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Strengthening Our Schools to Promote Resilience
and Health Among LGBTQ Youth:
Emerging Evidence and Research Priorities from The State
of LGBTQ Youth Health and Wellbeing Symposium
Michelle M. Johns, MPH, PhD,
1
V. Paul Poteat, PhD,
2
Stacey S. Horn, PhD,
3
and Joseph Kosciw, PhD
4
Abstract
Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) adolescents face well-documented health
disparities in suicide risk, substance use, and sexual health. These disparities are known to stem, in part, from
stigma directed toward LGBTQ youth in the form of minority stressors such as violence, discrimination, and ha-
rassment. Given the proportion of time that LGBTQ students spend in school, schools provide a critical context
within which protective factors may be developed and leveraged to improve the health and well-being of these
populations. This article provides a summary of key findings from a discussion among researchers, practitioners,
and community members who participated in ‘‘The State of LGBTQ Youth Health and Wellbeing: Strengthening
Schools and Families to Build Resilience,’’ a public symposium held in June 2017. We detail emerging science
on and future priorities for school-based research with LGBTQ youth which were identified by attendees at this
meeting, with a particular focus on intersectionality, supportive adults in schools, and in-school programs. We
call for more school-based research on priority gaps such as how LGBTQ students’ intersecting identities affect
their in-school experiences, how to design professional development programs that cultivate supportive educa-
tors, and how to leverage gay–straight alliances/gender and sexuality alliances as sites of health programming for
LGBTQ students.
Keywords: disparity, gender minority, resilience, schools, sexual minority, youth
Introduction
Lesbian, gay, bisexual, transgender, and queer/
questioning (LGBTQ) adolescents face well-documented
health disparities.
1–9
Suicidal ideation and suicide rates are
alarmingly high; national estimates have found that 29.4%
of lesbian, gay, and bisexual (LGB) high school students
attempted suicide in the past year, compared with 6.4% of
heterosexual students.
2
Although national data on transgen-
der youth do not yet exist, school-based surveys from select
states and urban areas indicate that suicide attempts may be
as high as 35% among transgender adolescents.
7,9
Substance
use is also elevated among LGBTQ adolescents.
2–4
One
meta-analysis found that LGB adolescents have as much as
190% higher odds of using alcohol and other drugs as hetero-
sexual youth,
3
and individual studies with transgender youth
indicate that the prevalence of lifetime use of substances is
between 1.5 and 4.8 times higher than among cisgender
youth, depending on the substance.
4,8
Sexual and gender
minority (SGM) adolescents, depending on the particular
LGBTQ population to which they belong, continue to expe-
rience high rates of HIV, sexually transmitted infections, and
unintended pregnancy, and youth of color are affected more
than White youth.
5,6,10–15
Statistics such as these present a
concerning picture of LGBTQ youth health.
Stigma and minority stress processes are the theorized drivers
of the negative health outcomes experienced by LGBTQ popu-
lations.
16,17
In this article, we use LGBTQ as an umbrella term
to capture the full range of individuals who identify as some-
thing other than heterosexual or cisgender. Stigma refers to la-
beling, stereotyping, marginalizing, and discriminating against
a social group.
18
Minority stress refers to the process by which
stigma is experienced by the individual through encounters
with external stressors (i.e., discrimination and harassment)
1
Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
2
Lynch School of Education, Boston College, Boston, Massachusetts.
3
College of Education, University of Illinois at Chicago, Chicago, Illinois.
4
GLSEN, New York, New York.
LGBT Health
Volume 00, Number 00, 2019
ªMary Ann Liebert, Inc.
DOI: 10.1089/lgbt.2018.0109
1
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and internal stressors (i.e., internalized homophobia/biphobia/
transphobia, expectations of rejection, and identity conceal-
ment).
16,17
These stressors activate a physiological stress re-
sponse, which can affect the mental and physical health of
stigmatized populations, such as LGBTQ youth.
16,19
For ex-
ample, LGBT youth who perceived that they were discrimi-
nated against because of their identities had significantly
higher levels of depressive symptomatology and were more
likely to report suicidal ideation.
