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Sexual and gender minority (SGM) emerging-adult college students experience unprecedented rates of psychopathology. They are also more likely to experience barriers to accessing traditional mental health resources and spiritual support groups and are more apt to seek support in alternative ways, such as through campus LGTBQIA+ support groups and online communities. Spiritual-mind-body (SMB) group wellness programming may fill an important role as a more accessible service for SGM students and as an adjunct to individual mental health services. The primary aim of the present study is to investigate the utility of Awakened Awareness for Adolescents and Emerging Adults (AA-A), a group SMB wellness intervention designed to support spiritual individuation and mental health, to support SGM college student spirituality, mental health, psychological, and psychosocial wellness. A secondary aim was to examine differences in SGM students’ response to AA-A when delivered online versus in-person using exploratory analyses. Participants were 116 non-clinically referred, self-selected undergraduates aged 18-25. Self-report measures captured spiritual well-being, psychological well-being, psychosocial well-being, and symptoms of psychopathology. SGM students’ rate of enrollment in AA-A was compared to broader university and national college demographics using chi-square analyses. SGM and non-SGM student engagement in AA-A was measured by the average number of sessions attended and compared using an independent sample t-test. SGM and non-SGM student pre-intervention wellness was compared using independent sample t-tests. Changes in wellness at post-intervention were assessed using paired sample t-tests, and differences in post-intervention changes in wellness were analyzed as a function of ethnicity and SGM status using independent sample t-tests and ANOVAs of change scores. Exploratory two-way ANOVAs were conducted and interactions between SGM status and AA-A delivery method on well-being change scores were analyzed to determine whether SGM students responded uniquely from their peers to the online delivery format. SGM students had greater spiritual and wellness support needs at pre-intervention as compared with their non-SGM peers and were twice as likely to enroll in AA-A, and more likely to stay and engage in the program. SGM students had statistically parallel rates of improvement across most measures of well-being, and statistically even greater rates of improvement on some psychological and psychosocial measures of well-being capturing negative self-talk and self-concept. Among students who participated in AA-A delivered online and during the COVID-19 pandemic, SGM students benefitted more than their non-SGM peers. Findings support the feasibility and acceptability of the AA-A intervention to support SGM college student spiritual well-being and mental health across both in-person and online delivery methods, and exploratory analyses indicate that the online delivery method may be a particularly helpful format for SGM students to engage.

The transgender population is makes up about 0.3% of the U.S. population (Gates 2011). The term transgender is both an identity and an umbrella term used to describe people who do not adhere to traditional gender norms (Institute of Medicine 2011). Transgender people experience many barriers to services, negative health outcomes, and discrimination (Fredrikson-Goldsen et al. 2013; Institute of Medicine 2011; Eliason et al. 2009; Hendricks & Testa 2012). Mental health clinics are an important site for understanding transgender peoples' experiences due to being a gatekeeper for other medical services and their role in helping transpeople with issues surrounding coming out, victimization, and discrimination (Grant et al. 2011; Youth Suicide Prevention Program 2011). The mental health field has a contested relationship with the transgender population due to a history of pathologizing gender variance, barriers to accessing services, and insensitivity from mental health providers (American Psychiatric Association 2013; Eliason et al. 2009). I conducted secondary data analysis using the National Transgender Discrimination Survey (2008) in order to understand the relationships between gender non-conforming identities, others' perception of one's gender identity, and discrimination at mental health clinics. Results suggest that there is an association between gender identity, others' perception of one's gender identity, and discrimination. This association depends on which gender identity, the degree to which an individual identifies with each term, and the type of discrimination. Logistic regression results reveal that identity and others' perception are not significant predictors for experiencing discrimination. Rather, income and race are significant predictors for experiencing discrimination at metal health clinics.

