Objective: To remedy the notable gap in evidence-based treatments for sexual minority women, this study tested the efficacy of a minority-stress-focused cognitive-behavioral treatment intended to improve this population's mental and behavioral health. Method: The intervention, EQuIP (Empowering Queer Identities in Psychotherapy), was adapted from a transdiagnostic cognitive-behavioral treatment as also recently adapted for sexual minority men. Sexual minority women at risk of mental and behavioral health problems (n ϭ 19) and expert providers with this population (n ϭ 12) shaped the treatment's development, including by supporting its primary focus on universal and minority-stress-focused processes underlying this population's disproportionately poor mental and behavioral health. The resulting treatment was then delivered to young adult sexual minority women (n ϭ 60; M age ϭ 25.58; 41.67% racial/ethnic minority; 43.33% transgender/nonbinary) experiencing depression/anxiety and past 90-day heavy alcohol use. Results: Compared to waitlist (n ϭ 30), participants randomized to immediately receive EQuIP (n ϭ 30) experienced significantly reduced depression and anxiety (d ϭ 0.85, 0.86, respectively); effects for alcohol use problems were smaller (d ϭ 0.29) and marginally significant. In preto post-intervention pooled analyses, effect sizes for minority stress processes (mean d ϭ .25) and universal risk factors (mean d ϭ .48), through which the treatment was expected to work, were small and moderate, respectively, and in the expected direction. Conclusions: This study provides initial support for a minority-stress-focused transdiagnostic cognitive-behavioral treatment for sexual minority women. These first results can launch exploration of other mechanisms and modalities through which to equip this population with evidence-based support. What is the public health significance of this article?Sexual minority women represent one of the highest-risk populations for depression, anxiety, and alcohol use problems, yet no intervention has been tested for efficacy for this population's cooccurring health risks. This first randomized trial of such a treatment shows that a transdiagnostic minority-stress-focused approach has potential to exert robust impact on sexual minority women's mental health. Future research into additional treatment targets, perhaps beyond minority stress, and factors relevant for reducing alcohol use problems, is needed.

Gay-Straight Alliances (GSAs) may promote resilience. Yet, what GSA components predict wellbeing? Among 146 youth and advisors in 13 GSAs (58% lesbian, gay, bisexual, or questioning; 64% white; 38% received free/reduced-cost lunch), student (demographics, victimization, attendance frequency, leadership, support, control), advisor (years served, training, control) and contextual factors (overall support or advocacy, outside support for the GSA) that predicted purpose, mastery, and self-esteem were tested. In multilevel models, GSA support predicted all outcomes. Racial/ethnic minority youth reported greater wellbeing, yet lower support. Youth in GSAs whose advisors served longer and perceived more control and were in more supportive school contexts reported healthier outcomes. GSA advocacy also predicted purpose. Ethnographic notes elucidated complex associations and variability in how GSAs operated.

There is little data on whether school discipline or juvenile justice sanctions are directed disproportionately toward sexual minority youth (e.g., lesbian, gay, bisexual, or questioning; LGBQ) compared with heterosexual youth and even less on factors that may relate to such disparities. We tested for sexual orientation-based disparities in school suspension and juvenile justice system involvement, and tested a model linking students' sexual orientation to victimization, punishable infractions (substance use, truancy, weapon carriage on school property), and disciplinary actions. Using cross-sectional data from the 2012 Dane County Youth Assessment, we compared 869 LGBQ youth to 869 heterosexual youth (a comparison sample selected through propensity score matching) in Grades 9 to 12 (60.6% female; 74.7% White). LGBQ youth were more likely to report school suspension and juvenile justice system involvement than heterosexual youth. We documented minimal support for a differential behavior explanation: sexual orientation-based differences on discipline were only weakly mediated through victimization and punishable infractions. Instead, a multiple group comparison showed that the paths from infraction engagement to discipline sanctions were not invariant for LGBQ and heterosexual youth: With higher rates of infractions, the odds were greater for LGBQ youth to have experienced punitive discipline than for heterosexual youth. Our findings underscore the need for psychologists, educators, and juvenile justice professionals to give attention to discipline disparities faced by sexual minority youth.

As a form of bias-based harassment, homophobic behavior remains prominent in schools. Yet, little attention has been given to factors that underlie it, aside from bullying and sexual prejudice. Thus, we examined multiple domain general (empathy, perspective-taking, classroom respect norms) and sexual orientation-specific factors (sexual orientation identity importance, number of sexual minority friends, parents' sexual minority attitudes, media messages). We documented support for a model in which these sets of factors converged to predict homophobic behavior, mediated through bullying and prejudice, among 581 students in grades 9-12 (55 % female). The structural equation model indicated that, with the exception of media messages, these additional factors predicted levels of prejudice and bullying, which in turn predicted the likelihood of students to engage in homophobic behavior. These findings highlight the importance of addressing multiple interrelated factors in efforts to reduce bullying, prejudice, and discrimination among youth.

Gay-Straight Alliances (GSAs) are school-based youth settings that could promote health. Yet, GSAs have been treated as homogenous without attention to variability in how they operate or to how youth are involved in different capacities. Using a systems perspective, we considered two primary dimensions along which GSAs function to promote health: providing socializing and advocacy opportunities. Among 448 students in 48 GSAs who attended six regional conferences in Massachusetts (59.8% LGBQ; 69.9% White; 70.1% cisgender female), we found substantial variation among GSAs and youth in levels of socializing and advocacy. GSAs were more distinct from one another on advocacy than socializing. Using multilevel modeling, we identified group and individual factors accounting for this variability. In the socializing model, youth and GSAs that did more socializing activities did more advocacy. In the advocacy model, youth who were more actively engaged in the GSA as well as GSAs whose youth collectively perceived greater school hostility and reported greater social justice efficacy did more advocacy. Findings suggest potential reasons why GSAs vary in how they function in ways ranging from internal provisions of support, to visibility raising, to collective social change. The findings are further relevant for settings supporting youth from other marginalized backgrounds and that include advocacy in their mission.