Project LEAP: Development and Preliminary Trial of a Brief, Portable Health Intervention for Rural Sexual Minority Emerging Adults

Sponsor

Yale University (Other)

Overall Status

Completed

CT.gov ID

NCT03751020

Collaborator

National Institute of Mental Health (NIMH) (NIH)

108

Enrollment

Locations

Arms

Actual Duration (Months)

Patients Per Site

1.8

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

The purpose of this study is to test the feasibility of writing interventions specifically designed for lesbian, gay, and bisexual (LGB) emerging adults (ages 18-29) that are aimed at improving the outcomes: depression, suicidality, substance abuse and HIV risk behaviors.

Condition or Disease	Intervention/Treatment	Phase
Depression Suicidality Substance Abuse HIV Minority Stress	Behavioral: Expressive Writing (EW) Intervention Behavioral: Self-Affirmation (SA) Intervention Other: Control	N/A

Detailed Description

This study is considered the third part ("Phase 3") of a larger study where parts one and two were designed to utilize elicitation focus groups to develop effective intervention materials (Phase 1) and then refine the developed materials through structured interviews (Phase 2). Phase 3 will test feasibility and assess early signs of efficacy of writing interventions. To do this, participants will be randomized to one of three arms (one arm will serve as control). Those that choose to participate will be asked to complete outcome measures (depressive symptoms, suicidality, use of alcohol and illicit drugs, HIV risk behavior) and measures of proposed mediators (self-reported and biological stress, behavioral and emotional self-regulation) and moderators (e.g., social support, identity centrality) at baseline, post-intervention, and three-month follow-up. In addition, structured interviews with 15 intervention participants will be used to refine study procedures as the investigators scale up this intervention for a future randomized controlled trial (RCT).

Study Design

Study Type:

Interventional

Actual Enrollment :

108 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

Double (Investigator, Outcomes Assessor)

Primary Purpose:

Prevention

Official Title:

Development and Preliminary Trial of a Brief, Portable Health Intervention for Rural Sexual Minority Emerging Adults

Actual Study Start Date :

Oct 27, 2017

Actual Primary Completion Date :

Jan 1, 2019

Actual Study Completion Date :

Jun 27, 2019

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Expressive Writing (EW) Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors.	Behavioral: Expressive Writing (EW) Intervention The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.
Experimental: Self-Affirmation (SA) Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person.	Behavioral: Self-Affirmation (SA) Intervention The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Placebo Comparator: Control Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days.	Other: Control Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.

Arm

Intervention/Treatment

Experimental: Expressive Writing (EW)

Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors.

Behavioral: Expressive Writing (EW) Intervention

The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.

Experimental: Self-Affirmation (SA)

Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person.

Behavioral: Self-Affirmation (SA) Intervention

The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.

Placebo Comparator: Control

Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days.

Other: Control

Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.

Outcome Measures

Primary Outcome Measures

Change in Depression. [Baseline, Post Intervention (day 5), and 3 Months.]
Depression will be measured using the Center for Epidemiological Studies -- Depression Scale (CESD). An overall depression score is computed as the sum of 20 items, with items 3, 11, 14, and 16 reversed. In cases with internally missing data (items not answered), the sums are computed after imputation of the missing values: # items on scale / # actually answered, multiplied by the sum obtained from the answered items. A range of 0-60, with higher scores indicating more depressive symptomatology during the past week.
Change in Psychological Distress. [Baseline, Post Intervention (day 5), and 3 Months.]
Psychological Distress will be measured using the Brief Symptom Inventory (BSI). The BSI consists of 18 items scored 0-4. Items are averaged to yield a final score of 0-4. The higher the score, the greater the psychological distress.
Change in Anxiety. [Baseline, Post Intervention (day 5), and 3 Months.]
Anxiety will be measured using the Beck Anxiety Inventory (BAI). The BAI total score is reported, which is the sum of all 21 items; with no subscales. The range of scores is 0-63, with higher scores indicating higher anxiety.
Change in Suicidality - Suicidal Ideation. [Baseline, Post Intervention (day 5), and 3 Months.]
Suicidal ideation will be measured using the Suicidal Ideation Attributes Scale (SIDAS) . Total SIDAS scores are calculated as the sum of the five items, with controllability reverse scored (10=0, 9=1, …, 0=10). Total scores range from 0 to 50.
Change in Alcohol Use. [Baseline, Post Intervention, 3 Months]
Alcohol use in participants will be assessed using the Alcohol Use Disorders Identification (AUDIT) instrument. The AUDIT consists of 10 items. Each of the questions has a set of responses to choose from, and each response has a score ranging from 0 to 4. All response scores should be added and recorded as "Total". Total scores of 8 or more are recommended as indicators of hazardous and harmful alcohol use, as well as possible alcohol dependence. (A cut-off score of 10 will provide greater specificity but at the expense of sensitivity.) The score range is 0-40. Higher scores indicate greater hazardous drinking.
Change in Drug Use. [Baseline, Post Intervention (day 5), and 3 Months.]
The Short Inventory of Problems-Modified for Drug Use (SIP-DU) is a 15-item scale that asks respondents to rate each item on a dichotomous scale ("No" = 0, "Yes" = 1). Total score reported, which is the sum of all items; no subscales: Range 0-15, higher scores indicate greater problems with drug use.
Suicidal Intent [Baseline, Post Intervention (day 5), and 3 Months.]
Suicidal intent will be assessed using a single item that asks: Within the last 3 months/past week, have you seriously considered attempting suicide? [yes/no] Number of participants who reported suicidal intent is reported. Originally titled "Change in Suicidality - Suicidal Thoughts".
Attempted Suicide [Baseline, Post Intervention (day 5), and 3 Months.]
Suicide attempts will be assessed using a single item that asks: Within the last past 3 months/past week, have you actually attempted suicide? [yes/no]. Reported are the number of participants who reported that they had attempted suicide. Original title: "Change in Suicidality: Suicide Attempts".

