University of Southern California Dissertations and Theses

Complicated relationships: the prevalence and correlates of sexual assault, dating violence victimization, and minority stress among sexual minority adolescents throughout the United States

(USC Thesis Other)

Complicated relationships: the prevalence and correlates of sexual assault, dating violence victimization, and minority stress among sexual minority adolescents throughout the United States

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Content COMPLICATED RELATIONSHIPS:
THE PREVALENCE AND CORRELATES OF SEXUAL ASSAULT, DATING VIOLENCE
VICTIMIZATION, AND MINORITY STRESS AMONG SEXUAL MINORITY
ADOLESCENTS THROUGHOUT THE UNITED STATES
By
Joshua Aaron Rusow
A Dissertation Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF SOCIAL WORK / DOCTOR OF PHILOSOPHY
(SOCIAL WORK)
August 2021
Copyright 2021 Joshua Aaron Rusow

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Dedication
To Aldrick

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Acknowledgements
Given that this dissertation did not, in fact, kill me, there are many people I need to thank
(and a couple I probably need to make amends to). Sincere apologies in advance for those that I
leave off—y’all know I have a terrible memory and am finally writing this at the eleventh hour.
For their patience, mentorship, and kindness, my gratitude to Jeremy, Eric, Bistra,
Harmony, Sheree, Mary Rose, Julie, Michàlle, Olivia, Devon, Jess, Kim, and Cathy. You
challenge me, but always coupled with support.
To the colleagues and co-conspirators, Ankur, Lindsey, Yoewon, Dan, Monique, Tasha,
Taylor, Judy, Carolina, Lizbeth, Jose, Sapna, Cary, Hadass, Jeremy, Robin, Amanda, Amy,
Wichada, Claire and Liz—what a great bonus to have been able to work alongside you and
experience your passion.
For the necessary distractions and listening to my complaints, a huge thanks for my
friends and chosen family, Kenny, Christos, Andrew, Ray, Christina, Dustin, Latisha, Jamie,
Josh, David, Armando, Airon, Theo, Jon, Nick, Monica, Sean, Jason, Jason (it was a popular
name in the early 1980’s), and all my West Coast Singers.
For keeping me alive at one point or another, I appreciate the love and support of my
biological family, the many families I’ve crashed over the years, and ones that have accepted me
as one of their own: mom, grandma, grandpa, sister, my wonderful aunts, uncles, and cousins,
Paul, Ken and Kristi, Pam, Diana, Tammy and Richard, Kim and Matthew, Jasper and Alyssa,
my PArents (not a typo) and the entire Springfield and Springfield-adjacent crew. And, of
course, my husband, because I know the dedication isn’t enough. ☺
Finally, my sincere appreciation to all the youth participants who shared their experiences
with us. We do this for them.

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Table of Contents

Dedication ....................................................................................................................................... ii

Acknowledgements ........................................................................................................................ iii

List of Tables ................................................................................................................................. vi

List of Figures .............................................................................................................................. viii

Abstract .......................................................................................................................................... ix

Chapter 1: Introduction and Background .........................................................................................1
Dissertation Project ..................................................................................................1
Background ..............................................................................................................2
Guiding Theory ......................................................................................................10
References ..............................................................................................................13

Chapter 2: Interpersonal violence victimization and minority stress among diverse sexual
minority adolescents ......................................................................................................................22
Introduction ............................................................................................................22
Methods..................................................................................................................29
Results ....................................................................................................................34
Discussion ..............................................................................................................45
References ..............................................................................................................50

Chapter 3: Prospective correlates of future interpersonal violence victimization among sexual
minority adolescents in the United States ......................................................................................57
Introduction ............................................................................................................57
Methods..................................................................................................................66
Results ....................................................................................................................73
Discussion ..............................................................................................................81
References ..............................................................................................................86

Chapter 4: Minority stress and sexual assault trajectories among sexual minority adolescents in
the United States ............................................................................................................................94
Introduction ............................................................................................................94
Methods................................................................................................................102
Results ..................................................................................................................107
Discussion ............................................................................................................110
References ............................................................................................................114

Chapter 5: Implications and Future Directions ............................................................................122
Major Findings .....................................................................................................122
Limitations and Conclusions................................................................................125
References ............................................................................................................129

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Bibliography ................................................................................................................................133

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List of Tables
Table 1.1. Baseline sample characteristics (N=2,560) ...................................................................35
Table 1.2. Bivariate analyses of past-year physical teen dating violence victimization by sex,
sexual identity, race/ethnicity, urbanicity, age, and minority stress experiences ..........................36
Table 1.3. Bivariate analyses of past-year teen dating sexual assault victimization by sex, sexual
identity, race/ethnicity, urbanicity, age, and minority stress experiences .....................................38
Table 1.4. Bivariate analyses of past-year sexual assault victimization by sex, sexual identity,
race/ethnicity, urbanicity, age, and minority stress experiences ....................................................39
Table 1.5. Bivariate analyses of lifetime physically forced sexual intercourse by sex, sexual
identity, race/ethnicity, urbanicity, age, and minority stress experiences .....................................40
Table 1.6. Multivariate logistic regression of past-year physical teen dating violence
victimization. (N=2,477) ................................................................................................................42
Table 1.7. Multivariate logistic regression of past-year teen dating sexual assault victimization.
(N=2,469) .......................................................................................................................................43
Table 1.8. Multivariate logistic regression of past-year sexual assault victimization.
(N=2,477) .......................................................................................................................................43
Table 1.9. Multivariate logistic regression of lifetime physically forced sexual intercourse.
(N=2,418) .......................................................................................................................................44
Table 2.1. Prospective Sample Characteristics (N=1,076) ............................................................75
Table 2.2. Multivariate logistic regression of future teen dating violence victimization.
(N=1,030) .......................................................................................................................................76
Table 2.3. Multivariate logistic regression of future teen dating sexual assault victimization.
(N=1,025) .......................................................................................................................................78

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Table 2.4. Multivariate logistic regression of future sexual assault victimization. (N=1,015)......79
Table 2.5. Multivariate logistic regression of future physically forced sexual intercourse.
(N=1,003) .......................................................................................................................................80
Table 3.1. Prospective Sample Characteristics (N=1,076) ..........................................................108
Table 3.2. Latent growth curve with time-invariant and time-varying covariates .......................110

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List of Figures
Figure 3.1 Time-varying Covariate Model ..................................................................................107

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Abstract
Sexual minority adolescents (SMA) experience interpersonal violence victimization
(IPVV)—including sexual assault, physically forced sexual intercourse, physical teen dating
violence victimization, and teen dating sexual assault—more frequently than their heterosexual
peers. Despite the literature that documents this phenomenon, there is a lack of research on
minority stressors and the other contemporaneous and prospective correlates of interpersonal
violence victimization among this vulnerable group. This dissertation is a collection of three
separate—but related—studies and aims to document among a national sample of diverse sexual
minority adolescents, subgroup differences, minority stress, and other correlates of violence
victimization.
Paper 1: Contemporaneous Correlates of IPVV
Most studies that measure IPVV among SMA do so in comparison to heterosexual
adolescents and either ignore or are unable to measure differences between SMA subgroups—
namely adolescents of different sexual identities. This study examines bivariate and multivariate
differences in reports of IPVV by age, sex, sexual identity, race and ethnicity, urbanicity, and by
experiences of minority stress. Sexual identity, race, urbanicity, and minority stress experience
are all associated with past-year physical teen dating violence. Sex, sexual identity, urbanicity,
and minority stress experience are all associated with past-year teen dating sexual assault. Sex,
sexual identity, race, and minority stress experience are all associated with past-year sexual
assault. Sexual identity, urbanicity, age, and minority stress experience are all associated with
lifetime physically forced sexual intercourse. Understanding the relationship between identity,
minority stress and IPVV gives violence preventionists additional tools in their fight against
victimization.

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Paper 2: Prospective Correlates of IPVV
Interpersonal violence victimization is a public health crisis and SMA bear
disproportionate burden. This paper identifies the relative prospective contribution of identity
characteristics (age, sex, sexual identity, race and ethnicity), urbanicity, mental health
symptomology (depressive, anxiety, and posttraumatic symptoms) and minority stress on each of
four IPVV experiences among SMA at a later time, accounting for previous violence
victimization. Previous research has examined some of these identity characteristics, in smaller
samples of SMA or larger samples that include heterosexual young adults, but this is the first
study of this size, of just SMA, and of this age range (14 to 17 years old at baseline) in assessing
future reports of IPVV. Recent minority stress, posttraumatic stress symptoms, and past-year
physical dating violence were prospectively associated with physical teen dating violence
victimization at a later time. Sex, recent minority stress experience, and past-year teen dating
sexual assault victimization were prospectively associated with teen dating sexual assault
victimization at a later time. Sexual identity, recent minority stress experience, posttraumatic
stress symptoms, and past-year sexual assault victimization were prospectively associated with
sexual assault victimization at a later time. Sexual identity and past lifetime physically forced
sexual intercourse were prospectively associated with physically forced sexual intercourse at a
later time. Past violence victimization and minority stress experiences—which are not routinely
assessed—are associated with future experiences of IPVV, thus helping professionals should
inquire about experiences of violence and stress for violence prevention.
Paper 3: Trajectory of Sexual Assault
The relationship between minority stress and sexual assault is apparent in the literature,
but little is known about the temporal relationship between these two victimization experiences.

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Minority stress may contribute to sexual assault, or sexual assault might sensitize one to, or
increase one’s risk of, minority stress experiences. Sexual assault may be a minority stress if it is
attributed to the victim’s sexual identity. This study follows a United States nationwide sample
of sexual minority adolescents, ages 14-17, across four data-collection timepoints over the course
of 18 months. This paper expands on previous work that identified an association between
lifetime minority stress experiences and later reports of sexual assault by examining any impact
recent minority stress has on trajectories of sexual assault. Overall, the likelihood of sexual
assault in the sample decreased over time. Rates of sexual assault were higher for adolescents
who reported a sexual assault experience prior to the start of the study. Adolescents who reported
more recent (past month) minority stress experiences at each wave were more likely to report a
sexual assault at the next wave of data collection. Understanding the timing and etiology of the
trajectory of sexual assault as it relates to minority stress will elucidate intervention targets and
can sensitize clinicians to the sequelae of behavioral health concerns that SMA are facing.
Implications and Conclusion:
These studies document several findings that should be of interest to preventionists or
interventionists—be they social workers, school counselors, public health officials, nurses,
community health workers, or any of the many other others working in helping professions.
Important differences in IPVV experiences, e.g., that bisexual and pansexual adolescents have
elevated risk for some IPVV experience than gay or lesbian adolescents, and important
similarities, e.g., that male and female SMA experience similar rates of physically forced sexual
intercourse, should shape our thinking in how to help vulnerable adolescents. Knowing that
minority stress and posttraumatic stress, in addition to past experience of violence, increases an

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SMA’s risk of future IPVV, gives professionals additional screening indicators to assist their
provisioning of services. Not attending to these issues may increase burden among SMA.
This dissertation is the first to examine the relationship between IPVV and minority
stress using a comprehensive inventory of developmentally appropriate minority stress
experiences. Thus, it assesses among adolescents, for the first time, how minority stress may be
related to violence victimization contemporaneously, prospectively, and over time. Given our
understanding that SMA are at higher risk for IPVV than their heterosexual peers, it is important
to document subgroup differences to measure if risk is uniformly distributed among this diverse
group. Only then can we begin to target mechanisms that may be driving the cycle of violence
victimization among this group that is disproportionately affected.

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Chapter 1: Introduction and Background
Sexual minority adolescents (SMA; i.e. not 100% heterosexual, ages 13-17) experience
interpersonal violence victimization (IPVV) more frequently than their heterosexual peers
(Basile et al., 2020; Holguin et al., 2018; Kann et al., 2018; Rusow, 2018; Rusow et al., 2019;
Rusow, Holguin, et al., 2018; Rusow, Srivastava, et al., 2018; Rusow & Srivastava, 2019). IPVV
is a public health crisis in the United States (Basile et al., 2020), with comorbid health
consequences including suicidality, substance use, depression, anxiety, sexual risk behaviors
(Holguin et al., 2018; Rusow, 2018; Rusow et al., 2019; Rusow, Holguin, et al., 2018; Rusow,
Srivastava, et al., 2018; Rusow & Srivastava, 2019), and homelessness (Kann et al., 2018; Rice
et al., 2013; Silverman et al., 2001; Temple & Freeman Jr, 2011; Wolitzky-Taylor et al., 2008).
Given the associations between IPVV and other deleterious health outcomes and the increased
likelihood for repetition across the lifetime, IPVV in adolescence is particularly troubling
(Centers for Disease Control and Prevention, 2021).
Dissertation Project
Given that SMA are a diverse and vulnerable population, are exposed to disproportionate
amounts of interpersonal violence victimization, are subject to unique sexual minority stressors,
and have an increased burden of mental health symptomology, it is concerning that no study has
investigated these constructs concurrently. This dissertation study is organized into three distinct,
but related, papers to advance our knowledge and lay the groundwork for future research on and
prevention of IPVV among SMA. The first paper is a descriptive dive into reports of IPVV
among SMA throughout the United States. We assess rates of IPVV by various subgroupings of
SMA, including by age, sex, sexual identity, race and ethnicity, urbanicity, and investigate
associations with reports of minority stressors. This first study brings to the fore important

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subgroup differences that will need to be considered analytically, and in future intervention
development and prevention work. The second paper builds off the first by combining significant
correlates of IPVV into models that prospectively test for later experiences of IPVV. Finally, in
the third paper, we focus on the trajectory of sexual assault experiences (one kind of IPVV) and
assess the role of minority stress over time with reporting of sexual assault. In addition to laying
the groundwork with urgently necessary descriptive data on the IPVV experiences of diverse
SMA, this study employs longitudinal quantitative methodology to examine prospective
correlates of IPVV and the relationship between sexual minority stress and trajectories of sexual
assault.
The aims for this dissertation study are:
Aim 1: Describe the rates of IPVV among diverse SMA and investigate differences by
subpopulations (sex, sexual identity, race/ethnicity, urbanicity).
Aim 2: Explore the relative contribution of baseline identity characteristics, environment,
and minority stressors on future experiences on IPVV.
Aim 3: Examine the association between minority stressors over time and trajectories of
sexual assault.
Background
Prevalence of Interpersonal Violence Victimization.
Interpersonal violence victimization (IPVV) is a public health crisis with numerous
consequences for adolescents in the United States (Basile et al., 2020). IPVV includes various
forms of dating violence, sexual violence, and experiences of harassment and bullying. Dating
violence can be categorized broadly into three categories: physical dating violence, sexual dating
violence, and psychological dating violence. Physical dating violence involves undesired

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physical contact by a partner including punching, slapping, shoving, kicking, thrown objects, or
other unwanted physical contact. Sexual dating violence extends unwanted physical contact by a
partner to specifically involve genital contact or kissing without consent. Psychological dating
violence covers all other undesirable behavior that is meant to control or monitor a partner or
cause emotional distress.
The Centers for Disease Control and Prevention (CDC) identify interpersonal violence as
particularly problematic for youth and adolescents given that violence can reoccur across the
lifespan and is associated with multiple other behavioral health concerns (Centers for Disease
Control and Prevention, 2021). Dating violence is a one particular form of interpersonal violence
victimization. Given a lack of standardized definitions and of consistency in constructs
measured, prevalence of dating violence among adolescents varies between studies. Recent
representative national estimates of high school students in the United States indicate that 8.2%
of adolescents experienced physical dating violence victimization in the past year, 8.2%
experienced sexual dating violence victimization in the past year, and 5.4% experienced sexual
violence by someone other than a partner in the past year (Basile et al., 2020). Overall, in their
nationally representative study of high school students, around one in eight students reported any
kind of dating violence victimization (Basile et al., 2020).
Sexual minority adolescents (SMA; i.e. not 100% heterosexual, ages 13-17) are
substantially more likely to experience all forms of IPVV than their heterosexual peers (Basile et
al., 2020; Holguin et al., 2018; Kann et al., 2018; Rusow, 2018; Rusow et al., 2019; Rusow,
Holguin, et al., 2018; Rusow, Srivastava, et al., 2018; Rusow & Srivastava, 2019). U.S.
probability studies suggest wide disparities in the prevalence of IPVV by sexual identity among
high school students in both recent and lifetime dating violence (Freedner et al., 2002; Kann et

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al., 2018; McLaughlin et al., 2012; Reuter et al., 2015), with psychological victimization rates as
high as 59% among SMA (Dank et al., 2014), physical dating violence ranging from 17% to
89% (Dank et al., 2014; McLaughlin et al., 2012; Zweig et al., 2013), and sexual dating violence
ranging from 23% to 61% (Dank et al., 2014; Zweig et al., 2013). Compared to 7.2% of
heterosexual high school students, 13.1% of SMA and 16.9% of unsure students reported past-
year physical dating violence. While 6.7% of heterosexual high school students reported sexual
dating violence, the prevalence was higher among SMA (16.4%) and unsure students (15.0%).
Similarly, for past-year sexual violence by anyone, SMA (21.5%) and unsure students (16.2%)
reported higher rates than heterosexual students (9.0%). In a nationwide study of high school
students, SMA were four times more likely to experience rape and nearly three times as likely to
experience sexual or physical dating violence than their heterosexual peers (Kann et al., 2018).
Subgroups of SMA may differentially experience interpersonal violence victimization.
Whether racial and ethnic, gender identity, sexual identity, or urban-rural differences exist in
violence victimization experiences among SMA remains largely unknown. In studies of dating
violence victimization, female-identified participants reported higher lifetime rates of verbal and
physical dating violence (Martin-Storey, 2015; Reuter et al., 2017), and higher rates of past-year
sexual dating violence than male-identified participants (Olsen et al., 2020). A recent analysis of
a national probability sample of adolescents found that relative to their heterosexual peers, SMA
had higher adjusted risk ratios (aRR) for physical dating violence (aRR=1.97) and sexual assault
by anyone (aRR=2.10) in the past year (Caputi et al., 2020). Bisexual youth were particularly at
risk for physical dating violence (aRR=2.22) and sexual violence by anyone (aRR=2.36) within
the last year. Additionally, male SMA were particularly vulnerable to sexual assault (aRR=4.64)

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and forced intercourse (aRR=4.70) compared to heterosexually-identified male adolescents
(Caputi et al., 2020).
Existing literature conflicts on whether race and ethnicity are associated with risk for
interpersonal violence victimization. The most recent administration of the Youth Risk Behavior
Survey (YRBS) shows no significant difference between non-Hispanic white, non-Hispanic
Black, and Hispanic students in regard to physical dating violence or sexual violence by anyone
in the past year (Basile et al., 2020). Another recent study examined dating violence
victimization in an ethnically diverse, community-based regional sample of LGBT youth (ages
16-25 years) showed elevated rates of physical dating violence victimization among ethnic
minority youth compared to White youth (Whitton et al., 2019).
For SMA in rural communities, we know that stigma and fear of being “outed” may
prevent them from accessing services in schools, health care facilities, and local LGBT service
organizations (Birkett et al., 2009), but almost nothing is known about the interpersonal violence
victimization experiences of this nearly 20% of the U.S. population. In the most recent bi-annual
assessment of high school student risk behaviors, when compared to their heterosexually
identified peers, sexual minority and unsure adolescents were found to report significantly
elevated rates of physical dating violence in the past year, sexual dating violence in the past year,
and sexual violence by anyone in the past year (Basile et al., 2020).
Trajectories of Interpersonal Violence Victimization.
Rates of IPVV among adolescents and young adults generally increase throughout
adolescence, as young people begin dating, before IPVV experiences peak in the early 20s and
begin to fall. A longitudinal study of a random sample of 1,146 adolescents in the United States
Midwest predicted the proportion of relationships with IPVV by age and sex, and found that for

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both male and female young people, rates of IPVV increased from age 13 to around age 24
before they began to drop (Johnson et al., 2015). These findings align with an earlier nationally
representative study using data from the National Longitudinal Study of Adolescent Health (Add
Health). Halpern and colleagues (2009) grouped participants into four distinct patterns of IPVV:
a) those with no history of IPVV, b) those who experienced IPVV in adolescents but not young
adulthood, c) those whose first experience of IPVV occurred in young adulthood, and d) those
who experienced IPVV in both adolescence and young adulthood (Halpern et al., 2009).
Researchers in that study limited their sample to the 4,134 respondents who reported only
opposite-sex romantic or sexual relationships. They found that 40% had reported IPVV at some
point in their life—8% in adolescence only, 25% only in young adulthood, and 7% in both
adolescence and young adulthood. Their results indicate an increase in the likelihood of IPVV as
youth age and highlight an additional concern: almost half (47%) of youth who reported IPVV in
adolescence indicated IPVV persisting into young adulthood.
Given the dearth of available prospective studies on SMA exposure to sexual assault,
retrospective studies are a reasonable first step to understanding the prevalence of sexual assault
for SMA. Asking adults to reflect on experiences before their eighteenth birthday can offer some
insight into the rates of childhood sexual assault (CSA)—as it’s often called in studies of adults.
A 2011 systematic review of sexual assault among sexual minority populations found that rates
of CSA among GB men range from 4.1% to 59.2% in probability-based samples and from 13.3%
to 49.2% in convenience samples. Among LB women, rates of CSA range from 14.9% to 44.8%
in probability samples and from 21% to 76% in convenience samples (Rothman et al., 2011).
In their analysis of the Add Health data, Halpern et al. (2009) discovered differences in
IPVV experience timing by sex and race/ethnicity such that female youth were more likely than

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male youth to report either adolescent-only or young adult-only IPVV relative to no IPVV
experience, but no sex differences were found for persistent IPVV from adolescence to young
adulthood. Compared to non-Hispanic white respondents, non-Hispanic black respondents
reported increased odds of young adult onset of IPVV and persistent IPVV, but not adolescent-
only IPVV. Hispanic respondents, relative to non-Hispanic white respondents, reported an
increased odds of persistent IPVV experiences. Non-Hispanic respondents of another racial or
ethnic identity did not report any differences in IPVV experience prevalence or timing compared
to non-Hispanic white respondents.
Few studies assess the trajectory of IPVV among SMA. In one regional convenience
sample of 248 LGBT youth ages 16-20 at baseline, 45% ever experienced physical IPVV and
17% experienced sexual IPVV (Whitton et al., 2019). In a past-year recall study, high school
students who reported physical or sexual dating violence in the past year, or sexual violence by
anyone in the past year, the majority only recalled one experience (Basile et al., 2020). For both
types of sexual violence (by a dating partner or by anyone), fewer reported 2-3 times, and fewer
yet reported four or more times, indicating sexual re-victimization among some but not most
respondents. Among those reporting physical dating violence, the second most frequently
reported number of incidents was four or more followed by 2-3 times. Different patterns emerge
by sex but not by race/ethnicity. Frequency by sexual identity was not assessed in their study.
Correlates of Interpersonal Violence Victimization.
Notwithstanding the public health crisis that violence victimization poses on its own,
IPVV is also associated with sundry other behavioral health concerns. Addressing IPVV among
youth is critical, as IPVV is associated with suicidality, substance use, depression, anxiety,
sexual risk behaviors (Holguin et al., 2018; Rusow, 2018; Rusow et al., 2019; Rusow, Holguin,

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et al., 2018; Rusow, Srivastava, et al., 2018; Rusow & Srivastava, 2019), and homelessness
(Kann et al., 2018; Rice et al., 2013; Silverman et al., 2001; Temple & Freeman Jr, 2011;
Wolitzky-Taylor et al., 2008). Furthermore, these same health concerns have been identified as
disparities among SMA. SMA experience higher rates of additional behavioral health concerns
that are associated with IPVV.
Sexual activity. SMA are more likely to initiate sex at younger ages (Coker et al., 2010;
Robinson & Espelage, 2013), engage in sexual activity more frequently (Ballard et al., 2017;
Coker et al., 2010; Rice et al., 2013; Robinson & Espelage, 2013), have more sex partners,
including anonymous partners (Coker et al., 2010; Robinson & Espelage, 2013), engage in
condomless sex more frequently (Ballard et al., 2017; Rice et al., 2013; Robinson & Espelage,
2013), have sex while feeling the effects of drugs or alcohol (Robinson & Espelage, 2013), and
are at least twice as likely to be involved in an unintended pregnancy than their heterosexual
peers (Saewyc, 2011). Mental health disparities among SMA are well documented in the
literature.
Suicidality. SMA experience higher rates of suicidality (di Giacomo et al., 2018;
Marshal et al., 2011). A recent meta-analysis of sexual minority youth (ages 12-20) found that
compared to their heterosexual peers, sexual minority youth had increased odds (odds ratio [OR]
= 3.50) of suicide attempt (di Giacomo et al., 2018). This finding was in line with a 2011 meta-
analysis by Marshal and colleagues (2011) that documented increased disparities by suicidality
severity—SMA reported increased suicidal ideation (OR = 1.96), making a suicide plan (OR =
2.20), attempted suicide (OR = 3.18) and having had an attempt that required medical
intervention (OR = 4.17). Suicidality is also associated with IPVV. A systematic review of
longitudinal studies documented a prospective association of intimate partner violence with

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suicide attempt reported at a later wave among adult women (Devries et al., 2013). Previous
sexual assault has also been linked to suicide attempt in a community sample (Davidson et al.,
1996). In their study, Davidson and colleagues (1996) noted that the odds of suicide attempt was
3 to 4 times greater among women who experienced their first sexual assault before age 16
relative to women who first experienced sexual assault at 16 or older. It may be that earlier IPVV
onset has a larger or longer-lasting impact than later-onset IPVV. The prospective temporal
relationship of IPVV and suicidality among SMA is not currently known.
Mental health symptomology. SMA report higher levels of depression (Marshal et al.,
2011), anxiety (Hatzenbuehler et al., 2008) and posttraumatic stress (CITE). In their 2011 meta-
analysis, Marshal and colleagues also documented increased depression among SMA. In a
longitudinal study using a community sample of middle school students, those who reported
same-sex attraction reported higher anxiety than those who did not report same-sex attraction
(Hatzenbuehler et al., 2008). Posttraumatic stress among SMA has been linked to internalized
homophobia and bias-based victimization wherein SMA are verbally or physically abused
because of their sexual orientation or gender atypicality (Dragowski et al., 2011).
Depression, anxiety, and posttraumatic stress are also associated with IPVV. Among
adult women, Devries and colleagues (2013) demonstrate in their systematic review of
longitudinal studies a bidirectional association between intimate partner violence and depressive
symptoms, where either depression or partner violence at an earlier wave is associated with the
other at a later wave. A recent meta-analysis found that anxiety was a significant risk marker for
IPVV among men and women (Spencer et al., 2019). Given the intimate and violent nature of
sexual assault, the connection between sexual assault and PTSD has been long established

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(Davidson et al., 1996). A recent meta-analysis corroborates the importance of these mental
health factors as significant correlates of IPVV (Spencer et al., 2019).
Guiding Theory
Minority Stress Theory.
Stress theory, in general, states that the cumulation of chronic and acute stressors limits
an individual’s ability to adapt, adjust, and tolerate continued life stress experiences (Brown &
Harris, 1978). The primary framework for understanding stress and disparities among SMA is
minority stress theory (MST), which has been recognized by the National Academy of Medicine,
Centers for Disease Control and Prevention, and Healthy People 2030. In his landmark paper,
Meyer (1995) explains the association between multiple social and psychological stressors for
sexual minority populations. MST posits that structural homophobia is the primary driver of
discrimination, violence, and victimization of SMA, leading to behavioral health disparities
(Goldbach et al., 2014, 2015; Meyer, 2003; Russell et al., 2001). Stigma, prejudice, and
discrimination that are related or attributed to sexual minority identity create unique minority
stressors (Meyer, 2003). Specific stressors include negative attitudes or discomfort toward sexual
minorities, and negative or discriminatory events (Rosario et al., 2002). These minority-based
stressors are correlated with behavioral and mental health outcomes for sexual minority
individuals (Goldbach et al., 2014, 2015; Rosario et al., 2002). Minority stressors are unique
stressors that only apply to minority populations and are in addition to the presence of general
stressors which apply to everyone. Given the cumulative effects of stress, it stands to reason that
populations with additional, unique stressors are likely to have additional, negative health
outcomes.

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Importantly, minority stress theory has been applied to and adapted for sexual minority
adolescents (Goldbach & Gibbs, 2017). Minority adolescents are exposed to three types of
minority stressors. The first are general stressors that may be augmented by their minority
identity. For example, any adolescent might feel stress from being “left out” of a social situation,
however, if an adolescent perceives being excluded due to their sexual minority identity, that
would then classify it as a minority stressor. The other two stressors are minority-specific distal
and proximal stressors (Goldbach & Gibbs, 2017; Meyer, 2003). Stress experiences exist on a
continuum from distal—which are external to the individual and therefore more objective—to
proximal, which are more subjective and may involve the internalization of social attitudes
toward sexual minority people, or expectations about the response of others. For example, the
expectation of how someone might respond to an SMA “coming out” as a sexual minority is
related to their subjective internalization of their own past experiences or their understanding of
the experiences of others.
All three types of minority-specific stressors are relevant when considering experiences
of IPVV. Experiencing IPVV may be all the more stressful if adolescents attribute the violence
to their sexual identity. Similarly, proximal stressors (internal to the person) like internalized
homophobia, concealment, or expectations of rejection based on their sexual identity may place
adolescents at risk for IPVV or prevent them from seeking support after an IPVV experience.
Distal stressors (in the environment), like other bias-based violence or discrimination might work
to normalize violence or cause adolescents to de-value their IPVV experiences. Importantly,
types of stressors are interrelated, such that expectations of rejection (proximal) may reduce both
exposure to victimization or social support and may have been caused by a negative disclosure
experience (distal).

12

Minority stress and IPVV. While investigations of the likely association between
minority stress and IPVV among SMA are seemingly non-existent, some work has been done
with adult sexual minority populations. Indeed, Balsam and colleagues have been looking at the
role of minority stress in relation to partner violence among sexual minority women for decades
(Balsam, 2001; Balsam & Szymanski, 2005). Their work identified associations between
minority stressors of discrimination and internalized homonegativity with dating violence
victimization (Balsam & Szymanski, 2005). These findings were mirrored in a study of sexual
minority men (Finneran & Stephenson, 2014). Internalized homophobia, in particular, has been
linked to sexual assault (Finneran & Stephenson, 2014), and relationship violence persistence
(Balsam & Szymanski, 2005). A recent review highlighted the role that internalized homophobia
has on reducing sexual assault disclosure—which thus limits access to recovery resources—
among sexual minority individuals (Binion & Gray, 2020).
In reporting a victimization experience, SMA have to navigate multiple layers of
disclosure, and the response received can additionally impact the survivor’s health trajectory
(Relyea & Ullman, 2015). One recent longitudinal study of a community-based convenience
sample of 248 LGBT youth (ages 16-20 years at baseline) investigated the link between LGBT
discrimination and IPVV (Whitton et al., 2019). They found that for this one facet of minority
stress, those who reported increased discrimination were more likely to report sexual dating
violence, but not physical dating violence. While that work was beneficial in highlighting the
link between a part of minority stress theory and dating violence, we stand to learn from a more
thorough examination of minority stress constructs among a larger, non-region-specific sample
of SMA.

