The evaluation team trained partner CBOs to recruit YMSM using the IRB approved protocol. Subsequently, partner CBOs in each city completed all recruitment activities for the Web-based questionnaire and interviews, recruiting youth through cards, posters, and word of mouth. Participants completed the questionnaire on study-dedicated computers in private areas at the CBOs. CBO staff scheduled interviews and provided interviewing space; however, the evaluation team conducted all interviews.

Recruitment for the questionnaire occurred between June and September of 2012, and the evaluation team interviewed youth between July and August of 2012. Youth were eligible for participation if they had all of the following characteristics: male; black, Latino, or multiracial with either black or Latino included; between 13 and 19 years of age; indicated attraction to or sexual behavior with other males and/or identified their sexual orientation as gay or bisexual; and attended at least 90 days of school since January 2011.

A broad definition of YMSM is used in this evaluation, and throughout the manuscript, that includes young men who had sex with other males, were attracted to other males, or identified as gay or bisexual. This broader definition allowed the evaluation team to assess youth who are currently at elevated risk or are likely to be in the future and is developmentally appropriate for teens who are developing a sense of personal identity and for those who are not yet sexually experienced.

A total of 415 youth (200 in New York; 188 in Philadelphia; and 27 in San Francisco) completed the questionnaire and 32 youth were interviewed (11 in New York; 12 in Philadelphia, and 9 in San Francisco). We aimed to recruit 200 youth in each city for the questionnaire and 10 youth in each city for the interviews. The San Francisco questionnaire target was not met; however, the interview target was met. The majority of the questionnaire sample was black (64.1%) and non-Hispanic (59.3%), and the mean age was 17.4 years. Overall, 99.0% of youth met the study’s definition of being YMSM based on reported attraction, identity, or behavior. Additional demographic information about the sample is published elsewhere.¹⁷

Among interview participants, approximately half indicated they would be enrolled in high school in the fall; of these, most were entering 11th or 12th grade. Most remaining participants had completed high school. Of these, some, but not all, were enrolled in college. Two interview participants reported having dropped out of school. No other descriptive information was collected on interview participants, but all met the study’s inclusion criteria, described previously.

The 53-item online questionnaire took 25 minutes to complete, on average. The questionnaire included items to assess demographics, school environment, willingness to talk with school staff, media campaign exposure, trusted sources of information, HIV/STD testing history, and preferred venues for accessing sexual health and related services. In-depth interviews lasted 60-90 minutes and covered similar domains to the questionnaire, with more in-depth discussion of school experiences and how sexual health services could be delivered within schools. In this manuscript, we focus our analysis on youths’ willingness to talk with school staff members about health-related topics such as dating and relationships, sexual orientation, and safety, and the perspective of youth on what made them comfortable discussing these topics with staff members.

Questionnaire data were analyzed using SPSS. Descriptive statistics were calculated for each variable for the overall sample. Logistic regression was used to conduct an exploratory analysis of predictors of willingness to speak with school staff while controlling for significant demographic covariates.

The evaluation team analyzed qualitative data by iteratively developing codes, establishing intercoder reliability among three experienced coders, single coding full transcripts with ATLAS.ti 7 software, and qualitatively analyzing coded data. To establish intercoder reliability, team members were given text segments from two randomly selected interview transcripts and applied the most relevant primary code to each segment. To obtain the Fleiss’s kappa and determine intercoder reliability, the team used an Excel-based macro¹⁸ and validated the result using SPSS syntax. Intercoder reliability was achieved at Fleiss K = .90. Coders reviewed and discussed four codes with a kappa statistic of less than 0.75 to resolve discrepancies. After establishing reliability, one team member coded each transcript for analysis. The team later triangulated data to identify common themes between questionnaire and interview results.

Among questionnaire participants, 63.4% reported being willing to talk to at least one school staff member about being teased, called names, harmed, or being made to feel unsafe (safety issues). More specifically, 45.6% of youth were willing to talk to a school counselor and 37.1% were willing to talk to a teacher. Only 16.0% of youth were willing to speak with a school nurse about these issues. In addition, 27.8% of youth specifically stated they would not talk to any school staff about these issues (see Table 1). No significant subgroup differences by age, race, and ethnicity were found.

