.0% of respondents agreed that they were comfortable treating LGBTQ patients. Yet many providers did not feel well informed on specific LGBTQ health needs (70.1%), on clinical management of LGBTQ care (74.8%), nor on referring patients with LGBTQ issues (78.7%). Overall accuracy on LGBTQ knowledge questions was 51.0%. This study revealed a lack of cultural competency and much need for improvement as primary care providers endorsed negative attitudes, biases, inconsistencies in clinical practice, and deficiencies in medical knowledge in specialty-specific ways. There is a need for greater LGBTQ-specific education to increase providers’ comfortability and competency in the needs, management, and referrals within LGBTQ health care.     

Positive Identity Experiences of Young Bisexual and Other Nonmonosexual People: A Qualitative Inquiry

The majority of LGBTQ psychological research focuses on dysfunction. The exclusion of strengths-based perspectives in LGBTQ psychology limits the understanding of LGBTQ mental health. In this article we report experiences that young bisexual and other nonmonosexual people perceive as affirming of their sexual identity. A 28-day, daily diary study was used to investigate whether bisexual-identified participants encountered positive experiences related to their sexual identity, and which type of experiences they perceived to be positive. Using a constructivist grounded theory approach, participants’ experiences were organized according to a social ecological model. Experiences were reported at the intrapersonal, interpersonal, and institutional levels, but most positive sexual identity experiences occurred at the interpersonal level. Implications for positive health outcome research and the integration of positive psychology with LGBTQ psychology are discussed, as well as study limitations.     

Heterosexism,Depression, and Campus Engagement Among LGBTQ College Students: Intersectional Differences and Opportunities for Healing

LGBTQ people experience health disparities related to multilevel processes of sexual and gender marginalization, and intersections with racism can compound these challenges for LGBTQ people of color. Although community engagement may be protective for mental health broadly and for LGBTQ communities in buffering against heterosexism, little research has been conducted on the racialized dynamics of these processes among LGBTQ communities. This study analyzes cross-sectional survey data collected among a diverse sample of LGBTQ college students (n = 460), which was split by racial status. Linear regression models were used to test main effects of interpersonal heterosexism and engagement with campus organizations on depression, as well as moderating effects of campus engagement. For White LGBTQ students, engaging in student leadership appears to weaken the heterosexism–depression link—specifically, the experience of interpersonal microaggressions. For LGBTQ students of color, engaging in LGBTQ-specific spaces can strengthen the association between sexual orientation victimization and depression.     

Cross-Cultural Analyses of Determinants of Quality of Life and Mental Health: Results from the Eurohis Study

Recent projects on international instrument development have produced a wide array of health indicators that may be used for cross-cultural field-testing, however more information on their cross-cultural performance in relation to health determinants is necessary. The current study approaches one step for international conceptual validation by analysing the association between various health determinants and different types of health outcomes (mental health, quality of life) across a range of countries or geographical areas. The current study is based on the EUROHIS project that has been conducted in a sample of 4849 adults across 10 European countries. Results highlight that interactions between health determinants with subjective mental health, general health and quality of life (QoL) differ between Western European countries, Eastern European countries and the Newly Associated States as well as Israel. Using a MIMIC model approach, we were able to show that the impact of each of the sociodemographic variables cannot be interpreted on the basis of its single loading but only seeing the interacting with other indicators. Future studies should include sociodemographics in MIMIC models in each latent factor before carrying out regressions on a larger scale. Future investigations will require larger and representative samples to (a) test models on latent factors of mental health and QoL and (b) on the basis of these findings test overall structural models across countries.     

A Review of the Literature on LGBTQ Adults Who Experience Homelessness

ABSTRACT

Little is known about lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults who experience homelessness. The current review critically analyzes the scant literature on LGBTQ adults who experience homelessness, with a particular focus on: (1) pathways into homelessness; (2) support needs; (3) targeted programming; and (4) exits out of homelessness. A total of 143 articles were identified, and 16 articles met the criteria of appropriate age range, article quality, and relevance of topic. Results from this review demonstrate that homeless LGBTQ adults have unique physical and mental health challenges, largely concerning HIV and substance use. Transgender and gender non-conforming adults who experience homelessness encounter several challenges in the homelessness system, particularly in regard to safety and gender-affirming supports. Recommendations focus on practical implications for support and suggestions for future research.     

