PROJECT SUMMARY Sexual and gender minority (i.e., lesbian, gay, bisexual, queer or other non-heterosexual or non-cis gender) adults are a population that experiences significant mental and physical health disparities. This project addresses sexual and gender minority health through a focus on the romantic relationship context of health, specifically at the point of marriage. Legalized marriage is only newly available to sexual minority couples in the United States as of 2015, but decades of research have demonstrated that marriage has health benefits for heterosexual couples. Sexual and gender minority stress is a primary driver of health disparities for this population and marriage may buffer or exacerbate minority stress experiences for couples. This longitudinal study will examine the intersection of sexual minority stress and marriage. It will measure health at multiple levels of analysis among recently-married sexual minority couples, inclusive of gender identity, across the first two years of marriage through the following aims. 1) Through repeated quantitative surveys with sexual minority couples (N=250 couples) over the first two years of marriage, we will examine changes in minority stress, relationship processes, and physical and mental health, as well as relationship mediators and moderators of the well-established link between minority stress and health. 2) Through longitudinal qualitative interviews (N=24-30 couples enrolled from Aim 1), we will explore the evolving meaning of marriage over the newlywed period, as well as perceptions of how marriage shapes minority stress. 3) Using a sub-set of couples (N=100), we will repeatedly measure physiological markers of stress (cortisol, alpha amylase) and associations with relationship interactions and minority stress in couples’ daily lives. This study will measure both self- reported health and biological mediators of health at an important transition in sexual minority couples’ lives. The proposed R01 is responsive to PAR-21-281 on dyadic processes and biopsychosocial health, NIH’s Trans-NIH Strategic Plan for Sexual and Gender Minority Health research (NOT-MD-19-001), and NIMHD’s Scientific Vision. Our pilot data suggest that: 1) sexual minority individuals face unique challenges to healthy relationship formation, 2) they appear to view marriage as a life choice in a fundamentally unique way, and 3) marriage is a potentially critical context for understanding sexual minority couples’ mental and physical health. The discoveries generated by this project will make important contributions to an unexplored and critical life and relationship transition: marriage, which is uniquely shaped by the social context of sexual orientation and has clear implications for the health of sexual minority couples.

NARRATIVE Sexual and gender minority adults face persistent, stark health disparities in both physical and mental health. Romantic relationships are a critical context for understanding health and legalized marriage, an important relationship milestone, is only newly available to sexual minority couples. This project has clear relevance for understanding sexual and gender minority health by examining stress, health, and relationship processes repeatedly and dyadically at multiple levels across the newlywed period among sexual minority couples.