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. Author manuscript; available in PMC: 2021 Mar 11.
Published in final edited form as: J Sch Nurs. 2018 Mar 14;34(4):301–309. doi: 10.1177/1059840518762536

Sex Differences in School Safety and Bullying Experiences among Sexual Minority Youth

India D Rose 1, Ganna Sheremenko 1, Catherine N Rasberry 2, Catherine A Lesesne 1, Susan N Hocevar Adkins 2
PMCID: PMC7948116  NIHMSID: NIHMS1675213  PMID: 29540111

Abstract

Schools play an integral role in creating safe, supportive environments for students, especially sexual minority youth (SMY). Using 2016 questionnaire data from seven high schools in a Florida school district, we obtained a sample of 1,364 SMY. Logistic regressions controlling for sex (as applicable), age, grade, race/ethnicity, and school explored differences between SMY and non-sexual-minority youth (nonSMY). Sex differences related to school environment perceptions and experiences related to safety, bullying, and hearing homophobic remarks were also explored. SMY were more likely than nonSMY to report several negative school environment perceptions and experiences. Where differences existed within SMY, male SMY were more likely than female SMY to have missed school in the past 30 days (Odds Ratio (OR) = 1.66, P=.03), report avoiding spaces at school due to safety concerns (OR = 1.38, P=.02), and report hearing homophobic remarks from teachers (OR = 2.00, P=.01). Implications for school nursing are discussed.

Keywords: schools, school nurses, bullying, students, sexual minority youth, safety

Introduction

In 2017, an estimated 15 million young people in the United States were enrolled in grades 9-12 (US Department of Education, 2016), and for most students, 6 or more hours of each weekday are spent in school, making schools an influential environment during critical years of students’ development (Centers for Disease Control and Prevention [CDC], 2016). However, for a good number of students, the school environment is not always positive. For example, 2015 national Youth Risk Behavior Survey (YRBS) data reveal that 20% of high school students reported being bullied on school property in the past year and 5.6% of students reported they had not gone to school on at least one day in the past 30 days because they felt unsafe at school or on their way to or from school (Kann et al., 2016a). Research shows that students who are bullied experience a number of adverse psychological, physical, and academic outcomes including mental and physical distress, poor academic performance, and increased absenteeism (CDC, 2016b; Loftus, 2013).

For the approximately 1.28 million high school students estimated to be lesbian, gay, or bisexual (LGB) (Zaza, Kann, & Barrios, 2016), several aspects of the school environment can be particularly problematic. Negative experiences related to safety and bullying have been reported by disproportionately more sexual minority youth (SMY)—specifically LGB youth—compared to heterosexual youth. For example, 2015 national YRBS data revealed that an estimated 12.5% of LGB students did not go to school because of safety concerns and 34.2% of LGB students reported being bullied on school property; both percentages significantly higher among LGB youth than heterosexual youth (Kann et al., 2016b). According to Gay, Lesbian and Straight Education Network’s (GLSEN) 2015 National School Climate Survey, 57.6% of sexual and gender minority youth (SGMY) felt unsafe at school because of their sexual orientation and 43.3% felt unsafe because of their gender expression (Kosciw et al., 2016). Furthermore, numerous studies show SMY are at increased risk for bullying and other forms of victimization including school-based harassment, physical and verbal harassment, physical assault, and isolation (Berlan, Corliss, Field, Goodman, & Austin, 2010; Birkett, Espelage, & Koenig, 2009; Fedewa & Ahn, 2011; Kann et al., 2016b; Kosciw, Greytak, & Diaz, 2009).

In addition to bullying and safety concerns, school climate can be influenced by homophobic or stigmatizing attitudes among students and staff within schools. The 2015 GLSEN School Climate Survey found that almost all SGMY in their survey (98.1%) reported hearing homophobic remarks at school. This same survey found that 56.2% of SGMY students reported hearing homophobic remarks from teachers or other school staff (Kosciw et al., 2016). Several studies have focused on the relationship between homophobic remarks and negative outcomes among SMY or SGMY including increased substance use, increased depression and suicidality, and increased absenteeism (Birkett, Espelage, & Koenig, 2009; Kosciw, Greytak, & Diaz, 2009).