20
Due to the burden of negative health outcomes ex-
perienced by LGBTQ youth, there is a need to cultivate
protective factors that can interrupt sexual orientation- and
gender-related stigma, thus fostering resilience among
these populations. Protective factors are characteristics, con-
ditions, and behaviors that either improve health directly or
reduce the negative effects of a risk factor on health.
21
Pro-
tective factors can be individual assets such as personality
characteristics or individual skills that improve/bolster
health, or they can be external resources such as supportive
relationships with friends/family or access to medical ser-
vices that improve/bolster health.
21–24
Resilience refers to
the process of positive functioning by individuals who expe-
rience hardship.
21,25
To experience resilience means that an
individual (1) lives through a difficult situation or experi-
ence, (2) has access to protective factors, either individual
assets or external resources, and subsequently, (3) succeeds
or thrives in the face of these obstacles.
21,25
For LGBTQ
youth, cultivating protective factors through interventions
and health programming may be important for nurturing pro-
cesses of resilience in the face of cultural stigma.
Schools are a critical site of adolescent development and
can provide an important avenue for intervention work with
LGBTQ youth. On average, students in the United States
spend 6.6 hours in school, 180 days of the year.
26
Given the
amount of time spent in schools, the structure of these environ-
ments is important for the health and well-being of children and
adolescents. For LGBTQ students, schools have the potential to
be sites of stigma-related risk factors or protective factors.
Schools are places where LGBTQ youth may experience
stigma and discrimination. LGBTQ students in schools en-
counter near-ubiquitous verbal harassment.
27
School climate
surveys have found that as many as 85.2% of LGBTQ students
experience verbal harassment at school, and 98.1% have heard
the term ‘‘gay’’ used in a negative way.
27
Notably, these forms
of verbal harassment come not only from peers but also from
school staff.
27
LGBTQ students also contend with high rates
of violent victimization on school grounds. National data indi-
cate that, at school, LGB high school students are more likely
to have been in a physical fight, threatened or injured with a
weapon, and bullied, than heterosexual students, as well as
more likely to have skipped school due to safety concerns.
2
Transgender adolescents encounter similar stigma at school—
they may be as much as four times more likely to experience
bullying and harassment as cisgender students.
4,9
Conversely, schools provide many resources that have the
potential to be leveraged for the benefit of LGBTQ students.
Formative research on the role of protective factors such
as school connectedness, supportive educators, anti-bullying
policies,and inclusive curricula highlightssome promising av-
enues to improving health and well-being for LGBTQ adoles-
cents.
23,28,29
Bolstering in-school resources such as these may
help to curtail the negative experiences of LGBTQ students
and, in turn, improve their health and well-being. However, ef-
forts to develop and understand in-school protective factors
and their effects on LGBTQ students may encounter institu-
tional challenges. Schools and districts may have limited re-
sources and may already face obstacles to meeting the many
educational and social-emotional learning needs of their stu-
dents.
30
Additional research and programmatic efforts may
pose challenges to already overburdened infrastructures.
30
Collaborative partnerships among researchers, practitioners,
and schools may offer one important potential avenue to ad-
dress some of these challenges, as cultivation of in-school sup-
ports could benefit a significant number of LGBTQ students.
31
In this article, we summarize the current research on protec-
tive factors that may shape the health of LGBTQ students, as
well as key research gaps on protective factors in schools that
need attention to advance the science in this area. Our aim is
for this review to provide guidance in better designing re-
search about and interventions that consider the role of schools
in improving the health and well-being of LGBTQ youth.
The State of LGBTQ Youth Health and Wellbeing
Symposium and Working Group Meeting
In June 2017, the Northwestern Institute for Sexual and
Gender Minority Health and Wellbeing, in partnership with
the Center for Prevention Implementation Methodology,
Advocates for Youth, and the AIDS Foundation of Chicago,
hosted a public symposium titled ‘‘The State of LGBTQ
Youth Health and Wellbeing: Strengthening Schools and Fam-
ilies to Build Resilience.’’ The day after the symposium, a
working group meeting was held with 40 participants from ac-
ademia, federal government health agencies, youth serving or-
ganizations, advocacy organizations, foundations, and youth
themselves. These stakeholders gathered to characterize
(1) areas of strong and emerging scientific evidence, (2)
gaps in knowledge, (3) research priorities regarding the pre-
vention of negative health outcomes among LGBTQ youth
(e.g., HIV, substance use, mental health and suicide, and vi-
olence), and (4) methods of supporting translation of re-
search findings into implementable programs.
