Sexually and racially diverse (SD) adolescents experience elevated proximal and distal minority stressors that vary across school, community, and policy contexts. Limited research has examined how access to and use of LGBTQIA+ supportive structures, such as Gender and Sexualities Alliances (GSAs), LGBTQIA+ community centers, and affirming school staff, shape distal minority stress for racially and sexually diverse youth across geographic settings. Using cross-sectional national sample data of SD adolescents from the Adolescent Stress Experiences Over Time Study (ASETS; N = 1076), this study applied binary logistic regression and linear regression to assess how racial identity, urbanicity, and structural access to and use of LGBTQ community centers and school affirmative SD groups are associated with distal sexual minority stress domains (homonegative climate, social marginalization, and intersectional stress), friend social support, and coping skills. Results indicated that GSA presence, regardless of individual participation, was associated with reduced odds of minority stress across all domains, while attending a GSA was further associated with increased use of engagement-oriented coping strategies. Conversely, community center attendance was associated with higher odds of social marginalization, suggesting contextual variability in the protective impacts of community-based supports. Geographic differences in distal minority stress were evident in only one domain, homonegative climate, and rurality was not significantly associated with differences in peer social support or coping. Findings underscore the importance of school-embedded, structurally inclusive supports for reducing minority stress and bolstering resilience among sexually and racially diverse adolescents, and highlight ongoing gaps in support for youth outside urban areas or in restrictive community climates. Future research should examine culturally grounded mechanisms that enhance the effectiveness of supportive structures and ensure inclusivity across racial and geographic contexts.

BACKGROUND:California is a leader in adopting numerous transgender and nonbinary adolescent (TNBA)-protective education policies. However, the adoption and implementation of these policies remain largely unexamined. This study explored local school adoption and implementation of California state TNBA-protective policies. METHODS:Nine Los Angeles area high schools enrolled in another study (R01MD016082) participated in this explorative qualitative case study. Case study methods included document collection, campus observations, member checks, and seven student focus group discussions (FGDs; n = 39) between August 2022 and April 2024. Data were analyzed by multiple coders following the Framework Method to compare the implementation of school, district, and state policies. RESULTS:Implementation of name changes, gender-neutral restrooms, private accommodations, and sexual health education varied between schools and districts. While many schools did not meet state mandates to protect TNBA student access to education, others feasibly implemented these policies, and some adopted innovative approaches to protect TNBA. District oversight, publication of policies and facility access, staff training, funding, and infrastructure were key factors in successful implementation. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY:Study findings highlight the feasibility of the implementation of TNBA protections in schools, with recommendations to adopt gender transition planning, publish policies for student access, and ensure the availability of gender-neutral restrooms and private accommodations. CONCLUSIONS:Implementation of these policies is feasible with sufficient support and oversight. TNBA-protective policies can be strengthened with accountability mechanisms and promotion of implementation strategies, such as technical assistance. Future research should examine the implementation of these policies statewide.

Objective: Sexual and gender minority adolescents (SGM) experience disparities in housing and mental health. Significant gaps remain in understanding the context of SGM housing trajectories and their consequences over time. These gaps stem, in part, from a dearth of longitudinal data needed to explore housing trajectories among SGM adolescents. Thus, this paper describes housing instability and mental health outcomes among SGM adolescents over time. Methods: Analysis of longitudinal national purposive sample, Adolescent Stress Experiences of Over Time Study (ages 13-17; N = 1,076) tested the associations between timing of housing instability, rejection due to sexual orientation, and chronicity of housing instability with 36-month suicidal thoughts and behaviors, depression (CESD4), PTSD (PCLC), and anxiety (GAD-7). Data were analyzed using logistic and linear regressions and the Benjamin-Hochberg procedure adjusted for multiple hypotheses. Results: Thirty-four percent of SGM adolescents experienced housing instability with 28.99% attributing this at least in part to rejection due to sexual orientation. Experiences of unaccompanied homelessness and mixed family and unaccompanied homelessness were similar, each reported by approximately 40% of housing unstable participants. Any unstable housing experience was associated with increased symptoms of PTSD. Multiple periods of instability were associated with all outcomes, and notably a ninefold increase in suicide attempts as compared to stably housed SGM adolescents. Housing instability because of rejection of sexual orientation was associated with six times the odds of suicide attempt in contrast to other reasons. Discussion: Expansion into family housing services and integrated housing and suicide services are urgently needed to reduce housing and mental health disparities among SGM adolescents.