13

References
Anyan, F., Morote, R., & Hjemdal, O. (2020). Temporal and Reciprocal Relations Between
Worry and Rumination Among Subgroups of Metacognitive Beliefs. Frontiers in
Psychology, 11. https://doi.org/10.3389/fpsyg.2020.551503
Ballard, M. E., Jameson, J. P., & Martz, D. M. (2017). Sexual identity and risk behaviors among
adolescents in rural Appalachia. Journal of Rural Mental Health, 41(1), 17–29.
https://doi.org/10.1037/rmh0000068
Balsam, K. F. (2001). Nowhere to Hide. Women & Therapy, 23(3), 25–37.
https://doi.org/10.1300/J015v23n03_03
Balsam, K. F., & Szymanski, D. M. (2005). Relationship Quality and Domestic Violence in
Women’s Same-Sex Relationships: The Role of Minority Stress. Psychology of Women
Quarterly, 29(3), 258–269. https://doi.org/10.1111/j.1471-6402.2005.00220.x
Basile, K. C., Clayton, H. B., DeGue, S., Gilford, J. W., Vagi, K. J., Suarez, N. A., Zwald, M. L.,
& Lowry, R. (2020). Interpersonal Violence Victimization Among High School
Students—Youth Risk Behavior Survey, United States, 2019. MMWR Supplements,
69(1), 28–37. https://doi.org/10.15585/mmwr.su6901a4
Binion, K., & Gray, M. J. (2020). Minority Stress Theory and Internalized Homophobia among
LGB Sexual Assault Survivors: Implications for Posttraumatic Adjustment. Journal of
Loss and Trauma, 25(5), 454–471. https://doi.org/10.1080/15325024.2019.1707987
Birkett, M., Espelage, D. L., & Koenig, B. (2009). LGB and Questioning Students in Schools:
The Moderating Effects of Homophobic Bullying and School Climate on Negative
Outcomes. Journal of Youth and Adolescence, 38(7), 989–1000.
https://doi.org/10.1007/s10964-008-9389-1

14

Brown, G. W., & Harris, T. (1978). Social Origins of Depression: A study of psychiatric disorder
in women. The Free Press, A Division of Macmillan Publishing Company, Inc.
Caputi, T. L., Shover, C. L., & Watson, R. J. (2020). Physical and Sexual Violence Among Gay,
Lesbian, Bisexual, and Questioning Adolescents. JAMA Pediatrics, 174(8), 791.
https://doi.org/10.1001/jamapediatrics.2019.6291
Centers for Disease Control and Prevention. (2021, March 16). Preventing Teen Dating
Violence. Preventing Teen Dating Violence.
https://www.cdc.gov/violenceprevention/intimatepartnerviolence/teendatingviolence/fastf
act.html
Coker, T. R., Austin, S. B., & Schuster, M. A. (2010). The health and health care of lesbian, gay,
and bisexual adolescents. Annual Review of Public Health, 31, 457–477.
https://doi.org/10.1146/annurev.publhealth.012809.103636
Dank, M., Lachman, P., Zweig, J. M., & Yahner, J. (2014). Dating Violence Experiences of
Lesbian, Gay, Bisexual, and Transgender Youth. Journal of Youth and Adolescence,
43(5), 846–857. https://doi.org/10.1007/s10964-013-9975-8
Davidson, J. R. T., Hughes, D. C., George, L. K., & Blazer, D. G. (1996). The Association of
Sexual Assault and Attempted Suicide Within the Community. Archives of General
Psychiatry, 53(6), 550–555. https://doi.org/10.1001/archpsyc.1996.01830060096013
Devries, K. M., Mak, J. Y., Bacchus, L. J., Child, J. C., Falder, G., Petzold, M., Astbury, J., &
Watts, C. H. (2013). Intimate Partner Violence and Incident Depressive Symptoms and
Suicide Attempts: A Systematic Review of Longitudinal Studies. PLOS Medicine, 10(5),
e1001439. https://doi.org/10.1371/journal.pmed.1001439

15

di Giacomo, E., Krausz, M., Colmegna, F., Aspesi, F., & Clerici, M. (2018). Estimating the Risk
of Attempted Suicide Among Sexual Minority Youths: A Systematic Review and Meta-
analysis. JAMA Pediatrics, 172(12), 1145–1152.
https://doi.org/10.1001/jamapediatrics.2018.2731
Dragowski, E. A., Halkitis, P. N., Grossman, A. H., & D’Augelli, A. R. (2011). Sexual
Orientation Victimization and Posttraumatic Stress Symptoms Among Lesbian, Gay, and
Bisexual Youth. Journal of Gay & Lesbian Social Services, 23(2), 226–249.
https://doi.org/10.1080/10538720.2010.541028
Finneran, C., & Stephenson, R. (2014). Intimate Partner Violence, Minority Stress, and Sexual
Risk-Taking Among U.S. Men Who Have Sex With Men. Journal of Homosexuality,
61(2), 288–306. https://doi.org/10.1080/00918369.2013.839911
Freedner, N., Freed, L. H., Yang, Y. W., & Austin, S. B. (2002). Dating violence among gay,
lesbian, and bisexual adolescents: Results from a community survey. Journal of
Adolescent Health, 31(6), 469–474. https://doi.org/10.1016/S1054-139X(02)00407-X
Goldbach, J. T., & Gibbs, J. J. (2017). A developmentally informed adaptation of minority stress
for sexual minority adolescents. Journal of Adolescence, 55, 36–50.
https://doi.org/10.1016/j.adolescence.2016.12.007
Goldbach, J. T., Schrager, S. M., Dunlap, S. L., & Holloway, I. W. (2015). The Application of
Minority Stress Theory to Marijuana Use Among Sexual Minority Adolescents.
Substance Use & Misuse, 50(3), 366–375.
https://doi.org/10.3109/10826084.2014.980958

16

Goldbach, J. T., Schrager, S. M., & Mamey, M. R. (2017). Criterion and divergent validity of the
sexual minority adolescent stress inventory. Frontiers in Psychology, 8, 2057.
https://doi.org/10.3389/fpsyg.2017.02057
Goldbach, J. T., Tanner-Smith, E. E., Bagwell, M., & Dunlap, S. (2014). Minority Stress and
Substance Use in Sexual Minority Adolescents: A Meta-analysis. Prevention Science,
15(3), 350–363. https://doi.org/10.1007/s11121-013-0393-7
Halpern, C. T., Spriggs, A. L., Martin, S. L., & Kupper, L. L. (2009). Patterns of Intimate Partner
Violence Victimization from Adolescence to Young Adulthood in a Nationally
Representative Sample. Journal of Adolescent Health, 45(5), 508–516.
https://doi.org/10.1016/j.jadohealth.2009.03.011
Hatzenbuehler, M. L., McLaughlin, K. A., & Nolen‐Hoeksema, S. (2008). Emotion regulation
and internalizing symptoms in a longitudinal study of sexual minority and heterosexual
adolescents. Journal of Child Psychology and Psychiatry, 49(12), 1270–1278.
https://doi.org/10.1111/j.1469-7610.2008.01924.x
Holguin, M., Rusow, J., & Srivastava, A. (2018, November). History of sexual assault is
associated with condomless sex and sex under the influence among high school youth in
the United States [Poster]. American Public Health Association 2018 Annual Meeting &
Expo, San Diego, CA.
Johnson, W. L., Manning, W. D., Giordano, P. C., & Longmore, M. A. (2015). Relationship
Context and Intimate Partner Violence From Adolescence to Young Adulthood. Journal
of Adolescent Health, 57(6), 631–636. https://doi.org/10.1016/j.jadohealth.2015.08.014
Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Queen, B., Lowry, R.,
Chyen, D., Whittle, L., & Thornton, J. (2018). Youth risk behavior surveillance—United

17

States, 2017. MMWR Surveillance Summaries, 67(8), 1–114.
https://doi.org/10.15585/mmwr.ss6708a1
Lang, A. J., Wilkins, K., Roy-Byrne, P. P., Golinelli, D., Chavira, D., Sherbourne, C., Rose, R.
D., Bystritsky, A., Sullivan, G., Craske, M. G., & Stein, M. B. (2012). Abbreviated PTSD
Checklist (PCL) as a guide to clinical response. General Hospital Psychiatry, 34(4), 332–
338. https://doi.org/10.1016/j.genhosppsych.2012.02.003
Marshal, M. P., Dietz, L. J., Friedman, M. S., Stall, R., Smith, H. A., McGinley, J., Thoma, B.
C., Murray, P. J., D’Augelli, A. R., & Brent, D. A. (2011). Suicidality and depression
disparities between sexual minority and heterosexual youth: A meta-analytic review.
Journal of Adolescent Health, 49(2), 115–123.
Martin-Storey, A. (2015). Prevalence of Dating Violence Among Sexual Minority Youth:
Variation Across Gender, Sexual Minority Identity and Gender of Sexual Partners.
Journal of Youth and Adolescence, 44(1), 211–224. https://doi.org/10.1007/s10964-013-
0089-0
McLaughlin, K. A., Hatzenbuehler, M. L., Xuan, Z., & Conron, K. J. (2012). Disproportionate
exposure to early-life adversity and sexual orientation disparities in psychiatric
morbidity. Child Abuse & Neglect, 36(9), 645–655.
https://doi.org/10.1016/j.chiabu.2012.07.004
Melchior, L. A., Huba, G., Brown, V. B., & Reback, C. J. (1993). A short depression index for
women. Educational and Psychological Measurement, 53(4), 1117–1125.
https://doi.org/10.1177/0013164493053004024
Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social
Behavior, 36(1), 38–56. https://doi.org/10.2307/2137286

18

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual
populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5),
674–697. https://doi.org/10.1037/0033-2909.129.5.674
Muthén, L. K., & Muthén, B. O. (2009). Mplus. Statistical analysis with latent variables. User’s
guide, 7.
Olsen, E. O., Vivolo-Kantor, A., & Kann, L. (2020). Physical and Sexual Teen Dating Violence
Victimization and Sexual Identity Among U.S. High School Students, 2015. Journal of
Interpersonal Violence, 35(17–18), 3581–3600.
https://doi.org/10.1177/0886260517708757
Relyea, M., & Ullman, S. E. (2015). Unsupported or Turned Against: Understanding How Two
Types of Negative Social Reactions to Sexual Assault Relate to Postassault Outcomes.
Psychology of Women Quarterly, 39(1), 37–52.
https://doi.org/10.1177/0361684313512610
Reuter, T. R., Newcomb, M. E., Whitton, S. W., & Mustanski, B. (2017). Intimate partner
violence victimization in LGBT young adults: Demographic differences and associations
with health behaviors. Psychology of Violence, 7(1), 101–109.
https://doi.org/10.1037/vio0000031
Reuter, T. R., Sharp, C., Link to external site, this link will open in a new window, Temple, J.
R., Babcock, J. C., & Link to external site, this link will open in a new window. (2015).
The relation between borderline personality disorder features and teen dating violence.
Psychology of Violence, 5(2), 163–173.
http://dx.doi.org.libproxy2.usc.edu/10.1037/a0037891

19

Rice, E., Barman-Adhikari, A., Rhoades, H., Winetrobe, H., Fulginiti, A., Astor, R., Montoya, J.,
Plant, A., & Kordic, T. (2013). Homelessness experiences, sexual orientation, and sexual
risk taking among high school students in Los Angeles. Journal of Adolescent Health,
52(6), 773–778. https://doi.org/10.1016/j.jadohealth.2012.11.011
Robinson, J. P., & Espelage, D. L. (2013). Peer victimization and sexual risk differences between
lesbian, gay, bisexual, transgender, or questioning and nontransgender heterosexual
youths in grades 7–12. American Journal of Public Health, 103(10), 1810–1819.
https://doi.org/10.2105/AJPH.2013.301387
Rosario, M., Schrimshaw, E. W., Hunter, J., & Gwadz, M. (2002). Gay-related stress and
emotional distress among gay, lesbian and bisexual youths: A longitudinal examination.
Journal of Consulting and Clinical Psychology, 70(4), 967–975.
https://doi.org/10.1037/0022-006X.70.4.967
Rothman, E. F., Exner, D., & Baughman, A. L. (2011). The Prevalence of Sexual Assault
Against People Who Identify as Gay, Lesbian, or Bisexual in the United States: A
Systematic Review. Trauma, Violence, & Abuse, 12(2), 55–66.
https://doi.org/10.1177/1524838010390707
Rusow, J. (2018, November). Sexual assault and teen dating violence are associated with sex
under the influence and condomless sex among LGBQ high school adolescents in the
U.S. [Paper]. The Society for the Scientific Study of Sexuality, 2018 Annual Meeting,
Montreal, Quebec, Canada.
Rusow, J., Holguin, M., & Srivastava, A. (2018, November). Sexual identity and sexual risk
among adolescents in the United States who have experienced physical or sexual teen

20

dating violence [Paper]. American Public Health Association 2018 Annual Meeting &
Expo, San Diego, CA.
Rusow, J., Mendon, S., & Srivastava, A. (2019, January). Intimate violence and suicide attempt
among lesbian, gay, bisexual, and questioning adolescents in the United States [Paper].
Society for Social Work and Research 23rd Annual Conference, San Francisco, CA.
Rusow, J., & Srivastava, A. (2019, January). Lifetime sexual assault, teen dating violence
victimization, and LGBQ-identity are associated with condomless sex and sex under the
influence among high school adolescents in the United States [Poster]. Society for Social
Work and Research 23rd Annual Conference, San Francisco, CA.
Rusow, J., Srivastava, A., Rhoades, H., & Goldbach, J. (2018, November). Suicide attempt and
violent experiences among lesbian, gay, bisexual, and questioning adolescents in the
United States [Paper]. American Public Health Association 2018 Annual Meeting &
Expo, San Diego, CA.
Russell, S. T., Franz, B. T., & Driscoll, A. K. (2001). Same-sex romantic attraction and
experiences of violence in adolescence. American Journal of Public Health, 91(6), 903.
Saewyc, E. M. (2011). Research on adolescent sexual orientation: Development, health
disparities, stigma, and resilience. Journal of Research on Adolescence, 21(1), 256–272.
Schrager, S. M., Goldbach, J. T., & Mamey, M. R. (2018). Development of the Sexual Minority
Adolescent Stress Inventory. Frontiers in Psychology, 9, 319.
https://doi.org/10.3389/fpsyg.2018.00319
Silverman, J. G., Raj, A., Mucci, L. A., & Hathaway, J. E. (2001). Dating violence against
adolescent girls and associated substance use, unhealthy weight control, sexual risk
behavior, pregnancy, and suicidality. JAMA, 286(5), 572–579.

21

Spencer, C. M., Stith, S. M., & Cafferky, B. (2019). Risk markers for physical intimate partner
violence victimization: A meta-analysis. Aggression and Violent Behavior, 44, 8–17.
https://doi.org/10.1016/j.avb.2018.10.009
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for
assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine,
166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092
Temple, J. R., & Freeman Jr, D. H. (2011). Dating violence and substance use among ethnically
diverse adolescents. Journal of Interpersonal Violence, 26(4), 701–718.
USDA ERS - Rural-Urban Commuting Area Codes. (n.d.). Retrieved April 16, 2021, from
https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes.aspx
Whitton, S. W., Newcomb, M. E., Messinger, A. M., Byck, G., & Mustanski, B. (2019). A
longitudinal study of IPV victimization among sexual minority youth. Journal of
Interpersonal Violence, 34(5), 912–945. https://doi.org/10.1177/0886260516646093
Wolitzky-Taylor, K. B., Ruggiero, K. J., Danielson, C. K., Resnick, H. S., Hanson, R. F., Smith,
D. W., Saunders, B. E., & Kilpatrick, D. G. (2008). Prevalence and correlates of dating
violence in a national sample of adolescents. Journal of the American Academy of Child
& Adolescent Psychiatry, 47(7), 755–762.
Zweig, J. M., Dank, M., Yahner, J., & Lachman, P. (2013). The Rate of Cyber Dating Abuse
Among Teens and How It Relates to Other Forms of Teen Dating Violence. Journal of
Youth and Adolescence, 42(7), 1063–1077. https://doi.org/10.1007/s10964-013-9922-8

22

Chapter 2: Interpersonal violence victimization and minority stress among diverse sexual
minority adolescents
Most studies that measure IPVV among SMA do so in comparison to heterosexual
adolescents and either ignore or are unable to measure differences between SMA subgroups—
namely adolescents of different sexual identities. This study examines bivariate and multivariate
differences in reports of IPVV by age, sex, sexual identity, race and ethnicity, urbanicity, and by
experiences of minority stress. Sexual identity, race, urbanicity, and minority stress experience
are all associated with past-year physical teen dating violence. Sex, sexual identity, urbanicity,
and minority stress experience are all associated with past-year teen dating sexual assault. Sex,
sexual identity, race, and minority stress experience are all associated with past-year sexual
assault. Sexual identity, urbanicity, age, and minority stress experience are all associated with
lifetime physically forced sexual intercourse. Understanding the relationship between identity,
minority stress and IPVV gives violence preventionists additional tools in their fight against
victimization.
Introduction
Sexual minority adolescents (SMA; i.e. not 100% heterosexual, ages 13-17) experience
interpersonal violence victimization (IPVV) more frequently than their heterosexual peers
(Basile et al., 2020; Holguin et al., 2018; Kann et al., 2018; Rusow, 2018; Rusow et al., 2019;
Rusow, Holguin, et al., 2018; Rusow, Srivastava, et al., 2018; Rusow & Srivastava, 2019). IPVV
is a public health crisis in the United States (Basile et al., 2020), with comorbid health
consequences including suicidality, substance use, depression, anxiety, sexual risk behaviors
(Holguin et al., 2018; Rusow, 2018; Rusow et al., 2019; Rusow, Holguin, et al., 2018; Rusow,
Srivastava, et al., 2018; Rusow & Srivastava, 2019), and homelessness (Kann et al., 2018; Rice

23

et al., 2013; Silverman et al., 2001; Temple & Freeman Jr, 2011; Wolitzky-Taylor et al., 2008).
Given the associations between IPVV and other deleterious health outcomes and the increased
likelihood for repetition across the lifetime, IPVV in adolescence is particularly troubling
(Centers for Disease Control and Prevention, 2021). This study investigates the differences in
IPVV reporting by various SMA by age, sex at birth, race and ethnicity, urbanicity, and reporting
of minority stress experiences.
Interpersonal violence victimization (IPVV) is a public health crisis with numerous
consequences for adolescents in the United States (Basile et al., 2020). IPVV covers various
forms violence experiences, including dating violence, sexual violence, and experiences of
harassment and bullying. Dating violence can be further subcategorized. Physical dating violence
involves undesired physical contact by a partner including punching, slapping, shoving, kicking,
thrown objects, or other unwanted physical contact. Sexual dating violence extends unwanted
physical contact by a partner to specifically involve genital contact or kissing without consent.
The Centers for Disease Control and Prevention (CDC) identify interpersonal violence as
particularly problematic for youth and adolescents given that violence can reoccur across the
lifespan and is associated with multiple other behavioral health concerns (Centers for Disease
Control and Prevention, 2021). Given a lack of standardized definitions and of consistency in
constructs measured, prevalence of dating violence among adolescents varies between studies.
Recent representative national estimates of high school students in the United States indicate that
8.2% of adolescents experienced physical dating violence victimization in the past year, 8.2%
experienced sexual dating violence victimization in the past year, and 5.4% experienced sexual
violence by someone other than a partner in the past year (Basile et al., 2020). Overall, in their

24

nationally representative study of high school students, around one in eight students reported any
kind of dating violence victimization (Basile et al., 2020).
Sexual minority adolescents (SMA; i.e. not 100% heterosexual, ages 13-17) are
substantially more likely to experience all forms of IPVV than their heterosexual peers (Basile et
al., 2020; Holguin et al., 2018; Kann et al., 2018; Rusow, 2018; Rusow et al., 2019; Rusow,
Holguin, et al., 2018; Rusow, Srivastava, et al., 2018; Rusow & Srivastava, 2019). U.S.
probability studies suggest wide disparities in the prevalence of IPVV by sexual identity among
high school students in both recent and lifetime dating violence (Freedner et al., 2002; Kann et
al., 2018; McLaughlin et al., 2012; Reuter et al., 2015), with physical dating violence ranging
from 17% to 89% (Dank et al., 2014; McLaughlin et al., 2012; Zweig et al., 2013), and sexual
dating violence ranging from 23% to 61% (Dank et al., 2014; Zweig et al., 2013). Compared to
7.2% of heterosexual high school students, 13.1% of SMA and 16.9% of unsure students
reported past-year physical dating violence. While 6.7% of heterosexual high school students
reported sexual dating violence, the prevalence was higher among SMA (16.4%) and unsure
students (15.0%). Similarly, for past-year sexual violence by anyone, SMA (21.5%) and unsure
students (16.2%) reported higher rates than heterosexual students (9.0%). In a nationwide study
of high school students, SMA were four times more likely to experience rape (i.e. forced
intercourse) and nearly three times as likely to experience sexual or physical dating violence than
their heterosexual peers (Kann et al., 2018).
Subgroups of SMA may differentially experience IPVV. Whether racial and ethnic,
gender identity, sexual identity, or urban-rural differences exist in violence victimization
experiences among SMA remains largely unknown. In studies of dating violence victimization,
female-identified participants reported higher lifetime rates of verbal and physical dating

25

violence (Martin-Storey, 2015; Reuter et al., 2017), and higher rates of past-year sexual dating
violence than male-identified participants (Olsen et al., 2020). A recent analysis of a national
probability sample of adolescents found that relative to their heterosexual peers, SMA had higher
adjusted risk ratios (aRR) for physical dating violence (aRR=1.97) and sexual assault by anyone
(aRR=2.10) in the past year (Caputi et al., 2020). Bisexual youth were particularly at risk for
physical dating violence (aRR=2.22) and sexual violence by anyone (aRR=2.36) within the last
year. Additionally, male SMA were particularly vulnerable to sexual assault (aRR=4.64) and
forced intercourse (aRR=4.70) compared to heterosexually-identified male adolescents (Caputi et
al., 2020).
Extant literature conflicts on whether race and ethnicity are associated with risk for
interpersonal violence victimization. The most recent administration of the Youth Risk Behavior
Survey (YRBS) shows no significant difference between non-Hispanic white, non-Hispanic
Black, and Hispanic students in regard to physical dating violence or sexual violence by anyone
in the past year (Basile et al., 2020). Another recent study examined dating violence
victimization in an ethnically diverse, community-based regional sample of LGBT youth (ages
16-25 years) showed elevated rates of physical dating violence victimization among ethnic
minority youth compared to White youth (Whitton et al., 2019).
For SMA in rural communities, we know that stigma and fear of being “outed” may
prevent them from accessing services in schools, health care facilities, and local LGBT service
organizations (Birkett et al., 2009), but almost nothing is known about the interpersonal violence
victimization experiences of this nearly 20% of the U.S. population. In the most recent biennial
assessment of high school student risk behaviors, when compared to their heterosexually
identified peers, sexual minority and unsure adolescents were found to report significantly

26

elevated rates of physical dating violence in the past year, sexual dating violence in the past year,
and sexual violence by anyone in the past year (Basile et al., 2020).
Notwithstanding the public health crisis that violence victimization poses on its own,
IPVV is also associated with sundry other behavioral health concerns. Addressing IPVV among
youth is critical, as IPVV is associated with suicidality, substance use, depression, anxiety,
sexual risk behaviors (Holguin et al., 2018; Rusow, 2018; Rusow et al., 2019; Rusow, Holguin,
et al., 2018; Rusow, Srivastava, et al., 2018; Rusow & Srivastava, 2019), and homelessness
(Kann et al., 2018; Rice et al., 2013; Silverman et al., 2001; Temple & Freeman Jr, 2011;
Wolitzky-Taylor et al., 2008). Furthermore, these same health concerns have been identified as
disparities among SMA.
Guiding Theory
Minority stress theory. Stress theory, in general, states that the accumulation of chronic
and acute stressors limits an individual’s ability to adapt, adjust, and tolerate continued life stress
experiences (Brown & Harris, 1978). The primary framework for understanding stress and
disparities among SMA is minority stress theory (MST), which has been recognized by the
National Academy of Medicine, Centers for Disease Control and Prevention, and Healthy People
2030. In his landmark paper, Meyer (1995) explains the association between multiple social and
psychological stressors for sexual minority populations. MST posits that structural homophobia
is the primary driver of discrimination, violence, and victimization of SMA, leading to
behavioral health disparities (Goldbach et al., 2014, 2015; Meyer, 2003; Russell et al., 2001).
Stigma, prejudice, and discrimination that are related or attributed to sexual minority identity
create unique minority stressors (Meyer, 2003). Specific stressors include negative attitudes or
discomfort toward sexual minorities, and negative or discriminatory events (Rosario et al., 2002).

27

These minority-based stressors are correlated with behavioral and mental health outcomes for
sexual minority individuals (Goldbach et al., 2014, 2015; Rosario et al., 2002). Minority
stressors are unique stressors that only apply to minority populations and are in addition to the
presence of general stressors which apply to everyone. Given the cumulative effects of stress, it
stands to reason that populations with unique additional stressors are likely to have additional
negative health outcomes.
Importantly, minority stress theory has been applied to and adapted for sexual minority
adolescents (Goldbach & Gibbs, 2017). Minority adolescents are exposed to three types of
minority stressors. The first are general stressors that may be augmented by their minority
identity. For example, any adolescent might feel stress from being “left out” of a social situation,
however, if an adolescent perceives being excluded due to their sexual minority identity, that will
then classify it as a minority stressor. The other two stressors are minority-specific distal and
proximal stressors (Goldbach & Gibbs, 2017; Meyer, 2003). Stress experiences exist on a
continuum from distal—which are external to the individual and therefore more objective—to
proximal, which are more subjective and may involve the internalization of social attitudes
toward sexual minority people, or expectations about the response of others. For example, the
expectation of how someone might respond to an SMA “coming out” as a sexual minority is
related to their subjective internalization of their own past experiences or their understanding of
the experiences of others.
All three types of minority-specific stressors are relevant when considering experiences
of IPVV. Experiencing IPVV may be all the more stressful if adolescents attribute the violence
to their sexual identity. Similarly, proximal stressors (internal to the person) like internalized
homophobia, concealment, or expectations of rejection based on their sexual identity may place

28

adolescents at risk for IPVV or prevent them from seeking support after an IPVV experience.
Distal stressors (in the environment), like other bias-based violence or discrimination might work
to normalize violence or cause adolescents to de-value their IPVV experiences. Importantly,
types of stressors are interrelated, such that expectations of rejection (proximal) may reduce both
exposure to victimization or social support and may have been caused by a negative disclosure
experience (distal).
Minority stress and IPVV. While investigations of the likely association between
minority stress and IPVV among SMA are seemingly non-existent, some work has been done
with adult sexual minority populations. Indeed, Balsam and colleagues have been looking at the
role of minority stress in relation to partner violence among sexual minority women for decades
(Balsam, 2001; Balsam & Szymanski, 2005). Their work identified associations between
minority stressors of discrimination and internalized homonegativity with dating violence
victimization (Balsam & Szymanski, 2005). These findings were mirrored in a study of sexual
minority men (Finneran & Stephenson, 2014). Internalized homophobia, in particular, has been
linked to sexual assault (Finneran & Stephenson, 2014), and relationship violence persistence
(Balsam & Szymanski, 2005). A recent review highlighted the role that internalized homophobia
has on reducing sexual assault disclosure—which thus limits access to recovery resources—
among sexual minority individuals (Binion & Gray, 2020).
In reporting a victimization experience, SMA have to navigate multiple layers of
disclosure, and the response received can additionally impact the survivor’s health trajectory
(Relyea & Ullman, 2015). One recent longitudinal study of a community-based convenience
sample of 248 LGBT youth (ages 16-20 years at baseline) investigated the link between LGBT
discrimination and IPVV (Whitton et al., 2019). They found that for this one facet of minority

29

stress, those who reported increased discrimination were more likely to report sexual dating
violence, but not physical dating violence. While that work was beneficial in highlighting the
link between a part of minority stress theory and dating violence, we stand to learn from a more
thorough examination of minority stress constructs among a larger, non-region-specific sample
of SMA.
Given the disparities that have been reported in smaller, or older, or regional samples,
this paper seeks to expand our understanding of the subgroup differences of IPVV among diverse
SMA in a large national sample. Specifically, this paper will examine differences in reporting of
various IPVV experiences by a) age, b) sex, c) sexual identity, d) race/ethnicity, e) urbanicity,
and examine associations between IPVV and f) minority stress experiences. Following the
bivariate examination, multivariate analyses will be used to answer the question, among
significant correlates of IPVV, what correlates remain associated with IPVV when controlling
for the others?
Methods
Participants
Adolescents ages 14 to 17 years old, who identified as having a sexual minority identity
(defined as not 100% heterosexual) were invited to participate in an online survey. Potential
participants were recruited from Facebook, Instagram, YouTube, or were referred by other
participants. Adolescents were able to participate in the study if they were between the ages of
14 and 17 (inclusive), identified as cisgender (i.e. their sex determined at birth aligned with their
current gender identity), lived in the United States, and identified as not 100% heterosexual using
sexual attraction questions from the Add Health study (Halpern et al., 2009).

30

Adolescents interested in screening for the study would enter the online screening survey
through a link that indicated whether they came from Facebook, Instagram, YouTube, or
participant referral link. Interested adolescents would provide their age in years, gender, sexual
attraction, and ZIP code (to determine residency) for eligibility. Eligible participants
immediately moved forward to the online assent form for the baseline survey. Ineligible
screeners would be asked to provide contact information if they were interested in future study
opportunities. While their data and screener responses were kept for potential future studies
conducted by the researchers (for participants that desired future contact), additionally, it
obfuscated ineligibility for the study and discouraged ineligible participants from re-entering the
screener to provide incorrect answers in an attempt to access the study with a false identity.
Participants who were deemed eligible during the online screening process were routed to
the IRB-approved online assent document. Participants read through the document and indicated
through a checkbox that they understood the study requirements and agreed to participate in the
study. Participants were able to download a PDF copy of the assent form and information sheet
for the study. Participants that did not agree to participate were routed out of the survey and
shown a message thanking them for their time. Those that agreed and indicated their desire to
proceed were then presented the survey. When they completed the survey, participants were
routed again to a separate survey that collected their contact information for an incentive
payment of a $15 Amazon gift card sent through Gyft.com. This additional step allowed the
research team to ensure that contact information and study data were always separate.
Prior online research experience by the study team (and conventional wisdom) indicated
that offering an incentive for an all-online study might invite attention from individuals who
would try to test the system for vulnerabilities, in order to gain access to the gift cards. A data

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quality check was designed to prevent ineligible participants from receiving gift cards. The data
quality check further prevented eligible participants from retaking the survey for an additional
incentive. The data quality check consisted of examining survey metadata for patterns of
potential fraud, including survey durations that were too short, exorbitant amounts of missing
data, successive repeat survey attempts from the same device, IP address, or geo-location as
recorded by the survey platform, Qualtrics. Further, repeat metadata was triangulated—through a
combination of randomly generated numbers and timestamp information—with the contact
information provided for payment to look for identical or near-identical matches. If it could be
determined that an ineligible respondent made several attempts to access the survey before
finding the right combination of eligibility criteria, their data were removed, and they were not
paid. If an eligible participant re-entered the survey in an attempt to obtain an additional gift
card, their initial data were retained, but subsequent attempts were discarded.
Measures.
Demographics. Age, race and ethnicity, urbanicity, sex at birth and sexual orientation
were assessed with items created by the authors. Participants were asked, “How old are you?”
and were able to enter a whole number of years. Participants were asked, “What is your
race/ethnicity?” and were allowed to select one or write in a response. Available options for
race/ethnicity included: Native American/American Indian/Alaskan Native, Asian/Pacific
Islander, Black or African American, White/Caucasian, Latino/Hispanic, Multi-racial (Please
specify), and Race/ethnicity not listed here (Please specify). Participants reported the ZIP code
where they lived. Urbanicity (rural or urban) was determined based on the Rural Urban
Community Area (RUCA) codes (USDA ERS - Rural-Urban Commuting Area Codes, n.d.).

