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• URL: https://subjectguides.lib.neu.edu/LGBT

• Research article
• Open access
• Published: 24 September 2021

Are we asking the right questions? Working with the LGBTQ+ community to prioritise healthcare research themes

• Sally Crowe 1 ,
• Eleanor Barker 2 ,
• Meg Roberts 3 ,
• Lucy Lloyd 4 ,
• Clara M. de Barros 5 ,
• Ben Rebelo-Harris 5 ,
• Catherine Meads 6 &
• Catherine L. Saunders   ORCID: orcid.org/0000-0002-3127-3218 4  

Research Involvement and Engagement volume  7 , Article number:  64 ( 2021 ) Cite this article

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Conversations about research priorities with members of the public are rarely designed specifically to include people who identify as Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) and are not researchers.

Generally, to address this gap, and specifically, to inform future research for CLS, we carried out a rapid review of published research priority sets covering LGBTQ+ topics, and an online workshop to prioritise identified themes.

Rapid review: results.

The rapid review identified 18 LGBTQ+ research priority sets. Some focussed on specific populations such as women or men, younger or older people or people living within families. Five addressed transgender and gender non- conforming populations. All of the research priority sets originated from English-speaking, high and middle-income countries (UK, US, Canada, and Australia), and date from 2016 onwards. Prioritization approaches were wide-ranging from personal commentary to expert workshops and surveys. Participants involved in setting priorities mostly included research academics, health practitioners and advocacy organisations, two studies involved LGBTQ+ public in their process. Research priorities identified in this review were then grouped into themes which were prioritised during the workshop.

Workshop: results.

For the workshop, participants were recruited using local (Cambridge, UK) LGBTQ+ networks and a national advert to a public involvement in research matching website to take part in an online discussion workshop. Those that took part were offered payment for their time in preparing for the workshop and taking part. Participants personal priorities and experiences contributed to a consensus development process and a final ranked list of seven research themes and participants’ experiences of healthcare, mental health advocacy, care homes, caring responsibilities, schools and family units added additional context.

Conclusions

From the workshop the three research themes prioritised were: healthcare services delivery , prevention, and particular challenges / intersectionality of multiple challenges for people identifying as LGBTQ+. Research themes interconnected in many ways and this was demonstrated by the comments from workshop participants. This paper offers insights into why these priorities were important from participants’ perspectives and detail about how to run an inclusive and respectful public involvement research exercise. On a practical level these themes will directly inform future research direction for CLS.

Plain English Summary

Conversations about research priorities with members of the public who identify as Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) and are not researchers are not common.

We reviewed published research priorities covering LGBTQ+ topics and held an online workshop. The review identified 18 LGBTQ+ research published priority sets. Some focussed on specific populations such as women or men, younger or older people or people living within families. Five were on transgender and gender non- conforming populations. Priorities were achieved by different methods such as workshops and surveys. People involved in setting priorities mostly included researchers, health practitioners and advocacy organisations, two studies involved LGBTQ+ public in their process. Research priorities identified in the review were grouped into themes which were prioritised during the workshop.

For the online workshop, participants were recruited using local (Cambridge, UK) LGBTQ+ networks and a national advert and offered payment for their time. Participants personal priorities and experiences contributed to agreeing a final list of seven research themes in priority order. Participants’ experiences of healthcare, mental health advocacy, care homes, caring responsibilities, schools and family units were helpful.

From the workshop the three top research themes were: healthcare services delivery , prevention, and particular and multiple challenges of people identifying as lesbian, gay, bisexual, transgender or queer. Research themes interconnected in many ways as shown by the comments from workshop participants. This paper describes why these priorities were important from participants’ perspective and offers information about how to run an inclusive and respectful public involvement research exercise.

Peer Review reports

The aim of this research was to orientate future research projects and funding applications, (primarily for CLS), and to develop research priorities in collaboration with LGBTQ+ public, mainly through an online workshop informed by a rapid review. This article describes the process and outcomes of the exercise, with reflections from the team and public participants. This work was not intended to produce a generic LGBTQ+ healthcare research priorities list.

Regarding terminology, in this article we refer to Lesbian, Gay, Bisexual, Transgender, Queer plus (LGBTQ+) public participants. The plus including other forms of identification such as non-binary, asexual and intersex. Elsewhere in the article we refer to sexual and gender minority health in terms of research priorities. Public involvement is used as a short hand phrase to describe a process of working with the public as part of a research process, not as participants of a research study.

Research agendas are often set by public policy, health professionals, guideline developers, researchers and research funders. Less common is the clear and inclusive involvement of the public in research priority decisions. This can lead to research priorities that don’t necessarily reflect the needs and preferences of the public [ 1 , 2 ].

However, the recent growth in reports and descriptions of research priority setting suggests that working in partnership with the public (patients, carers, service users etc.) to determine research priorities is becoming more common, especially with the adoption of frameworks that set out clear methods and considerations for equitable participation [ 3 ]. Examples of frameworks include: James Lind Alliance [ 4 ]; Dialogue Model [ 5 ]; surveys [ 6 ], Q Sort [ 7 ]; and more recently online ‘crowd sourcing’ approaches [ 8 ]. Common features of frameworks for research priority setting with the public are: stated values and expectations; guidance on and considerations for involving the public; a process flow of steps to describe and prioritise research questions or themes and a plan for what happens to priorities [ 9 ].

There is evidence of health inequalities in LGBTQ+ populations, for example in mental health [ 10 ], suicide [ 11 ], substance use [ 12 ], and health screening [ 13 ]. These health inequalities have activated calls to highlight evidence gaps for future research and policy consideration, but also address the needs and concerns of LGBTQ+ people using healthcare systems. While there is strong evidence describing large disparities in health and healthcare outcomes [ 14 ], detailed evidence on how to address these disparities still emerging, not least because of limitations in sexual orientation collection and monitoring in health data used for research. Prioritisation work with public involvement is required to understand where research is most needed.

Published existing research priority sets can help researchers coming to an area of interest assess what appears to be important and to whom. Assembling these publications in a review (scoping or systematic reviews) [ 15 , 16 ] provides further clarity. Combining a review of research priority sets in LGBTQ+ health with LGBTQ+ lived experience of health and social care provides a more complete approach to setting research priorities.

We identified a lack of involvement of people that identify as LGBTQ+ in healthcare research priority setting. Prior to applications for research funding CLS wanted to orientate research ideas towards topics that were considered important and reflect published accounts of research priority setting in LGBTQ+ healthcare.

From a methodological perspective, the growth in reports and descriptions of research priority setting that involve the general public provides more evidence and analysis of different frameworks and approaches, however how these exercises were conducted and who was involved is often under reported making it difficult to assess the exercise and outcomes. Nine common themes of good practice in priority setting [ 17 ] and more recent REPRISE guidance [ 18 ] for reporting accounts of research priority setting helped the team to agree a short set of criteria for appraising published research priority sets for inclusion in the rapid review.

Our approach to this project was therefore inspired by the James Lind Alliance (JLA) [ 9 ] and the Ensuring Value in Health Care Research movement [ 19 ], combining inclusive approaches to research priority setting and an evidence informed approach. This translates to a rapid review of published research priority sets in LGBTQ+ healthcare, and the recruitment of relevant public to provide insights and experiences, primarily through an online workshop.

We used the UK Standards for Public Involvement [ 20 ] to guide our work with the public, and in reporting this project, we use the GRIPP 2 checklist [ 21 ] so that the specific elements of public involvement are described and evaluated.

Rapid review methods

The search strategy was developed and conducted by a medical librarian (EB). Prior to conducting the searches, the search terms were peer reviewed by another medical librarian according to PRESS criteria [ 22 ]. The databases (platforms) Medline (via Ovid), CINHAL (via Ebscohost), Embase (via Ovid), Web of Science (core collection) and PsycINFO (via Ebscohost) were searched from inception to June 2020 with variants of the following search terms, which were in the title and abstract fields, as well as in the subject heading (MESH) term field when these existed in the database. The author team acknowledge the complexity of language associated with gender and sexual identities, that they change over time and that some may be stigmatizing. Our intention with this list of terms was to capture studies that may be relevant to the review acknowledging that some of the search terms reflect historical language rather than current usage.

The Medline search is reproduced below;

((research adj3 (priorit* or agenda* or consult* or consensus)) OR ((patient* or public or stakeholder* or communit*) adj3 (engag* or involv* or empower* or activat* or participat*)) OR (“patient centered research” or “patient centred research”)).ti,ab. OR Health Priorities/.

(homosexual* or gay* or lesbian* or bisexual* or “sexual minorit*” or “sexual orientation” or transsexual* or trans-sexual or transgender* or queer* or “gender fluid” or “gender nonconforming” or LGBT* or non-binary or nonbinary or bisexual or bi-sexual or MSM or MSW or WSW or “men who have sex with men” or “men who have sex with women” or “women who have sex with women” or “gender reassignment” or pansexual or asexual or “sexual identity”).ti,ab. OR exp. Transgender Persons/ or exp. Gender Dysphoria/ or exp. Sexuality/ or exp. Gender Minorities/ or exp. Homosexuality/ or exp. Bisexuality/.

In addition, Google was searched using the following search “research priority setting” AND lgbt (site:.edu OR site:.ac OR site:.gov OR site:.org).

We additionally reviewed references identified from LGBT Magazine Archive and LGBT Thought and Culture Database, searching for the term research priorit*.

We screened abstracts and then full text. Abstracts that only identified health needs rather than research priorities, and sources that identify a very general statement of “more research needed” were excluded. Inclusion criteria for the review were: accounts that identify any LGBTQ+ research priorities; research priority sets based on all methodologies and exercises published in the last 5 years (on the premise that research priorities are time sensitive).

Quality assessment of the priority sets was conducted by (CLS, MR, SC) using adapted from the REPRISE framework. These included; country, population and focus, methods for prioritization, participants in the process, number of priorities, stated strategy/plan for priorities and research-specific calls for action/innovation. We additionally used the Strength of Recommendation Taxonomy (SORT) approach to evaluate the strength of patient-oriented evidence in each paper.

Extracting the priorities and identifying themes was conducted by CLS using an iterative approach, meaning that themes across priorities were developed during the analysis. However, two identified priority sets [ 23 , 24 ] provided lists of priorities that fell under all of the identified priority themes and for the workshop the team combined these two approaches. (CLS, MR and SC) matching the individual priorities from these two sets independently to the identified themes and following discussion a final amalgamated set of themes with example priorities were agreed for discussion in the workshop.

Workshop methods

Criteria for people to apply to participate in the process were that they needed to be 18 years and over, identify as LGBTQ+ and either have good health, or use health and social care services. Experience of chronic and long-term conditions, disability and caring roles were also highlighted. Potential participants needed to be able to speak, read, and understand English. We did not attempt to include those who did not speak and understand English. We limited recruitment of researchers (in LGBTQ+ research or other) as we felt that they already have the potential to influence LGBTQ+ research priorities through their work and publications. We were primarily interested in the views of non-researchers that are less likely to have this influence.. Recruitment was UK wide, from urban and rural settings and we prioritised recruitment of participants from black, Asian and other ethnic minority backgrounds.

Recruitment took place over 3 months, following ethical approval for the work from the University of Cambridge Psychology Research Ethics Committee (Application No: PRE.2020.112). A ‘stakeholder map’ was developed of local (to Cambridge) and national LGBTQ+ community groups and organisations. This was followed up with formal (use of mailing list) and informal (conversations and social media) networking by (MR, SC) and an advert was placed in the ‘People in Research’ matching website [ 25 ].

We specified that ideally participants would have access to a device (laptop, tablet) to join the workshop (as a mobile phone experience would not be optimal), however this was not a barrier to participating. Participants were offered £100 for 1 h of preparation, taking part in a 2-h online discussion and 1 h follow up activity, this is in line with guidance from NIHR Centre for Engagement [ 26 ].

Project information was sent to interested people and organisations with a deadline to respond. Interested candidates were encouraged to make personal contact with the organiser (SC) helping to establish relationships, identify needs to participate fully and troubleshoot/rehearse technical requirements.

Selected participants were sent via email pre workshop materials including; participant information and consent, a workshop programme, an exercise in personal ranking of research themes identified during the rapid review (Additional file 1 ), a participant list (including people’s interests and motivations to take part), and a ‘wellbeing document’ acknowledging that for some participants the discussion might prove painful or triggering and how to address that (Additional file 2). Material was provided in alternative formats to support inclusion of participants with specific disabilities.

A slide set for use during the workshop, and a detailed set of team notes for each step of the process were developed following team conversations. The use of pronouns (e.g., he/him, she/her, they/them) during the workshop was encouraged, but it was not a requirement. Similarly, participants were encouraged to keep their cameras on during the workshop, but again this was not compulsory.

Before the workshop, participants personally ranked the research themes (1 = most important, 7 = least important), considered the research questions in each theme and chose two that they most resonated with. They were encouraged to record their reasons for these choices.

At the workshop, following an introductions exercise and ‘scene setting’ participants split into two smaller groups, with a facilitator, observer/note taker in each. Another member of the team provided technical support across the two groups and was available for any other issues during the workshop. Facilitators had prepared to maintain a safe space for discussion and ensured that all participants had their say on what was important to them.

Participants referred to their workshop preparation and discussed their top two themes. Facilitators made a note of important themes allocating pre-agreed scores (Number 1 theme = 2 points; Number 2 theme = 1 point). Facilitators encouraged participants to share issues that were considered important, but missing from the research themes list. Facilitators ranked the themes accordingly and shared their screens, inviting comments. Ranked scores were combined across the two small groups and the resultant priority themes were assembled during a short break in the workshop. The whole group appraised, discussed and challenged the overall results. Scores were not changed at this stage, but challenges were heard and discussed. The process concluded with sharing next steps, assessing interest in these and thanks to participants.

Following the workshop, the results were analysed by the research team using a narrative summary approach and were shared with participants, who were invited to comment and add to the themes. Some also sent in their pre workshop notes on the themes providing further context and rationale for their choices.

Rapid review results

Initially 7809 abstracts, papers and priority sets were identified from across all sources, following de duplication this reduced to 5061. Of these 155 were relevant identified from abstract screening. Further screening of full texts reduced this to 18 relevant reported research priority exercises of which three were removed as they were ongoing studies [ 27 , 28 , 29 ]. This resulted in 15 relevant studies for the review. After the workshop while writing up this report three additional relevant priority sets were identified and added in, resulting in 18 relevant studies. The three reports added later were not appraised by workshop participants and did not form part of the framework used in the workshop, however we include them for completeness (Fig.  1 ).

Flow chart of literature search and results

Of the 18 research priority sets included, four had a broad sexual and gender minority health focus [ 30 , 31 , 32 , 33 ] three concerned young people (plus school contexts) [ 34 , 35 , 36 ], three focussed on older people [ 37 , 38 , 39 ], one on lesbians [ 40 ] and one on family units [ 41 ]. Six specifically addressed transgender and gender non-conforming populations [ 42 , 43 , 44 , 45 , 46 , 47 ] (Table  1 , included at the end of this manuscript).

All the included research priority sets originate from English speaking, high and middle- income countries (UK, US, Canada, and Australia), and date from 2016 onwards. Their prioritization approaches ranged from personal commentary, literature reviews, expert workshops, surveys, to ‘in person’ public consultation and meetings and workshops. Participants involved in setting priorities mostly included research academics, health practitioners and advocacy organisations. We noted that two studies involved LGBTQ+ public in their process and four provided consistent patient-oriented evidence (SORT criteria A).

Some exercises focussed on small numbers of priorities [ 3 ], others had much larger sets requiring themes and further categorisation.

Of note is that only three exercises had an explicit strategy, action or implementation plan for their priorities, these were direct commissioning (papers for research articles, systematic reviews and meta-analyses) calls, and a special journal issue.

The majority of the exercises [ 13 ] suggested methodological developments such as; new and more sensitive theoretical frameworks, increased implementation science studies, recruiting more minority participants in studies, larger and more diverse research cohorts, and research in outcome measures. Several called for more inclusion of LGBTQ+ people in research priority setting and other aspects of research design.

The included priority sets yielded 123 identifiable priorities for research. Numbers of priorities and their specificity varied across reported priority sets. Some were one word e.g., ‘ depression’ , others were more specific ‘ identifying points of intervention in the pathways through which minority stress impacts depression, anxiety and suicidal ideation and behaviours’ . Some of the shorter word priorities had descriptive context and considerations for researchers and research funders.

There were common themes across the priorities including: research methodology and theory development (e.g. prevalence, comparative designs); intersectionality (e.g. race/ethnicity, deprivation, age, trans health priorities (e.g. healthcare access and quality); health literacy; LGBTQ+ health in relation to families and other settings (e.g. school); health care delivery; health promotion and ill health prevention; mental health, emotional wellbeing and stressors; relationships ; policy evaluation; and sexual health and relationships. The group decided to put to one side priorities concerned with research methodology and theories as this wasn’t in the remit of the study.

The final themes agreed from the research priority sets identified pre-workshop (CLS, SC and MR) were: Health services delivery; Health and social policy; Preventing ill health; Developing or evaluating treatments and interventions; LGBTQ+ specific issues; Particular challenges/intersectionality and Health condition specific.

Workshop results

Workshop recruitment.

Initially the aim for was 10 people to take part, however the recruitment process resulted in 17 potential participants so we expanded our planning to accommodate everyone that applied. On the day 14 took part as three sent apologies beforehand (one for personal circumstances and 2 were work related). Characteristics of participants were diverse and are described in Table  2 ;

There was an intention to have a diverse project and workshop team and this was achieved.

Of the 14 that took part in the project, eight remain connected to the team, and interested in future developments, some have participated in the preparation of this manuscript.

Workshop consensus

The seven themes were ordered into priorities by workshop participants. Firstly, in two smaller groups then a combined list was appraised. The small group results were similar with the identical 1st and 3rd and 7th themes, but also some differences. The collective top three research themes were ‘Health Services Delivery’, ‘Prevention’ with ‘Particular Challenges /Intersectionality’. Table  3 (included at the end of this manuscript) contains the full rank order the research themes with additional comments from workshop participants.

For priority theme 1, ‘Health Services Delivery’ there were common experiences of challenges “Primary care (GP) is the front door, coming out can be exhausting and potentially risky” . Research into effective training, guidance and support for front line workers in health and social care was considered important. The balance of ones’ identity being acknowledged, but not pathologized was also clear, ‘being LGBTQ+ is not an illness’ . Mental health was singled out as very important especially in relation to domestic violence. Finally, a focus on older people (and inclusive care homes) was felt to be missing in this theme.

For ‘Prevention’ research, (priority number 2), many participants wanted to improve the overall health of LGBTQ+ people, for example with cancer screening and HIV prevention. Of particular note was participants’ reflections on issues of bullying and violence, substance misuse and stress which were thought to be generally under reported and addressed. As one participant said “We are here, we have feelings, I need to be cared for sometimes, I want to be able to breathe” “it feels like ‘living in a world of isolation”.

The particular challenges and intersectionality (priority 3) in LGBTQ+ healthcare experiences were vividly described in the workshop, with particular emphasis on race and inequalities. Additionally, stigma particularly in Asian communities, living with neuro diversity and disability were cited as areas research could usefully address. Experiencing racism at work, or in accessing healthcare with “homosexuality on top of that feels like you are the lowest of the low’. Finally, people of colour needed to be part of the research conversation, otherwise intersectionality between gender and sexual identity and race would not be taken seriously. “ We need a stronger focus on how structural racism and colonialism impacts our health care and health care options”.

Other commentary on the themes ranged from inclusion of more working-class LGBTQ+ public in healthcare research, recognising the role of “ factors with roots outside healthcare settings (such as criminal justice, care homes, reporting of violence etc.) for an effective investigation”. There were also observations about different types of research such as population studies where “Poor ‘counting’ which means it is difficult to assess and prevent ill health in this group ”.

Despite achieving general agreement or consensus of the top research themes across the two small groups some people’s priorities weren’t reflected in the top 3. The workshop framework accounted for this and individual challenges to the priority order were discussed, once the whole group reassembled. One example was the lower rank of the research theme ‘Health and Social Policy’. One participant who was familiar with this area through activism was disappointed that others hadn’t seen this as an important research theme. An engaging discussion about the proximity of policy to people’s lives took place and the challenger was content that their point of view had been discussed. There was a similar debate about the different research issues associated with gender non-conforming and transgender needs as distinct from those of lesbians, gay and bisexual people. This is reflected to some extent in the findings in the literature review where transgender research priorities were considered separately in some studies.

The facility for individuals to challenge the results of a group priority setting exercise is an important methodological feature. Whilst these discussions were facilitated, the rank order of research themes weren’t open for re-ranking. Authors were encouraged by the candid and frank exchange of views in the group, who were never intolerant or disrespectful of each other. The workshop closed with participants content with the outcome.

Workshop experience

Participants reflections on their experience of being part of the project and the workshop were submitted during the workshop verbally or in the chat function and after via email.

“It was a great workshop, thank you so much. I must say, it was one of the best conducted ones I have attended, from start to finish”. Clara, workshop participant.

“I'd like to be forward in thanking you for hosting a culturally diverse group. Whether this was organic or thought about doesn't matter; it was extremely welcomed and was very different from other LGBTQ projects/spaces I've been involved with in Cambridge.” Jade, Workshop participant.

“I have been involved in Patient and Public Involvement and Engagement (PPIE) for over three years and this is the first invitation I have had to explore LGBTQ+ matters”. Rumi, Workshop participant.

Researcher and facilitator reflections are also important in exercises such as these, including reflection on how much does identity reflect our approach to the exercise and how we interpret the results?

“as a straight woman facilitating the process, my role is to support and enable participants to speak their truth. I have no vested interest in the outcomes but care greatly about how they are achieved”

“I learned more about is the critical importance of sensitivity and recognition of the tensions people might (very legitimately) bring from difficult experiences/bias/discrimination. I really noticed that use of language, pre-briefings, use of pronouns, pre briefings and careful preparation by the team etc all had an impact on helping participants feel safe and respected and therefore able to express views/discuss/disagree without any difficulties”.

“It has felt extremely validating to work on a project that genuinely puts LGBTQ+ voices at the centre of the research but doesn't put the burden of labour on LGBTQ+ people. It often feels like the only way for LGBTQ+ research to get done is for the LGBTQ+ community itself to initiate, advocate and keep the momentum going, so it was lovely to be part of a project that fully engaged with the community and amplified the LGBTQ+ experience without demanding extensive work from the participants. I felt like a really valued member of the team, and felt my perspective as a queer person was being taken into account at every stage. The thoughts and experiences shared in the workshop and the paper feel very true to my own experience of healthcare and I'm pleased that we've been able to capture them in a tangible and useful way.”

We carried out a rapid review of published accounts of research priority setting in LGBTQ+ healthcare. The results of this informed an online workshop with 14 members of the public that identified as LGBTQ+. In this workshop a consensus was agreed on a priority order of 7 research themes and their associated questions. Priority themes were Health Services Delivery, Prevention, and Particular Challenges and Intersectionality; the other four were prioritised less highly but were nonetheless still identified as important within the exercise. We recognise that this was a relatively small group of people, and that their views will be shaped by their personal experiences, the current sociocultural climate, and maybe even the COVID 19 pandemic. Within each theme there was variety of specific questions and points raised by workshop participants. Workshop participants highlighted the inter connectedness of themes, for example, there were overlaps in themes especially between Intersectionality [ 3 ] and LGBTQ+ Specific [ 4 ] themes where mental health featured in both.

A strength of this exercise has been assembling a set of published existing priority sets in LGBTQ+ research, which shows the breadth of approaches used to establish priorities and more understanding of the nature of participants in these processes, and the breadth of areas where research is had been identified as required. Having developed the themes independently through the rapid literature review we noted that they have a lot of overlap with the research areas defined by the Health Research Classification System which encompass all aspects of health-related research activity [ 48 ].

It has also pointed to a ‘western’ view of LGBTQ+ research, with all the priority setting processes focussing on high- and middle-income countries. This fits with the Western, Educated, Industrialized, Rich and Democratic (WEIRD) [ 49 ] bias in social science research. It is worth noting that although included priority sets were from 2016 onwards, earlier priority sets relating to research priorities in HIV/AIDS from low- and middle-income countries might have addressed this bias.