Structural stigma, which includes policies and attitudes that mark minorities for discrimination, contributes to sexual minority adolescents' (SMA) stress and mental health disparities, yet the relative contributions of county- vs. state-level stigma remain unknown. This study examined how structural stigma affects SMA exposure to minority stress and mental health symptoms with a U.S. national sample of SMA (N = 2,558, ages 14-17, M = 15.9), of whom 64.35% were cisgender designated female at birth and 48.28% were bisexual/pansexual. Researchers analyzed links between county- and state-level stigma with anxiety and depression symptoms and assessed whether minority stress mediated these associations. Minority stress significantly linked structural stigma to mental health symptoms. Adolescents in supportive counties and supportive states experienced fewer minority stressors and mental health symptoms compared to those in unsupportive counties of unsupportive states. Locally supportive counties and local action to address structural stigma may protect SMA mental health, even in otherwise unsupportive state contexts.

ObjectiveThis study aimed to create and validate a novel measure of gender-related minority stress in transgender and non-binary adolescents (TNBA). TNBA face higher risks of varied behavioral health concerns compared to their cisgender peers, a disparity often attributed to the presence of minority stress due to discrimination. To date, no comprehensive measures of gender-related minority stress exist for use with TNBA.MethodThe present study recruited a U.S. national sample (N = 444, aged 12–17; 65.5% White, 9.5% Black, 9.5% Latine, 15.5% other ethnicity; 34.7% transmasculine, 17.3% transfeminine, 38.3% non-binary, 9.5% agender) of TNBA. An initial item pool was developed from life history calendars, a modified Delphi process, and cognitive interviews with TNBA. Analytic methods including principal components analysis, item response theory, measurement invariance testing, and reliability analyses were conducted to establish the final scale. Concurrent validity was established across behavioral outcomes (mental health, suicidal thoughts and behavior, substance use), and convergent and divergent validity compared the Transgender Adolescent Stress Survey–Minority Stress (TASS-MS) to existing measures of gender-related minority stress.ResultsThe TASS-MS and its subscales (disaffirmation, visibility and internalized transnegativity, family) were significantly associated with anxiety and depressive symptoms, PTSD symptoms, suicidal behaviors, non-suicidal self-injury, marijuana, and prescription drug use. The TASS-MS was moderately and weakly correlated with convergent and divergent measures, respectively, indicating specificity to minority stress.ConclusionThe TASS-MS is a reliable and valid measure for future research with TNBA. It is inclusive and usable by all gender minority adolescents, uses a standard simple scoring system, and assesses adolescent-specific stressors.

Background: Sexual minority youth are at more than twice the risk of experiencing homelessness than their peers and both sexual minority youth and youth experiencing homelessness have disproportionate risk for mental health disorder symptoms. Couch-surfing is a common form of homelessness experienced by youth, but research on the relationship between couch-surfing and mental health outcomes, especially among sexual minority adolescents (SMA), is limited. Methods: Utilizing a sample of 2,558 SMA (14-17 years old) recruited via social media and respondent-driven sampling, this study explores the relationship between different forms of homelessness (exclusive couch-surfing vs. multiple types of homelessness) and symptoms of depression, anxiety, suicidal ideation, and suicide attempt. Results: Nearly 21% of participants experienced any homelessness in their lifetime, with 14% reporting exclusive couch-surfing. All forms of homelessness were associated with large increases in symptoms of anxiety, depression, suicidal ideation and suicide attempt. Conclusion: Homelessness - primarily couch-surfing - is a common experience for SMA in this sample. All forms of homelessness - including exclusive couch-surfing - were associated with large increases in depression, anxiety, suicidal ideation, and suicide attempt, emphasizing the importance of services that are available to couch-surfing young people and responsive to the needs of sexual minority adolescents.