Negative school environment perceptions and experiences can impact mental health outcomes among SMY. Emotional distress associated with bullying among SGMY has been documented (Almeida, Johnson Corliss, Molnar, & Azrael, 2009). Swearer and colleagues (2008) state that perceived discrimination related to actual or perceived sexual orientation accounted for increased depressive symptomatology, and accounted for an elevated risk of self-harm and suicidal ideation. Negative school environment perceptions and experiences can also lead to bodily harm and can contribute to suicidal thoughts and behaviors among SMY (Russell & Joyner, 2001).

Although some literature has shed light on the experiences of SMY in schools and their experiences of bullying overall (Birkett, Espelage, & Koenig, 2009; Espelage, Aragon, Birkett, & Koenig, 2008; Fedewa & Ahn, 2011), less is known about differences between male and female SMY related to the school environment. Given this, the primary aim of this report was to explore school environment measures within a group of SMY. We first sought to determine if the increased risk of negative school environment perceptions and experiences among SMY compared to non-sexual-minority youth (nonSMY) held true in this study’s data. Then, we sought to explore differences between male and female SMY related to the school environment in terms of perceptions and experiences related to safety, bullying, and homophobic remarks.

Methods

Data in this study are from an evaluation of a school-centered HIV/STD prevention project implemented in seven high schools in an urban Florida school district. The evaluation included multiple cross-sectional, school-wide administrations of a student questionnaire in the seven participating schools. The present study uses data collected in December 2016 to explore differences between male and female SMY in measures related to the school environment. This study was approved by ICF’s Institutional Review Board (IRB) and the Research Review Board of the participating school district.

Procedures and Instrumentation

In accordance with the passive parental consent process, parental notification and opt-out forms were sent home via students in the participating schools prior to data collection. All students in regular classroom settings were invited to complete the questionnaire unless a parent/guardian had signed a form opting their child out of participation. Students chose for themselves whether or not to complete the survey on the day of administration. Self-contained special education or special needs classrooms as well as classrooms dedicated to non-English speaking students were excluded from the study to ensure all participants could self-administer the English language questionnaire. Each student received a 46-item, paper-and-pencil questionnaire that assessed student demographic characteristics, sexual behavior, school climate, sexual health education, and bullying. The anonymous questionnaire took students approximately 40 minutes to complete.

Measures

Demographic characteristics.

Demographic characteristics included sex, age, grade, and race/ethnicity. Race and ethnicity were assessed using two individual items, but the final race/ethnicity variable was collapsed into the following four categories: (1) Hispanic, (2) Black, non-Hispanic, (3) White, non-Hispanic (used as the referent group), and (4) other or multiracial. In addition to these demographics, students were also asked about their sexual orientation, sex of sexual partners, and sexual attraction. Students were considered SMY if they (1) identified as gay, bisexual, or lesbian, and/or (2) reported having had sex with partners of the same sex or both sexes, and/or (3) reported sexual attraction to people of the same sex or both sexes.

Bullying experiences.

Student bullying experiences were assessed using three items: (1) Do students at school bully you? Response options included: “Always, most of the time, some of the time, never.” Responses were collapsed to “Never” and “At least some of the time.” (2) During the past 3 months, how many times on school property were you harassed or bullied? Response options included: “0 times, 1 time, 2-3 times, 4-5 times, 6 or more times.” Responses were collapsed to “0 times” and “at least 1 time.” (3) Do you think you were harassed or bullied during the past 3 months because of any of the following reasons? Response options included: “income or economic status, disability or perceived disability, sexual orientation or perceived sexual orientation, gender expression, other, and none of the above.”

Perceptions of school safety.

Perceptions of school safety were assessed using four items: (1) Do you feel safe at your school? Response options included: “yes” or “no.” (2) Do you avoid spaces at school because you feel uncomfortable or unsafe in the space? Response options included: “yes” or “no.” (3) Which of the following spaces at school do you avoid because you feel uncomfortable or unsafe in the space? Response options included: “cafeteria or lunch room, locker rooms, hallways/stairwells, school athletic fields or facilities, school buses, physical education (PE) or gym class, school grounds (not including athletic fields), another space not listed, and I don’t avoid anywhere at school because of feeling uncomfortable or unsafe.” (4) During the past 30 days, on how many days did you not go to school because you felt unsafe at school or unsafe on your way to or from school? Response options included: “0 days, 1 day, 2 or 3 days, 4 or more days.” Responses were collapsed to “0 days” and “1 or more days.”

Homophobic remarks.