32

“Urban” was defined as ZIP Codes corresponding to RUCA codes of 1.0, 1.1, 2.0, 2.1, 4.1, 5.1,
7.1, 8.1, and 10.1. “Rural” included all other valid US ZIP Codes.
Sex was assessed by asking, “What was your sex assigned at birth?” with female or male
response options available. For sexual identity, participants freely wrote in a response to the
question “What would you say is your sexual orientation or identity?” Free responses were coded
by the study team while considering the participant’s response to an additional prompt, “If you
had to pick one of the following options, please choose the description that best fits how you
think about yourself” [100% heterosexual; Mostly heterosexual, but somewhat attracted to
people of your own gender; Bisexual or pansexual (pansexual refers to individuals who are
attracted to people regardless of gender identity); Mostly homosexual (gay/lesbian), but
somewhat attracted to people of the opposite gender, 100% homosexual (gay/lesbian), and
Unsure]. The study team used existing literature and prior work to develop a qualitative coding
scheme for sexual identity variables, which were categorized into the following: gay, lesbian,
bisexual, pansexual, bisexual/pansexual (indicated both), complex/multiple identities (e.g., gay
pansexual, bisexual lesbian), queer, straight/mostly straight, asexual, something else (e.g.,
demisexual, agrosexual), or missing. For the purposes of this analysis, sexual identity was
collapsed into four distinct groups: 1) gay or lesbian, 2) bisexual, 3) pansexual (those who
identified as only pansexual or a primary pansexual identity), and 4) another identity (includes
complex identities, queer, mostly straight, asexual, or something else).
Interpersonal violence victimization. Prevalence of interpersonal violence victimization
experiences were measured with questions adapted from the YRBS (Kann et al., 2018). Lifetime
forced sex was assessed by asking participants if they had ever “Been physically forced to have
sexual intercourse when [they] did not want to,” and at follow-ups “since the list time [they] took

33

the survey.” Past-year sexual assault was assessed by asking, “How many times did anyone force
you to do sexual things that you did not want to do? (Count things such as kissing, touching or
being physically forced to have sexual intercourse.).” Past-year sexual dating violence was
assessed by asking, “How many times did someone you were dating or going out with force you
to do sexual things that you did not want to do? (Count such things as kissing, touching or being
physically forced to have sexual intercourse.).” Past-year physical dating violence was assessed
by asking, “How many times did someone you were dating or going out with physically hurt you
on purpose? (Count such things as being hit, slammed into something, or injured with an object
or weapon.).” Response options for each include: 0 times, 1 time, 2 or 3 times, 4 or 5 times, 6 or
more times, or decline to answer. The dating questions include an additional response option of
“I did not go out with anyone in the past 12 months.” All IPVV items were each dichotomized
into 0 times, or 1 or more times.
Sexual minority stress. Minority stress was assessed using the Sexual Minority
Adolescent Stress Inventory (SMASI), which was designed for racially and ethnically diverse
adolescents and assesses 10 domains of minority stress with 54 items (Goldbach et al., 2017;
Schrager et al., 2018). Adolescents were asked if they have had each experience “ever” and “in
the past 30 days.” Stressful experiences were assessed for each of these subdomains: identity
management, social marginalization, negative disclosure experiences, internalized
homonegativity, family rejection, homonegative communication, negative expectancies,
homonegative climate, intersectionality, and religion. A sum score of minority stress was
calculated across domains for a total score ranging from 0 to 54.
Analytic Plan

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Reported rates of each of the four types of IPVV (past year physical dating violence and
past-year sexual dating violence, past-year sexual assault, and lifetime forced sex) were stratified
across sexual identity, sex at birth, urbanicity, race and ethnicity, and minority stressors. Chi-
square tests were used to detect significant differences between categorical variables and t-tests
were used to detect significant differences between continuous variables. Following bivariate
analyses, multivariate logistic regressions were used to assess the relative contribution of each
correlate while controlling for the others. Listwise deletion excluded any observations missing
data on any included variables. Model fit was assessed using log likelihood (LL). All analyses
were conducted in Stata MP 17.0.
Results
Sample Description (Univariate Analyses)
Table 1.1 presents the sample characteristics of SMA of all adolescents enrolled in the
baseline study (N=2,560). Adolescents in the baseline sample had a mean age of just under 16
years (mean [M] = 15.90; standard deviation [SD] = 0.97). The sample was predominately
White/Caucasian (60.57%), followed by Hispanic/Latino/Latina/Latinx (14.46%), Multi-racial
(8.48%), Black or African American (7.78%), Asian/Pacific Islander (6.41%), or Native
American/American Indian/Alaskan Native (2.31%). Nearly one-fifth of adolescents lived in
rural areas (19.73%). Most of the sample was designated female sex at birth (64.34%). Sexual
identity varied across the sample: gay (24.69%), lesbian (17.42%), bisexual (31.52%), pansexual
(11.37%), bisexual/pansexual (3.95%), complex/multiple identities (3.16%), mostly straight
(1.76%), queer (2.03%), questioning (1.64%), asexual (1.64%) or another identity (0.82%).
Of the 2,560 participants enrolled in the baseline study, 292 reported an experience of
forced sex in their life (11.41%), 487 reported past-year sexual assault by anyone (19.02%), 283

35

reported past-year sexual dating violence (11.05%), and 129 reported past-year physical dating
violence (5.04%). Participants in the baseline reported an average of 20.13 (SD = 9.89) unique
lifetime sexual minority stressors.
Table 1.1. Baseline sample characteristics (N=2,560)
Variable n %
Age* 15.90 0.97
Race/ethnicity (mutually exclusive)

White/Caucasian 1550 60.57%
Hispanic/Latino/Latina/Latinx 370 14.46%
Multi-racial 217 8.48%
Black or African American 199 7.78%
Asian/Pacific Islander 164 6.41%
Native American/American Indian/Alaskan Native 59 2.31%
Urbanicity

Urban 2055 80.27%
Rural 505 19.73%
Sex at birth

Female 1647 64.34%
Male 913 35.66%
Sexual identity

Bisexual 807 31.52%
Gay 632 24.69%
Lesbian 446 17.42%
Pansexual 291 11.37%
Bisexual/Pansexual 101 3.95%
Complex/Multiple Identities 81 3.16%
Queer 52 2.03%
Mostly Straight 45 1.76%
Questioning 42 1.64%
Asexual 42 1.64%
Another Identity 21 0.82%
Sexual identity (Collapsed)
Gay/Lesbian 1078 42.11%
Bisexual 807 31.52%
Pansexual+ 392 15.31%
Another ID 283 11.05%
Interpersonal Violence Victimization

Forced Sex (lifetime) 292 11.41%

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Sexual Assault (past year) 487 19.02%
Sexual Dating Violence (past year) 283 11.05%
Physical Dating Violence (past year) 129 5.04%
Sexual Minority Stress* 20.13 9.89
*For these variables, mean and standard deviation are presented.

Bivariate Analyses
Table 1.2 presents the bivariate associations of past-year teen dating violence
victimization (PTDVV) with sex, sexual identity, race and ethnicity, urbanicity, age, and
minority stress. More female SMA reported PTDVV than male SMA (5.82% vs 3.74%; 
2
(1) =
5.218, p=0.022). Differences by sexual identity were observed, such that gay and lesbian
identified adolescents had lower rates of PTDVV (3.83%) than bisexual adolescents (6.25%),
pansexual adolescents (6.72%), or adolescents with another sexual identity (4.24%; 
2
(3) =
8.299, p=0.040). Differences by race and ethnicity also emerged: PTDVV was reported by
4.99% of white SMA, 0.61% of Asian or Pacific Islander SMA, 4.17% of Black or African
American SMA, 8.62% of Native American, American Indian, or Alaskan Native SMA, 7.10%
of Hispanic or Latinx SMA, and 5.58% of multi-racial SMA ( 
2
(5) = 11.884, p=0.036). SMA
living in rural settings had higher rates of PTDVV (7.80%) than SMA living in urban settings
(4.41%; 
2
(1) = 9.563, p=0.002). Minority stress experiences were also associated with PTDVV:
SMA who reported PTDVV had higher minority stress scores (t=-7.212, p<0.001). No
differences were observed for PTDVV by age.
Table 1.2. Bivariate analyses of past-year physical teen dating violence victimization by sex,
sexual identity, race/ethnicity, urbanicity, age, and minority stress experiences
Variable
No, PTDVV
not reported
Yes, PTDVV
reported

n % n % 
2
Sig.
Sex at birth 5.218 p=0.022
Female 1537 94.18% 95 5.82%

37

Male 874 96.26% 34 3.74%
Sexual identity

8.299 p=0.040
Gay/Lesbian 1029 96.17% 41 3.83%

Bisexual 750 93.75% 50 6.25%

Pansexual+ 361 93.28% 26 6.72%

Another ID 271 95.76% 12 4.24%

Race/ethnicity (mutually exclusive) 11.884 p=0.036
White/Caucasian 1467 95.01% 77 4.99%
Asian/Pacific Islander 163 99.39% 1 0.61%
Black or African American 184 95.83% 8 4.17%
Native American/American Indian/
Alaska Native 53 91.38% 5 8.62%
Hispanic/Latino/Latina/Latinx 340 92.90% 26 7.10%
Multi-racial 203 94.42% 12 5.58%
Urbanicity

9.563 p=0.002
Urban 1950 95.59% 90 4.41%

Rural 461 92.20% 39 7.80%

M SD M SD t Sig.
Age 15.91 0.974 15.78 1.000 1.423 n.s.
SMASI (life) 19.78 9.772 26.21 9.856 -7.212 p<0.001
Notes: PTDVV = physical teen dating violence victimization; Sig. = significance; n.s. = not
significant; SMASI = Sexual Minority Adolescent Stress Inventory

Table 1.3 presents the bivariate associations of past-year teen dating sexual assault
(TDSA) with sex, sexual identity, race and ethnicity, urbanicity, age, and minority stress. More
female SMA reported TDSA than male SMA (13.12% vs 7.72%; 
2
(1) = 17.075, p<0.001).
Differences by sexual identity were observed, such that gay and lesbian identified adolescents
had lower rates of TDSA (8.36%) than bisexual adolescents (11.86%), pansexual adolescents
(14.55%), or adolescents with another sexual identity (15.36%; 
2
(3) = 18.231, p<0.001). SMA
living in rural settings had higher rates of TDSA (14.34%) than SMA living in urban settings
(10.40%; 
2
(1) = 6.302, p=0.012). Minority stress experiences were also associated with TDSA:
SMA who reported TDSA had higher minority stress scores (t=-7.028, p<0.001). No significant
differences were observed for TDSA by race, ethnicity, or age.

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Table 1.3. Bivariate analyses of past-year teen dating sexual assault victimization by sex, sexual
identity, race/ethnicity, urbanicity, age, and minority stress experiences
Variable
No, TDSA
not
reported
Yes, TDSA
reported

n % n % 
2
Sig.
Sex at birth 17.075 p<0.001
Female 1411 86.88% 213 13.12%
Male 837 92.28% 70 7.72%
Sexual identity

18.231 p<0.001
Gay/Lesbian 976 91.64% 89 8.36%

Bisexual 706 88.14% 95 11.86%

Pansexual+ 329 85.45% 56 14.55%

Another ID 237 84.64% 43 15.36%

Race/ethnicity (mutually exclusive) 8.462 n.s.
White/Caucasian 1353 87.97% 185 12.03%
Asian/Pacific Islander 149 91.41% 14 8.59%
Black or African American 171 89.53% 20 10.47%
Native American/American Indian/
Alaska Native 48 82.76% 10 17.24%
Hispanic/Latino/Latina/Latinx 328 89.62% 38 10.38%
Multi-racial 199 92.99% 15 7.01%
Urbanicity

6.302 p=0.012
Urban 1818 89.60% 211 10.40%

Rural 430 85.66% 72 14.34%

M SD M SD t Sig.
Age 15.89 0.979 15.95 0.946 -0.981 n.s.
SMASI (life) 19.60 9.687 23.97 10.448 -7.028 p<0.01
Notes: TDSA = teen dating sexual assault; Sig. = significance; n.s. = not significant; SMASI =
Sexual Minority Adolescent Stress Inventory

Table 1.4 presents the bivariate associations of past-year sexual assault (SA)
victimization with sex, sexual identity, race and ethnicity, urbanicity, age, and minority stress.
More female SMA reported SA than male SMA (22.75% vs 13.43%; 
2
(1) = 32.065, p<0.001).
Differences by sexual identity were observed, such that gay and lesbian identified adolescents
had lower rates of SA (14.27%) than bisexual adolescents (22.47%), pansexual adolescents
(26.30%), or adolescents with another sexual identity (20.65%; 
2
(3) = 34.553, p<0.001).

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Differences by race and ethnicity also emerged: SA was reported by 19.83% of white SMA,
9.88% of Asian or Pacific Islander SMA, 18.52% of Black or African American SMA, 31.58%
of Native American, American Indian, or Alaskan Native SMA, 18.90% of Hispanic or Latinx
SMA, and 21.60% of multi-racial SMA ( 
2
(5) = 15.808, p=0.007). Minority stress experiences
were also associated with SA: SMA who reported SA had higher minority stress scores (t=-
11.325, p<0.001). No differences were observed for SA by urbanicity or age.
Table 1.4. Bivariate analyses of past-year sexual assault victimization by sex, sexual identity,
race/ethnicity, urbanicity, age, and minority stress experiences
Variable
No, Sexual
Assault
Not Reported
Yes, Sexual
Assault
Reported

n % n % 
2
Sig.
Sex at birth 32.065 p<0.001
Female 1243 77.25% 366 22.75%
Male 780 86.57% 121 13.43%
Sexual identity

34.553 p<0.001
Gay/Lesbian 907 85.73% 151 14.27%

Bisexual 614 77.53% 178 22.47%

Pansexual+ 283 73.70% 101 26.30%

Another ID 219 79.35% 57 20.65%

Race/ethnicity (mutually exclusive) 15.808 p=0.007
White/Caucasian 1221 80.17% 302 19.83%
Asian/Pacific Islander 146 90.12% 16 9.88%
Black or African American 154 81.48% 35 18.52%
Native American/American Indian/
Alaska Native 39 68.42% 18 31.58%
Hispanic/Latino/Latina/Latinx 296 81.10% 69 18.90%
Multi-racial 167 78.40% 46 21.60%
Urbanicity

1.725 n.s.
Urban 1632 81.11% 380 18.89%

Rural 391 78.51% 107 21.49%

M SD M SD t Sig.
Age 15.91 0.975 15.89 0.971 0.292 n.s.
SMASI (life) 19.01 9.535 24.58 10.054
-
11.325 p<0.001
Notes: Sig. = significance; n.s. = not significant; SMASI = Sexual Minority Adolescent Stress
Inventory

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Table 1.5 presents the bivariate associations of lifetime experiences of physically forced
sexual intercourse (PFSI) with sex, sexual identity, race and ethnicity, urbanicity, age, and
minority stress. Differences by sexual identity were observed, such that gay and lesbian
identified adolescents had lower rates of PFSI (9.70%) than bisexual adolescents (13.86%),
pansexual adolescents (14.92%), and with similar rates as adolescents with another sexual
identity (9.45%; 
2
(3) = 12.630, p=0.006). SMA living in rural settings had higher rates of PFSI
(14.99%) than SMA living in urban settings (11.01%; 
2
(1) = 5.974, p=0.015). Age was
associated with PFSI, such that SMA who reported PFSI were older (t=-4.149, p<0.001).
Minority stress experiences were also associated with PFSI: SMA who reported PFSI had higher
minority stress scores (t=-8.956, p<0.001). No differences were observed for PFSI by sex, race
or ethnicity.
Table 1.5. Bivariate analyses of lifetime physically forced sexual intercourse by sex, sexual
identity, race/ethnicity, urbanicity, age, and minority stress experiences
Variable
No, PFSI
Not Reported
Yes, PFSI
Reported

n % n % Chi-sq Sig.
Sex at birth 3.485 n.s.
Female 1382 87.30% 201 12.70%
Male 803 89.82% 91 10.18%
Sexual identity

12.630 p=0.006
Gay/Lesbian 940 90.30% 101 9.70%

Bisexual 671 86.14% 108 13.86%

Pansexual+ 325 85.08% 57 14.92%

Another ID 249 90.55% 26 9.45%

Race/ethnicity (mutually exclusive) 9.586 n.s.
White/Caucasian 1326 88.22% 177 11.78%
Asian/Pacific Islander 152 95.00% 8 5.00%
Black or African American 169 88.95% 21 11.05%
Native American/American Indian/
Alaska Native 50 84.75% 9 15.25%

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Hispanic/Latino/Latina/Latinx 304 86.12% 49 13.88%
Multi-racial 184 87.20% 27 12.80%
Urbanicity

5.974 p=0.015
Urban 1771 88.99% 219 11.01%

Rural 414 85.01% 73 14.99%

M SD M SD t Sig.
Age 15.86 0.984 16.12 0.901 -4.149 p<0.001
SMASI (life) 19.36 9.658 24.87 10.072 -8.956 p<0.001
Notes: PFSI = physically forced sexual intercourse; Sig. = significance; n.s. = not significant;
SMASI = Sexual Minority Adolescent Stress Inventory

Multivariate Analyses
Multivariate models retaining significant bivariate correlates for each violence experience
evaluated the relative contribution of each while controlling for the others. For each experience,
full models (with all correlates) were compared to the reduced models (just retaining the
variables that were significant in bivariate analyses), and for each, the full models were not
significantly better than the more parsimonious models. Table 1.6 presents the results of the
multivariate logistic regression of past-year PTDVV. Controlling for the other constructs, sexual
identity, race/ethnicity, urbanicity and minority stress experiences remained associated with
PTDVV while sex was not. Compared to gay and lesbian SMA, bisexual SMA (adjusted odds
ratio [aOR] = 1.71; 95% CI 1.08-2.71) and pansexual SMA (aOR = 1.75; 95% CI 1.01-3.02) had
higher odds of reporting PTDVV. Relative to white/Caucasian SMA, Asian or Pacific Islander
SMA (aOR = 0.13; 95% CI 0.02-0.95) reported lower odds of past-year PTDVV. Compared to
SMA in urban settings, SMA living in rural settings (aOR = 1.87; 95% CI 1.23-2.83) reported
higher odds of past-year PTDVV. For each additional minority-specific stressor endorsed by
SMA, their odds of reporting past-year PTDVV increased by 7% (aOR = 1.07; 95% CI 1.05-
1.09).

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Table 1.6. Multivariate logistic regression of past-year physical teen dating violence
victimization. (N=2,477)
Variable aOR 95% CI Sig.
Sex at birth (Ref. Female)
Male
0.67 (0.43,1.04) n.s.
Sexual identity (Ref. Gay/Lesbian)

Bisexual
1.71 (1.08,2.71) *
Pansexual+
1.75 (1.01,3.02) *
Another ID
1.17 (0.59,2.32) n.s.
Race/ethnicity (Ref. White/Caucasian)

Asian/Pacific Islander
0.13 (0.02,0.95) *
Black or African American
0.94 (0.44,2.02) n.s.
Native American/American Indian/
Alaska Native
1.64 (0.62,4.36) n.s.
Hispanic/Latino/Latina/Latinx
1.62 (1,2.64) n.s.
Multi-racial
1.25 (0.66,2.37) n.s.
Urbanicity (Ref. Urban)

Rural
1.87 (1.23,2.83) **
SMASI (lifetime)
1.07 (1.05,1.09) ***
Constant
0.01 (0,0.02) ***
Notes: aOR = adjusted odds ratio; CI = confidence interval; Sig. = significance; Ref. =
reference group; n.s. = not significant; SMASI = Sexual Minority Adolescent Stress
Inventory. Log likelihood = -457.558.
*p<0.05; **p<0.01; ***p<0.001

Table 1.7 presents the results of the multivariate logistic regression of past-year TDSA.
Controlling for the other constructs, sex, sexual identity, urbanicity and minority stress
experiences remained associated with TDSA. Compared to female SMA, male SMA (aOR =
0.63; 95% CI 0.46-0.86) reported lower odds of TDSA. Compared to gay and lesbian SMA,
pansexual SMA (aOR = 1.66; 95% CI 1.13-2.43) had higher odds of reporting TDSA, as did
SMA of another sexual identity (aOR 1.87; 95% CI 1.23-2.83). Compared to SMA in urban
settings, SMA living in rural settings (aOR = 1.45; 95% CI 1.08-1.95) reported higher odds of
past-year TDSA. For each additional minority-specific stressor endorsed by SMA, their odds of
reporting past-year TDSA increased by 5% (aOR = 1.05; 95% CI 1.03-1.06).

43

Table 1.7. Multivariate logistic regression of past-year teen dating sexual assault
victimization. (N=2,469)
Variable aOR 95% CI Sig.
Sex at birth (Ref. Female)
Male
0.63 (0.46,0.86) **
Sexual identity (Ref. Gay/Lesbian)

Bisexual
1.34 (0.96,1.86) n.s.
Pansexual+
1.66 (1.13,2.43) **
Another ID
1.87 (1.23,2.83) **
Urbanicity (Ref. Urban)

Rural
1.45 (1.08,1.95) *
SMASI (lifetime)
1.05 (1.03,1.06) ***
Constant
0.04 (0.03,0.06) ***
Notes: aOR = adjusted odds ratio; CI = confidence interval; Sig. = significance; Ref. =
reference group; n.s. = not significant; SMASI = Sexual Minority Adolescent Stress
Inventory. Log likelihood = -824.726.
*p<0.05; **p<0.01; ***p<0.001

Table 1.8 presents the results of the multivariate logistic regression of past-year SA.
Controlling for the other constructs, sex, sexual identity, race/ethnicity, and minority stress
experiences remained associated with SA. Compared to female SMA, male SMA (aOR = 0.63;
95% CI 0.49-0.81) reported lower odds of past-year SA. Compared to gay and lesbian SMA,
bisexual SMA (aOR = 1.68; 95% CI 1.29-2.19), pansexual SMA (aOR = 2.00; 95% CI 1.46-
2.74), and SMA reporting a different sexual identity (aOR = 1.49; 95% CI 1.03-2.15) had higher
odds of reporting SA. Relative to white/Caucasian SMA, Asian or Pacific Islander SMA (aOR =
0.38; 95% CI 0.22-0.66) reported lower odds of past-year SA. For each additional minority-
specific stressor endorsed by SMA, their odds of reporting past-year SA increased by 6% (aOR =
1.06; 95% CI 1.05-1.08).
Table 1.8. Multivariate logistic regression of past-year sexual assault victimization.
(N=2,477)
Variable aOR 95% CI Sig.
Sex at birth (Ref. Female)
Male
0.63 (0.49,0.81) ***

44

Sexual identity (Ref. Gay/Lesbian)

Bisexual
1.68 (1.29,2.19) ***
Pansexual+
2.00 (1.46,2.74) ***
Another ID
1.49 (1.03,2.15) *
Race/ethnicity (Ref. White/Caucasian)

Asian/Pacific Islander
0.38 (0.22,0.66) **
Black or African American
0.81 (0.54,1.23) n.s.
Native American/American Indian/
Alaska Native
1.72 (0.93,3.18) n.s.
Hispanic/Latino/Latina/Latinx
0.90 (0.66,1.23) n.s.
Multi-racial
1.05 (0.73,1.52) n.s.
SMASI (lifetime)
1.06 (1.05,1.08) ***
Constant
0.05 (0.04,0.08) ***
Notes: aOR = adjusted odds ratio; CI = confidence interval; Sig. = significance; Ref. =
reference group; n.s. = not significant; SMASI = Sexual Minority Adolescent Stress
Inventory. Log likelihood = -1104.423.
*p<0.05; **p<0.01; ***p<0.001

Table 1.9 presents the results of the multivariate logistic regression of lifetime
experiences of PFSI. Controlling for the other constructs, sexual identity, urbanicity, age, and
minority stress experiences remained associated with lifetime PFSI. Compared to gay and
lesbian SMA, bisexual SMA (aOR = 1.71; 95% CI 1.26-2.31) had higher odds of reporting
lifetime PFSI, as did pansexual SMA (aOR 1.85; 95% CI 1.28-2.66). Compared to SMA in urban
settings, SMA living in rural settings (aOR = 1.44; 95% CI 1.07-1.94) reported higher odds of
lifetime PFSI. For one year increase in age, SMA were 41% higher odds (aOR = 1.41; 95% CI
1.22-1.62) of reporting an experience of PFSI in their life. For each additional minority-specific
stressor endorsed by SMA, their odds of reporting PFSI increased by 6% (aOR = 1.06; 95% CI
1.05-1.07).
Table 1.9. Multivariate logistic regression of lifetime physically forced sexual intercourse.
(N=2,418)
Variable aOR 95% CI Sig.
Sexual identity (Ref. Gay/Lesbian)

Bisexual
1.71 (1.26,2.31) **

45

Pansexual+
1.85 (1.28,2.66) **
Another ID
1.04 (0.65,1.68) n.s.
Urbanicity (Ref. Urban)

Rural
1.44 (1.07,1.94) *
Age
1.41 (1.22,1.62) ***
SMASI (lifetime)
1.06 (1.05,1.07) ***
Constant
0 (0,0) ***
Notes: aOR = adjusted odds ratio; CI = confidence interval; Sig. = significance; Ref. =
reference group; n.s. = not significant; SMASI = Sexual Minority Adolescent Stress
Inventory. Log likelihood = -810.805.
*p<0.05; **p<0.01; ***p<0.001

Discussion
This study sought to extend previous research that identified elevated rates of IPVV
among SMA (Basile et al., 2020; Holguin et al., 2018; Kann et al., 2018; Rusow, 2018; Rusow et
al., 2019; Rusow, Holguin, et al., 2018; Rusow, Srivastava, et al., 2018; Rusow & Srivastava,
2019). Specifically, we looked within a large national sample of SMA for differences in reports
of IPVV by age, sex, sexual identity, race/ethnicity, urbanicity, and in association with minority
stress experiences. Major findings include the lack of association of age with some IPVV
experiences, finding no difference between females and males for PFSI or PTDVV, and
statistically significant differences by sexual identity and differences by urbanicity.
We found that age was not significantly associated with past-year physical or sexual teen
dating violence, nor was it associated with sexual assault. This somewhat conflicts with previous
research that shows increasing rates of IPVV through adolescence into young adulthood before
plateauing and dropping off (Johnson et al., 2015). It could be that in our sample, the age range
was too narrow to identify differences. We did, however, see significant differences in
experiences of lifetime PFSI such that older SMA were more likely to report having had such
experiences. This is perhaps unsurprising, as older SMA are more likely to have any sexual

46

experience (Kann et al., 2018), and given that it was a lifetime measure, were alive longer to
have any experience that might be assessed. Age remained a significant correlate of PFSI when
controlling for sexual identity, urbanicity, and minority stress experiences.
Differences by sex were observed for past-year PTDVV, past-year TDSA, and past-year
sexual assault, but interestingly, not for lifetime PFSI. This is consistent with studies that show
female SMA reporting higher lifetime rates of physical dating violence (Martin-Storey, 2015;
Reuter et al., 2017), and past-year sexual dating violence (Olsen et al., 2020). These sex
differences are consistent with populations of heterosexual adolescents as well (Kann et al.,
2018). The finding of no sex difference for males and females for lifetime forced intercourse
runs counter to this narrative—SMA males are much more likely to report forced intercourse
victimization than heterosexual male adolescents (Caputi et al., 2020), and report rates similar to
female adolescents, generally. Additionally, when controlling for sexual identity, race/ethnicity,
urbanicity and minority stress, the association between sex and PTDVV went away. Significant
associations remained in comprehensive models of sexual dating violence and sexual assault.
Our assessment of sexual identity showed differences across identities for all types of
IPVV assessed. For past-year PTDVV, bisexual and pansexual SMA reported higher rates than
gay and lesbian or SMA of another identity. This pattern shifted slightly for past-year TDSA and
past-year sexual assault, where bisexual, pansexual, and other sexual identity SMA all reported
higher rates than gay and lesbian SMA. This could be somewhat due to adolescents endorsing
both questions (i.e., dating sexual assault and general sexual assault) for the same experience.
For lifetime PFSI, bisexual and pansexual SMA reported higher rates than gay/lesbian SMA or
SMA of another sexual identity. In multivariate models controlling other variables, these
findings remained mostly consistent. Compared to gay and lesbian SMA, bisexual SMA had

47

higher odds of past-year PTDVV, TDSA, and lifetime PFSI, but not past-year sexual assault.
Pansexual SMA had the highest odds of all sexual identities assessed, for all four violence
experiences. Relative to gay and lesbian SMA, SMA of another sexual identity had higher odds
of TDSA and past-year sexual assault. These findings corroborate the work of Caputi and
colleagues (2020) who found elevated rates of victimization among bisexual adolescents, and
extends those findings to pansexual SMA and SMA of other sexual identities.
Differences by race and ethnicity were found for PTDVV and past-year sexual assault,
but not for TDSA or PFSI. Relative to white/Caucasian SMA (the largest racial group in the
sample), Asian/Pacific Islander SMA had lower odds of reporting PTDVV or past-year sexual
assault. No other differences were observed in the multivariate models controlling for other
variables. These results are contrary to that of Whitton and colleagues (2019) who found
elevated rates of IPVV among ethnic minority youth, but are in line with recent national
probability samples that just looked at differences between non-Hispanic white, non-Hispanic
Black, and Hispanic/Latinx youth (Basile et al., 2020). In bivariate models considering only
race/ethnicity and IPVV, Native American SMA exhibited the highest proportions of each of the
four IPVV experiences. It may be that the relatively small number of non-white SMA made
difficult the ability to identify any significant differences. Future studies may want to increase
the number of non-white SMA, especially Native American, American Indian, and Alaskan
Native SMA who may be at elevated risk of IPVV.
Adolescents in rural settings reported higher rates of past-year physical and sexual dating
violence victimization and lifetime PFSI than SMA in urban settings. These findings all held in
multivariate models, controlling for the other significant variables. This may be related to a lack
of resources available in rural communities, or fear of being “outed” for accessing available

48

services (Birkett et al., 2009). Finally, minority stressors were associated with all four forms of
IPVV assessed, before and after controlling for other variables. SMA who reported IPVV
experiences had, on average, higher levels of minority stress, and likewise, in multivariate
models, increased minority stress was associated with higher odds of each of the IPVV
experiences. This finding suggests that environments where stigma against and discrimination of
SMA occurs is also conducive to experiences of IPVV. An alternative may be that survivors of
IPVV are more susceptible to or sensitive to recognizing minority stress experiences. Future
work should consider the timing of events to see if IPVV of minority stress more often precede
each other or occur in tandem.
Limitations
This study is not without limitations. Our focus on cisgender youth does not capture the
disparities experienced by transgender, nonbinary, and gender expansive adolescents (Srivastava
et al., 2021). Recruiting online has both advantages and disadvantages. We were able to reach a
large sample of SMA, in both rural and urban settings, throughout the United States. Given the
non-random sampling method used, there are concerns about generalizability of the study
findings to all SMA. Similarly, although the sample is similar to national probability samples
regarding race and ethnicity (Kann et al., 2018), white SMA and females were over-represented
in the sample, potentially skewing the results. Confidential—and potentially anonymous—
internet research has validity concerns including duplicate or fraudulent participants. Our
rigorous study protocols helped to mitigate these concerns through a thorough examination of
response patterns and survey metadata. Although data were self-report, which inherently carries
the potential for response bias, participants were informed that their responses would be
completely separate from their contact information (required to administer a virtual gift card),

49

reducing response bias. Finally, the cross-sectional nature of this analysis prevents causal
inference. Given the lack of research about IPVV among these subgroupings in the extant
research literature, these baseline associations increase our understanding of differential rates of
IPVV and their relation to other victimization experiences like minority stress.
Conclusions
For preventionists and interventionists, this work highlights several important
considerations. Although previous studies have shown elevated rates of IPVV among SMA
relative to heterosexual adolescents (Basile et al., 2020; Holguin et al., 2018; Kann et al., 2018;
Rusow, 2018; Rusow et al., 2019; Rusow, Holguin, et al., 2018; Rusow, Srivastava, et al., 2018;
Rusow & Srivastava, 2019), this work shows that even within SMA, several important subgroup
differences exist. The differences that emerged for age, sex, sexual identity, urbanicity and
minority stress experiences highlight the need for multiple, targeted intervention and prevention
strategies. Particularly, interventions developed for monosexual SMA (i.e., gay and lesbian
SMA) may not be appropriate for bisexual or pansexual SMA, who already show elevated risk.
Further, interventions that purport to be dedicated to them but minimize or exclude their actual
identity might be, to the adolescent, a discriminating minority stress experience that increases
their risk for other negative outcomes even more. Likewise, interventions should be sensitive to
the needs of SMA in rural settings, who exhibit higher rates and risk of IPVV than their peers in
urban settings. Further investigation of the relation between minority stress and experiences of
IPVV could highlight the best ways to integrate both kinds of negative experience.