Another strength is the ethnic diversity, age and inclusion of people that experience disability in different forms that took part in the workshop. We set out to recruit people from different backgrounds, ethnicity and contexts, whilst acknowledging the WEIRD context of the prioritisation process, and this was achieved. The rapid literature review showed a tendency not to involve LGBTQ+ non-researcher public in healthcare research priority setting; many participants mentioned the novelty of their experience in this regard “LGBTQ+ folk are overlooked and this definitely could be pursued”.

Strengths in the process were noted by several contributors, such as the critical importance of sensitivity and recognition of the tensions people might bring from difficult experiences, discrimination and homophobia. The careful use of language, pronouns, expectation management and preparation by the team “all had an impact on helping participants feel safe and respected ”. This helped people to express their views, discuss and disagree without any difficulties. The financial incentive to take part helped people commit to the process in terms of their time and they were generous with extra feedback and insights subsequent to the workshop.

There were weaknesses in this exercise . We started with the results of a rapid literature review, rather than from where participants wanted to start [ 50 ]. Many priority setting exercises gather ideas for research themes initially and then prioritise these. This doesn’t discredit our approach and asking for comments on the themes and ‘missed issues’ helped balance up our quicker method. From a methodological perspective, the themes were presented in the same order to all workshop participants; it is possible that this had an unconscious influence on the prioritisation outcomes, although hopefully mitigated through the wider discussion part of the workshop.

We did not involve our participants in the rapid review process due to the scheduling of the project, however some members of the project team identify as LGBTQ+ and provided expertise in relation to search terms, journals etc. and critique on the results. CLS and SC also corresponded with international authors in LGBTQ+ research to inform aspects of the project. Recent research databases such as ‘knowsy’ [ 51 ] will further support work in this area.

We did not attempt to include those who did not speak and understand English, due to the small scale of the project and funding. We stated in recruitment materials and processes that applicants needed to ‘identify under the umbrella of LGBTQ+’. On contact we did not ask them to disclose their identity, but all did. By not seeking participants that have not disclosed their sexual or gender identity is a potential limitation to interpreting our results. The low number of younger people involved in this process is a limitation and might have influenced the nature of priority topic areas identified.

We note that trans healthcare can be very different and separate from LGBTQ+ community health issues generally and that transgender perspectives are represented more fully in the results of the rapid review than from the workshop.

Some participants joined via mobile phone; whilst this wasn’t a barrier to take part it was potentially less satisfying for them. Some participants didn’t come on camera for the workshop, again this wasn’t a barrier to take part but it did make it harder for the facilitators and other participants to connect. Conversely being off camera may have made it easier for some people to take part especially if they weren’t ‘out’ to others about their identity. With a relatively small number of ‘people in the room’ the outputs were always going to reflect the priorities of those taking part. However, as the starting point of the workshop reflected the current published evidence from research priorities in LGBTQ+ research perhaps this represents a balance of approaches and outcomes? Finally, the presentation of the themes (Additional file  1 ) was on the whole descriptive, but in one instance a theme hinted at the result from the rapid review and this may have biased participants view of the themes.

There are implications for LGBTQ+ research from our exercise, both in terms of identified priorities that future research should focus on and on a practical level making sure that the work from this exercise is used and taken forwards CLS is pursuing these currently as an individual researcher. These prioritised themes are also more widely relevant for research funders and commissioners. The second set of implications from this research are in setting a template and reflecting on considerations for involving LGBTQ+ public in strategic research conversations.

Health services delivery, prevention and the intersectionality of sexual orientation and gender identity with other disadvantage were highlighted as research priorities for LGBTQ+ health from workshop participants in this shortened research prioritisation exercise. The challenge now to the research team, the wider LGBTQ+ research community and to research funders is to commission, plan and carry out research that addresses these priorities.

Availability of data and materials

No additional data or materials are available.

Abbreviations

Lesbian, Gay, Bisexual, Transgender and Queer, the + denotes other dimensions of sexuality and gender that may exist

Men who have Sex with Men

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Acknowledgements

Thanks to workshop participants: Katherine Barrett, Mark Caruana, Emily Dixon, Frankie Frangeskou; Rumi Kidwai; Manos Kumar; John Marsh, Jade Pollard-Crowe and Azim Richardson. Thank you also to workshop participants and those that contributed to this paper that wish to remain anonymous. Recruitment was greatly assisted by Cici Carey Stuart from the Encompass Network. Thanks to Elisabeth Sandler for considerations about workshop design and Naoise Murphy for directing us towards the QTI Coalition of Colour and other local groups. Finally, thanks to Katherine Cowan for workshop facilitation.

This project is funded by the National Institute for Health Research (NIHR) School for Primary Care Research (project reference SPCR-2014-10043 Capacity Building Award 10a SPCR). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

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‘Your Wellbeing’ sheet.

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Crowe, S., Barker, E., Roberts, M. et al. Are we asking the right questions? Working with the LGBTQ+ community to prioritise healthcare research themes. Res Involv Engagem 7 , 64 (2021). https://doi.org/10.1186/s40900-021-00298-7

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A milestone for researchers focused on LGBTQ health

The Harvard SOGIE Health Equity Research Collaborative celebrates its 10-year anniversary during Pride Month 2021

June 22, 2021 – One day in June 2011, a handful of Harvard-affiliated researchers sat around a small table in a cramped sixth-floor library in Boston Children’s Hospital to talk about forming a collaborative focused on LGBTQ health. At the time, research on the topic was limited, focused mainly on simply documenting the fact that health disparities exist between LGBTQ individuals and their heterosexual, cisgender peers.

This June, the group—known as Harvard SOGIE (Sexual Orientation and Gender Identity and Expression) Health Equity Research Collaborative —celebrates its 10th anniversary. Based at Harvard T.H. Chan School of Public Health and Boston Children’s Hospital, Harvard SOGIE now has 100+ members—including staff, trainees, and faculty, either currently or formerly affiliated with Harvard—from more than a dozen academic institutions across the U.S.

The field of LGBTQ health research has blossomed, according to Brittany Charlton , an assistant professor in the Department of Epidemiology at Harvard Chan School, who co-directs Harvard SOGIE along with Sabra Katz-Wise , an assistant professor in the Department of Social and Behavioral Sciences . “Only recently have we been able to elucidate some of the mechanisms that drive health disparities between LGBTQ people and heterosexual, cisgender people,” said Charlton, who wrote about SOGIE’s milestone in a recent Twitter thread . “We’re at a turning point in the field where it’s possible to design interventions, advocate for policy changes, and improve the lives of LGBTQ people.”

Founded by Bryn Austin , professor in the Department of Social and Behavioral Sciences at Harvard Chan School and research scientist in the Division of Adolescent and Young Adult Medicine at Boston Children’s Hospital, Harvard SOGIE supports researchers in a variety of ways—through biweekly works-in-progress meetings, journal clubs, professional development workshops, peer mentorship lunches, grant writing sessions, and seminar series.

Harvard SOGIE has also hosted advocacy trainings in order to help its members advocate for LGBTQ-inclusive policies like the Massachusetts Healthy Youth Act. “This bill would ensure youth receive sex education that is evidence-based, including age-appropriate information about sexual orientation and gender identity,” Charlton said. “It was introduced a decade ago—the same year that Harvard SOGIE was founded—and it’s critical that it passes.” Research from Charlton and her team has revealed that LGBTQ youth, in particular, need sex education; for example, LGBTQ youth have more unintended pregnancies than their heterosexual, cisgender peers. A recent study led by Ari Tabaac , an instructor at Boston Children’s Hospital, found that LGBTQ youth are seeking out supplemental sex education from peers and media as school-based curricula do not meet their needs.

Filling knowledge gaps

Charlton’s research team has focused over the last decade on documenting reproductive health issues facing LGBTQ people. “We know that this population is more vulnerable to poor gynecological health and they encounter barriers in their gynecological care,” said Charlton. “Despite the mounting evidence of gynecological disparities, we actually know almost nothing about the obstetrical health of LGBTQ people, or the health of their offspring at birth. This is especially troubling because we know that bisexual and lesbian women are more likely than heterosexual women to experience depression and to use substances—all because of the discrimination and stigma that LGBTQ people encounter—and that these are risk factors for adverse obstetrical outcomes.”

Charlton and her colleagues are helping to fill the research gap. She’s principal investigator of a new five-year R01 grant from the National Institutes of Health to study sexual orientation–related disparities in obstetrical and perinatal health, drawing on data from Harvard’s longitudinal studies, including the Nurses’ Health Study and the Growing Up Today Study. Co-investigators on the grant include Austin, Sebastien Haneuse , Jorge Chavarro , and Heather Eliassen , all from Harvard Chan School; and Bethany Everett of the University of Utah. “This new grant will enable us to reveal the needs of these vulnerable groups, and then be able to target interventions and improve the health of subsequent generations,” Charlton said.

Charlton and co-investigators Austin, Chavarro, and Stacey Missmer are also working to quantify sexual orientation–related cancer disparities and pinpoint the risk factors for such cancers, funded by a five-year grant from the American Cancer Society.

Other recent research by Harvard SOGIE members has covered a wide range of topics. For example, the New England Journal of Medicine published a Perspective piece by Carl Streed and colleagues about the importance of collecting data on sexual orientation and gender identity. Another study led by Alex McDowell revealed how non-discrimination policies lead to improved mental health among transgender individuals—those whose gender identity is different than their sex assigned at birth. Research led by Jessica Kremen outlined the harm of new legislation restricting access to healthcare for transgender youth.

Charlton described research in the field of LGBTQ health as “continuing to flourish,” propelled by growing interest around issues of health inequity. “People are increasingly thinking about the health of vulnerable populations—and that must include the LGBTQ community,” she said. “This is such a thrilling time to be in this field.”

– Karen Feldscher

photo courtesy Brittany Charlton

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Inclusive All of Us data poised to transform research on LGBTQ health challenges, outcomes

Previous large health studies didn’t collect sexual orientation and gender identity information. A Stanford Medicine study finds the All of Us Research Program a boon to LGBTQ health researchers, future health outcomes.

July 31, 2023 - By Krista Conger

The goal of the program is to collect health data from at least 1 million people who reflect the diversity of the United States. Rainbow Black/Shutterstock.com

A nationwide health research program that includes the collection of data on participants’ sexual orientation and gender identity is producing a powerful, unprecedented and long-awaited resource for researchers studying health outcomes and inequities in the LGBTQ community, according to a new study by Stanford Medicine researchers.

The researchers used data gathered by the National Institutes of Health’s All of Us Research Program to evaluate whether sexual and gender minority groups have a higher prevalence of anxiety, depression, HIV diagnosis and tobacco use disorder than cisgender straight people. These associations have long been observed but have been difficult to study due to the lack of reliable health data for LGBTQ people, who are estimated to make up about 9% of the U.S. population. 

“When fully enrolled, the All of Us Research Program will be the largest data set of LGBTQ people in the world,” said associate professor of medicine Mitchell Lunn , MD. “It includes self-reported data as well as information from electronic health records and physical measurements that we know impact health, like weight and blood pressure. It is a powerful, rich and impactful resource for studying myriad questions about health and health outcomes for members of the LGBTQ communities.” 

The goal of the program is to collect health data from at least 1 million people who reflect the diversity of the United States, allowing researchers to learn more about how biology, environment, and lifestyle impact health. Currently, 75% of participants identify with communities historically underrepresented in medical research, including racial, economic, rural, and sexual and gender minorities. The program has enrolled more than 650,000 people.  

Rather than focusing strictly on this preliminary study’s findings, however, the researchers emphasize that their analysis serves primarily as a proof of principle for the data set’s utility. It allows them for the first time to tweeze apart the varying health outcomes of lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority people.

“We finally have the data to disaggregate the L from the G and the B and the T and the Q, and more, and to learn more about the unique health challenges of each group with a goal of providing better support and care for all,” Lunn said.

Lunn is a lead author of the study, which was published online July 31 in JAMA Network Open. Postdoctoral scholar Nguyen Tran , PhD, is also a lead author. Associate professor of obstetrics and gynecology Juno Obedin-Maliver , MD, is the study’s senior author. Lunn and Obedin-Maliver co-direct The PRIDE Study — a Stanford-based effort to gather data about the physical, mental, and social health experiences and outcomes of people who are LBGTQ. 

Mitchell Lunn

Seeking better data

“Until now, there hasn’t been an accurate way of collecting data among the sexual and gender minority populations,” Tran said. “Either that information hasn’t been collected at all, or it wasn’t collected in the most accurate way. For example, the U.S. census doesn’t include information on sexual orientation or gender identity. So, we don’t get an accurate count of this community, and that influences how resources are allocated nationally. All of Us is one of the first efforts to capture this information on a nationwide level.” 

 All of Us participants can choose to provide information on their sexual orientation, gender identity, and sex assigned at birth. These data are integrated with race, ethnicity, economic status, data from wearable devices and other health data from electronic health records, as well as genetic data. Participants also can choose to receive genetic health-related information in return, including whether they are at a higher risk for certain hereditary diseases and how their body might react to certain medications. Eventually, most participants will also have their whole genome sequenced. Collecting such wide-ranging information will allow researchers to pursue many questions, including how racism, economic instability or neighborhood impact the health of specific populations or even subgroups of the LGBTQ community.

“Many of us have heard the saying ‘Your ZIP code can predict more about your health than your genetic code’,” Lunn said. “We’re particularly interested in understanding how some of these social determinants of health influence the experiences and outcomes of LGBTQ people compared with cisgender straight people.”  

The results of the study, which analyzed the data from about 30,000 LGBTQ people and more than 370,000 cisgender straight people, were consistent with what has been previously observed — mental and substance use disorders are more prevalent in the LGBTQ community, and cisgender sexual minority men are more likely than cisgender straight people or other members of the LGBTQ community to be living with HIV. This consistency is reassuring to the researchers. 

“The All of Us Research Program is so large and is collecting so many types of data, it’s important to evaluate whether the data is accurate and can capture some of these known health outcomes,” Tran said. “Our findings demonstrate that it is feasible to use this information to improve health and health outcomes for the sexual and gender minority populations. One of the things that is most interesting is that we saw variations in outcomes not just between LGBTQ and cisgender straight people, but also among subgroups.” 

Varying health findings

For example, the study found gender diverse people assigned male at birth and transgender women were less likely to have asthma than cisgender straight people, while members of other LGBTQ subgroups were more likely to have asthma. Transgender men were more likely than cisgender straight men to have a body mass index equal to or over 25, which is considered overweight, while other LGBTQ subgroups were less likely to have a body mass index above 25. 

“We have not been able to ascribe data from electronic health records to specific LGBTQ groups before,” Tran said. “Now we’ve laid the groundwork for a multi-dimensional view of health outcomes among sexual and gender minority people. It’s a very exciting starting point.”

As Lunn noted, “I want to emphasize that it’s not being LGBTQ that creates health problems. It’s the homophobia and transphobia, the lack of access to health care and the many other challenges faced by this community. We’ve not been able to study this thoroughly before. But now there is almost an overload of rich and complex data.” 

People who want to enroll in the All of Us Research Program can do so online or by emailing [email protected] to arrange a one-to-one appointment via Zoom or in person with a Stanford-based All of Us research coordinator regardless of their sexual orientation or gender identity. 

Researchers from the All of Us Research Program; Covalent Solutions; the University of Minnesota, Minneapolis; Cherokee Health Systems; the University of Chicago; the Asian Health Coalition; the Los Angeles LGBT Center; and the University of California, San Francisco, contributed to the study. 

Precision Medicine Initiative, PMI, All of Us, the All of Us logo, and “The Future of Health Begins With You” are service marks of the U.S. Department of Health and Human Services, National Institute of Health.

The study was funded by the National Institutes of Health (grants OT2 OD026549, OT2 OD026554, OT2 OD026557, OT2 OD026556, OT2 OD026550, OT2 OD 026552, OT2 OD026553, OT2 OD026548, OT2 OD026551, OT2 OD026555, AOD21037, AOD22003, AOD16037, AOD21041, HHSN 263201600085U, U2C OD023196, U24 OD023121, U24 OD023176, U24 OD023163 OT2 OD023205, OT2 OD023206, OT2 OD025277, OT2 OD025315, OT2 OD025337, OT2 OD025276 and OT2 OD027077) and the Gill Foundation. 

About Stanford Medicine

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Executive Summary

Profile of lgbtq americans, attitudes toward lgbtq policies, the role of lgbtq rights in elections, the relationship between christian nationalism and support for lgbtq rights, appendix a. methodology for measuring lgbtq identity, appendix b. methodology for measuring christian nationalism scale, appendix c. survey methodology.

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Throughout 2023, PRRI interviewed more than 22,000 adults as part of its American Values Atlas , allowing for the ability to provide a detailed profile of the demographic, religious, and political characteristics of LGBTQ Americans. As in years past, this analysis measures Americans’ attitudes on LGBTQ rights across all 50 states on three key policies: nondiscrimination protections, religiously based service refusals, and same-sex marriage. This year’s report also includes new analysis of the intersection between Christian nationalist views and LGBTQ attitudes in each state.

LGBTQ Americans skew younger, more Democratic, and less religious than other Americans.

• More than one in five young Americans (18-29 years) identify as LGBTQ (22%). One in ten people ages 30-49 (10%), 6% of people between 50 and 64 years, and 3% of people 65 years or older identify as LGBTQ. Twenty-four percent of Gen Z Americans (aged 18 to 25) identify as LGBTQ.
• A plurality of LGBTQ Americans are Democrats (46%); nearly six in ten LGBTQ Americans consider themselves liberal politically (58%).
• The majority of LGBTQ Americans identify as religiously unaffiliated (52%), nearly twice the rate of the general U.S. population (27%). More than a third of LGBTQ Americans identify with a Christian faith (35%) and 5% belong to non-Christian religions.

LGBTQ identification and support for LGBTQ rights differ by state.

• Geographically, the proportion of residents who identify as LGBTQ ranges from 4% in both Alabama and South Carolina, respectively, to 16% in New Mexico.
• Since 2016, LGBTQ identification among those under 30 has increased by about 15 percentage points in blue states and battleground states (from 10% to 25% and from 9% to 23%, respectively) and by more than ten percentage points in red states (from 9% to 20%).
• More than seven in ten residents of red (71%), battleground (75%), and blue (79%) states favor nondiscrimination laws; however, residents of blue states are far more likely to strongly favor LGBTQ nondiscrimination laws compared with their red state counterparts (43% v. 34%).
• Opposition to religious refusals is lowest among red state residents (54%) while two-thirds (66%) of residents in blue states oppose service refusals; 58% of residents in battleground states oppose such refusals.
• While majorities across almost all states support same-sex marriage rights, there is wide variation across the country. In states where same-sex marriage would continue to be legal if the Supreme Court’s 2015 Obergefell decision were overturned, 72% of people favor allowing gay and lesbian couples to marry legally compared with 64% in states where same-sex marriage would no longer be legal if Obergefell were overturned.

Strong majorities of Americans — including most people of faith — support nondiscrimination protections for LGBTQ individuals, but overall support has declined.

• More than three-quarters of Americans supported policies that protect LGBTQ Americans from discrimination in housing, employment, and public accommodation (76%) in 2023, a decline from a high of 80% the previous year, in 2022.
• While support for nondiscrimination protections among Democrats stayed steady from 2022 to 2023, support dropped among Republicans by seven percentage points (from 66% to 59%).
• Many religious groups — though not all — registered small drops in support for nondiscrimination protections in the past year.
• Americans aged 18-29 show a gradual decrease in support for LGBTQ nondiscrimination laws over the last three years, declining from a peak of 83% in 2020 to 75% in 2023.

Opposition to religiously based service refusals dropped five percentage points in the past year, from 65% in 2022 to 60% in 2023.

• A majority (59%) of independents and more than eight in ten Democrats (82%) oppose allowing small business owners to refuse service to LGBTQ people based on their religious beliefs; opposition to such refusals has declined among Republicans, from 40% in 2015 to just 34% in 2023.
• A majority of members of most religious groups oppose religiously based service refusals; however, just 30% of white evangelical Protestants oppose religiously based service refusals, down from 37% in 2022.

Support for same-sex marriage has declined among Americans in the last year, dropping from 69% to 67%.

• Majorities of most religious traditions favor allowing same-sex couples to marry legally. Yet some religious groups show a decline in support from the last year, including Hispanic Catholics, whose support declined from 75% in 2022 to 68% in 2023.
• Fewer than half of Latter-day Saints, Hispanic Protestants, white evangelical Protestants, Muslims, and Jehovah’s Witnesses support same-sex marriage.
• Older Americans are less supportive of same-sex marriage than younger Americans. However, support among young Americans (18-29) has seen a gradual decline since 2018, when 79% of young Americans supported this right, to 71% today.

  LGBTQ rights drive voting decisions of Democrats more than Republicans, younger Americans more than older Americans.

• A plurality of Americans (38%) say that LGBTQ rights is one of various factors they will consider, 30% say they would only vote for a candidate who shares their views on this issue, and 29% say they do not see LGBTQ rights as a major issue.
• A plurality of young Americans (38%) and members of Gen Z (38%) say they would only vote for a candidate who shares their views on LGBTQ rights.
• Democrats are the most likely to say they would only vote for a candidate who shares their views on this issue (38%), compared with Republicans (29%) and independents (25%).

Christian nationalism Rejecters are more likely to support LGBTQ rights than Skeptics, Sympathizers, or Adherents.

• Christian nationalism Rejecters are nearly unanimous (93%) in their support for laws that protect LGBTQ people from discrimination in housing, employment, and accommodation, including more than seven in ten (72%) who strongly favor nondiscrimination laws. Only among Christian nationalism Adherents does a majority (52%) oppose nondiscrimination laws.
• Just 32% of Christian nationalism Adherents oppose allowing religiously based refusals compared with 85% of Christian nationalism Rejecters.
• Just 22% of Christian nationalism Adherents support same-sex marriage, compared with 93% of Christian nationalism Rejecters.
• Across all 50 states, scatter plots show a clear pattern: support for Christian nationalism is negatively correlated with support for the three policies discussed in this report.  

In 2023, roughly one in ten Americans (10%) identified as part of the LGBTQ community; this includes 3% who identify as gay or lesbian, 4% who identify as bisexual, and 2% who identify as “something else.” Among the LGBTQ population, a plurality identifies as bisexual (45%), 34% identify as gay or lesbian, and 21% identify as “something else.” In addition, 2% of the LGBTQ population are transgender or nonbinary. [1]

The characteristics of LGBTQ Americans show a very young and diverse population. LGBTQ Americans are overrepresented among the youngest generations, Democrats, and liberals, while reflecting the geographic and racial diversity of the general population.

Age and Generation

A plurality of LGBTQ Americans (44%) are between the ages of 18 and 29. Youth representation in the LGBTQ community is more than twice what it is in the general U.S. adult population (44% vs. 19%). Along with one-third of LGBTQ Americans between the ages of 30 and 49 (34%), nearly three-quarters of LGBTQ Americans (78%) are under the age of 50. By contrast, a slim majority of American adults are younger than 50 (51%). Fifteen percent of LGBTQ Americans are between the ages of 50 and 64. Fewer than one in ten are 65 years or older (7%), roughly one-third of the national rate (22%).

More than one in five Americans 18-29 years (22%) identify as LGBTQ. One in ten people ages 30-49 (10%), 6% of people between 50 and 64, and 3% of seniors (65 years or older) identify as LGBTQ.

A plurality of LGBTQ Americans (44%) are millennials. In comparison, nearly three in ten LGBTQ Americans (27%) are members of Generation Z. [2] Overall, more than seven in ten LGBTQ Americans belong to the two youngest generational cohorts. The percentage of Gen Z adults within the LGBTQ adult population (27%) is more than twice the share of Gen Z among the general adult population (11%). Millennials (44%) are also overrepresented among the adult LGBTQ population compared with their share in the general adult population (30%). Members of Generation X (16%), baby boomers (12%), and the Silent Generation (1%) are underrepresented among LGBTQ populations compared with their share in the general population (26%, 28%, and 5%, respectively).