This measure was assessed using three questions: (1) How many students do you hear make homophobic remarks? Response options included: “most of the students, some of the students, a few of the students, none of the students.” Responses were collapsed to “a few or none of students” and “most or some of students.” (2) When homophobic remarks are made and a teacher or other school staff is present, how often does the teacher or staff person intervene or do something about it? Response options included: “always, most of the time, some of the time, never.” Responses were collapsed to “some of the time or never” and “most of the time or always.” (3) How often do you hear homophobic remarks from teachers or school staff? Response options included: “always, most of the time, some of the time, never.” Responses were collapsed to “some of the time or never” and “most of the time or always.”

Sample

In total, 10,231 students completed the questionnaire for a response rate of 66.8%. Questionnaires with 25% or more of items missing responses (n=547), as well as questionnaires with missing responses to “What is your sex?” item (n=53) or missing responses to sexual identity, attraction, and sexual behavior questions (n=12) were removed, leaving an analytic sample of 9,619 students. Of those, 1,364 (14.2%) students were categorized as SMY—332 males and 1032 females. The majority of the SMY sample was 15 years of age or older (85.8%) and Black, non-Hispanic (30.4%) or Hispanic (43.8%). Table 1 provides demographic characteristics for the analytic sample.

Table 1.

Descriptive Statistics for Characteristics of Sexual Minority Youth (SMY) and Non-SMY

Variable Name Response Option Female SMY Male SMY Total SMY Non-SMY
Na % N % N % N %
Age 12 years or younger 5 0.5 7 2.1 12 0.9 12 0.1
13 years old 2 0.2 0 0.0 2 0.1 24 0.3
14 years old 148 14.4 32 9.6 180 13.2 1259 15.3
15 years old 260 25.2 91 27.4 351 25.8 2142 26.0
16 years old 281 27.3 94 28.3 375 27.5 2229 27.0
17 years old 239 23.2 75 22.6 314 23.0 1805 21.9
18 years old or older 96 9.3 33 9.9 129 9.5 770 9.3
Grade 9th grade 245 23.9 75 22.6 320 23.5 2279 27.7
10th grade 294 28.6 100 30.1 394 29.0 2358 28.6
11th grade 266 25.9 92 27.7 358 26.3 2056 25.0
12th grade 216 21.0 63 19.0 279 20.5 1538 18.7
Ungraded or other grade 6 0.6 2 0.6 8 0.6 3 0.0
Race/Ethnicity Hispanic 451 43.7 146 44.0 597 43.8 3408 41.3
Black (not Hispanic) 337 32.7 77 23.2 414 30.4 2889 35.0
White (not Hispanic) 157 15.2 70 21.1 227 16.6 1217 14.7
Other 87 8.4 39 11.7 126 9.2 741 9.0
Indicator of Sexual Attraction Opposite sex 83 8.1 52 15.8 135 9.9 8203 100.0
Same sex 186 18.1 139 42.1 325 23.9 0 0.0
Both 759 73.8 139 42.1 898 66.1 0 0.0
Sex of Sexual Partner Indicatorb Opposite sex 190 37.8 44 28.0 234 35.5 2776 100.0
Same sex 118 23.5 64 40.8 182 27.6 0 0.0
Both 194 38.6 49 31.2 243 36.9 0 0.0
Which of the following best describes you? Heterosexual (straight) 125 12.2 66 20.2 191 14.1 7906 96.6
Gay or Lesbian 139 13.6 101 31.0 240 17.8 0 0.0
Bisexual 682 66.6 131 40.2 813 60.2 0 0.0
I don’t know 78 7.6 28 8.6 106 7.9 279 3.4
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a

Nfemale smy=1032, Nmale smy=332. Nsmy=1364, Nnon-smy=8255. Individual item totals may differ slightly due to missing responses in the data.

b

Sample was limited to sexually active students.

Analysis

We used a series of logistic regressions to examine differences between SMY and nonSMY, and also between male and female SMY in relation to school safety, bullying, and hearing homophobic remarks. Regressions examining differences between SMY and nonSMY controlled for sex, age, grade, race/ethnicity, and school; regressions examining differences between male and female SMY controlled for age, grade, race/ethnicity, and school. Statistical analyses were performed using IBM SPSS Statistics, version 21 and Stata, version 14 (IBM Corp., 2012; Stata, 2014). Alpha levels were set at P<.05.

