Associations of Sexual Identity-Based Discrimination With Mental Health Symptoms and Substance Use Among Rural- and Urban-Residing Sexual Minority Young Adults: Differences by Resilience, Locus of Control, and Emotion Regulation

INTRODUCTION: Rural- versus urban-residing sexual minority young adults (SMYAs) report greater sexual identity-based discrimination and higher rates of mental health symptoms and substance use. Although individual-level factors, such as resilience, locus of control (LOC), and emotion regulation may buffer these associations, existing research has largely focused on protective factors among urban-residing SMYAs only. Understanding factors that buffer sexual identity-based discrimination-health outcome associations for SMYAs in rural versus urban areas is needed. METHODS: We analyzed 2 waves of survey data among 549 SMYAs (n = 179 rural and n = 370 urban) ages 18 to 25. Multivariable regressions examined main effects and interactions of baseline sexual identity-based discrimination and individual factors (resilience, internal LOC, cognitive reappraisal, and suppression) with SMYAs' health outcomes, including mental health symptoms, past-month tobacco, cannabis, and alcohol use at follow-up controlling for sociodemographic covariates and health outcomes at baseline. RESULTS: Multivariable regressions indicated that discrimination was associated with mental health symptoms and cannabis use among rural SMYAs and with mental health symptoms and tobacco use among urban SMYAs. The association of discrimination with mental health symptoms was buffered by resilience for urban SMYAs only. Moreover, suppression served as a risk factor for alcohol use among urban SMYAs facing discrimination. CONCLUSIONS: Individual protective factors may not be universally beneficial for SMYAs experiencing discrimination related to their sexual identity. Future research should examine the interplay of individual- and structural-level factors with health outcomes among rural SMYAs to inform prevention and intervention efforts among SMYAs at greatest risk for problematic health outcomes.