Looking at the share of Americans by generation who identify as LGBTQ, nearly one-quarter of Gen Z adults (24%) identify as LGBTQ, as do 15% of millennials. Fewer than one in ten Gen Xers (6%), baby boomers (4%), and members of the Silent Generation (2%) identify as LGBTQ.

Race and Education

LGBTQ Americans’ racial composition is similar to the U.S. adult general population. A majority of LGBTQ Americans identify as white (59%), one in five are Hispanic (20%), 11% are Black, 5% of LGBTQ Americans are Asian American or Pacific Islanders (AAPI), 3% are multiracial, and 2% have another racial identity. Twelve percent of Hispanic Americans identify as LGBTQ, as do 9% of Black and white Americans and 8% of the AAPI population.

LGBTQ Americans (33%) are as likely as the general population (35%) to be college graduates. LGBTQ Americans account for similar shares of college graduates (9%) and of people without college degrees (10%). Nine percent of white people with college degrees and without college degrees are LGBTQ.

Similarly, the geographic distribution of the LGBTQ population echoes the general population. More than one-third of LGBTQ Americans (35%) live in the South, about one-quarter live in the West (27%), and about one in five each live in the Northeast (20%) and Midwest (19%). Meanwhile, similar proportions of the population in all of the country’s regions identify as LGBTQ: 9% of Midwesterners, 9% of Southerners, 11% of Northeasterners, and 12% of Westerners.

New Mexico (16%), the District of Columbia (15%), Nebraska (14%), Nevada (14%), and Oregon (14%) have the highest proportion of LGBTQ residents. The three states in the Northeast with the highest share of LGBTQ residents are Vermont (13%), Massachusetts (13%), and New York (12%).

The five states with the lowest proportion of LGBTQ residents are Alabama (4%), South Carolina (4%), Louisiana (5%), Iowa (5%), and Hawaii (6%).

Compared with 2016, the size of the LGBTQ population has more than doubled from 4% to 10%. In 2016, the state with the highest proportion of LGBTQ residents was Nevada (7%). With the exception of six states, most states matched or surpassed this percentage in 2023.

In addition, when we sort states into safe Republican states, safe Democratic states, and the seven states considered to be battlegrounds in the 2024 presidential election and compare them with 2016, LGBTQ Americans living in these states have doubled (roughly from 4% to 10%), and this is especially evident among young Americans. [3]  While LGBTQ identification among those under 30 who live in blue states (from 10% in 2016 to 25% in 2023) and battleground states (from 9% in 2016 to 23% in 2023) went up by about 15 percentage points, it also went up by 11 percentage points among those who live in red states (from 9% to 20%). Further, although at a lower rate, LGBTQ identification increased among those over 30, too.

Party and Ideology

A plurality of LGBTQ Americans identify as Democrats (46%), about three in ten are independents (30%), and fewer than one in ten are Republicans (8%). A substantial group (16%) identify with other parties or don’t know their preferred political identity. Fourteen percent of Democrats and 10% of independents identify as LGBTQ. Only 3% of Republicans identify as LGBTQ.

When it comes to political ideology, nearly six in ten LGBTQ Americans (58%) consider themselves liberal, and more than one-quarter are moderate (27%). Thirteen percent say they are conservative. Among self-professed liberals, nearly one in five identify as LGBTQ (19%). Less than one in ten independents (8%) and conservatives (4%) identify as LGBTQ.

Religious Tradition

The majority of LGBTQ Americans identify as religiously unaffiliated (52%), nearly twice the rate of the general U.S. population (27%). More than one-third identify with various Christian faiths (35%), including white mainline/non-evangelical Protestant (8%), white Catholic (6%), Black Protestant (5%), white evangelical Protestant (5%), and Hispanic Catholic (5%). A similar number belong to other non-Christian religions (5%).

The religious traditions with the largest share of LGBTQ people in their midst include Unitarian Universalists (29%), members of other non-Christian religions (28%), and the religiously unaffiliated (19%). Other traditions with shares of LGBTQ adherents similar to the share of LGBTQ representation in the general population include Jewish Americans (13%), Buddhists (14%), Muslims (12%), Hispanic Protestants (10%), and Hindus (8%). The religious traditions with the lowest proportion of LGBTQ adherents are white evangelical Protestants (4%), Jehovah’s Witnesses (4%), and Latter-day Saints (3%).

As part of the American Values Atlas , PRRI has been asking questions to gauge Americans’ support for or opposition to three critical policies related to LGBTQ rights: (1) nondiscrimination laws, (2) service refusals, and (3) same-sex marriage. The nondiscrimination laws are worded as, “Laws that would protect gay, lesbian, bisexual, and transgender people against discrimination in jobs, public accommodations, and housing.” Service refusal policies are worded as, “Allowing a small business owner in your state to refuse to provide products or services to gay or lesbian people if doing so would violate their religious beliefs.” With respect to same-sex marriage, we asked Americans whether they were in favor of “allowing same-sex couples to marry legally.” [4]

Support for Nondiscrimination Protections 2015-2023

Party affiliation.

Asked about their support for or opposition to policies that protect LGBTQ Americans from discrimination in housing, employment, and public accommodation, more than three-quarters of U.S. adults (76%) favor the enactment of such policies. This represents a five-percentage-point increase compared with when the question was first asked in 2015, although support for such nondiscrimination protections dropped from a high of 80% of Americans in 2022.

Majorities of Americans, regardless of political affiliation, support laws protecting LGBTQ Americans from discrimination. This includes nearly nine in ten Democrats (89%), about eight in ten independents (78%), and almost six in ten Republicans (59%). Compared with 2015, support for LGBTQ nondiscrimination laws has increased by 11 percentage points among Democrats (89% v. 78%) and by five percentage points among independents (78% v. 73%). Republican support is slightly lower in 2023 compared with 2015 (61%). Yet, support has dropped among both Republicans and independents from 2022. In 2022, two in three Republicans supported laws protecting LGBTQ Americans, compared with roughly six in ten today. Support for nondiscrimination protections among independents also dropped four percentage points, from 82% in 2022 to 78% in 2023.

Religious Affiliation

The majority of most religious groups support nondiscrimination protections, the only exception being Jehovah’s Witnesses (40% in favor). The strongest supporters of nondiscrimination protections include Unitarian Universalists (93%), religiously unaffiliated Americans (86%), Buddhists (83%), and Jewish Americans (81%).

Aside from Jehovah’s Witnesses, the lowest levels of support for nondiscrimination protections are from white evangelical Protestants and Muslims (56%) and Hispanic Protestants (61%). Compared with 2015, when PRRI started asking this question, Black Protestants have shown the largest increase in support. In 2015, nearly two-thirds of Black Protestants favored laws protecting LGBTQ Americans from discrimination (64%), compared with more than three-quarters in 2023 (77%), a 13-percentage-point increase. Jehovah’s Witnesses (-10 points), and Hispanic Catholics (-8 points) show the most dramatic declines in support for nondiscrimination laws between 2022 and 2023.

Demographics

Americans in all age groups favor nondiscrimination laws, including around three-quarters of Americans under 30 (75%), Americans between 30 and 49 (76%), Americans between 50 and 64 (75%), and seniors over the age of 65 (75%). Americans 18 to 29, however, have experienced a gradual decline in support for LGBTQ nondiscrimination laws over the last three years. Support among this age group peaked in 2020 when 83% expressed support for LGBTQ nondiscrimination laws. In 2022, support declined to 80%, then dropped an additional five percentage points between 2022 and 2023. Support among other age cohorts has also declined in recent years from their peak levels, but those peak levels of support were not as high as the 18-29 cohort.

About three-quarters of white (75%), Black (74%), and Hispanic (75%) Americans, and 82% of Asian American and Pacific Islanders favor laws protecting LGBTQ people from discrimination. Nearly eight in ten women (78%), more than seven in ten men (72%), and nine in ten LGBTQ Americans (90%) support nondiscrimination laws.

In states where nondiscrimination laws are in place, nearly eight in ten residents favor such laws (79%). [5] More than seven in ten residents of states without LGBTQ nondiscrimination laws are also in favor (72%).

More than eight in ten residents of Hawaii (88%), the District of Columbia (87%), Connecticut (86%), Utah (86%), and Nevada (85%) favor laws protecting LGBTQ Americans from discrimination. The five states with the lowest levels of support for nondiscrimination laws are Arkansas (60%), Alabama (61%), Oklahoma (61%), Wyoming (61%), and South Carolina (65%). There are also six states where support for nondiscrimination laws declined by nine percentage points or more between 2022 and 2023: Rhode Island (-15), Arkansas (-14), Louisiana (-14), New Hampshire (-14), Iowa (-11), and West Virginia (-9).

Dividing the national map into battleground, blue, and red states shows minor differences in support for nondiscrimination laws. More than seven in ten residents of red (71%), battleground (75%), and blue (79%) states favor laws that would protect gay, lesbian, bisexual, and transgender people against discrimination in jobs, public accommodations, and housing. However, residents of blue states are far more likely to strongly favor LGBTQ nondiscrimination laws compared with their red state counterparts (43% vs. 34%).

Opposition to Religiously Based Refusals 2015-2023

Since the American Values Atlas started measuring this policy, the American public has consistently opposed “allowing a small business owner in your state to refuse to provide products or services to gay or lesbian people if doing so would violate their religious beliefs.” In 2015, 59% opposed the idea; 60% opposed it in 2023.

A majority of independents (59%) and more than eight in ten Democrats (82%) oppose allowing small business owners to refuse service to LGBTQ people based on their religious beliefs. By contrast, nearly two-thirds of Republicans (64%) favor this policy, and only about one-third oppose it (34%). Opposition among independents grew from 59% to a high of 66% in 2021 but dropped again to 59% in 2023. Opposition among Democrats also increased from 74% in 2015. However, there has been a four-percentage-point decrease since 2022, from 86%. Meanwhile, fewer Republicans oppose allowing small business owners to refuse service to LGBTQ people if it violates their religious beliefs. In 2015, 40% were opposed, but just 34% oppose religiously based service refusals in 2023.

A majority of members of most religious groups oppose religiously based service refusals, with some exceptions. Among the most vigorous opponents of laws allowing small business owners to refuse service to LGBTQ people are Unitarian Universalists (85%), Hindus (77%), the religiously unaffiliated (74%), Jewish Americans (71%), other non-white Catholics (71%), Hispanic Catholics (70%), Black Protestants (68%), Buddhists (68%) and members of other non-Christian religions (67%). [6]  Opposition to religiously based refusals among Hispanic Catholics went down by eight percentage points since 2022, from 78% to 70% in 2023, reaching similar 2015 levels (69%).

A slim majority of Muslims (58%), white Catholics (57%), white mainline/non-evangelical Protestants (57%), Orthodox Christians (54%), and half of Hispanic Protestants and other protestants of color (49%) also oppose religiously based refusals. Opposition to religiously based refusals among Hispanic Protestants went down from 63% in 2022 to 50% in 2023, even lower than 2015 levels (59%). Among white Catholics and white mainline/non-evangelical Protestants, opposition also went down from 2022 (64% and 62%, respectively), reaching 2015 levels as well (58% and 56%, respectively).

Among adherents of three religious traditions, white evangelical Protestants (30%), Latter-day Saints (41%), and Jehovah’s Witnesses (45%), a minority opposes while the majority stands in support. Among white evangelical Protestants, opposition has consistently declined from 38% in 2015 and 37% in 2022 to 30% in 2023.

Sixty-four percent of young Americans and a majority of seniors (56%) oppose service refusals. There has been some fluctuation since 2015, but majorities across age groups continue to oppose religiously based refusals. However, there has been a decline in opposition among young Americans (70%), Americans ages 50-64 (65%), and seniors (61%) since 2022.

Majorities of all racial groups oppose small businesses refusing service to LGBTQ people based on religious beliefs, including roughly two-thirds of Hispanics (65%), Black Americans (68%), and Asian Americans (69%). A majority of white Americans (56%) also oppose refusals.

In our 2023 American Values Atlas , there are few differences by educational attainment, with roughly six in ten Americans with no college degree (59%) and with college degrees (63%) opposing businesses refusing service to LGBTQ people. A majority of white people without a college degree (54%) and nearly six in ten whites with college degrees (60%) also oppose service refusals.

Women (64%) are more likely to oppose businesses refusing service to LGBTQ people, though a majority of men (55%) also oppose them. More than eight in ten LGBTQ Americans (82%) also oppose religiously based LGBTQ service refusals.

Majorities of Americans in all regions of the country also oppose allowing small businesses to refuse service to LGBTQ persons if doing so would violate the businesses’ religious beliefs. Opposition ranges from roughly two-thirds of people in the Northeast (67%) and West (63%) to the majority of Midwesterners (59%) and Southerners (56%).

Residents in Massachusetts (75%), Hawaii (73%), Connecticut (70%), New York (70%), and the District of Columbia (69%) have the strongest opposition to religiously based service refusals. By contrast, in five states at least half of residents are in favor of service refusals: Nebraska (56%), South Dakota (55%), Idaho (53%), Montana (52%), and West Virginia (50%).

A majority of residents in red states (54%), 58% of residents of battleground states, and nearly two-thirds of residents in blue states (66%) oppose laws allowing a small business owner to refuse to provide products or services to LGBTQ people if doing so would violate their religious beliefs.

Support for Same-Sex Marriage 2014-2023

Two-thirds of Americans (67%) support allowing same-sex couples to marry legally, an increase of 13 percentage points from 2014, when a slight majority (54%) favored same-sex marriage. Support for same-sex marriage rates decreased slightly from 2022, when 69% of Americans supported same-sex marriage rights.

More than eight in ten Democrats favor same-sex marriage (82%), a 17% increase since 2014, when 65% of Democrats favored allowing gay and lesbian couples to marry legally. The majority of independents (71%) also support same-sex marriage, showing a similar 13-point increase compared with 2014 (58%). Republicans are more divided on this issue. While a small majority (51%) opposes allowing same-sex couples to marry legally, a substantial minority is in favor (47%). Since 2014, Republican support for same-sex marriage has increased by 12 percentage points, when over one-third (35%) were in favor. However, their support for same-sex marriage rights dropped slightly from 2022, when 49% of Republicans supported such rights. Among independents, there was also a 2% drop in support, from 73% in 2022 to 71% in 2023.

Majorities of most religious traditions are in favor of allowing same-sex couples to marry legally. Most notably, at least eight in ten Unitarian Universalists (88%), religiously unaffiliated (86%), Buddhists (82%), and Jewish Americans (80%) favor same-sex marriage. Hispanic Catholics show the most decline in their support since 2022, from 75% to 68% in 2023.

By contrast, there are four traditions in which a minority is in favor of same-sex marriage, and the majority opposes it. About one in five Jehovah’s Witnesses (18%), roughly four in ten white evangelical Protestants (37%) and Hispanic protestants (44%), 40% of Muslims, and 47% of Latter-day Saints favor allowing gay and lesbian couples to marry. Some of these traditions have seen substantial increases in support for same-sex marriage since 2014, when 12% of Jehovah’s Witnesses, 28% of white evangelical Protestants, and 27% of Latter-day Saints were in favor.

The Role of Age and Support for Same-Sex Marriage

Seventy-one percent of young Americans (18-29) currently favor same-sex marriage. However, this level of support represents a slight but gradual decline among younger Americans for same-sex marriage rights since 2018, when 79% of young Americans supported such rights. A similar share of people aged 30-49 (71%) favor same-sex marriage. More than six in ten Americans ages 50-64 (65%) and seniors (61%) are also in favor of allowing gay and lesbian couples to marry legally.

There are important age differences within various religious groups. A majority of white evangelical Protestants oppose same-sex marriage regardless of age. However, white evangelical Protestants under the age of 50 are less opposed than their older cohorts. Forty-two percent of young white evangelical Protestants and 44% of those between the ages of 30-49 favor same-sex marriage. Only 27% of seniors in their cohort favor allowing same-sex marriage.

Among Black Protestants, only seniors are divided regarding same-sex marriage. Forty-seven percent are in favor and 48% are opposed, while the majority of all other age groups favor same-sex marriage. The pattern is similar among Hispanic Protestants. The majority of people over 30 oppose same-sex marriage, but more than six in ten young Hispanic Protestants (63%) favor allowing same-sex couples to marry legally.

While Republicans are split on the issue of same-sex marriage, among Republican seniors, a majority oppose (59%) and 39% are in favor. Only among Republicans ages 30-49 is a majority in favor of same-sex marriage (52% favor, 47% oppose). Among Democrats, at least 79% of all age groups are in favor of same-sex marriage, including 85% of people under 30, 83% of people aged 30-49, 80% of people between 50 and 64, and 79% of seniors. At least two-thirds of independents of all ages also favor same-sex marriage. Seventy-five percent of young independents, 74% of independents 30-49 years, 69% of independents ages 50-64, and 65% of seniors are in favor of allowing same-sex couples the right to marry.

Women are more likely than men to support same-sex marriage in all age brackets. However, the differences are more substantial between young women (75% in favor) and young men (67%), an eight-point difference. The differences between women and men in other age cohorts are smaller: three points among people ages 30-49 (72% vs. 69%), two points between people 50-64 (66% vs. 64%), and three points between women (62%) and men (59%) 65 years and older.

A majority of Americans of all races are in favor of allowing gay and lesbian couples to marry legally. This support ranges from 56% among Black Americans, 63% of Hispanics, 69% of whites, and 75% of AAPIs.

Roughly six in ten Americans without a college degree (61%) and three-quarters of college graduates (77%) are in favor of same-sex marriage. Among whites with no college degree, 63% are in favor of same-sex marriage, while nearly eight in ten whites with college degrees (79%) favor it.

More than six in ten men (65%) and women (69%) favor same-sex marriage, while more than nine in ten LGBTQ Americans (90%) support the policy.

The Northeast (74%) is the region exhibiting the strongest support for same-sex marriage, followed by the West (70%) and Midwest (68%). The weakest support for same-sex marriages is in the South (61%).

Solid majorities across all states support same-sex marriage with the top states showing about eight in ten residents in favor, including 81% in Massachusetts, 81% in Vermont, and 80% in Connecticut, as well as 80% in the District of Columbia. The five states with the least support for same-sex marriage are Arkansas (49%), Mississippi (50%), Alabama (51%), and South Carolina (52%).

Further, 72% of people who live in states where same-sex marriage would continue to be legal if the Supreme Court’s 2015 Obergefell v. Hodges decision were overturned are in favor of allowing gay and lesbian couples to marry legally, while 64% of people who live in states where same-sex marriage would no longer be legal favor same-sex marriage. [7]

PRRI asked a question about the role of LGBTQ rights with respect to respondents’ voting decisions that reads, “Thinking about how the following issues might affect your vote for major political offices, would you: Only vote for a candidate who shares your views on this issue; consider a candidate’s position on this issue as just one of many important factors; not see this as a major issue.” A plurality of Americans (38%) say that LGBTQ rights is one of many important factors they will consider, 30% say they would only vote for a candidate who shares their views on this issue, and 29% say they do not see LGBTQ rights as a major issue. A plurality of young Americans (38%) and members of Gen Z (38%) say they would only vote for a candidate who shares their views on LGBTQ rights.

Though a plurality of Democrats (43%) say LGBTQ rights is one of many issues they consider when voting, they are the least likely to say it is not an issue (17%). Democrats are also the most likely to say they would only vote for a candidate who shares their views on this issue (38%), compared with 29% of Republicans and 25% of independents. The religiously unaffiliated is the only tradition where a plurality (39%) says that they would only vote for a candidate who shares their views on LGBTQ rights, while 36% say they consider a candidate’s position on LGBTQ rights as one of many important issues, and one-quarter do not see LGBTQ rights as a major issue deciding their vote (25%). White evangelical Protestants have views similar to the religiously unaffiliated. More than one-third say they would only vote for a candidate whose views match their own (35%), while 35% say LGBTQ rights is one of many issues they consider when voting for a candidate. Nearly three in ten say this is not a major issue (29%).

The link between Christian nationalism and support or opposition to policies affecting LGBTQ populations is stark. Attitudes toward the three policies discussed in this report have opposite reactions depending on peoples’ affinity for Christian nationalism. Using PRRI’s Christian nationalism scale, which sorts respondents into four types depending on their responses to a battery of five questions gauging different tenets of Christian nationalism, we can see how adherence or rejection to Christian nationalism relates to support or opposition to LGBTQ policies. [8]

Support for Nondiscrimination Protections

Christian nationalism Rejecters are nearly unanimous (93%) in their support for laws that protect LGBTQ people from discrimination in housing, employment, and accommodation, including more than seven in ten who strongly favor them (72%). Majorities of Christian nationalism Skeptics (79%) and Sympathizers (63%) are in favor of LGBTQ nondiscrimination laws. Only among Christian nationalism Adherents (52%) does a majority oppose nondiscrimination laws, while 45% favor them.

Majorities of white Christian nationalism Rejecters (93%), Skeptics (79%), and Sympathizers (62%) favor laws that protect LGBTQ individuals from discrimination in housing, accommodation, and employment. A majority of white Christian nationalism Adherents (57%) oppose LGBTQ antidiscrimination laws, and 41% are in favor.

Black Americans, regardless of their support for Christian nationalism, are in favor of laws protecting LGBTQ Americans from discrimination. Black Christian nationalism Rejecters (89%) are the most in favor of these laws, including roughly two-thirds who strongly favor them (66%). Eighty percent of Black Christian nationalism Skeptics, 69% of Sympathizers, and 61% of Adherents favor LGBTQ nondiscrimination laws.

Hispanic Americans have a similar pattern to whites in the way Christian nationalism intersects with support for LGBTQ nondiscrimination laws. More than nine in ten Hispanic Christian nationalism Rejecters (92%), 80% of Skeptics, and 60% of Sympathizers favor laws that would protect LGBTQ people from discrimination. Among Hispanic Christian nationalism Adherents, a majority (51%) opposes nondiscrimination laws and 45% favors them.

The Relationship Between Christian Nationalism and Support for Nondiscrimination Protections by State

Support for Christian nationalism is negatively correlated with support for LGBTQ nondiscrimination laws in the 50 states. The scatter plot below shows the relationship between a state’s average raw score on the Christian nationalism scale (with a range from zero to one) on the X axis, plotted against the percentage of that state’s support for LGBTQ nondiscrimination laws on the Y axis.

The downward sloping trend line through the distribution demonstrates that, overall, the higher a state’s residents scored on the Christian nationalism scale, the less likely they are to favor laws protecting LGBTQ people from discrimination.

For example, Alabama has an average score of 0.48 on the Christian nationalism scale, and 61% of its residents favor nondiscrimination protections. Similarly, Mississippi has an average score of 0.48 on the Christian nationalism scale and 74% of that state’s residents support laws protecting LGBTQ people from discrimination. At the other end of the scale, Oregon has an average Christian nationalism score of 0.22 and 81% of its residents support these laws.

Opposition to Religiously Based Refusals

Regarding the policy of allowing small businesses to refuse service to LGBTQ persons if doing so violates their religious beliefs, the vast majority of Christian nationalism Rejecters (85%) and six in ten Skeptics (60%) oppose it. By contrast, among Christian nationalism Sympathizers (58%) and Adherents (66%), the majority favors service refusals. Forty percent of Sympathizers and 32% of Adherents oppose.

White Christian nationalism Rejecters (85%) oppose allowing a small business owner to refuse to provide products or services to LGBTQ people if doing so would violate their religious beliefs, similar to all Christian nationalism Rejecters. A majority of white Christian nationalism Skeptics (55%) also oppose but with a slightly lower majority than Skeptics in general.

Opposition among white Christian nationalism Sympathizers (35%) and Adherents (23%) is weaker than among Christian nationalism Sympathizers and Adherents overall. A larger majority of white Christian nationalism Sympathizers (65%) and Adherents (76%) are in favor of LGBTQ service refusal laws than among Christian nationalism Sympathizers and Adherents overall.

A majority of Black Americans oppose service refusals independent of their support for Christian nationalism. Eighty-five percent of Black Christian nationalism Rejecters oppose laws allowing businesses to refuse service to LGBTQ people, including 63% who strongly oppose. More than seven in ten Black Christian nationalism Skeptics (72%), 60% of Sympathizers, and 55% of Adherents also oppose service refusal laws.