50

References
Balsam, K. F. (2001). Nowhere to Hide. Women & Therapy, 23(3), 25–37.
https://doi.org/10.1300/J015v23n03_03
Balsam, K. F., & Szymanski, D. M. (2005). Relationship Quality and Domestic Violence in
Women’s Same-Sex Relationships: The Role of Minority Stress. Psychology of Women
Quarterly, 29(3), 258–269. https://doi.org/10.1111/j.1471-6402.2005.00220.x
Basile, K. C., Clayton, H. B., DeGue, S., Gilford, J. W., Vagi, K. J., Suarez, N. A., Zwald, M. L.,
& Lowry, R. (2020). Interpersonal Violence Victimization Among High School
Students—Youth Risk Behavior Survey, United States, 2019. MMWR Supplements,
69(1), 28–37. https://doi.org/10.15585/mmwr.su6901a4
Binion, K., & Gray, M. J. (2020). Minority Stress Theory and Internalized Homophobia among
LGB Sexual Assault Survivors: Implications for Posttraumatic Adjustment. Journal of
Loss and Trauma, 25(5), 454–471. https://doi.org/10.1080/15325024.2019.1707987
Birkett, M., Espelage, D. L., & Koenig, B. (2009). LGB and Questioning Students in Schools:
The Moderating Effects of Homophobic Bullying and School Climate on Negative
Outcomes. Journal of Youth and Adolescence, 38(7), 989–1000.
https://doi.org/10.1007/s10964-008-9389-1
Brown, G. W., & Harris, T. (1978). Social Origins of Depression: A study of psychiatric disorder
in women. The Free Press, A Division of Macmillan Publishing Company, Inc.
Caputi, T. L., Shover, C. L., & Watson, R. J. (2020). Physical and Sexual Violence Among Gay,
Lesbian, Bisexual, and Questioning Adolescents. JAMA Pediatrics, 174(8), 791.
https://doi.org/10.1001/jamapediatrics.2019.6291

51

Centers for Disease Control and Prevention. (2021, March 16). Preventing Teen Dating
Violence. Preventing Teen Dating Violence.
https://www.cdc.gov/violenceprevention/intimatepartnerviolence/teendatingviolence/fastf
act.html
Dank, M., Lachman, P., Zweig, J. M., & Yahner, J. (2014). Dating Violence Experiences of
Lesbian, Gay, Bisexual, and Transgender Youth. Journal of Youth and Adolescence,
43(5), 846–857. https://doi.org/10.1007/s10964-013-9975-8
Finneran, C., & Stephenson, R. (2014). Intimate Partner Violence, Minority Stress, and Sexual
Risk-Taking Among U.S. Men Who Have Sex With Men. Journal of Homosexuality,
61(2), 288–306. https://doi.org/10.1080/00918369.2013.839911
Freedner, N., Freed, L. H., Yang, Y. W., & Austin, S. B. (2002). Dating violence among gay,
lesbian, and bisexual adolescents: Results from a community survey. Journal of
Adolescent Health, 31(6), 469–474. https://doi.org/10.1016/S1054-139X(02)00407-X
Goldbach, J. T., & Gibbs, J. J. (2017). A developmentally informed adaptation of minority stress
for sexual minority adolescents. Journal of Adolescence, 55, 36–50.
https://doi.org/10.1016/j.adolescence.2016.12.007
Goldbach, J. T., Schrager, S. M., Dunlap, S. L., & Holloway, I. W. (2015). The Application of
Minority Stress Theory to Marijuana Use Among Sexual Minority Adolescents.
Substance Use & Misuse, 50(3), 366–375.
https://doi.org/10.3109/10826084.2014.980958
Goldbach, J. T., Schrager, S. M., & Mamey, M. R. (2017). Criterion and divergent validity of the
sexual minority adolescent stress inventory. Frontiers in Psychology, 8, 2057.
https://doi.org/10.3389/fpsyg.2017.02057

52

Goldbach, J. T., Tanner-Smith, E. E., Bagwell, M., & Dunlap, S. (2014). Minority Stress and
Substance Use in Sexual Minority Adolescents: A Meta-analysis. Prevention Science,
15(3), 350–363. https://doi.org/10.1007/s11121-013-0393-7
Halpern, C. T., Spriggs, A. L., Martin, S. L., & Kupper, L. L. (2009). Patterns of Intimate Partner
Violence Victimization from Adolescence to Young Adulthood in a Nationally
Representative Sample. Journal of Adolescent Health, 45(5), 508–516.
https://doi.org/10.1016/j.jadohealth.2009.03.011
Holguin, M., Rusow, J., & Srivastava, A. (2018, November). History of sexual assault is
associated with condomless sex and sex under the influence among high school youth in
the United States [Poster]. American Public Health Association 2018 Annual Meeting &
Expo, San Diego, CA.
Johnson, W. L., Manning, W. D., Giordano, P. C., & Longmore, M. A. (2015). Relationship
Context and Intimate Partner Violence From Adolescence to Young Adulthood. Journal
of Adolescent Health, 57(6), 631–636. https://doi.org/10.1016/j.jadohealth.2015.08.014
Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Queen, B., Lowry, R.,
Chyen, D., Whittle, L., & Thornton, J. (2018). Youth risk behavior surveillance—United
States, 2017. MMWR Surveillance Summaries, 67(8), 1–114.
https://doi.org/10.15585/mmwr.ss6708a1
Martin-Storey, A. (2015). Prevalence of Dating Violence Among Sexual Minority Youth:
Variation Across Gender, Sexual Minority Identity and Gender of Sexual Partners.
Journal of Youth and Adolescence, 44(1), 211–224. https://doi.org/10.1007/s10964-013-
0089-0

53

McLaughlin, K. A., Hatzenbuehler, M. L., Xuan, Z., & Conron, K. J. (2012). Disproportionate
exposure to early-life adversity and sexual orientation disparities in psychiatric
morbidity. Child Abuse & Neglect, 36(9), 645–655.
https://doi.org/10.1016/j.chiabu.2012.07.004
Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social
Behavior, 36(1), 38–56. https://doi.org/10.2307/2137286
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual
populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5),
674–697. https://doi.org/10.1037/0033-2909.129.5.674
Olsen, E. O., Vivolo-Kantor, A., & Kann, L. (2020). Physical and Sexual Teen Dating Violence
Victimization and Sexual Identity Among U.S. High School Students, 2015. Journal of
Interpersonal Violence, 35(17–18), 3581–3600.
https://doi.org/10.1177/0886260517708757
Relyea, M., & Ullman, S. E. (2015). Unsupported or Turned Against: Understanding How Two
Types of Negative Social Reactions to Sexual Assault Relate to Postassault Outcomes.
Psychology of Women Quarterly, 39(1), 37–52.
https://doi.org/10.1177/0361684313512610
Reuter, T. R., Newcomb, M. E., Whitton, S. W., & Mustanski, B. (2017). Intimate partner
violence victimization in LGBT young adults: Demographic differences and associations
with health behaviors. Psychology of Violence, 7(1), 101–109.
https://doi.org/10.1037/vio0000031
Reuter, T. R., Sharp, C., Link to external site, this link will open in a new window, Temple, J.
R., Babcock, J. C., & Link to external site, this link will open in a new window. (2015).

54

The relation between borderline personality disorder features and teen dating violence.
Psychology of Violence, 5(2), 163–173.
http://dx.doi.org.libproxy2.usc.edu/10.1037/a0037891
Rice, E., Barman-Adhikari, A., Rhoades, H., Winetrobe, H., Fulginiti, A., Astor, R., Montoya, J.,
Plant, A., & Kordic, T. (2013). Homelessness experiences, sexual orientation, and sexual
risk taking among high school students in Los Angeles. Journal of Adolescent Health,
52(6), 773–778. https://doi.org/10.1016/j.jadohealth.2012.11.011
Rosario, M., Schrimshaw, E. W., Hunter, J., & Gwadz, M. (2002). Gay-related stress and
emotional distress among gay, lesbian and bisexual youths: A longitudinal examination.
Journal of Consulting and Clinical Psychology, 70(4), 967–975.
https://doi.org/10.1037/0022-006X.70.4.967
Rusow, J. (2018, November). Sexual assault and teen dating violence are associated with sex
under the influence and condomless sex among LGBQ high school adolescents in the
U.S. [Paper]. The Society for the Scientific Study of Sexuality, 2018 Annual Meeting,
Montreal, Quebec, Canada.
Rusow, J., Holguin, M., & Srivastava, A. (2018, November). Sexual identity and sexual risk
among adolescents in the United States who have experienced physical or sexual teen
dating violence [Paper]. American Public Health Association 2018 Annual Meeting &
Expo, San Diego, CA.
Rusow, J., Mendon, S., & Srivastava, A. (2019, January). Intimate violence and suicide attempt
among lesbian, gay, bisexual, and questioning adolescents in the United States [Paper].
Society for Social Work and Research 23rd Annual Conference, San Francisco, CA.

55

Rusow, J., & Srivastava, A. (2019, January). Lifetime sexual assault, teen dating violence
victimization, and LGBQ-identity are associated with condomless sex and sex under the
influence among high school adolescents in the United States [Poster]. Society for Social
Work and Research 23rd Annual Conference, San Francisco, CA.
Rusow, J., Srivastava, A., Rhoades, H., & Goldbach, J. (2018, November). Suicide attempt and
violent experiences among lesbian, gay, bisexual, and questioning adolescents in the
United States [Paper]. American Public Health Association 2018 Annual Meeting &
Expo, San Diego, CA.
Russell, S. T., Franz, B. T., & Driscoll, A. K. (2001). Same-sex romantic attraction and
experiences of violence in adolescence. American Journal of Public Health, 91(6), 903.
Schrager, S. M., Goldbach, J. T., & Mamey, M. R. (2018). Development of the Sexual Minority
Adolescent Stress Inventory. Frontiers in Psychology, 9, 319.
https://doi.org/10.3389/fpsyg.2018.00319
Silverman, J. G., Raj, A., Mucci, L. A., & Hathaway, J. E. (2001). Dating violence against
adolescent girls and associated substance use, unhealthy weight control, sexual risk
behavior, pregnancy, and suicidality. JAMA, 286(5), 572–579.
Srivastava, A., Rusow, J. A., & Goldbach, J. T. (2021). Differential risks for suicidality and
mental health symptoms among transgender, nonbinary, and cisgender sexual minority
youth accessing crisis services. Transgender Health, 6(1), 51–56.
Temple, J. R., & Freeman Jr, D. H. (2011). Dating violence and substance use among ethnically
diverse adolescents. Journal of Interpersonal Violence, 26(4), 701–718.
USDA ERS - Rural-Urban Commuting Area Codes. (n.d.). Retrieved April 16, 2021, from
https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes.aspx

56

Whitton, S. W., Newcomb, M. E., Messinger, A. M., Byck, G., & Mustanski, B. (2019). A
longitudinal study of IPV victimization among sexual minority youth. Journal of
Interpersonal Violence, 34(5), 912–945. https://doi.org/10.1177/0886260516646093
Wolitzky-Taylor, K. B., Ruggiero, K. J., Danielson, C. K., Resnick, H. S., Hanson, R. F., Smith,
D. W., Saunders, B. E., & Kilpatrick, D. G. (2008). Prevalence and correlates of dating
violence in a national sample of adolescents. Journal of the American Academy of Child
& Adolescent Psychiatry, 47(7), 755–762.
Zweig, J. M., Dank, M., Yahner, J., & Lachman, P. (2013). The Rate of Cyber Dating Abuse
Among Teens and How It Relates to Other Forms of Teen Dating Violence. Journal of
Youth and Adolescence, 42(7), 1063–1077. https://doi.org/10.1007/s10964-013-9922-8

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Chapter 3: Prospective correlates of future interpersonal violence victimization among
sexual minority adolescents in the United States
Interpersonal violence victimization is a public health crisis and SMA bear
disproportionate burden. This paper identifies the relative prospective contribution of identity
characteristics (age, sex, sexual identity, race and ethnicity), urbanicity, mental health
symptomology (depressive, anxiety, and posttraumatic symptoms) and minority stress on each of
four IPVV experiences among SMA at a later time, accounting for previous violence
victimization. Previous research has examined some of these identity characteristics, in smaller
samples of SMA or larger samples that include heterosexual young adults, but this is the first
study of this size, of just SMA, and of this age range (14 to 17 years old at baseline) in assessing
future reports of IPVV. Recent minority stress, posttraumatic stress symptoms, and past-year
physical dating violence were prospectively associated with physical teen dating violence
victimization at a later time. Sex, recent minority stress experience, and past-year teen dating
sexual assault victimization were prospectively associated with teen dating sexual assault
victimization at a later time. Sexual identity, recent minority stress experience, posttraumatic
stress symptoms, and past-year sexual assault victimization were prospectively associated with
sexual assault victimization at a later time. Sexual identity and past lifetime physically forced
sexual intercourse were prospectively associated with physically forced sexual intercourse at a
later time. Past violence victimization and minority stress experiences—which are not routinely
assessed—are associated with future experiences of IPVV, thus helping professionals should
inquire about experiences of violence and stress for violence prevention.
Introduction

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Sexual minority adolescents (SMA; i.e. not 100% heterosexual, ages 13-17) experience
elevated rates of interpersonal violence victimization (IPVV) than their heterosexual peers
(Basile et al., 2020; Holguin et al., 2018; Kann et al., 2018; Rusow, 2018; Rusow et al., 2019;
Rusow, Holguin, et al., 2018; Rusow, Srivastava, et al., 2018; Rusow & Srivastava, 2019). IPVV
is a national public health crisis on its own (Basile et al., 2020), and has been associated with
comorbid health consequences including suicidality, substance use, depression, anxiety, sexual
risk behaviors (Holguin et al., 2018; Rusow, 2018; Rusow et al., 2019; Rusow, Holguin, et al.,
2018; Rusow, Srivastava, et al., 2018; Rusow & Srivastava, 2019), and homelessness (Kann et
al., 2018; Rice et al., 2013; Silverman et al., 2001; Temple & Freeman Jr, 2011; Wolitzky-Taylor
et al., 2008). Given the associations between IPVV and other deleterious health outcomes and
the increased likelihood for repetition across the lifetime, IPVV in adolescence is particularly
troubling (Centers for Disease Control and Prevention, 2021). Understanding which
characteristics and comorbidities are associated with later reports IPVV would assist
preventionists and interventionists in identifying potential intervention targets or vulnerable
populations on which to focus efforts. This study assesses the relationships between age, sex,
sexual identity, race and ethnicity, urbanicity, recent minority stress experiences, mental health
symptomology, and previous violence victimization with reports of IPVV outcomes at a later
time.
Counselors, social workers, and other front-line mental health and crisis interventionists
frequently come into contact with SMA who may be referred to them for multiple reasons (Roe,
2013), including minority stress experiences (e.g., bias-based victimization), mental health
symptoms of depression, anxiety, or posttraumatic stress, or after experiences of IPVV. It’s
important for such practitioners to understand how these experiences may be related to future

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experiences of IPVV. Given that IPVV is associated with sundry behavioral health concerns
(Holguin et al., 2018; Kann et al., 2018; Rice et al., 2013; Rusow, 2018; Rusow et al., 2019;
Rusow, Holguin, et al., 2018; Rusow, Srivastava, et al., 2018; Rusow & Srivastava, 2019;
Silverman et al., 2001; Temple & Freeman Jr, 2011; Wolitzky-Taylor et al., 2008), efforts must
be taken to recognize risk and intervene whenever possible. Particularly, given that sexual
identity or victimization experiences are not readily apparent, clinicians should be prepared to
assess for and nonjudgmentally receive that information (Roe, 2013).
Interpersonal violence victimization (IPVV) among adolescents is a public health crisis in
the United States, with numerous consequences (Basile et al., 2020). Dating violence, sexual
assault, and forced intercourse (i.e., rape) are violent experiences that can disrupt development
and propagate poor health among young people. The Centers for Disease Control and Prevention
(CDC) identify interpersonal violence as particularly problematic for youth and adolescents
given that violence can reoccur across the lifespan and is associated with multiple other
behavioral health concerns (Centers for Disease Control and Prevention, 2021). Primary
prevention—preventing IPVV incidence—and secondary prevention—addressing the immediate
consequences of IPVV—among adolescents should be a priority for school counselors and social
workers who are primely placed to intervene with youth at risk of IPVV. In representative
national estimates of high school students in the United States, 8.2% of adolescents reported
past-year physical dating violence victimization, 8.2% reported past-year sexual dating violence
victimization, and 5.4% reported past-year sexual violence by someone other than a partner
(Basile et al., 2020). Overall, in their nationally representative study of high school students,
around one in eight students reported any kind of dating violence victimization (Basile et al.,
2020).

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Extant literature highlights the disproportionate burden of all forms of IPVV on sexual
minority adolescents (SMA; i.e. not 100% heterosexual, ages 13-17) relative to their
heterosexual peers (Basile et al., 2020; Holguin et al., 2018; Kann et al., 2018; Rusow, 2018;
Rusow et al., 2019; Rusow, Holguin, et al., 2018; Rusow, Srivastava, et al., 2018; Rusow &
Srivastava, 2019). U.S. probability studies suggest wide disparities in the prevalence of IPVV by
sexual identity among high school students in both recent and lifetime dating violence (Freedner
et al., 2002; Kann et al., 2018; McLaughlin et al., 2012; Reuter et al., 2015), with psychological
victimization rates as high as 59% among SMA (Dank et al., 2014), physical dating violence
ranging from 17% to 89% (Dank et al., 2014; McLaughlin et al., 2012; Zweig et al., 2013), and
sexual dating violence ranging from 23% to 61% (Dank et al., 2014; Zweig et al., 2013). While
7.2% of heterosexual high school students reported past-year physical dating violence, 13.1% of
SMA and 16.9% of unsure students reported past-year physical dating violence. Compared to
6.7% of heterosexual high school students reported sexual dating violence, the prevalence was
higher among SMA (16.4%) and unsure students (15.0%). Similarly, for past-year sexual
violence by anyone, SMA (21.5%) and unsure students (16.2%) reported higher rates than
heterosexual students (9.0%). In a nationwide probability sample of study of high school
students, SMA were nearly three times as likely to experience sexual or physical dating violence
and four times more likely to experience rape than their heterosexual peers (Kann et al., 2018).
SMA are clearly a population deserving of extra attention for violence victimization prevention.
Subgroups of SMA may differentially experience interpersonal violence victimization.
Whether racial and ethnic, gender identity, sexual identity, or urban-rural differences exist in
violence victimization experiences among SMA remains largely unknown. Knowing when,
where, and to whom to direct limited resources would be useful information for interventionists

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with limited time and heavy caseloads. In studies of dating violence victimization, male-
identified participants reported lower lifetime rates of verbal and physical dating violence
(Martin-Storey, 2015; Reuter et al., 2017), and lower rates of past-year sexual dating violence
than female-identified participants (Olsen et al., 2020). A recent analysis of a national study
using a probability sample of adolescents found that SMA had higher adjusted risk ratios (aRR)
for physical dating violence (aRR=1.97) and sexual assault by anyone (aRR=2.10) in the past
year (Caputi et al., 2020) compared to their heterosexual peers. Bisexual youth were particularly
at risk for physical dating violence (aRR=2.22) and sexual violence by anyone (aRR=2.36)
within the last year. Additionally, male SMA were increasingly vulnerable to sexual assault
(aRR=4.64) and forced intercourse (aRR=4.70) compared to heterosexually-identified male
adolescents (Caputi et al., 2020).
Conflicting research exists on whether race and ethnicity are associated with risk for
interpersonal violence victimization. One recent study of an ethnically diverse community-based
regional sample of lesbian, gay, bisexual and transgender (LGBT) youth (ages 16-25) showed
elevated rates of physical dating violence victimization among ethnic minority youth compared
to White youth (Whitton et al., 2019). However, the most recent administration of the Youth
Risk Behavior Survey (YRBS)—a nationwide probability sample of high school students
throughout the United States—showed no significant difference between non-Hispanic white,
non-Hispanic Black, and Hispanic students in regard to physical dating violence or sexual
violence by anyone in the past year (Basile et al., 2020).
SMA in rural communities may experience different challenges compared to their urban
peers. For example, we know that stigma and fear of being “outed” may prevent them from
accessing local LGBT serving organizations, or services offered in schools or health care

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facilities (Birkett et al., 2009), but almost nothing is known about the interpersonal violence
victimization experiences of this nearly 20% of the U.S. population. If differences do indeed
exist, practitioners in different localities may need to tailor their approaches for these youth who
are having difference experiences, or experience similar things, differently.
Interpersonal Violence Victimization and other Health Concerns.
Although violence victimization is a public health crisis on its own, IPVV is also
associated with numerous other behavioral health concerns that are also the focus of
preventionists. Addressing IPVV among youth is critical, as IPVV is associated with suicidality,
substance use, depression, anxiety, sexual risk behaviors (Holguin et al., 2018; Rusow, 2018;
Rusow et al., 2019; Rusow, Holguin, et al., 2018; Rusow, Srivastava, et al., 2018; Rusow &
Srivastava, 2019), and homelessness (Kann et al., 2018; Rice et al., 2013; Silverman et al., 2001;
Temple & Freeman Jr, 2011; Wolitzky-Taylor et al., 2008). Furthermore, these same health
concerns have been identified as elevated disparities among SMA—SMA experience higher
rates of these behavioral health concerns that are also associated with IPVV.
Mental health symptomology. SMA report higher levels of depression (Marshal et al.,
2011), anxiety (Hatzenbuehler et al., 2008) and posttraumatic stress (Dragowski et al., 2011). In
their 2011 meta-analysis, Marshal and colleagues also documented increased depression among
SMA. In a longitudinal study using a community sample of middle school students, those who
reported same-sex attraction reported higher anxiety than those who did not report same-sex
attraction (Hatzenbuehler et al., 2008). Posttraumatic stress among SMA has been linked to
internalized homophobia and bias-based victimization wherein SMA are verbally or physically
abused because of their sexual orientation or gender atypicality (Dragowski et al., 2011).

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Depression, anxiety, and posttraumatic stress are also associated with IPVV. Among
adult women, Devries and colleagues (2013) demonstrate in their systematic review of
longitudinal studies a bidirectional association between intimate partner violence and depressive
symptoms, where either depression or partner violence at an earlier wave is associated with the
other at a later wave. A recent meta-analysis found that anxiety was a significant risk marker for
IPVV among men and women (Spencer et al., 2019). Given the intimate and violent nature of
sexual assault, the connection between sexual assault and PTSD has been long established
(Davidson et al., 1996). A recent meta-analysis corroborates the importance of these mental
health factors as significant correlates of IPVV (Spencer et al., 2019).
Minority Stress Theory as an Explanation of Minority Health Disparities.
Minority stress theory. In general, stress theory identifies the amassing of chronic and
acute stressors as limits on an individual’s ability to adapt, adjust, and tolerate additional life
stress experiences (Brown & Harris, 1978). The primary framework for understanding stress and
disparities among SMA is minority stress theory (MST), which has been recognized by the
National Academy of Medicine, Centers for Disease Control and Prevention, and Healthy People
2030. In his landmark paper, Meyer (1995) explicates the relation between multiple social and
psychological stressors for sexual minority populations. MST posits that structural homophobia
is the primary driver of violence, discrimination, and victimization of SMA, leading to
behavioral health disparities (Goldbach et al., 2014, 2015; Meyer, 2003; Russell et al., 2001).
Prejudice, and discrimination and stigma that can be attributed to sexual minority identity create
unique minority stressors (Meyer, 2003). Specific stressors include negative attitudes or
discomfort toward sexual minorities, and negative or discriminatory events (Rosario et al., 2002).
These minority-based stressors are associated with behavioral and mental health outcomes for

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sexual minority individuals (Goldbach et al., 2014, 2015; Rosario et al., 2002). Minority
stressors are unique stress experiences that only apply to minority populations and are in addition
to the occurrence of general stressors which apply to everyone. Given the cumulative effects of
stress, it stands to reason that populations with unique additional stressors are likely to have
additional negative health outcomes. Inasmuch as stress leads to poorer health, additional
stressors might contribute to poorer health among minority populations and explain health
disparities endured by such populations.
Importantly, minority stress theory has been extended and adapted to sexual minority
adolescents (Goldbach & Gibbs, 2017). Minority adolescents are exposed to three types of
minority stressors. The first are general stressors that may be attributed to their minority identity.
For example, any adolescent might feel stress from being “left out” of a social situation,
however, it would be a minority stressor if an adolescent perceives being excluded due to their
sexual minority identity. The other two stressors are minority-specific distal and proximal
stressors (Goldbach & Gibbs, 2017; Meyer, 2003). Stress experiences exist on a continuum from
distal—which are external to the individual and therefore more objective—to proximal, which
are more subjective and may involve the internalization of social attitudes toward sexual
minority people, or expectations about the response of others. For example, the expectation of
how someone might respond to an SMA “coming out” as a sexual minority is related to their
subjective internalization of their own past experiences or their understanding of the experiences
of others.
All three types of minority-specific stressors are relevant when considering experiences
of IPVV. Experiencing IPVV may be all the more stressful if adolescents attribute the violence
to their sexual identity. Similarly, proximal stressors (internal to the person) like internalized

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homophobia, concealment, or expectations of rejection based on their sexual identity may place
adolescents at risk for IPVV or prevent them from seeking support after an IPVV experience.
Distal stressors (in the environment), like other bias-based violence or discrimination might work
to normalize violence or cause adolescents to de-value their IPVV experiences. Importantly,
types of stressors are interrelated, such that expectations of rejection (proximal) may reduce both
exposure to victimization or social support and may have been caused by a negative disclosure
experience (distal).
Minority stress and IPVV. In the absence of research on the likely association between
minority stress and IPVV among SMA, we turn to work that has been done with adult sexual
minority populations. Balsam and colleagues, for example, have been looking at the role of
minority stress in relation to partner violence among sexual minority women for decades
(Balsam, 2001; Balsam & Szymanski, 2005). Their work identified associations between dating
violence victimization and minority stressors of discrimination and internalized homonegativity
(Balsam & Szymanski, 2005). These findings were mirrored in a study of sexual minority men
(Finneran & Stephenson, 2014). Internalized homophobia, in particular, has been linked to
sexual assault (Finneran & Stephenson, 2014), and relationship violence persistence (Balsam &
Szymanski, 2005). A recent review highlighted the role that internalized homophobia has on
reducing sexual assault disclosure—which thus limits access to recovery resources—among
sexual minority individuals (Binion & Gray, 2020).
In reporting a victimization experience, SMA have to navigate multiple layers of
disclosure, and the response received can additionally impact the survivor’s health trajectory
(Relyea & Ullman, 2015). Practitioners must be open and prepared to receive information on
both adolescent sexual identity and history of victimization, otherwise they may further

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contribute to the adolescent’s stress and victimization history. One recent longitudinal study of a
community-based convenience sample of 248 LGBT youth (ages 16-20 years at baseline)
investigated the link between LGBT discrimination and IPVV (Whitton et al., 2019) and found
that LGBT discrimination—one facet of minority stress—was associated with increased reports
of sexual dating violence, but not physical dating violence. While that work was beneficial in
highlighting the link between a part of minority stress theory and dating violence, we stand to
learn from a more thorough examination of minority stress constructs among a larger, non-
region-specific sample of SMA. Given that SMA are a diverse and vulnerable population, are
exposed to disproportionate amounts of interpersonal violence victimization, are subject to
unique sexual minority stressors, and have an increased burden of mental health symptomology,
it is concerning that no study has investigated these constructs concurrently. This study brings
these prospective correlates together to assess their relative association with later IPVV
experiences while accounting for past experiences. We hypothesize that there will be differences
in future IPVV reporting for some—if not all—prospective correlates. This is the first study to
test them all concurrently.
Methods
Overview.
This paper explores the relative contribution of identity characteristics (age, sex at birth,
sexual identity, race and ethnicity, urbanicity), recent minority stress experiences, recent mental
health symptomology, and experience of IPVV on the occurrence of violence victimization 6 to
18 months later. This study employs data from the first four waves of a prospective study of
SMA (1R01MD012252; Co-PI: Goldbach & Schrager). The study design and protocols were
approved by the Social Behavioral Institutional Review Board at the University of Southern

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California. Data were collected every six months—this study uses data from the baseline (Wave
1), 6-month follow-up (Wave 2), 12-month follow-up (Wave 3) and 18-month follow-up.
Participant data quality was screened after baseline before inviting them to participant for the
additional waves of data collection and the prospective sample (N=1,076).
Study Protocol.
Study Eligibility. Adolescents were able to participate in the study if they were between
the ages of 14 and 17 (inclusive), identified as cisgender (i.e. their sex determined at birth
aligned with their current gender identity), lived in the United States, and identified as not 100%
heterosexual using sexual attraction questions from the Add Health study (Halpern et al., 2009).
Recruitment. Potential participants were recruited from social media (Facebook,
Instagram, and YouTube) using targeted advertising in spaces and on channels that were more
likely to be followed by the target demographic (sexual minority adolescents in the United
States). Once a participant screened and was enrolled into the longitudinal study, they would also
be given the opportunity to recruit additional adolescents “like them” (specific eligibility criteria
were withheld to prevent intentional misrepresentation) using the snowball sampling technique
of respondent-driven sampling (RDS). This helped ensure that we had the potential to reach
adolescents who weren’t receiving or responsive to our targeted online advertising. Eligible
referrals through the RDS process would earn the referring participants a $10 incentive for up to
three referrals.
Online Screener. Adolescents interested in screening for the study would enter the
online screening survey through a link that indicated whether they came from Facebook,
Instagram, YouTube, or an RDS referral link. Interested adolescents would provide their age in
years, gender, sexual attraction, and ZIP code (to determine residency) for eligibility. Eligible

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participants immediately moved forward to the online assent form for the baseline survey.
Ineligible screeners would be asked to provide contact information if they were interested in
future study opportunities. While their data and screener responses were kept for potential future
studies conducted by the researchers (for participants that desired future contact), additionally, it
obfuscated ineligibility for the baseline study and discouraged ineligible participants from re-
entering the screener to provide incorrect answers in an attempt to access the study with a false
identity.
Baseline Survey. Participants who were deemed eligible during the online screening
process were routed to the IRB-approved online assent document. Participants read through the
document and indicated through a checkbox that they understood the study requirements and
agreed to participate in the study. Participants were able to download a PDF copy of the assent
form and information sheet for the study. Participants that did not agree to participate were
routed out of the survey and shown a message thanking them for their time. Those that agreed
and indicated their desire to proceed were then presented the survey. When they completed the
survey, participants were routed again to a separate survey that collected their contact
information for an incentive payment of a $15 Amazon gift card sent through Gyft.com. This
additional step allowed the research team to ensure that contact information and study data were
always separate.
Data Quality Check. Prior online research experience by the study team (and
conventional wisdom) indicated that offering an incentive for an all-online study might invite
attention from individuals who would try to test the system for vulnerabilities, in order to gain
access to the gift cards. A data quality check was designed to prevent ineligible participants from
receiving gift cards. The data quality check further prevented eligible participants from retaking

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the survey for an additional incentive. The data quality check consisted of examining survey
metadata for patterns of potential fraud, including survey durations that were too short,
exorbitant amounts of missing data, successive repeat survey attempts from the same device, IP
address, or geo-location as recorded by the survey platform, Qualtrics. Further, repeat locations
were triangulated—through a unique random number—with the contact information provided for
payment to look for identical or near-identical matches. If it could be determined that an
ineligible respondent made several attempts to access the survey before finding the right
combination of eligibility criteria, their data were removed, and they were not paid. If an eligible
participant re-entered the survey in an attempt to obtain an additional gift card, their data were
retained, but that participant would not be invited to participate in the rest of the prospective
study. Eligible participants who opted for contact about future studies and for whom no fraud
was detected were invited to the 3-year prospective study.
Prospective Study Procedures. Approximately one week after their baseline survey
completion, interested and eligible participants were contacted about participation in the 3-year
prospective study. This one-week delay allowed the data quality check team to investigate and
served as a cool-down time to wait and see if and fraudulent survey entries would be attempted.
Research staff would use the participant-provided contact information to reach out in real-time
and engage participants in a conversation about the 3-year prospective portion of the study.
Interested participants provided assent for the additional study requirements (additional surveys
every 6 months) and were asked to provide additional contact information so that we could be
sure to reach them “when it was time for [their] next survey.” Participants were given a password
at the end of the baseline survey so that staff would be able to identify them during the

