Investigating site-level longitudinal effects of population health interventions: Gay-Straight Alliances and school safety

Abstract

There is limited research on evaluating nonrandomized population health interventions. We aimed to introduce a new approach for assessing site-level longitudinal effects of population health interventions (SLEPHI) by innovatively applying multiple group multilevel (MG-ML) modeling to repeated cycles of cross-sectional data collected from different individuals of the same sites at different times, a design commonly employed in public health research. For illustration, we used this SLEPHI method to examine the influence of Gay-Straight Alliances (GSAs) on school-level perceived safety among lesbian, gay, and bisexual (LGB) and heterosexual (HET) adolescents. Individual-level data of perceived school safety came from 1625 LGB students (67.4% female; mean age, 15.7 years) and 37,597 HET students (50.2% female; mean age, 15.4 years) attending Grades 7–12 in 135 schools, which participated in 3 British Columbia Adolescent Health Surveys (BCAHS: 2003, 2008, 2013) in Canada. School-level data of GSA length since established were collected by telephone in 2008 and 2014. Nested MG-ML models suggested that after accounting for secular trend, cohort effects, measurement error, measurement equivalence, and student age, GSA length linearly related to increased school-level perceived safety among LGB students (b = 1.57, SE = 0.21, p < .001, β = 0.32) and also among HET students (β = 0.34 in 2003 & 2013, β = 0.32 in 2008) although statistical differences between years for HET youth were likely due to the large sample size. By conducting MG-ML analysis on repeated cross-sectional surveys, this SLEPHI method accounted for many confounding factors and followed schools for a longer period than most longitudinal designs can follow individuals. Therefore, we drew a stronger conclusion than previous observational research about GSAs and LGB students’ well-being. The SLEPHI method can be widely applied to other repeated cycles of cross-sectional data in public health research.

Self-Reported Health and Patterns of Romantic Love in Adolescents from Eight European Countries and Regions

“…Some of these positive effects have been observed not just in SMY youth but in heterosexual adolescents as well. [65][66][67][68]…”

Romantic Attraction and Substance Use in 15-Year-Old Adolescents from Eight European Countries

“…Promoting healthy romantic relationships, both for SMY and heterosexual youth, may reduce (romantic) stress and have a positive impact on peer norms. Direct measures to promote health and resilience in SMY, such as ‘gay-straight alliances’ or ‘gender-sexuality alliances’ [70], media-based interventions to address sexual orientation related prejudice [71] or introducing safe school policies [72] have a documented beneficial effect on the health of not just SMY, but on heterosexual adolescents as well. Risk prevention and enhancing resilience and well-being in SMY should be part of national youth health strategies [73].…”

Safety and Predictors of Sexual Minority Youth Carrying Weapons

“…Future research should investigate associations between longitudinal trends in bullying and attitudes toward sexual and gender minority persons in US politics. Further, policies explicitly protecting SMY have been associated with fewer suicide attempts and fewer physical and emotional stressors (Hatzenbuehler et al, 2014;Li et al, 2019;Meyer et al, 2019;Saewyc et al, 2014), and a protective school climate has been found to associate with the same, as well as with improved academic performance (Birkett et al, 2009;Kosciw et al, 2015;Kosciw et al, 2013). Consequently, understanding the impact of bullying and bullyingrelated victimization among SMY, particularly as they relate to political climate and policy interventions (Murchison et al, 2019), may help identify avenues for intervention to decrease weapon carrying among SMY.…”

“…It is important therefore to ask not only how we may reduce rates of bullying but also how to promote safe and supportive environments for SMY at all levels (Birkett et al, 2009; Saewyc et al, 2014). The presence of gender and sexuality alliances (GSAs) in schools has been associated with reductions in bullying and concomitant increases in both sexual minority and heterosexual students’ sense of perceived safety (Li et al, 2019; Saewyc et al, 2014). Establishing a protective climate for SMY in schools by advocating for GSAs or other school-based anti-bullying and stigma reduction interventions may therefore not only improve health and scholastic outcomes (Marx & Kettrey, 2016) but also reduce the risk of weapon carrying and inevitable disciplinary intervention (Kosciw et al, 2015).…”