Objective Transgender and nonbinary adolescents (TNBA) may experience gender dysphoria arising from incongruities between their body and their gender. Prior dysphoria measures have largely focused on clinical diagnosis with little regard to comparability of forms for people assigned male or female at birth, overall psychometric performance, or applicability to nonbinary populations. This study develops and validates the Transgender Adolescent Stress Survey-Dysphoria (TASS-D), intended to address these gaps.Methods The current study recruited a U.S. national sample of TNBA (N = 444, aged 12-17; 65.5% White, 9.5% Black, 9.5% Latine, 15.5% other ethnicity; 34.7% transmasculine, 17.3% transfeminine, 38.3% nonbinary, 9.5% agender). The item pool was developed from life history calendars, a modified Delphi process, and cognitive interviews with TNBA. Scale development included factor analysis, item response theory modeling, measurement invariance testing, and reliability analyses. Associations were examined between the TASS-D and existing measures of gender dysphoria (convergent validity), gender minority stress (divergent validity), and behavioral health outcomes (criterion validity).Results TASS-D and its subscales (body distress and gender expression burden) were significantly and strongly associated with gender dysphoria; significantly but weakly associated with gender minority stress; and significantly associated with most indicators of psychological distress including depressive, anxiety, and posttraumatic stress symptoms, suicidal behaviors and nonsuicidal self-injury.Conclusions The TASS-D is a reliable and valid measure of gender dysphoria for TNBA, offering notable benefits over existing measures: It is psychometrically sound, inclusive of all gender identities, and does not assume that respondents identify binarily or desire medical transition as a terminal goal.

OBJECTIVE:Beliefs about suicide are important aspects of suicide prevention gatekeeper trainings. This study sought to determine if workers in finance- and legal/judicial-related industries have significantly different levels of suicide acceptability compared to the general US population.METHOD:Cross-sectional data are from the 2002 to 2021 General Social Survey (GSS). Suicide acceptability was measured with four dichotomous items to which respondents indicated yes/no if they thought someone has the right to end their life in four negative life scenarios. Occupational categories were coded based on U.S. Census Bureau occupation and industry codes. Covariates for multiple logistic regression analyses included age, educational attainment, sex, race, ethnicity, survey year, and religiosity.RESULTS:Among the 15,166 respondents, 651 people worked in finance-related occupations and 319 people worked in legal/judicial-related occupations. In adjusted models, people in finance-related occupations had greater odds of endorsing suicide as acceptable if one has an incurable disease (aOR = 1.25, 95%CI = 1.03-1.52) and marginally greater odds of endorsing suicide as acceptable if one dishonors their family (aOR = 1.31, 95%CI = 0.99-1.74) than the general adult population. People in legal/judicial-related occupations were more likely to endorse 3 of the 4 suicide acceptability items compared to the general adult population, however these differences were not statistically significant after accounting for demographic factors.CONCLUSION:Workers in non-clinical industries that frequently see clients during negative life events are prime audiences for gatekeeper trainings but may have entrenched beliefs about suicide acceptability. Research is needed to determine how these beliefs may impact gatekeeper training.