Hispanic Christian nationalism Rejecters (81%) and Skeptics (70%) have patterns similar to those of Black Americans. However, contrary to white (majority in favor) and Black (majority opposed) Christian nationalism Sympathizers and Adherents, Hispanic Christian nationalism Sympathizers and Adherents are more divided on the issue (47% oppose, 50% favor and 44% oppose, 51% favor, respectively).

The Relationship Between Christian Nationalism and Opposition to Allowing Religiously Based Service Refusal by State

In Figure 20, the downward sloping trend line through the distribution shows that, overall, the higher a state’s residents scored on the Christian nationalism scale, the less likely they are to oppose religiously based refusals. Mississippi has an average score of 0.48 on the Christian nationalism scale, and 53% of residents oppose allowing small business owners to refuse services to LGBTQ people. Similarly, Alabama has an average score of 0.48 on the Christian nationalism scale and 51% of the state’s residents oppose religiously based refusals. At the other end of the scale, Oregon and Washington both have average Christian nationalism scores of 0.22 and 66% and 64% of their residents respectively oppose religiously based refusals.

Support for Same-Sex Marriage

When it comes to same-sex marriage, a similar pattern emerges. While strong majorities of Christian nationalism Rejecters and Skeptics are in favor of allowing gay and lesbian couples the right to marry legally, Christian nationalism Sympathizers and Adherents oppose it.

Ninety-three percent of Christian nationalism Rejecters and nearly three-quarters of Skeptics (74%) favor allowing same-sex couples to marry legally. By contrast, the majority of Christian nationalism Sympathizers (55%) and more than three-quarters of Adherents (77%) oppose same-sex marriage. A majority of Adherents (52%) strongly oppose same-sex marriage. On this issue, Christian nationalism Rejecters, Skeptics, Sympathizers, and Adherents have similar patterns regardless of race.

White Christian nationalism Rejecters are nearly unanimous (95%) in their support for same-sex marriage while 83% of Black Rejecters and 89% of Hispanic Rejecters also favor same-sex marriage. More than three-quarters of white (77%), 62% of Black, and 70% of Hispanic Christian nationalism Skeptics also favor allowing gay and lesbian couples the right to marry legally.

Majorities of Christian nationalism Sympathizers and Adherents, regardless of race, oppose same-sex marriage. Among Sympathizers opposition is weaker than among Adherents, but still 53% of white, 56% of Black, and 55% of Hispanic Sympathizers oppose allowing same-sex marriage. Strong majorities of Christian nationalism Adherents oppose same-sex marriage across racial groups, including 78% of white, 70% of Black, and 75% of Hispanic Adherents.

The Relationship Between Christian Nationalism and Support for Same-Sex Marriage by State

Figure 22 shows a clear negative correlation between a state’s score on the Christian nationalism scale and support for same-sex marriage. For example, both Alabama and Mississippi score 0.48 on the Christian nationalism scale, and 51% and 50% of their residents favor same-sex marriage, respectively. At the other end of the scale, Oregon and Washington have average Christian nationalism scores of 0.22 and 75% and 78% of their residents favor same-sex marriage, respectively.

Measuring Gender Identity

We derive our gender identity measure from the following two questions:

What sex were you assigned at birth on your original birth certificate? Select one answer only.

1. Male 2. Female

What is your current gender identity?  Select all answers that apply.

1. Male 2. Female 3. Transgender 4. Non-binary 5. A different identity, please specify

We first count the number of responses to the current gender identity question. If respondents give one answer only, and it matches their response for sex assigned at birth, they are considered cisgender. All other cases are classified as transgender/non-binary, including: if respondents answer the current gender identity question with the gender that is opposite their sex at birth, the transgender response alone, or the transgender response in combination with the gender opposite their sex at birth; if respondents select the non-binary alone, or a different identity option alone; or if the respondents pick the non-binary or different identity option along with male or female.

Measuring Sexual Orientation

We measure sexual orientation using the following question: Which of the following best describes how you think of yourself? Select one answer only.

1. Gay or lesbian 2. Straight, that is, not gay 3. Bisexual 4. Something else

Creating the LGBTQ Identity Variable

We code “gay or lesbian,” “bisexual,” and “something else” responses as LGBTQ and “straight, that is, not gay” into straight or non-LGBTQ. Then we combine this variable with our gender identity variable and code those who identify as “transgender/non-binary/something else” and “gay or lesbian/ bisexual/something else,” as LGBTQ and code “cisgender males and females” who identify as “straight” as non-LGBTQ. We also code those who identify as “transgender/non-binary/something else” and “straight” as part of our LGBTQ identity category.

The Christian nationalism scale replicates the methodology developed in the PRRI/Brookings Christian Nationalism Survey (fielded November – December 2022). To measure Christian nationalism, PRRI used a battery of five questions about the relationship between Christianity, American identity, and the U.S. government, which were first developed for the PRRI/Brookings Christian Nationalism Survey, which was based on data collected in late 2022 and released in a major report in February 2023. PRRI included these five questions in four follow-up surveys throughout 2023, which were each conducted among a representative sample of more than 5,000 Americans Respondents in our American Values Atlas were asked whether they completely agree, mostly agree, mostly disagree, or completely disagree with each of the following statements:

• The U.S. government should declare America a Christian nation.
• U.S. laws should be based on Christian values.
• If the U.S. moves away from our Christian foundations, we will not have a country anymore.
• Being Christian is an important part of being truly American.
• God has called Christians to exercise dominion over all areas of American society.

Based on their answers to these five questions, each respondent receives a composite score on the Christian nationalism scale using an additive scale and recalibrates the scores to values from 0 (low) to 1 (high). Respondents’ answers across all five questions are highly correlated, with a Cronbach’s alpha of 0.93, indicating a high degree of reliability for the scale and is then assigned to one of four groups:

Christian Nationalism Adherents (Score 0.75–1): These Americans overwhelmingly either agree or completely agree with all five statements in the scale. This group includes 10% of Americans.

Christian Nationalism Sympathizers (Score 0.5–0.74): These Americans agree with most statements in the scale, but they are less likely than Adherents to completely agree. This group includes 20% of Americans.

Christian Nationalism Skeptics (Score 0.01-0.49): These Americans disagree with most statements in the scale, but they are less likely than Rejecters to completely disagree. This group includes 37% of Americans.

Christian Nationalism Rejecters (Score 0): These Americans completely disagree with all five statements in the scale. This group includes 30% of Americans.

To see the components of the Christian nationalism scale, please see Appendix A in PRRI’s February 2024 report.

The survey was designed and conducted by PRRI. The survey was made possible through the generous support of the Arcus Foundation, the E. Rhodes and Leona B. Carpenter Foundation, the Gill Foundation, and the Unitarian Universalist Veatch Program at Shelter Rock. The survey was carried out among a random representative sample of 22,465 adults (age 18 and up) living in all 50 states and the District of Columbia. Among those, 20,799 are part of Ipsos’s KnowledgePanel and an additional 1,666 were recruited by Ipsos using opt-in survey panels to increase the sample sizes in smaller states. Interviews were conducted online between March 9 and December 7, 2023.

Respondents are recruited to the KnowledgePanel using an addressed-based sampling methodology from the Delivery Sequence File of the USPS – a database with full coverage of all delivery addresses in the U.S. As such, it covers all households regardless of their phone status, providing a representative online sample. Unlike opt-in panels, households are not permitted to “self-select” into the panel; and are generally limited to how many surveys they can take within a given time period.

The initial sample drawn from the KnowledgePanel was adjusted using pre-stratification weights so that it approximates the adult U.S. population defined by the 2022 March Supplement of the Current Population Survey (CPS), except language proficiency, which is not available from CPS, were obtained from the 2021 American Community Survey (ACS). Next, a probability proportional to size (PPS) sampling scheme was used to select a representative sample.

To reduce the effects of any non-response bias, a post-stratification adjustment was applied based on demographic distributions from the CPS. The post-stratification weight rebalanced the sample based on the following benchmarks: age, race and ethnicity, gender, Census division, metro area, education, and income. The sample weighting was accomplished using an iterative proportional fitting (IFP) process that simultaneously balances the distributions of all variables. Weights were trimmed to prevent individual interviews from having too much influence on the final results. In addition to an overall national weight, separate weights were computed for each state to ensure that the demographic characteristics of the sample closely approximate the demographic characteristics of the target populations. The state-level post-stratification weights rebalanced the sample based on the following benchmarks: age, race and ethnicity, gender, education, and income.

These weights from the KnowledgePanel cases were then used as the benchmarks for the additional opt-in sample in a process called “calibration.” This calibration process is used to correct for inherent biases associated with nonprobability opt-in panels. The calibration methodology aims to realign respondents from nonprobability samples with respect to a multidimensional set of measures to improve their representation.

The margin of error for the national survey is +/- 0.82 percentage points at the 95% level of confidence, including the design effect for the survey of 1.56. In addition to sampling error, surveys may also be subject to error or bias due to question wording, context, and order effects. Additional details about the KnowledgePanel can be found on the Ipsos website: https://www.ipsos.com/en-us/solution/knowledgepanel

[1] For an overview of how we measure gender identity and sexual orientation, please see Appendix A.

[2] Members of Generation Z were born after 1996; millennials were born between 1981 and 1996; members of Generation X were born between 1965 and 1980; baby boomers were born between 1946 and 1964; and members of the Silent Generation were born before 1964. In this report, Gen Z adults fall into the 18- to 25-year-old category.

[3] Battleground states include Arizona, Georgia, Michigan, Nevada, North Carolina, Pennsylvania, and Wisconsin.

[4] Prior to 2023, PRRI asked Americans how favorable they were toward “allowing gay and lesbian couples to marry legally.”

[5] The states with nondiscrimination protections for LGBTQ people are California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Iowa, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Hampshire, New Jersey, New Mexico, New York, Oregon, Rhode Island, Utah, Vermont, Virginia, and Washington, as well as the District of Columbia. States were determined to fall into this category if they had laws explicitly protecting LGBTQ people from housing, employment, and public accommodations discrimination, https://www.lgbtmap.org/equality-maps/non_discrimination_laws

[6] The number of cases for Hindu Americans is 87. Results need to be interpreted with caution.

[7] Same-sex couples would be legally allowed to marry in the District of Columbia and 18 states: California, Connecticut, Delaware, Hawaii, Illinois, Iowa, Maine, Maryland, Massachusetts, Minnesota, Nevada, New Hampshire, New Jersey, New Mexico, New York, Rhode Island, Vermont, and Washington. In the rest of the states, same-sex marriage would become banned.

[8] For more information on the Christian nationalism scale, see Appendix B.

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• Relationships

Two Decades of LGBTQ Relationships Research

To what extent is relationship science reflective of lgbtq+ experiences.

Posted September 29, 2022 | Reviewed by Jessica Schrader

• Why Relationships Matter
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• While same-sex marriage has been legal in some jurisdictions for two decades, relationships research continues to focus on mixed-sex couples.
• A review of 2,181 relationship science articles published since 2001 found that 85.8% excluded LGBTQ+ relationships.
• Without LGBTQ+ relationships research, it is hard to provide empirically-supported advice to same-sex and gender-diverse relationships.

In 2014, I attended the annual meeting of the Society for Personality and Social Psychology—one of the largest annual social psychology conferences. The conference covers a wide range of topics and one of the sub-areas is Close Relationships, which hosts a wonderful pre-conference each year leading up to the larger event. As I found myself strolling through the poster presentations for this section of the conference, I began to notice that most of them were reporting the results of research conducted with mixed-sex and presumably heterosexual couples. The pattern became so apparent that I decided to review each poster a bit more systematically and to ask the presenters some standard questions about the demographics of their samples. I was able to visit 58 of the 71 posters listed on the program for the Close Relationships section—there were quite a few posters missing due to a horrendous winter storm that made the annual trip to SPSP impossible for many. Of the posters reviewed, only 15.5% included LGBTQ participants and only one study specifically focused on LGBTQ relationships. Following the conference, I wrote an article for the Relationships Research Newsletter published by the International Association for Relationships Research discussing the "state of LGBTQ-inclusive research methods" in the field of relationship science.

The following year, a somewhat more systematic approach to evaluating the inclusion of sexual minority couples in research was undertaken by Judith Andersen and Christopher Zou, who published their findings in the Health Science Journal . Their analysis focused on the inclusion of sexual minority couples in research relevant to relationships and health and they focused on publications indexed by Medline and PsychINFO between 2002-2012. Their results indicated that a striking 88.7% of the studies reviewed had excluded sexual minority couples from participating—meaning that even fewer of the papers in their sample were inclusive than my snapshot of the posters presented during the 2014 Close Relationships Poster Session.

Fast forward nearly another decade and the International Association for Relationship Research decided to launch two special issues of their flagship journals, Personal Relationships and the Journal of Social and Personal Relationships , dedicated to reviewing the last two decades of relationship science. Along with two other leading researchers in the area of LGBTQ+ relationships, I was invited to write a review focused on LGBTQ+ relationship science. The burning question in my mind was whether or not we would see a stark increase in inclusion as time progressed. After all, the two decades spanning 2002-2022 represent a time of significant advancements for LGBTQ+ civil rights, particularly those related to the legal recognition of same-sex relationships.

What Is the State of LGBTQ Inclusion in Relationships Research Today?

To answer this question, we gathered every single article published in Personal Relationships (PR) and the Journal of Social and Personal Relationships (JSPR) starting in 2002 until April 2021. This resulted in 2,181 articles; 1,392 articles from JPSR and 789 from PR. We used a variety of coding techniques, including automatic keyword coding and manual screening of articles, to identify which articles contained any information relevant to LGBTQ+ identities and relationships. Roughly 85.8% of these articles were excluded from further analysis as they did not contain any words relevant to sexual or gender minority identities or relationships. The remaining 329 articles were manually coded to identify how they handled issues related to sexual and gender identity . Some articles mentioned LGBTQ+ issues in their limitations section (n = 58), for example to state that future research should consider testing similar questions with a more inclusive and diverse sample. Another 42 articles explicitly stated that they excluded LGBTQ+ participants from their recruitment or analysis process, and while this may seem harsh, it still reflects a methodological improvement over the 1,852 articles that did not even provide adequate information to understand how the exclusion process took place. Some studies did include LGBTQ+ participants in their recruitment process and analyses, but often the sample sizes were small, meaning that no further efforts were taken to understand whether LGBTQ+ participants had unique experiences.

Ultimately, of the 2,181 articles published in these two journals between 2002 and April 2021, 92 articles, or 4.2%, presented LGBTQ-relevant information that we considered capable of providing empirical evidence concerning the lives and experiences of sexual and gender minorities within the context of close relationships. Thus, with only 4.2% of the articles being LGBTQ-relevant, our review of two decades of relationship science research did not seem to suggest that great improvement was occurring over time.

Has LGBTQ Inclusion Increased Over Time?

However, when we broke our data down into smaller periods, we did see a slight indication of improvement over time for the general inclusion of LGBTQ+ participants in relationship science published in these two journals. For example, research published in Personal Relationships climbed from roughly 2% of articles being LGBTQ-relevant between 2002 and 2006 to a peak of just over 4% in 2012-2015, a rate that either slightly decreased or remained constant for the final five-year period, 2016-2021. The Journal of Social and Personal Relationships had a somewhat higher inclusion rate over time, with roughly 3.5% of articles in 2002-2006 being LGBTQ-relevant, peaking at nearly 6% between 2007-2011, and then settling back between 4% and 5% for the periods ranging from 2012-2015 and 2016-2021. Despite these slight differences, overall, there was no significant difference between the proportion of articles considered LGBTQ-relevant in each of the two journals reviewed.

Additional Patterns of Inclusion and Exclusion

Most of the research in the review that was deemed "LGBTQ-relevant" tended to explore the LGBTQ+ community as a whole, rather than presenting studies that specifically explored the experiences of one identity group or another (e.g., lesbian women vs. gay men). Only one of the 92 articles exclusively focused on the experiences of bisexual individuals and 54.3% of the LGBTQ-relevant articles did not include bisexuals in their sample at all. The overall body of research also had an androcentric slant, such that 17.4% of the articles focused exclusively on sexual minority men while only 9.8% focused exclusively on sexual minority women.

Finally, although our interest was in exploring relationship science that was considered relevant to LGBTQ+ populations, a better descriptor would be LGBQ, as very few of the studies included transgender , non-binary, or gender-diverse relationship experiences. In total, 15 articles included transgender participants while only four included non-binary participants.

LGBTQ+ Specific Journals

Of course, this review focused on two of the leading relationship science journals and thus did not cover research published in other journals. Anecdotally, many researchers working in LGBTQ psychology and related areas note that when they try to publish in mainstream journals, reviewers often recommend that they send their LGBTQ-relevant research to more specialized, niche journals. Thus, there is likely more research on LGBTQ+ relationship experiences in journals such as Psychology & Sexuality , LGBT Health, Journal of Lesbian Studies, Journal of Homosexuality, and the APA Journal of Sexual Orientation and Gender Diversity. However, none of these journals specifically focus on relationship science and may not be widely read by other scholars studying relationships specifically. While one of the benefits of LGBTQ-inclusive research is that it helps us to better understand the experiences within this specific population, such research also benefits the wider population, as often LGBTQ-inclusive research suggests new and novel questions that help to shed light on relationship experiences that are relevant to all individuals, regardless of sexual or gender identity.

Despite the indication that there is still a long way to go in terms of encouraging broad inclusion of LGBTQ+ experiences in mainstream relationship research, there were still many positive signs. The overall trajectory of inclusion appears to be increasing over time, conferences are beginning to include specific programming on how to increase the inclusivity of relationship research, and the editors of the special issues celebrating the past two decades of relationship science saw fit to include a review that was specific to LGBTQ+ relationship experiences. The review concluded by noting that we, the authors, were "looking forward to the next 20 years" of LGBTQ-inclusive relationship research, with a specific "focus on deciphering the minutiae of all the colourful intersection of identity that make up the true richness of human relationships."

Pollitt, A. M., Blair, K. L., & Lannutti, P. J. (2022). A review of two decades of LGBTQ‐inclusive research in JSPR and PR . Personal Relationships . https://doi.org/10.1111/pere.12432

Andersen, J. P., & Zou, C. (2015). Exclusion of sexual minority couples from research. Health Science Journal, 9(6), 1.

Blair, K. L., McKenna, O., & Holmberg, D. (2022). On guard: Public versus private affection-sharing experiences in same-sex, gender-diverse, and mixed-sex relationships . Journal of Social and Personal Relationships , 02654075221090678.

Karen Blair, Ph.D. , is an assistant professor of psychology at Trent University. She researches the social determinants of health throughout the lifespan within the context of relationships.

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LGBT Studies

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• LGBTQ Resources in Special Collections/University Archives This link opens in a new window
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Sometimes the hardest aspect of research is deciding what to write about! The following links provide great information on how you might go about choosing a topic and narrowing it down. In addition, use databases and books for background information / introduction to the topic.

• Develop Research Questions (Modesto Junior College)
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• CQ Researcher Full-text database that provides comprehensive analysis of each topic, including history and background information, relevant pro & con arguments, current status, bibliographies, contact information, and outlooks on upcoming "hot topics" in current events. Covers news topics in a wide range of subject fields, from social issues to the environment, health, education, politics, and science and technology. Online access to issues dating back to 1923
• Opposing Viewpoints in Context Fulltext database covering social issues with topic overviews and pro/con viewpoints. Sources include news, journal articles, magazines, media, maps, websites and statistics.

Broad topics and possible research focus: transgender in the military legislation or laws or policies healthcare  lgbt employment discrimination religious exemption

lgbt bullying schools legislation or laws or policies title ix  

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• Is there evidence to support that children suffer psychological effects from having a gay parents?
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• Should homophobic politicians and clergy who are gay or bisexual be outed?
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Expert Commentary

The impact of COVID-19 on LGBTQ communities: A research roundup

“Economic effects of COVID-19 have been enormous on LGBTQ people, so it’s not just a viral reality,” says Dr. Perry Halkitis, dean of Rutgers’ School of Public Health, whose research focuses on LGBTQ populations. “It’s a social reality. It’s an economic reality. It’s a psychological reality.”

Republish this article

This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License .

by Naseem S. Miller, The Journalist's Resource February 19, 2021

This <a target="_blank" href="https://journalistsresource.org/home/covid-19-lgbtq-research/">article</a> first appeared on <a target="_blank" href="https://journalistsresource.org">The Journalist's Resource</a> and is republished here under a Creative Commons license.<img src="https://journalistsresource.org/wp-content/uploads/2020/11/cropped-jr-favicon-150x150.png" style="width:1em;height:1em;margin-left:10px;">

The LGBTQ population in the U.S. has been historically affected disproportionately by poverty, lack of health insurance, unemployment, and poorer mental and physical health compared with non-LGBTQ people.

The COVID-19 pandemic has only made those challenges worse.

“Economic effects of COVID-19 have been enormous on LGBTQ people, so it’s not just a viral reality,” says Dr. Perry Halkitis , dean of Rutgers’ School of Public Health, whose research focuses on LGBTQ populations. “It’s a social reality. It’s an economic reality. It’s a psychological reality.”

Moreover, LGBTQ people of color face additional risks and vulnerabilities, compared with their white counterparts, study after study has shown. While the news media has covered disparities brought to light by the pandemic among racial and ethnic minorities, there has been less coverage of the LGBTQ population.

“We know these disparities exist. We know they’re out there, but I’m not reading about it,” says Tari Hanneman , director of the Health & Aging Program at the Human Rights Campaign Foundation, an advocacy organization focused on the LGBTQ community. “There’s an old saying, ‘If you don’t count us, we don’t count.’ So it’s kind of the same thing: if journalists aren’t writing about us, it’s almost like we’re not existing.”

It’s also important to note the dearth of government data about LGBTQ people.

Most government data collection efforts focused on COVID-19 do not include sexual orientation and gender identity measures, including the U.S. Census Bureau’s Household Pulse Survey and other state and federal death and disease tracking efforts.

The lack of data hinders “efforts to incorporate the needs of LGBT populations into COVID-19 recovery efforts,” says a February report by the Williams Institute , a public policy research institute based at the UCLA School of Law focused on sexual orientation and gender identities issues.

Journalists can use academic research to better understand and report on the impact of the pandemic on LGBTQ communities. Here, we have selected seven studies and reports on this topic to help you get started.

(Note: Both LGBT and LGBTQ are acceptable acronyms, according to Associated Press style, which Journalist’s Resource follows. We have chosen to use LGBTQ, unless a study indicates otherwise.)

———

The Impact of the Fall 2020 COVID-19 Surge on LGBT Adults in the U.S. Brad Sears, Kerith J. Conron and Andrew R. Flores. Williams Institute at UCLA School of Law, February 2021.

This report draws on one the most recent surveys on the impact of the pandemic on LGBTQ communities. Data are from a nationally representative survey of 12,000 adults conducted by Ipsos between August and December 2020, with 842 respondents identifying as LGBT.

The report finds that several months into the pandemic, LGBT adults were more likely to be laid off (12.4% vs. 7.8%) or furloughed from their job (14.1% vs. 9.7%), have problems affording basic household goods (23.5% vs. 16.8%) and were twice as likely to report having problems paying their rent or mortgage, compared with their non-LGBTQ peers.

It also highlights the disproportionate impact of the pandemic on LGBTQ people of color.

“LGBT people of color are more likely to experience the health and economic impacts of COVID-19 than non-LGBT White people,” the authors write, adding that they’re also more likely to get tested for COVID-19, practice social distancing and wear masks, compared with non-LGBT white people.

They add that LGBT people of color are more likely to have tested positive for COVID-19, to personally know someone who died of COVID-19, and to have experienced several types of economic instability as a result of the pandemic.

They write that the federal government should take into account the impact of the pandemic on LGBT people, specifically LGBT people of color, as it responds to the crisis and provides support to those most economically affected.

Sexual Orientation Disparities in Risk Factors for Adverse COVID-19-Related outcomes, by Race/Ethnicity Kevin C. Heslin and Jeffrey E. Hall. CDC MMWR , Vol. 70, No. 5. Feb. 5, 2021.

