Project Summary The goal of this study is to test the efficacy of a theoretically informed, school-based intervention for sexual and gender minority (SGM, e.g., lesbian, gay, bisexual, transgender) adolescents, Proud & Empowered (P&E). Studies found that SGM students are 8 to 10 times more likely to experience victimization in schools than heterosexuals, with rates even higher among transgender youth. This bias-based victimization, part of which is commonly known as minority stress, has been cited as a participating factor in the substantial behavioral health disparities SGM face when compared to their heterosexual counterparts, such as depression, anxiety, self-harm, and suicidal ideation and attempt. These disparities are unique to SGM, as when compared to similarly victimized non-SGM peers, victimized SGM adolescents report significantly higher rates of suicide. When schools lack SGM bullying policies, SGM students are more likely to report suicidality than peers in schools with protective policies. Studies also indicate that SGM victimization is more common in schools that lack protective policies and resources such as gender and sexuality alliances (GSAs), SGM-specific antibullying guidelines, teacher and staff training, and openly supportive allies. Therefore, it is clear that any intervention for SGM youth must simultaneously (a) help SGM youth cope with the effects of minority stress and (b) work to reduce the likelihood of future victimization by addressing school-level factors. The P&E intervention seeks to address these outcomes through a novel multi-level school-based intervention. Supported by nine years of research including an NIH- supported feasibility study conducted at four schools (1R21MD013971), we will determine the interventions' efficacy by completing three specific aims: 1) Determine participant-level efficacy of the intervention in an RCT with 24 schools. 2) Determine the schoolwide intervention effects on (a) reporting of minority stress and behavioral health outcomes among all SGM students and (b) perceptions of school climate (i.e., norms, attitudes, beliefs, bullying behavior toward SGMA, policies) among all students. 3) Examine factors that may affect intervention success (e.g., fidelity of implementation, barriers or facilitators to implementation, school or student characteristics) to prepare the intervention for future dissemination. Following the completion of all ten P&E sessions, school-level factors will be addressed by student-led implementation of environmental change strategies at the school focused on key domains of school climate: safety, relationships, teaching and learning, and institutional environment. This innovative R01 application brings together a team of nationally recognized minority stress and prevention science experts and responds to a nationally established public health need for research from the National Academy of Medicine, the National Institutes of Health (NOT-MD-19-001), and the National Gay and Lesbian Task Force.

Project Narrative Sexual and gender minority (SGM:, e.g., lesbian, gay, bisexual, transgender) adolescents experience disparities in behavioral health outcomes compared to their peers. The goal of this grant is to test the efficacy of a theoretically informed, multi-level school-based intervention for SGM adolescents, Proud & Empowered (P&E). Based upon our extensive preliminary studies and pilot data, we expect that P&E will help to a) reduce minority stress; b) improve behavioral health and coping along SGM; and c) create sustainable change in school climate to improve the health of this high need population of youth.