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.