This timely report by Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, examines the disproportionate health impact of the pandemic on LGBTQ adults. The report uses the Behavioral Risk Factor Surveillance System survey — a nationwide health-related telephone survey — because the “current COVID-19 surveillance systems do not capture information about sexual orientation,” the authors write.

Researchers combined data from BRFSS surveys between 2017 and 2019, which included 24,500 individuals who identified as gay, lesbian or gay, or bisexual. The report notes that “although BRFSS includes a question on gender identity, the number of respondents identifying as transgender or nonbinary was too small for reliable estimates compared with the majority cisgender population.”

The report identifies several underlying health conditions that increase or might increase the risk for more severe COVID-19-related illness were more common among gay, lesbian and bisexual adults than those who identified as heterosexual.

Those self-reported conditions include cancer, kidney disease, chronic obstructive pulmonary disease, heart disease, obesity, smoking, diabetes, asthma, hypertension and stroke.

Moreover, “sexual minority adults who are members of racial/ethnic minority groups disproportionately affected by the pandemic also have higher prevalences of several of these health conditions than do racial/ethnic minority adults who are heterosexual,” the report shows.

The authors reiterate what other researchers have cited as the reasons behind disparities affecting LGBTQ people: “Because of their sexual orientation, sexual minority persons experience stigmatization and discrimination that can increase vulnerabilities to illness and limit the means to achieving optimal health and well-being through meaningful work and economic security, routine and critical health care, and relationships in which sexual orientation and gender identity can be openly expressed.”

The authors call for expanding sexual orientation and gender identity data collection to surveillance systems to help with decision-making during and after the pandemic.

The Disproportionate Impacts of COVID-19 on LGBTQ Households in the U.S. Movement Advancement Project. November 2020.

This report is based on data from a polling series by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, conducted between July 1 and Aug. 3, 2020, on more than 3,400 adults, 353 of whom identified as LGBTQ. Consistent with previous research, the poll found that LGBTQ respondents are twice as likely as non-LGBTQ respondents to have very low incomes.

The report, created by a nonprofit think tank, provides a wealth of data points that can help reporters compare the impact of the pandemic on LGBTQ and non-LGBTQ communities. It also provides data based on race, income and region of the country.

The report shows 66% of LGBTQ households reported serious financial problems compared with 44% of non-LGBTQ individuals. Nearly 40% said they weren’t able to get medical care or delayed getting medical care for serious problems, compared to 19% of non-LGBTQ households.

Meanwhile, 95% of Black LGBTQ survey respondents said they face one or more serious financial problems, compared with 70% of Latino LGBTQ households and 62% of white LGBTQ participants.

The report also shows that more than one in eight LGBTQ people have lost their health insurance coverage since the pandemic started. That’s more than twice the rate of non-LGTBQ people in the polling sample.

Also, more than one in four LGBTQ households have had serious problems affording medical care — again, twice the rate of non-LGBTQ households.

The report’s findings “point to the need for targeted assistance and explicit protections from discrimination as our country continues to weather the storm and looks to rebuild,” the authors write.

Sex in the Time of COVID-19: Results of an Online Survey of Gay, Bisexual and Other Men Who Have Sex with Men’s Experience of Sex and HIV Prevention During the US COVID-19 Epidemic Rob Stephenson et. al. AIDS and Behavior, September 2020.

This study, based on a survey of 518 gay, bisexual and other men who have sex with men conducted between April and May 2020, aims to understand changes in sexual behavior of this group and access to HIV prevention options, including pre-exposure prophylaxis, also called PrEP.

The study finds that in the early days of the pandemic men reported an increase in the number of sex partners, although the increase in unprotected sex was small. It also finds the increase in sexual behavior during COVID-19 was associated with increases in substance use.

About one-third of the men reported that the pandemic had prevented them from accessing testing for HIV or sexually transmitted infections, the report finds.

The study also finds that nearly 95% of the respondents believed it was possible to contract COVID-19 through kissing, but about half or less believed it was possible to contract the virus through all other sex acts.

About 9% of people surveyed said the pandemic prevented them from accessing their PrEP prescription and nearly one-third said that about getting tested for HIV or other sexually transmitted infections.

“There is a clear need to continue to provide comprehensive HIV prevention and care services during COVID-19, and telehealth and other eHealth platforms provide a safe, flexible mechanism for providing services,” the authors write.

They add that sexual activity and substance use behaviors may be to some degree related to the stress of the pandemic, “and therefore services should consider addressing the mental health needs of those living on lockdown, and incorporate discussions and strategies for managing stress in the delivery of HIV prevention and care services.”

LGBTQ populations: Psychologically vulnerable communities in the COVID-19 pandemic John P. Salerno and Natasha D. Williams, Katrina A. Gattamorta. Psychological Trauma: Theory, Research, Practice, and Policy, August 2020.

This commentary highlights structural, social and individual challenges faced by LGBTQ populations during the pandemic in the United States. It also includes recommendations to mitigate the psychological effects of the pandemic-related trauma on LGBTQ individuals.

The authors write that mental health disparities among LGBTQ individuals compared with their non-LGBTQ counterparts are related to social inequities, such as higher rates of poverty and lack of insurance.

“Ultimately, mental health burden among LGBTQ persons (e.g., PTSD, anxiety, depression, suicidality) may be exacerbated by the psychological impact of COVID-19 pandemic trauma and its intersection with dimensions of social inequality,” the authors write.

The commentary also points to the significant psychological threats facing LGBTQ elders due to stay-at-home orders earlier in the pandemic.

LGBTQ elders are twice as likely to be single and living alone, four times less likely to have children, and more likely to be estranged from their biological families compared with their heterosexual, cisgender counterparts, according to the commentary.

“This is highly concerning because social isolation, loneliness, and existing health and mental health concerns may be exacerbated among already-vulnerable LGBTQ elders as a result of COVID-19 pandemic trauma,” the authors write.

The authors encourage mental health therapists, social service providers, employers and other institutions serving LGBTQ individuals to move toward online delivery of services “to mitigate the mental health ramifications of COVID-19 psychological trauma and social isolation.”

Mental Health Needs Among Lesbian, Gay, Bisexual, and Transgender College Students During the COVID-19 Pandemic Gilbert Gonzales et. al. Journal of Adolescent Health , November 2020.

The study, based on an online survey of 477 LGBTQ college students in the U.S., aged 18 to 25, shows that nearly half had immediate families that don’t support or know their LGBTQ identity and almost 60% were experiencing psychological distress, anxiety and depression during the pandemic.

“To overcome the high prevalence of frequent mental distress, anxiety, and depression among LGBT students, colleges and universities should ensure that LGBT students receive mental health support during the COVID-19 pandemic,” the authors write.

They recommend telehealth options with flexible hours and identity based virtual groups that help sustain a sense of community. They add that universities should “seek to eliminate any closure-related stressors by providing housing accommodations and financial resources to those expressing need.”

Finally, they write that health-care providers should be mindful of the mental health needs of LGBTQ college students who, due to campus closures, may have returned home to unsafe or unaccepting environments.

“Our study is one of few investigations identifying the mental health needs of LGBT college students during the COVID-19 pandemic, which are substantial based on our results,” the authors write.

Addressing the Disproportionate Impacts of the COVID-19 Pandemic on Sexual and Gender Minority Populations in the United States: Actions Toward Equity Gregory Phillips II et. al. LGBT Health, September 2020.

In this paper, researchers call on public health practitioners to serve as proponents of the LGBTQ community and other marginalized populations and amplify the voices of those advocating for health equity.

“We must recognize the architecture of our social, political, and historical conditions as precedents that create material condition under which marginalized populations could be affected disproportionately by crises such as the COVID-19 pandemic,” the authors write.

Sexual and gender minority populations — the academic term referring to LGBTQ individuals — are less likely to seek care due to stigma, discrimination and economic factors that make medical care unaffordable for them, the authors explain.

They’re also affected disproportionately by poverty, lack of insurance and unemployment, while the pandemic could cause a higher burden of poor mental health in this population.

“A lack of cultural responsiveness among health care professionals has perpetuated health disparities, combined with limitations within the epidemiological surveillance system, which have resulted in challenges quantifying the impact of COVID-19 on marginalized populations,” the authors write.

They set out four priorities for immediate action to address the needs of LGBTQ individuals: cultural competency in hospitals and health systems; improvement of data collection at local, state and federal level to include LGBTQ populations; more research on the impact of the pandemic on this group; and the creation of disaster preparedness plans that explicitly include equity-focused initiatives.

Additional resources

• CDC’s Lesbian, Gay, Bisexual and Transgender Health page provides data and information on a range of topics related to health of this population.
• The Substance Abuse and Mental Health Services Administration’s (SAMHSA) LGBT website  includes national survey reports, agency and federal initiatives, and related behavioral health resources.
• The Trevor Project is a national organization providing crisis intervention and suicide prevention services to LGBTQ youth.
• The Williams Institute is a public policy research institute based at the UCLA School of Law focused on sexual orientation and gender identity issues.
• The Human Rights Campaign is a national advocacy organization for LGTBQ individuals with many informational resources for the public and the media.
• The Fenway Institute is a health policy organization that focuses on research, education and policy development on specific health needs of LGTBQ individuals and those living with HIV.
• GLAAD is a media monitoring organization, founded as a protest against defamatory coverage of LGBTQ people. Its agenda has since extended to the entertainment industry and its portrayal of the LGBTQ population.
• GLMA , previously known as the Gay & Lesbian Medical Association, is a national organization that uses the scientific expertise of a diverse multidisciplinary membership to inform and drive advocacy, education, and research.

For more on the disproportionate effects of COVID-19, see “ Covid-19 has disproportionately depleted finances of Latino, Black, Native American Households: Survey .”

About The Author

Naseem S. Miller

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Social support in schools and related outcomes for LGBTQ youth: a scoping review

Enoch leung.

Department of Educational and Counseling Psychology, Faculty of Education, McGill University, Montreal, Canada

Gabriela Kassel-Gomez

Samantha sullivan, flavio murahara, tara flanagan, associated data.

Recent research has increasingly focused on positive factors and supports for LGBTQ youth. This scoping review explores existing social support for LGBTQ youth in schools through the Ecological Systems Theory to respond to the following four objectives: (1) define social support systems in schools, (2) identify current research on outcomes for LGBTQ youth, (3) identify barriers to support LGBTQ youth in schools, and (4) identify areas for future research for LGBTQ youth and social support in schools. A systematic search (Arksey and O’Malley in Int J Soc Res Methodol 8(1):19–32, 2005) between 2007 through 2021 resulted in 94 articles. This review gave rise to an organizational framework to consolidate various systems of social support for LGBTQ youth in schools. Social support consisted of seven social support systems (family, curriculum, family, peers, school policies, GSAs and programs, and school climate) that are positively associated with the promotion of positive socioemotional, behavioural, and educational outcomes for LGBTQ youth. Though the literature has been clear surrounding the risks associated with LGBTQ youth, this scoping review provides a positive outlook on LGBTQ youth’s school experiences and how these systems of social support allow for LGBTQ youth to act as active participants to foster a positive school climate and sense of safety.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44217-022-00016-9.

Introduction

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth spend most of their lives in schools, navigating through the difficult and threatening space [ 54 , 80 ]. Schools can be a threatening space for LGBTQ youth as they experience increased victimization and a lack of safety [ 59 ]. This fact is alarming since students spend most of their time in schools, approximately 175 to 220 days per year with an average of 5 to 8.5 h per school day [ 81 ]. Schools, then, can be thought of as youths’ second home, particularly concerning for LGBTQ youth due to the lack of safety in their school environment.

Many studies have indicated that LGBTQ youth experience numerous socioemotional, educational, and health risks at school due to LGBTQ-specific prejudice and victimization. This includes isolation from peers, low social support, low school engagement, low academic success, school dropout, stress, anxiety, depressive symptoms, and suicidal ideation and attempts [ 41 , 47 , 60 ]. However, rather than problematizing youth as at-risk, emerging research is shifting the focus onto the systems that create and carry the risks towards LGBTQ youth, subsequently exploring through a positive lens to begin unpacking LGBTQ needs in schools [ 54 ]. Recent research has increasingly focused on positive factors and supports for LGBTQ youth. For example, the presence of a supportive adult in a LGBTQ youth’s lives facilitated a smoother high school experience (i.e., decreased absenteeism, increased academic engagement, [ 76 ]). The goal of this study is to systematically explore the positive support systems available for LGBTQ youth, further exploring other potential social support systems, beyond supportive adults, that are present in schools to mitigate the risks for LGBTQ youth and promote positive outcomes. This study will begin by outlining Bronfenbrenner’s [ 15 ] Ecological Systems Theory as an approach to understanding social support for LGBTQ youth. A cursory review of the protective factors and stress experiences for LGBTQ youth in schools will be explored followed by the process of a scoping review and thematic analysis. Notably, the review seeks to pivot from a deficit lens of LGBTQ youth considered as at-risk toward systems that promote the positive outcomes of LGBTQ youth. Additionally, the acronym LGBTQ will be used primarily when discussing the LGBTQ+ population. However, when applicable, other acronyms will be used to denote specific subgroups. This can include LGB for studies that explore sexual minority individuals only.

Understanding social support for LGBTQ youth through Ecological Systems Theory

LGBTQ youth experiences have been increasingly explored in a variety of settings: family, community, and school settings. One approach to organize the LGBTQ youth literature is through a broader, systemic lens. Bronfenbrenner’s [ 14 – 16 ] Ecological Systems Theory can provide the systemic lens needed that allows a way of thinking for the study of interconnections among systems. The model views the individual’s development as a complex system of interactions and relationships across multiple systems surrounding the individual. The systems suggested by Bronfenbrenner [ 14 – 16 ] include: (1) microsystem, (2) mesosystem, (3) exosystem, (4) macrosystem, and (5) chronosystem. Briefly, the microsystem consists of the immediate stakeholders that are directly in contact with the individual (e.g., peers, family). The mesosystem includes the interactions between the individual’s microsystems (e.g., parents speaking with educators). The exosystem consists of stakeholders or environments which do not contain the individual and that indirectly influence the individual via their microsystems (e.g., family’s workplace). The macrosystem consists of the cultural components that influence an individual’s development (e.g., class, ethnicity). The chronosystem consists of normative and/or non-normative environmental changes that occur over the lifespan that can influence an individual’s development (e.g., elementary to high school transition, COVID-19 pandemic). An understanding of the various systems surrounding the individual allows for the exploration of the relationships between the systems (e.g., mesosystems). Previous empirical research on youth and LGBTQ studies have applied the Ecological Systems Theory to understand effective ways LGBTQ youth are accessing the necessary support to thrive in their environment. For example, Watson and others [ 119 ] interviewed gay-straight alliance (GSA) advisors addressing various topics including school climate-related issues (e.g., sexual and gender-based victimization) that influenced their ability to be advocates for their students. The authors found that sociocultural factors (e.g., public policies), school-based factors (e.g., administrators), and individual factors (e.g., knowledge of LGBTQ issues) were both barriers and facilitators of their ability to be advocates. From the advisors’ perspective, aligned with Bronfenbrenner’s Ecological Systems Theory, they are required to navigate across systems to effectively support their LGBTQ youth. Results were corroborated from other studies that consider the necessity of school counselors to navigate across ecological systems to support the LGBTQ youth in their schools [ 7 ]. Other studies focusing more on the community surrounding LGBTQ youth revealed similar navigations across systemic barriers (or facilitators) in their identity exploration. Katz-Wise and others [ 57 ] interviewed TGNB (transgender and non-binary folks) youths’ experience in their gender identity exploration, specifically in family and community settings. Eight themes were developed from this study that aligned with the ecological systems: individual factors (e.g., emotions, coping), family factors (e.g., family support), community factors (e.g., general and LGBTQ community experiences), and societal factors (e.g., external forces). Broadly, the Ecological Systems Theory shifts the research focus to a more relational, developmental systems view, acknowledging the interconnectedness of the systems and its associations to the individual (e.g., [ 15 , 16 ]).

Taken together, this scoping review attempts to explore existing social support for LGBTQ youth in schools through the Ecological Systems Theory. An ecological systems approach in understanding the existing literature on social support for LGBTQ youth can provide an organizational framework necessary to consolidate the comprehensive literature of social support for LGBTQ youth in schools. As the scoping review attempts an initial exploration and organization of existing social support for LGBTQ youth in schools, a deeper exploration on the relationship between the systems will be explored in a separate review.

School-based protective systems for LGBTQ youth

American Psychological Association [ 1 ] published an informational guide summarizing the various school-based protective systems present for LGBTQ youth. Although not comprehensive, the guide listed several support systems available in schools: (1) educators, (2) school policies, (3) gay-straight alliances, (4) inclusive curriculum, and (5) school climate. Briefly, the guide implicated the importance of educators to help create a safe school climate for LGBTQ youth, the need to create and enforce anti-harassment policies, the creation of gay-straight alliances, and the development of LGBTQ-inclusive curriculum. Each system (educators, policies, GSAs, inclusive curriculum) were found to be critical to an establishment of a LGBTQ-affirming school climate, which in turn was shown to help minimize victimization rates and increase sense of safety for LGBTQ youth [ 54 , 122 ]. Other research similarly suggests the importance of LGBTQ-affirming school climate as a support system to help minimize victimization rates and increase sense of safety for LGBTQ youth [ 28 ].

As literature in this field typically examine systems of social support in isolation (e.g., curriculum, teachers, school policies separately), this scoping review aims to provide a more comprehensive search strategy in consolidating the research on the available social support systems for LGBTQ youth in schools. This scoping review attempts to bring together the literature across multiple systems of social support for LGBTQ youth to develop a systemic definition of social support for LGBTQ youth, identify current research across all systems of social support, identify barriers and difficulties experienced by LGBTQ youth in schools, and identify areas for future research in understanding the social support systems for LGBTQ youth.

Schools as a key site of stress for LGBTQ youth

Results from the 2015 Youth Risk Behavior Survey (YRBS) indicate that over 60% of LGB youth experienced prolonged feelings of hopelessness compared to only 25% of heterosexual youth. In a national survey of LGBTQ youth [ 59 ], 67% heard homophobic comments in schools, 58% perceived a lack of safety as a result of their sexual orientation identity, and 43% perceived a lack of safety as a result of their gender identity and expression. Although there was a high percentage of LGBTQ-specific concerns, only 12% of LGBTQ youth reported teacher intervention. In Gay Lesbian Straight Education Network (GLSEN)’s national survey [ 59 ], 92.6% of LGBTQ youth mentioned health concerns (e.g., depression, anxiety) as the main reason for not graduating high school, followed by academic (e.g., poor grades, absences), and safety concerns (e.g., hostile school climate, harassment, unsupportive peers and staff). Therefore, a further detailed systematic breakdown of existing social support systems in educational settings is required to better understand what can be done to offset negative experiences and risks. This analysis will also clarify the barriers schools face in providing support and inform future inquiry for schools to move towards improved support for LGBTQ youth.

Present data highlights that LGBTQ youth are at a heightened risk for numerous health and educational concerns. Such concerns can be attributed to a lack of connection with their teachers and school staff [ 58 ], a lack of acceptance from their family members [ 57 , 74 ] and peers [ 122 ], a lack of school curricula and policies that value LGBTQ diversity [ 105 ], and the existence of overall hostile and exclusionary school climates [ 59 ]. The level of warmth and positivity in a school environment can positively impact LGBTQ students’ experiences and their subsequent health and educational outcomes. For example, teacher-student relationships are positively associated with increased academic engagement, performance, and social-emotional wellbeing for LGBTQ youth [ 66 ]. This review seeks to pull together literature on how LGBTQ youth are supported in schools and examine the ways that different types of social support can affect outcomes to provide an organized framework to effectively support LGBTQ youth.

Research question and aims of the current study

While efforts have been made to support LGBTQ youth in schools, literature is diffuse and show mixed results [ 54 , 109 ]. Subsequently, a systematic surveying of the literature on all existing support systems that provide the necessary social support for LGBTQ youth is necessary. Social support includes numerous school professionals and community members such as school psychologists, educators, counsellors, and principals to act as critical individuals holding the power to support and advocate for LGBTQ youth. The scoping review aims to synthesize current research on social support for LGBTQ youth in schools. Recurring literature on social supports for LGBTQ youth include gay-straight alliances (GSAs), school policies, curriculum, and parent and peer support [ 54 ]. The review seeks to direct future research by providing clarity and illuminating gaps in literature to foster more nuanced research and interventions that ameliorate significant health and educational disparities for LGBTQ youth. As research is robust, indicating the disproportionate stress that LGBTQ youth experience [ 122 ], this review is imperative to systematically explore the systems of social support for LGBTQ youth.

This study seeks to respond to the following question:

How does social support in elementary and secondary education relate to outcomes for LGBTQ youth?

with the following objectives:

• Define what it means to have social support in schools,
• Identify and describe the current research on outcomes for LGBTQ youth given the implementation of these social support systems,
• Identify barriers and difficulties to support LGBTQ youth in an educational setting, and
• Identify areas for future research for LGBTQ youth and social support in schools.

Search strategy

This study follows the methodologically rigorous scoping review approach designed by Arksey and O’Malley [ 5 ] and conducted a systemic search across the disciplines of education and psychology. Though the keywords and categories used to conduct the systemic search was all-encompassing and should capture relevant stakeholders in schools, specific domains of studies outside of the field of education and psychology was not explicitly considered due to the interdisciplinary nature of education. Therefore, the search strategy may not have a wide reach for paraprofessionals that work with LGBTQ youth in schools (e.g., social workers). However, based on the broad nature of the keywords, paraprofessionals working in schools to support LGBTQ youth should be included. A scoping review was chosen to allow for the inclusion of multiple study designs and to allow for post-hoc analysis of inclusion and exclusion criteria [ 86 ]. In particular, as a systematic review approach required study appraisals, a scoping review was more appropriate due to the inclusion criteria of both empirical and non-empirical studies.

Eligibility criteria

A set of inclusion and exclusion criteria were established a priori to provide guidance for the systematic search strategy. Inclusion criteria included: (a) empirical articles that were published in peer-reviewed journals between 2007 and 2021; (b) non-empirical literature including books, book chapters, case reports, reviews between 2007 and 2021; (c) written in the English language; (d) LGBTQ individuals; (e) school environment-specific (ranging from elementary through high school, including technical schools); (f) all geographical locations; and (g) social support outcomes for students. Exclusion criteria included: (a) non-LGBTQ specific; (b) unrelated to school environment; (c) social support outcomes not for students (i.e., teachers, parents).

Information sources

The search used the following databases: PsycINFO, ERIC, Genderwatch, ProQuest Dissertation and Thesis, Web of Science, Cochrane Database of Systematic Reviews, and Campbell Systematic Review. A description of keywords can be seen in Supplementary Table 1 and a visual for the search and data collection process in Supplementary Figure 1.

A social science librarian was consulted to ensure the scoping review was conducted in a systematic procedure. The five databases were cross-checked with an expert in the field of LGBTQ studies to ensure a comprehensive collection of databases. After databases were confirmed, key concepts were brainstormed and cross-checked with the second and third author, the expert in the field of LGBTQ research (April 2017), and the librarian (May 2017). Keywords were broken down into three sections. The first column consists of LGBTQ terms (e.g., homosexuality, bisexuality, gender identity, transgender or [attitudes towards]). The second column consists of school terms (e.g., high school students). The last column consists of social support terms (e.g., peers). Refer to Supplementary Table 1 for a full list of search terms. All keywords in each column were combined. After a collaborative process between the authors, librarians, and expert, all keywords and related terms were included in each database.

Data collection process

Data were collected during June 2017 and revised in February 2021 to ensure consistency between the searches. Throughout the collection process, the authors engaged in an iterative process to discuss obstacles that arose during the screening phase. As depicted in the flow chart (Supplementary Figure 1), the initial data collection yielded 565 articles ( n 2017  = 364; n 2021  = 199). After deduplications were removed, 533 articles remained ( n 2017  = 335; n 2021  = 198).

Phase one: title and abstract screening (2017)

Phase one consisted of an initial screening of the relevant literature. During this phase, the first, second, and third authors conducted independent title and abstract screening of the 335 articles, resulting in an interrater agreement of 71.94%. Any disagreements across the authors were discussed until a consensus was reached based on the inclusion/exclusion criteria. Following the screening, 128 articles remained.