To accomplish this task, stakeholders at the working group
meeting formed two separate teams to address two important
systems in the lives of youth: schools and families. The two
teams each consisted of symposium participants with a par-
ticular expertise in each of the two systems (schools and
families). Researchers within each team presented to each
other summaries of current evidence pertaining to the ways
in which factors within these two contexts contributed to
the health of LGBTQ youth. Then, within each topic-focused
team, attendees discussed potentially effective strategies for
leveraging factors within these two systems and discussed
the questions that needed to be asked (i.e., research gaps)
to advance both research and programmatic efforts.
Based on these discussions, plans were made to develop arti-
cles on three topic areas: (1) school-based research, (2) family-
focused research, and (3) methods of conducting research with
LGBTQ youth. This article is the synthesis of the discussion
of topic 1: school-based research on LGBTQ youth, and it,
thus, does not address family-related research or methodological
questions about working with LGBTQ youth. Table 1 offers a
complete overview of the topics discussed by the school-
based research team.
23,27,32–55
For clarity, we organized the
2 JOHNS ET AL.
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Table 1. Emerging Evidence in and Future Research Questions for School-Based Research with Lesbian,
Gay, Bisexual, Transgender, and Queer/Questioning Youth
Topic Emerging evidence Future research questions
Individual-level factors
Intersectionality LGBTQ youth are diverse, and school
experiences are shaped by other
intersecting social identities.
32–35
Youth of color
Youth with disabilities
Youth in rural versus urban locations
What are the school experiences of LGBTQ young
people across various social identities (i.e., race,
ethnicity, socioeconomic status, ability, and religion)?
How do various forms of systemic oppression (e.g.,
racism, sexism, and classism) intersect to shape the
school experiences of LGBTQ youth?
How do the pathways between negative school
experiences and developmental outcomes differ for
LGBTQ youth across various social identities?
What are the individual protective factors that disrupt or
exacerbate these pathways for LGBTQ youth across
various social identities?
Which specific supports and strategies lead to positive
outcomes for LGBTQ youth with other marginalized
identities in differing contexts (i.e., type of school,
neighborhood, and geographical region)?
Characteristics For LGBT youth, disclosure of LGBT
identity to others (i.e., outness) is
associated with better health.
36
For LGBTQ youth, self-compassion is
associated with lower mental health
concerns.
37
Transgender youth with skills in self-
advocacy are better able to navigate
negative school environments.
23,38
What are the characteristics of LGBTQ students who are
thriving in their schools?
How are in-school supports experienced differently
across sex and gender (e.g., boys/girls/non-binary
youth and cisgender/transgender) for LGBTQ youth?
To what extent could a research focus on positive
psychology and outcomes such as hope, agency,
confidence, critical consciousness, empowerment,
caring, and purpose inform positive youth development
for LGBTQ youth?
Safety and
inclusivity
Feeling unsafe at school has a negative
impact on academic success (i.e., lower
GPA, less likely to attend school, and
more likely to drop out).
27
Students in rural and southern schools
report that their schools are less LGBT-
inclusive and more hostile.
34
What do LGBTQ youth name as the key indicators of
inclusive and welcoming schools?
Which physical areas of the school do LGBTQ youth
perceive as safe or unsafe?
Does safety and inclusivity vary across sub-populations of
LGBTQ youth (e.g., race, gender, socioeconomic
status, and ability) in schools?
How can educators be best prepared to address school
climate concerns for LGBTQ students?
How do community-level beliefs and attitudes about
LGBTQ people affect the school community?
Interpersonal-level factors
Supportive adults
in schools
Supportive educators benefit LGBTQ
youth.
39–41
Educators and resources that are
supportive of LGBTQ students are
increasingly more visible/available in
recent years.
39,40
Training teachers to learn skills to be
supportive is essential.
42
Transgender youth report that adult role
models are critically important.