Secondary Outcome Measures

Self Injury. [Baseline, Post Intervention (day 5), and 3 Months.]
Self injury behaviors will be assessed with the item that asks: How many times in the past 3 months/past week have you engaged in self-harm behavior (e.g., cutting, biting, burning, hitting self) with the intent of harming, but not killing, yourself? Reported are the frequency of self-harm behaviors/self-injury reported by participants. Original title: "Change in Self Injury".
Rumination [Baseline, Post Intervention (day 5), and 3 Months.]
Rumination will be assessed using the Ruminative Response Scale - Brooding Subscale (RRS). This scale is modified from the original measure where only items 5, 10, 13, 15 and 16 are used. Each item is scored by respondents on a scale of 1 to 4. To get the overall score, the 5 items are summed; total scores range from 5-20, with higher scores indicating greater brooding and rumination (related to depression) in an individual.
Perceived Support [Baseline, Post Intervention (day 5), and 3 Months.]
Perceived social support is measured using the Multidimensional Scale of Perceived Social Support (MSPSS). The MSPSS is a 12 item instrument that uses a scale 1-7 to rate each item. The scoring is done by taking the average of the items- therefore a score of 7 indicates the highest level of perceived social support.
Hopelessness [Baseline, Post Intervention, 3 Months]
Hopelessness will be measured using the Beck Hopelessness Scale (BHS). The BHS is a 20-item dichotomous scale ("No" = 0, "Yes" = 1). Items 1, 3, 5, 6, 8, 10, 13, 15 and 19 are reverse-scored. The total score is out of 20, where 20 would be the highest score and considered a negative indicator of hopelessness.
Lesbian, Gay, Bisexual (LGB) Identity [Baseline, Post Intervention (day 5), and 3 Months.]
LGB identity will be measured using the 'LGB Identity Centrality' instrument.The measure consists of 4 items that are rated on a scale of 1-7. The summed scores have a range of 4-28 and the higher score would indicate a stong agreement (positive) with the centrality of one's LGB identity.
Change in Cortisol [1 and 4 months post baseline.]
Participants will provide 50-100 hair strands (at least 2 cm in length) to be used to determine levels of stress based on the cortisol levels found in the analyses of the hair provided.
Change in Stress [Baseline, Post Intervention (day 5), and 3 Months.]
Stress will be assessed using the Perceived Stress Scale (PSS). Participants were asked to respond to the 14-item version. Participants respond to each item on a 0-4 scale and scores are obtained by reversing responses to the 7 positively stated items (items 4,5,6,7,9,10, & 13), and then summing across all scale items. Range = 0-56. Higher scores indicating higher perceived stress.
Change in Impulsiveness Total Score [Baseline, Post Intervention (day 5), and 3 Months.]
Impulsiveness will be assessed using the Barratt Impulsiveness Scale (BIS). The BIS is a 30 item questionnaire that uses a 1-4 rating scale per item. The 30-item self-report questionnaire, can yield a total score where the range is 30-120. The highest score indicates the greatest the level of impulsiveness.
Change in Impulsiveness- Attentional [Baseline, Post Intervention (day 5), and 3 Months.]
Impulsiveness will be assessed using the Barratt Impulsiveness Scale (BIS). The BIS is a 30 item questionnaire that uses a 1-4 rating scale per item. The 30-item self-report questionnaire, can yield a total score, as well as three factors: attentional (6, 5, 9, 11, 20, 24, 26, 28; motor (2, 3, 4, 16, 17, 19, 21, 22, 23, 25, 30); non-planning (1, 7, 8, 10, 12, 13, 14, 15, 18, 27, 29). The attentional scale has a range of 8-32, the greater the value, the greater the level of attentional impulsiveness.
Change in Impulsiveness- Motor [Baseline, Post Intervention (day 5), and 3 Months.]
Impulsiveness will be assessed using the Barratt Impulsiveness Scale (BIS-11). The BIS-11 is a 30 item questionnaire that uses a 1-4 rating scale per item. The 30-item self-report questionnaire, can yield a total score, as well as three factors: attentional (6, 5, 9, 11, 20, 24, 26, 28; motor (2, 3, 4, 16, 17, 19, 21, 22, 23, 25, 30); non-planning (1, 7, 8, 10, 12, 13, 14, 15, 18, 27, 29). The motor scale has a range of 11-44, the greater the value, the greater the level of motor impulsiveness.
Change in Impulsiveness- Non-Planning [Baseline, Post Intervention (day 5), and 3 Months.]
Impulsiveness will be assessed using the Barratt Impulsiveness Scale (BIS-11). The BIS-11 is a 30 item questionnaire that uses a 1-4 rating scale per item. The 30-item self-report questionnaire, can yield a total score, as well as three factors: attentional (6, 5, 9, 11, 20, 24, 26, 28; motor (2, 3, 4, 16, 17, 19, 21, 22, 23, 25, 30); non-planning (1, 7, 8, 10, 12, 13, 14, 15, 18, 27, 29). The non-planning scale has a range of 11-44, the greater the value, the greater the level of non-planning impulsiveness.
Change in Risk Taking [Baseline, Post Intervention (day 5), and 3 Months.]
Risk taking impulse will be assessed using the Columbia Card Task. Participants are presented with 32 face-down cards. Some of these cards are "gain cards" (which add either +10 or +30 points to the participant's total score) and some of these cards are "loss cards" (which subtract either -250 or -750 points from the participant's total score). On each trial, the participant may turn over as many cards as desired until a loss card is encountered or the participant chooses to not turn over any more cards. As a participant turns over more cards, the probability of encountering a loss card increases. Therefore, turning over more cards constitutes greater risk taking.
Change in Minority Stress (Rejection) [Baseline, Post Intervention (day 5), and 3 Months.]
To assess rejection as a form of minority stress, the Gay-Related Rejection Sensitivity Scale (GRRS) will be used.The Gay-related rejection sensitivity scale was adapted for this study to be gender-inclusive and has 12 items. Scale range 1-36, where higher scores indicate greater rejection sensitivity based on one's sexual orientation (worse outcome).
Change in Parental Attitudes [Baseline, Post Intervention (day 5), and 3 Months.]
The participant's perception of their parent's attitudes towards their sexual orientation are assessed using the Parental Attitudes Toward Child's Sexual Orientation. This tool has 4 items- 2 that deal with mother/parent 1/closest female guardian, 2 that deal with father/parent 2/closest male guardian. The second item for each parent asks about their attitude towards the respondent's sexual orientation on a scale from 1 (completely tolerant and accepting) to 7 (completely hostile and rejecting). Scores for maternal and paternal attitude should be averaged for each participant. The score has a range from 1-7, where higher scores indicate greater rejection from parents (worse outcome).
Change in Outness [Baseline, Post Intervention (day 5), and 3 Months.]
Participants openness about one's sexual orientation will be assessed using the Outness Inventory (OI). A respondent is asked to rate how open they are with various people in society (from family to strangers) on an 11 item questionnaire. The scale for responding is 0-7- where 7 indicates that a person is completely open with their sexual orientation status. The scale score is obtained by averaging the 11 items for a score range of 0-7, where higher scores indicate more openness about respondents' sexual orientation in different domains of their lives/different people. 0 indicates that an item does not apply/ there is no such group of people/person in the respondents' life. A score of 7 would indicate that one is completely open or "out" with respect to sexual orientation.
Change in Internalized Homophobia [Baseline, Post Intervention (day 5), and 3 Months.]
Internalized homophobia in participants will be assessed using the Internalized Homophobia Scale (IHS). The IHS score is obtained by averaging the scores across the 9 items (rather than summing). Range is 1-4, with higher scores indicating higher internalized stigma related to one's sexual orientation.
Change in Discrimination - 9 Items (Part 1) [Baseline, Post Intervention (day 5), and 3 Months.]
Everyday discrimination experienced by participants will be measured using the Everyday Discrimination - Sexual Orientation (EDSO) Part 1. Part 1 is a 9 item inventory where respondents rate statements on a scale of 1-6. The scale has a summed total score ranging from 9-54, higher scores indicate higher discrimination. The higher the score, the greater the feeling that one is discriminated against for one's sexual orientation.
Change in Discrimination - Item 1 (Part 2) [Baseline, Post Intervention (day 5), and 3 Months.]
Everyday discrimination experienced by participants will be measured using the Everyday Discrimination - Sexual Orientation (EDSO) Part 2. Part 2 is a 2 item inventory where respondents rate statements on a scale of 0-3. The lower the score, the less the feeling that one is discriminated against overall for one's sexual orientation. Item 1: Overall, how much has discrimination based on your sexual orientation interfered with you having a full and productive life?
Change in Discrimination - Item 2 (Part 2) [Baseline, Post Intervention (day 5), and 3 Months.]
Everyday discrimination experienced by participants will be measured using the Everyday Discrimination - Sexual Orientation (EDSO) Part 2. Part 2 is a 2 item inventory where respondents rate statements on a scale of 0-3. The lower the score, the less the feeling that one is discriminated against overall for one's sexual orientation. Item 2: Overall, how much harder has your life been because of discrimination based on your sexual orientation?
Change in Victimization [Baseline, Post Intervention (day 5), and 3 Months.]
Feelings of victimization are captured using the LGBT Victimization Experiences measure. This questionnaire consists of 10 items. The LGBT victimization scale is rated on a 0 "Never" to 3 "3+ times" scale with a total score range 0-30. The total score reflects the amount of victimization one has experienced due to being known or thought to be LGBTQ. Higher scores indicate more negative experiences.
Change in Religious Affiliation [Baseline, Post Intervention (day 5), and 3 Months.]
Tolerance of one's sexual orientation through the lense of one's practiced religion is measured using a single question. Respondents use a 1-7 scale to rate the question "How tolerant is your religion toward your sexual orientation?"- where 7 indicates total rejection and hostility.
Change in Religious Strain [Baseline, Post Intervention (day 5), and 3 Months.]
Religious Strain Scale total score obtained by reverse scoring items 1-7 and then summing across the 20 items (range 0-60), higher scores indicate greater religious strain.