In terms of willingness to talk about dating and relationships or feeling attracted to other guys, 58.4% and 55.9% of youth, respectively, reported they were willing to talk to at least one school staff member. School counselors were the most common choice participants reported being willing to talk to about dating and relationships (36.8%) and feeling attracted to other guys (38.3%). Teachers were selected as the second most common choice whom youth would be willing to talk to about dating and relationships (30.6%) and feeling attracted to other guys (25.1%). Few youth reported school nurses as staff members they would be willing to talk to about being attracted to other guys (13.3%) or dating and relationships (10.5%). Over one-third of youth specifically reported they would not talk to any staff at school about feeling attracted to other guys or dating and relationships (34.3% and 35.1% of youth, respectively) (see Table 1).

When YMSM were asked how much they trust the information they get about dating, relationships, sex, or sexual health from teachers, schools counselors, and school nurses, respondents reported a level of trust between a little and some trust (see Table 1). Mean levels of trust for teachers (M=2.46, SD=1.1), counselors (M=2.63, SD=1.1), and nurses (M=2.48, SD=1.1) were modest and similar.

Although our study was descriptive in nature and limited in plausible predictor variables, selected potential predictors of willingness to talk with any school staff member (teachers, counselors, nurses, or other staff members) about safety, dating/relationships, or same sex attraction were explored using logistic regression. Specifically, the experience of feeling unsafe at school in the last 18 months and level of trust of information about dating, relationships, sex or sexual health were examined as potential predictors of willingness to talk with school staff while controlling for age and Latino ethnicity. Results (see Table 2) indicated that YMSM who felt unsafe at school were nearly 3 times more likely (aOR = 2.80, 95% CI = 1.28 – 6.16) to be willing to talk with any school staff members about these topics and YMSM with higher levels of trust in the information from school staff were nearly 5 times more likely (aOR = 4.86, 95% CI = 3.17 – 7.45) to be willing to talk with any school staff about these topics after controlling for demographic covariates, X²(4, N=302) = 93.78, p <.01.

Interview results provide additional detail about staff members with whom YMSM would discuss issues such as safety, sexual orientation, and relationships. In general, interview participants concurred with questionnaire respondents; however, a broader range of staff¹ emerged as potential confidants (e.g. math teacher, security guard, cafeteria worker). Most interviewed youth identified at least one school staff member with whom they felt comfortable talking about these sorts of issues. Although students may have confided in many different types of school staff, interview participants described several types of staff members as confidants more often than others. Youth most often reported talking to: (1) school counselors, principals, selected teachers or staff with whom they already had strong relationships; (2) teachers or staff known to be LGBT; and (3) staff of the same race/ethnicity as the student.

YMSM highlighted a wide range of teachers and staff members as confidants because of personal relationships. The way youth described these individuals highlighted the importance of caring, open, and relatable interaction styles. Many youth described these staff members as very important to their school experience and like a trusted friend. One youth shared his experience with a teacher confidant saying,

“She was actually my global studies teacher, but they also give you like an advisor, like somebody who’s just probably in one of your core classes, they just become your advisor, somebody to just be close or cool as a teacher. So cool, like I loved that lady, if it wasn’t for her I probably never would’ve even made it through high school. Like she was like my rock, like whenever there was something wrong, like I knew I could go to her. Like even after I graduated, like I still speak to her.”

In addition, some youth mentioned specific school staff who were approachable because they were known to be LGBT. That identity made some youth more comfortable approaching staff for life advice or safety concerns. Youth viewed these staff as more approachable because they thought LGBT staff had probably been through experiences similar to their own. Interview respondents shared this view saying,

“Cause they’re gay and I’m gay and, you know, like, ’cause you know, if you got a problem, come to them, ’cause they know, sometimes they’ve already been through that problem, and you’re just starting to go through, you know, stuff like that.”

“They’re, well they’re successful, and they’re in the LGBTQ community, so I just feel comfortable talking to someone that is in the same community but has overcome a lot of things and is successful.”

Although it is difficult to generalize the importance of student-to-confidant similarity, a few youth mentioned race/ethnicity as an important quality of a trusted advisor with whom they would talk about being attracted to other guys. Specifically, these youth reported more comfort talking with school staff who were of like racial or ethnic background. One youth captured this in their own words saying,

“Okay, I think I’m going to have to, I just thought about it, like I would end up talking to a teacher that is also a person of color, rather than a white teacher…‘cause they’d understand what the pressures of actually being a person of color--whether they’re queer or not, they all understand that, and I’m able to really pull that, as an example, and as like a really, a reference point. When talking about my own issues. And you know, that there’s an understanding there that that is there, that isn’t really anywhere else.”