23
What are the critical dimensions of support from
educators needed by LGBTQ youth?
How do we train supportive educators?
What are the educational supports needed to cultivate
supportive/trained educators?
To what extent are currently available resources meeting
these needs?
How do role models or mentors inform the identities of
LGBTQ youth and their ability to navigate school
environments?
Peers Peers are a primary source of emotional
and social support for LGB youth in
schools.
43,44
For transgender youth, social support from
peers increases mental health and
decreases absenteeism.
23
What role might peers have in establishing norms around
LGBTQ-affirming attitudes and behaviors in schools?
To what extent can heterosexual allies be leveraged to
promote resilience in LGBTQ youth?
What are the components of an effective anti-bullying
intervention that reduces bias and discriminatory
behavior?
Parents/families
in schools
Parents generally support inclusive safe
schools policies and practices in
schools, especially those that protect
students from harm.
45
Parents generally support inclusive and
comprehensive sexuality education.
46
Which family factors affect school outcomes for LGBTQ
youth?
What are effective models of parent-school partnerships
that could be leveraged to improve outcomes for
LGBTQ youth?
(continued)
3
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school-based research findings by ecological level (i.e., individ-
ual, interpersonal, and school). Table 1 presents an overview of
these findings and specifies both the emerging evidence and the
critical research gaps for each topic raised by the schools work-
ing group. Within each level, we provide a more in-depth focus
on one topic in which the article authors have significant sub-
ject matter expertise based on their own programs of research:
intersectionality (author 3), supportive adults in schools (author
4), and in-school programs (author 2); and we summarize, in
brief, the other topics identified by the working group as critical
for enabling LGBTQ youth to succeed in the face of adversity.
Individual-Level Factors
Intersectionality
Definitions and emerging evidence. Intersectionality was
raised by the working group as a critical dimension for
consideration in school-based research focused on LGBTQ
youth, given that young peoples’ diverse social identities
affect many of the other individual-, interpersonal-, and
school-level protective factors discussed in the working
group meeting (outlined in Table 1). Intersectionality refers
to the perspective that individuals have multiple social iden-
tities (e.g., ability status, ethnicity, gender, racial, sexual ori-
entation, and socioeconomic status) that mutually shape their
experience of the world, social relationships, and under-
standing of themselves.
56,57
Individual social identities
create distinct patterns of privilege and oppression at the so-
cietal level (e.g., racism, sexism, heterosexism, and ableism),
and they thus have implications for stigma, minority stress,
and health outcomes.
58,59
Because sexual orientation and gen-
der identity are not the only identities shaping youth’s school
experiences, intersectional approaches may benefit research
on LGBTQ adolescents, schooling, and health, as they provide
a more complete understanding of who youth are, what chal-
lenges they may face, and which strengths they may be able to
leverage.
32,33,56,57
Although a robust literature on adolescent
health generally makes use of intersectional frameworks,
60–62
Table 1. (Continued)
Topic Emerging evidence Future research questions
School-level factors
In-school
programs
On average, youth in schools with GSAs
report less truancy, smoking, drinking,
suicide attempts, and sex with casual
partners, although differences are larger
for LGBTQ youth.
47
Greater involvement in various GSA
practices is associated with greater well-
being among members.
48
GSAs are viewed positively by
transgender youth and are associated
with lower absenteeism.
23,49
Which GSA characteristics provide the greatest health
benefits to LGBTQ youth?
What are the health effects of membership in a GSA,
versus simply being in a school with a GSA, for
LGBTQ youth?
To what extent are GSAs universally beneficial for all
students or beneficial for some students more than
others, based on differences by sexual orientation, race
or ethnicity, gender identity, SES, or geography?
What role might positive youth development programs
designed for adolescents broadly (e.g., 4H and Boys
and Girls Club) have in supporting LGBTQ youth?
Curricula Curricula that are inclusive of LGBTQ
identities are associated with
perceptions of safer school
climates.
50–52
Inclusive curricula can be used to raise
awareness of LGBTQ issues, increase
visibility of LGBTQ individuals, and
foster dialogue.
50
Inclusive curricula have been linked to
less absenteeism among transgender
students.
