Objective: People of color who are also sexual and gender minorities (SGM) experience forms of enacted stigma based on both their racial/ethnic identity and their SGM status. We set out to test the effects of enacted stigma specific to race/ethnicity and SGM identity on mental health and substance use problems among female assigned at birth (FAB) SGM of color. Method: Data come from a community-based sample of FAB SGM who also identified as racial/ethnic minorities (N = 352). The effects of racial discrimination, SGM victimization, and sexual orientation microaggressions on depression symptoms, anxiety symptoms, alcohol-related problems, and marijuana-related problems were tested using linear regression and negative binomial models. Results: Enacted stigma based on both race/ethnicity and SGM status were significant predictors of mental health outcomes and alcohol-related problems within the same model, which suggested that both uniquely contributed to poorer health. There was little support for interactive effects between the multiple forms of enacted stigma. Marijuana-related problems were best explained by enacted stigma based on race/ethnicity only. Conclusions: Racially diverse FAB SGM are at unique risk of experiencing multiple forms of discrimination and aggression based on their minority identities that each contribute negatively to their wellbeing. Consideration of the multiple forms of enacted stigma they face is necessary for understanding health disparities in these populations.

Nonmonosexual individuals (i.e., people with attractions to more than 1 gender) are at heightened risk for numerous negative health outcomes compared to individuals with exclusive attractions to either same-gender or different-gender individuals. This increased risk has been linked to the unique stress nonmonosexual individuals experience due to the stigmatization of nonmonosexuality (i.e., monosexism). However, research with this population has rarely considered multiple intersecting stigmatized identities (e.g., gender, race/ ethnicity) and has focused predominately on internalizing symptoms (i.e., anxiety/depression). The current study aimed to expand this research by taking an intersectional approach to examining (a) associations between three nonmonosexual stressors (enacted, internalized, and anticipated monosexism) and 3 dimensions of health (i.e., physical health, internalizing symptoms, substance use and problems); and (b) differences in these associations and rates of nonmonosexual stressors and health problems by sexual, gender, and racial/ ethnic identities among a diverse sample of 360 nonmonosexual individuals assigned female at birth. Results indicated that all three nonmonosexual stressors were associated with the 3 dimensions of health for the sample as a whole. There were several notable moderators of these associations. First, enacted monosexism was more strongly associated with physical health and substance use/problems for gender minorities compared to cisgender women. Second, several interactions indicated that nonmonosexual stressors were associated with poorer health for White, but not Black or Latinx, individuals. These findings highlight the importance of attending to within-group heterogeneity to understand and address the range of health disparities affecting nonmonosexual individuals. Public Significance StatementThis study advances our understanding of the influence of stigma on the health of nonmonosexual individuals (i.e., people with attractions to more than one gender). While all types of nonmonosexual stressors were associated with worse health outcomes, experiences of bias had a stronger impact on the health of transgender individuals compared to cisgender women, and people of color appeared to be more resilient in the face of bias than their White peers. These findings highlight the importance of attending to multiple stigmatized identities in order to understand the health disparities affecting marginalized populations.