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prospective study outreach. Participants were told that they would be asked what the survey was
about, and they needed to say something about “LGBTQ youth.”
After enrollment into the prospective study, participants were emailed monthly to refresh
their contact information if it had changed. Participants would provide contact information for
any social media platform of their choosing, and study staff would create an account or use an
existing shared lab account for participant outreach. After completing the monthly check in
surveys, participants were entered into a monthly raffle with one participant winning a $100 gift
card each month. Approximately 80% of participants respond to the monthly check-in survey
each month. Participants can choose not to receive the monthly check-in surveys and only
receive the 6-month study surveys. Participants are automatically emailed through the Qualtrics
system every six months when they are eligible for a new study survey. Participants who prefer
not to use email—or don’t respond to the automatic emails—are followed manually by study
staff to complete their semi-annual surveys. As of April 2021, the prospective study was ongoing
and had a wave over wave retention of 93.33% from the 18-month survey to the 24-month
survey.
Measures.
Demographics. Age, race and ethnicity, urbanicity, sex at birth and sexual orientation
were assessed with items created by the authors. At each wave of data collection, participants
were asked, “How old are you?” and were able to enter a whole number of years. Automatic
validation checks during follow-up surveys restrict available responses to the possible ages for
that wave of data collection (e.g., 14-18 years at the 12-month follow-up). At baseline,
participants were asked, “What is your race/ethnicity?” Available options for race/ethnicity
included: Native American/American Indian/Alaskan Native, Asian/Pacific Islander, Black or

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African American, White/Caucasian, Latino/Hispanic, Multi-racial (Please specify), and
Race/ethnicity not listed here (Please specify). At each wave, participants reported the ZIP code
where they live. Urbanicity (rural or urban) was determined based on the Rural Urban
Community Area (RUCA) codes (USDA ERS - Rural-Urban Commuting Area Codes, n.d.).
“Urban” was defined as ZIP Codes corresponding to RUCA codes of 1.0, 1.1, 2.0, 2.1, 4.1, 5.1,
7.1, 8.1, and 10.1. “Rural” included all other valid US ZIP Codes.
At baseline, participants answered “What was your sex assigned at birth?” with response
options of female or male. At each wave, participants freely wrote in a response to the question
“What would you say is your sexual orientation or identity?” Free responses were coded by the
study team while considering the participant’s response to an additional prompt, “If you had to
pick one of the following options, please choose the description that best fits how you think
about yourself” [100% heterosexual; Mostly heterosexual, but somewhat attracted to people of
your own gender; Bisexual or pansexual (pansexual refers to individuals who are attracted to
people regardless of gender identity); Mostly homosexual (gay/lesbian), but somewhat attracted
to people of the opposite gender, 100% homosexual (gay/lesbian), and Unsure]. The study team
used existing literature and prior work to develop a qualitative coding scheme for sexual identity
variables, which were categorized into the following: gay, lesbian, bisexual, pansexual,
bisexual/pansexual (indicated both), complex/multiple identities (e.g., gay pansexual, bisexual
lesbian), queer, straight/mostly straight, asexual, something else (e.g., demisexual, agrosexual),
or missing. Sexual identity was assessed and coded at each wave of data collection.
Interpersonal violence victimization. Prevalence of interpersonal violence victimization
experiences were measured at each wave with questions adapted from the YRBS (Kann et al.,
2018). At baseline, lifetime forced sex was assessed by asking participants if they had ever “Been

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physically forced to have sexual intercourse when [they] did not want to,” and at follow-ups
“since the list time [they] took the survey.” Past-year dating violence and sexual assault was
assessed at baseline and “in the past 6 months” at each follow-up wave. Sexual assault was
assessed by asking, “How many times did anyone force you to do sexual things that you did not
want to do? (Count things such as kissing, touching or being physically forced to have sexual
intercourse.).” Sexual dating violence was assessed by asking, “How many times did someone
you were dating or going out with force you to do sexual things that you did not want to do?
(Count such things as kissing, touching or being physically forced to have sexual intercourse.).”
Physical dating violence was assessed by asking, “How many times did someone you were
dating or going out with physically hurt you on purpose? (Count such things as being hit,
slammed into something, or injured with an object or weapon.).” Response options for each
include: 0 times, 1 time, 2 or 3 times, 4 or 5 times, 6 or more times, or decline to answer. The
dating questions include an additional response option of “I did not go out with anyone in the
past [6 or 12] months.”
Sexual minority stress. Minority stress was assessed using the Sexual Minority
Adolescent Stress Inventory (SMASI), which was designed for racially and ethnically diverse
adolescents and assesses 10 domains of minority stress with 54 items (Goldbach et al., 2017;
Schrager et al., 2018). At baseline, adolescents were asked if they have had each experience
“ever” and “in the past 30 days.” At each follow-up wave, they were asked, “since [they] last
took the survey” and “in the past 30 days.” Stressful experiences were assessed for each of these
subdomains: identity management, social marginalization, negative disclosure experiences,
internalized homonegativity, family rejection, homonegative communication, negative
expectancies, homonegative climate, intersectionality, and religion.

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Mental health. Symptoms of depression, anxiety, and posttraumatic stress were assessed.
Depression symptoms were assessed using the Center for Epidemiological Studies Depression
Scale Short Form (CES-D-4) at each wave. Participants responded to their four items about how
they felt or behaved in the past week. Response options ranged from 0 (rarely or none of the time
[less than 1 day]) to 3 (most or all of the time [5-7 days]). Scores were summed (0-12) with
higher scores indicating more severe or frequent depression symptoms (Melchior et al., 1993).
Anxiety symptoms were assessed using the Generalized Anxiety Disorder 7-item (GAD-7) scale
at each wave. Participants indicated the frequency of anxiety symptoms (e.g., “Feeling nervous,
anxious or on edge”) in the past two weeks. Response options ranged from 0 (not at all) to 3
(nearly every day). Scores were summed (0-21) with higher scores indicating more severe or
frequent anxiety symptoms (Spitzer et al., 2006). Symptoms of posttraumatic stress were
measured at each wave using the Abbreviated PTSD Civilian Checklist, which contains six items
about past-month responses to stressful life experiences. Participants responded to each item by
indicating how much they had “been bothered by each problem in the past month,” from 1 (not at
all) to 5 (extremely). Scores were summed (6-30) with higher scores indicating more severe or
frequent symptoms of posttraumatic stress (Lang et al., 2012).
Analytic Plan
Multivariate logistic regressions were used to assess the baseline correlates of later IPVV,
controlling for baseline experiences of IPVV. Listwise deletion excluded any observations
missing data on any included variables. Model fit was assessed using log likelihood (LL) and
model performance is estimated using Nagelkerke’s R
2
. All analyses were conducted in Stata
MP 17.0.
Results

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Sample Characteristics
Table 2.1 presents sample characteristics of participants enrolled in the prospective study
(N=1,076). At baseline, adolescents in the prospective sample had a mean age of just under 16
years (mean [M] = 15.86; standard deviation [SD] = 0.98). The sample was predominately
White/Caucasian (58.09%), followed by Hispanic/Latino/Latina/Latinx (13.65%), Multi-racial
(10.32%), Black or African American (8.36%), Asian/Pacific Islander (6.69%), or Native
American/American Indian/Alaskan Native (2.88%). Nearly one-fifth of adolescents lived in
rural areas (19.80%). Most of the sample was designated female sex at birth (66.82%). Sexual
identity varied across the sample: gay (22.21%), lesbian (16.64%), bisexual (33.55%), pansexual
(12.36%), bisexual/pansexual (4.00%), complex/multiple identities (3.07%), mostly straight
(1.30%), queer (2.60%), questioning (1.67%), asexual (1.58%) or another identity (1.02%).
Participants reported experiences of violence at baseline and at each of the follow-up
survey waves. Of the 1,076 participants enrolled in the study, 136 reported an experience of
forced sex in their life (13.03%) at baseline, 199 reported past-year sexual assault by anyone
(18.84%) at baseline, 115 reported past-year sexual dating violence (10.78%) at baseline, and 64
reported past-year physical dating violence (5.98%) at baseline. At either 12- or 18-month survey
(Wave 3 or 4), 62 participants reported at least one experience of physically forced sexual
intercourse in the past 6 months (5.76%), 214 participants reported at least one experience of
sexual assault in the past 6 months (19.89%), 111 participants reported at least one experience of
sexual dating violence in the past 6 months (10.32%), and 67 participants reported at least one
experience of physical dating violence in the past 6 months (6.23%). Participants in the baseline
reported an average of 20.94 (SD = 9.60) lifetime sexual minority stressors. Participants reported
an average of 6.49 depressive symptoms (SD = 3.40) over the prior week, an average of 12.13

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anxiety symptoms (SD = 5.87) over the prior two weeks, and an average of 17.74 posttraumatic
stress symptoms (SD = 5.73) over the prior month.
Table 2.1. Prospective Sample Characteristics (N=1,076)
Variable n %
Age* 15.86 0.98
Race/ethnicity (mutually exclusive)

White/Caucasian 625 58.09%
Latino/Hispanic 147 13.65%
Multi-racial 111 10.32%
Black or African American 90 8.36%
Asian/Pacific Islander 72 6.69%
Native American/American Indian/Alaskan Native 31 2.88%
Urbanicity

Urban 863 80.20%
Rural 213 19.80%
Sex at birth

Female 719 66.82%
Male 357 33.18%
Sexual identity

Bisexual 361 33.55%
Gay 239 22.21%
Lesbian 179 16.64%
Pansexual 133 12.36%
Bisexual/Pansexual 43 4.00%
Complex/Multiple Identities 33 3.07%
Queer 28 2.60%
Questioning 18 1.67%
Asexual 17 1.58%
Mostly Straight 14 1.30%
Another Identity 11 1.02%
Sexual identity (Collapsed)
Gay/Lesbian 418 38.85%
Bisexual 361 33.55%
Pansexual+ 176 16.36%
Another ID 121 11.25%
Interpersonal Violence Victimization at Baseline

Physical Dating Violence (past year) 64 5.98%
Sexual Dating Violence (past year) 115 10.78%

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Sexual Assault (past year) 199 18.84%
Forced Sex (lifetime) 136 13.03%
Interpersonal Violence Victimization at Wave 3 or 4
(6-18 mos. Later)
Physical Dating Violence (past 6 months) 67 6.23%
Sexual Dating Violence (past 6 months) 111 10.32%
Sexual Assault (past 6 months) 214 19.89%
Forced Sex (past 6 months) 62 5.76%
Sexual Minority Stress* 20.94 9.60
Mental Health Symptomology

Depression* (Range 0-12) 6.49 3.40
Anxiety* (Range 0-21) 12.13 5.87
Posttraumatic Stress* (Range 6-30) 17.74 5.73
*Mean and standard deviation presented for this variable.

Table 2.2 presents a multivariate logistic regression of baseline reporting of mental health
symptomology, minority stress, past PTDVV, and demographics with future experiences of
PTDVV six to 18 months later. Controlling for other variables in the model, minority stressors,
posttraumatic stress symptoms, and previous PTDVV were all associated with later PTDVV,
while age, sex, sexual identity, race/ethnicity, urbanicity, depression and anxiety symptoms were
not. For each additional recent (past 30 days) minority stress experiences endorsed, participants
had 4% higher odds (aOR = 1.04; 95% CI 1.01-1.08) of experiencing PTDVV prior to the third
or fourth wave of data collection. For each additional point on the PCLC, participants had 7%
higher odds (aOR = 1.07; 95% CI 1.00-1.15) of experiencing PTDVV prior to the third or fourth
wave of data collection. Finally, participants who reported PTDVV in the year leading up to the
baseline survey had 222% higher odds (aOR = 3.22; 95% CI 1.55-6.72) of experiencing PTDVV
in the six months preceding the 12- or 18-month surveys than those that reported no past-year
PTDVV at baseline.
Table 2.2. Multivariate logistic regression of future teen dating violence victimization.
(N=1,030)
Variable aOR 95% CI Std. OR Sig.
Age
0.87 (0.66,1.13) 0.87 n.s.

77

Sex at birth (Ref. Female)

Male
0.85 (0.45,1.61) 0.93 n.s.
Sexual identity (Ref. Gay/Lesbian)

Bisexual
0.76 (0.39,1.49) 0.88 n.s.
Pansexual+
1.07 (0.51,2.26) 1.03 n.s.
Another ID
0.73 (0.26,2.01) 0.91 n.s.
Race/ethnicity (Ref. White/Caucasian)

Asian/Pacific Islander
0.82 (0.24,2.84) 0.95 n.s.
Black or African American
1.11 (0.41,3) 1.03 n.s.
Native American/American Indian/
Alaska Native
1.00 (0.21,4.75) 1.00 n.s.
Hispanic/Latino/Latina/Latinx
1.17 (0.56,2.46) 1.06 n.s.
Multi-racial
0.54 (0.18,1.58) 0.83 n.s.
Urbanicity (Ref. Urban)

Rural
1.50 (0.81,2.77) 1.17 n.s.
SMASI (past 30 days)
1.04 (1.01,1.08) 1.42 *
Depression (CESD-4: Range 0-12)
0.96 (0.86,1.07) 0.87 n.s.
Anxiety (GAD-7: Range 0-21)
0.97 (0.91,1.04) 0.85 n.s.
Posttraumatic Stress (PCLC: Range 6-30)
1.07 (1,1.15) 1.50 *
Past year physical dating violence victimization
3.22 (1.55,6.72) 1.32 **
Constant
0.16 (0,13.2) n.s.
Notes: aOR = adjusted odds ratio; CI = confidence interval; Std. OR = standardized odds ratio;
Sig. = significance; Ref. = reference group; n.s. = not significant; SMASI = Sexual Minority
Adolescent Stress Inventory. Log likelihood = -219.377. Nagelkerke R
2
= 0.092.
*p<0.05; **p<0.01; ***p<0.001

Table 2.3 presents a multivariate logistic regression of baseline reporting of mental health
symptomology, minority stress, past TDSA, and demographics with future experiences of TDSA
six to 18 months later. Controlling for other variables in the model, sex at birth, minority
stressors, and previous TDSA were all associated with later TDSA, while age, sexual identity,
race/ethnicity, urbanicity, depression, anxiety, and posttraumatic stress symptoms were not.
Relative to participants assigned female sex at birth, participants assigned male sex were 46%
lower odds (aOR = 0.54; 95% CI 0.30-0.97) of reporting TDSA in the 6 months leading up to the
third or fourth wave of data collection. For each additional recent (past 30 days) minority stress

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experiences endorsed, participants had 3% higher odds (aOR = 1.03; 95% CI 1.00-1.06) of
experiencing TDSA prior to the third or fourth wave of data collection. Finally, participants who
reported TDSA in the year leading up to the baseline survey had 169% higher odds (aOR = 2.69;
95% CI 1.57-4.59) of experiencing TDSA in the six months preceding the 12- or 18-month
surveys than those that reported no past-year TDSA at baseline.
Table 2.3. Multivariate logistic regression of future teen dating sexual assault victimization.
(N=1,025)
Variable aOR 95% CI Std. OR Sig.
Age
0.91 (0.73,1.14) 0.92 n.s.
Sex at birth (Ref. Female)

Male
0.54 (0.3,0.97) 0.75 *
Sexual identity (Ref. Gay/Lesbian)

Bisexual
1.23 (0.71,2.14) 1.10 n.s.
Pansexual+
1.46 (0.78,2.75) 1.15 n.s.
Another ID
0.99 (0.45,2.17) 1.00 n.s.
Race/ethnicity (Ref. White/Caucasian)

Asian/Pacific Islander
0.99 (0.39,2.48) 1.00 n.s.
Black or African American
0.57 (0.22,1.49) 0.53 n.s.
Native American/American Indian/
Alaska Native
0.24 (0.03,1.9) 0.80 n.s.
Hispanic/Latino/Latina/Latinx
0.80 (0.4,1.58) 0.92 n.s.
Multi-racial
1.10 (0.55,2.18) 1.03 n.s.
Urbanicity (Ref. Urban)

Rural
1.21 (0.71,2.04) 1.08 n.s.
SMASI (past 30 days)
1.03 (1,1.06) 1.29 *
Depression (CESD-4: Range 0-12)
1.03 (0.94,1.12) 1.10 n.s.
Anxiety (GAD-7: Range 0-21)
1.00 (0.95,1.05) 1.00 n.s.
Posttraumatic Stress (PCLC: Range 6-30)
1.04 (0.98,1.09) 1.22 n.s.
Past year teen dating sexual assault victimization
2.69 (1.57,4.59) 1.36 ***
Constant
0.11 (0,4.28) n.s.
Notes: aOR = adjusted odds ratio; CI = confidence interval; Std. OR = standardized odds ratio;
Sig. = significance; Ref. = reference group; n.s. = not significant; SMASI = Sexual Minority
Adolescent Stress Inventory. Log likelihood = -300.507. Nagelkerke R
2
= 0.109.
*p<0.05; **p<0.01; ***p<0.001

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Table 2.4 presents a multivariate logistic regression of baseline reporting of mental health
symptomology, minority stress, past sexual assault, and demographics with future experiences of
sexual assault six to 18 months later. Controlling for other variables in the model, sexual identity,
minority stressors, posttraumatic stress symptoms, and previous sexual assault victimization
were all associated with later sexual assault victimization, while age, sex, race/ethnicity,
urbanicity, depression and anxiety symptoms were not. Relative to gay or lesbian identified
participants, bisexual participants had 57% higher odds (aOR = 1.57; 95% CI 1.03-2.39) of
experiencing sexual assault victimization in the six months before either the third or fourth wave
of data collection. For each additional recent (past 30 days) minority stress experiences endorsed,
participants had 3% higher odds (aOR = 1.03; 95% CI 1.01-1.05) of experiencing sexual assault
victimization prior to the third or fourth wave of data collection. For each additional point on the
PCLC, participants had 7% higher odds (aOR = 1.07; 95% CI 1.02-1.12) of experiencing sexual
assault prior to the third or fourth wave of data collection. Finally, participants who reported
sexual assault victimization in the year leading up to the baseline survey had 292% higher odds
(aOR = 2.92; 95% CI 2.01-4.25) of experiencing sexual assault in the six months preceding the
12- or 18-month surveys than those that reported no past-year sexual assault victimization at
baseline.
Table 2.4. Multivariate logistic regression of future sexual assault victimization. (N=1,015)
Variable aOR 95% CI Std. OR Sig.
Age
1.09 (0.92,1.29) 1.08 n.s.
Sex at birth (Ref. Female)

Male
0.72 (0.47,1.1) 0.86 n.s.
Sexual identity (Ref. Gay/Lesbian)

Bisexual
1.57 (1.03,2.39) 1.24 *
Pansexual+
1.40 (0.84,2.34) 1.13 n.s.
Another ID
0.92 (0.49,1.73) 0.97 n.s.
Race/ethnicity (Ref. White/Caucasian)

Asian/Pacific Islander
0.76 (0.36,1.6) 0.93 n.s.

80

Black or African American
0.51 (0.25,1.06) 0.83 n.s.
Native American/American Indian/
Alaska Native
0.34 (0.09,1.27) 0.84 n.s.
Hispanic/Latino/Latina/Latinx
0.94 (0.58,1.54) 0.98 n.s.
Multi-racial
0.85 (0.48,1.5) 0.95 n.s.
Urbanicity (Ref. Urban)

Rural
1.08 (0.71,1.65) 1.03 n.s.
SMASI (past 30 days)
1.03 (1.01,1.05) 1.27 *
Depression (CESD-4: Range 0-12)
1.03 (0.96,1.1) 1.11 n.s.
Anxiety (GAD-7: Range 0-21)
0.96 (0.92,1) 0.78 n.s.
Posttraumatic Stress (PCLC: Range 6-30)
1.07 (1.02,1.12) 1.46 **
Past year sexual assault victimization
2.92 (2.01,4.25) 1.52 ***
Constant
0.01 (0,0.22) **
Notes: aOR = adjusted odds ratio; CI = confidence interval; Std. OR = standardized odds ratio;
Sig. = significance; Ref. = reference group; n.s. = not significant; SMASI = Sexual Minority
Adolescent Stress Inventory. Log likelihood = -442.404. Nagelkerke R
2
= 0.155.
*p<0.05; **p<0.01; ***p<0.001

Table 2.5 presents a multivariate logistic regression of baseline reporting of mental health
symptomology, minority stress, past PFSI, and demographics with future experiences of PFSI six
to 18 months later. Controlling for other variables in the model, sexual identity and previous
PFSI were all associated with later PFSI, while age, sex, sexual identity, race/ethnicity,
urbanicity, minority stressors, depression, anxiety, and posttraumatic stress symptoms were not.
Relative to gay or lesbian identified participants, pansexual participants had 136% higher odds
(aOR = 2.36; 95% CI 1.04-5.35) of experiencing PFSI in the six months before either the third or
fourth wave of data collection. Participants who reported ever experiencing PFSI prior to the
baseline survey had 202% higher odds (aOR = 3.02; 95% CI 1.59-5.76) of experiencing PFSI in
the six months preceding the 12- or 18-month surveys than those that reported no lifetime PFSI
at baseline.
Table 2.5. Multivariate logistic regression of future physically forced sexual intercourse.
(N=1,003)
Variable aOR 95% CI Std. OR Sig.

81

Age
1.22 (0.89,1.68) 1.22 n.s.
Sex at birth (Ref. Female)

Male
0.78 (0.36,1.67) 0.89 n.s.
Sexual identity (Ref. Gay/Lesbian)

Bisexual
1.48 (0.68,3.19) 1.20 n.s.
Pansexual+
2.36 (1.04,5.35) 1.37 *
Another ID
0.89 (0.28,2.9) 0.97 n.s.
Race/ethnicity (Ref. White/Caucasian)

Asian/Pacific Islander
0.32 (0.04,2.43) 0.75 n.s.
Black or African American
0.7 (0.23,2.13) 0.91 n.s.
Native American/American Indian/
Alaska Native
0.9 (0.19,4.31) 0.98 n.s.
Hispanic/Latino/Latina/Latinx
0.65 (0.25,1.65) 0.86 n.s.
Multi-racial
1.06 (0.41,2.71) 1.02 n.s.
Urbanicity (Ref. Urban)

Rural
1.17 (0.6,2.31) 1.07 n.s.
SMASI (past 30 days)
1.02 (0.99,1.06) 1.20 n.s.
Depression (CESD-4: Range 0-12)
1.12 (0.99,1.27) 1.48 n.s.
Anxiety (GAD-7: Range 0-21)
1 (0.93,1.08) 1.02 n.s.
Posttraumatic Stress (PCLC: Range 6-30)
1.01 (0.94,1.09) 1.07 n.s.
Past lifetime physically forced sexual intercourse
3.02 (1.59,5.76) 1.44 **
Constant
0 (0,0.08) **
Notes: aOR = adjusted odds ratio; CI = confidence interval; Std. OR = standardized odds ratio;
Sig. = significance; Ref. = reference group; n.s. = not significant; SMASI = Sexual Minority
Adolescent Stress Inventory. Log likelihood = -183.434. Nagelkerke R
2
= 0.138.
*p<0.05; **p<0.01; ***p<0.001

Discussion
By a large margin, the largest unstandardized correlate in each model of IPVV is past
experience of IPVV. Repeat violence experiences have been established in previous research
(Basile et al., 2020; Halpern et al., 2009). Accounting for any association of age, sex, sexual
identity, race and ethnicity, urbanicity, recent minority stress and mental health symptomology,
past experience of IPVV ranged from 2.62 times higher odds (sexual dating violence) to 3.22
times higher odds (physical dating violence) of recurrence of the same type of experience 6 to 18
months later. Given the repetitive nature and propagation of violence experiences, assessing for

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violence history among SMA is paramount. Notably, standardized models of future violence
mirrored this finding except for physical teen dating violence, in which past PTDVV had a lower
standardized odds ratio that minority stress. Intervention must break the chain of experiences as a
means to improve immediate and future health and wellbeing. In some cases, violence
assessment may unearth experiences that may be “reportable” by youth-serving professionals
who are often mandated reporters. Despite the discomfort this might cause some practitioners, it
should be outweighed by the opportunity to make a real and lasting change for the youth they
serve.
Our results seem to indicate that stress is associated with IPVV among diverse SMA
throughout the United States, accounting for other common correlates. Minority stress and
posttraumatic stress symptoms were significant prospective correlates of PTDVV, TDSA, and
sexual assault, even after accounting for a history of similar violence experiences. Neither
minority nor posttraumatic stress were significant prospective correlates of PFSI, which may be
related to the extended recall time of ever experiencing PFSI before baseline changing the model
as compared to past-year recall of the other IPVV experiences. For PTDVV, TDSA, and sexual
assault, recall was more recent—within the last 12 months. Lifetime recall allows for more
participants to endorse the experience, but can’t account for the recency of such experiences,
which may confound their association with stress. For practitioners who are unable (or
unwilling) to assess past violence experiences, it is important to understand that minority stress
experiences and posttraumatic stress symptomology—which may be more easily assessed in an
intake questionnaire—are also associated with future experiences of IPVV. Inasmuch as
victimization can lead to re-victimization, minority stress and posttraumatic stress may be
indicators of past victimization experiences.

83

Sexual identity plays a role in IPVV experiences. SMA, generally, are at higher risk than
heterosexually identified adolescents (Basile et al., 2020; Holguin et al., 2018; Kann et al., 2018;
Rusow, 2018; Rusow et al., 2019; Rusow, Holguin, et al., 2018; Rusow, Srivastava, et al., 2018;
Rusow & Srivastava, 2019). For practitioners who see adolescents, generally, this distinction
may be important in understanding some of the different needs of their sexual minority clients. In
this sample of only SMA, bisexual and pansexual adolescents were at higher risk of some IPVV
experiences than gay or lesbian adolescents. It’s important that clinicians and counselors
working with adolescents are aware of the nuances of adolescent sexual identity, and how each
might be differentially associated with behaviors and risk. There appear to be other factors at
play for bisexual and pansexual youth compared to their monosexual gay and lesbian peers.
Some researchers have attributed these disparities, particularly among bisexual individuals, to
binegativity from both heterosexual populations and gay and lesbian populations (Feinstein &
Dyar, 2017). Here, again, minority stress is identified as a primary driver of health disparities.
Limitations
Despite the important associations and prospective correlates of IPVV experiences
identified in this study, it is not without limitations. This study focused exclusively on cisgender
youth and does not further out understanding of the relative contribution of prospective
correlates of IPVV among transgender, nonbinary, or gender expansive adolescents (Srivastava
et al., 2021). Additionally, while online recruitment allowed us to assemble a large, national,
sample of AMA, in both rural and urban settings, the expressed confidentiality of study
participation raises validity concerns about participant duplication or fraud. We established
rigorous study protocols to mitigate fraud and duplicate survey attempts by thoroughly
examining validation checks and survey metadata. Generalizability is a concern given the non-

84

random sampling methods used—our sample had over-representation of white and female SMA
relative to national probability samples (Kann et al., 2018).
Self-report data may induce response bias, so participants were informed that their study
data would always be kept completely separate from their personal identifying information
(which was required to provide them a gift card incentive and follow them for future study
participation). Importantly, while the models were able to identify some important prospective
correlates of future IPVV experience, the individual model metrics indicated that much more
than the variables included were driving experiences of IPVV. Even so, understanding important
subgroup differences among an already impacted group, and the contributions of stress and past
IPVV on future experiences, provides practitioners additional indicators for risk of future
victimization.
Conclusions
For social workers, counselors, other preventionists, as well as policymakers, this work
elucidates several important considerations. Work has shown the elevated rates of IPVV among
SMA compared to their heterosexual peers (Basile et al., 2020; Holguin et al., 2018; Kann et al.,
2018; Rusow, 2018; Rusow et al., 2019; Rusow, Holguin, et al., 2018; Rusow, Srivastava, et al.,
2018; Rusow & Srivastava, 2019). This work extends that by highlighting additional risk among
bisexual and pansexual adolescents. These groups should be represented in prevention material
and practitioners should be aware of these disparities so as not to exacerbate them by further
victimizing these vulnerable populations through dismissal.
It is important to recognize the relationship between stress and victimization experiences.
Even accounting for past violence victimization and controlling for demographic characteristics,
minority stress experiences and posttraumatic stress symptomology were prospectively

85

associated with future experiences of physical and sexual dating violence, as well as sexual
assault. Future work should examine the consistency of this relationship between minority stress
and trajectories of IPVV, over time, to examine chronicity and determine if there are common
patterns that emerge in timing to identify potential targets for intervention.

86

References
Balsam, K. F. (2001). Nowhere to Hide. Women & Therapy, 23(3), 25–37.
https://doi.org/10.1300/J015v23n03_03
Balsam, K. F., & Szymanski, D. M. (2005). Relationship Quality and Domestic Violence in
Women’s Same-Sex Relationships: The Role of Minority Stress. Psychology of Women
Quarterly, 29(3), 258–269. https://doi.org/10.1111/j.1471-6402.2005.00220.x
Basile, K. C., Clayton, H. B., DeGue, S., Gilford, J. W., Vagi, K. J., Suarez, N. A., Zwald, M. L.,
& Lowry, R. (2020). Interpersonal Violence Victimization Among High School
Students—Youth Risk Behavior Survey, United States, 2019. MMWR Supplements,
69(1), 28–37. https://doi.org/10.15585/mmwr.su6901a4
Binion, K., & Gray, M. J. (2020). Minority Stress Theory and Internalized Homophobia among
LGB Sexual Assault Survivors: Implications for Posttraumatic Adjustment. Journal of
Loss and Trauma, 25(5), 454–471. https://doi.org/10.1080/15325024.2019.1707987
Birkett, M., Espelage, D. L., & Koenig, B. (2009). LGB and Questioning Students in Schools:
The Moderating Effects of Homophobic Bullying and School Climate on Negative
Outcomes. Journal of Youth and Adolescence, 38(7), 989–1000.
https://doi.org/10.1007/s10964-008-9389-1
Brown, G. W., & Harris, T. (1978). Social Origins of Depression: A study of psychiatric disorder
in women. The Free Press, A Division of Macmillan Publishing Company, Inc.
Caputi, T. L., Shover, C. L., & Watson, R. J. (2020). Physical and Sexual Violence Among Gay,
Lesbian, Bisexual, and Questioning Adolescents. JAMA Pediatrics, 174(8), 791.
https://doi.org/10.1001/jamapediatrics.2019.6291
Centers for Disease Control and Prevention. (2021, March 16). Preventing Teen Dating
Violence. Preventing Teen Dating Violence.

