Envisioning supportive and safe learning environments: A dialogical study with LGBTQ+ adolescents living with chronic conditions or diagnoses

Abstract Background LGBTQ+ adolescents living with mental conditions are affected by stigma based on their health status, sexual orientation, and/or gender identity/expression (SOGIE), especially when navigating their learning environments. Our aim is to gain detailed insights into how LGBTQ+ adolescents living with mental conditions vision their learning environments so that they can feel safe and supported enough to freely disclose their SOGIE and health status, and hence thrive. Methods Aware of the participants’ vulnerabilities, a dialogical narrative-based approach was used to gather thick descriptions and deep insight, while applying the “seven C's”: conversation, curiosity, context, complexity, challenge, caution, and care (Frank, 2019). Recruitment was done through LGBTQ+ Denmark and via networks of networks. Two LGBTQ+ young adults living with chronic conditions held the dialogues. Mode of communication was chosen by the participants (either face-to-face, via internet or via telephone). Data analysis was conducted via the “analysis grid” (Roest et al. 2021). Results Nine dialogues lasting from 20 to 50 minutes were held with youth from 14 to 24 years old during spring 2022. According to their narratives, supportive and safe learning environments would: respect for change of names and pronouns, update learning materials, allow for flipped classrooms (hybrid teaching tested under COVID lockdowns), have separate neutral change rooms/bathrooms and create safe private spaces to take medications. They would also permit higher absenteeism rates for those living with chronic conditions or getting hormonal treatments, allow for more breaks/slower version of the pensum, and show proactive healthy curiosity and respect for “invisible diseases”, fluid SOGIEs and neurodiversity/neurodivergent profiles. Conclusions The differing participants’ narratives provide innovative ways to create safe and supportive inclusive learning environment that embrace and enhance diversity.


Background:
Studies show that the LGBTQ+ population is particularly vulnerable to suicidal thoughts and behavior. This vulnerability is even more pronounced in the younger population. However, in Switzerland, qualitative studies on this topic are missing. Our study investigates the processual dynamics and background of suicide attempts of LGBTQ+ youths while looking into their subjective meaning. Here, behaviors of helpseeking are also from interest. In addition, the burdens and resources associated with being LGBTQ+ are explored. By better understanding the process of suicide attempts, we can identify relevant contexts of the respondents' experiences and illustrate how to enhance suicide prevention strategies. We are referring here to the school context. Methods: From 2021 until 2024, we interview LGBTQ+ youths in the German-and French-speaking parts of Switzerland who have tried to end their lives between the ages of 14 to 25 (max. three attempts). Applying a multi-perspective approach, we interview persons from their social environment if agreed. Recruitment is based on 'theoretical sampling'. Data collection and analysis follow the grounded theory methodology. As of July 2022, the sample consists of 18 persons: 3 bisexual women, 1 lesbian woman, 2 gay men, 7 transgender persons, and 5 persons with fluid identities.

Results:
Through preliminary analysis, the school context could be identified as one relevant burdening context in the respondents' experience and suicide attempt process. In this respect, respondents experienced complicated social relationships: e.g., bullying, social exclusion, and pressure to conform. Moreover, the school environment was experienced by some as LGBTQ+ hostile.

Conclusions:
Our current findings support the necessity to integrate schools as important stakeholders in suicide prevention but highlight a need for LGBTQ-specific and LGBTQ-sensitive orientations to suicide prevention strategies.
Abstract citation ID: ckac129.677 Sexual attraction-based disparities in adolescent mental health: The role of school norms Purpose: Few researchers have explained disparities in mental health between sexual minority and heterosexual adolescents by focusing on structural forms of stigma as, for instance, heterosexist school or classroom norms. Addressing this gap, our paper aimed to study disparities in life satisfaction, psychosomatic complaints, and emotional problems between sexual minority and heterosexual adolescents and examine the moderating role of heterosexist norms in the classroom and school.

Methods:
We used data from the 2013 and 2017 Dutch Health and Behaviour in School-Aged Children (HBSC) study (N = 12,756; M age = 14.02; SD = 1.54). Separate multilevel analyses for life satisfaction, psychosomatic complaints, and emotional problems were conducted in which cross-level interaction effects between sexual attraction and school and classroom-level heterosexist norms were estimated. Results: Same-sex attracted, both-sex attracted, and adolescents unsure about their sexual attraction reported lower life satisfaction, more psychosomatic complaints (not for unsure adolescents), and more emotional problems than their other-sex attracted peers. Stronger school-level heterosexist norms were associated with higher life satisfaction and fewer psychosomatic complaints and fewer emotional problems. Stronger classroomlevel heterosexist norms were associated with less emotional problems. Few moderating effects of classroom and schoollevel heterosexist norms were found. Contrary to expectations, disparities in life satisfaction between same-sex attracted and other-sex attracted adolescents decreased when classroom-level heterosexist norms were stronger. Conclusions: Although our findings suggest pressing health disparities between heterosexual and sexual minority adolescents, heterosexist norms at the school-and classroom-level hardly contributed to these health disparities.

