LGB prevalence in schools is associated with unhealthy weight-control behaviors in lesbian, gay, and bisexual youth: a multilevel analysis

Carolina Da Franca Bandeira Ferreir Santos,Valdenice Aparecida De Menezes,Fabiana Godoy,Patrícia Maria Pereira De Araújo Zarzar,Ichiro Kawachi,Raquel C Ferreira,Viviane Colares

doi:10.1186/s12889-021-11260-3

Carolina Da Franca Bandeira Ferreir Santos, Valdenice Aparecida De Menezes + Show 5 more

Open Access

https://doi.org/10.1186/s12889-021-11260-3

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Abstract

BackgroundPrevious studies have found that a school climate of more heteronormativity is associated with adverse effects on the mental health of LGB students. Accordingly, our aim was to assess the association between lower LGB prevalence in schools and unhealthy weight-control behaviors among LGB youth.MethodsA cross-sectional, multilevel study based in public high schools in the city of Olinda, Northeast Brazil. A multilevel logistic regression was performed, including 2500 adolescents enrolled in 27 schools. The contextual variable was the prevalence of LGB youth in each school (as a proxy for heteronormativity in schools), while the outcome was unhealthy weight-control behaviors (fasting, purging, and taking diet pills). We controlled for socioeconomic characteristics (age, sex, receiving a family allowance), obesity, and self-reported happiness.ResultsLower LGB prevalence in schools was associated with higher odds of engaging in unhealthy weight-control behaviors (OR: 1.5, 95%CI: 1.0, 2.2) among all youth, regardless of sexual orientation. No cross-level interactions between school context and individual characteristics were statistically significant.ConclusionLower LGB prevalence in schools was associated with a higher risk of unhealthy weight-control behaviors in youth regardless of sexual orientation, which may reflect either the contextual influence of school climate, or may be due to residual confounding.

Highlights

Previous studies have found that a school climate of more heteronormativity is associated with adverse effects on the mental health of LGB students
According to Johns et al [7], there is a need for more school-based research focusing on the health of sexual and gender minority youth utilizing a multi-level framework to consider the influence of school contexts and climate
We found associations at the individual level in the expected directions, such as higher reports of unhealthy weight control behaviors among LGB youth (OR: 1.9, 95%CI, 1.1–3.2), as well as adolescents reporting victimization (OR: 1.6, 95%CI, 1.1–2.4)

Summary

Introduction

Previous studies have found that a school climate of more heteronormativity is associated with adverse effects on the mental health of LGB students. Schools need to provide a safe environment to guarantee the healthy development of their students. These conditions are not always met for sexual and gender minority youth as they are more likely to report negative perceptions and experiences of Santos et al BMC Public Health (2021) 21:1256 truancy, and graduation) for all students, regardless of sexuality. We examined whether lower LGB prevalence (as a measure of school context) is associated with unhealthy weightcontrol behaviors among youth, irrespective of their sexual orientation

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