Phase two: full text screening

An independent screening by the first, second, and third authors of the 128 articles identified in phase one resulted in 54 articles being retained in the review. Interrater agreement was 80.47%. Consensus was achieved through iterative discussion among the authors to determine the final literature count.

Phase three: data extraction

Once the final sample of studies were selected, a table was created to depict important information from each study: (1) study characteristics (e.g., study design, school setting, research question), (2) group demographics (e.g., LGBTQ acronym, sample size, grade level, age range), (3) social support factors, and (4) key findings.

The resulting 54 articles from the full-text screening were broken into three blocks of 18. Each author independently read two of the three blocks of articles and extracted relevant data (such that the first author independently read blocks A and B; the second author independently read blocks A and C; and the third author independently read blocks B and C). After independent data extraction, the two reviewers for each corresponding block resolved any differences.

Phase four: Revised data collection (2021)

A revised data collection was addended since the 2007 through 2017 phase. Another round of data collection, abstract, and full-text screening was conducted from 2017 through 2021. The update in data collection was done in 2021 to account for the many changes happening in society related to LGBTQ populations (e.g., anti-LGBTQ bills; [ 95 ]) as the manuscript was in the process of writing and revisions, along with the delays as a result of the COVID-19 pandemic. An additional 198 articles were collected for initial screening (totalling 533 articles, see Supplementary Figure 1). Following the same procedures of phase one title and abstract screening, independent screening was conducted by the first and fourth author, resulting in 56 articles retained with an inter-rater reliability of 84.34% ( N 2017+2021  = 184). Replicating phase two, the first and fourth author conducted independent full-text screening on the 56 articles, resulting in 40 articles with an inter-rater reliability (IRR) of 75.00% ( N 2017+2021  = 94). Following phase three, the resulting 40 articles from the full-text screening were broken into two blocks of 20. Each author independently read one block of articles and extracted relevant data. After independent data extraction, the two authors checked and resolved any differences in the other block.

Synthesis of results

After data abstraction, quantitative data was collected on the following categories (see Supplementary Table 2): (1) research design, (2) participant sample size range, (3) LGBTQ acronym, (4) school setting, (5) number of schools, (6) number of students, and (7) the types of social support. Initial IRR of 94 articles was 76.60% and discrepancies were discussed and resolved through an iterative process between the first through fourth authors.

Subsequent thematic analysis [ 3 , 13 , 25 , 36 , 117 ] was conducted. This method of analysis is justified as a descriptive, qualitative method to identify common themes found in the key findings of the 94 articles. Initial IRR was 78.72%, above the acceptable level of reproducibility, and discrepancies were discussed and resolved among the first four authors.

Data analysis involved both quantitative (e.g., frequency analysis) and qualitative (e.g., thematic analysis) methods, resulting in a multi-layered synthesis process that allowed for the identification of existing gaps in the literature and revealed potential topics for conducting future systematic or novel reviews.

Study characteristics

Refer to Supplementary Table 2 for a tabulation of characteristics across the 94 articles.

Research design

Out of the 94 articles, there were 48 (51.06%) quantitative studies, 43 (45.74%) qualitative studies, and three (3.19%) mixed-methods studies.

LGBTQ acronym

As each article used several LGBTQ acronyms interchangeably, there are a total of 102 acronym frequencies across 94 articles. Acronyms include LGBTQ/GLBTQ ( n  = 40; 39.22%), LGBT/GLBT ( n  = 15; 14.71%), sexual minority/SMY ( n  = 10; 9.80%), LGBQ ( n  = 7; 6.86%), LGB/GLB ( n  = 6; 5.88%), transgender/trans* ( n  = 4; 3.92%), SSA ( n  = 3, 294%), GSM/GSD ( n  = 3; 2.94%), LGBTQQ ( n  = 2; 1.96%), gender-variant ( n  = 2; 1.96%), GM ( n  = 2; 1.96%), LGBTQ2S ( n  = 2; 1.96%), LGBTQ+ ( n  = 2; 1.96%), queer ( n  = 1, 0.98%), MSMY ( n  = 1; 0.98%), bisexual/pansexual ( n  = 1; 0.98%), TGD ( n  = 1; 0.98%).

Participant sample range

Across 94 articles, 42 studies provided specific age or grade ranges of the participants. Participants ranged from students in grades nine through 13 ( n  = 20; 21.28%), grades seven through 12 ( n  = 10; 10.64%), grades eight through 12 ( n  = 6; 6.38%), grades 10 through 12 ( n  = 4; 4.26%), and grades six through 12 ( n  = 2; 2.13%). 40 studies did not provide specific age or grade range of students and only included the educational institution broadly: high school ( n  = 16; 17.02%), middle and high school ( n  = 7; 7.45%), high school and college ( n  = 5; 5.32%), middle school ( n  = 4; 4.26%), elementary school ( n  = 4; 4.26%), college ( n  = 3; 3.19%), elementary and high school ( n  = 1; 1.06%). The remaining 12 studies included adult staff or parent participants ( n  = 5; 5.32%) or did not specify ( n  = 7; 7.45%).

School setting

As each study recruited school settings that were different in type (i.e., catholic, private, democratic) and in developmental age (i.e., elementary, middle, high school), there was a total of 108 counts of school settings across the 94 articles. School settings included high school ( n  = 46; 42.59%), middle and high school ( n  = 28; 25.93%), private schools ( n  = 5; 4.63%), elementary through high school ( n  = 4; 3.70%), elementary school ( n  = 4; 3.70%), catholic schools ( n  = 4; 3.70%), middle school ( n  = 3; 2.78%), college ( n  = 3; 2.78%), alternative schools ( n  = 2; 1.85%), community center ( n  = 1; 0.93%), democratic school ( n  = 1; 0.93%), and independent school ( n  = 1; 0.93%). Six studies (5.56%) did not specify the type of school setting.

Types of social support

Each study reported more than one type of social support related to LGBTQ students, resulting in a total of 188 counts of social support types. Social support was organized into four categories: school support ( n  = 139; 73.94%), peer support ( n  = 24; 12.77%), parental support ( n  = 16; 8.51%), and community support ( n  = 9; 4.79%). School support was further broken to include gay-straight alliances ( n  = 42; 22.34%), supportive non-teaching staff ( n  = 34; 18.09%), supportive teachers ( n  = 24; 12.77%), positive school climate ( n  = 12; 6.38%), programs and policies ( n  = 11; 5.85%), school-wide approaches ( n  = 9; 4.79%), and curriculum ( n  = 7; 3.72%).

Based on Bronfenbrenner’s Ecological Systems Theory, the constructed themes that was developed across the 94 articles were organized into support systems that directly impact LGBTQ youth outcomes (see Supplementary Table 3). As geographical information was not extracted, findings are generalized and may not accurately represent specific geographically contextualized policies and environments.

The role of family (caregiver) systems and social support

Three distinct themes were constructed from the literature: (1) high actual or perceived family/caregiver support buffered many negative socioemotional or educational outcomes ( n articles  = 12), (2) family/caregiver support was not consistently adequate to buffer the negative emotional, behavioral, and educational outcomes ( n articles  = 3), and sex differences within family experiences highlighted complexities of family/caregiver support ( n articles  = 3).

High caregiver support buffering negative outcomes

When family (or caregiver) support was low, LGBTQ youths’ level of emotional and behavioural distress was high [ 4 , 8 , 18 , 24 , 40 , 55 , 85 , 90 , 124 ]. A lack of social support in the family system (e.g., family harassment, low caregiver support, low communication and closeness) was positively associated with adverse social (e.g., disengaging from peers, running away from home [ 40 , 55 , 85 , 124 ]), emotional (e.g., depression, psychological distress, substance abuse, suicidal ideation [ 4 , 8 , 18 , 55 , 85 ]), and educational outcomes (e.g., school dropout [ 8 ]), for LGBTQ youth. However, studies have shown that family acceptance was a type of social support that fostered LGBTQ youths’ critical thinking and advocacy for safe spaces in schools to support marginalized students [ 40 , 124 ]. Family support was particularly associated with better school performance for LGBTQ racialized youth. For both White and racialized LGBTQ youth, perceptions of being close with parents and direct involvement with parents in activities moderated experiences of victimization at school, and reduced substance use and suicidality, educational risks, and increased school belonging [ 18 , 85 , 90 ]. Moreover, LGBTQ-affirming resources aimed at developing family support (e.g., parent advocacy, allyship, communication, trust) fostered LGBTQ youth academic well-being, physical and emotional safety, and ability to be authentic in classrooms [ 23 , 38 , 82 ].

Caregiver support inconsistent in buffering negative outcomes

Studies showed that family (or caregiver) support did not consistently buffer the negative outcomes that happens at school [ 17 , 90 ]. Though family support may be protective against victimization and self-harm among youth, effects were less robust for gender minority youth [ 96 ].

Sex differences within family experiences

Three unique studies found differences present for (1) boys and girls and (2) mothers and fathers. Pearson and Wilkinson [ 85 ] found that only sexual minority girls were less distressed when they reported a sense of strong family relationships. However, there was no association found between caregiver support and peer victimization for sexual minority girls [ 55 ]. Bos and others [ 11 ] found less distress among all LGBTQ youth who established a strong relationship with their fathers (e.g., more disclosure and communication but not their mothers). A strong relationship with fathers resulted in increased positive social (e.g., more peer acceptance), emotional (e.g., increased self-esteem, decreased depression), and educational outcomes (e.g., increased school belonging, [ 11 ]).

Supporting LGBTQ youth through the curricular education system

Four distinct themes were constructed from the literature: (1) LGBTQ-inclusive curriculum was most often taught in social sciences, humanities, and health classes, fostering authenticity with students and creating an inclusive classroom ( n articles  = 6), (2) LGBTQ-inclusive curriculum led to decreased victimization and negative socioemotional outcomes and increased sense of safety ( n articles  = 5), (3) a hidden, heteronormative curriculum exists behind the official academic curriculum that impedes LGBTQ youth support and engagement ( n articles  = 4), and (4) a need for teachers to feel supported to teach LGBTQ-inclusive curriculum effectively ( n articles  = 4).

LGBTQ-inclusive curriculum fostering authenticity with students and creating an inclusive classroom

LGBTQ-inclusive curriculum appeared to be taught only in specific classes, specifically in social sciences, humanities, and health classes [ 10 , 103 – 105 , 124 ]. Making connections with LGBTQ-inclusive material allowed students to make authentic connections between their lives and the class content [ 73 ] which contributed to an increased psychological wellbeing and disrupted homophobia and other forms of oppression [ 10 , 103 , 118 , 124 ]. Teachers who incorporated LGBTQ material into their curriculum allowed youth to identify teachers as possible safe adults to discuss sensitive concerns (e.g., LGBTQ-related concerns, coming out). Teachers also agreed on the importance of weaving social justice topics in the curriculum to model critical literacy and to create an inclusive curriculum, benefitting all students [ 84 ].

LGBTQ-inclusive curriculum decreased negative outcomes and increased sense of safety

LGBTQ-inclusive curricula had supportive elements at the individual and school level (i.e., increased feelings of safety at school, decreased feelings of isolation and depression, and more awareness of victimization at school; [ 70 , 105 ]). Incorporating LGBTQ-inclusive curriculum and having access to LGBTQ-related information in schools was positively associated with perceptions of a safer school environment and negatively associated with perceptions of victimization [ 105 , 110 ]. Therefore, developing a curriculum that centers LGBTQ issues can disrupt homophobia, injustice, and other forms of oppression, which can provide safety and acceptance, and validate LGBTQ youths’ experiences at school [ 102 , 118 ].

Hidden, heteronormative curriculum impedes LGBTQ youth support and engagement

This theme expands on the hidden, heteronormative curriculum that exists behind the official academic curriculum. Castro and Sujak [ 19 ] mentioned the need for LGBTQ-inclusive curriculum to expand outside of academics, such as the social (e.g., relationships and communication) and campus curriculum (e.g., inclusive group space). LGBTQ-inclusive curriculum is most effective when it can be generalized beyond formal learning spaces. Gay-straight alliances (GSAs), a supportive network outside of the classroom, is one space that can supplement LGBTQ-inclusive curriculum outside formal education. Informal spaces of LGBTQ-inclusive curriculum can foster student engagement and provide further opportunities for students to engage in social advocacy and promote a positive school climate [ 64 , 73 , 123 ].

Teachers need to feel supported to teach effective LGBTQ-inclusive curriculum

Though LGBTQ-inclusive curricula can be a pillar of social support for LGBTQ youth, teachers often miss teachable moments conducive to inclusive curriculum [ 70 , 103 ]. Teachers mentioned difficulty fostering an inclusive curriculum due to rigid curriculum, high stakes testing, and parental resistance [ 84 ], requiring the administration to provide the support needed for teachers to change the curriculum [ 69 ]. Note that the barriers may be contextual as high-stakes testing does not occur in all school contexts and curricula may be externally constructed in relation to the geographical context of the school environment.

Gay-straight alliances (GSAs) and other school programs

Six distinct themes were constructed from the literature: (1) gay-straight alliances (GSAs) fostered a space for empowerment and change, creating a safe space and climate for LGBTQ youth ( n articles  = 24), (2) GSAs created opportunities for connection for LGBTQ youth in their community ( n articles  = 13), (3) GSAs allowed for engagement and youth involvement in schools ( n articles  = 11), (4) GSAs had varying functions ( n articles  = 7), (5) GSAs encountered challenges in delivering positive outcomes ( n articles  = 15), and (6) school-based interventions (non-GSAs) were effective in supporting LGBTQ youth ( n articles  = 6). Note that most of the articles referred to GSAs as gay-straight alliances. One article referred to them as gender-sexuality alliances.

GSAs foster a space for empowerment and change, creating a safe space and climate for LGBTQ youth

GSAs help students provide a space to act together to create cultural and institutional change [ 31 , 98 , 123 ] and can be transformative for school culture. These spaces provide a positive and safe physical and intellectual space where students can engage in knowledge transfer and discuss LGBTQ issues otherwise silenced in the larger school community [ 31 , 40 , 63 , 64 , 69 , 71 , 72 , 77 , 78 , 98 , 106 , 107 , 123 ]. GSAs give LGBTQ youth a safe place to go where they can be accepted [ 69 ]. GSAs can be a space where mental health promotion programs can be incorporated to provide students with coping skills and resources [ 44 ]. The presence and membership in GSAs were positively associated with school belongingness, school engagement, school safety, academic success, wellbeing, and negatively associated with substance use, psychological distress, and victimization incidents [ 6 , 45 , 46 , 53 , 67 , 93 , 111 , 112 ]. Entering GSA classrooms offered visibility, positive symbols of acceptance, respect, and affirmation, providing LGBTQ youth with a sense of safety [ 6 , 87 ].

GSAs create opportunities for connection for LGBTQ students in their community

GSAs provide accountability, support, community, increased academic success, and decreased feelings of isolation by connecting youth with other LGBTQ community members, events, and resources. Subsequently, the connections lead to increased validation and normalization of identity, sense of hope, acceptance, greater self-esteem, greater appreciation for self and other peers, adaptive social relationship skills, and a sense of safety and empowerment for LGBTQ youth [ 31 , 40 , 46 , 69 , 71 – 73 , 75 , 98 , 106 , 111 ]. GSAs allowed for connections to community organizations, providing a gateway to the wider LGBTQ community, supportive adults, community resources, fostering activism opportunities and increasing LGBTQ visibility [ 6 , 87 ].

GSAs allow for engagement and youth involvement in schools

Participation in GSAs were positively associated with perceptions of a safer space for LGBTQ youth to engage in self-expression and identity validation [ 62 ]. Their involvement in GSA-related activities and events increased their self-efficacy [ 20 ], academic success, school engagement, school belongingness [ 43 , 111 , 112 ], sense of hope, and advocacy and awareness-raising efforts [ 88 , 91 ]. Engaging with GSAs enabled students to form their own identities grounded in empowerment rather than as victims [ 31 , 98 ]. LGBTQ youth, teachers, and school administrators have reported that having and engaging in their GSA gave students space for emotional safety [ 71 , 72 ].

GSAs vary in their function (e.g., advocacy, educational, socialization)

GSAs had distinct purposes in assisting different aspects of LGBTQ youth: (1) advocacy, education, and social support; (2) literature to reflect on the lives and experiences of LGBTQ youth; and (3) developing skillsets to assist students in fostering inclusion and acceptance [ 114 ]. Advisors believed the primary role of GSAs is to bring awareness and act in schools, whereas students believed the purpose was to foster a sense of community and belongingness [ 63 , 71 , 94 ]. The varying functions of GSAs depended on the internal provisions of support, from visibility raising to collective social change [ 71 , 92 , 123 ]. Students who were more involved in accessing information and advocacy efforts discussed more health-related topics, prepared more awareness-raising campaigns, and had increased school engagement [ 89 ]. On the other hand, GSAs with a stronger focus on socialization efforts focused less on mental health discussions [ 89 ].

GSAs encounter challenges in delivering positive outcomes

Although GSAs were found to be effective in supporting LGBTQ youth in schools, only 19.1% of youth reported an existence of a GSA in their high school [ 8 ]. Program implementations within GSAs also encountered common problems. Problems included a lack of staff training and safe staff, a lack of student understanding towards LGBTQ issues, a lack of sensitivity towards LGBTQ topics, and challenges in facilitating a discussion on sexual or gender-related topics [ 50 , 69 ]. GSAs struggled to subvert the heteronormative school climate in schools where the greater community was unsafe, particularly in rural environments [ 28 , 63 , 71 ]. For example, high schools had concerns and restricted policies on GSA student behaviours, limiting activities allowed by students [ 31 , 35 ]. In communities that were indifferent or hostile towards LGBTQ populations, GSA advisors were required to negotiate with school administrators to provide LGBTQ youth a safe space in schools [ 6 ]. In schools with high levels of victimization, the benefits of GSA-related social justice involvement and presence dissipated [ 111 , 112 ]. In some schools, the presence or participation in GSA activities did not predict student school engagement and was not associated with mental health outcomes or sense of safety [ 21 , 28 , 93 , 99 , 100 ]. Rather, the presence of a GSA led to emotional vulnerabilities to the wider school community [ 6 ]. As such, the impact of GSAs on LGBTQ youth safety and school climate may vary widely across schools and geographic context.

School-based interventions (non-GSAs) were effective to support LGBTQ youth

There is a need to employ a pragmatic approach and focus on student safety to gain administrative support to conduct interventions [ 65 , 69 , 94 ]. Classroom intervention focused on accepting individual differences through open discussion and participation of emotional and sensitive issues were effective in framing uniqueness as a strength and fostered change towards an accepting classroom climate [ 70 , 94 ]. Youth-led theater and dialogue-based interventions were effective to address heterosexism and genderism in schools, with increased reports of willingness and intention to advocate for social justice and equality for LGBTQ people [ 121 ]. Hall and others [ 42 ] showed how a student-led community art gallery was effective to create a space for discussion on gender issues and act towards supporting LGBTQ youth.

The role of peer systems in supporting LGBTQ youth

Two distinct themes were constructed from the literature: (1) peer support and acceptance were related to lower levels of emotional and behavioural distress and fostered positive outcomes ( n articles  = 13), and (2) inconsistencies in the effectiveness of peer support for diverse LGBTQ youth ( n articles  = 4).

Fostering peer support and acceptance relates to lower levels of emotional distress and fosters positive social and educational outcomes

LGBTQ youth who had higher levels of peer acceptance and lower levels of strained peer relationships experienced lower levels of depression and suicidal behaviour, higher levels of self-esteem, increased academic success [ 11 , 51 , 56 ], particularly for youth from rejecting families [ 23 ]. On the other hand, lower peer acceptance or connection predicted higher levels of depressive symptoms and lower levels of self-esteem and belongingness to the school [ 11 ]. Uniquely, peer acceptance from straight allies played an important role to address anti-gay stereotypes [ 64 ]. Engaging in peer education and interventions led to increased levels of safety for LGBTQ youth [ 28 , 33 , 102 ]. Older youth were found to have less homophobic attitudes and were more willing to remain friends with GL youth [ 110 ]. Schools where GLB youth had opportunities to socialize reported increased belonging in their school and in their larger community [ 79 ]. Being out (i.e., disclosure of gender or sexuality) to more peers at school was generally associated with higher grades and less school harassment [ 120 ]. Similarly, seeing peers who were out was positively associated with a sense of safety in schools [ 83 ]. Having thick friendships were shown to help encourage LGBTQ youth to question their sexuality [ 37 ]. The culmination of research on peer support reiterates the importance of peer support in schools for an increasingly safe and positive school environment.

Inconsistencies in the effectiveness of peer support for diverse LGBTQ youth

Though peer support was effective in fostering positive socioemotional outcomes and minimizing emotional distress, inconsistencies were found within the LGBTQ community. Sub-group identities had different conclusions regarding the effectiveness of peer support. Craig and Smith [ 24 ] found that racialized LGBTQ youth did not have a relationship between peer support and educational outcomes. Studies show that having supportive peers to discuss problems increased the risks of suicidal ideation and attempts for LGBTQ youth, particularly for LGBQ youth who have had been victimized and gender minority youth [ 17 , 96 ]. Generally, social support did not buffer effects of victimization on self-esteem for LGBTQ students [ 108 ], questioning the nuances in the efficacy of peer support as a social support system.

School professionals and teachers as a system of support for LGBTQ youth

Four distinct themes were constructed from the literature: (1) high level of within-school adult support resulted in positive benefits ( n articles  = 19), (2) high level of within-school adult support reduced negative outcomes ( n articles  = 10), (3) teachers and school staff were ineffective and inconsistent in supporting LGBTQ students ( n articles  = 7), and (4) school staff perceived external support as key to ensure coordination of inclusivity for LGBTQ students ( n articles  = 4).

High level of within-school adult support results in positive benefits

LGBTQ youth perceived more support in schools when they perceived that their school staff, administrators, and teachers showed more than verbal support (i.e., lip service). LGBTQ youth mentioned the need to observe school staff acting and having a presence explicitly taking a stance against bigotry, emphasizing the importance of behavioural management to establish a safe classroom space [ 10 , 69 – 71 , 84 ]. LGBTQ youth who had natural mentors (e.g., teachers, staff members, school administrators) were three times as likely to graduate from high school, had increased intentions to seek help for suicidal thoughts [ 21 ], and had positively impacted their engagement and connectedness to their school [ 23 ] compared to youth who did not have such mentors [ 30 ]. When the number of “safe adults” increased at school, LGBTQ youth would become more engaged with their school and community through opportunities and access to resources from supportive staff members [ 69 , 72 , 99 , 100 ]. Supportive teachers had the power to foster a safe classroom climate and environment, set clear expectations, open inclusive dialogue with students, implement LGBTQ-inclusive school and classroom procedures that positively impacted LGBTQ youths’ safety and acceptance in schools [ 28 , 102 ], educational achievement [ 34 ], and wellbeing [ 116 ]. Teachers having power to foster a safe classroom climate was similarly voiced by TGNC youth, subsequently supporting their transition [ 38 ]. Likewise, teachers and school staff understood the importance of developing skill sets (e.g., use of inclusive language) to foster an inclusive and supportive classroom environment for LGBTQ youth [ 113 , 114 ]. Therefore, supportive school staff are key stakeholders to foster a safer classroom environment and to create opportunities to foster awareness of LGBTQ issues in their school environment (i.e., creating a community art gallery, [ 42 ]).

High level of within-school adult support reduces negative outcomes

LGBTQ youth perceptions of greater adult support (i.e., principals, social work professionals, teachers, school administrators) at school was linked to lower levels of victimization, school avoidance, substance use, suicidal behaviour, and other mental health risks (depressive symptoms; [ 21 , 23 , 26 , 51 , 101 ]). The identification of an adult ally predicted a decrease in fear-based truancy [ 72 , 99 , 100 ]. Principals agreed that there is a need to increase efforts to reduce discrimination towards LGBTQ youth by setting a safe and positive climate in schools [ 12 ]. An avenue that was effective in creating an inclusive and affirmative environment and reduce health risks among LGBTQ youth are school-based health centers [ 125 ].