Background: Sexual minority women (SMW; e.g., lesbian, bisexual women) are at substantially higher risk for hazardous drinking (HD) than their heterosexual, cisgender counterparts. There is considerable evidence that minority stressors at the individual (e.g., internalized stigma) and interpersonal (e.g., discrimination) levels are associated with HD among SMW, but minority stressors at the structural level (e.g., structural stigma) are understudied. Further, there is a wide gap in the literature on the relationships between multilevel minority stressors and HD. Additionally, there is evidence that these associations may differ by race/ethnicity and sexual identity, but relatively little is known about these differences, particularly in a multilevel context. Methods: This dissertation includes three studies that were guided by an adaptation of the minority stress model and the social ecological model. In the first study we conducted a systematic review of quantitative research studies that examined associations between structural stigma and alcohol-related outcomes among sexual and gender minority (SGM) adults in the United States. In the second study we used data from a diverse sample of SMW enrolled in the Chicago Health and Life Experiences of Women (CHLEW) study to determine whether structural stigma at Wave 4 (2017-2019) was prospectively associated with HD at Wave 5 (2019-2022), and whether this association was attenuated when accounting for individual- (i.e., internalized stigma, stigma consciousness) and interpersonal- (i.e., discrimination, sexual identity concealment) level minority stressors. In the third study we used data from Waves 4 and 5 of the CHLEW study to examine whether associations between multilevel minority stressors (i.e., internalized stigma, stigma consciousness, discrimination, sexual identity concealment, structural stigma) and HD varied by race/ethnicity and sexual identity. Results: The systematic review included 11 studies. There was moderate to strong support for a positive association between structural stigma and poor alcohol-related outcomes among SGM people, with differences by gender, sexual identity, race, and ethnicity. All studies used cross-sectional designs, and nearly half utilized non-probability samples. Transgender and nonbinary people, SGM people of color, and sexual identity subgroups beyond gay, lesbian, and heterosexual were underrepresented. Multilevel stigma and resiliency factors were understudied. In the second study, structural stigma was positively associated with HD alone, and when combined with interpersonal-level minority stressors. With the addition of individual-level minority stressors, the association between structural stigma and HD was attenuated, with partial attenuation (i.e., structural stigma was still significant) in the model combining all three levels, and full attenuation (i.e., structural stigma was no longer significant) in the model with only structural stigma and individual-level stressors. Discrimination was negatively associated with HD in the fully combined model and was not associated with HD in any other models. In the third study, we found that associations between structural stigma and HD did not vary by race/ethnicity or sexual identity. However, the associations between individual-level minority stressors (i.e., internalized stigma, stigma consciousness) and interpersonal-level minority stressors (i.e., sexual identity concealment) with HD varied somewhat by race/ethnicity and sexual identity. Conclusions: Findings from this dissertation highlight the importance of structural stigma in SMW’s HD and underscore the importance of both structural-level and multilevel minority stressors in designing interventions to effectively address HD drinking disparities and inequities among SMW. Future research is needed using intersectional approaches with probability samples, longitudinal designs, expanded measures of structural stigma, and samples that reflect the diversity of SGM people.

The purpose of this research was to explore social hardships of non-gay identifying, [behaviorally] bisexual, and “other” marginal LGBTQ+ men who are sexually intimate with men in a heteronormative and [toxic] masculine world. Relatedly, hegemonic masculinity dominates the patriarch through regulating behavioral norms that often stigmatize and discriminate opposing traits, ideologies, or groups, such as LGBTQ+. This has been known to affect and mediate health outcomes and “outness.” Therefore, this study explored how minority stressors impact self-concept, mental health, well-being, and motivations to disclose and/or conceal. Data collection involved survey and interview formats (mixed-methods cross-sectional design) that assessed internalized homophobia, conformity to masculine norms, subjective masculinity stress, disclosure, and concealment in relation to lifestyle and social context. While all variables had expected linear associations, not all were causal. Those who conformed to masculine norms significantly experienced internalized stigma/homophobia. Hence, it can be hypothesized that participants who conformed sought to conceal stigma under pressure of heteronormative culture and the patriarch. However, subjective masculinity stress was nonsignificant, exemplifying hegemonic influence as more defining to their self-concept than their own. Further, minority stress constructs (masculine norms, internalized stigma/homophobia, and subjective masculinity stress), when age, regional location, and faith were controlled, significantly predicted less disclosure and more concealment in social contexts. This reinforces the power of modern patriarchy/masculine norms/minority stress and its adverse effects on mental health, well-being, and outness in marginalized populations of LGBTQ+. Relatedly, qualitative data validated these quantitative findings but generally over the lifecycle of “coming out” as opposed to respondents’ current growth and development in outness, mental health, and well-being. However, to further affirm such quantitative findings, both survey and interview data did report distress regarding modern day masculinity and its ill standards that place unrealistic expectations on men, which continue to create disparities among and between many communities and humanity.