87

https://www.cdc.gov/violenceprevention/intimatepartnerviolence/teendatingviolence/fastf
act.html
Dank, M., Lachman, P., Zweig, J. M., & Yahner, J. (2014). Dating Violence Experiences of
Lesbian, Gay, Bisexual, and Transgender Youth. Journal of Youth and Adolescence,
43(5), 846–857. https://doi.org/10.1007/s10964-013-9975-8
Davidson, J. R. T., Hughes, D. C., George, L. K., & Blazer, D. G. (1996). The Association of
Sexual Assault and Attempted Suicide Within the Community. Archives of General
Psychiatry, 53(6), 550–555. https://doi.org/10.1001/archpsyc.1996.01830060096013
Devries, K. M., Mak, J. Y., Bacchus, L. J., Child, J. C., Falder, G., Petzold, M., Astbury, J., &
Watts, C. H. (2013). Intimate Partner Violence and Incident Depressive Symptoms and
Suicide Attempts: A Systematic Review of Longitudinal Studies. PLOS Medicine, 10(5),
e1001439. https://doi.org/10.1371/journal.pmed.1001439
Dragowski, E. A., Halkitis, P. N., Grossman, A. H., & D’Augelli, A. R. (2011). Sexual
Orientation Victimization and Posttraumatic Stress Symptoms Among Lesbian, Gay, and
Bisexual Youth. Journal of Gay & Lesbian Social Services, 23(2), 226–249.
https://doi.org/10.1080/10538720.2010.541028
Feinstein, B. A., & Dyar, C. (2017). Bisexuality, minority stress, and health. Current Sexual
Health Reports, 9(1), 42–49. https://doi.org/10.1007/s11930-017-0096-3
Finneran, C., & Stephenson, R. (2014). Intimate Partner Violence, Minority Stress, and Sexual
Risk-Taking Among U.S. Men Who Have Sex With Men. Journal of Homosexuality,
61(2), 288–306. https://doi.org/10.1080/00918369.2013.839911

88

Freedner, N., Freed, L. H., Yang, Y. W., & Austin, S. B. (2002). Dating violence among gay,
lesbian, and bisexual adolescents: Results from a community survey. Journal of
Adolescent Health, 31(6), 469–474. https://doi.org/10.1016/S1054-139X(02)00407-X
Goldbach, J. T., & Gibbs, J. J. (2017). A developmentally informed adaptation of minority stress
for sexual minority adolescents. Journal of Adolescence, 55, 36–50.
https://doi.org/10.1016/j.adolescence.2016.12.007
Goldbach, J. T., Schrager, S. M., Dunlap, S. L., & Holloway, I. W. (2015). The Application of
Minority Stress Theory to Marijuana Use Among Sexual Minority Adolescents.
Substance Use & Misuse, 50(3), 366–375.
https://doi.org/10.3109/10826084.2014.980958
Goldbach, J. T., Schrager, S. M., & Mamey, M. R. (2017). Criterion and divergent validity of the
sexual minority adolescent stress inventory. Frontiers in Psychology, 8, 2057.
https://doi.org/10.3389/fpsyg.2017.02057
Goldbach, J. T., Tanner-Smith, E. E., Bagwell, M., & Dunlap, S. (2014). Minority Stress and
Substance Use in Sexual Minority Adolescents: A Meta-analysis. Prevention Science,
15(3), 350–363. https://doi.org/10.1007/s11121-013-0393-7
Halpern, C. T., Spriggs, A. L., Martin, S. L., & Kupper, L. L. (2009). Patterns of Intimate Partner
Violence Victimization from Adolescence to Young Adulthood in a Nationally
Representative Sample. Journal of Adolescent Health, 45(5), 508–516.
https://doi.org/10.1016/j.jadohealth.2009.03.011
Hatzenbuehler, M. L., McLaughlin, K. A., & Nolen‐Hoeksema, S. (2008). Emotion regulation
and internalizing symptoms in a longitudinal study of sexual minority and heterosexual

89

adolescents. Journal of Child Psychology and Psychiatry, 49(12), 1270–1278.
https://doi.org/10.1111/j.1469-7610.2008.01924.x
Holguin, M., Rusow, J., & Srivastava, A. (2018, November). History of sexual assault is
associated with condomless sex and sex under the influence among high school youth in
the United States [Poster]. American Public Health Association 2018 Annual Meeting &
Expo, San Diego, CA.
Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Queen, B., Lowry, R.,
Chyen, D., Whittle, L., & Thornton, J. (2018). Youth risk behavior surveillance—United
States, 2017. MMWR Surveillance Summaries, 67(8), 1–114.
https://doi.org/10.15585/mmwr.ss6708a1
Lang, A. J., Wilkins, K., Roy-Byrne, P. P., Golinelli, D., Chavira, D., Sherbourne, C., Rose, R.
D., Bystritsky, A., Sullivan, G., Craske, M. G., & Stein, M. B. (2012). Abbreviated PTSD
Checklist (PCL) as a guide to clinical response. General Hospital Psychiatry, 34(4), 332–
338. https://doi.org/10.1016/j.genhosppsych.2012.02.003
Marshal, M. P., Dietz, L. J., Friedman, M. S., Stall, R., Smith, H. A., McGinley, J., Thoma, B.
C., Murray, P. J., D’Augelli, A. R., & Brent, D. A. (2011). Suicidality and depression
disparities between sexual minority and heterosexual youth: A meta-analytic review.
Journal of Adolescent Health, 49(2), 115–123.
Martin-Storey, A. (2015). Prevalence of Dating Violence Among Sexual Minority Youth:
Variation Across Gender, Sexual Minority Identity and Gender of Sexual Partners.
Journal of Youth and Adolescence, 44(1), 211–224. https://doi.org/10.1007/s10964-013-
0089-0

90

McLaughlin, K. A., Hatzenbuehler, M. L., Xuan, Z., & Conron, K. J. (2012). Disproportionate
exposure to early-life adversity and sexual orientation disparities in psychiatric
morbidity. Child Abuse & Neglect, 36(9), 645–655.
https://doi.org/10.1016/j.chiabu.2012.07.004
Melchior, L. A., Huba, G., Brown, V. B., & Reback, C. J. (1993). A short depression index for
women. Educational and Psychological Measurement, 53(4), 1117–1125.
https://doi.org/10.1177/0013164493053004024
Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social
Behavior, 36(1), 38–56. https://doi.org/10.2307/2137286
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual
populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5),
674–697. https://doi.org/10.1037/0033-2909.129.5.674
Olsen, E. O., Vivolo-Kantor, A., & Kann, L. (2020). Physical and Sexual Teen Dating Violence
Victimization and Sexual Identity Among U.S. High School Students, 2015. Journal of
Interpersonal Violence, 35(17–18), 3581–3600.
https://doi.org/10.1177/0886260517708757
Relyea, M., & Ullman, S. E. (2015). Unsupported or Turned Against: Understanding How Two
Types of Negative Social Reactions to Sexual Assault Relate to Postassault Outcomes.
Psychology of Women Quarterly, 39(1), 37–52.
https://doi.org/10.1177/0361684313512610
Reuter, T. R., Newcomb, M. E., Whitton, S. W., & Mustanski, B. (2017). Intimate partner
violence victimization in LGBT young adults: Demographic differences and associations

91

with health behaviors. Psychology of Violence, 7(1), 101–109.
https://doi.org/10.1037/vio0000031
Reuter, T. R., Sharp, C., Link to external site, this link will open in a new window, Temple, J.
R., Babcock, J. C., & Link to external site, this link will open in a new window. (2015).
The relation between borderline personality disorder features and teen dating violence.
Psychology of Violence, 5(2), 163–173.
http://dx.doi.org.libproxy2.usc.edu/10.1037/a0037891
Rice, E., Barman-Adhikari, A., Rhoades, H., Winetrobe, H., Fulginiti, A., Astor, R., Montoya, J.,
Plant, A., & Kordic, T. (2013). Homelessness experiences, sexual orientation, and sexual
risk taking among high school students in Los Angeles. Journal of Adolescent Health,
52(6), 773–778. https://doi.org/10.1016/j.jadohealth.2012.11.011
Roe, S. (2013). “Put It Out There That You Are Willing To Talk About Anything”: The Role of
School Counselors in Providing Support to gay and Bisexual Youth. Professional School
Counseling, 17(1), 2156759X0001700111.
https://doi.org/10.1177/2156759X0001700111
Rosario, M., Schrimshaw, E. W., Hunter, J., & Gwadz, M. (2002). Gay-related stress and
emotional distress among gay, lesbian and bisexual youths: A longitudinal examination.
Journal of Consulting and Clinical Psychology, 70(4), 967–975.
https://doi.org/10.1037/0022-006X.70.4.967
Rusow, J. (2018, November). Sexual assault and teen dating violence are associated with sex
under the influence and condomless sex among LGBQ high school adolescents in the
U.S. [Paper]. The Society for the Scientific Study of Sexuality, 2018 Annual Meeting,
Montreal, Quebec, Canada.

92

Rusow, J., Holguin, M., & Srivastava, A. (2018, November). Sexual identity and sexual risk
among adolescents in the United States who have experienced physical or sexual teen
dating violence [Paper]. American Public Health Association 2018 Annual Meeting &
Expo, San Diego, CA.
Rusow, J., Mendon, S., & Srivastava, A. (2019, January). Intimate violence and suicide attempt
among lesbian, gay, bisexual, and questioning adolescents in the United States [Paper].
Society for Social Work and Research 23rd Annual Conference, San Francisco, CA.
Rusow, J., & Srivastava, A. (2019, January). Lifetime sexual assault, teen dating violence
victimization, and LGBQ-identity are associated with condomless sex and sex under the
influence among high school adolescents in the United States [Poster]. Society for Social
Work and Research 23rd Annual Conference, San Francisco, CA.
Rusow, J., Srivastava, A., Rhoades, H., & Goldbach, J. (2018, November). Suicide attempt and
violent experiences among lesbian, gay, bisexual, and questioning adolescents in the
United States [Paper]. American Public Health Association 2018 Annual Meeting &
Expo, San Diego, CA.
Russell, S. T., Franz, B. T., & Driscoll, A. K. (2001). Same-sex romantic attraction and
experiences of violence in adolescence. American Journal of Public Health, 91(6), 903.
Schrager, S. M., Goldbach, J. T., & Mamey, M. R. (2018). Development of the Sexual Minority
Adolescent Stress Inventory. Frontiers in Psychology, 9, 319.
https://doi.org/10.3389/fpsyg.2018.00319
Silverman, J. G., Raj, A., Mucci, L. A., & Hathaway, J. E. (2001). Dating violence against
adolescent girls and associated substance use, unhealthy weight control, sexual risk
behavior, pregnancy, and suicidality. JAMA, 286(5), 572–579.

93

Spencer, C. M., Stith, S. M., & Cafferky, B. (2019). Risk markers for physical intimate partner
violence victimization: A meta-analysis. Aggression and Violent Behavior, 44, 8–17.
https://doi.org/10.1016/j.avb.2018.10.009
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for
assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine,
166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092
Srivastava, A., Rusow, J. A., & Goldbach, J. T. (2021). Differential risks for suicidality and
mental health symptoms among transgender, nonbinary, and cisgender sexual minority
youth accessing crisis services. Transgender Health, 6(1), 51–56.
Temple, J. R., & Freeman Jr, D. H. (2011). Dating violence and substance use among ethnically
diverse adolescents. Journal of Interpersonal Violence, 26(4), 701–718.
USDA ERS - Rural-Urban Commuting Area Codes. (n.d.). Retrieved April 16, 2021, from
https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes.aspx
Whitton, S. W., Newcomb, M. E., Messinger, A. M., Byck, G., & Mustanski, B. (2019). A
longitudinal study of IPV victimization among sexual minority youth. Journal of
Interpersonal Violence, 34(5), 912–945. https://doi.org/10.1177/0886260516646093
Wolitzky-Taylor, K. B., Ruggiero, K. J., Danielson, C. K., Resnick, H. S., Hanson, R. F., Smith,
D. W., Saunders, B. E., & Kilpatrick, D. G. (2008). Prevalence and correlates of dating
violence in a national sample of adolescents. Journal of the American Academy of Child
& Adolescent Psychiatry, 47(7), 755–762.
Zweig, J. M., Dank, M., Yahner, J., & Lachman, P. (2013). The Rate of Cyber Dating Abuse
Among Teens and How It Relates to Other Forms of Teen Dating Violence. Journal of
Youth and Adolescence, 42(7), 1063–1077. https://doi.org/10.1007/s10964-013-9922-8

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Chapter 4: Minority stress and sexual assault trajectories among sexual minority
adolescents in the United States
The relationship between minority stress and sexual assault is apparent in the literature,
but little is known about the temporal relationship between these two victimization experiences.
Minority stress may contribute to sexual assault, or sexual assault might sensitize one to, or
increase one’s risk of, minority stress experiences. Sexual assault may be a minority stress if it is
attributed to the victim’s sexual identity. This study follows a United States nationwide sample
of sexual minority adolescents, ages 14-17, across four data-collection timepoints over the course
of 18 months. This paper expands on previous work that identified an association between
lifetime minority stress experiences and later reports of sexual assault by examining any impact
recent minority stress has on trajectories of sexual assault. Overall, the likelihood of sexual
assault in the sample decreased over time. Rates of sexual assault were higher for adolescents
who reported a sexual assault experience prior to the start of the study. Adolescents who reported
more recent (past month) minority stress experiences at each wave were more likely to report a
sexual assault at the next wave of data collection. Understanding the timing and etiology of the
trajectory of sexual assault as it relates to minority stress will elucidate intervention targets and
can sensitize clinicians to the sequelae of behavioral health concerns that SMA are facing.
Introduction
Sexual minority adolescents (SMA) are four times more likely to experience rape and
nearly three times as likely to experience sexual assault (SA) than their heterosexual peers (Kann
et al., 2018). Contributing to the risk for sexual assault—or possibly as a consequence of sexual
assault—SMA are more likely to initiate sex at younger ages (Coker et al., 2010; Robinson &
Espelage, 2013), engage in sexual activity and condomless sex more frequently (Ballard et al.,

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2017; Coker et al., 2010; Rice et al., 2013; Robinson & Espelage, 2013), have more sex partners,
including anonymous partners (Coker et al., 2010; Robinson & Espelage, 2013), have sex while
feeling the effects of drugs or alcohol (Robinson & Espelage, 2013), and are at least twice as
likely to be involved in an unintended pregnancy than their heterosexual peers (Saewyc, 2011).
Addressing sexual assault among SMA is critical, as experiencing SA is associated with negative
behavioral health consequences including suicidality, substance use, depression, anxiety, and
homelessness (Kann et al., 2018; Rice et al., 2013; Silverman et al., 2001; Temple & Freeman Jr,
2011; Wolitzky-Taylor et al., 2008) that may persist into adulthood (Maniglio, 2009). Sexual
minority health disparity research often positions unique minority stressors as the driving
mechanism for observed disparities (Goldbach et al., 2014, 2015; Goldbach & Gibbs, 2017;
Meyer, 1995, 2003). This paper will examine the timing and reports of sexual minority stress and
sexual assault experiences among SMA.
Background
The Centers for Disease Control and Prevention (CDC) identify SA as particularly
problematic for youth and adolescents given that violence can reoccur across the lifespan and is
associated with multiple other behavioral health concerns (Centers for Disease Control and
Prevention, 2021). Subgroups of SMA may differentially experience sexual assault. Whether
racial and ethnic, gender identity, sexual identity, or urban-rural differences exist in violence
victimization experiences among SMA remains largely unknown. A recent analysis of a national
probability sample of adolescents found that relative to their heterosexual peers, SMA had higher
adjusted risk ratios (aRR) for sexual assault by anyone (aRR=2.10) in the past year (Caputi et al.,
2020). Bisexual youth were particularly at risk for sexual violence by anyone (aRR=2.36) within
the last year. Additionally, male SMA were particularly vulnerable to sexual assault (aRR=4.64)

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and forced intercourse (aRR=4.70) compared to heterosexually-identified male adolescents
(Caputi et al., 2020).
Existing literature conflicts on whether race and ethnicity are associated with sexual
assault victimization. The most recent administration of the Youth Risk Behavior Survey
(YRBS) shows no significant difference between non-Hispanic white, non-Hispanic Black, and
Hispanic students in regard to sexual violence by anyone in the past year (Basile et al., 2020).
For SMA in rural communities, we know that stigma and fear of being “outed” may prevent
them from accessing services in schools, health care facilities, and local LGBT service
organizations (Birkett et al., 2009), but almost nothing is known about the sexual assault
victimization experiences of this nearly 20% of the U.S. population.
Trajectories of Interpersonal Violence Victimization.
Rates of sexual assault among adolescents and young adults generally increase
throughout adolescence, as young people begin dating and exerting independence, before rates
peak in the early 20s and begin to fall. Given the dearth of available prospective studies on SMA
exposure to sexual assault, retrospective studies are a reasonable first step to understanding the
prevalence of sexual assault for SMA. Asking adults to reflect on experiences before their
eighteenth birthday can offer some insight into the rates of childhood sexual assault (CSA)—as
it’s often called in studies of adults who retrospectively report on childhood experiences. A 2011
systematic review of sexual assault among sexual minority populations found that rates of CSA
among GB men range from 4.1% to 59.2% in probability-based samples and from 13.3% to
49.2% in convenience samples. Among LB women, rates of CSA range from 14.9% to 44.8% in
probability samples and from 21% to 76% in convenience samples (Rothman et al., 2011).

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Few studies assess the trajectory of sexual assault among SMA. In one regional
convenience sample of 248 LGBT youth ages 16-20 at baseline, 17% experienced sexual assault
in a dating relationship (Whitton et al., 2019). In a past-year recall study, high school students
who reported sexual dating violence in the past year, or sexual violence by anyone in the past
year, the majority only recalled one experience (Basile et al., 2020). For both types of sexual
violence (by a dating partner or by anyone), fewer reported 2-3 times, and fewer yet reported
four or more times, indicating sexual re-victimization among some but not most respondents.
Different patterns emerge by sex but not by race/ethnicity. Frequency by sexual identity was not
assessed in their study.
Correlates of Sexual Assault Victimization.
Notwithstanding the public health crisis that sexual assault poses on its own, sexual
assault is also associated with sundry other behavioral health concerns. Addressing sexual assault
among youth is critical, as sexual assault is associated with suicidality, substance use,
depression, anxiety, sexual risk behaviors (Holguin et al., 2018; Rusow, 2018; Rusow et al.,
2019; Rusow, Holguin, et al., 2018; Rusow, Srivastava, et al., 2018; Rusow & Srivastava, 2019),
and homelessness (Kann et al., 2018; Rice et al., 2013; Silverman et al., 2001; Temple &
Freeman Jr, 2011; Wolitzky-Taylor et al., 2008). Furthermore, these same health concerns have
been identified as disparities among SMA, who experience higher rates of other behavioral
health concerns that are associated with sexual assault.
Sexual activity. SMA are more likely to initiate sex at younger ages (Coker et al., 2010;
Robinson & Espelage, 2013), engage in sexual activity more frequently (Ballard et al., 2017;
Coker et al., 2010; Rice et al., 2013; Robinson & Espelage, 2013), have more sex partners,
including anonymous partners (Coker et al., 2010; Robinson & Espelage, 2013), engage in

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condomless sex more frequently (Ballard et al., 2017; Rice et al., 2013; Robinson & Espelage,
2013), have sex while feeling the effects of drugs or alcohol (Robinson & Espelage, 2013), and
are at least twice as likely to be involved in an unintended pregnancy than their heterosexual
peers (Saewyc, 2011). Mental health disparities among SMA are well documented in the
literature.
Suicidality. SMA experience higher rates of suicidality (di Giacomo et al., 2018;
Marshal et al., 2011). A recent meta-analysis of sexual minority youth (ages 12-20) found that
compared to their heterosexual peers, sexual minority youth had increased odds (odds ratio [OR]
= 3.50) of suicide attempt (di Giacomo et al., 2018). This finding was in line with a 2011 meta-
analysis by Marshal and colleagues (2011) that documented increased disparities by suicidality
severity—SMA reported increased suicidal ideation (OR = 1.96), making a suicide plan (OR =
2.20), attempted suicide (OR = 3.18) and having had an attempt that required medical
intervention (OR = 4.17). Suicidality is also associated with sexual assault. A systematic review
of longitudinal studies documented a prospective association of sexual partner violence with
suicide attempt reported at a later wave among adult women (Devries et al., 2013). Previous
sexual assault has also been linked to suicide attempt in a community sample (Davidson et al.,
1996). In their study, Davidson and colleagues (1996) noted that the odds of suicide attempt was
3 to 4 times greater among women who experienced their first sexual assault before age 16
relative to women who first experienced sexual assault at 16 or older.
Mental health symptomology. SMA report higher levels of depression (Marshal et al.,
2011), anxiety (Hatzenbuehler et al., 2008) and posttraumatic stress (CITE). In their 2011 meta-
analysis, Marshal and colleagues also documented increased depression among SMA. In a
longitudinal study using a community sample of middle school students, those who reported

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same-sex attraction reported higher anxiety than those who did not report same-sex attraction
(Hatzenbuehler et al., 2008). Posttraumatic stress among SMA has been linked to internalized
homophobia and bias-based victimization wherein SMA are verbally or physically abused
because of their sexual orientation or gender atypicality (Dragowski et al., 2011). Depression,
anxiety, and posttraumatic stress are also associated with sexual assault. Given the intimate and
violent nature of sexual assault, the connection between sexual assault and PTSD has been long
established (Davidson et al., 1996). A recent meta-analysis corroborates the importance of these
mental health factors as significant correlates of sexual violence (Spencer et al., 2019).
Minority Stress Theory
Stress theory, in general, states that chronic and acute stressors, accumulating over time,
limit an individual’s ability to adapt, adjust, and tolerate continued life stress experiences (Brown
& Harris, 1978). The primary framework for understanding stress and disparities among SMA is
minority stress theory (MST), which has been recognized by the National Academy of Medicine,
Centers for Disease Control and Prevention, and Healthy People 2030. In his landmark paper,
Meyer (1995) identifies the link between multiple social and psychological stressors for sexual
minority populations. According to MST, structural homophobia is the primary driver of
discrimination, violence, and victimization of SMA, leading to behavioral health disparities
(Goldbach et al., 2014, 2015; Meyer, 2003; Russell et al., 2001). Stigma, prejudice, and
discrimination that are related or attributed to sexual minority identity create unique minority
stressors (Meyer, 2003). Specific stressors include negative attitudes or discomfort toward sexual
minorities, and negative or discriminatory events (Rosario et al., 2002). These minority-based
stressors are correlated with behavioral and mental health outcomes for sexual minority
individuals (Goldbach et al., 2014, 2015; Rosario et al., 2002). Minority stressors are unique

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stress experiences that only apply to minority populations and are in addition to the presence of
general stressors which apply to everyone. Given the cumulative effects of stress, it stands to
reason that populations with additional unique stress experiences are likely to have additional
negative health outcomes.
Minority stress theory has been applied to and adapted for sexual minority adolescents
(Goldbach & Gibbs, 2017). Minority adolescents are exposed to three types of minority stressors.
The first are general stressors that may be augmented by their minority identity. For example,
any adolescent might feel stress from being “left out” of a social situation, however, if an
adolescent perceives being excluded due to their sexual minority identity, that then classifies it as
a minority stressor. The other two stressors are minority-specific distal and proximal stressors
(Goldbach & Gibbs, 2017; Meyer, 2003). Stress experiences exist on a continuum from distal—
which are external to the individual and therefore more objective—to proximal, which are more
subjective and may involve the internalization of social attitudes toward sexual minority people,
or expectations about the response of others. For example, the expectation of how someone
might respond to an SMA “coming out” as a sexual minority is related to their subjective
internalization of their own past experiences or their understanding of the experiences of others.
All three types of minority-specific stressors are relevant when considering experiences
of sexual assault. Experiencing sexual assault may be all the more stressful if adolescents
attribute the violence to their sexual identity. Similarly, proximal stressors (internal to the
person) like internalized homophobia, concealment, or expectations of rejection based on their
sexual identity may place adolescents at risk for sexual assault or prevent them from seeking
support after a victimization experience. Distal stressors (in the environment), like other bias-
based violence or discrimination might work to normalize violence or cause adolescents to de-

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value their sexual assault experiences. Importantly, types of stressors are interrelated, such that
expectations of rejection (proximal) may reduce both exposure to victimization or social support
and may have been caused by a negative disclosure experience (distal).
Minority stress and sexual assault. In the absence of research on the relationship
between minority stress and sexual assault among SMA populations, we turn to the work that has
been done with adult sexual minority populations. Indeed, Balsam and colleagues have been
looking at the role of minority stress in relation to partner sexual violence among sexual minority
women for decades (Balsam, 2001; Balsam & Szymanski, 2005). Their work identified
associations between minority stressors of discrimination and internalized homonegativity with
dating violence victimization (Balsam & Szymanski, 2005). These findings were mirrored in a
study of sexual minority men (Finneran & Stephenson, 2014). Internalized homophobia, in
particular, has been linked to sexual assault (Finneran & Stephenson, 2014). A recent review
highlighted the role that internalized homophobia has on reducing sexual assault disclosure—
which thus limits access to recovery resources—among sexual minority individuals (Binion &
Gray, 2020).
In reporting a sexual assault, SMA have to navigate multiple layers of disclosure, and the
response received can additionally impact the survivor’s health trajectory (Relyea & Ullman,
2015). One recent longitudinal study of a community-based convenience sample of 248 LGBT
youth (ages 16-20 years at baseline) investigated the link between LGBT discrimination and
sexual dating violence (Whitton et al., 2019). They found that for discrimination—one facet of
minority stress—those who reported increased discrimination were more likely to report sexual
dating violence. While that work was beneficial in highlighting the link between a part of
minority stress theory and dating violence, we stand to learn from a more thorough examination

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of minority stress constructs among a larger, non-region-specific sample of SMA. Indeed, fact
that both minority stress and sexual assault have been independently linked to so many health
concerns begs further investigation into the timing and relationship between minority stress and
sexual assault experiences.
Methods
This study utilizes data from the first four waves of a prospective study of SMA
(1R01MD012252; Co-PI: Goldbach & Schrager) to examine the impact of recent minority stress
experiences on following reports of sexual assault victimization. The study design and protocols
were approved by the Social Behavioral Institutional Review Board at the University of Southern
California. Participants (N=1,076) were recruited through online social media advertising on
Facebook, Instagram, and YouTube, and were encouraged to refer additional participants
through respondent-driven sampling. Adolescents were able to participate in the study if they
were between the ages of 14 and 17 (inclusive), lived in the United States, identified as cisgender
(i.e. their sex determined at birth aligned with their current gender identity), and identified as
anything other than 100% heterosexual using sexual attraction questions from the Add Health
study (Halpern et al., 2009). Data were collected every six months—this study will use data from
the baseline (Wave 1), 6-month follow-up (Wave 2), 12-month follow-up (Wave 3) and 18-
month follow-up (Wave 4). Participant data quality was screened after baseline before inviting
them to participant for the additional waves of data collection.
Study Protocol.
Recruitment. Potential participants were recruited from Facebook, Instagram, and
YouTube using targeted advertising in spaces and on channels that were more likely to be
followed by the target demographic (sexual minority adolescents in the United States). Once a

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participant screened and was enrolled into the longitudinal study, they would also be given the
opportunity to recruit additional adolescents “like them” (specific eligibility criteria were
withheld to prevent intentional misrepresentation) using the snowball sampling technique of
respondent-driven sampling (RDS). This helped ensure that we had the potential to reach
adolescents who weren’t receiving or responsive to our targeted online advertising. Eligible
referrals through the RDS process would earn the referring participants a $10 incentive for up to
three referrals.
Baseline Survey. Adolescents interested in screening for the study would enter the online
screening survey through a link that indicated whether they came from Facebook, Instagram,
YouTube, or an RDS referral link. Participants who were deemed eligible during the online
screening process were routed to the IRB-approved online assent document. When they
completed the survey, participants were routed again to a separate survey that collected their
contact information for an incentive payment of a $15 Amazon gift card sent through Gyft.com.
This additional step allowed the research team to ensure that contact information and study data
were always separate.
Data Quality Check. Prior online research experience by the study team indicated that
offering an incentive for an all-online study might invite fraudulent attempts by individuals in
order to gain access to the gift cards. A data quality check was designed to prevent ineligible
participants from receiving gift cards or being invited to future survey waves. Eligible
participants who opted for contact about future studies and for whom no fraud was detected were
invited to the 3-year prospective study.
Prospective Study Procedures. Approximately one week after their baseline survey
completion, interested and eligible participants were contacted about participation in the 3-year

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prospective study. This one-week delay allowed the data quality check team to investigate and
served as a cool-down time to wait and see if fraudulent survey entries would be attempted.
Research staff would use the participant-provided contact information to reach out in real-time
and engage participants in a conversation about the 3-year prospective portion of the study.
Interested participants provided assent for the additional study requirements (additional surveys
every 6 months) and were asked to provide additional contact information so that we could be
sure to reach them “when it was time for [their] next survey.” Participants were given a password
at the end of the baseline survey so that staff would be able to identify them during the
prospective study outreach. Participants were told that they would be asked what the survey was
about and they needed to say something similar to “LGBTQ youth.”
After enrollment into the prospective study, participants were emailed monthly to refresh
their contact information if it had changed. Participants would provide contact information for
any social media platform of their choosing, and study staff would create an account or use an
existing shared lab account for participant outreach. After completing the monthly check in
surveys, participants were entered into a monthly raffle with one participant winning a $100 gift
card each month. Approximately 80% of participants respond to the monthly check-in survey
each month. Participants were able to choose not to receive the monthly check-in surveys and
only receive the 6-month study surveys. Participants were automatically emailed through the
Qualtrics system every six months when they are eligible for a new study survey. Participants
who preferred not to use email—or didn’t respond to the automatic emails—are followed
manually by study staff to complete their semi-annual surveys. As of April 2021, the prospective
study is ongoing and currently has a wave over wave retention of 93.33% from the 18-month
survey to the 24-month survey.