23,49
Inclusive sexuality education may
improve sexual health outcomes of
LGBTQ youth.
53
What are the essential features of an inclusive curriculum
to ensure effectiveness for social-emotional or
academic outcomes?
What effect does inclusive sex education have on the
physical and mental well-being of LGBTQ youth?
How can inclusive curricula be best delivered for various
subject matters?
Policies and
resources
Having LGBTQ-related resources leads to
more academic success and better
general outcomes.
27,41
Policies that are inclusive of sexual
orientation and gender
identity/expression are more
effective.
54
LGB youth living in areas where schools
have inclusive anti-bullying policies are
less likely to attempt suicide.
55
Presence of anti-bullying policies is linked
to less absenteeism for transgender
youth.
23,49
Which in-school resources best support LGBTQ
students?
How do schools develop policies that best create a safe
and supportive environment for LGBTQ students?
What is the most effective way to implement policies and
practices to support LGBTQ students?
GSA, gay–straight alliance; LGBTQ, Lesbian, gay, bisexual, transgender, and queer/questioning; SES, socioeconomic status.
4 JOHNS ET AL.
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currently only a few studies intentionally investigate how sex-
ual orientation and gender identity intersect with other social
identities (e.g., race/ethnicity, ability, and socioeconomic sta-
tus) to shape young peoples’ experiences of school-based risk
and protective factors.
The existing evidence suggests that school experiences for
LGBTQ students do, indeed, differ as a result of each youth’s
unique social position.
34,63
For example, gender identity
and gender expression shape school victimization rates: Gay/bi-
sexual males and transgender youth experience higher rates of
victimization in school than lesbian/bisexual females, and gen-
der nonconforming youth (especially males) report more vic-
timization than cisgender, gender-conforming students.
34,63–66
These experiences of bullying due to multiple stigmatized iden-
tities translate into worse health outcomes. For example, inves-
tigations of bias-motivated bullying (i.e., bullying based on bias
and stigma connected to social identities such as race, socioeco-
nomic status, and gender expression) provide evidence that
young people who experience school bullying due to multiple
stigmatized social identities report worse developmental out-
comes than young people experiencing generalized bullying
or bullying related to one type of bias (Horn SS, Safe SPACES
Team.Bias-basedbullyinginIllinois:Apracticetoresearchto
practice partnership. Unpublished work presented at the Prevent
School Violence Illinois Annual Summit, Arlington Heights,
IL, 2014.)
67
School policies also appear to affect LGBTQ students dif-
ferentially depending on their other intersecting identities.
Research suggests that among LGBTQ students, African
American, transgender, and gender-expansive (i.e., those
whose expression of gender does not align with social
expectations of men and women) youth experience higher
rates of exclusionary and punitive discipline, such as being
disciplined for public displays of affection, than other
LGBTQ-identified youth.
68,69
The greater risk for discipline
disparities experienced by transgender and gender-expansive
youth of color can become pathways into criminal-legal sys-
tem involvement and, subsequently, have long-term effects
on overall health and well-being.
68,69
Further, LGBTQ stu-
dents’ realities differ by geographical location: Rural youth
and those in the Midwest and Southern regions of the United
States report more negative school climates than other
LGBTQ students.
34,35
Research gaps and implications for science/programming.
Intentionally incorporating intersectional perspectives into
school-based research with LGBTQ youth will begin to
address several significant research gaps. For example,
although there is emerging literature on school risk factors
associated with LGBTQ youth’s other social identities (mar-
ginalized identities, in particular), we know much less about
how these other social identities relate to school protective
factors (e.g., supportive adults, policy, and gay-straight alli-
ances). One area of research that has investigated how
LGBTQ students’ diverse identities affect experiences of
protective factors has been research on Gender and Sexuality
Alliances or Gay–Straight Alliances (GSAs). Within the
overall literature on protective factors, GSAs emerge as
one of the most robust school-based protective factors for
LGBTQ students in relation to several outcomes (see school-
level factors section for a more detailed discussion of this lit-
erature). LGBTQ students of color, however, attend GSAs
significantly less frequently than White youth,
70
and when
they do attend, GSAs appear to be less protective for
LGBTQ students of color than for those who identify as
White.
