Contextual Determinants of Sexual Minority Health in the United States R01 Application Summary/Abstract Kara Joyner (PI) and Wendy Manning (Co-I) Researchers have long documented health disparities for sexual minority populations (or sexual diverse populations) and they are beginning to document them for gender minority populations (or gender diverse populations). These health disparities remain largely intractable because researchers have not been able to rigorously capture the putative mechanism behind them: stigma. The minority stress perspective posits that sexual minority populations, like racial/ethnic minority populations, experience a higher prevalence of adverse health outcomes than heterosexual populations due to their stigmatized status in society. Researchers testing this perspective have increasingly measured stigma at the societal level or “structural stigma,” a concept that captures both social climate (public attitudes towards sexual/gender minorities) and legal climate (laws and policies relevant to sexual/gender minorities). Researchers have been hampered in their ability to adequately assess the effects of structural stigma due to the design of most population-based surveys that include questions on sexual minority status and health. Few of these surveys permit researchers to measure stigma at multiple levels. Another limitation of these surveys is that they are cross-sectional, precluding a consideration of how exposure to structural stigma changes over the life course. The National Longitudinal Study of Adolescent to Adult Health (Add Health) has the necessary criteria to rigorously investigate the effects of structural stigma on the health outcomes of sexual minority respondents, including a formal and regulated mechanism for producing and disseminating contextual data. Add Health users interested in testing minority stress and intersectionality perspectives will have unprecedented opportunities to examine how various outcomes are associated with structural stigma for sexual minority respondents and how the associations differ across subgroups. Aim 1 of this project is to create a contextual database that researchers can use to better study the effects of structural stigma. Specifically, this database will include measures of social and legal climate relevant to sexual minorities that correspond to the tract, county, and state levels before or around the time of Waves 3, 4, and 5. This database will also include measures of structural racism since many sexual minorities are also racial/ethnic minorities. We will convene an advisory team to ensure we have the best measures of structural stigma and racism. Aim 2 will examine with this contextual database how state-level measures of legal climate are associated with self-rated health and health biomarkers among Add Health respondents and consider how these associations differ by key factors (e.g., gender, socioeconomic status, and race/ethnicity). This database will promote r...