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Measures.
Demographics. Age, race and ethnicity, urbanicity, sex at birth and sexual orientation
were assessed with items created by the authors. At each wave of data collection, participants are
asked, “How old are you?” and are able to enter a whole number of years. Automatic validation
checks during follow-up surveys restrict available responses to the possible ages for that wave of
data collection (e.g., 14-18 years at the 12-month follow-up). At baseline, participants were
asked, “What is your race/ethnicity?” and were allowed to select one or write in a response.
Available options for race/ethnicity included: Native American/American Indian/Alaskan
Native, Asian/Pacific Islander, Black or African American, White/Caucasian, Latino/Hispanic,
Multi-racial (Please specify), and Race/ethnicity not listed here (Please specify). At each wave,
participants reported the ZIP code where they live. Urbanicity (rural or urban) was determined
based on the Rural Urban Community Area (RUCA) codes (USDA ERS - Rural-Urban
Commuting Area Codes, n.d.). “Urban” was defined as ZIP Codes corresponding to RUCA
codes of 1.0, 1.1, 2.0, 2.1, 4.1, 5.1, 7.1, 8.1, and 10.1. “Rural” included all other valid US ZIP
Codes.
At baseline, participants answered “What was your sex assigned at birth?” with response
options of female or male. At each wave, participants freely wrote in a response to the question
“What would you say is your sexual orientation or identity?” Free responses were coded by the
study team while considering the participant’s response to an additional prompt, “If you had to
pick one of the following options, please choose the description that best fits how you think
about yourself” [100% heterosexual; Mostly heterosexual, but somewhat attracted to people of
your own gender; Bisexual or pansexual (pansexual refers to individuals who are attracted to
people regardless of gender identity); Mostly homosexual (gay/lesbian), but somewhat attracted

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to people of the opposite gender, 100% homosexual (gay/lesbian), and Unsure]. The study team
used existing literature and prior work to develop a qualitative coding scheme for sexual identity
variables, which were categorized into the following: gay, lesbian, bisexual, pansexual,
bisexual/pansexual (indicated both), complex/multiple identities (e.g., gay pansexual, bisexual
lesbian), queer, straight/mostly straight, asexual, something else (e.g., demisexual, agrosexual),
or missing. Sexual identity was assessed and coded at each wave of data collection.
Sexual assault victimization. Prevalence of sexual assault experiences were measured at
each wave with a question adapted from the YRBS (Kann et al., 2018). At baseline, sexual
assault was assessed by asking, “During the past 12 months, how many times did anyone force
you to do sexual things that you did not want to do? (Count things such as kissing, touching or
being physically forced to have sexual intercourse.).” Response options included: 0 times, 1
time, 2 or 3 times, 4 or 5 times, 6 or more times, or decline to answer. At the follow-up survey
waves, the recall period was adjusted to “Since the last time you took this survey” to ensure that
participants were reporting on unique experiences at each wave.
Sexual minority stress. Minority stress was assessed using the Sexual Minority
Adolescent Stress Inventory (SMASI), a developmentally-appropriate inventory of 54
experiences designed for racially and ethnically diverse adolescents across 10 domains of
minority stress (Goldbach et al., 2017; Schrager et al., 2018). At each follow-up wave,
participants were asked if they had each experience “in the past 30 days.” Stressful experiences
were assessed for each of these subdomains: identity management, social marginalization,
negative disclosure experiences, internalized homonegativity, family rejection, homonegative
communication, negative expectancies, homonegative climate, intersectionality, and religion.
Analytic Plan

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A multi-step process examined the effect of minority stress experiences on sexual assault
victimization. A time-varying covariate latent growth model (Figure 3.1) was used to examine
how recent minority stress experiences influenced sexual assault victimization in the following
six-month period (Grimm et al., 2016). A series of models were tested to determine if the effect
of minority stress was a fixed effect (i.e., should be constrained to be equal over time) versus a
random effect (i.e., should be allowed to be estimated freely). A total of 1,076 participants
completed the baseline assessment. Survey completion rates for variables of interest at
subsequent waves were: 87.3% at Wave 2 (n = 939), 84.9 % at Wave 3 (n = 913), and 82.8% at
Wave 4 (n = 891). Adolescents who missed follow-up assessments did not differ from survey
completers by age, sex, sexual identity, race, ethnicity, urbanicity, minority stressors, or baseline
reporting of sexual assault. Analyses were carried out using the structural equation modeling
(SEM) framework of Mplus 8.6; skewness and missing values of the outcome variables were
addressed using a robust estimation method, MLR (Muthén & Muthén, 2017).
Figure 3.1: Time-varying Covariate Model

Results
Sample Characteristics
Sexual
Assault T2
Sexual
Assault T3
Sexual
Assault T4
Minority
Stress
T1
Minority
Stress
T2
Minority
Stress
T3
Sexual
Assault T1
Demographics
Intercept
Sexual
Assault
Slope
Sexual
Assault

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Table 3.1 presents the study sample characteristics study (N=1,076). At baseline,
adolescents in the prospective sample had a mean age of just under 16 years (mean [M] = 15.86;
standard deviation [SD] = 0.98). The sample was predominately White/Caucasian (58.09%),
followed by Hispanic/Latina/Latino/Latinx (13.66%), Multi-racial (10.32%), Black or African
American (8.36%), Asian/Pacific Islander (6.69%), or Native American/American
Indian/Alaskan Native (2.88%). Nearly one-fifth of adolescents lived in rural areas (19.80%).
Most of the sample was designated female sex at birth (66.82%). Sexual identity varied across
the sample: gay (22.21%), lesbian (16.64%), bisexual (33.55%), pansexual (12.36%),
bisexual/pansexual (4.00%), complex/multiple identities (3.07%), mostly straight (1.30%), queer
(2.60%), questioning (1.67%), asexual (1.58%) or another identity (1.02%).
Of the 1,076 participants enrolled in the study, 199 reported an experience of sexual
assault in the year preceding the baseline visit (18.84%), 150 in the six months before Wave 2
(15.69%), 145 in the six months before Wave 3 (15.61%), and 115 in the six months before
Wave 4 (12.68%). Participants in the baseline reported an average of 13.84 (SD = 8.64) sexual
minority stressors in the past month. At Wave 2, they reported an average of 11.70 (SD = 8.25)
sexual minority stressors in the past month, and at Wave 3, they reported an average of 10.67
(SD = 7.72) sexual minority stressors in the past month.
Table 3.1. Prospective Sample Characteristics (N=1,076)
Variable n %
Age* 15.86 0.98
Race/ethnicity (mutually exclusive)

White/Caucasian 625 58.09%
Hispanic/Latina/Latino/Latinx 147 13.66%
Multi-racial 111 10.32%
Black or African American 90 8.36%
Asian/Pacific Islander 72 6.69%
Native American/American Indian/Alaskan Native 31 2.88%
Urbanicity

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Urban 863 80.20%
Rural 213 19.80%
Sex at birth

Female 719 66.82%
Male 357 33.18%
Sexual identity

Bisexual 361 33.55%
Gay 239 22.21%
Lesbian 179 16.64%
Pansexual 133 12.36%
Bisexual/Pansexual 43 4.00%
Complex/Multiple Identities 33 3.07%
Queer 28 2.60%
Questioning 18 1.67%
Asexual 17 1.58%
Mostly Straight 14 1.30%
Another Identity 11 1.02%
Sexual Assault Victimization

Baseline (past year) 199 18.84%
Wave 2 (past 6 months) 150 15.69%
Wave 3 (past 6 months) 145 15.61%
Wave 4 (past 6 months) 115 12.68%
Sexual Minority Stress*
Baseline (past 30 days) 13.84 8.64
Wave 2 (past 30 days) 11.70 8.25
Wave 3 (past 30 days) 10.67 7.72
*Mean and standard deviation presented for these variables.

Effects of Minority Stress on Sexual Assault Victimization
Results of our model fitting process indicated a model that constrained the effect of
minority stress on sexual assault experience was most appropriate. Table 3.2 presents the
estimates of the time-varying covariate model. Minority stress was significantly associated with
increased reporting of sexual assault victimization over the next wave (b = 0.064, SE = 0.010, p
< 0.001), controlling for age, sex, sexual identity, race, ethnicity, urbanicity, and experiences of
sexual assault in the year leading up to the baseline survey. Relative to white SMA, Asian SMA

110

had significantly lower growth intercepts (b = -2.061, SE = 0.628, p = 0.001). Past sexual assault
was associated with a higher growth intercept (b = 2.310, SE = 1.101, p = 0.036). No significant
differences were found for age, sex, sexual identity, or urbanicity.
Table 3.2. Latent growth curve with time-invariant and time-varying covariates
Variable Estimate S.E. Sig.
SMASI T1 on Sexual Assault T2 0.064 0.010 p < 0.001
SMASI T2 on Sexual Assault T3 0.064 0.010 p < 0.001
SMASI T3 on Sexual Assault T4 0.064 0.010 p < 0.001
Growth parameters
Intercept -3.394 3.892 p = 0.383
Slope -1.801 2.859 p = 0.529
Variance
Intercept 2.390 4.662 p = 0.608
Slope 0.299 1.556 p = 0.847
Note: SMASI = minority stress; S.E. = standard error; Sig. = significance level. Model
controlled for age, birth sex (reference: male), sexual identity (reference: gay/lesbian), race
(reference: white) and urbanicity.

Discussion
This study sought to examine the temporal relationship of minority stress and sexual
assault experiences among a sample of sexual minority adolescents in the United States. Using
latent growth modeling techniques, we modeled the trajectory of sexual assault among SMA
across the United States and found important additions to the existing literature on sexual
violence among SMA. First, the overall trajectory of sexual assault rates neither significantly
increased nor decreased across the study. This is somewhat consistent with research on
trajectories of violence that show decreases after an initial peak in adolescence or early
adulthood (Johnson et al., 2015; Whitton et al., 2019)—although this is a longitudinal study, it
may not be a long enough view to see the drop off in sexual assault previous literature would
suggest. Second, consistent with research showing that revictimization is unfortunately common

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(Basile et al., 2020; Halpern et al., 2009), the intercept for growth trajectories of adolescents who
reported previous sexual assault victimization at baseline were significantly higher. While the
slope was not significantly different, the overall rates of sexual assault for adolescents who
experienced prior victimization, were higher. Notably, there were no slope differences by any
demographic or other correlate in the study. Again, we attribute that lack of change to 18 months
of observation being perhaps to short in this age range (14 to 17 at baseline).
Equally as important as differences observed are similarities across the sample. Notably,
we didn’t observe any different sexual assault growth trajectory intercepts or slopes by age, sex,
sexual identity, or urbanicity. Relative to white adolescents, the only racial difference was that
Asian adolescents had a significantly lower intercept, indicating that they started the growth
trajectory reporting lower rates of sexual assault. Contrary to work that identified differing rates
of sexual assault by sexual identity (Basile et al., 2020; Holguin et al., 2018; Kann et al., 2018),
we did not observe any differences by sexual identity in the trajectory of sexual assault over
time.
Perhaps the most important discovery in this study is the consistent effect of minority
stress experiences preceding reporting of sexual assault. Our study examined whether sexual
minority stress experiences in the 30 days leading up to a survey wave were associated with a
report of sexual assault over the subsequent 6 months. Consistent with studies of sexual minority
adults (Balsam, 2001; Balsam & Szymanski, 2005; Finneran & Stephenson, 2014), and Whitton
and colleagues (2019) study of SMA and young adults, our modelling showed that at each wave,
SMA who reported more recent minority stress experiences were at increased risk of sexual
assault. This finding suggests that efforts to reduce minority stress experiences may additionally
work to reduce the risk of sexual assault among SMA in the United States. While perpetrator

112

information and other victimization context were not assessed in this study, the results are
consistent with routine activities theory which posits that for victimization to occur, three things
need to be present: a) the absence of a guardian or bystander to intervene, b) a motivated
perpetrator, and c) a target deemed suitable by the perpetrator (Cohen & Felson, 1979). It may be
that “looking stressed” makes one a more attractive target to perpetrators. Reducing minority
stress for SMA may indirectly work to reduce the interest of perpetrators.
Limitations and Conclusions
This study has limitations. Our focus on cisgender youth means that we have not
expanded our understanding of the trajectories of sexual assault and the impact of minority stress
among transgender, nonbinary, or gender expansive adolescents (Srivastava et al., 2021).
Although large, our sample was not assembled using probabilistic methods and thus limits the
generalizability of our findings. Perhaps we were unable to survey adolescents with more or less
minority stress or those with increased or decreased rates of sexual assault experience. Efforts
were taken during recruitment to obtain a diversity of sexual identities, and youth demographics
proportional to national rates of race, ethnicity, and urbanicity. Participants were also allowed to
refer other adolescents to the study, possibly increasing our reach beyond those who would
respond to ads posted on social media. Although self-report can often induce response bias in
interviewer-led surveys, our online self-administered survey aimed to reduce this bias by
separating the data and contact information collection and reiterating the confidentiality of their
survey responses.
Importantly, this study used prospective data for a cohort of sexual minority adolescents
to track experiences of minority stress and sexual assault across time. Such information is
lacking from large, probability studies of adolescents throughout the United States. Targeting

113

questions about sexual minority stressors to heterosexual adolescents in representative samples,
like the biannual YRBS, would be time and cost prohibitive, as well as place undue burden on
the youth participants. Future studies may use advanced blocking techniques to assess additional
relevant questions with in-survey branching, but this is currently not possible with the paper-
based self-administered surveys often used in American schools. Until then, large national
convenience samples are our best source for this data.
Our finding that minority stress persisted as a prospective correlate of sexual assault
highlights minority stress as a potential target for sexual assault prevention and intervention.
Notably, the overall trajectory was similar for the sample irrespective of age, sex, sexual identity,
race, ethnicity, or urbanicity. Perhaps a focus on reducing adolescent minority stressors would
improve the lives of adolescents across all these demographic categories. Policies that limit or
exacerbate minority stress are likely to have numerous other consequences that should be
considered (for example, beyond the teams youth can play on or the bathrooms they can use).
Future studies should look over a longer period of time to further assess the trajectory of sexual
assault, as previous literature has indicated that it is unlikely to be flat during adolescence and
young adulthood when viewed over longer periods (Johnson et al., 2015; Whitton et al., 2019).
Over a longer observation period, researchers can more closely investigate constructs that are
associated with the increases or decreases in overall trajectory. Additionally, capturing
perpetrator information and victimization context during study visits may assist researchers in
identifying additional prevention and intervention targets. Researchers should also attend to the
experiences of transgender, non-binary, and gender expansive adolescents who also experience
increased minority stress and behavioral health disparities (Srivastava et al., 2021).

114

References
Ballard, M. E., Jameson, J. P., & Martz, D. M. (2017). Sexual identity and risk behaviors among
adolescents in rural Appalachia. Journal of Rural Mental Health, 41(1), 17–29.
https://doi.org/10.1037/rmh0000068
Balsam, K. F. (2001). Nowhere to Hide. Women & Therapy, 23(3), 25–37.
https://doi.org/10.1300/J015v23n03_03
Balsam, K. F., & Szymanski, D. M. (2005). Relationship Quality and Domestic Violence in
Women’s Same-Sex Relationships: The Role of Minority Stress. Psychology of Women
Quarterly, 29(3), 258–269. https://doi.org/10.1111/j.1471-6402.2005.00220.x
Basile, K. C., Clayton, H. B., DeGue, S., Gilford, J. W., Vagi, K. J., Suarez, N. A., Zwald, M. L.,
& Lowry, R. (2020). Interpersonal Violence Victimization Among High School
Students—Youth Risk Behavior Survey, United States, 2019. MMWR Supplements,
69(1), 28–37. https://doi.org/10.15585/mmwr.su6901a4
Binion, K., & Gray, M. J. (2020). Minority Stress Theory and Internalized Homophobia among
LGB Sexual Assault Survivors: Implications for Posttraumatic Adjustment. Journal of
Loss and Trauma, 25(5), 454–471. https://doi.org/10.1080/15325024.2019.1707987
Birkett, M., Espelage, D. L., & Koenig, B. (2009). LGB and Questioning Students in Schools:
The Moderating Effects of Homophobic Bullying and School Climate on Negative
Outcomes. Journal of Youth and Adolescence, 38(7), 989–1000.
https://doi.org/10.1007/s10964-008-9389-1
Brown, G. W., & Harris, T. (1978). Social Origins of Depression: A study of psychiatric disorder
in women. The Free Press, A Division of Macmillan Publishing Company, Inc.

115

Caputi, T. L., Shover, C. L., & Watson, R. J. (2020). Physical and Sexual Violence Among Gay,
Lesbian, Bisexual, and Questioning Adolescents. JAMA Pediatrics, 174(8), 791.
https://doi.org/10.1001/jamapediatrics.2019.6291
Centers for Disease Control and Prevention. (2021, March 16). Preventing Teen Dating
Violence. Preventing Teen Dating Violence.
https://www.cdc.gov/violenceprevention/intimatepartnerviolence/teendatingviolence/fastf
act.html
Cohen, L. E., & Felson, M. (1979). Social change and crime rate trends: A routine activity
approach. American Sociological Review, 44, 588–608.
Coker, T. R., Austin, S. B., & Schuster, M. A. (2010). The health and health care of lesbian, gay,
and bisexual adolescents. Annual Review of Public Health, 31, 457–477.
https://doi.org/10.1146/annurev.publhealth.012809.103636
Davidson, J. R. T., Hughes, D. C., George, L. K., & Blazer, D. G. (1996). The Association of
Sexual Assault and Attempted Suicide Within the Community. Archives of General
Psychiatry, 53(6), 550–555. https://doi.org/10.1001/archpsyc.1996.01830060096013
Devries, K. M., Mak, J. Y., Bacchus, L. J., Child, J. C., Falder, G., Petzold, M., Astbury, J., &
Watts, C. H. (2013). Intimate Partner Violence and Incident Depressive Symptoms and
Suicide Attempts: A Systematic Review of Longitudinal Studies. PLOS Medicine, 10(5),
e1001439. https://doi.org/10.1371/journal.pmed.1001439
di Giacomo, E., Krausz, M., Colmegna, F., Aspesi, F., & Clerici, M. (2018). Estimating the Risk
of Attempted Suicide Among Sexual Minority Youths: A Systematic Review and Meta-
analysis. JAMA Pediatrics, 172(12), 1145–1152.
https://doi.org/10.1001/jamapediatrics.2018.2731

116

Dragowski, E. A., Halkitis, P. N., Grossman, A. H., & D’Augelli, A. R. (2011). Sexual
Orientation Victimization and Posttraumatic Stress Symptoms Among Lesbian, Gay, and
Bisexual Youth. Journal of Gay & Lesbian Social Services, 23(2), 226–249.
https://doi.org/10.1080/10538720.2010.541028
Finneran, C., & Stephenson, R. (2014). Intimate Partner Violence, Minority Stress, and Sexual
Risk-Taking Among U.S. Men Who Have Sex With Men. Journal of Homosexuality,
61(2), 288–306. https://doi.org/10.1080/00918369.2013.839911
Goldbach, J. T., & Gibbs, J. J. (2017). A developmentally informed adaptation of minority stress
for sexual minority adolescents. Journal of Adolescence, 55, 36–50.
https://doi.org/10.1016/j.adolescence.2016.12.007
Goldbach, J. T., Schrager, S. M., Dunlap, S. L., & Holloway, I. W. (2015). The Application of
Minority Stress Theory to Marijuana Use Among Sexual Minority Adolescents.
Substance Use & Misuse, 50(3), 366–375.
https://doi.org/10.3109/10826084.2014.980958
Goldbach, J. T., Schrager, S. M., & Mamey, M. R. (2017). Criterion and divergent validity of the
sexual minority adolescent stress inventory. Frontiers in Psychology, 8, 2057.
https://doi.org/10.3389/fpsyg.2017.02057
Goldbach, J. T., Tanner-Smith, E. E., Bagwell, M., & Dunlap, S. (2014). Minority Stress and
Substance Use in Sexual Minority Adolescents: A Meta-analysis. Prevention Science,
15(3), 350–363. https://doi.org/10.1007/s11121-013-0393-7
Grimm, K. J., Ram, N., & Estabrook, R. (2016). Growth modeling: Structural equation and
multilevel modeling approaches. Guilford Publications.

117

Halpern, C. T., Spriggs, A. L., Martin, S. L., & Kupper, L. L. (2009). Patterns of Intimate Partner
Violence Victimization from Adolescence to Young Adulthood in a Nationally
Representative Sample. Journal of Adolescent Health, 45(5), 508–516.
https://doi.org/10.1016/j.jadohealth.2009.03.011
Hatzenbuehler, M. L., McLaughlin, K. A., & Nolen‐Hoeksema, S. (2008). Emotion regulation
and internalizing symptoms in a longitudinal study of sexual minority and heterosexual
adolescents. Journal of Child Psychology and Psychiatry, 49(12), 1270–1278.
https://doi.org/10.1111/j.1469-7610.2008.01924.x
Holguin, M., Rusow, J., & Srivastava, A. (2018, November). History of sexual assault is
associated with condomless sex and sex under the influence among high school youth in
the United States [Poster]. American Public Health Association 2018 Annual Meeting &
Expo, San Diego, CA.
Johnson, W. L., Manning, W. D., Giordano, P. C., & Longmore, M. A. (2015). Relationship
Context and Intimate Partner Violence From Adolescence to Young Adulthood. Journal
of Adolescent Health, 57(6), 631–636. https://doi.org/10.1016/j.jadohealth.2015.08.014
Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Queen, B., Lowry, R.,
Chyen, D., Whittle, L., & Thornton, J. (2018). Youth risk behavior surveillance—United
States, 2017. MMWR Surveillance Summaries, 67(8), 1–114.
https://doi.org/10.15585/mmwr.ss6708a1
Maniglio, R. (2009). The impact of child sexual abuse on health: A systematic review of
reviews. Clinical Psychology Review, 29(7), 647–657.
https://doi.org/10.1016/j.cpr.2009.08.003

118

Marshal, M. P., Dietz, L. J., Friedman, M. S., Stall, R., Smith, H. A., McGinley, J., Thoma, B.
C., Murray, P. J., D’Augelli, A. R., & Brent, D. A. (2011). Suicidality and depression
disparities between sexual minority and heterosexual youth: A meta-analytic review.
Journal of Adolescent Health, 49(2), 115–123.
Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social
Behavior, 36(1), 38–56. https://doi.org/10.2307/2137286
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual
populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5),
674–697. https://doi.org/10.1037/0033-2909.129.5.674
Muthén, L. K., & Muthén, B. O. (2017). Mplus User’s Guide. Eighth Edition. Muthén &
Muthén.
Relyea, M., & Ullman, S. E. (2015). Unsupported or Turned Against: Understanding How Two
Types of Negative Social Reactions to Sexual Assault Relate to Postassault Outcomes.
Psychology of Women Quarterly, 39(1), 37–52.
https://doi.org/10.1177/0361684313512610
Rice, E., Barman-Adhikari, A., Rhoades, H., Winetrobe, H., Fulginiti, A., Astor, R., Montoya, J.,
Plant, A., & Kordic, T. (2013). Homelessness experiences, sexual orientation, and sexual
risk taking among high school students in Los Angeles. Journal of Adolescent Health,
52(6), 773–778. https://doi.org/10.1016/j.jadohealth.2012.11.011
Robinson, J. P., & Espelage, D. L. (2013). Peer victimization and sexual risk differences between
lesbian, gay, bisexual, transgender, or questioning and nontransgender heterosexual
youths in grades 7–12. American Journal of Public Health, 103(10), 1810–1819.
https://doi.org/10.2105/AJPH.2013.301387

119

Rosario, M., Schrimshaw, E. W., Hunter, J., & Gwadz, M. (2002). Gay-related stress and
emotional distress among gay, lesbian and bisexual youths: A longitudinal examination.
Journal of Consulting and Clinical Psychology, 70(4), 967–975.
https://doi.org/10.1037/0022-006X.70.4.967
Rothman, E. F., Exner, D., & Baughman, A. L. (2011). The Prevalence of Sexual Assault
Against People Who Identify as Gay, Lesbian, or Bisexual in the United States: A
Systematic Review. Trauma, Violence, & Abuse, 12(2), 55–66.
https://doi.org/10.1177/1524838010390707
Rusow, J. (2018, November). Sexual assault and teen dating violence are associated with sex
under the influence and condomless sex among LGBQ high school adolescents in the
U.S. [Paper]. The Society for the Scientific Study of Sexuality, 2018 Annual Meeting,
Montreal, Quebec, Canada.
Rusow, J., Holguin, M., & Srivastava, A. (2018, November). Sexual identity and sexual risk
among adolescents in the United States who have experienced physical or sexual teen
dating violence [Paper]. American Public Health Association 2018 Annual Meeting &
Expo, San Diego, CA.
Rusow, J., Mendon, S., & Srivastava, A. (2019, January). Intimate violence and suicide attempt
among lesbian, gay, bisexual, and questioning adolescents in the United States [Paper].
Society for Social Work and Research 23rd Annual Conference, San Francisco, CA.
Rusow, J., & Srivastava, A. (2019, January). Lifetime sexual assault, teen dating violence
victimization, and LGBQ-identity are associated with condomless sex and sex under the
influence among high school adolescents in the United States [Poster]. Society for Social
Work and Research 23rd Annual Conference, San Francisco, CA.

120

Rusow, J., Srivastava, A., Rhoades, H., & Goldbach, J. (2018, November). Suicide attempt and
violent experiences among lesbian, gay, bisexual, and questioning adolescents in the
United States [Paper]. American Public Health Association 2018 Annual Meeting &
Expo, San Diego, CA.
Russell, S. T., Franz, B. T., & Driscoll, A. K. (2001). Same-sex romantic attraction and
experiences of violence in adolescence. American Journal of Public Health, 91(6), 903.
Saewyc, E. M. (2011). Research on adolescent sexual orientation: Development, health
disparities, stigma, and resilience. Journal of Research on Adolescence, 21(1), 256–272.
Schrager, S. M., Goldbach, J. T., & Mamey, M. R. (2018). Development of the Sexual Minority
Adolescent Stress Inventory. Frontiers in Psychology, 9, 319.
https://doi.org/10.3389/fpsyg.2018.00319
Silverman, J. G., Raj, A., Mucci, L. A., & Hathaway, J. E. (2001). Dating violence against
adolescent girls and associated substance use, unhealthy weight control, sexual risk
behavior, pregnancy, and suicidality. JAMA, 286(5), 572–579.
Spencer, C. M., Stith, S. M., & Cafferky, B. (2019). Risk markers for physical intimate partner
violence victimization: A meta-analysis. Aggression and Violent Behavior, 44, 8–17.
https://doi.org/10.1016/j.avb.2018.10.009
Srivastava, A., Rusow, J. A., & Goldbach, J. T. (2021). Differential risks for suicidality and
mental health symptoms among transgender, nonbinary, and cisgender sexual minority
youth accessing crisis services. Transgender Health, 6(1), 51–56.
Temple, J. R., & Freeman Jr, D. H. (2011). Dating violence and substance use among ethnically
diverse adolescents. Journal of Interpersonal Violence, 26(4), 701–718.

121

USDA ERS - Rural-Urban Commuting Area Codes. (n.d.). Retrieved April 16, 2021, from
https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes.aspx
Whitton, S. W., Newcomb, M. E., Messinger, A. M., Byck, G., & Mustanski, B. (2019). A
longitudinal study of IPV victimization among sexual minority youth. Journal of
Interpersonal Violence, 34(5), 912–945. https://doi.org/10.1177/0886260516646093
Wolitzky-Taylor, K. B., Ruggiero, K. J., Danielson, C. K., Resnick, H. S., Hanson, R. F., Smith,
D. W., Saunders, B. E., & Kilpatrick, D. G. (2008). Prevalence and correlates of dating
violence in a national sample of adolescents. Journal of the American Academy of Child
& Adolescent Psychiatry, 47(7), 755–762.

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Chapter 5: Implications and Future Directions
Major Findings and Implications
The goal of this dissertation was to expand our understanding of differential experiences
of interpersonal violence victimization (IPVV) among sexual minority adolescents (SMA). This
dissertation study was organized as a three-paper project, aimed to establish cross-sectional and
prospective correlations of IPVV experiences for SMA, and model trajectories of sexual assault
among SMA while considering their experiences of minority stress and other relevant correlates.
Key findings from each study follow.
In Chapter 2, we looked within a large national sample of SMA at differences in reports
of IPVV by age, sex, sexual identity, race/ethnicity, urbanicity, and in association with minority
stress experiences. We found that within the range of 14 to 17 years old, SMA did not differ by
age on experiences of physical of sexual dating violence or sexual assault, contrary to literature
that found risk increased with age before dropping off (Johnson et al., 2015). Physically forced
sexual intercourse (PFSI), the most extreme type of IPVV assessed in this dissertation, was
positively correlated with age. Similar to age, sex was associated with some types of IPVV but
not all. Consistent with literature showing elevated risk for female SMA (Martin-Storey, 2015;
Olsen et al., 2020; Reuter et al., 2017), we found that female participants in our study were more
likely than males to report past-year physical teen dating violence victimization (PTDVV), past-
year teen dating sexual assault (TDSA), and past-year sexual assault. Interestingly, there were no
sex differences for the outcome of lifetime PFSI. This finding suggests that SMA males
experience PFSI at similar rates to female adolescents, generally, in that both groups report
higher rates than heterosexual males (Caputi et al., 2020).

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Important differences were observed for sexual identity, where SMA who identified as
bisexual or pansexual at baseline were more likely to also report IPVV experience. This
underscores the importance of including multiple representations of identity and relationship
structure in prevention and intervention material targeting IPVV among adolescents. Similarly,
that SMA living in rural environments experienced some types of IPVV more frequently than
SMA living in urban environments highlights the needs of SMA in more remote settings.
In Chapter 3, we modeled future experiences of IPVV among SMA with prospective
correlates of age, sex, sexual identity, race and ethnicity, urbanicity, recent minority stress
experiences, mental health symptomology, and previous IPVV experience. Importantly, previous
experience of IPVV was a correlate in each model of individual IPVV experience, which was
consistent with literature showing re-victimization as a function of previous victimization (Basile
et al., 2020; Halpern et al., 2009). In addition to violence experiences, stress was another
important prospective correlate identified by our models. Both minority stress and posttraumatic
stress symptoms were prospectively associated with PTDVV, TDSA, and sexual assault.
Notably, PFSI was associated with neither minority stress nor posttraumatic stress,
however we believe that may be a function of how PFSI was assessed at baseline (a lifetime
recall) affecting the model. We believe recent experiences may show significant associative
effects. In this study—like in Chapter 2—bisexual and pansexual adolescents reported higher
rates of some IPVV experiences over time. Indeed, both studies utilize the same sample,
however the study in Chapter 2 uses a larger cross-sectional sample (N=2,560), while Chapter 3
uses a subset of that sample (N=1,076), but followed them over 18 months and had up to four
reporting periods for each adolescent. Such differential experiences by bisexual and pansexual
adolescents may be due to double-jeopardy stigmatization—homonegativity from heterosexual

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populations and bi-negativity or pan-negativity from queer communities (Feinstein & Dyar,
2017). All such “-negativity” experiences are forms of minority stress.
In Chapter 4, we sought to examine the temporal relationship of minority stress and
sexual assault experiences among a sample of sexual minority adolescents in the United States
using latent growth modeling techniques. The overall trajectory of sexual assault rates neither
significantly increased nor decreased across the study. This is partially consistent with research
on trajectories of violence that show decreases after an initial peak in adolescence or early
adulthood (Johnson et al., 2015; Whitton et al., 2019)—although this is a longitudinal study, it
may not be a long enough view to see the drop off in sexual assault previous literature would
suggest. Second, consistent with research showing that revictimization is unfortunately common
(Basile et al., 2020; Halpern et al., 2009), the intercept for growth trajectories of adolescents who
reported previous sexual assault victimization at baseline were significantly higher. While the
slope was not significantly different, the overall rates of sexual assault at each wave for
adolescents who experienced prior victimization, were higher.
Perhaps the most important discovery in this study was the consistent effect of minority
stress experiences preceding reporting of sexual assault. Our study examined whether sexual
minority stress experiences in the 30 days leading up to a survey wave were associated with a
report of sexual assault over the subsequent 6 months. Consistent with studies of sexual minority
adults (Balsam, 2001; Balsam & Szymanski, 2005; Finneran & Stephenson, 2014), and Whitton
and colleagues’ (2019) study of SMA and young adults, our modelling showed that at each
wave, SMA who reported more recent minority stress experiences were at increased risk of
sexual assault. This finding suggests that efforts to reduce minority stress experiences may
additionally work to reduce the risk of sexual assault among SMA in the United States. While

125

perpetrator information and other victimization context were not assessed in our study, the
results are consistent with routine activities theory which posits that for victimization to occur,
three things need to be present: a) the absence of a guardian or bystander to intervene, b) a
motivated perpetrator, and c) a target deemed suitable by the perpetrator (Cohen & Felson,
1979). It may be that “looking stressed” makes one a more attractive target to perpetrators.
Reducing minority stress for SMA may indirectly work to reduce the interest of perpetrators.
Limitations and Conclusions
Despite the important associations and prospective correlates of IPVV experiences
identified in this dissertation, it is not without limitations. These studies focused exclusively on
cisgender youth which does not further our understanding of the experiences of IPVV among
transgender, nonbinary, or gender expansive adolescents (Srivastava et al., 2021). Future studies
should replicate these techniques with gender expansive adolescent samples. Additionally, while
online recruitment allowed us to assemble a large, national, sample of AMA, in both rural and
urban settings, the explicit confidentiality of study participation raises validity concerns about
participant duplication or fraud. We established rigorous study protocols to mitigate fraud and
duplicate survey attempts by thoroughly examining validation checks and survey metadata.
Although large, our sample was not assembled using probabilistic methods and thus limits the
generalizability of our findings. Our sample had over-representation of white and female SMA
relative to national probability samples (Kann et al., 2018). Participants were allowed to refer
other adolescents to the study, possibly increasing our reach beyond those who would respond to
ads posted on social media. Although self-report can often induce response bias in interviewer-
led surveys, our online self-administered survey aimed to reduce this bias by separating the data
and contact information collection and reiterating the confidentiality of their survey responses.