71
Further, prioritizing an intersectional approach to school-
based research with LGBTQ youth will enable us to continue
to document how school experiences of LGBTQ students
(e.g., levels of violence and victimization) vary across their
other social identities, and how these social identities and so-
cial positions affect those experiences in both positive and
negative ways. As O’Brien et al. suggest, using an intersec-
tional lens within research on LGBTQ populations allows us
to ‘‘specifically target their unique individual differences,
rather than approach the SGM group with a ‘‘one size fits
all’’ approach that may actually serve to further invalidate
their own unique needs and experiences.’’
59
Additional individual-level factors. The working group
also identified nascent work on other individual-level factors
that may increase the ability of LGBTQ students to thrive in
school: individual characteristics such as outness,
36
self-
compassion,
37
and self-advocacy,
23,38
as well as feelings of
safety and inclusivity.
27,34
A summary of what the working
group identified as being currently known about these factors
and suggested research questions are presented in Table 1.
Interpersonal-Level Factors
Supportive adults in schools
Definitions and emerging evidence. A second key con-
sideration raised by the working group is the important
role of supportive adults in schools as a protective factor
for LGBTQ students, particularly in light of the stigma and
discrimination faced, at times, on school grounds.
2,4,27
Social
support, or aid and assistance exchanged through social and
interpersonal relationships, has well quantified health ef-
fects.
72
For students in general, support from teachers and
school staff leads to greater educational success, less truancy,
less depression, and greater well-being.
73,74
Thus, teachers
and school staff are well positioned to improve both the
school experience and personal well-being for LGBTQ
students.
27,75,76
Existing research reinforces the positive role of supportive
adults in schools for LGBTQ students. LGBTQ students who
identify the presence of supportive teachers and staff report
more positive mental well-being and better academic out-
comes.
40,41,76,77
In addition, when teachers and school staff
intervene effectively in incidents of anti-LGBTQ bullying
and harassment, LGBTQ students report fewer experiences
of harassment and assault at school and lower rates of absen-
teeism.
27
Research has also shown that when the contribution
of positive supports for LGBTQ students in school are con-
sidered together (e.g., GSAs, comprehensive anti-bullying/
harassment policies, inclusive curriculum, and supportive
educators), supportive educators have the strongest effect
for LGBTQ student academic success and well-being.
28
One growing area of research on supportive adults in
schools is professional development to build educators’ ca-
pacity to intervene when anti-LGBTQ bias occurs in schools
and support LGBTQ students.
78
Although educators fre-
quently receive professional development on bullying and
diversity issues, they are less likely to have received
LGBTQ YOUTH AND SCHOOL-BASED RESEARCH 5
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professional development on LGBTQ issues specifically, and
transgender student issues particularly, compared with bully-
ing and harassment or diversity/multicultural education.
79
Early evidence suggests that educators who receive profes-
sional development on LGBTQ issues are more likely to
take action to create safe and supportive environments.
80,81
Schools with this type of professional development appear
to be safer and more welcoming to gay and lesbian stu-
dents,
39
and professional development can effectively
change beliefs and self-efficacy for intervention on their
behalf.
42,82
Research gaps and implications for science/programming.
To ensure that school environments are safe and supportive
for LGBTQ students, we need additional research on the
training and attributes of supportive adults in schools.
Given the demonstrated impact of supportive educators on
LGBTQ student well-being, we require more work to iden-
tify the best methods to prepare staff to support LGBTQ stu-
dents, and to design and identify the critical components of
professional development with school staff to cultivate
their capacity to champion LGBTQ students. Little research
exists that examines the effectiveness of LGBTQ-inclusive
professional development for educators. One evaluation
study of a district-wide program demonstrated an increase
in educators’ awareness of their own practices that might
have been harmful, beliefs about the importance of interven-
ing when anti-LGBTQ language is used, and the frequency
of intervention in anti-LGBTQ language and behaviors.
83
However, there was no change in educator self-efficacy for
intervention, perhaps because efforts to develop specific
skills, such as direct instruction, modeling, and practice,
were not emphasized in the program. Thus, how to design
professional development that enhances educators’ self-
efficacy alongside awareness, knowledge, and resources
remains a critical knowledge gap.