Teaching and non-teaching school staff were ineffective in supporting LGBTQ students

Though there are benefits in having a supportive school staff, there was a lack of communication between LGBTQ youth and school staff. 80.9% of LGBTQ youth reported never talking to a teacher about LGBTQ topics, 70.8% of youth never talked to a school health counselor, and 86.5% of youth never talked to a school administrator about LGBTQ issues in school [ 8 ]. The lack of action or silence teachers and school administrators take towards LGBTQ topics or incidents is a reason for the lack of communication. Students reported that teachers are inconsistent in their intervention against victimization incidents, often focused on stopping the harassment and providing reasoning for why such incidents can cause harm [ 48 ]. There was a common perception of school administration silence surrounding LGBTQ topic as normative in school environments [ 71 ]. Teachers reported feeling unprepared to support LGBTQ youth and required more information, for example, through collaboration with GSAs to improve pedagogy [ 70 , 72 ]. Coulter and others [ 22 ] found that within-school adult support was ineffective in protecting LGBTQ youth against suicidality compared to outside-school adult support. Therefore, teachers and school staff need to increase their responsibility to support LGBTQ youth [ 38 ].

School staff perceived external support as necessary to foster staff support for LGBTQ students

School staff mentioned the importance of having a coordinator external to the school to provide support for curricular efforts and activities to students and staff, and adapting to school needs, reducing harassment for LGBTQ youth [ 50 , 69 , 70 ]. Schools with an external source of support (i.e., external staff) showed significant improvements towards supporting LGBTQ youth, as reported by student observations [ 50 ]. Sexuality education workshops were another form of external support that led to significant positive effects on teachers’ beliefs and behaviours to support their LGBTQ youth [ 61 ].

The role of school policies and safer school spaces for LGBTQ youth

Three distinct themes were constructed from the literature: (1) socio-political values of the wider community beyond the school impacted school policies and staff attitudes ( n articles  = 7), (2) implementation of inclusive and anti-discriminatory policies were effective in fostering a safer school space for LGBTQ students ( n articles  = 5), and (3) school policy and community support showed challenges in fostering positive outcomes ( n articles  = 4).

Socio-political values of wider community impacting school policies and attitudes

Policies from the broader context can provide the support needed for schools to have inclusive school policies. Supportive government and school board policies allowed for organizations (i.e., GSAs) to be accepted, subsequently fostering community connection and support for LGBTQ youth [ 69 , 106 ]. However, schools located in communities with more non-progressive attitudes and beliefs about LGBTQ individuals due to political or religious conservatism generated hesitation to support LGBTQ students by school administrators [ 65 , 71 , 124 ]. Hesitations to support LGBTQ youth include the ban of GSA creation, sending a message regarding LGBTQ invisibility in school environments [ 65 ]. School staff were cautious and focused on minimizing external resistance and pressure from the larger community. As a result, this led to restrictions in GSA activities and spaces [ 65 , 71 ]. Snapp and others [ 104 ] found that school policies were inequitably enforced as LGBTQ youth were punished for public displays of affection and violation of dress code compared to heterosexual peers, indicative of a lack of inclusive school policies.

Reframing the support for LGBTQ youth as systematic inclusion to meet the needs of all students may be a method to circumvent the restrictions and pressures from the larger community environment. Reframing support for LGBTQ youth to general support for all students can reduce the hesitance school staff have to support LGBTQ youth [ 65 , 71 , 106 ]. Most notably, a school-wide approach and communal investment is required to change and move towards inclusive school policies, promoting the social, psychological, and physical safety for all students [ 33 ].

The implementation of inclusive and anti-discriminatory policies to foster safe school spaces

Schools with higher reported implementation of inclusive and anti-discriminatory policies had lower levels of discrimination against LGBTQ youth [ 12 ], fostering a safer school space. Effective bills such as Bill 13 (i.e., Accepting Schools Act, Ontario, Canada) allowed LGBTQ youth to create a space to transform their lives and offer opportunities of activism [ 52 ]. Inclusive policies allowed for inclusive events (i.e., Pride Prom, Day of Silence) that provided a safer environment for LGBTQ youth [ 107 ]. Therefore, inclusive policies are important to set up a safe environment for students and challenge the hetero/cisnormative dynamic present in policy documents and classroom environment [ 113 ]. Introducing inclusive policies require collaboration across professionals to support legislation that acknowledges LGBTQ issues in schools [ 61 ].

Inconsistencies in fostering positive outcomes from inclusive school policies and wider community support

Bullying policies did not consistently predict LGBTQ safety and victimization [ 12 , 28 ]. Rather, higher proportions of students who reported inclusive school policies predicted lower perceptions of safety based on gender nonconformity [ 110 ]. Lastly, community support was not related to decreased rates of harm for LGBTQ youth [ 96 ].

The role of a positive school climate on LGBTQ youth outcomes in school

Three distinct themes were constructed from the literature: (1) a positive school climate reduced negative emotional-behavioural outcomes ( n articles  = 4), (2) a positive school climate fostered positive psychosocial and educational outcomes ( n articles  = 11), and (3) a whole school effort is required to foster a positive school climate ( n articles  = 10).

Positive school climate reducing negative emotional-behavioural outcomes

For both LGBTQ and heterosexual youth, a positive school climate, strong school connectedness, and involvement in school-based activities predicted fewer physical victimization, fewer depressive symptoms, less suicidal ideation and attempts, substance use, and truancy [ 9 , 21 , 29 , 32 ]. Similarly, teachers reported perceiving fewer depressive symptoms among their male sexual minority youth in positive and supportive school environments [ 29 ].

Positive school climate fostering positive psychosocial and educational outcomes

A positive and safe school climate (e.g., GSA activities; LGBTQ-affirming school-wide campaigns) can promote tolerance, respect and inclusion for LGBTQ youth [ 69 , 72 , 121 ]. LGBTQ youth who were in less heteronormative schools, had inclusive classroom environments, and LGBTQ affirming school climates allowed them to be more inclusive, have increased opportunities to understand diversity and differences [ 102 ], fostered increased psychological wellbeing [ 116 ], and had more positive perceptions of safety in their schools [ 28 ]. A positive school climate has also benefitted teachers by helping them feel comfortable to advocate for their LGBTQ youth [ 70 , 72 ]. Students, parents, and school staff mentioned the importance of having a safe space as a deciding factor to attend school for students to be recognized, accepted, and to participate in their school [ 49 ]. Subsequently, those who were more involved in school activities and had stronger school connectedness felt safer in schools and had increased achievement [ 32 , 34 , 100 ].

Whole school effort is required to foster a positive school climate

Creating and maintaining a positive and safe school climate for LGBTQ youth can foster positive outcomes for all students. This effort requires constant vigilance from all relevant stakeholders: students, teachers, administration, and community members [ 94 ]. Effective interventions (LGBTQ-inclusive curriculum, GSAs, supportive school staff, staff development and training, awareness events, appropriate mental health services, inclusive policies, inclusive language, school-home-community connections, and community partners) are all necessary to foster a positive school climate. This, in turn, provides support for LGBTQ youth and fosters wellbeing, and educational and social success [ 39 , 50 , 56 , 83 , 94 , 121 , 123 , 124 ]. A concerted effort provides LGBTQ youth with access to resources and create more opportunities to carry out programs and training that can maximize the potential for LGBTQ youth to feel supported in their wellbeing and safety. Additionally, a whole-school approach can support teachers and school administrators by providing them with more resources and external support, all instrumental to attain a whole-school system that is positive and inclusive [ 69 ]. GSAs may be an avenue whereby students can act to address anti-LGBTQ bias, to provide education, and address the silences on LGBTQ issues through whole school efforts [ 69 , 121 , 123 ]. Most importantly, having a supportive principal can facilitate a positive whole-school approach to promote LGBTQ inclusivity in schools [ 70 ].

A systemic definition of social support for LGBTQ youth

The first objective of this review is to define what social support in schools mean for LGBTQ youth. Prior to understanding how social support in elementary and high school education relate to outcomes for LGBTQ youth, the scope of social support needs to be defined to create a systemic framework that can map how different social support systems are associated with LGBTQ youth outcomes in school.

Organized through the Ecological Systems Theory, social support can be defined as support that is provided across various systems related to LGBTQ youth. This scoping review brought forth how social support in schools for LGBTQ youth can span across systems: (1) family, (2) curriculum, (3) GSAs (and other school programs), (4) peers, (5) school administrators and teachers, (6) school policies, and (7) school climate.

The seven systems that were constructed from the review indicated that they impact LGBTQ youth and their experiences in school. The parental system was constructed from the review as a form of social support that is associated with LGBTQ youth outcomes in schools. Parents or caregivers who supported their LGBTQ youth through advocacy, open communication, trust, closeness, and acceptance minimized many negative educational outcomes (i.e., depressive symptoms, substance use, victimization) and promoted wellbeing, academic success, physical and emotional safety among other outcomes. The curricular system was constructed to show how influential LGBTQ-inclusive curriculum can be for LGBTQ youth. LGBTQ-inclusive curriculum provided LGBTQ youth the opportunity to explore their LGBTQ identity, make authentic connections, challenge oppression, and acquire knowledge inclusive of LGBTQ people and issues. When a LGBTQ-inclusive curriculum is introduced in classrooms, LGBTQ youth reported feeling safer, more accepted in their classroom, and lower victimization incidents. GSAs and other school-based programs were social support systems that were constructed based on the robust data related to how GSAs can provide space for empowerment and change, creating a safe space and climate for LGBTQ youth. This, in turn, can promote many positive outcomes in schools (i.e., school engagement, safety, acceptance, wellbeing) and decrease substance use, victimization, and psychological distress among other risks. Supportive and accepting peers were a system of social support that fostered higher levels of school belongingness, school engagement, academic success, sense of safety, and minimized levels of depression and school victimization for LGBTQ youth. School administrators and teachers were another system of support for LGBTQ youth. The higher the number of safe adults that were identified at school, the greater the school engagement for LGBTQ youth. Supportive adults at school, through the knowledge, resources, and connections they have about LGBTQ issues, acted against bigotry and victimization incidents at school, and fostered a positive student–teacher relationship for LGBTQ youth. Subsequently, they perceived a safer and accepting classroom environment, increased sense of school belonging, academic success, and wellbeing. School policies were constructed as a system influential to LGBTQ youth outcomes in schools. Schools with LGBTQ-inclusive policies reported lower levels of victimization, and increased sense of safety and opportunities for LGBTQ youth to act towards an empowering climate. School climate arose as an overarching system where the other systems (i.e., GSAs, school policies, curriculum, school administrators and teachers, peers) interacted to foster a safer and accepting climate for LGBTQ youth, promoting tolerance, respect, academic success, wellbeing, and school connectedness.

Based on the seven systems of social support for LGBTQ youth in schools, social support in schools can be defined as an understanding of systemic interactions amongst the seven systems (i.e., family, peers, curriculum, GSAs, school administrators and teachers, school policies, and school climate) and how each system, uniquely and in overlap, can both positively promote academic, socioemotional, and behavioural outcomes, and moderate the health and psychological risks typically associated with LGBTQ youth in schools. Studies that did not align through the lens of ecological systems focused on specific definitions of social support. For example, Day and others [ 27 ] conceptualized social support as LGBTQ youths’ perception of teachers as caring, fostering supportive classroom environments, and friendly and attentive classmates encouraging inclusivity in activities. McDonald [ 76 ] mentioned the difficulty in defining social support due to the multiple interpretations present in the literature. In their review, social support was defined as social, school, and family connectedness, support from peers, adults, advisors, and support groups [ 76 ]. Therefore, grounded in the ecological systems approach, social support cannot simply be understood in a single dimension but across multiple dimensions. This study further enhances the importance of defining, evaluating, and measuring social support for LGBTQ youth through multiple dimensions.

Changing the narrative of social support: from passive recipients of support to opportunities and spaces for activism, skill learning, and engagement

The second objective of this review was to identify current research on outcomes for LGBTQ youth given the implementation of the social support systems. Identifying current research shed light to understand how social support provided across the social support systems are associated with LGBTQ youth outcomes. The current research on social support outcomes for LGBTQ youth sheds light on the multifaceted nature of social support systems shown to influence LGBTQ youth outcomes in schools.

The current research on family systems focuses on fostering positive connections between parents and LGBTQ youth. More specifically, current research expands beyond family acceptance and closeness as family support. Family support also entails the active support through advocacy, allyship, and communication. This finding was replicated in other social support systems where providing social support for LGBTQ youth entails the act of standing up, advocating, and challenging the LGBTQ-related issues present in schools and community.

Current research on curriculum support highlights variance in the implementation of LGBTQ-inclusive curriculum. LGBTQ-inclusive curriculum was most often incorporated in social sciences, humanities, and health classes where students were able to make authentic connections between their lives and LGBTQ-relevant social events (i.e., Stonewall, DADT legislation). Moving towards a systematic implementation of LGBTQ-inclusive curriculum that expands beyond social sciences, humanities, and health classes is an important step to provide safety for LGBTQ youth in schools. A heteronormative curriculum excludes LGBTQ youth from making authentic connections with their own lives, subsequently influencing their interest and engagement in classrooms. Increasingly incorporating LGBTQ-inclusive curriculum in education can move towards the vision for LGBTQ youth to foster authentic connections between their identity and their curriculum. This can result in improvements in their learning, wellbeing, identity exploration, and foster a supportive school and classroom climate. Like the family system, pushing for a LGBTQ-inclusive curriculum moves the system to actively challenge and disrupt the homophobia and injustice that is present in schools. Based on the findings from both systems, it appears that activism, advocacy, and this shift towards criticality against an injustice educational system is common in the literature reviewed from 2017 through 2021.

Current research on GSAs and other school programs were effective in creating a safe space for empowerment and change for LGBTQ youth. Though GSAs had different functions based on the schools’ needs and context, two of GSAs’ functions were to act as a space for advocacy and education, and acquire coping skills and resources to support their mental health. Similar to the previous systems, GSAs are moving towards providing LGBTQ youth the skills and opportunities necessary to be active participants in fostering a LGBTQ-inclusive school environment and make connections to the wider community for support.

Current research on peer support similarly highlights the importance of peers as active participants in schools to foster a sense of safety and positive classroom environment for LGBTQ youth. Beyond peers as allies, the act of peer education and intervention where peers take an active role to support their LGBTQ peers in schools led to increased sense of safety and positive classroom experiences for LGBTQ youth. Positive friendships, also known as ‘thick’ friendships, pushed LGBTQ youth to question their sexualities, reflect, and consider how their LGBTQ identity emerges in their lives. This form of close relationship with friends helped LGBTQ youth take an active role in self-reflection of their LGBTQ identity and disruption against existing oppression in schools.

Current research on school administrators and teachers focused on school staffs’ LGBTQ-inclusive knowledge, relationships with students, and opportunities for students to open the space for discussion on inclusion and diversity. School administrators and teachers have the power to create opportunities for students to foster awareness of LGBTQ issues in their schools through community events (i.e., community art gallery). This shows the importance for school administrators and teachers to have the knowledge and skills to create opportunities for students to be active participants in critical dialogue and reflection, subsequently promoting safety and acceptance in the classroom.

Like the interaction between GSAs and the community system surrounding the school, school policies were also impacted by the socio-political values of the wider community. Inclusive school policies allowed students to have opportunities to create change in schools, such as the creation of LGBTQ-inclusive events like Pride Prom and the Day of Silence to acknowledge and promote awareness of LGBTQ issues and inclusivity. Recent research further emphasized the importance of a school-wide approach to effect change in schools and incorporate inclusive policies. The research on school policies as a social support system emphasizes social support as an interaction of systems where the larger context and values can impact both the inclusivity of school policies for LGBTQ youth and the level of supportiveness from school administrators and teachers, family, and peers.

School climate, the last social support system, highlights the interrelatedness between all systems. Many articles indicated the robustness of a positive school climate and the academic, socio-emotional, and behavioural benefits for LGBTQ youth. To achieve a positive school climate, each social support system is relevant to provide social support for LGBTQ youth. Each social support system can influence each other in their effectiveness to provide the necessary space and opportunity for LGBTQ youth to act and challenge their school environment.

In sum, the current research on social support for LGBTQ youth has moved beyond understanding LGBTQ youth as passive recipients of education to recognizing LGBTQ youth as active co-creators of supportive spaces and opportunities that promote inclusive school climates that foster a sense of belongingness and safety. Other reviews exploring the impact of positive school climate on LGBTQ youth similarly emphasized the importance of a positive school climate for LGBTQ youth. Ancheta and others [ 2 ] found that a positive LGBTQ-specific school climate, as defined by supportive staff, teachers, and nurses, decreased suicidality among LGBTQ youth, promoting student empowerment and visibility through GSAs, inclusive curricula, and inclusive policies. Like previous reviews, this review highlights the importance of social support for LGBTQ youths’ experiences in schools. However, this research expands on the change in narrative that may be an indication that social support is more than providing support to LGBTQ youth. Rather, social support is changing the narrative from passive LGBTQ youth towards active LGBTQ youth, taking initiative to create change and develop skillsets to be successful in their school (i.e., both academic and social outcomes), aligned with more self-determined behaviours.

School administration and larger community environment as barriers to supporting LGBTQ youth in educational settings

The third objective of this review was to identify barriers and inconsistencies to support LGBTQ youth in schools. Though seven social support systems were identified to foster positive socioemotional, behavioural, and educational outcomes, barriers, and inconsistencies to support LGBTQ youth were identified in each system.

Family support did not consistently buffer negative emotional, behavioural, and educational outcomes. Rather, general parental support was associated with peer victimization, self-harm, and poorer academic success [ 17 , 90 , 96 ]. Button [ 17 ] found that victimized LGBQ youth performed worse academically when they reported general parental support, indicating nuances between the buffer from parental support on LGBTQ youth outcomes. Inconsistencies may be explained by the functionality of family support as LGBTQ youth may perceive that their family support is ineffective to resolve harassment experienced at school.

Several studies indicated the barriers of incorporating LGBTQ-inclusive curriculum in an effective manner in schools. One aspect includes the need to understand the hidden curriculum that exists beyond the formal, academic curriculum. The social relationships and school spaces can convey heteronormativity, adversely affecting LGBTQ youth and their sense of safety and engagement in schools. Additionally, there is a need for administration to provide support for teachers to effectively incorporate LGBTQ-inclusive curriculum. Oftentimes, teachers miss teachable moments that is conducive to inclusive curriculum due to the rigid curriculum of high stakes testing and fear of parental backlash. There is indication where GSAs can be spaces used to insert LGBTQ-inclusive curriculum in an informal space to compensate the barriers that exist in classrooms (e.g., rigid curriculum). Therefore, school administrators act as key members to ensure a LGBTQ-inclusive curriculum can be incorporated effectively in classrooms.

GSAs also demonstrated barriers and difficulties in delivering positive outcomes for LGBTQ youth. Schools restricted GSA activities and presence because of sociopolitical reasons (i.e., parental and community backlash, surrounding political environment), limiting activism for LGBTQ youth. There is a need to negotiate between GSA advisors and administration for LGBTQ spaces in schools. Beyond macro-level barriers, GSAs also encountered difficulties in program implementation because of a lack of staff training to discuss sensitive topics (e.g., sexuality) in schools. There were inconsistent results in the benefits of having a GSA in schools. Possible barriers may be due to the larger school and geographic context as being involved in GSAs in more hostile or unsafe environments that place LGBTQ youth at risk. In schools and geographical areas that is more hostile, the presence and involvement of GSA-related activities is associated with increased risks of safety and decreased positive outcomes.

Peers were inconsistent in their support for LGBTQ youth. Victimized LGBTQ youth who had peers to confide to and discuss problems performed worse academically, had lower self-esteem, and had increased suicidal ideation. For racialized LGBTQ youth, peer support did not moderate perceived discrimination in schools and had no association with school performance. In addition, the lack of association for racialized LGBTQ youth suggests how peer support may be overshadowed by other (non)-LGBTQ concerns (e.g., victimization based on ethnicity, lack of family acceptance due to cultural norms and stigma towards LGBTQ identities).

School administrators and teachers were met with barriers to effectively support their LGBTQ youth in schools. Many LGBTQ youth reported not reaching out to school adults for support. The barrier appears to lie on the onus of LGBTQ youth to reach out to school staff for support. This can be due to a lack of trust or belief that teachers or administrators can effectively help them. LGBTQ youth reported teachers not knowing how to intervene in situations of harassment or teachers not feeling prepared to teach inclusive content and answer LGBTQ-related questions. LGBTQ students reported the need for teachers to increase their responsibility in teaching and conveying LGBTQ-inclusive material as the burden lies on students to provide education to their peers. From the perspective of school staff, they perceived the need for external support to coordinate support for teachers for curricular efforts, activities, and actions to reduce harassment towards LGBTQ youth and foster a greater sense of safety. Having an external coordinator as the point person to organize efforts to push the school for LGBTQ inclusion can increase LGBTQ acceptance in schools.

The wider sociopolitical context that surrounds the school has an influence on the availability of LGBTQ-inclusive school policies. The sociopolitical context act as barriers limiting the schools’ abilities to have GSAs and school staff to show support for their LGBTQ youth. However, there has been mixed evidence showing an inverse relationship between an increase of inclusive school policies and a decrease in perceptions of safety. Though there may be inclusive policies put in place in schools, such policies may not be consistently enforced by school staff, lending to the ineffectiveness of inclusive policies. Consistent implementation of inclusive school policies will require dedicated school staff to monitor the progress of policy implementation. In this review, school administrators and teachers have mentioned the need to have an external staff coordinator to monitor consistent implementation of inclusive school policies due to the lack of time and energy. School principals also played a major role in the implementation of inclusive school policies as top-down administrative support is needed to send a message to school staff that they are supported by administration should they receive family or community backlash. Compared to the findings in this review, Russell and others [ 97 ] similarly found that inclusive policies have been associated with improved school climates for LGBTQ and all youth, with LGBT students reporting feeling safer at school, hearing less verbal harassment, and experiencing less gender and sexual-specific victimization. The review emphasized that mixed results were rather due to the lack of appropriate communication of policy implementation. The findings in this review provided added evidence that it is insufficient just to simply have inclusive school policies. Rather, the implementation of inclusive school policies throughout the environment and ensuring that the policy is communicated across all relevant stakeholders is key to providing effective support for LGBTQ youth.

A whole school approach to support LGBTQ youth with particular focus to subpopulations within the LGBTQ acronym

The fourth objective of this review was to identify areas for future research for the seven social support systems and their associations with LGBTQ youth outcomes in schools. The barriers and inconsistencies found to support LGBTQ youth across each system merits further research to explore the nuances in each system and their relationships to LGBTQ youth outcomes in school.

Within family support, there is a nuance that lie between fathers and mothers, and LGBTQ boys and girls, indicating a need to understand the complex nature of family relationships and reasons why certain family members may provide more effective social support towards LGBTQ boys or girls. For GSAs, there needs to be further exploration to understand effective methods to overcome problems in discussing gender and sexuality in school settings due in part to the lack of school staff training and student sensitivity towards LGBTQ issues. Different aspects of a GSA (i.e., presence, membership, engagement) have shown different social support outcomes for LGBTQ youth. In schools that are hostile and unsafe, positive outcomes from GSA presence and engagement dissipate, highlighting the interaction between the school climate and GSAs’ ability to be considered as an effective social support system. Mixed findings demonstrated an inverse relationship between GSA presence and lower sense of safety by LGBTQ youth. Lastly, though GSAs were primarily conceptualized as gay-straight alliances, an exploration of gender-sexuality alliances can provide insight in the nuances between experiences of students from diverse sexualities and diverse genders.

For peer systems, it is necessary to further explore reasons why peer support is either positively associated with more behavioural and emotional risks or have a lack of association. This can be due to the nature of peer support. As peer rumination can lead to further issues in schools rather than problem-solving discussions, the nature in how peers support LGBTQ peers in schools can shed light why there may be such an association. Another avenue of future research is the intersection of ethnicity among LGBTQ youth. The lack of association between peer support and positive social outcomes for racialized LGBTQ youth may be a result of the interplay of other identities that require other forms of support. For example, LGBTQ Asian youth may have an increased emphasis on the importance of family and familial piety, the need for racialized youth to bring pride to their family and minimize shame [ 68 ]. Perhaps for racialized LGBTQ youth, the lack of association between peer support and positive outcomes may be a result that lean towards family systems as increasingly important for such racialized youth.

