Associations between Policy on Minority Stress: Early Findings from the Adolescent Stress Experiences over Time Study (ASETS)

Sexual minority adolescents (SMA) experience substantial health disparities compared to their heterosexual counterparts, including high rates of anxiety, depression, post-traumatic stress, and suicide ideation and attempt. State legislation may exacerbate or alleviate these health disparities in SMA. According to the minority stress model, structural heterosexist discrimination at the legislation level (i.e., a form of structural stigma) is thought to contribute to disparities in health through internalizing psychological processes such as internalized homonegativity (i.e., devaluation of the self for being a sexual minority). However, the association between structural discrimination and minority stress and the moderating effect of local factors have received little empirical attention. Thus, we sought to determine whether discriminatory legislation would be associated with greater experiences of minority stress, and whether this would differ by urbanicity (e.g., urban vs. rural dwelling SMA). It was hypothesized that (1) greater state equality would be associated with fewer SMA experiences of minority stress, and that (2) this association between state equality and minority stress would be moderated by urbanicity. A nationally representative, diverse sample of SMA (N=2484; ages 14-17, M=15.90, SD=0.97) was recruited via social media advertising and respondent-driven sampling approaches to complete baseline questionnaires as part of the Adolescent Stress Experiences over Time Study (ASETS), a three-year longitudinal assessment of SMA experiences of minority stress, mental and behavioral health, and demographic information. Respondents were eligible to participate in ASETS if they were between 14-17 years old, lived in the United States, did not identify as 100% heterosexual, and were cisgender at baseline. State equality was measured using a count score, operationalized from the Human Rights Campaign’s State Equality Index, of anti- and pro-LGBTQ legislation passed by each State legislature. Minority stress was measured with the Sexual Minority Adolescent Stress Inventory (SMASI), a 54-item, 11-domain validated measure of minority stress among SMA. As Little’s test of missing completely at random (MCAR; x²(2, N=2565) = 3.75, p=.15) confirmed random missingness in legislation-related and SMASI data, all hypotheses were tested within a multiple regression framework with listwise deletion. Preliminary multivariate results suggested that the number of pro-LGBTQ bills passed by the SMA’s state legislature was associated with fewer lifetime experiences of minority stress (b=-.09, t=-3.09, p<.01) while controlling for sex assigned at birth, race / ethnicity, and eligibility for free and reduced lunch at school. Living in an urban area did not moderate the association between pro-LGBTQ legislation and lifetime experiences of minority stress (p>.05), suggesting that the relationship between state legislation and individual experiences of minority stress does not differ between rural and urban areas of states. These findings indicate that state level factors shape individual experiences of discrimination across the United States and that there is an ongoing need for social worker involvement in LGBTQ policy advocacy to foster more positive environments for LGBTQ youth. Future analyses will examine whether this association is upheld within the larger mediation framework, with SMASI mediating the relationship between structural indices and behavioral health.