Date of Award

Spring 5-4-2021

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Dr. Richard Rothenberg, M.D., M.P.H.

Second Advisor

Dr. Karen Nielsen, Ph. D.

Third Advisor

Dr. Joseph Kosciw, Ph. D.

Fourth Advisor

Dr. Maryna Shevtsova, Ph. D.

Abstract

INTRODUCTION: School bullying is a component of social determinants of health that contributes to the marginalization of LGBTQ+ adolescents and correlates significantly with academic indicators and mental health, reported by an extensive body of research. However, very little is known about the relationship between school victimization and sexual risk-taking behavior among LGBTQ+ Youth in Ukraine, where HIV and other STDs remain one of the biggest public health concerns.

AIM: Determine the associations between bullying, based on sexual orientation and gender expression characteristics, and high-risk sexual practices in order to inform the prevention policy development.

METHODS: The final study sample of 1,743 participants was obtained from the 2020 Ukrainian School Climate Survey (USCS), the cross-sectional study focused on measuring bullying experiences of LGBTQ+ students in Ukraine that also collected data on sexual behavior. The survey was conducted online from April 2020 through August 2020 and distributed through social media, targeting students who attended secondary-level school during the 2019-2020 academic year and identified themselves as LGBTQ+. The logistic regression analysis and bootstrapping tools of SAS 9.4 software were applied to estimate the exposure-outcome associations and potential mediation effects.

RESULTS: Severe exposures to verbal and physical harassment that was based on gender expression are associated with a two-fold increase in the risk of condomless sexual intercourse (odds ratios, adjusted to age and gender, equal to 2.1, 95% CI: [1.2 - 3.5] and 1.9, 95% CI: [1.03 - 3.4] respectively). The odds of sexual risk behavior, adjusted to age and gender, among those who had been sexually harassed (AOR = 2.6, 95% CI: [1.5 - 4.5]) and those who experienced cyberbullying (AOR = 2.2, 95% CI: [1.3 - 3.7]) were even higher. There is also evidence suggesting that the more frequent exposure to physical and sexual harassment, the higher odds of condomless sex practices. However, there were no significant indirect effects between any type of school victimization and sexual risk behavior mediated by depression or low self-esteem.

CONCLUSION: Evidence provided by this study underlines the necessity of inclusive anti-bullying policies that would decrease the exposure of LGBTQ+ students to bullying based on prejudice to gender expression. There are reasons to believe that inclusive bullying prevention could reduce HIV incidence among adolescents in Ukraine by minimizing sexual risk behavior.

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