PROJECT SUMMARY/ABSTRACT
An unprecedented number of new policies across the US threaten the rights of lesbian, gay, bisexual,
and transgender (LGBT) populations. In 2023, >500 discriminatory LGBT bills were introduced in state legisla-
tures—four-times more than in recent years. Such bills include those banning access to healthcare for trans-
gender individuals and those criminalizing teachers for discussing the existence of LGBT people. Emerging
data reveal that 70% of LGBT people report discriminatory bills adversely impact their mental health, even
when the bills do not become law. Before this rapid increase in discriminatory policies, LGBT people were dis-
proportionally burdened by adverse health outcomes, particularly mental health outcomes. The growing threat
and enactment of discriminatory LGBT policies will likely widen these disparities. However, little is known about
how the recent onslaught of discriminatory LGBT bills collectively influences mental health, particularly in ado-
lescence and young adulthood when mental health problems typically onset and when health service use tra-
jectories are often established. Without this time-sensitive research, we cannot evaluate the impact of real-
world policy environments and address the potential health effects of these discriminatory policies. Informed by
the Minority Stress Model, the proposed project's objective is to elucidate how mental health during the critical
years of late adolescence and early adulthood (ages 18–24 years) is influenced by four types of LGBT-target-
ed policies: 1) religious exemptions, 2) gender-affirming healthcare bans, 3) LGBT-restrictive school curricula,
and 4) LGBT-supportive school curricula. To substantiate the link between policies and mental health, we will
use a multi-method approach. In the R61 phase, we will collect time-sensitive survey data in the national
Healthy Minds Study—the largest ongoing survey of mental health in US colleges and universities—to quantify
associations among these policies, enacted stigma (e.g., discrimination, bullying, harassment), and mental
health among young adult college students (predicted N=80,850 students at 105 institutions, including four-
year schools, community colleges, and minority-serving institutions). In the R33 phase, we will use our newly
collected Healthy Minds Study data to identify individuals directly impacted by these policies, with whom we will
conduct in-depth qualitative interviews (n=120). To understand the population-level impact of these policies
and their mechanisms, we will then use nationally representative data from the Behavioral Risk Factor Surveil-
lance System (BRFSS, N=89,493 young adults) to evaluate the impact of LGBT-targeted policies. We will lev-
erage quasi-experimental methods (i.e., difference-in-differences analyses) to quantify the causal effect of
LGBT-targeted policies as well as causal mediation analyses informed by multi-method results from Aims 1
and 2. This project will produce robust and time-sensitive new evidence of how discriminatory and supportive
LGBT policies affect mental health. This work will have a positive impact by informing healthcare providers,
school leaders, and policymakers about the necessary actions to reduce entrenched mental health disparities.