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years to 29 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Yes

Inclusion Criteria:

Self-identify as lesbian, gay, or bisexual
Live in Washington county, Tennessee (TN), or any of its 6 contiguous counties in northeastern TN
Have personal Internet access
Hair at least 2cm in length

Exclusion Criteria:

Failure to meet inclusion criteria

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Yale University	New Haven	Connecticut	United States	06520
2	College of the Holy Cross	Worcester	Massachusetts	United States	01610
3	East Tennessee State University	Johnson City	Tennessee	United States	37614

Sponsors and Collaborators

Yale University
National Institute of Mental Health (NIMH)

Investigators

Principal Investigator: John Pachankis, PhD, Yale University

Study Documents (Full-Text)

More Information

Publications

None provided.

Responsible Party:

Yale University

ClinicalTrials.gov Identifier:

NCT03751020

Other Study ID Numbers:

1512016952
1R21MH113860-01

First Posted:

Nov 23, 2018

Last Update Posted:

Aug 28, 2020

Last Verified:

Aug 1, 2020

Individual Participant Data (IPD) Sharing Statement:

Yes

Plan to Share IPD:

Yes

Studies a U.S. FDA-regulated Drug Product:

Studies a U.S. FDA-regulated Device Product:

Keywords provided by Yale University

Expressive Writing

Minority Stress

Lesbian Gay Bisexual

Additional relevant MeSH terms:

Substance-Related Disorders

Study Results

Participant Flow

Recruitment Details	Participants were specifically recruited through tailored advertising on geo-targeted websites; bulletin boards and listservs of local colleges; in-person announcement and flyers at local businesses, community events, and the gay-straight alliances of area schools. Participants completed a brief online survey to confirm eligibility.
Pre-assignment Detail	Participants completed a brief online survey to confirm eligibility, defined as: age 18 -29; identifying as sexual minority; currently living in one of the eligible counties; and having daily personal Internet access. Participants emailed a photo of an identification card(e.g. a driver's license), as proof of age. 108 people were randomized.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Period Title: Overall Study
STARTED	36	36	36
Post Intervention	33	33	30
3 Month Follow Up	27	32	26
COMPLETED	27	32	26
NOT COMPLETED	9	4	10

