LGBT Policy Discourse and Prevention of Homophobic Bullying

The past 20 years have been characterized by pronounced political progress and pushback surrounding the civil rights of lesbian, gay, bisexual, and transgender (LGBT) Americans. During this time, several public campaigns promoting LGBT stigma have gained momentum, including campaigns supporting the introduction of “bathroom bills” to restrict access to bathrooms and other facilities on the basis of sex assigned at birth, “no promo homo” laws to prohibit the discussion of LGBT topics within health and sexuality education classes in schools, and state constitutional amendments to ban same-sex marriage.¹ It has been theorized that public campaigns that promote stigma act as contextual and ecological factors that drive bias-based bullying among youth,² which, evidence reveals, results in lasting psychological and physical harm.³ Yet to date, research on associations between these public campaigns that promote stigma and rates of bias-based bullying has been limited.

In their innovative article, “Proposition 8 and Homophobic Bullying in California,” Hatzenbuehler et al⁴ address this critical gap in the literature. They examine changes in rates of homophobic bullying spanning the introduction and passing of Proposition 8 (a voter referendum to ban same-sex marriage in California) using a sophisticated interrupted time series analysis. On the basis of cross-sectional survey data from nearly 5 million students across >5000 schools in California, results reveal that rates of homophobic bullying increased between 2000 and 2008, when the Proposition 8 vote occurred, and then decreased afterward until 2015. Strengthening confidence that the association between the public campaign and rates of homophobic bullying was not merely coincidental, the authors demonstrate that several other forms of bias-based bullying (due to race and/or ethnicity, religion, and gender) decreased over the same time period. Consistent with previous findings revealing that both LGBT and non-LGBT students experience homophobic bullying,^5,6 results suggest that all students, both LGBT and non-LGBT, may have been at increased risk of homophobic bullying during this time period. Additionally, consistent with previous findings in which Gay-Straight Alliances were identified as protective resources against homophobic bullying,^7,8 results reveal that there were both lower rates of and less dramatic increases in homophobic bullying in schools with Gay-Straight Alliances.

This research represents a call to action for pediatricians, who have a unique opportunity to address homophobic bullying as health care providers, as researchers, and as advocates.³ As health care providers, pediatricians can identify and counsel youth experiencing homophobic bullying, as well as their families, to promote their well-being.⁹ Results of this study can help pediatricians identify risk environments for homophobic bullying. Pediatricians practice within the same ecological and contextual environments in which youth are bullied. Pediatricians practicing in places with active public campaigns that promote "bathroom bills" or "no promo homo" laws should be on alert for signs of homophobic bullying and should be prepared to support youth experiencing bullying. There are resources available from the American Academy of Pediatrics (AAP) and the Department of Health and Human Services to guide pediatricians in responding to homophobic bullying.^10–12 As researchers, pediatricians can be inspired to ask new scientific questions concerning anti-LGBT climates such as the following: What impact, if any, do policies that restrict the rights of LGBT individuals have on access to and provision of quality health care for youth?

As advocates, pediatricians wield powerful voices that have contributed, and can continue to contribute, to change in the political discourse surrounding LGBT civil rights. The AAP has spoken against several public campaigns promoting LGBT stigma. The AAP released a policy statement advocating for same-sex marriage to support the health and well-being of youth amid national campaigns to ban same-sex marriage.¹³ The AAP has also joined with other organizations to oppose bathroom bills and other policies promoting transgender stigma.^14,15 Individual pediatricians can add their voices to that of the AAP to denounce bathroom bills, no promo homo laws, and other policies that restrict the civil rights of LGBT individuals. Pediatricians can also advocate for the establishment of Gay-Straight Alliances at schools, often now referred to as Genders and Sexualities Alliances to include the full spectrum of diversity of youth experiences. Pediatricians may seek to partner with school health professionals, such as school nurses, psychologists, and guidance counselors, to advocate for these alliances and address homophobic bullying in their communities.^16,17

Dr Donald Berwick¹⁸ describes the moral choice for today’s physicians as such: “To try to avoid the political fray through silence is impossible, because silence is now political. Either engage, or assist the harm. There is no third choice.” We join Dr Berwick and call on pediatricians to lend their voices to the political discourse. Advocating for LGBT civil rights will promote the health and well-being of all youth, LGBT and non-LGBT alike.

Glossary

AAP

American Academy of Pediatrics

LGBT

lesbian, gay, bisexual, and transgender