Project Summary Transgender and other gender minority youth (TGMY) experience concerning rates of mental health problems, self-harm, alcohol and drug use, sexual risk-taking, and violence victimization and perpetration. Minority stress theory states that peer and family rejection and internalized transphobia predict deleterious health outcomes in TGMY, underscoring the urgent need to identify effective programs that prevent psychosocial and behavioral health issues among TGMY. Mentoring programs may be especially impactful for TGMY, given that these programs may help alleviate adverse outcomes associated with peer and family rejection and promote self- acceptance among TGMY. However, few mentoring programs exist specifically for TGMY, and those that do have not been rigorously evaluated; often require guardian permission; generally occur in person via community organizations which precludes TGMY in high stigma, rural areas of the United States from accessing such programs; and rarely include evidence-based skill-building components (e.g., social-emotional skills). The purpose of this innovative project is to develop and complete feasibility and pilot testing of a time- limited synchronous group-delivered eHealth mentoring and skill-building program for TGMY (ages 14 to 17), preliminarily entitled the Teen Connection Project (TCP). The TCP is expected to include seven 90-minute sessions co-facilitated by two TGM adults (who are also mentors). TGMY will be paired with a TGM adult mentor based on shared social identities and interests, and mentors and mentees will participate together in each session along with other mentors and mentees. Mentors will direct activities and discussion to promote TGMY social-emotional skills acquisition. The TCP sessions will include one-on-one mentor-mentee break-out sessions. During the development phase, researchers will use an iterative process to create and refine the TCP program materials through ongoing feedback from both a Youth Advisory Board and Expert Advisory Board and conduct and open pilot trial (n=10). During the pilot evaluation phase, researchers will recruit 140 TGMY across the U.S. via social media sites and LGBTQ+ organizations and randomly assign TGMY to the intervention condition (n=70) or wait-list control condition (n=70). Using similar methods, recruit 20 TGM adult mentors from across the U.S. The researchers will (1) assess acceptability and feasibility of the program and research procedures via program observations as well as post-session surveys and exit interviews with both mentor and mentees; (2) generate initial data on the TCP’s efficacy in reducing mental health problems, self- harm, alcohol and drug use, sexual risk-taking, and violence victimization and perpetration among TGMY; and (3) examine treatment change mechanisms, including youth (e.g., increased social-emotional skills, reduced minority stress) and relationship (i.e., increased bonding) intermediary outcomes among TGMY. TGMY will complete a baseline survey and immediate and 3-month follow-up surveys. This study represents the first RCT of a TGMY-specific mentoring program developed to prevent psychosocial and behavioral health issues.

Project Narrative Transgender and other gender minority youth (TGMY) experience high rates of psychosocial (e.g., depression, teen dating violence) and behavioral health (e.g., substance use) problems, which are rooted in experiences of gender-related minority stress (e.g., peer and family rejection, internalized transphobia). This project aims to complete feasibility and pilot testing of a synchronous, group-delivered eHealth mentoring and skill-building program (i.e., Teen Connection Project) for TGMY ages 14 to 17 that focuses on evidence-based skill-building components (e.g., social-emotional skills) designed to reduce psychosocial and behavioral health problems in this population. The proposed project aligns with NIMHD’s research priorities to advance the scientific understanding of health disparities and improve minority health as well as the NIH Strategic Plan to Advance Research on the Health and Well-Being of Sexual and Gender Minorities (2021-2025).