Baseline Characteristics

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)	Total
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.	Total of all reporting groups
Overall Participants	36	36	36	108
Age (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]	24.14 (3.24)	23.47 (2.88)	23.42 (3.25)	23.68 (3.11)
Sex/Gender, Customized (Count of Participants)
Man	10 27.8%	12 33.3%	9 25%	31 28.7%
Woman	20 55.6%	21 58.3%	19 52.8%	60 55.6%
Transgender Man	1 2.8%	3 8.3%	3 8.3%	7 6.5%
Transgender Woman	1 2.8%	0 0%	0 0%	1 0.9%
Gender Queer	4 11.1%	2 5.6%	4 11.1%	10 9.3%
Gender Non-Conforming/Binary	3 8.3%	3 8.3%	4 11.1%	10 9.3%
Two-spirit	0 0%	0 0%	1 2.8%	1 0.9%
Other	2 5.6%	2 5.6%	1 2.8%	5 4.6%
Sex: Female, Male (Count of Participants)
Female	25 69.4%	26 72.2%	26 72.2%	77 71.3%
Male	11 30.6%	10 27.8%	10 27.8%	31 28.7%
Ethnicity (NIH/OMB) (Count of Participants)
Hispanic or Latino	1 2.8%	0 0%	1 2.8%	2 1.9%
Not Hispanic or Latino	35 97.2%	36 100%	35 97.2%	106 98.1%
Unknown or Not Reported	0 0%	0 0%	0 0%	0 0%
Race/Ethnicity, Customized (Count of Participants)
American Indian /Alaskan Native	0 0%	2 5.6%	0 0%	2 1.9%
Asian	1 2.8%	0 0%	0 0%	1 0.9%
Black/African American	2 5.6%	4 11.1%	4 11.1%	10 9.3%
Native Hawaiian/Pacific Islander	1 2.8%	0 0%	0 0%	1 0.9%
White	33 91.7%	33 91.7%	34 94.4%	100 92.6%
Other	1 2.8%	0 0%	0 0%	1 0.9%
Region of Enrollment (participants) [Number]
United States	36 100%	36 100%	36 100%	108 100%
Sexual Orientation (Count of Participants)
Asexual	0 0%	1 2.8%	1 2.8%	2 1.9%
Bisexual	13 36.1%	9 25%	8 22.2%	30 27.8%
Gay	8 22.2%	9 25%	9 25%	26 24.1%
Lesbian	12 33.3%	9 25%	9 25%	30 27.8%
Pansexual	3 8.3%	6 16.7%	6 16.7%	15 13.9%
Questioning	0 0%	0 0%	1 2.8%	1 0.9%
Other	0 0%	2 5.6%	2 5.6%	4 3.7%
Education Level (Count of Participants)
Less than College	18 50%	19 52.8%	21 58.3%	58 53.7%
College Degree	18 50%	17 47.2%	15 41.7%	50 46.3%
Employment Status (Count of Participants)
Full-time	14 38.9%	13 36.1%	14 38.9%	41 38%
Part-time	21 58.3%	13 36.1%	12 33.3%	46 42.6%
Student	0 0%	5 13.9%	6 16.7%	11 10.2%
Unemployed	1 2.8%	5 13.9%	4 11.1%	10 9.3%
Personal Income (Count of Participants)
Less than $10,000	11 30.6%	17 47.2%	13 36.1%	41 38%
More than $10,000	25 69.4%	19 52.8%	23 63.9%	67 62%
Family Class Background (Count of Participants)
Poor	3 8.3%	7 19.4%	6 16.7%	16 14.8%
Working Class	12 33.3%	11 30.6%	13 36.1%	36 33.3%
Lower Middle Class	8 22.2%	4 11.1%	5 13.9%	17 15.7%
Middle Class	10 27.8%	11 30.6%	11 30.6%	32 29.6%
Upper Middle Class	3 8.3%	3 8.3%	1 2.8%	7 6.5%
Relationship Status (Count of Participants)
Single	11 30.6%	10 27.8%	14 38.9%	35 32.4%
In a Relationship	25 69.4%	26 72.2%	22 61.1%	73 67.6%

Outcome Measures

1. Primary Outcome

Title	Change in Depression.
Description	Depression will be measured using the Center for Epidemiological Studies -- Depression Scale (CESD). An overall depression score is computed as the sum of 20 items, with items 3, 11, 14, and 16 reversed. In cases with internally missing data (items not answered), the sums are computed after imputation of the missing values: # items on scale / # actually answered, multiplied by the sum obtained from the answered items. A range of 0-60, with higher scores indicating more depressive symptomatology during the past week.
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	24.75 (11.83)	25.17 (12.07)	29.06 (13.41)
Post-Intervention	21.03 (11.79)	17.42 (11.46)	21.73 (13.45)
3 Months	23.44 (13.09)	18.45 (10.97)	22.92 (14.61)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Control, Expressive Writing (EW)
	Comments	The primary comparison was between EW and control to test the interaction between treatment and time.
	Type of Statistical Test	Superiority
	Comments

Statistical Test of Hypothesis	p-Value	<0.01
	Comments
	Method	Mixed Models Analysis
	Comments

Method of Estimation	Estimation Parameter	Mean Difference (Net)
	Estimated Value	-6.34
	Confidence Interval	(2-Sided) 95% -11.03 to -1.64
	Parameter Dispersion	Type: Value:
	Estimation Comments

2. Primary Outcome

Title	Change in Psychological Distress.
Description	Psychological Distress will be measured using the Brief Symptom Inventory (BSI). The BSI consists of 18 items scored 0-4. Items are averaged to yield a final score of 0-4. The higher the score, the greater the psychological distress.
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	2.31 (0.85)	2.22 (0.73)	2.63 (0.86)
Post-Intervention	1.84 (0.77)	1.82 (0.67)	2.08 (0.86)
3 Months	2.14 (0.92)	1.77 (0.65)	2.35 (0.80)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Control, Expressive Writing (EW)
	Comments	The primary comparison was between EW and control to test the interaction between treatment and time.
	Type of Statistical Test	Superiority
	Comments

