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However, little is known about the experiences of SMA living in rural communities across the United States. Thus, the present study sought to examine differences in mental health patterns between urban and rural dwelling SMA, and to see whether these differences are, at least in part, explained by experiences of lifetime minority stress.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A nationwide sample of SMA residing in the United States (N = 2,558; aged 14\u201017, <jats:italic>M<\/jats:italic> = 15.90 years, <jats:italic>SD<\/jats:italic> = 0.98) was recruited through purposive social media and respondent\u2010driven sampling methods to complete a cross\u2010sectional survey online. Measures included those of minority stress, urbanicity, and symptoms of anxiety, depression, and PTSD. Parallel multiple mediation (PMM) analysis was employed to test whether urbanicity was associated with anxiety, depressive, and PTSD symptoms through reported lifetime minority stress.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>On average, SMA living in rural areas significantly reported more lifetime minority stress, depressive, and PTSD symptoms than SMA living in urban settings. Results from our PMM analysis indicated that heightened experiences of lifetime minority stress indirectly linked the effects of living in rural areas on anxiety (b = \u20130.288, 95% CI = [\u20130.491, \u20130.085]), depressive (b = \u20130.158, 95% CI = [\u20130.270, \u20130.047), and PTSD symptoms PTSD (b = \u20130.349, 95% CI = [\u20130.596, \u20130.105]). The model accounted for 16.8%, 18%, and 24.1% of the variability in anxiety symptoms, depressive symptoms, and PTSD symptoms, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>SMA in our study who reside in rural areas reported elevated minority stress, depressive, and PTSD symptoms as compared to their urban dwelling peers. Our study found that lifetime experiences of minority stress fully mediated the relationship between urbanicity and both depressive and PTSD symptoms, and partially mediated the relationship between urbanicity and anxiety. These findings highlight the need to increase support for rural youth who are growing into adulthood and may find continuing challenges in their family, peer, and community relationships.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jrh.12706","type":"journal-article","created":{"date-parts":[[2022,8,18]],"date-time":"2022-08-18T02:19:50Z","timestamp":1660789190000},"page":"262-271","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Explaining behavioral health differences in urban and rural sexual minority adolescents"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4355-046X","authenticated-orcid":false,"given":"Jeremy T.","family":"Goldbach","sequence":"first","affiliation":[{"name":"Brown School Washington University in St. Louis  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis A.","family":"Parra","sequence":"additional","affiliation":[{"name":"School of Nursing University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8718-8354","authenticated-orcid":false,"given":"Rory P.","family":"O'Brien","sequence":"additional","affiliation":[{"name":"Suzanne Dworak\u2010Peck School of Social Work University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harmony","family":"Rhoades","sequence":"additional","affiliation":[{"name":"Suzanne Dworak\u2010Peck School of Social Work University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6352-5056","authenticated-orcid":false,"given":"Sheree M.","family":"Schrager","sequence":"additional","affiliation":[{"name":"California State University  Carson California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,8,17]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1559-1816.2009.00567.x"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.3109\/10826084.2014.980958"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0029597"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/jora.12495"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/00224490409552240"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/10826084.2016.1223691"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2008.02149.x"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/0044118X06287689"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.publhealth.012809.103636"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2011.02.005"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/00918369.2011.534038"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.129.5.674"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/10926771.2013.785455"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11121-013-0393-7"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0037171"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1080\/00224499.2014.886321"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2018.07.006"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10508-017-0964-y"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2015.302976"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/00918360903489127"},{"key":"e_1_2_7_22_1","volume-title":"Strengths and Silences: The Experiences of Lesbian, Gay, Bisexual and Transgender Students in Rural and Small Town Schools","author":"Palmer N","year":"2012"},{"key":"e_1_2_7_23_1","unstructured":"KosciwJG GreytakEA ZongroneAD ClarkCM TruongNL.The 2017 National School Climate Survey: the Experiences of Lesbian Gay Bisexual Transgender and Queer Youth in Our Nation's Schools. 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