Introduction: Social network changes are common as individuals transition from homeless to Supportive Housing. Egocentric approaches to elicit network members have been utilized with young adults experiencing homelessness to better understand such socio-environmental contexts; however, such approaches are subject to recall bias. Momentary measurements of one's social network via Ecological Momentary Assessment (EMA) can support in understanding the accuracy of egocentric elicitation methods.Objective: To examine who is elicited using an interaction-based approach in egocentric social network analysis among currently homeless and formerly homeless young adults residing in Supportive Housing and explore which alters are reported in interactions and how often are they reported when egocentric network analysis is embedded in EMA.Methods: The present study utilizes interaction-based elicitation embedded within Ecological Momentary Assessment (EMA) in two sub-samples: currently homeless young adults (n = 72) and formerly homeless young adults residing in Supportive Housing (n = 118). Results: Most egos interacted with three of their top five alters, while only 8.9% interacted with all five. Conversely, only 2% of egos reported that they did not interact with any of their top five. Several differences in alter characteristics were identified by housing status. Alters indicated as being more supportive are elicited first and alters elicited first are interacted with the most.Conclusions: EMA findings suggest that a cross-sectional social network survey of top five alters will results in an ordered list, with the most important/frequent alter being named first and trend downward. Results have implications for future study design involving egocentric network analyses. Present findings indicate qualities of alters present and thus, offer plausible "best practices" when utilizing network elicitation methods, particularly interaction-based methods.

BackgroundLesbian, gay, bisexual, and other non-heterosexual (LGB+) adults and those experiencing houselessness report disproportionate risk of negative mental health and are overreported in carceral settings. However, we lack estimates of associations between sexual orientation, houselessness, and mental health among adults incarcerated in prisons.MethodsUsing secondary data from the 2016 Survey of Prison Inmates (N = 24,848), multivariate logistic regression models were run to examine the associations between sexual orientation, houselessness, and mental health indicators.ResultsAmong respondents, 7.4% identified as LGB + and 9.7% reported houselessness in the 12 months before arrest. Identifying as LGB+, experiencing houselessness, and both (i.e., LGB + identity and experiencing houselessness) were significantly associated mental health indicators, compared to those who identified as heterosexual and/or had not experienced houselessness. Odds were higher for those who reported both houselessness and identified as LGB + compared to those who reported only houselessness or only LGB + identity. All models controlled for age, assigned sex at birth, and race/ethnicity.ConclusionsTargeted mental health interventions are needed for people with multiple minority identities (i.e., LGB + and experience of houselessness) who are incarcerated. These interventions should recognize that their needs may be more intersectional than their counterparts with one minority identity.Policy ImplicationsAddressing issues of mass incarceration, systemic violence, and mental health disparities faced by multiple minoritized adults in prisons will require new national legal standards and policies collectively established by policymakers, legal experts, public health practitioners, social advocates, and researchers.

Background Web-based recruitment for research studies is becoming increasingly popular and necessary. When compared with the traditional methods of recruitment, these methods may enable researchers to reach more diverse participants in less time. Social media use is highly prevalent among adolescents, and the unique context of social media may be particularly important for the recruitment of sexual minority young people who would not be captured by traditional methods. Objective This paper described the details of a national web-based study recruitment approach aimed at sexual minority adolescents across the United States, focusing on important details of this relatively novel approach, including cost, time efficiency, and retention outcomes. Methods This study recruited sexual minority adolescents aged 14-17 years living in the United States through targeted advertisements on Facebook, Instagram, and YouTube and through respondent-driven sampling (RDS). Potential participants completed eligibility screening surveys and were automatically directed to a baseline survey if they were eligible. After baseline survey completion, additional data checks were implemented, and the remaining participants were contacted for recruitment into a longitudinal study (surveys every 6 months for 3 years). Results Recruitment lasted 44 weeks, and 9843 participants accessed the initial screening survey, with 2732 (27.76%) meeting the eligibility criteria and completing the baseline survey. Of those, 2558 (93.63%) were determined to have provided nonfraudulent, usable study data and 1076 (39.39%) subsequently enrolled in the longitudinal study. Of the baseline sample, 79.05% (2022/2558) was recruited through Facebook and Instagram, 3.05% (78/2558) through YouTube, and 17.9% (458/2558) through RDS. The average cost of recruiting a participant into the study was US $12.98, but the recruitment cost varied by method or platform, with a realized cost of US $13 per participant on Facebook and Instagram, US $24 on YouTube, and US $10 through RDS. Participant differences (sex assigned at birth, race and ethnicity, sexual orientation, region, and urbanicity) were identified between platforms and methods both in terms of overall number of participants and cost per participant. Facebook and Instagram were the most time efficient (approximately 15 days to recruit 100 participants), whereas RDS was the least time efficient (approximately 70 days to recruit 100 participants). Participants recruited through YouTube were the most likely to be longitudinally retained, followed by Facebook and Instagram, and then RDS. Conclusions Large differences exist in study recruitment cost and efficiency when using social media and RDS. Demographic, region, and urbanicity differences in recruitment methods highlight the need for attention to demographic diversity when planning and implementing recruitment across platforms. Finally, it is more cost-effective to retain than recruit samples, and this study provided evidence that with thorough screening and data quality practices, social media recruitment can result in diverse, highly involved study populations.