Statistical Test of Hypothesis	p-Value	0.03
	Comments
	Method	Mixed Models Analysis
	Comments

Method of Estimation	Estimation Parameter	Mean Difference (Net)
	Estimated Value	-0.33
	Confidence Interval	(2-Sided) 95% -0.62 to -0.03
	Parameter Dispersion	Type: Value:
	Estimation Comments

3. Primary Outcome

Title	Change in Anxiety.
Description	Anxiety will be measured using the Beck Anxiety Inventory (BAI). The BAI total score is reported, which is the sum of all 21 items; with no subscales. The range of scores is 0-63, with higher scores indicating higher anxiety.
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	21.72 (14.14)	20.28 (12.29)	26.94 (13.91)
Post-Intervention	14.73 (13.43)	13.54 (10.91)	19.47 (13.16)
3 Months	18.26 (13.19)	13.03 (10.55)	19.73 (10.78)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Control, Expressive Writing (EW)
	Comments	The primary comparison was between EW and control to test the interaction between treatment and time.
	Type of Statistical Test	Superiority
	Comments

Statistical Test of Hypothesis	p-Value	0.07
	Comments
	Method	Mixed Models Analysis
	Comments

Method of Estimation	Estimation Parameter	Mean Difference (Net)
	Estimated Value	-4.03
	Confidence Interval	(2-Sided) 95% -8.55 to 0.47
	Parameter Dispersion	Type: Value:
	Estimation Comments

4. Primary Outcome

Title	Change in Suicidality - Suicidal Ideation.
Description	Suicidal ideation will be measured using the Suicidal Ideation Attributes Scale (SIDAS) . Total SIDAS scores are calculated as the sum of the five items, with controllability reverse scored (10=0, 9=1, …, 0=10). Total scores range from 0 to 50.
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	6.05 (9.81)	4.19 (6.92)	9.42 (11.21)
Post-Intervention	2.36 (4.08)	1.21 (3.57)	2.70 (6.24)
3 Months	4.63 (8.19)	3.87 (7.40)	5.31 (7.54)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Control, Expressive Writing (EW)
	Comments	The primary comparison was between EW and control to test the interaction between treatment and time.
	Type of Statistical Test	Superiority
	Comments

Statistical Test of Hypothesis	p-Value	0.73
	Comments
	Method	Mixed Models Analysis
	Comments

Method of Estimation	Estimation Parameter	Mean Difference (Net)
	Estimated Value	1.12
	Confidence Interval	(2-Sided) 95% -6.48 to 8.77
	Parameter Dispersion	Type: Value:
	Estimation Comments

5. Primary Outcome

Title	Change in Alcohol Use.
Description	Alcohol use in participants will be assessed using the Alcohol Use Disorders Identification (AUDIT) instrument. The AUDIT consists of 10 items. Each of the questions has a set of responses to choose from, and each response has a score ranging from 0 to 4. All response scores should be added and recorded as "Total". Total scores of 8 or more are recommended as indicators of hazardous and harmful alcohol use, as well as possible alcohol dependence. (A cut-off score of 10 will provide greater specificity but at the expense of sensitivity.) The score range is 0-40. Higher scores indicate greater hazardous drinking.
Time Frame	Baseline, Post Intervention, 3 Months

Outcome Measure Data

Analysis Population Description
Data were analyzed intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	5.08 (3.77)	4.25 (4.29)	5.97 (6.00)
Post-Intervention	4.67 (4.00)	3.70 (4.33)	3.73 (4.35)
3 Months	5.26 (4.62)	2.91 (3.76)	5.58 (5.98)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Control, Expressive Writing (EW)
	Comments	The primary comparison was between EW and control to test the interaction between treatment and time.
	Type of Statistical Test	Superiority
	Comments

Statistical Test of Hypothesis	p-Value	0.10
	Comments
	Method	Mixed Models Analysis
	Comments

Method of Estimation	Estimation Parameter	Mean Difference (Net)
	Estimated Value	-1.28
	Confidence Interval	(2-Sided) 95% -2.80 to 0.24
	Parameter Dispersion	Type: Value:
	Estimation Comments

6. Primary Outcome

Title	Change in Drug Use.
Description	The Short Inventory of Problems-Modified for Drug Use (SIP-DU) is a 15-item scale that asks respondents to rate each item on a dichotomous scale ("No" = 0, "Yes" = 1). Total score reported, which is the sum of all items; no subscales: Range 0-15, higher scores indicate greater problems with drug use.
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	0.39 (0.99)	0.31 (0.98)	1.47 (2.99)
Post-Intervention	0.36 (1.03)	0.67 (2.53)	0.57 (1.70)
3 Months	0.33 (0.83)	0.84 (2.89)	1.58 (3.56)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Control, Expressive Writing (EW)
	Comments	The primary comparison was between EW and control to test the interaction between treatment and time.
	Type of Statistical Test	Superiority
	Comments

Statistical Test of Hypothesis	p-Value	0.76
	Comments
	Method	Mixed Models Analysis
	Comments

Method of Estimation	Estimation Parameter	Mean Difference (Net)
	Estimated Value	0.09
	Confidence Interval	(2-Sided) 95% -1.19 to 1.57
	Parameter Dispersion	Type: Value:
	Estimation Comments

7. Primary Outcome

Title	Suicidal Intent
Description	Suicidal intent will be assessed using a single item that asks: Within the last 3 months/past week, have you seriously considered attempting suicide? [yes/no] Number of participants who reported suicidal intent is reported. Originally titled "Change in Suicidality - Suicidal Thoughts".
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	4 11.1%	4 11.1%	9 25%
Post-Intervention	0 0%	0 0%	1 2.8%
3 Months	3 8.3%	1 2.8%	2 5.6%

8. Primary Outcome

Title	Attempted Suicide
Description	Suicide attempts will be assessed using a single item that asks: Within the last past 3 months/past week, have you actually attempted suicide? [yes/no]. Reported are the number of participants who reported that they had attempted suicide. Original title: "Change in Suicidality: Suicide Attempts".
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	1 2.8%	0 0%	1 2.8%
Post-Intervention	0 0%	0 0%	0 0%
3 Months	0 0%	0 0%	0 0%

