Measuring Stress in Diverse Gender Minority Adolescents Project Summary (30 lines) This study will develop a comprehensive measure of stress for TGA—the Transgender Adolescent Stress Scale (TASS). TGA experience significantly higher risks of many behavioral health outcomes, including anxiety, depression, substance use and suicide. Such disparities are likely related to experiences of gender dysphoria, and separately, minority stress – i.e., prejudice, stigma, and victimization against transgender persons – but existing research has typically focused on adults, and existing measures have sub-optimal psychometric characteristics. Thus, we will develop a comprehensive measure of transgender adolescent stress – which includes subscales for gender dysphoria and minority stress that can be used independently or in concert -- as a means to facilitate improved clinical assessment and intervention development. Toward this end, Aim 1 will utilize a modified Delphi process and data analysis of existing interviews with TGAs to identify and operationalize unique stressors that influence transgender persons during adolescence, including cognitive interviews (n=20) with transgender adolescents. Based on the extensive experience of the team in developing the Sexual Minority Adolescent Stress Inventory (SMASI), these methods will ensure that Aim 1 results in a comprehensive preliminary Transgender Adolescent Stress Scale (TASS) ready for testing. In Aim 2, we will utilize a dual- method social media and respondent driven sampling (RDS) approach to recruit 450 racially and ethnically diverse TGAs. These adolescents will complete the preliminary TASS as well as a series of behavioral health, substance use, and suicidality measures. Data analysis in Aim 2 will focus on assessing reliability and criterion validity of the TASS, as well as convergant/divergent validity of the TASS as compared to existing measures. In each stage, the presence of an expert panel, as well as rigorous methods for recruitment, data cleaning, and analysis, will ensure that the produced TASS is a comprehensive measure ready to be utilized by researchers and clinicians to better understand and address stress experiences among transgender adolescents.

Measuring Stress in Diverse Gender Minority Adolescents Project Narrative This proposed study aims to develop a comprehensive measure of stress for TGA—the Transgender Adolescent Stress Scale (TASS). To do this, we will identify and operationalize unique stressors that influence transgender persons during adolescence related to both gender dysphoria and minority stress, utilize rigorous psychometric development to create a set of measures, and examine their relation to behavioral health outcomes. This study has two aims: 1. Develop a preliminary Transgender Adolescent Stress Scale (TASS) through an analysis of life history calendar (LHC) data and a modified Delphi process with an expert panel; 2. Assess reliability and preliminary criterion validity of the TASS in a cross-sectional study of racially and ethnically diverse TGA (N = 450).