The Impact of Community Size, Community Climate, and Victimization on the Health of Sexual and Gender Minority Youth

Background: Sexual and gender minority (SGM) youth experience high rates of adverse mental and physical health (Connolly, et al., 2016; Kann et al., 2011; Lick et al., 2013), and living in a nonmetropolitan or hostile community increases their vulnerability to these outcomes (Cohn & Leake, 2012; Hatzenbuehler, 2011; Palmer et al., 2012; Woodford et al., 2015). Minority stress theory (MST; Meyer, 2003) contends that health disparities are the result of minority-specific stressors that SGM youth face, such as victimization and discrimination (Ballard et al., Burton et al., 2013). Research on SGM youth in nonmetropolitan communities has primarily examined either the experience of victimization or health outcomes rather than the relationships between all of these variables. To promote SGM youth well-being, we must understand the complex relationships among community, victimization, and health. This study tests tenets of MST to understand how community context shapes experiences of victimization and health among SGM youth.

Methods:  This study utilizes data from a quantitative online survey measuring perceived physical health; mental health (anxiety and depression); anti-SGM victimization; community context, including size (large metropolitan, small metropolitan, nonmetropolitan) and perceived climate (supportive, tolerant, hostile); and demographics. Participants (N=201) were SGM youth (ages 14-18) living in one Midwestern state. Participants were 76% white; 72% cisgender; 25% lesbian or gay, 25% bisexual; and an average age of 16. First, we conducted bivariate analyses to test whether health outcomes varied across community contexts. Next, to test the association between community context and health, we estimated a multivariable regression in a path-analysis framework. We then tested whether victimization mediated the association between community climate and health-related outcomes. Although we hypothesized that associations between perceived community climate and health would be mediated by victimization, we also tested a plausible alternative model: that victimization might influence youths’ perceptions of their community climate and subsequently their health.

Results: At the bivariate level, youth who perceived their community climate as supportive reported less anxiety (F(2,194)=5.59, p=.004), depression (F(2,193)=10.27, p<.001), and victimization (F(2,197) = 18.44, p<.001) than youth who perceived their communities as hostile or tolerant. Youth in nonmetropolitan areas reported more victimization than youth in small or large metropolitan areas (F(2,198)=3.50, p=.032). Associations between community climate and health from a minority stress framework showed that youth who perceived their community to be tolerant or hostile reported greater anxiety and depression than youth who perceived their community as supportive; community size was unrelated to health. Victimization statistically mediated the association between perceived climate and anxiety and depression. Finally, the alternative model showed poor fit, suggesting our hypothesized model fit the data better.

Conclusions and Implications: This study provides novel findings demonstrating how minority stress and its association with health outcomes vary by community context for SGM youth. Practice and research implications include attending to community climate heterogeneity alongside community size, assessing the complex relationship between victimization and climate, and developing a qualitative understanding of SGM youth’s perceptions of their community climate and its impacts on health.