9. Secondary Outcome

Title	Self Injury.
Description	Self injury behaviors will be assessed with the item that asks: How many times in the past 3 months/past week have you engaged in self-harm behavior (e.g., cutting, biting, burning, hitting self) with the intent of harming, but not killing, yourself? Reported are the frequency of self-harm behaviors/self-injury reported by participants. Original title: "Change in Self Injury".
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	0.61 (1.50)	1.36 (5.11)	0.94 (2.11)
Post-Intervention	0.12 (0.48)	0.21 (1.22)	0.07 (0.25)
3 Months	0.26 (0.71)	0.97 (4.45)	1.27 (3.97)

10. Secondary Outcome

Title	Rumination
Description	Rumination will be assessed using the Ruminative Response Scale - Brooding Subscale (RRS). This scale is modified from the original measure where only items 5, 10, 13, 15 and 16 are used. Each item is scored by respondents on a scale of 1 to 4. To get the overall score, the 5 items are summed; total scores range from 5-20, with higher scores indicating greater brooding and rumination (related to depression) in an individual.
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	12.39 (3.68)	12.97 (3.48)	13.03 (3.55)
Post-Intervention	11.58 (3.57)	11.67 (3.48)	12.10 (4.41)
3 Months	11.44 (4.86)	10.81 (3.81)	11.81 (3.62)

11. Secondary Outcome

Title	Perceived Support
Description	Perceived social support is measured using the Multidimensional Scale of Perceived Social Support (MSPSS). The MSPSS is a 12 item instrument that uses a scale 1-7 to rate each item. The scoring is done by taking the average of the items- therefore a score of 7 indicates the highest level of perceived social support.
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	5.11 (1.30)	5.35 (0.94)	4.89 (1.40)
Post-Intervention	5.10 (1.08)	5.34 (0.93)	5.03 (1.44)
3 Months	5.12 (1.39)	5.53 (1.01)	5.09 (1.65)

12. Secondary Outcome

Title	Hopelessness
Description	Hopelessness will be measured using the Beck Hopelessness Scale (BHS). The BHS is a 20-item dichotomous scale ("No" = 0, "Yes" = 1). Items 1, 3, 5, 6, 8, 10, 13, 15 and 19 are reverse-scored. The total score is out of 20, where 20 would be the highest score and considered a negative indicator of hopelessness.
Time Frame	Baseline, Post Intervention, 3 Months

Outcome Measure Data

Analysis Population Description
Data analyzed as intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	7.00 (6.08)	5.14 (4.28)	7.44 (6.07)
Post-Intervention	6.93 (6.31)	4.88 (4.87)	7.80 (6.51)
3 Months	5.85 (5.80)	5.19 (5.07)	7.77 (7.00)

13. Secondary Outcome

Title	Lesbian, Gay, Bisexual (LGB) Identity
Description	LGB identity will be measured using the 'LGB Identity Centrality' instrument.The measure consists of 4 items that are rated on a scale of 1-7. The summed scores have a range of 4-28 and the higher score would indicate a stong agreement (positive) with the centrality of one's LGB identity.
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed as intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	22.44 (6.08)	18.47 (5.36)	20.11 (5.67)
Post-Intervention	19.91 (5.17)	17.33 (5.95)	18.27 (7.08)
3 Months	20.74 (4.92)	17.00 (5.81)	18.27 (7.48)

14. Secondary Outcome

Title	Change in Cortisol
Description	Participants will provide 50-100 hair strands (at least 2 cm in length) to be used to determine levels of stress based on the cortisol levels found in the analyses of the hair provided.
Time Frame	1 and 4 months post baseline.

Outcome Measure Data

Analysis Population Description
Data were analyzed as intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
1 Month	10.12 (12.20)	8.28 (10.96)	10.91 (15.85)
4 Months	10.37 (10.18)	6.18 (5.49)	12.21 (28.72)

15. Secondary Outcome

Title	Change in Stress
Description	Stress will be assessed using the Perceived Stress Scale (PSS). Participants were asked to respond to the 14-item version. Participants respond to each item on a 0-4 scale and scores are obtained by reversing responses to the 7 positively stated items (items 4,5,6,7,9,10, & 13), and then summing across all scale items. Range = 0-56. Higher scores indicating higher perceived stress.
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed as intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	30.25 (8.62)	29.53 (8.40)	31.61 (9.51)
Post-Intervention	27.03 (9.96)	24.70 (9.67)	26.73 (8.58)
3 Months	28.41 (10.66)	25.88 (7.77)	28.69 (9.01)

16. Secondary Outcome

Title	Change in Impulsiveness Total Score
Description	Impulsiveness will be assessed using the Barratt Impulsiveness Scale (BIS). The BIS is a 30 item questionnaire that uses a 1-4 rating scale per item. The 30-item self-report questionnaire, can yield a total score where the range is 30-120. The highest score indicates the greatest the level of impulsiveness.
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed as intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	53.75 (11.92)	51.03 (11.31)	54.31 (4.11)
Post-Intervention	52.35 (10.50)	52.76 (12.34)	54.06 (11.36)
3 Months	53.39 (11.38)	54.14 (11.43)	53.58 (9.37)

17. Secondary Outcome

Title	Change in Impulsiveness- Attentional
Description	Impulsiveness will be assessed using the Barratt Impulsiveness Scale (BIS). The BIS is a 30 item questionnaire that uses a 1-4 rating scale per item. The 30-item self-report questionnaire, can yield a total score, as well as three factors: attentional (6, 5, 9, 11, 20, 24, 26, 28; motor (2, 3, 4, 16, 17, 19, 21, 22, 23, 25, 30); non-planning (1, 7, 8, 10, 12, 13, 14, 15, 18, 27, 29). The attentional scale has a range of 8-32, the greater the value, the greater the level of attentional impulsiveness.
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed as intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	16.36 (4.98)	16.44 (4.59)	16.33 (4.11)
Post-Intervention	15.79 (4.69)	15.64 (4.62)	16.70 (4.19)
3 Months	15.43 (4.33)	15.75 (4.19)	16.69 (5.53)

