Project Summary Early life adversity, also known as adverse childhood experiences (ACEs) contribute to poor mental and physical health outcomes in adulthood in the general population. Research shows that sexual and gender minority (SGM) adults report more ACEs than heterosexual adults. We argue that it is cisheteronormativity – the societal belief that everyone is cisgender and heterosexual, that increases risk for exposure to general ACEs, that cisheteronormativity leads to cisheterosexism – or SGM-identity based discrimination, mistreat and violence exposure, and that exposure to cisheterosexism in early life should be considered a unique ACE experienced by SGM populations (SGM-ACEs). In fact, there is some evidence to suggest that exposure to cisheterosexism prior to adulthood may follow similar biological and neurodevelopmental pathways as exposure to ACEs. We have developed a first iteration of an SGM-ACEs measure, found that it had good to excellent psychometric properties, and was associated with proximal and distal minority stress factors in adulthood. However, evidence for SGM- ACEs impact on mental and physical health outcomes has not been examined rigorously. In addition, our measure was initially developed from a sample in Bexar County, TX and attention was not given to the potential differences in experiences at the intersection of sexual and gender identity. To inform future efforts to address mental and physical health disparities in SGM adults, additional development and testing of SGM-ACEs is needed, specially using a test-retest design of the measure, more valid and reliable psychological outcome measures, and an assessment of more objective biomarker measures (e.g., immune function) in adulthood. In addition, a more thoughtful approach is needed in the development of the next iteration of the measure that includes identification of the unique experiences of SGM adults outside the geographic boundaries of the original study, and at the intersection of gender and sexual identity, more specifically across four intersectional SGM groups: 1. Cisgender monosexuals 2. Gender minority monosexuals 3. Cisgender non-monosexuals 4. Gender minority (e.g., transgender, non-binary) non-monosexual, and this needs to be followed by an assessment of measurement equivalence across these four intersectional groups. We propose to: 1. Recruit 15 SGM adults in each intersectional SGM groups and interview them to identify additional SGM-ACE items related to the experiences of gender minority individuals, non-monosexual individuals, and SGM adults outside of TX, and to better understand the perceived impact of SGM-ACEs in early life through adulthood., 2. Use human centered design methods to co-create SGM-ACEs with community advisory board, and pre-test it with 40 SGM adults and an expert panel, and 3. Recruit a national sample of 1,844 SGM adults from The PRIDE Study to reach 300 respondents in each the four intersectional SGM groups, use EFA and CFA ...