Results

Sexual Minority Youth and Non-Sexual-Minority Youth

Across most variables, SMY reported more negative school environment perceptions and experiences than nonSMY. SMY were more likely than nonSMY to report being bullied by students at school (OR = 2.09, P<.01) and were less likely than nonSMY to report feeling safe at school (OR = .53, P<.01). In terms of specific spaces students avoided due to feeling uncomfortable or unsafe, three—locker rooms, athletic fields or facilities, and PE or gym class—emerged as significantly more likely to be avoided by SMY compared to nonSMY. Table 2 presents descriptive statistics for school environment measures among SMY and nonSMY. Table 3 presents results of logistic regressions exploring differences in students’ perceptions and experiences related to school safety, bullying, and homophobic remarks.

Table 2.

Descriptive Statistics for School Environment Outcomes for SMY and non-SMY

Variable Name Response Option Female SMY Male SMY Total SMY Non-SMY
Na % N % N % N %
Do you feel safe at your school? No 279 27.3 110 33.5 389 28.8 1406 17.2
Yes 742 72.7 218 66.5 960 71.2 6745 82.8
Do you avoid spaces at school because you feel uncomfortable or unsafe in the space? No 626 70.7 192 63.8 818 69.0 6033 85.4
Yes 259 29.3 109 36.2 368 31.0 1035 14.6
Which of the following spaces at school do you avoid because you feel uncomfortable or unsafe in the spaceb?
Cafeteria or lunch room Selected 85 32.8 27 24.8 112 30.4 267 25.8
Locker rooms Selected 69 26.6 42 38.5 111 30.2 198 19.1
Hallways/stairways Selected 73 28.2 29 26.6 102 27.7 276 26.7
School athletic fields or facilities Selected 33 12.7 24 22.0 57 15.5 113 10.9
School buses Selected 30 11.6 18 16.5 48 13.0 147 14.2
Physical Education (PE) or gym class Selected 43 16.6 30 27.5 73 19.8 117 11.3
School grounds, excluding athletic fields Selected 39 15.1 23 21.1 62 16.8 153 14.8
Another space not listed above Selected 71 27.4 32 29.4 103 28.0 310 30.0
I don't avoid anywhere at school Selected 32 12.4 13 11.9 45 12.2 128 12.4
During the past 30 days, on how many days did you not go to school because you felt unsafe at school or unsafe on your way to or from school? 0 days 582 86.6 145 79.2 727 85.0 4320 93.1
At least 1 day 90 13.4 38 20.8 128 15.0 320 6.9
How many students do you hear make homophobic remarks? A few or none of students 446 43.5 133 40.5 579 42.8 4317 52.8
Most or some of students 579 56.5 195 59.5 774 57.2 3854 47.2
When homophobic remarks are made and a teacher or other school staff person is present, how often does the teacher or staff person intervene or do something about it? Never or some of the time 608 72.0 174 63.7 782 70.0 3807 63.4
Always or most of the time 236 28.0 99 36.3 335 30.0 2194 36.6
How often do you hear homophobic remarks from teachers or school staff? Never or some of the time 960 94.8 300 90.6 1260 93.8 7742 96.0
Always or most of the time 53 5.2 31 9.4 84 6.3 324 4.0
Do students at school bully you? Never 777 75.7 230 69.7 1007 74.2 7085 86.2
At least some of the time 250 24.3 100 30.3 350 25.8 1132 13.8
During the past 3 months, how many times on school property were you harassed or bullied? 0 times 733 71.6 222 67.9 955 70.7 6954 84.9
At least 1 time 291 28.4 105 32.1 396 29.3 1241 15.1
Do you think you were harassed or bullied during the past 3 months because of any of the following reasonsb?
Your sexual orientation or what others think about your sexual orientation Selected 148 15.3 86 28.3 234 18.4 167 2.2
How you express your gender Selected 116 12.0 73 24.0 189 14.9 256 3.4
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a

Nfemale smy=1032, Nmale smy=332. Nsmy=1364, Nnon-smy=8255. Individual item totals may differ slightly due to missing responses in the data.

b

Students could select all that applied.

Table 3.

