(PS9-64) Structural Minority Stress Predicts Suicidality, Substance Use, and Sexual Behaviors Among Sexual Minority Adolescents

Background: Sexual minority adolescents experience suicidal behaviors, substance use, and HIV transmission at disproportionately high rates compared to their heterosexual peers. Mental health disparities have been explained in part by structural minority stress including neighborhood hate crimes and anti-LGBT school district policies. Meanwhile research on state-level policies have predominately focused on sexual minority adults, which overlooks the impact of structural stress on adolescents. The current study addresses that gap by examining the associations between state equality-related policies and past health behaviors among sexual minority adolescents.  

Method: Data were analyzed from the 2021 Youth Risk Behavior Surveillance survey. Analyses were limited to adolescents who identified as a sexual minority (n=3,996). State equality was assessed using the Human Rights Campaign Foundation’s State Equality Index which categorizes states into four categories based on laws and policies that affect the livelihood of LGBTQ+ individuals. For analyses, state rankings were dichotomized to distinguish between states with supportive sexual and gender minority policies (i.e., working toward innovative equality; solidifying equality) from states without supportive policies (i.e., building equality; high priority to achieve basis equality). Outcomes of interest included past year suicidal thoughts and behaviors, past 30-day substance use, and condom use during last sexual intercourse. A series of logistic regression models were calculated with State Equity Index predicting each outcome. Covariates included age, sex assigned at birth, grade, and race/ethnicity. 

Results: As expected, state equality was associated with suicidal thoughts and behaviors, substance use, and risky sex. Living in a state with higher equality – i.e., lower structural minority stress – was associated with lower odds of suicidal ideation (OR=0.76, p< .01), vaping nicotine (OR=0.55, p< .01), illicit substance use (OR=0.81, p< .05), and condomless sex (OR=0.62, p< .01).  

Discussion: Results demonstrated that state-level protections for sexual and gender minorities are important predictors of health outcomes that disproportionately impact sexual minority adolescents. Clinicians should be mindful of structural policies at local, state, and national levels that are discriminatory towards sexual minorities and should consider interventions that specifically target coping with experiences of minority stress.