An area of future research involves an exploration of methods to circumvent the larger sociopolitical context that limits the provision of LGBTQ support via inclusive policies. One possible avenue to provide LGBTQ support can be under the guise of Universal Design for Learning (UDL). This framework suggests the need to support all students, focusing LGBTQ support under the need to support diverse students. Another avenue of research involves exploring an explanation for inclusive policies predicting lower perceptions of safety. This may be due to the inclusive policies setting up motion to create change towards an inclusive school environment. Creating change, however, can still lead to decreased sense of safety and increased harassment issues for LGBTQ youth.

One of the specific populations highlighted to be a key support system for LGBTQ youths were educators. One constructed theme involved the inconsistency in showing support through their actions. Several of the themes highlighted how students perceived their school staff members (teachers, counselors, school psychologists, administration, principals) as being hesitant to discuss LGBTQ issues. By being hesitant and uncomfortable to teach LGBTQ issues, a norm of LGBTQ silence exists in the school environment. Attitudes and beliefs where educators believed that homosexuality and other LGBTQ topics should not be discussed in school can lead to students perceiving their school staff as uncaring and exclusive towards LGBTQ youth. Therefore, educators and other school staff members need to be comfortable and foster an inclusive attitude and belief that they are supportive of all students, as shown through their actions. Effective actions students have mentioned include consistent intervention against LGBTQ-specific harassment, and opening dialogue on the importance of inclusion and acceptance (i.e., through a LGBTQ-inclusive curriculum). When students heard LGBTQ-inclusive topics in their classes, they felt an increased sense of safety. It is therefore important to have teachers be comfortable and open to teach LGBTQ-inclusive curriculum to increase LGBTQ youths’ sense of safety.

The findings of this scoping review indicate three primary implications for future research and application. First, a whole school approach was emphasized by the themes as one of the most effective ways to provide social support for LGBTQ youths. Studies that focused on specific domains of support such as peer support or family support have similarly shown their effectiveness in supporting LGBTQ youth. However, having all relevant stakeholders involved in the process of supporting LGBTQ youth, such as a whole school approach, was evidently the most effective. Notwithstanding, a collaborative, whole school approach may be overly idealistic and an unrealistic approach for schools embedded in a larger, more conservative environment. A middle ground between realism and idealism could be attained by auctioning the GSA as a physical, supportive space where students can feel safe (within the club). This would be contrasted to having GSAs be a space for education and activism towards an increasingly LGBTQ-inclusive environment. In some cases, the inclusion of GSA spaces within schools may mean that, generally, the larger school spaces are unsafe for LGBTQ youth, influencing the concrete actions that educational stakeholders can take to provide support and opportunities for their students.

Second, there were differences in perceived support and outcomes depending on the subpopulation of LGBTQ youth, highlighting the issues of generalizing the LGBTQ youth population as a homogenous population. For example, there were different perceptions of safety and struggles between sexual orientation minority youth and gender identity minority youth. For example, there were unique issues of gender nonconformity for youth who did not conform to their assigned gender at birth, whereas LGBQ youth were faced with victimization due to their sexual orientation. Of note, there have been a recent trend for studies reviewed between 2017 through 2021 to include trans and gender non-conforming (TGNC) youth as the focus, beyond the LGBTQ general identities. As several key findings foregrounded sexual identities over gender identities, future inquiries of LGBTQ youth should take into consideration the specific LGBTQ subgroups to be studied by researchers. Particularly, intersectionality should be taken into consideration as issues of gender, class, and ability may influence how specific LGBTQ students experience school supports. By doing so, researchers can be aware of the various intersecting sexual orientation and gender identities that LGBTQ youth manage and to be inclusive of programs, interventions, and strategies that are intended to support LGBTQ youth as a whole. Though the seven social support systems have been shown to effectively support LGBTQ youth, the inconsistencies that some articles brought up shed light with the interaction of these social support systems and their intersectional identities.

Third, there were differences in perceived support and outcomes depending on the ethnicity and race of the youths. For example, LGBTQ Eurocentric youths experienced increasing emotional and behavioral distress due to LGBTQ-specific victimization, whereas LGBTQ racial and ethnic minority youths experienced less distress. A hypothesis explaining the difference may be linked to the coping skills and resilience that the racial and ethnic minority LGBTQ youths have already learned to cope in the face of racial and ethnic-specific victimization. This results in more frequent use of their coping skills and a higher resilience and grit in the face of LGBTQ-specific victimization and being in a school environment that is perceived to be less safe. Therefore, future inquiry should consider the multiple, intersecting minority identities LGBTQ youths may have had to juggle and its effect on their perceived safety and support in their school environment. Particularly, critically thinking through race and its impacts on the experience of school supports for LGBTQ youth should be a priority for future research. Based on their intersectional identities and experiences in schools, the seven social support systems found in this review may vary in effectiveness based on their other identities.

Limitations

This scoping review attempts to consolidate material from 2007 through early 2021, organize, and respond to the four research questions of defining social support, identifying the current social support outcomes for LGBTQ youth, the barriers and inconsistencies encountered by the social support systems, and the areas for further research because of the barriers and inconsistencies found in the literature. Due to the scope of the review, the literature search strategy was broad and resulted in a larger volume of articles. Though the search strategy was comprehensive, consulting various experts to ensure rigidity and confidence of the search strategy, a scoping review search strategy utilizes a less defined search compared to a full systematic review. Additionally, difficulty in consolidating a comprehensive search term strategy can lead to an increasingly narrow understanding of LGBTQ individuals. For example, no articles explored nonbinary parents or children. The search strategy did not account for an intersectional understanding of LGBTQ+ identities, particularly Two-spirit (2S) identities. As the initial search strategy was executed in 2017, Two-spirit identities were uncommon and, subsequently, not taken into consideration. Future reviews should include the search strategy to account for an intersectional approach to the 2SLGBTQ+ community. Further, search strategies for LGBTQ+ terms are difficult to standardize and capture comprehensively. Even though various experts were consulted to ensure confidence in the search strategy, the rigidity of keywords and subheadings in article search engines can be barriers in capturing the nuances inherent to the 2SLGBTQ+ community. Particularly, transgender and non-binary (TGNC) terms were limited. Moving forward, it would be important to implement the University of Minnesota’s search hedges (tested and standardized search strategies to retrieve articles on specific concepts) for TGNC terms [ 115 ]. As well, this scoping review did not follow the required critical appraisals and risk of bias assessment found in systematic literature reviews. However, based on the purpose of this study, a scoping review methodology was the best approach due to the wide body of literature that has not been comprehensively reviewed. Additionally, scoping reviews are best used when the purpose is to clarify working definitions (i.e., social support) and conceptual boundaries of this topic (i.e., social support systems for LGBTQ youth in schools), and identify gaps in existing literature. Therefore, though a scoping review utilizes a less defined, broader search strategy, resulting in a broader literature less systematic and confident compared to a full systematic review, the purposes of this study and research questions align with the scoping review design.

There have been many studies replicating the risks that LGBTQ youth experience in schools: socioemotional (e.g., depression), behavioural (e.g., substance use), and educational (e.g., truancy, decreased school engagement). However, literature exploring the positive or protective factors for LGBTQ youth has been steadily increasing in the field of youth and LGBTQ studies. As it is still an emerging perspective to explore the protective factors for LGBTQ youth through positive youth development lens, this review consolidated literature and gave rise to an organizational framework to consolidate the various systems of social support for LGBTQ youth in schools. From the review, social support consists of seven social support systems (family, curriculum, school professionals and teachers, peers, school policies, GSAs and programs, and school climate) that, both uniquely and in overlap, are positively associated with the promotion of positive socioemotional, behavioural, and educational outcomes, as well as the moderation of the risks typically associated with LGBTQ youth in schools. Though the literature consistently revealed the benefits of ensuring that these seven systems are present to positively support LGBTQ youth’s development, inconsistencies and barriers in providing positive outcomes for LGBTQ youth was a result of (1) a lack of training and support for school administrators and teachers to enforce LGBTQ-inclusive policies and curriculum, (2) a larger sociopolitical context impeding or preventing LGBTQ activism and support in schools, and (3) unique differences within the subgroups of LGBTQ youth including ethnicity, sex, and gender identity and expression. Future research should explore the gaps present in this review to address the barriers and inconsistencies found to effectively provide social support for LGBTQ youth across these seven systems. This review highlights a positive outlook towards the available systems of social support to promote positive development for LGBTQ youth. Though the literature has been clear surrounding the risks associated with LGBTQ youth, this scoping review endeavored to provide a positive outlook on LGBTQ youth’s school experiences by highlighting how these systems of social support allow LGBTQ youth to act as active participants in the promotion of a positive and safe school climate.

Below is the link to the electronic supplementary material.

Author contributions

EL wrote the main manuscript text. GKG and SS participated in the whole study design and contributed in the results and discussion section. FM updated the results and discussion with the current studies. TF provided feedback throughout the process. All authors reviewed the manuscript. All authors read and approved the final manuscript.

Declarations

For this type of study, formal consent is not required.

The authors declare that they have no conflict of interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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140 LGBT Research Topics And Helpful Ideas For Students

One of the hardest parts of writing a great research paper about and LGBT issue is coming up with a good topic to research. There are a lot of LGBT research topics in discussion, but students can be overwhelmed with all the options. Our research paper writers have put together this list of unique LGBT research paper topics for consideration when writing for sociology .

Table of Contents

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Issues related to transgender people and their rights have been at the forefront of the news in the past decade. Here are some topics worth consideration:

• Why does the transgender community feel separated from the gay community?
• How to tell your family and friends that you are transgender?
• How does the medical community treat transgender people?
• What does it mean to be accepted as transgender?
• When does one decide to tell others that they are transgender?
• What is the biggest challenge transgender people face in the workplace?
• Are people that are transgender afforded the same rights?
• What challenges do transgender people face in public spaces?
• Do transgender people identify as gay?
• What laws have limited the rights of transgender people?
• How has religion oppressed transgender people?
• What makes transgender youth such a difficult period in life?
• What type of discrimination do transgender people face?
• Can transgender people hold religious positions?

LGBT essay topics are great to write about because many discussions are occurring on the internet. Writing about controversial ideas is a great way to get the reader’s attention. Here are some great topics to consider:

• Does age have a role in the way people respond to LGBT issues?
• How can the LGBTQ community express personal traits?
• Does personal fashion put the LGBT community at risk of harm?
• How has our interpretation of sexuality changed in terms of psychology?
• How does gender fluidity change how we view sexuality?
• What does it mean to be “open” today?
• What is paraphilia and how does it affect mental health?
• How has our view of sexuality changed in the last half-century?
• How has human sexuality research advanced in the last decade?
• What is the meaning of human sexuality in the 21 st century?
• What is considered healthy sexual behavior?
• Is the LGBT community more likely to be promiscuous?
• How does aging affect sexuality in the LGBT community?
• Should teens be educated about sexuality at an earlier age?

When it comes to human rights, there are plenty of gay topics that will make great research assignments. Here are a few topics from MyPaperWriter (your helper type papers online ) to consider and think about to get the ball rolling:

• What are some examples of the adversities the gay community faces?
• How is the gay community discriminated against in the workplace?
• What role do openly gay athletes play in promoting the rights of the LGBT community?
• How did the activist groups of the 1970s help promote gay rights?
• How have politicians of the 21 st century impacted gay rights?
• In what ways have people used religion to diminish the rights of the LGBT community?
• What impact did the protection of civil unions have in the U.S.?
• Why do some states deny acknowledgment of civil unions from other states?
• What effect did the incarceration of gay protestors have on the country?
• What influence did Harvey Milk have in promoting the rights of the LGBT community?
• How much have celebrities impacted the promotion of gay rights?
• How have assassinations of prominent gay leaders helped the rights of gay people?
• What has been the aftermath of the rights movements of the 1980s?
• How much impact has the Human Rights Campaign had on the U.S.?

There are a ton of LGTBQ  research topics that can make for good discussion issues. The following ideas have been put together by our academic experts and can be easily researched on the web:

• How do phrases like “it will get better” impact the LGBTQ community?
• How has the sports community embraced people that identify as LGBT?
• What role have filmmakers had in promoting the LGBTQ culture and community?
• How has the current media affected the way we view the LGBT community?
• How have professional athletes help promote the acceptance of the gay community?
• What impact has Gay Pride Month had on social awareness?
• Are people more likely to come out as LGBTQ in our current society?
• What impact does religion have on the policy that denies LGBTQ rights?
• How has the music community helped spread messages in support of gay rights?
• The common effect of counterculture and the LGBT community?
• Community efforts to mobilize work in LGBT communities.
• Moving resources from the U.S. to third world countries will help?
• The massive effort from the first world to third world nations.
• Medical implants that go against cultural traditions.

Several transgender research questions are reaching the forefront of popular discussion. For those students interested in researching this area, the following topics might be interesting:

• What is the current state of transgender rights in the U.S.?
• What does science tell us about sexual orientation?
• How have the legal rights of transgender people changed in the last 50 years?
• In what ways is sexual orientation different from gender identity?
• What role did the Stonewall Riots of 1969 have on transgender people?
• The best ways to understand the current transgender phenomenon.
• What are the major challenges between the transgender community and the gay community?
• Should transgender athletes be allowed to compete in sports?
• What is the best way to get Americans to consider diversity in society?
• What impact did Bruce Jenner’s transition have on transgender acceptance?
• How are transgender people discriminated against in the workplace?
• At what age should transgender people identify with their chosen gender?
• Does birth order affect whether a person may identify as LGBTQ?
• What is the difference between a non-binary and a transgender person?

If you don’t have much time to conduct in-depth research, you need to consider a topic that is relatively easy to find information about. The following list of ideas are suitable for a project you need to get done quickly:

• Changing cultural views when there is so much information to rely on.
• Gender identity in the U.S. and how it impacts social norms.
• The impact that video games have on human sexuality.
• In what ways has the U.S. healthcare system made it difficult for the LGBTQ communities?
• Violence against the LGBTQ communities over the decades.
• How can we educate youth to be inclusive of the LGBTQ communities?
• Discuss the relationship between the LGBT community and religious groups.
• Will same-sex marriages ever be protected by federal law?
• The impact that the Human Rights Campaign has had in raising awareness.
• Gender issues in the workplace for women that identify as gay.
• An examination of how acceptance of the LGBTQ community has evolved in the U.S.
• In what ways does the LGBT community feel isolated?
• What challenges and dangers do LGBT inmates face?
• What are the best practices for political groups working to improve LGBT rights?

These LGBT project ideas are great for serious academic discussions. They cover a variety of issues and can be easily researched online and at the library. Just be sure you get your information from trustworthy sources:

• What can schools do to improve LGBT inclusion on campuses?
• Discuss the treatment of the LGBT community in the early 20 th
• What are the divorce rates among same-sex marriages?
• LGBT populations around the world.
• Should LGBTQ people be allowed to hold high offices in religious organizations?
• What are some unique challenges affecting LGBT communities?
• How have gender roles changed as a result of LGBT communities?
• Have employers done enough to implement anti-discriminatory practices?
• The length of time it takes to identify sexual abnormalities.
• In what ways does the internet affect LGBT communities?
• Are there any LGBT-specific diseases?
• Are LGBT couples better at raising children?
• The effectiveness of LGBT support groups.
• Should the military reconsider the acceptance of LGBT persons?

Here are some ideas that can be used for a research paper or a presentation. They are argumentative and allow students to encourage debate on a hot topic:

• Are schools doing enough to support LGBT students?
• Are LGBT couples more or less likely to divorce compared to straight couples?
• Will the LGBT community thrive under the Biden administration?
• Should the health community do more to reach out to LGBT people?
• How can we learn more about the mental health of people in the LGBT community?
• How important is it for professional athletes to come out?
• How has the LGBT community been portrayed in media?
• What challenges do same-sex couples face when adopting?
• What are the biggest issues with same-sex marriage?
• Are professional LGBT athletes afraid of discrimination?
• Does the LGBT community get adequate medical attention?
• What is the state of LGBT in militaries around the world?
• How have LGBTQ people been portrayed on television?
• How do adolescents identify with sexuality?

If you are working on a group project, the following LGBT thesis topics allow you to take in different perspectives and address several questions related to a single focus:

• What are the biggest issues with LGBTQ hate crimes?
• What is the history of LGBTQ rights in New York?
• The portrayal of LGBTQ people in films.
• Should the federal government add an anti-discrimination bill?
• Should the government intervene with discriminatory practices in the workplace?
• Is there worldwide support for same-sex marriages?
• How effective is LGBT parenting?
• Which religions are more likely to reject LGBT people in their congregations?
• At what point was homosexuality considered an identity?
• How has gender identity changed cultural norms?
• What is the success rate for an LGBT marriage to a heterosexual person?
• What has biological research shown us about sexual orientation?
• How do reproductive technologies affect the LGBT community?
• When did LGBT emerge as an identity?

These LGBT topics cover a wide variety of subjects that from legal issues to social issues. You should be able to find an ample amount of resources online and at the library:

• How is gender identity differs from sexual orientation?
• What are some inspirational coming-out stories?
• How are people of LGBTQ communities being bullied?
• Who are some of the most influential LGBTQ writers or artists?
• Why do transgender people feel the need to “pass”?
• What impact have LGBTQ film festivals had on encouraging visibility?
• Are there any LGBT themes in the Bible?
• Was there a period when the social climate was accepting of same-sex attraction?
• What are the differences between gay and lesbian parenting?
• Who are some pioneering LGBT activists?
• Who is a person that has had a great influence on LGBT rights?
• Why is asexuality misunderstood?
• What are discrimination issues that are unique to LGBTQ?
• What legal rights have changed for LGBT people in the last decade?

We are an expert online service that provides the highest quality research papers that other cheap services cannot match. If you need professional writing help and cheap custom research papers , contact our support staff by chat, email, or phone. We will connect you with an editing and writing expert who can help you with your college assignments.

189 Social Media Research Paper Topics To Top Your Paper

Social media has been around since the late 1990s and refers to the means of interaction and communication between groups of people from all over the world. It allows them to create, share, and exchange information, ideas, and conversations in virtual communities over the internet. Society embraced social media and it was made popular by individuals that wanted to connect with others but quickly became a tool used by businesses and organizations to promote products and services and is now a vital component in building relationships, broadcasting, and marketing at small- and large-scale levels.

• Different Types Of Social Media
• What Goes Into The Structure Of Great Social Media Paper
• Excellent Social Media Research Topics
• Easy Research Topics About Social Media
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• Social Networks Topics For Graduate Students
• Popular List Of Social Networks Topics For 2023

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Q&a: how and why we surveyed americans about their views on gender identity.

Pew Research Center has studied U.S. public attitudes about gender identity and transgender issues for years. A new survey , conducted May 16 to 22, 2022, dives deeper into some of these attitudes, from the fundamental question of whether sex at birth determines a person’s gender to whether the public thinks society is moving too quickly or not quickly enough on these issues.

We spoke with Anna Brown, a research associate at the Center, about why and how we conducted this study and what we learned from it.

What are some of the biggest takeaways from this survey?

Americans’ views on gender identity and transgender issues are complex and nuanced. A majority of U.S. adults say that whether someone is a man or woman is determined by the sex they were assigned at birth, and this share has been rising. There is also a fair amount of support for restricting medical care for gender transitions among minors and requiring trans athletes to compete on teams that match their sex assigned at birth. At the same time, there’s wide support for laws and policies that would protect trans people from discrimination. The public is divided on whether our society still has work to do when it comes to accepting people who are transgender or if society has gone too far in this regard.

There is a diversity of opinion even among those who think someone’s gender is determined by sex assigned at birth.

One interesting takeaway is that there is a diversity of opinion even among those who think someone’s gender is determined by sex assigned at birth. For example, half of adults in this group say they would favor laws that would protect trans people from discrimination, and about one-in-four say forms and online profiles should include options other than “male” or “female” for people who don’t identify as either.

Why did you decide to conduct this survey? And why now?

This report is part of a larger project that included measuring the share of U.S. adults who identify as a gender that is different from their sex assigned at birth . We also spoke to trans and nonbinary adults in a series of focus groups to learn more about their experiences.

These new findings come at a time when some long-standing, fundamental assumptions about gender are being challenged.

These new findings come at a time when some long-standing, fundamental assumptions about gender are being challenged. A rising share of adults say they personally know someone who is transgender. A large majority say they’ve heard at least a little about people who don’t identify as a man or a woman and who may instead describe themselves as not having a gender or use terms such as “nonbinary” or “gender fluid” to describe their gender.

Our mission is to inform the public about the trends shaping our society today. By measuring public attitudes on these topics, we can provide objective data and contribute to the national conversation.

How did you define “transgender” and “nonbinary” in this report?

When asking respondents about transgender people, our survey questionnaire defined them as people whose gender is different from the sex they were assigned at birth, such as a person assigned male at birth who identifies as a woman.

When asking respondents about transgender people, our survey questionnaire defined them as people whose gender is different from the sex they were assigned at birth, such as a person assigned male at birth who identifies as a woman. We also asked respondents about people who don’t identify as a man or a woman and instead may describe themselves as not having a gender or describe their gender using terms such as “nonbinary” or “gender fluid.” In this report, we use “nonbinary” as a shorthand to describe this group of people.

In estimating the share of U.S. adults who are trans or nonbinary , we classified respondents based on their answers to two separate questions: the sex they were assigned at birth and how they describe their gender.

Why don’t you include the survey responses of transgender and nonbinary adults in this new report?

Trans and nonbinary adults are among our survey respondents, and their responses are included in the figures for the general population that are cited throughout the report. But even with the relatively large size of our survey panel , they make up such a small share of the U.S. population that we aren’t able to provide reliable data on their views. Instead, the focus groups we conducted allowed us to dive more deeply into the views and experiences of 27 trans and nonbinary adults, even though their views are not representative of the entire trans and nonbinary U.S. adult population.

Why does Pew Research Center refer to someone’s “sex assigned at birth” instead of their “biological sex”? What made you choose this language?

Many government surveys use this language in their questionnaires, and we modeled our approach after those. We used this language both when asking about the public’s attitudes on whether gender and sex assigned at birth can be different and when asking respondents about their own gender and sex.

This language acknowledges that some transgender people take steps to medically transition to a sex that is different from the one they were assigned at birth, as well as the fact that some people are born with ambiguous sex characteristics but are assigned either “male” or “female” on their birth certificate.

Do views on gender identity and transgender issues differ along demographic lines or by party affiliation?

Democrats and those who lean toward the Democratic Party are more than four times as likely as Republicans and Republican leaners to say that whether a person is a man or a woman can be different from their sex assigned at birth.

These topics are extremely polarized by party. For example, Democrats and those who lean toward the Democratic Party are more than four times as likely as Republicans and Republican leaners to say that whether a person is a man or a woman can be different from their sex assigned at birth. There are also wide party gaps on each of the policies or laws we asked about in the survey.

Age is another dividing line on many of these issues. For example, while about half of adults younger than 30 say government documents that ask about gender should offer options other than “male” and “female” for people who do not identify as either, that share falls to just a third among those 65 and older.

Can you provide any additional details about how the survey was conducted?

We surveyed 10,188 U.S. adults who are all members of Pew Research Center’s American Trends Panel . Panelists were selected through random sampling of residential addresses, which ensures that nearly all adults living in the U.S. have a chance of being selected. The data is then weighted to be representative of the overall adult population. These questions were part of a larger survey conducted May 16 to 22 of this year.

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Rising shares of U.S. adults know someone who is transgender or goes by gender-neutral pronouns

About four-in-ten u.s. adults say forms should offer more than two gender options, about one-in-five u.s. adults know someone who goes by a gender-neutral pronoun, most americans see value in steering children toward toys, activities associated with opposite gender, views of transgender issues divide along religious lines, most popular.

About Pew Research Center Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of The Pew Charitable Trusts .