ABSTRACT Gender diverse youth (GDY) are those with incongruence between their gender identity and sex assigned at birth. This population faces significant mental health inequities compared to cisgender (not gender diverse) youth, including increased rates of depression and suicidal ideation. Research suggests that parent affirmation, or parents supporting their child’s gender identity, can reduce these health inequities, but there are no evidence- based strategies to help parents affirm their GDY. Being affirming can be challenging for parents, and current literature indicates that both external experiences, like connectedness and discrimination, and internal experiences, like fear and stigma, may shape these challenges. Further, there are limitations to existing support systems for parents including geographical considerations, as most groups or opportunities to meet are in urban centers, and social pressure, as many parents feel overwhelmed in large group settings. Online support programs have the potential to overcome these barriers and allow for 1:1 parent peer mentoring, which has shown success in other pediatric patient populations as well as potential for GDY and their families. However, there is a need for increased stakeholder-engaged research to understand parent factors associated with being affirming. Such data are needed to develop acceptable and feasible online support programs that are effective at aiding parents to affirm GDY. The central hypothesis of this research is that an online 1:1 parent peer support program will lead to increased parent affirmation and improved health outcomes for GDY. This K23 project will: 1) survey a geographically and racially diverse cross-section of parents of GDY in the United States to better understand factors associated with being affirming, 2) design a stakeholder-informed online support intervention featuring 1:1 parent peer mentoring for parents of GDY, and 3) pilot test the online support intervention for feasibility and acceptability. Conduct of these aims, in addition to a career development plan inclusive of coursework, workshops, and leadership development, will allow for the applicant’s academic growth in nationally representative surveys, stakeholder-engaged intervention development, clinical trials, and research program leadership, and will further advance the applicant’s transition to independence. These aims also will provide the necessary data to conduct a future R01 randomized control trial to evaluate the effectiveness of the stakeholder- designed online 1:1 parent peer mentoring intervention to improve parent affirmation of GDY, ultimately helping to improve health equity for this vulnerable population.

NARRATIVE Gender diverse youth have a gender identity that differs from their sex assigned at birth, and this at-risk population has improved health outcomes when they feel affirmed or supported by their parents. This study will survey a diverse cross-section of parents about the factors associated with being affirming and will develop an online intervention that connects them with other parents for mentored peer support. By assessing feasibility and acceptability of the new parent support intervention, this work will inform future research aimed at improving health outcomes for gender diverse youth.