Logistic Regression Models Comparing School Environment Outcomes for Sexual Minority Youth (SMY) and non-SMY

Outcome N Odds Ratio P-value
School Safety
Do you feel safe at your school? (1=Yes) 9,408 0.53 <.01
Do you avoid spaces at school because you feel uncomfortable or unsafe in the space? (1=Yes) 8,171 2.44 <.01
Which of the following spaces at school do you avoid because you feel uncomfortable or unsafe in the space?
Cafeteria or lunch room (1=Selected) 1,389 1.16 .30
Locker rooms (1=Selected) 1,389 1.96 <.01
Hallways/stairways (1=Selected) 1,389 1.03 .86
School athletic fields or facilities (1=Selected) 1,389 1.50 .03
School buses (1=Selected) 1,389 0.90 .56
Physical Education (PE) or gym class (1=Selected) 1,389 1.93 <.01
School grounds, excluding athletic fields (1=Selected) 1,389 1.18 .35
Another space not listed above (1=Selected) 1,389 0.94 .68
I don't avoid anywhere at school (1=Selected) 1,389 0.93 .70
During the past 30 days on how many days did you not go to school because you felt unsafe at school or unsafe on your way to or from school? (1=At least 1 day) 5,445 2.40 <.01
Homophobic Remarks
How many students do you hear make homophobic remarks? (1=Most or some of students) 9,432 1.61 <.01
When homophobic remarks are made and a teacher or other school staff person is present how often does the teacher or staff person intervene or do something about it? (1=Always or most of the time ) 7,063 0.78 <.01
How often do you hear homophobic remarks from teachers or school staff? (1=Always or most of the time) 9,320 1.91 <.01
Bullying Experiences
Do students at school bully you? (1=At least some of the time) 9,479 2.09 <.01
During the past 3 months how many times on school property were you harassed or bullied? (1=At least 1 time) 9,452 2.16 <.01
Do you think you were harassed or bullied during the past 3 months because of any of the following reasons?
Your sexual orientation or what others think about your sexual orientation (1=Selected) 8,656 12.01 <.01
How you express your gender (1=Selected) 8,656 5.12 <.01
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Note: All models control for student's age, sex, grade, race/ethnicity and school. Non-SMY is the reference group. N for each regression model varies, as analyses were limited to individuals with complete data for the variables in the model.

Male and Female Sexual Minority Youth

School safety.

Male and female SMY did not differ significantly in their reports of feeling safe at school, however, male SMY were more likely than female SMY to report avoiding spaces at school because they felt uncomfortable or unsafe (OR = 1.38, P=.02). When asked about spaces at school they avoided because they felt uncomfortable or unsafe, there were significant differences for male and female SMY for three spaces. Male SMY were more likely than female SMY to report avoiding locker rooms (OR = 1.88, P=.01), school athletic fields or facilities (OR = 2.04, P=.02), and physical education or gym class (OR = 1.88, P=.03). Male SMY were also more likely than female SMY to report having missed at least 1 day of school because they felt unsafe at school or unsafe on their way to or from school (OR = 1.66, P=.03) (see Table 4).

Table 4.

Logistic Regression Models Comparing School Environment Outcomes for Male and Female Sexual Minority Youth

Outcome N Odds Ratio P-value
School Safety
Do you feel safe at your school? (1=Yes) 1,339 0.77 .06
Do you avoid spaces at school because you feel uncomfortable or unsafe in the space? (1=Yes) 1,178 1.38 .02
Which of the following spaces at school do you avoid because you feel uncomfortable or unsafe in the space?
Cafeteria or lunch room (1=Selected) 365 0.73 .24
Locker rooms (1=Selected) 365 1.88 .01
Hallways/stairways (1=Selected) 365 0.96 .88
School athletic fields or facilities (1=Selected) 365 2.04 .02
School buses (1=Selected) 365 1.51 .24
Physical Education (PE) or gym class (1=Selected) 365 1.88 .03
School grounds, excluding athletic fields (1=Selected) 365 1.56 .16
Another space not listed above (1=Selected) 365 1.06 .83
I don't avoid anywhere at school (1=Selected) 365 0.90 .79
During the past 30 days on how many days did you not go to school because you felt unsafe at school or unsafe on your way to or from school? (1=At least 1 day) 850 1.66 .03
Homophobic Remarks
How many students do you hear make homophobic remarks? (1=Most or some of students) 1,343 1.10 .45
When homophobic remarks are made and a teacher or other school staff person is present how often does the teacher or staff person intervene or do something about it? (1=Always or most of the time) 1,109 1.45 .02
How often do you hear homophobic remarks from teachers or school staff? (1=Always or most of the time) 1,334 2.00 .01
Bullying Experiences
Do students at school bully you? (1=At least some of the time) 1,347 1.30 .07
During the past 3 months how many times on school property were you harassed or bullied? (1=At least 1 time) 1,341 1.18 .23
Do you think you were harassed or bullied during the past 3 months because of any of the following reasons?
Your sexual orientation or what others think about your sexual orientation (1=Selected) 1,260 2.29 <.01
How you express your gender (1=Selected) 1,260 2.39 <.01
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Note: All models control for student's age, grade, race/ethnicity, and school. Female SMY is the reference group. N for each regression model varies, as analyses were limited to SMY with complete data for the variables in the model.