18. Secondary Outcome

Title	Change in Impulsiveness- Motor
Description	Impulsiveness will be assessed using the Barratt Impulsiveness Scale (BIS-11). The BIS-11 is a 30 item questionnaire that uses a 1-4 rating scale per item. The 30-item self-report questionnaire, can yield a total score, as well as three factors: attentional (6, 5, 9, 11, 20, 24, 26, 28; motor (2, 3, 4, 16, 17, 19, 21, 22, 23, 25, 30); non-planning (1, 7, 8, 10, 12, 13, 14, 15, 18, 27, 29). The motor scale has a range of 11-44, the greater the value, the greater the level of motor impulsiveness.
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed as intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	20.78 (4.33)	20.78 (4.00)	21.39 (4.14)
Post-Intervention	15.71 (5.01)	20.52 (3.94)	21.23 (4.16)
3 Months	21.96 (5.17)	21.23 (4.18)	20.27 (3.11)

19. Secondary Outcome

Title	Change in Impulsiveness- Non-Planning
Description	Impulsiveness will be assessed using the Barratt Impulsiveness Scale (BIS-11). The BIS-11 is a 30 item questionnaire that uses a 1-4 rating scale per item. The 30-item self-report questionnaire, can yield a total score, as well as three factors: attentional (6, 5, 9, 11, 20, 24, 26, 28; motor (2, 3, 4, 16, 17, 19, 21, 22, 23, 25, 30); non-planning (1, 7, 8, 10, 12, 13, 14, 15, 18, 27, 29). The non-planning scale has a range of 11-44, the greater the value, the greater the level of non-planning impulsiveness.
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed as intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	17.00 (5.20)	16.80 (5.59)	16.58 (5.18)
Post-Intervention	15.71 (5.01)	16.61 (6.58)	16.13 (5.31)
3 Months	16.00 (4.74)	17.16 (6.06)	16.62 (4.98)

20. Secondary Outcome

Title	Change in Risk Taking
Description	Risk taking impulse will be assessed using the Columbia Card Task. Participants are presented with 32 face-down cards. Some of these cards are "gain cards" (which add either +10 or +30 points to the participant's total score) and some of these cards are "loss cards" (which subtract either -250 or -750 points from the participant's total score). On each trial, the participant may turn over as many cards as desired until a loss card is encountered or the participant chooses to not turn over any more cards. As a participant turns over more cards, the probability of encountering a loss card increases. Therefore, turning over more cards constitutes greater risk taking.
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
This outcome measure was never collected.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	0	0	0

21. Secondary Outcome

Title	Change in Minority Stress (Rejection)
Description	To assess rejection as a form of minority stress, the Gay-Related Rejection Sensitivity Scale (GRRS) will be used.The Gay-related rejection sensitivity scale was adapted for this study to be gender-inclusive and has 12 items. Scale range 1-36, where higher scores indicate greater rejection sensitivity based on one's sexual orientation (worse outcome).
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed as intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	14.47 (7.35)	12.33 (6.11)	14.94 (7.43)
Post-Intervention	12.92 (8.23)	10.95 (6.51)	12.99 (6.41)
3 Months	12.17 (8.16)	9.31 (7.60)	12.33 (5.65)

22. Secondary Outcome

Title	Change in Parental Attitudes
Description	The participant's perception of their parent's attitudes towards their sexual orientation are assessed using the Parental Attitudes Toward Child's Sexual Orientation. This tool has 4 items- 2 that deal with mother/parent 1/closest female guardian, 2 that deal with father/parent 2/closest male guardian. The second item for each parent asks about their attitude towards the respondent's sexual orientation on a scale from 1 (completely tolerant and accepting) to 7 (completely hostile and rejecting). Scores for maternal and paternal attitude should be averaged for each participant. The score has a range from 1-7, where higher scores indicate greater rejection from parents (worse outcome).
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzes as intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	2.85 (1.50)	2.59 (1.52)	2.61 (1.46)
Post-Intervention	2.71 (1.21)	2.60 (1.47)	2.36 (1.28)
3 Months	2.75 (1.46)	2.63 (1.36)	2.68 (1.48)

23. Secondary Outcome

Title	Change in Outness
Description	Participants openness about one's sexual orientation will be assessed using the Outness Inventory (OI). A respondent is asked to rate how open they are with various people in society (from family to strangers) on an 11 item questionnaire. The scale for responding is 0-7- where 7 indicates that a person is completely open with their sexual orientation status. The scale score is obtained by averaging the 11 items for a score range of 0-7, where higher scores indicate more openness about respondents' sexual orientation in different domains of their lives/different people. 0 indicates that an item does not apply/ there is no such group of people/person in the respondents' life. A score of 7 would indicate that one is completely open or "out" with respect to sexual orientation.
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed as intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	4.46 (1.56)	5.32 (1.43)	5.05 (1.40)
Post-Intervention	4.55 (1.66)	5.13 (1.39)	4.94 (1.21)
3 Months	4.95 (1.49)	5.16 (1.49)	5.01 (1.33)

24. Secondary Outcome

Title	Change in Internalized Homophobia
Description	Internalized homophobia in participants will be assessed using the Internalized Homophobia Scale (IHS). The IHS score is obtained by averaging the scores across the 9 items (rather than summing). Range is 1-4, with higher scores indicating higher internalized stigma related to one's sexual orientation.
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed as intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	1.42 (0.57)	1.38 (0.50)	1.58 (0.65)
Post-Intervention	1.27 (0.64)	1.27 (0.53)	1.56 (0.58)
3 Months	1.29 (0.63)	1.39 (0.57)	1.52 (0.58)

