Structural Minority Stress Predicts Suicidality, Substance Use, and Sexual Risk Behaviors among Sexual Minority...

This study examines associations between structural minority stress and behavioral health outcomes including suicidal ideation and behaviors, substance use, and sexual risk taking among sexual minority adolescents. Data were analyzed from the 2021 Youth Risk Behavior Survey, which included 3,996 sexual minority adolescents. A series of multi-level binomal logistic models were calculated to examine the association between state equity index and suicidal thoughts and behaviors (ideation, plan, attempt, hospitalization), condom use at last intercourse, and substance use (nicotine vape, marijuana use, illicit drug use). State equity index was associated with lower odds of suicidal ideation and having a plan for suicide in the past year. Similarly, state equity index was also associated with lower odds of vaping nicotine in the past 30-days as well as having condomless sex during last sexual intercourse. Living in a state with more protections for sexual minority and transgender people through state-level policies was generally associated with less risk taking. These results underscore the importance of public policy on potentially severe or life-threatening behaviors - particularly around suicidal ideation and plan and sexual risk taking.