This study assessed associations between state legislative activity, sexual minority adolescent minority stress, and suicide attempt. State-level sociopolitical climates are variably supportive and hostile toward sexual minority adolescents. This study, therefore, examined whether state sociopolitical climate is associated with sexual minority adolescent minority stress and, in turn, the risk of suicide attempt in this high-risk population. A nationwide sample of sexual minority adolescents (N= 2,558) responded to online surveys in 2018 and 2019 assessing minority stress and past-year suicide attempt. Legislative activity scores, that is, the number of anti- and pro-LGBTQ pieces of legislation proposed each year in each state, were accessed from the Human Rights Campaign State Equality Index, assigned to youth based on their state of residence, and used as an indicator of sociopolitical climate. We examined associations between legislative activity, minority stress, and suicide attempt using path analyses. Legislative activity is directly associated with sexual minority adolescent minority stress and indirectly associated with suicide attempt through minority stress among sexual minority adolescents. Amidst nationwide attacks on sexual minority adolescent health and well-being, study findings emphasize the associations between sociopolitical climate, minority stress exposure, and health.

Introduction: Young adults experiencing homelessness have poorer overall health compared with the general population. However, not much is known about how health care needs may change in the transition from homelessness to supportive housing. This study utilizes the Gelberg-Andersen Behavioral Model for Vulnerable Populations to examine unmet health care needs among young adults currently experiencing homelessness and formerly homeless young adults living in supportive housing. Methods: This study includes data from 192 young adults who were either residing in a supportive housing program (n=103) or were “unhoused” (eg, residing on the street, staying in emergency shelters; n=89) in Los Angeles, CA, between 2017 and 2019. Hierarchical modeling examined unmet health care needs and factors that may enable those needs to be met, controlling for predisposing and other need factors. Results: Controlling for predisposing and other need characteristics, this study identified increased enabling factors among those residing in supportive housing, the most widely applied intervention for homelessness. Participants who resided in supportive housing were more likely to report at least 1 type of unmet need than youth who did not have access to housing. Additional findings regarding the association of enabling factors and unmet need yield mixed results based on the type of unmet need. Discussion: The acknowledgment of unmet needs may, in fact, be a byproduct of shifting priorities, which often occurs in the transition from homelessness to housing. Understanding the unmet need and health implications of this transition has relevance for practice as we work to better support formerly homeless young adults in meeting the needs that they identify.

GIS is increasingly popular in the study of complex social issues, such as homelessness. This study aims to assess how GIS has been leveraged and applied to homelessness research and service delivery. Systematic searching of sixteen databases was completed between January and March of 2021 using the terms "homeless" and "Geospatial Information Systems (GIS)." A final sample of 19 sources were identified from a total of 1719 identified sources. Through quantitative and qualitative methods, the included sources examined 1) static location characteristics associated with homelessness, and 2) mobility of homeless persons.