This dissertation aims to fill important gaps in the weight discrimination literature by applying a non-pathologizing, intersectional approach and by focusing on previously understudied groups (i.e., sexual and gender minority (SGM) people, racial and ethnic minoritized people, and early adolescents). Chapter 1 is an introduction to weight discrimination, including its origins in anti-fatness, its intersections with other systems of oppression, and the necessity to de-pathologize fatness to confront anti-fat oppression. Chapter 2 describes a scoping review of weight stigma/discrimination and its relationship with mental and emotional health among SGM people across the lifespan. Across 23 included studies, findings include consistent relationships between weight stigma and worse mental and emotional health and a scarcity of research focused on gender minority people, racial and ethnic minoritized people, early adolescents, and important outcomes such as self-injurious thoughts and behaviors (SITBs). Aiming to address these gaps, Chapters 3 and 4 both describe cross-sectional analyses of data from a large national sample of 10- to 14-year-old adolescents from the Adolescent Brain Cognitive Development Study. Chapter 3 reports analyses of prevalence of weight discrimination among early adolescents with minoritized sexual, gender, racial, and ethnic identities and those who are gender nonconforming, as well as those at the intersections of these identities. Minoritized adolescents, including intersectionally minoritized adolescents, were significantly more likely to report weight discrimination compared to their peers. Chapter 4 reports analyses of weight discrimination in association with SITBs, and includes testing of sexual identity, gender identity, gender nonconformity, race/ethnicity, sex assigned at birth, and social support as potential moderators. It also includes analysis of intersectional discrimination (based on weight plus sexual identity and/or race/ethnicity) in association with SITBs. Findings indicate that weight discrimination is associated with higher odds of SITBs; none of the proposed moderators had a significant effect. Intersectional discrimination was associated with heightened odds of SITBs. Finally, Chapter 5 presents a synthesis of results and discusses overall strengths, limitations, and implications. This includes implications for future research to fill identified gaps, policy changes to confront anti-fatness and protect adolescents from weight discrimination, and clinical interventions to make healthcare safe and affirming for fat and intersectionally minoritized adolescents.

The purpose of this study was to explore the religion – health link in a sample of adults and undergraduate students (N = 555) that identified as lesbian, gay, or bisexual (LGB), and to explore how perceptions of cultural humility of religious individuals and groups toward LGB individuals affect the relationship between religion and health. First, I found religious commitment among LGB individuals was positively correlated with satisfaction in life, but it was negatively correlated with physical health. Second, I found that cultural humility moderated the relationship between religious commitment and satisfaction in life for LGB individuals involved in a religious community. The lowest levels of satisfaction with life were found for individuals with low religious commitment and perceived the cultural humility of their religious community to be low. However, cultural humility did not moderate the relationship between religious commitment and mental and physical health outcomes. Third, I found cultural humility did not moderate the relationship between religious commitment and minority stress (i.e., internalized homophobia). Fourth, I found that cultural humility was a significant positive predictor of motivations to forgive a hurt caused by a religious individual. I conclude by discussing limitations, areas for future research, and implications for counseling.

Anti-LGBTQ laws and policies are considered to be institutional forms of discrimination,or the provide legal pathways for people to actively discriminate against LGBTQ+ people, or they fail to provide protections from discrimination to LGBTQ+ communities. Given the rise of far-right government in the (United States) U.S. and its foundations on Christian Nationalism, there has been an alarming increase of anti-LGBTQ legislations across the United States as evidenced by the resurgence of “don’t say gay” bills and transgender health care bans across multiple states. While the detrimental effect of anti-LGBTQ legislation on LGBTQ+ people’s mental health has been documented, little research has been done to understand the ways in which these larger structural forms of discrimination are internalized and translate to individual mental health outcomes. Relevant to LGBTQ+ communities, suicide has been a prevalent public health concern that disproportionally impacts these communities. Building on Minority Stress Theory (MST) and the Psychological Mediation Framework (PMF) the present study sought to understand the direct and indirect associations of anti-LGBTQ legislations and anticipated discrimination with suicidal ideation. Perceived Burdensomeness, thwarted Belongingness, and entrapment were looked as mediators of these associations. Further the role of perceived social support as a potential protective factor was assessed. Results indicated that anti-LGBTQ policies were significantly associated with suicidal ideation. Anticipated discrimination was indirectly associated with suicidal ideation through perceived burdensomeness and entrapment. Finally perceived social support did not moderate any of these associations. Implications for practice, research and policy are discussed.