LGBT Health in the Midlands: A Rural/Urban Comparison of Basic Health Indicators

Research into the health and wellbeing of rural lesbian, gay, bisexual, and transgender (LGBT) populations is limited. A community-based participatory research (CBPR) approach was used to develop an online survey for LGBT Nebraskans. The 770 participants replied to an array of questions on social determinants of health and basic health outcomes. Only significant differences in having health insurance were found between urban and rural participants. Social determinants of health were explored. Results of this study suggest that regional culture may be more salient to health for lesbian, gay, bisexual, and transgender persons living in the Midwest than rural or urban residence.     

The Concept,Dimensions and Methods of Assessment of Human Well-Being within a Socioecological Context: A Literature Review

The concept of well-being has evolved over the past several decades as research has continued to reveal its multidimensional, dynamic, person-specific and culture-specific nature. Most recently, the ecological embeddedness of well-being has also gained recognition, and this development of the concept demands that we explore and identify new conceptual frameworks and appropriate methodological approaches towards the assessment of quality of life within a socioecological context. This paper offers a review of seminal and current research in the fields of social indicators, human development, ecological economics, and natural resources management, with the aim of examining the concept and the various methodologies designed to assess both the objective and subjective components and the multiple dimensions that comprise well-being. We also present some methodological approaches that have the capacity to account for the role of ecosystem services, considering several studies of rural populations whose well-being depends on the flow of ecosystem services, highlighting the participatory methods these studies employed to identify and assess locally relevant well-being indicators, and addressing some of the challenges inherent in such methods. We conclude with an appraisal of what we regard as the most appropriate methodological approach for measuring human well-being in the socioecological context.     

Understanding How Policy and Culture Create Oppressive Conditions for LGBTQ2S Youth in the Shelter System

This study examined the experiences that lesbian, gay, bisexual, transgender, queer, questioning, and two-spirit (LGBTQ2S) homeless youth have in shelters and the disjunctures that occur for this population in Toronto’s shelter system. The attitudes and behaviors of shelter workers and management toward LGBTQ2S youth were also explored. A critical action research approach, informed by critical ethnography and institutional ethnography was employed. Thirty-three people participated in this study in the Greater Toronto Area. The study triangulated data from interviews, focus groups, observations, and document analysis. The systemic enactment of homophobia, transphobia, and hegemonic masculinity are often normalized in shelters and create significant barriers to safe, accessible, and supportive services for LGBTQ2S youth. Excessive bureaucratic regulation and the lack of necessary bureaucratic regulation in highly significant areas play a key role in creating the disjunctures that occur for LGBTQ2S youth in shelters.     

Helping Young People Stay Afloat: A Qualitative Study of Community Resources and Supports for LGBTQ Adolescents in the United States and Canada

LGBTQ youth are at increased risk of poor health outcomes. This qualitative study gathered data from LGBTQ adolescents regarding their communities and describes the resources they draw on for support. We conducted 66 go-along interviews with diverse LGBTQ adolescents (mean age = 16.6) in Minnesota, Massachusetts, and British Columbia in 2014–2015, in which interviewers accompanied participants in their communities to better understand those contexts. Their responses were systematically organized and coded for common themes, reflecting levels of the social ecological model. Participants described resources at each level, emphasizing organizational, community, and social factors such as LGBTQ youth organizations and events, media presence, and visibility of LGBTQ adults. Numerous resources were identified, and representative themes were highly consistent across locations, genders, orientations, racial/ethnic groups, and city size. Findings suggest new avenues for research with LGBTQ youth and many opportunities for communities to create and expand resources and supports for this population.     

Assessing LGBTQ campus climate and creating change

We report the findings of a climate study of a liberal arts college in Pennsylvania. This climate assessment was comprehensive in content (heterosexual and cisgender individuals' attitudes, and LGBTQ individuals' experiences), participants (faculty, staff, and students), and methodology (qualitative and quantitative). We found low levels of sexual prejudice and generally positive perceptions of the campus, but positive attitudes were more strongly endorsed by heterosexual and cisgender than LGBTQ participants. We consider the impact of these perceptions on LGBTQ students' co-curricular involvement and discuss the institutional changes that are underway as a result of our study.     