Alongside professional development for adults already in
the schools is consideration of pre-service learning and train-
ing of adults before they enter the field of education as pro-
fessionals.
84–86
Although very little is known about the
inclusion of LGBTQ-related topics in pre-service education
for school professionals, it appears to be a relatively uncom-
mon practice.
80,82
A recent study of school mental health
professionals demonstrated that both graduate education on
LGBT student issues and later professional development
may enhance educator self-efficacy and positive LGBT-
related practice,
82
suggesting that further inquiry into pre-
service learning for educators may yield important results
for LGBTQ students.
In general, the evidence base on key attributes and behav-
iors that constitute supportive adults at school needs to be
expanded. Knowledge of the best practices for adults in
schools to support LGBTQ students is still underdeveloped.
Further, much of the literature discussed in this article fo-
cuses specifically on classroom teachers; however, under-
standing the unique role of others, such as school mental
health professionals, school nurses, and administrators, is
also needed. Although there may be universal actions that
all school professionals can take (e.g., increasing knowledge
of LGBTQ identities), each person may be able to take
unique additional actions that may vary by position in the
institution (e.g., administrators may best support students
through implementation of programmatic solutions, whereas
teachers may need strong bystander intervention skills given
their day-to-day interactions with students). Even among
classroom educators, evaluation of the varying needs by con-
tent (e.g., English vs. STEM), and by type of classroom (e.g.,
English language learners and special education) will also be
important to moving this evidence base forward.
Additional interpersonal-level factors. In addition to sup-
portive adults in schools, the working group identified peers
in schools as sources of social support for LGBTQ stu-
dents,
23,43,44
and some early work points to the potential
role of parents in schools to champion the inclusion of
LGBTQ students within school programs and policies.
45,46
Table 1 offers a summary of these factors with research
and programmatic questions of interest for each factor iden-
tified by the working group.
School-Level Factors
In-school programs
Definitions and emerging evidence. In-school programs,
particularly those that focus on issues of social justice and
equity, have strong potential to be protective for LGBTQ stu-
dents experiencing hardship. GSAs are one such group for
LGBTQ students and cisgender heterosexual allies; recent
data suggest that *37% of U.S. high schools currently
have a GSA.
87
In general, GSAs provide space for LGBTQ
students to receive support, advocate for protective school
policies, and promote affirming school climates.
88
The
GSAs often meet during or after school for up to 1 hour,
are youth-led, and have adult advisors (e.g., teacher, coun-
selor, or school nurse) who can provide support and role
modeling. In these ways, GSAs are consistent with empiri-
cally supported youth program models.
89
The presence of
GSAs has been associated with fewer health and academic
concerns (e.g., less substance use, fewer suicide attempts,
and lower truancy) for all youth (LGBTQ and cisgender het-
erosexual) in these schools.
47,90,91
In addition, LGBTQ and
cisgender heterosexual youth involved in GSAs report a
range of benefits, such as a greater sense of agency, self-
esteem, and empowerment.
48,72,92,93
Whole-school approaches, or programs designed to reach
all students regardless of sexual orientation or gender iden-
tity, are another avenue of in-school programming. Social-
emotional learning programs appear to reduce bullying and
improve school climate and student health outcomes for stu-
dents in general,
94
and thus they may be promising avenues
for improving climate for LGBTQ students as well. For in-
stance, LGBTQ-inclusive curricula in lesson plans
95
appear
to be able to raise awareness of LGBTQ issues, increase vis-
ibility of LGBTQ individuals, and foster dialogue.
50–53
This
type of exposure to inclusive curricula in schools can shift
perceptions of safer school climates.
51
Research gaps and implications for science/programming.
Despite these promising findings for in-school programs,
there remain questions about how to ensure their effectiveness.
For GSAs, more information is needed about which specific
GSA practices promote thriving among LGBTQ youth, how
GSAs can best meet a range of needs across members who
are marginalized and privileged in different ways (e.g., across
6 JOHNS ET AL.
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gender, race/ethnicity, and socioeconomic status), what are
immediate and long-term gains of GSA involvement, and
how GSAs operate within a larger umbrella of LGBTQ student
programs. For example, future work with GSAs might develop
and evaluate tailored interventions to be delivered within
GSAs to reduce health risks and promote well-being among
GSA members. These interventions could align well with
the existing aims of GSAs to empower youth and promote
thriving.