126

For social workers, counselors, other preventionists, as well as policymakers, this work
elucidates several important considerations. Work has documented the elevated rates of IPVV
among SMA compared to their heterosexual peers (Basile et al., 2020; Holguin et al., 2018;
Kann et al., 2018; Rusow, 2018; Rusow et al., 2019; Rusow, Holguin, et al., 2018; Rusow,
Srivastava, et al., 2018; Rusow & Srivastava, 2019). This work extends that by highlighting
additional risk among bisexual and pansexual adolescents relative to their gay and lesbian peers.
These groups should be represented in prevention material and practitioners should be aware of
these disparities so as not to exacerbate them by further victimizing these vulnerable populations
through dismissal.
It is important to recognize the relationship between stress and victimization experiences.
Whether contemporaneous, future, or over time, these studies identified several important
correlates of IPVV experiences for SMA. Even accounting for past violence victimization and
controlling for demographic characteristics, minority stress experiences and posttraumatic stress
symptomology were prospectively associated with future experiences of physical and sexual
dating violence, as well as sexual assault. Future work should examine the consistency of this
relationship between minority stress and trajectories of IPVV, over time, to examine chronicity
and determine if there are common patterns that emerge in timing, to identify potential targets for
intervention.
Importantly, these studies used prospective data for a cohort of sexual minority
adolescents to track experiences of minority stress and sexual assault across time. Such
information is lacking from large, probability studies of adolescents throughout the United
States. Targeting questions about sexual minority stressors to heterosexual adolescents in
representative samples, like the biannual YRBS, would be time and cost prohibitive, as well as

127

place undue burden on the youth participants. Future studies may use advanced blocking
techniques to assess additional relevant questions with in-survey branching, but this is currently
not possible with the paper-based self-administered surveys often used in American schools.
Until then, large national convenience samples are our best source for this data.
Our finding in Chapter 4 that minority stress persisted as a prospective correlate of sexual
assault highlights minority stress as a potential target for sexual assault prevention and
intervention. Notably, the overall trajectory was similar for the sample irrespective of age, sex,
sexual identity, race, ethnicity, or urbanicity. Perhaps a focus on reducing adolescent minority
stressors would improve the lives of adolescents across all these demographic categories.
Policies that limit or exacerbate minority stress are likely to have numerous other consequences
that should be considered (for example, beyond the teams youth can play on or the bathrooms
they can use). Future studies should look over a longer period of time to further assess the
trajectory of sexual assault, as previous literature has indicated that it is unlikely to be flat during
adolescence and young adulthood when viewed over longer periods (Johnson et al., 2015;
Whitton et al., 2019). Over a longer observation period, researchers can more closely investigate
constructs that are associated with the increases or decreases in overall trajectory. Additionally,
capturing perpetrator information and victimization context during study visits may assist
researchers in identifying additional prevention and intervention targets.
In summary, even though SMA experience higher rates of PTDVV, TDSA, sexual
assault, and PFSI, relative to their heterosexual peers (Basile et al., 2020; Holguin et al., 2018;
Kann et al., 2018; Rusow, 2018; Rusow et al., 2019; Rusow, Holguin, et al., 2018; Rusow,
Srivastava, et al., 2018; Rusow & Srivastava, 2019), important subgroup differences exist. This
is partly explained by the accumulation of unique minority stressors in addition to daily life

128

stressors (Goldbach et al., 2015; Meyer, 1995, 2003). This dissertation identified multiple
covariates of sexual assault, physically forced sexual intercourse, physical teen dating violence
victimization, and teen dating sexual assault—both cross-sectionally and prospectively—as well
as investigated the trajectory of sexual assault, over time, for a national sample of sexual
minority adolescents. Social workers and other helping professionals should acquire specialized
training in understanding the various needs and experiences of diverse sexual minority
adolescents who may come to them for help (Roe, 2013). Failing to do so may increase
adolescent experiences of minority stress, potentially increasing the burden for an already
vulnerable population.

129

References
Balsam, K. F. (2001). Nowhere to Hide. Women & Therapy, 23(3), 25–37.
https://doi.org/10.1300/J015v23n03_03
Balsam, K. F., & Szymanski, D. M. (2005). Relationship Quality and Domestic Violence in
Women’s Same-Sex Relationships: The Role of Minority Stress. Psychology of Women
Quarterly, 29(3), 258–269. https://doi.org/10.1111/j.1471-6402.2005.00220.x
Basile, K. C., Clayton, H. B., DeGue, S., Gilford, J. W., Vagi, K. J., Suarez, N. A., Zwald, M. L.,
& Lowry, R. (2020). Interpersonal Violence Victimization Among High School
Students—Youth Risk Behavior Survey, United States, 2019. MMWR Supplements,
69(1), 28–37. https://doi.org/10.15585/mmwr.su6901a4
Caputi, T. L., Shover, C. L., & Watson, R. J. (2020). Physical and Sexual Violence Among Gay,
Lesbian, Bisexual, and Questioning Adolescents. JAMA Pediatrics, 174(8), 791.
https://doi.org/10.1001/jamapediatrics.2019.6291
Cohen, L. E., & Felson, M. (1979). Social change and crime rate trends: A routine activity
approach. American Sociological Review, 44, 588–608.
Feinstein, B. A., & Dyar, C. (2017). Bisexuality, minority stress, and health. Current Sexual
Health Reports, 9(1), 42–49. https://doi.org/10.1007/s11930-017-0096-3
Finneran, C., & Stephenson, R. (2014). Intimate Partner Violence, Minority Stress, and Sexual
Risk-Taking Among U.S. Men Who Have Sex With Men. Journal of Homosexuality,
61(2), 288–306. https://doi.org/10.1080/00918369.2013.839911
Goldbach, J. T., Schrager, S. M., Dunlap, S. L., & Holloway, I. W. (2015). The Application of
Minority Stress Theory to Marijuana Use Among Sexual Minority Adolescents.

130

Substance Use & Misuse, 50(3), 366–375.
https://doi.org/10.3109/10826084.2014.980958
Halpern, C. T., Spriggs, A. L., Martin, S. L., & Kupper, L. L. (2009). Patterns of Intimate Partner
Violence Victimization from Adolescence to Young Adulthood in a Nationally
Representative Sample. Journal of Adolescent Health, 45(5), 508–516.
https://doi.org/10.1016/j.jadohealth.2009.03.011
Holguin, M., Rusow, J., & Srivastava, A. (2018, November). History of sexual assault is
associated with condomless sex and sex under the influence among high school youth in
the United States [Poster]. American Public Health Association 2018 Annual Meeting &
Expo, San Diego, CA.
Johnson, W. L., Manning, W. D., Giordano, P. C., & Longmore, M. A. (2015). Relationship
Context and Intimate Partner Violence From Adolescence to Young Adulthood. Journal
of Adolescent Health, 57(6), 631–636. https://doi.org/10.1016/j.jadohealth.2015.08.014
Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Queen, B., Lowry, R.,
Chyen, D., Whittle, L., & Thornton, J. (2018). Youth risk behavior surveillance—United
States, 2017. MMWR Surveillance Summaries, 67(8), 1–114.
https://doi.org/10.15585/mmwr.ss6708a1
Martin-Storey, A. (2015). Prevalence of Dating Violence Among Sexual Minority Youth:
Variation Across Gender, Sexual Minority Identity and Gender of Sexual Partners.
Journal of Youth and Adolescence, 44(1), 211–224. https://doi.org/10.1007/s10964-013-
0089-0
Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social
Behavior, 36(1), 38–56. https://doi.org/10.2307/2137286

131

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual
populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5),
674–697. https://doi.org/10.1037/0033-2909.129.5.674
Olsen, E. O., Vivolo-Kantor, A., & Kann, L. (2020). Physical and Sexual Teen Dating Violence
Victimization and Sexual Identity Among U.S. High School Students, 2015. Journal of
Interpersonal Violence, 35(17–18), 3581–3600.
https://doi.org/10.1177/0886260517708757
Reuter, T. R., Newcomb, M. E., Whitton, S. W., & Mustanski, B. (2017). Intimate partner
violence victimization in LGBT young adults: Demographic differences and associations
with health behaviors. Psychology of Violence, 7(1), 101–109.
https://doi.org/10.1037/vio0000031
Roe, S. (2013). “Put It Out There That You Are Willing To Talk About Anything”: The Role of
School Counselors in Providing Support to gay and Bisexual Youth. Professional School
Counseling, 17(1), 2156759X0001700111.
https://doi.org/10.1177/2156759X0001700111
Rusow, J. (2018, November). Sexual assault and teen dating violence are associated with sex
under the influence and condomless sex among LGBQ high school adolescents in the
U.S. [Paper]. The Society for the Scientific Study of Sexuality, 2018 Annual Meeting,
Montreal, Quebec, Canada.
Rusow, J., Holguin, M., & Srivastava, A. (2018, November). Sexual identity and sexual risk
among adolescents in the United States who have experienced physical or sexual teen
dating violence [Paper]. American Public Health Association 2018 Annual Meeting &
Expo, San Diego, CA.

132

Rusow, J., Mendon, S., & Srivastava, A. (2019, January). Intimate violence and suicide attempt
among lesbian, gay, bisexual, and questioning adolescents in the United States [Paper].
Society for Social Work and Research 23rd Annual Conference, San Francisco, CA.
Rusow, J., & Srivastava, A. (2019, January). Lifetime sexual assault, teen dating violence
victimization, and LGBQ-identity are associated with condomless sex and sex under the
influence among high school adolescents in the United States [Poster]. Society for Social
Work and Research 23rd Annual Conference, San Francisco, CA.
Rusow, J., Srivastava, A., Rhoades, H., & Goldbach, J. (2018, November). Suicide attempt and
violent experiences among lesbian, gay, bisexual, and questioning adolescents in the
United States [Paper]. American Public Health Association 2018 Annual Meeting &
Expo, San Diego, CA.
Srivastava, A., Rusow, J. A., & Goldbach, J. T. (2021). Differential risks for suicidality and
mental health symptoms among transgender, nonbinary, and cisgender sexual minority
youth accessing crisis services. Transgender Health, 6(1), 51–56.
Whitton, S. W., Newcomb, M. E., Messinger, A. M., Byck, G., & Mustanski, B. (2019). A
longitudinal study of IPV victimization among sexual minority youth. Journal of
Interpersonal Violence, 34(5), 912–945. https://doi.org/10.1177/0886260516646093

133

Bibliography
Ballard, M. E., Jameson, J. P., & Martz, D. M. (2017). Sexual identity and risk behaviors among
adolescents in rural Appalachia. Journal of Rural Mental Health, 41(1), 17–29.
https://doi.org/10.1037/rmh0000068
Balsam, K. F. (2001). Nowhere to Hide. Women & Therapy, 23(3), 25–37.
https://doi.org/10.1300/J015v23n03_03
Balsam, K. F., & Szymanski, D. M. (2005). Relationship Quality and Domestic Violence in
Women’s Same-Sex Relationships: The Role of Minority Stress. Psychology of Women
Quarterly, 29(3), 258–269. https://doi.org/10.1111/j.1471-6402.2005.00220.x
Basile, K. C., Clayton, H. B., DeGue, S., Gilford, J. W., Vagi, K. J., Suarez, N. A., Zwald, M. L.,
& Lowry, R. (2020). Interpersonal Violence Victimization Among High School
Students—Youth Risk Behavior Survey, United States, 2019. MMWR Supplements,
69(1), 28–37. https://doi.org/10.15585/mmwr.su6901a4
Binion, K., & Gray, M. J. (2020). Minority Stress Theory and Internalized Homophobia among
LGB Sexual Assault Survivors: Implications for Posttraumatic Adjustment. Journal of
Loss and Trauma, 25(5), 454–471. https://doi.org/10.1080/15325024.2019.1707987
Birkett, M., Espelage, D. L., & Koenig, B. (2009). LGB and Questioning Students in Schools:
The Moderating Effects of Homophobic Bullying and School Climate on Negative
Outcomes. Journal of Youth and Adolescence, 38(7), 989–1000.
https://doi.org/10.1007/s10964-008-9389-1
Brown, G. W., & Harris, T. (1978). Social Origins of Depression: A study of psychiatric disorder
in women. The Free Press, A Division of Macmillan Publishing Company, Inc.

134

Caputi, T. L., Shover, C. L., & Watson, R. J. (2020). Physical and Sexual Violence Among Gay,
Lesbian, Bisexual, and Questioning Adolescents. JAMA Pediatrics, 174(8), 791.
https://doi.org/10.1001/jamapediatrics.2019.6291
Centers for Disease Control and Prevention. (2021, March 16). Preventing Teen Dating
Violence. Preventing Teen Dating Violence.
https://www.cdc.gov/violenceprevention/intimatepartnerviolence/teendatingviolence/fastf
act.html
Cohen, L. E., & Felson, M. (1979). Social change and crime rate trends: A routine activity
approach. American Sociological Review, 44, 588–608.
Coker, T. R., Austin, S. B., & Schuster, M. A. (2010). The health and health care of lesbian, gay,
and bisexual adolescents. Annual Review of Public Health, 31, 457–477.
https://doi.org/10.1146/annurev.publhealth.012809.103636
Dank, M., Lachman, P., Zweig, J. M., & Yahner, J. (2014). Dating Violence Experiences of
Lesbian, Gay, Bisexual, and Transgender Youth. Journal of Youth and Adolescence,
43(5), 846–857. https://doi.org/10.1007/s10964-013-9975-8
Davidson, J. R. T., Hughes, D. C., George, L. K., & Blazer, D. G. (1996). The Association of
Sexual Assault and Attempted Suicide Within the Community. Archives of General
Psychiatry, 53(6), 550–555. https://doi.org/10.1001/archpsyc.1996.01830060096013
Devries, K. M., Mak, J. Y., Bacchus, L. J., Child, J. C., Falder, G., Petzold, M., Astbury, J., &
Watts, C. H. (2013). Intimate Partner Violence and Incident Depressive Symptoms and
Suicide Attempts: A Systematic Review of Longitudinal Studies. PLOS Medicine, 10(5),
e1001439. https://doi.org/10.1371/journal.pmed.1001439

135

di Giacomo, E., Krausz, M., Colmegna, F., Aspesi, F., & Clerici, M. (2018). Estimating the Risk
of Attempted Suicide Among Sexual Minority Youths: A Systematic Review and Meta-
analysis. JAMA Pediatrics, 172(12), 1145–1152.
https://doi.org/10.1001/jamapediatrics.2018.2731
Dragowski, E. A., Halkitis, P. N., Grossman, A. H., & D’Augelli, A. R. (2011). Sexual
Orientation Victimization and Posttraumatic Stress Symptoms Among Lesbian, Gay, and
Bisexual Youth. Journal of Gay & Lesbian Social Services, 23(2), 226–249.
https://doi.org/10.1080/10538720.2010.541028
Feinstein, B. A., & Dyar, C. (2017). Bisexuality, minority stress, and health. Current Sexual
Health Reports, 9(1), 42–49. https://doi.org/10.1007/s11930-017-0096-3
Finneran, C., & Stephenson, R. (2014). Intimate Partner Violence, Minority Stress, and Sexual
Risk-Taking Among U.S. Men Who Have Sex With Men. Journal of Homosexuality,
61(2), 288–306. https://doi.org/10.1080/00918369.2013.839911
Freedner, N., Freed, L. H., Yang, Y. W., & Austin, S. B. (2002). Dating violence among gay,
lesbian, and bisexual adolescents: Results from a community survey. Journal of
Adolescent Health, 31(6), 469–474. https://doi.org/10.1016/S1054-139X(02)00407-X
Goldbach, J. T., & Gibbs, J. J. (2017). A developmentally informed adaptation of minority stress
for sexual minority adolescents. Journal of Adolescence, 55, 36–50.
https://doi.org/10.1016/j.adolescence.2016.12.007
Goldbach, J. T., Schrager, S. M., Dunlap, S. L., & Holloway, I. W. (2015). The Application of
Minority Stress Theory to Marijuana Use Among Sexual Minority Adolescents.
Substance Use & Misuse, 50(3), 366–375.
https://doi.org/10.3109/10826084.2014.980958

136

Goldbach, J. T., Schrager, S. M., & Mamey, M. R. (2017). Criterion and divergent validity of the
sexual minority adolescent stress inventory. Frontiers in Psychology, 8, 2057.
https://doi.org/10.3389/fpsyg.2017.02057
Goldbach, J. T., Tanner-Smith, E. E., Bagwell, M., & Dunlap, S. (2014). Minority Stress and
Substance Use in Sexual Minority Adolescents: A Meta-analysis. Prevention Science,
15(3), 350–363. https://doi.org/10.1007/s11121-013-0393-7
Grimm, K. J., Ram, N., & Estabrook, R. (2016). Growth modeling: Structural equation and
multilevel modeling approaches. Guilford Publications.
Halpern, C. T., Spriggs, A. L., Martin, S. L., & Kupper, L. L. (2009). Patterns of Intimate Partner
Violence Victimization from Adolescence to Young Adulthood in a Nationally
Representative Sample. Journal of Adolescent Health, 45(5), 508–516.
https://doi.org/10.1016/j.jadohealth.2009.03.011
Hatzenbuehler, M. L., McLaughlin, K. A., & Nolen‐Hoeksema, S. (2008). Emotion regulation
and internalizing symptoms in a longitudinal study of sexual minority and heterosexual
adolescents. Journal of Child Psychology and Psychiatry, 49(12), 1270–1278.
https://doi.org/10.1111/j.1469-7610.2008.01924.x
Holguin, M., Rusow, J., & Srivastava, A. (2018, November). History of sexual assault is
associated with condomless sex and sex under the influence among high school youth in
the United States [Poster]. American Public Health Association 2018 Annual Meeting &
Expo, San Diego, CA.
Johnson, W. L., Manning, W. D., Giordano, P. C., & Longmore, M. A. (2015). Relationship
Context and Intimate Partner Violence From Adolescence to Young Adulthood. Journal
of Adolescent Health, 57(6), 631–636. https://doi.org/10.1016/j.jadohealth.2015.08.014

137

Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Queen, B., Lowry, R.,
Chyen, D., Whittle, L., & Thornton, J. (2018). Youth risk behavior surveillance—United
States, 2017. MMWR Surveillance Summaries, 67(8), 1–114.
https://doi.org/10.15585/mmwr.ss6708a1
Lang, A. J., Wilkins, K., Roy-Byrne, P. P., Golinelli, D., Chavira, D., Sherbourne, C., Rose, R.
D., Bystritsky, A., Sullivan, G., Craske, M. G., & Stein, M. B. (2012). Abbreviated PTSD
Checklist (PCL) as a guide to clinical response. General Hospital Psychiatry, 34(4), 332–
338. https://doi.org/10.1016/j.genhosppsych.2012.02.003
Maniglio, R. (2009). The impact of child sexual abuse on health: A systematic review of
reviews. Clinical Psychology Review, 29(7), 647–657.
https://doi.org/10.1016/j.cpr.2009.08.003
Marshal, M. P., Dietz, L. J., Friedman, M. S., Stall, R., Smith, H. A., McGinley, J., Thoma, B.
C., Murray, P. J., D’Augelli, A. R., & Brent, D. A. (2011). Suicidality and depression
disparities between sexual minority and heterosexual youth: A meta-analytic review.
Journal of Adolescent Health, 49(2), 115–123.
Martin-Storey, A. (2015). Prevalence of Dating Violence Among Sexual Minority Youth:
Variation Across Gender, Sexual Minority Identity and Gender of Sexual Partners.
Journal of Youth and Adolescence, 44(1), 211–224. https://doi.org/10.1007/s10964-013-
0089-0
McLaughlin, K. A., Hatzenbuehler, M. L., Xuan, Z., & Conron, K. J. (2012). Disproportionate
exposure to early-life adversity and sexual orientation disparities in psychiatric
morbidity. Child Abuse & Neglect, 36(9), 645–655.
https://doi.org/10.1016/j.chiabu.2012.07.004

138

Melchior, L. A., Huba, G., Brown, V. B., & Reback, C. J. (1993). A short depression index for
women. Educational and Psychological Measurement, 53(4), 1117–1125.
https://doi.org/10.1177/0013164493053004024
Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social
Behavior, 36(1), 38–56. https://doi.org/10.2307/2137286
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual
populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5),
674–697. https://doi.org/10.1037/0033-2909.129.5.674
Muthén, L. K., & Muthén, B. O. (2017). Mplus User’s Guide. Eighth Edition. Muthén &
Muthén.
Olsen, E. O., Vivolo-Kantor, A., & Kann, L. (2020). Physical and Sexual Teen Dating Violence
Victimization and Sexual Identity Among U.S. High School Students, 2015. Journal of
Interpersonal Violence, 35(17–18), 3581–3600.
https://doi.org/10.1177/0886260517708757
Relyea, M., & Ullman, S. E. (2015). Unsupported or Turned Against: Understanding How Two
Types of Negative Social Reactions to Sexual Assault Relate to Postassault Outcomes.
Psychology of Women Quarterly, 39(1), 37–52.
https://doi.org/10.1177/0361684313512610
Reuter, T. R., Newcomb, M. E., Whitton, S. W., & Mustanski, B. (2017). Intimate partner
violence victimization in LGBT young adults: Demographic differences and associations
with health behaviors. Psychology of Violence, 7(1), 101–109.
https://doi.org/10.1037/vio0000031

139

Reuter, T. R., Sharp, C., & Babcock, J. C. (2015). The relation between borderline personality
disorder features and teen dating violence. Psychology of Violence, 5(2), 163–173.
http://dx.doi.org.libproxy2.usc.edu/10.1037/a0037891
Rice, E., Barman-Adhikari, A., Rhoades, H., Winetrobe, H., Fulginiti, A., Astor, R., Montoya, J.,
Plant, A., & Kordic, T. (2013). Homelessness experiences, sexual orientation, and sexual
risk taking among high school students in Los Angeles. Journal of Adolescent Health,
52(6), 773–778. https://doi.org/10.1016/j.jadohealth.2012.11.011
Robinson, J. P., & Espelage, D. L. (2013). Peer victimization and sexual risk differences between
lesbian, gay, bisexual, transgender, or questioning and nontransgender heterosexual
youths in grades 7–12. American Journal of Public Health, 103(10), 1810–1819.
https://doi.org/10.2105/AJPH.2013.301387
Roe, S. (2013). “Put It Out There That You Are Willing To Talk About Anything”: The Role of
School Counselors in Providing Support to gay and Bisexual Youth. Professional School
Counseling, 17(1), 2156759X0001700111.
https://doi.org/10.1177/2156759X0001700111
Rosario, M., Schrimshaw, E. W., Hunter, J., & Gwadz, M. (2002). Gay-related stress and
emotional distress among gay, lesbian and bisexual youths: A longitudinal examination.
Journal of Consulting and Clinical Psychology, 70(4), 967–975.
https://doi.org/10.1037/0022-006X.70.4.967
Rothman, E. F., Exner, D., & Baughman, A. L. (2011). The Prevalence of Sexual Assault
Against People Who Identify as Gay, Lesbian, or Bisexual in the United States: A
Systematic Review. Trauma, Violence, & Abuse, 12(2), 55–66.
https://doi.org/10.1177/1524838010390707

140

Rusow, J. (2018, November). Sexual assault and teen dating violence are associated with sex
under the influence and condomless sex among LGBQ high school adolescents in the
U.S. [Paper]. The Society for the Scientific Study of Sexuality, 2018 Annual Meeting,
Montreal, Quebec, Canada.
Rusow, J., Holguin, M., & Srivastava, A. (2018, November). Sexual identity and sexual risk
among adolescents in the United States who have experienced physical or sexual teen
dating violence [Paper]. American Public Health Association 2018 Annual Meeting &
Expo, San Diego, CA.
Rusow, J., Mendon, S., & Srivastava, A. (2019, January). Intimate violence and suicide attempt
among lesbian, gay, bisexual, and questioning adolescents in the United States [Paper].
Society for Social Work and Research 23rd Annual Conference, San Francisco, CA.
Rusow, J., & Srivastava, A. (2019, January). Lifetime sexual assault, teen dating violence
victimization, and LGBQ-identity are associated with condomless sex and sex under the
influence among high school adolescents in the United States [Poster]. Society for Social
Work and Research 23rd Annual Conference, San Francisco, CA.
Rusow, J., Srivastava, A., Rhoades, H., & Goldbach, J. (2018, November). Suicide attempt and
violent experiences among lesbian, gay, bisexual, and questioning adolescents in the
United States [Paper]. American Public Health Association 2018 Annual Meeting &
Expo, San Diego, CA.
Russell, S. T., Franz, B. T., & Driscoll, A. K. (2001). Same-sex romantic attraction and
experiences of violence in adolescence. American Journal of Public Health, 91(6), 903.
Saewyc, E. M. (2011). Research on adolescent sexual orientation: Development, health
disparities, stigma, and resilience. Journal of Research on Adolescence, 21(1), 256–272.

141

Schrager, S. M., Goldbach, J. T., & Mamey, M. R. (2018). Development of the Sexual Minority
Adolescent Stress Inventory. Frontiers in Psychology, 9, 319.
https://doi.org/10.3389/fpsyg.2018.00319
Silverman, J. G., Raj, A., Mucci, L. A., & Hathaway, J. E. (2001). Dating violence against
adolescent girls and associated substance use, unhealthy weight control, sexual risk
behavior, pregnancy, and suicidality. JAMA, 286(5), 572–579.
Spencer, C. M., Stith, S. M., & Cafferky, B. (2019). Risk markers for physical intimate partner
violence victimization: A meta-analysis. Aggression and Violent Behavior, 44, 8–17.
https://doi.org/10.1016/j.avb.2018.10.009
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for
assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine,
166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092
Srivastava, A., Rusow, J. A., & Goldbach, J. T. (2021). Differential risks for suicidality and
mental health symptoms among transgender, nonbinary, and cisgender sexual minority
youth accessing crisis services. Transgender Health, 6(1), 51–56.
Temple, J. R., & Freeman Jr, D. H. (2011). Dating violence and substance use among ethnically
diverse adolescents. Journal of Interpersonal Violence, 26(4), 701–718.
USDA ERS - Rural-Urban Commuting Area Codes. (n.d.). Retrieved April 16, 2021, from
https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes.aspx
Whitton, S. W., Newcomb, M. E., Messinger, A. M., Byck, G., & Mustanski, B. (2019). A
longitudinal study of IPV victimization among sexual minority youth. Journal of
Interpersonal Violence, 34(5), 912–945. https://doi.org/10.1177/0886260516646093

142

Wolitzky-Taylor, K. B., Ruggiero, K. J., Danielson, C. K., Resnick, H. S., Hanson, R. F., Smith,
D. W., Saunders, B. E., & Kilpatrick, D. G. (2008). Prevalence and correlates of dating
violence in a national sample of adolescents. Journal of the American Academy of Child
& Adolescent Psychiatry, 47(7), 755–762.
Zweig, J. M., Dank, M., Yahner, J., & Lachman, P. (2013). The Rate of Cyber Dating Abuse
Among Teens and How It Relates to Other Forms of Teen Dating Violence. Journal of
Youth and Adolescence, 42(7), 1063–1077. https://doi.org/10.1007/s10964-013-9922-8

Abstract (if available)

Abstract Sexual minority adolescents (SMA) experience interpersonal violence victimization (IPVV)?including sexual assault, physically forced sexual intercourse, physical teen dating violence victimization, and teen dating sexual assault?more frequently than their heterosexual peers. Despite the literature that documents this phenomenon, there is a lack of research on minority stressors and the other contemporaneous and prospective correlates of interpersonal violence victimization among this vulnerable group. This dissertation is a collection of three separate?but related?studies and aims to document among a national sample of diverse sexual minority adolescents, subgroup differences, minority stress, and other correlates of violence victimization. ? Paper 1: Contemporaneous Correlates of IPVV ? Most studies that measure IPVV among SMA do so in comparison to heterosexual adolescents and either ignore or are unable to measure differences between SMA subgroups?namely adolescents of different sexual identities. This study examines bivariate and multivariate differences in reports of IPVV by age, sex, sexual identity, race and ethnicity, urbanicity, and by experiences of minority stress. Sexual identity, race, urbanicity, and minority stress experience are all associated with past-year physical teen dating violence. Sex, sexual identity, urbanicity, and minority stress experience are all associated with past-year teen dating sexual assault. Sex, sexual identity, race, and minority stress experience are all associated with past-year sexual assault. Sexual identity, urbanicity, age, and minority stress experience are all associated with lifetime physically forced sexual intercourse. Understanding the relationship between identity, minority stress and IPVV gives violence preventionists additional tools in their fight against victimization. ? Paper 2: Prospective Correlates of IPVV ? Interpersonal violence victimization is a public health crisis and SMA bear disproportionate burden. This paper identifies the relative prospective contribution of identity characteristics (age, sex, sexual identity, race and ethnicity), urbanicity, mental health symptomology (depressive, anxiety, and posttraumatic symptoms) and minority stress on each of four IPVV experiences among SMA at a later time, accounting for previous violence victimization. Previous research has examined some of these identity characteristics, in smaller samples of SMA or larger samples that include heterosexual young adults, but this is the first study of this size, of just SMA, and of this age range (14 to 17 years old at baseline) in assessing future reports of IPVV. Recent minority stress, posttraumatic stress symptoms, and past-year physical dating violence were prospectively associated with physical teen dating violence victimization at a later time. Sex, recent minority stress experience, and past-year teen dating sexual assault victimization were prospectively associated with teen dating sexual assault victimization at a later time. Sexual identity, recent minority stress experience, posttraumatic stress symptoms, and past-year sexual assault victimization were prospectively associated with sexual assault victimization at a later time. Sexual identity and past lifetime physically forced sexual intercourse were prospectively associated with physically forced sexual intercourse at a later time. Past violence victimization and minority stress experiences?which are not routinely assessed?are associated with future experiences of IPVV, thus helping professionals should inquire about experiences of violence and stress for violence prevention. ? Paper 3: Trajectory of Sexual Assault ? The relationship between minority stress and sexual assault is apparent in the literature, but little is known about the temporal relationship between these two victimization experiences. Minority stress may contribute to sexual assault, or sexual assault might sensitize one to, or increase one’s risk of, minority stress experiences. Sexual assault may be a minority stress if it is attributed to the victim’s sexual identity. This study follows a United States nationwide sample of sexual minority adolescents, ages 14–17, across four data-collection timepoints over the course of 18 months. This paper expands on previous work that identified an association between lifetime minority stress experiences and later reports of sexual assault by examining any impact recent minority stress has on trajectories of sexual assault. Overall, the likelihood of sexual assault in the sample decreased over time. Rates of sexual assault were higher for adolescents who reported a sexual assault experience prior to the start of the study. Adolescents who reported more recent (past month) minority stress experiences at each wave were more likely to report a sexual assault at the next wave of data collection. Understanding the timing and etiology of the trajectory of sexual assault as it relates to minority stress will elucidate intervention targets and can sensitize clinicians to the sequelae of behavioral health concerns that SMA are facing. ? Implications and Conclusion: ? These studies document several findings that should be of interest to preventionists or interventionists?be they social workers, school counselors, public health officials, nurses, community health workers, or any of the many other others working in helping professions. Important differences in IPVV experiences, e.g., that bisexual and pansexual adolescents have elevated risk for some IPVV experience than gay or lesbian adolescents, and important similarities, e.g., that male and female SMA experience similar rates of physically forced sexual intercourse, should shape our thinking in how to help vulnerable adolescents. Knowing that minority stress and posttraumatic stress, in addition to past experience of violence, increases an SMA’s risk of future IPVV, gives professionals additional screening indicators to assist their provisioning of services. Not attending to these issues may increase burden among SMA. ? This dissertation is the first to examine the relationship between IPVV and minority stress using a comprehensive inventory of developmentally appropriate minority stress experiences. Thus, it assesses among adolescents, for the first time, how minority stress may be related to violence victimization contemporaneously, prospectively, and over time. Given our understanding that SMA are at higher risk for IPVV than their heterosexual peers, it is important to document subgroup differences to measure if risk is uniformly distributed among this diverse group. Only then can we begin to target mechanisms that may be driving the cycle of violence victimization among this group that is disproportionately affected.

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Asset Metadata

Creator Rusow, Joshua Aaron (author)

Core Title Complicated relationships: the prevalence and correlates of sexual assault, dating violence victimization, and minority stress among sexual minority adolescents throughout the United States

School Suzanne Dworak-Peck School of Social Work

Degree Master of Social Work / Doctor of Philosophy

Degree Program Social Work

Degree Conferral Date 2021-08

Publication Date 07/19/2023

Defense Date 06/17/2021

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag adolescence,dating violence,LGBTQ,Mental Health,minority stress,OAI-PMH Harvest,Sexual assault,sexual minority,violence victimization

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Goldbach, Jeremy (committee chair), Dilkina, Bistra (committee member), Rice, Eric (committee member)

Creator Email joshua.rusow@gmail.com,rusow@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC15614226

Unique identifier UC15614226

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