Bullying experiences.

Among SMY, sex did not significantly predict being bullied at school or having been harassed or bullied on school property in the past 3 months, however, it did significantly predict two reasons students thought they were harassed or bullied. Specifically, male SMY were more likely than female SMY to report their sexual orientation or what others think about their sexual orientation (OR = 2.29, P<.01) and how they expressed their gender (OR = 2.39, P<.01) as reasons they thought they were bullied in the past 3 months (see Table 4).

Homophobic remarks.

Although sex was not a significant predictor among SMY of hearing homophobic remarks from other students, male SMY were more likely to report hearing homophobic remarks from teachers or other school staff in comparison to female SMY (OR = 2.00, P=.01). Male SMY were also more likely to report that a staff person always or most of the time intervenes when homophobic remarks are made by students (OR = 1.45, P=.02) (see Table 4).

Discussion

Consistent with previous studies and reports, our findings support the idea that SMY report more negative perceptions and experiences related to school safety, bullying, and homophobic remarks compared to nonSMY. Findings suggest that SMY are more likely to feel unsafe and more likely to be bullied at school when compared to nonSMY. SMY are also more likely to hear homophobic remarks from students, teachers, and other school staff. These findings are concerning given the association between a negative school environment and greater health and safety risks among SMY (Ethier, Harper, & Dittus, 2017), which highlights the importance of creating a safe and supportive environment for all students, but especially SMY.

This study’s findings related to differences between male and female SMY in measures related to the school environment—specifically, perceptions and experiences related to safety, bullying, and homophobic remarks—revealed that when significant differences did exist, male SMY usually were more likely than female SMY to report negative perceptions and experiences. For example, male SMY were more likely than female SMY to have missed school in the past 30 days due to feeling unsafe. In addition, male SMY were more likely than female SMY to report avoiding spaces at school due to safety concerns. Although this is consistent with previous research showing students are more likely to avoid areas of the school considered hotspots for bullying (Arseneault, Bowes, & Shakoor, 2010; Grant, 2001), our data cannot explain why this might occur more among male SMY than female. However, the findings do highlight three specific areas—locker rooms, athletic fields/facilities, and physical education/gym class—that male SMY avoided more than female SMY, which may indicate a particular concern related to athletics or physical activity that may be more pronounced for male SMY than female SMY.

Although there were no significant differences in the number of male and female SMY who reported hearing homophobic remarks from students, male SMY were more likely than female SMY to report hearing homophobic remarks from teachers or school staff. SMY experience persistent patterns of bullying, isolation and exclusion which can make these students feel unwelcomed and unsafe at school (Almeida, Johnson, Corliss, Molnar, & Azrael, 2009; Berlan, Corliss, Field, Goodman, & Austin, 2010). Results from the National School Climate Survey indicate that teachers are sometimes the perpetrators in these incidents (Kosciw et al., 2016). Our study does not describe what type of homophobic remarks students experienced (i.e., whether they were blatant or more subtle). However, other research shows that sexual and gender-related microaggressions, brief and often commonplace actions or comments that—either intentionally or unintentionally—subtly express prejudice toward marginalized groups, can be indications of climate and contribute to settings that can lead to bullying (Nadal et al., 2011). Although schools can work to address these types of comments and actions for both male and female SMY, our study shows that males may be experiencing more prejudiced remarks from school staff, and this warrants further attention. Future studies, particularly qualitative studies, could better explore reasons for these sex differences. However, regardless of why such differences exist, these findings highlight a need to help SMY be and feel safe at school, which likely requires providing staff with professional development and cultural competency training to ensure respectful treatment of all students by all staff.