In addition, evaluations of programs and awareness raising
campaigns that focus explicitly on creating respectful and
welcoming schools for LGBTQ students are needed.
Whether whole-school programs adequately cover issues of
diversity or bias-based harassment and whether their benefits
extend to LGBTQ students remains unclear. For programs
that do focus explicitly on creating affirming and welcoming
schools for LGBTQ students by addressing factors at the in-
dividual level (e.g., counteracting bias-based harassment)
and institutional level (e.g., implementing LGBTQ-affirming
policies and teacher training),
96,97
evaluation research is
needed. Evaluations would help to clarify the acceptability
and feasibility of these programs, the extent to which they
increase staff awareness of LGBTQ issues and reduce bias,
the degree to which they increase the safety of LGBTQ stu-
dents, and the extent to which these benefits are sustained
over time.
Additional school-level factors. The working group
also highlighted work being done on the relationship be-
tween school resources and policies and the well-being
of LGBTQ students in schools. In general, having more
LGBTQ-related resources on campus and anti-bullying
policies appears to be linked to better health and academic
outcomes for LGBTQ students.
23,27,41,49,54,55
However,
more work is needed to identify the types of policies that
may be most effective to promote certain outcomes (e.g.,
reducing health disparities, improving school safety, and
reducing bias in discipline practices) and why (e.g., what
differences in effectiveness do we see between enumerated
anti-bullying policies and non-enumerated policies, and
why do these differences exist?)
98
and how policies can
be implemented with fidelity. A summary of these factors
and research questions of interest is presented in Table 1.
Conclusion
LGBTQ youth face many challenges as a result of stigma
and minority stress that affect their health and well-being ad-
versely. Although, at times, schools can be a site of minority
stressors, they also can serve as sites for protective factors
that enable LGBTQ youth to thrive in the face of these stress-
ors. LGBTQ school-based research and interventions may
pose significant challenges, but schools are a key setting
for both to be done. Our objective of laying out the critical
gaps in school-based research focused on LGBTQ students
is to provide multiple avenues for researchers and practition-
ers to move the evidence base forward. At the individual
level, using a lens of intersectionality to examine how
LGBTQ students’ diverse identities may shape their experi-
ences of risk and protective factors is crucial. At the interper-
sonal level, further consideration of which attributes constitute
a supportive educator and how professional development can
be best designed to cultivate these attributes is needed. At the
institutional level, examining methods of utilizing GSAs as
sites of interventions for LGBTQ youth and leveraging in-
school programming to improve school climate broadly are
warranted. In addition, there are questions to be explored
that cut across ecological levels—for example, intersection-
ality can be applied to how professional development may be
received by educators with various social identities, or how
LGBTQ students’ diverse identities may shape their experi-
ences of in-school programming. By seeking answers to
these and the other questions outlined in this article, we
can better develop effective, asset-based interventions for
LGBTQ youth in schools, thus insuring their health, safety,
and thriving.
Acknowledgments
The authors would like to thank the researchers, practi-
tioners, and community members who participated in the
2017 State of LGBTQ Youth Health and Wellbeing Sympo-
sium at Northwestern University. Their contributions were
essential to the development of this article. The symposium
and consultation were supported by the Northwestern Insti-
tute for Sexual and Gender Minority Health and Wellbeing
and the National Institute on Drug Abuse (P30DA027828-
07S1).
Disclaimer
The findings and conclusions in this article are those of the
authors and do not necessarily represent the official position
of the Centers for Disease Control and Prevention, the
National Institute on Drug Abuse, or the National Institutes
of Health.
Author Disclosure Statement
No competing financial interests exist.
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Address correspondence to:
Michelle M. Johns, MPH, PhD
Division of Adolescent and School Health
Centers for Disease Control and Prevention
1600 Clifton Road, MS E-75
Atlanta, GA 30329-4027
E-mail: mjohns1@cdc.gov
10 JOHNS ET AL.
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