Perceptions of the LGBTQ College Campus Climate Scale: Development and Psychometric Evaluation

ABSTRACT

This article reports the development and psychometric properties of scores on a new scale designed to assess views of the university/college campus climate concerning LGBTQ students and issues: Perceptions of the LGBTQ College Campus Climate Scale. This 6-item scale includes two subscales: College Response to LGBTQ Students and LGBTQ Stigma. We provide evidence for structural validity (via exploratory and confirmatory factor analyses) and reliability for scores on this new measure. Supporting construct validity, Perceptions of the LGBTQ College Campus Climate full scale and subscales were each positively correlated with experiences of LGBTQ victimization on campus, anxiety, and depression and negatively correlated with satisfaction with college and intention to persist in college. Relationships with mental health and academic outcomes held true, even after controlling for LGBTQ victimization experiences, providing support for incremental validity. Implications for future research and practice are discussed.     

Adaptation and Validation of a Positive Health Scale for Adolescents

There is a demonstrated need to develop alternative approaches to measuring health from a positive health perspective in order to support systematic planning and evaluation of health promotion in schools. The Salutogenic Health Indicator Scale (SHIS) aims to measure health from a positive perspective. However, it has not been developed, or previously been tested, for use with adolescents between the ages of 12 and 16, at which age youth often exhibit a need for extra support in order to be successful in school and life. Inspired by the SHIS, we generated a Positive Health Scale (PHS) appropriate for 12–16-year-olds and determined its validity and reliability using principal component analysis (PCA). In the study, the scale was tested in a sample of 1,527 Grade 6–9 students, using PCA. The findings indicated the need to reduce the scale to nine items, which was then shown to be valid and reliable for use with both adolescent boys and adolescent girls. We conclude that the PHS can be used in systematic health promotion planning and evaluation. Communities and schools can use this scale to examine and improve health determinants in different adolescent settings.     

Is the Lack of Specific Lesbian,Gay, Bisexual,Transgender and Queer/Questioning (LGBTQ) Health Care Education in Medical School a Cause for Concern? Evidence From a Survey of Knowledge and Practice Among UK Medical Students

Lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) people frequently report negative health care encounters. Medical professionals may inadequately manage LGBTQ persons’ health if they have not received training in this area. An anonymous survey measuring efficacy in health situations among LGBTQ persons was answered by 166 medical students across all years of a UK university. Results show that 84.9% of participants reported a lack of LGBTQ health care education, with deficits in confidence clarifying unfamiliar sexual and gender terms, deciding the ward in which to nurse transgender patients, finding support resources, and discussing domestic abuse with LGBTQ patients. Most participants reported that they would not clarify gender pronouns or ask about gender or sexual identity in mental health or reproductive health settings. Participants reported infrequently observing doctors making similar inquiries. Participants held positive attitudes toward LGBTQ patients, with attitude scores positively correlating with LGBTQ terminology knowledge scores (r_s = 0.5052, p < .01). Addressing gender identity and sexuality issues within medical curricula may remove barriers to accessing health care and improve encounters for LGBTQ patients.     

Hungarian Medical Students’ Knowledge About and Attitude Toward Homosexual,Bisexual, and Transsexual Individuals

ABSTRACT

Discrimination that LGBTQ individuals experience in health care settings might affect their health and intention of using health care services. However, health needs of LGBTQ patients are still inappropriately addressed in the medical curriculum. First-, third-, and fourth-year medical students (N = 569) from the four Hungarian medical universities participated in a study in 2017 to assess knowledge about homosexuality, homonegativity, and their attitude as health care professionals toward sexual minorities. We found that higher levels of knowledge about homosexuality were associated with lower levels of homonegativity, upper-grade level in university, not being religious, and having close LGBTQ acquaintances. Our results suggest that it may be necessary to introduce LGBTQ themes in the medical curricula (not only in Hungary, but also in other countries) in order to improve the knowledge and attitude of medical students and thereby improve the health care of LGBTQ individuals.