25. Secondary Outcome

Title	Change in Discrimination - 9 Items (Part 1)
Description	Everyday discrimination experienced by participants will be measured using the Everyday Discrimination - Sexual Orientation (EDSO) Part 1. Part 1 is a 9 item inventory where respondents rate statements on a scale of 1-6. The scale has a summed total score ranging from 9-54, higher scores indicate higher discrimination. The higher the score, the greater the feeling that one is discriminated against for one's sexual orientation.
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed as intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	19.75 (10.63)	19.22 (7.26)	21.14 (8.72)
Post Intervention	18.61 (9.47)	17.88 (7.27)	20.47 (9.42)
3 Months	17.81 (9.22)	16.87 (7.49)	17.81 (8.64)

26. Secondary Outcome

Title	Change in Discrimination - Item 1 (Part 2)
Description	Everyday discrimination experienced by participants will be measured using the Everyday Discrimination - Sexual Orientation (EDSO) Part 2. Part 2 is a 2 item inventory where respondents rate statements on a scale of 0-3. The lower the score, the less the feeling that one is discriminated against overall for one's sexual orientation. Item 1: Overall, how much has discrimination based on your sexual orientation interfered with you having a full and productive life?
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed as intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	0.78 (0.76)	0.89 (0.82)	1.19 (0.98)
Post Intervention	0.67 (0.66)	1.00 (0.79)	0.97 (0.89)
3 Months	0.74 (0.81)	0.87 (0.72)	0.73 (0.87)

27. Secondary Outcome

Title	Change in Discrimination - Item 2 (Part 2)
Description	Everyday discrimination experienced by participants will be measured using the Everyday Discrimination - Sexual Orientation (EDSO) Part 2. Part 2 is a 2 item inventory where respondents rate statements on a scale of 0-3. The lower the score, the less the feeling that one is discriminated against overall for one's sexual orientation. Item 2: Overall, how much harder has your life been because of discrimination based on your sexual orientation?
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed as intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	1.03 (0.81)	1.42 (0.87)	1.53 (0.91)
Post Intervention	1.00 (0.79)	1.24 (0.87)	1.30 (1.02)
3 Months	0.85 (0.72)	1.06 (0.73)	1.15 (0.97)

28. Secondary Outcome

Title	Change in Victimization
Description	Feelings of victimization are captured using the LGBT Victimization Experiences measure. This questionnaire consists of 10 items. The LGBT victimization scale is rated on a 0 "Never" to 3 "3+ times" scale with a total score range 0-30. The total score reflects the amount of victimization one has experienced due to being known or thought to be LGBTQ. Higher scores indicate more negative experiences.
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed as intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	1.47 (2.16)	1.33 (2.05)	2.56 (5.42)
Post-Intervention	0.30 (0.81)	0.24 (0.56)	0.67 (1.65)
3 Months	0.81 (1.33)	0.97 (2.47)	1.08 (2.42)

29. Secondary Outcome

Title	Change in Religious Affiliation
Description	Tolerance of one's sexual orientation through the lense of one's practiced religion is measured using a single question. Respondents use a 1-7 scale to rate the question "How tolerant is your religion toward your sexual orientation?"- where 7 indicates total rejection and hostility.
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed as intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	2.70 (1.86)	3.05 (1.84)	2.78 (2.06)
Post Intervention	2.78 (1.57)	2.79 (1.65)	2.71 (1.94)
3 Months	2.20 (1.47)	2.56 (1.50)	3.13 (1.96)

30. Secondary Outcome

Title	Change in Religious Strain
Description	Religious Strain Scale total score obtained by reverse scoring items 1-7 and then summing across the 20 items (range 0-60), higher scores indicate greater religious strain.
Time Frame	Baseline, Post Intervention (day 5), and 3 Months.

Outcome Measure Data

Analysis Population Description
Data were analyzed as intention to treat.

Arm/Group Title	Control	Expressive Writing (EW)	Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.	Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.	Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
Measure Participants	36	36	36
Baseline	29.08 (8.92)	27.11 (10.01)	32.75 (9.36)
Post Intervention	27.52 (9.52)	26.52 (9.49)	31.40 (10.62)
3 Months	27.11 (9.63)	25.44 (9.31)	29.50 (9.61)

Adverse Events

	Control		Expressive Writing (EW)		Self-Affirmation (SA)
Time Frame	Adverse events were monitored for up to 3 months.
Adverse Event Reporting Description

Arm/Group Title	Control		Expressive Writing (EW)		Self-Affirmation (SA)
Arm/Group Description	Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.		Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors. Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.		Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person. Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
All Cause Mortality
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/36 (0%)		0/36 (0%)		0/36 (0%)
Serious Adverse Events
	Control		Expressive Writing (EW)		Self-Affirmation (SA)
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/36 (0%)		0/36 (0%)		0/36 (0%)
Other (Not Including Serious) Adverse Events
	Control		Expressive Writing (EW)		Self-Affirmation (SA)
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/36 (0%)		0/36 (0%)		0/36 (0%)

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

All Principal Investigators ARE employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.

Results Point of Contact

Name/Title	Dr. John Pachankis
Organization	Yale University School of Public Health (Social and Behavioral Sciences)
Phone	(203) 785-3710
Email	john.pachankis@yale.edu

Responsible Party:

Yale University

ClinicalTrials.gov Identifier:

NCT03751020

Other Study ID Numbers:

1512016952
1R21MH113860-01

First Posted:

Nov 23, 2018

Last Update Posted:

Aug 28, 2020

Last Verified:

Aug 1, 2020

Project LEAP: Development and Preliminary Trial of a Brief, Portable Health Intervention for Rural Sexual Minority Emerging Adults

Study Details

Study Description

Brief Summary

Detailed Description

Study Design

Arms and Interventions

Outcome Measures

Primary Outcome Measures

Secondary Outcome Measures

Eligibility Criteria

Criteria

Inclusion Criteria:

Exclusion Criteria:

Contacts and Locations

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Sponsors and Collaborators

Investigators

Study Documents (Full-Text)

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Study Results

Participant Flow

Baseline Characteristics

Outcome Measures

Outcome Measure Data

Statistical Analysis 1

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Adverse Events

All Cause Mortality

Serious Adverse Events

Other (Not Including Serious) Adverse Events

Limitations/Caveats

More Information

Certain Agreements

Results Point of Contact