Abstract Homelessness poses risks to the health and safety of young adults; particularly among sexual and gender minority (SGM) young adults. The current study sought to better understand service use and perceived safety in community and service settings among SGM and cisgender heterosexual (cis‐hetero) young adults experiencing homelessness. Data come from a mixed‐method, ecological momentary assessment study (n = 80; 43% sexual minority; 10% gender minority) in Los Angeles, California. Participants reported their current location (service vs. nonservice setting) and perceived safety. Multilevel modeling examined associations between identity, location, and perceived safety; qualitative interviews with 20 SGM participants added context to quantitative findings. Overall, service location was associated with greater perceived safety (β = .27, p < .001). Compared to cis‐hetero participants, cisgender sexual minorities (β = −.23, p = .03) and sexual and gender minorities (β = −.50, p = .002) reported lower perceived safety in service settings (vs. nonservice settings). Qualitative interviews revealed themes and subthemes detailing safe/unsafe spaces and interpersonal conflict in the community, and relationships with staff, peers, transphobia, and positive experiences in service settings.

Purpose Experiences of sexuality-based discrimination (ie, minority stressors) against youth who identify as nonheterosexual (ie, sexual minority) have been associated with increased symptoms of anxiety, depression, and post-traumatic stress disorder (PTSD) for sexual minority adolescents (SMA; ages 14-17). However, little is known about the experiences of SMA living in rural communities across the United States. Thus, the present study sought to examine differences in mental health patterns between urban and rural dwelling SMA, and to see whether these differences are, at least in part, explained by experiences of lifetime minority stress. Methods A nationwide sample of SMA residing in the United States (N = 2,558; aged 14-17, M = 15.90 years, SD = 0.98) was recruited through purposive social media and respondent-driven sampling methods to complete a cross-sectional survey online. Measures included those of minority stress, urbanicity, and symptoms of anxiety, depression, and PTSD. Parallel multiple mediation (PMM) analysis was employed to test whether urbanicity was associated with anxiety, depressive, and PTSD symptoms through reported lifetime minority stress. Findings On average, SMA living in rural areas significantly reported more lifetime minority stress, depressive, and PTSD symptoms than SMA living in urban settings. Results from our PMM analysis indicated that heightened experiences of lifetime minority stress indirectly linked the effects of living in rural areas on anxiety (b = -0.288, 95% CI = [-0.491, -0.085]), depressive (b = -0.158, 95% CI = [-0.270, -0.047), and PTSD symptoms PTSD (b = -0.349, 95% CI = [-0.596, -0.105]). The model accounted for 16.8%, 18%, and 24.1% of the variability in anxiety symptoms, depressive symptoms, and PTSD symptoms, respectively. Conclusions SMA in our study who reside in rural areas reported elevated minority stress, depressive, and PTSD symptoms as compared to their urban dwelling peers. Our study found that lifetime experiences of minority stress fully mediated the relationship between urbanicity and both depressive and PTSD symptoms, and partially mediated the relationship between urbanicity and anxiety. These findings highlight the need to increase support for rural youth who are growing into adulthood and may find continuing challenges in their family, peer, and community relationships.

IntroductionLittle is known about the momentary patterns and predictors of substance use among young adults who experience homelessness. To enhance understanding of substance use patterns, smartphone-based ecological momentary assessment (EMA) was utilized to examine the real-time association between affect and substance use. Methods: 251 young adults (aged 18-27) with history of homelessness were recruited from supportive housing programs and drop-in facilities in Los Angeles. Exploratory factor analysis was used to examine the latent structure of positive and negative affective states and mixed-effects logistic regression models were completed separately for both the full remaining sample (n = 227) and a subsample of alcohol or cannabis users (n = 145) to evaluate whether positive or negative affect predicted lead, recent, or lagged substance use. Results: Greater positive affect within-person was associated with greater odds of alcohol or cannabis use within the past two hours, and participants who reported feeling more negative than their peers experienced greater odds of reporting use within the past 4 h and the following two hours. Conclusion: Results suggest that individuals experience a heightened positive mood compared to their own average mood, concurrently or immediately after engaging in alcohol or cannabis use. Heightened positive mood might be an anticipatory effect of drinking or cannabis use. Future research should consider a longer study period to capture multiple drinking or drug use events over a longer period and consider more environmental exposures that may influence the frequency or intensity of substance use.