Few studies have examined the reasons why SMY believe they are bullied or harassed (Kosciw, 2016; Vargas et al., 2008). The current study found that male SMY were more likely than female SMY to report their sexual orientation and gender expression as reasons why they were bullied in the past 3 months. This provides evidence of sex differences in experiences or perceptions, and we speculate this difference could be related to (1) cultural norms that may result in males receiving harsher treatment than females for stepping outside of traditional gender roles (Chonody, Woodford, Brennan, Newman, & Bernie, 2014; Monto & Supinski, 2014), (2) intersections of gender and specific identities (gay, lesbian, bisexual) which may have variations in levels of related stigma, and/or (3) differences in the percentages of all males and females in this study who were classified as SMY. Regardless of the reason for this finding, it does extend previous research on the association between bullying and perceptions of sexual minority status (Swearer, Turner, & Givens, 2008), by providing evidence that perceived or actual sexual orientation and gender expression may contribute to victimization among SMY.

Study Limitations

This study’s findings should be interpreted in the context of several limitations. First, the study uses self-reported data, which may be influenced by social desirability bias. Second, recall bias could be a limitation given that the questionnaire asked students to recall certain experiences retrospectively. Lastly, data were collected from students in only a subgroup of schools within a single school district, which limits generalizability. Despite these limitations, this study provides valuable insight into differences between male and female SMY in perceptions and experiences related to the school environment.

Implications for School Nursing and School Health Services

Collectively, these findings have notable implications for school nurses and school health services. Our study found that SMY, specifically male SMY, are at increased risk for negative perceptions and experiences related to the school environment; these in turn, can impact students’ physical safety and mental health (Birkett, Espelage, & Koenig, 2009; Burton, Marshal, Chisolm, Sucato, & Friedman, 2013). School nurses have the ability to foster trusting relationships with students, which may result in students being more open with school nurses about bullying experiences, safety concerns, and mental health issues. This allows for identification of unmet health needs (e.g., depression or other mental health concerns). In collaboration with youth-serving organizations, school nurses can help facilitate access to needed health services. Nurses may also serve as a school-based advocate for students impacted by bullying or safety concerns and work to improve school climate for SMY youth.

The National Association of School Nurses asserts that school nurses are well-positioned to advance school climate by promoting the prevention of school violence (Tuck, Cagginello, & Rose, 2013). National school health models call for increased communication and partnerships among professionals within schools, highlighting the important role that school nurses can play in improving the school environment for students (King, 2014; Kub & Feldman, 2015; Pigozi & Bartoli, 2016). Using their comprehensive education and skills, school nurses can educate school administrators, teachers, other school staff and parents about the risk factors and characteristics of a negative school environment and the long-term effects that victimization can have on the well-being of SMY (Almeida, Johnson, Corliss, Molnar, & Azrael 2009; Burton, Marshal, Chisolm, Sucato, & Friedman, 2013; Loftus, 2013).

Creating a safe and supportive environment for students could help mitigate the effects of bullying and enhance the feelings of safety among SMY. Given the association between bullying and mental health outcomes, understanding sex differences in school experiences among SMY is imperative and can assist school nurses in designing and implementing targeted interventions for SMY. As has been suggested by Loftus (2013), conducting additional research that examines differences—including cultural differences—in bullying experiences could allow school nurses to sharpen their intervention and prevention strategies in an effort to end bullying and improve school climate for all students.

Acknowledgements:

The authors thank the staff and students of all schools involved in the data collection as well as the staff of Broward County Public Schools district, especially Brad Koogler and Dr. Kevin O’Connor for their support of this data collection.

Funding: This project was supported by funding from the Division of Adolescent and School Health (DASH) in the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) at the Centers for Disease Control and Prevention (CDC), Contract #HHSS2002013M53944B Task Order #200-2014-F-59670.

Biography

India D. Rose, PhD, MPH, CHES, is a senior associate at ICF, Health Research, Informatics, and Technology Division, Atlanta, Georgia, USA.

Ganna Sheremenko, PhD, MS, is a senior associate at ICF, Health Research, Informatics, and Technology Division, Atlanta, Georgia, USA.

Catherine N. Rasberry, PhD, MCHES, is a Health Scientist at the Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, GA, USA.

Catherine A. Lesesne, PhD, MPH is a Principal at ICF, Health Research, Informatics, and Technology Division, Atlanta, Georgia, USA.

Susan N. Hocevar Adkins, MD is a Senior Medical Officer at the Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, GA, USA.

Footnotes

Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Disclaimer: The findings and conclusions in the manuscript are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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