Background:
LGBTQ+ adolescents living with mental conditions are affected by stigma based on their health status, sexual orientation, and/or gender identity/expression (SOGIE), especially when navigating their learning environments. Our aim is to gain detailed insights into how LGBTQ+ adolescents living with mental conditions vision their learning environments so that they can feel safe and supported enough to freely disclose their SOGIE and health status, and hence thrive.

Methods:
Aware of the participants' vulnerabilities, a dialogical narrative-based approach was used to gather thick descriptions and deep insight, while applying the ''seven C's' ': conversation, curiosity, context, complexity, challenge, caution, and care (Frank, 2019). Recruitment was done through LGBTQ+ Denmark and via networks of networks. Two LGBTQ+ young adults living with chronic conditions held the dialogues. Mode of communication was chosen by the participants (either face-to-face, via internet or via telephone). Data analysis was conducted via the ''analysis grid' ' (Roest et al. 2021).

Results:
Nine dialogues lasting from 20 to 50 minutes were held with youth from 14 to 24 years old during spring 2022. According to their narratives, supportive and safe learning environments would: respect for change of names and pronouns, update learning materials, allow for flipped classrooms (hybrid teaching tested under COVID lockdowns), have separate neutral change rooms/bathrooms and create safe private spaces to take medications. They would also permit higher absenteeism rates for those living with chronic conditions or getting hormonal treatments, allow for more breaks/slower version of the pensum, and show proactive healthy curiosity and respect for ''invisible diseases'', fluid SOGIEs and neurodiversity/neurodivergent profiles.

Conclusions:
The differing participants' narratives provide innovative ways to create safe and supportive inclusive learning environment that embrace and enhance diversity.

Background:
Previous research has shown that structural-level factors (discriminatory laws and policies) result in impaired health and well-being for transgender and gender diverse (TGD) adults. This study aims to assess if structural stigma is associated with school bullying/victimization and well-being among TGD youth and if more LGBTI supportive school environments, as well as social, physical, and legal gender identity affirmation ameliorate the effects of both structural stigma and experiencing violence.

Methods:
The study was conducted online in 2019 in 27 EU Member States and in the UK. We analyzed data from TGD students, aged 15 to 24 years, who at most had completed lower secondary education (n = 2,714). Well-being indicators used in the analyses included one-item measures of life satisfaction, depression, and considering leaving or changing school. Results: School environment, but not structural-level stigma, was associated with school bullying/victimization. Similarly, the effects of structural-level stigma, along with physical and legal gender identity affirmation were inconsistently related to students' well-being across the multilevel models, whereas a more positive school environment and especially experiences of social identity affirmation were related to greater life satisfaction, better mental health, and lower odds of considering leaving or changing school; even though the negative effects of school bullying/victimization remained statistically significant across all models.

Conclusions:
This study's results suggest that compared with distal factors, more proximal factors -better school environment and social identity affirmation -have a greater impact on TGD students' well-being. Given the inconsistency of our findings, more research is needed to understand the role of structural stigma and legal and physical gender identity affirmation in TGD students' well-being. The social, ecological, economic and health crises exacerbated by COVID-19 pandemic are challenges of extraordinary magnitude and complexity for global public health. Moreover, the context in which the pandemic emerged was characterized by underinvestment in public health and growing distrust in institutions. Public health responses were often fragmented and failed to make use of existing resources and expertise. Nearly 3 years after the start of the COVID-19 pandemic much has been learned and much is still to be learned. Accordingly, European national public health agencies have been pushed to their limits and currently face an urgent need to be renovated incorporating innovations in surveillance, communication and knowledge translation. National agencies should network and collaborate at the EU level. EUPHA may play an important role in this effort. On the one hand, there is the need of improving surveillance of harmful effects of the pandemic, specifically the health inequalities aggravated at local, national and global levels; and, on the other, to improve the availability of this knowledge to policymakers. Public Health communication needs to be further developed as it has been a crucial piece of national and international efforts to protect and promote health in the pandemic and so will be in the future. With this workshop proposal, we would like to bring up for discussion how could we further improve surveillance, communication and knowledge translation to policy makers and citizens in our European national public health agencies. Innovative and updated public health agencies will help regaining trust and strengthening public health institutions. National and European Public