IntroductionSexual minority adolescents (SMA) report higher rates of anxiety, self-harm, depression and suicide than heterosexual peers. These disparities appear to persist into adulthood and may worsen for certain subgroups, yet the mechanisms that drive these concerns remain poorly understood. Minority stress theory, the predominant model for understanding these disparities, posits that poorer outcomes are due to the stress of living in a violently homophobic and discriminatory culture. Although numerous studies report associations between minority stress and behavioural health in adolescence, no study has comprehensively examined how minority stress may change throughout the course of adolescence, nor how stress trajectories may predict health outcomes during this critical developmental period.Methods and analysisBetween 15 May 2018 and 1 April 2019, we recruited a US national sample of diverse SMA (n=2558) age 14–17 through social media and respondent-driven sampling strategies. A subset of participants (n=1076) enrolled in the longitudinal component and will be followed each 6 months until 1 July 2022. Primary outcomes include symptoms of depression, anxiety and post-traumatic stress disorder; suicidality and self-harm and substance use. The key predictor is minority stress, operationalised as the Sexual Minority Adolescent Stress Inventory. We will use parallel cohort-sequential latent growth curve models to test study hypotheses within a developmental framework.Ethics and disseminationAll participants provided assent to participate, and longitudinal participants provided informed consent at the first follow-up survey after reaching age 18. All study procedures were reviewed and approved by the University of Southern California Social–Behavioral Institutional Review Board, including a waiver of parental permission given the potential for harm due to unintentional ‘outing’ to a parent during the consent process. The final anonymous data set will be available on request, and research findings will be disseminated through academic channels and products tailored for the lay community.

Sexual and gender minority adolescents (SGMA) experience higher rates of internalizing psychopathology, including depression, anxiety, self-harm, and posttraumatic stress disorder. The primary explanation for these mental health disparities is minority stress theory, which suggests that discrimination, violence, and victimization are key drivers of chronic minority stress and place SGMA at higher risk of mental health concerns. To help address these concerns, the authors undertook a nearly 8-year process of developing Proud Empowered, a school-based intervention to help SGMA cope with minority stress experiences. This manuscript details the intervention development process, including: (a) identifying the mechanisms of change (Stage 0), (b) building the intervention (Stage 1A, Part 1), (c) acceptability testing and program revision (Stage 1A, Part 2), (d) feasibility and pilot testing (Stage 1B, Part 1), (e) modification of the intervention to improve implementability (Stage 1B, Part 2), and (f) the final intervention.

BACKGROUND:Minority stress may lead to poorer mental health for sexual and gender minority adolescents, yet no interventions have been tested through an RCT to address these concerns.METHODS:We report on an RCT of an intervention-Proud & Empowered-with four high schools. Measures assess the intervention's impact on mental health symptoms.RESULTS:Compared to the control, participants in the treatment condition reported significant differences in minority stress, anxiety, and depressive symptoms. Moderation analyses showed that the intervention significantly moderated the relationship between minority stress and PTSD (b = -1.28, p = .032), depression (b = -0.79, p = .023), and suicidality (b = 0.14, p = .012) symptoms; those in the intervention condition had mitigated relationships between measures of stress and health outcomes compared to those in the control condition.CONCLUSIONS:Results suggest that Proud & Empowered help reduce mental health symptoms and exposure to minority stressors and build coping strategies.TRIAL REGISTRATION:The intervention was registered on clinicaltrials.gov on August 1, 2019 under Trial # NCT04041414 .