Youth also described characteristics of staff members that made them people with whom youth would discuss issues of safety, relationships, and sexual orientation. In particular, youth highlighted three key characteristics: (1) ability and willingness to help the youth, (2) willingness to keep confidentiality, and (3) expression of genuine care. With regard to discussing bullying, homophobia, or other sexual orientation related safety concerns within and outside of school, youth often reported interest in talking to staff who could and would do something about their concerns. In describing this, youth often mentioned principals, counselors, or other staff they witnessed address safety issues head on. Action to address problems seemed to gain the youth’s respect and demonstrate when staff care and are trustworthy. One youth captured this sentiment by saying,

“I would say because, like, [dean, principal, vice principal and teachers] would do something about it. They’re not the type of people that don’t like just let it sit to the side, and don’t do nothing or that might start something and don’t finish it.”

In discussing sexual orientation and relationships, most interview participants described the importance of confidentiality. Most youth equated “safe” conversations with keeping what was shared private. The desire for privacy and confidentiality was a main reason youth often cited school counselors as staff members with whom they could talk freely about sexuality-related health or safety issues, citing counselors’ legal requirement to maintain confidentiality as a reason they could talk with them.

In addition, interview participants expressed regard for staff who truly seemed to listen rather than disregarding or cutting conversation short. The sense that staff members actually cared about what youth had to say was very important to their willingness to discuss these topics. Youth also expressed preference for being treated with respect and feeling that staff members genuinely cared for them.

Despite many interview participants identifying at least one school staff member they would talk to or had talked to about safety, sexual orientation, or relationships, a notable minority of youth said they did not trust other people at all. As a result, they did not really talk to school staff or other people about topics related to being YMSM. Most often, these youth described themselves as “private” and indicated they did not talk to school staff about anything personal. Youth cited reasons for their resistance to talking with school staff that included beliefs staff would not do anything about it or they did not want school staff members “in my business.” One respondent shared his perspective saying,

“Oh, I really don’t talk with teachers. Like I don’t talk to any teacher about my problems. I know I can, but I just don’t because I’m like I know she wouldn’t say nothing, but still. I don’t want too many people in my business.”

In addition, some youth were unwilling to talk with school staff for fear that once they disclosed information about themselves or their relationships, they would be treated differently or staff would breach confidentiality by telling others (staff, students’ family members, or other students) intentionally or unintentionally. In summary, a substantial number of interview participants said “nothing” would have made them more comfortable talking with school staff about sexual orientation or related concerns. This finding was also supported in the questionnaire data (see Table 1).

This study has several important limitations. Findings only describe the experience of these black and Latino teen YMSM in the three participating urban areas and cannot be generalized to other youth. Data also underrepresent perspectives of YMSM who do not openly identify as MSM, who are younger, and who do not connect with LGBTQ-serving CBOs. Although we did not explicitly exclude transgender men from the study, our survey instrument was not adequate to detect them and we do not know if any were included in our sample. To avoid such uncertainty, future studies could use a two-step method of assessing gender which includes both natal gender and current gender identity.

Although not every school staff member will embody characteristics YMSM reported favoring in confidants, each staff member can be prepared to support YMSM students by knowing when, how, and where to refer students for needed resources. With professional development on resources for LGBT students and on skills for connecting with YMSM (and other LGBT students), addressing safety concerns, maintaining and communicating confidentiality, and sharing resources with these students, staff could be more prepared to support their LGBT youth. In addition, school staff could seek to build all students’, including YMSM, regard and trust for information they may share about sexual health related topics. As trust is established with school staff, it may provide opportunities to further engage YMSM in health care services through linkage and referral activities. Helping YMSM to see the value and importance of disclosing their orientation to their health care providers is a role that trusted school staff can play. If successful, such disclosures may help ensure that YMSM receive timely and appropriate health screenings and counseling regarding preventative healthcare, including HIV risk and safer sex practices. Lastly, our study also points to the need for more research and education on how schools and their staff can create safer, more embracing spaces for LGBTQ youth to thrive.