Social Marginalization Experiences of Sexual and Gender Diverse Adolescents across Geographic and Restrictive Policy Environments

Background and Purpose: Sexual and gender diverse (SGD) adolescents face increased minority stress, which contributes to disparities in mental health and well-being. These stressors are influenced not only by interpersonal environments but also by broader structural factors, including geographic location and state-level policy climates. Nearly half of SGD youth in the United States live in states with restrictive or hostile policies, yet limited research has explored how these policy environments intersect with rurality to affect distal minority stress experiences (e.g., social marginalization (SM) in community and school settings). The existing literature is further limited by metronormativity bias—the concept of underrepresenting rural SGD youth thus omitting this population’s lived experiences from the discussion. This study aims to fill these gaps by examining how state policy environments and rurality together influence social marginalization among SGD adolescents.

Methods: This study utilized cross-sectional baseline data (N = 1,748) from a national sample of SGD adolescents aged 13–18 collected in 2024-2025 to assess relationships between rurality, political context, and SM. Participants were recruited online and completed a 30–45-minute survey. Distal minority stress was measured using the social marginalization subscale of the Sexual Minority Adolescent Stress Inventory (SMASI), dichotomized to indicate any exposure in the past 30 days. Primary correlates included urbanicity (rural vs. urban), state-level LGBTQIA+ youth policy context derived from Movement Advancement Project categories, gender identity, race/ethnicity, and U.S. region. Logistic regression models estimated associations with adjusted odds ratios and reported average marginal effects. Model fit, multicollinearity, and missing data assumptions were evaluated prior to analysis.

Results: Urban SGD adolescents had lower odds of SM than rural youth across policy contexts (OR = 0.40, p < .01), while transgender and nonbinary youth had higher odds than cisgender peers across geographic locations (OR = 1.50, p < .001). Youth in the “Other” racial/ethnic category were less likely to report SM than White youth (OR = 0.40, p < .05), and those in the Southwest had lower odds than those in the West (OR = 0.43, p < .05). Policy context showed a graded protective effect: the three most supportive environments, fair (OR = 0.16), medium (OR = 0.50), and high (OR = 0.53), were associated with lower SM compared to the most restrictive context. Average marginal effects illustrate these patterns, with urban residence (–0.10) and more supportive policy environments (–0.10 to –0.17) reducing SM probability, while transgender and nonbinary identity increased risk (+0.09).

Conclusions and Implications: Findings highlight the crucial role of structural and geographic context in shaping minority stress among SGD adolescents. Restrictive policy environments and rural settings independently contribute to increased social marginalization, while inclusive policies buffer these effects. Gender-diverse youth are especially vulnerable across different settings. Results emphasize the need for multilevel strategies that combine policy reform with targeted local initiatives to improve school and community climates. Achieving equity for SGD youth requires addressing both macro-level structural stigma and place-based disparities, especially in rural areas where access to affirming resources may be limited.