Evaluation of State-Level Sexual and Gender Minority Laws for the Primary Prevention of Sexual and Intimate Partner Violence Among Sexual and Gender Minority Youth in the U.S. (YAP)

The goal of this observational study is to learn how state-level laws related to sexual and gender minority (SGM) youth affect the risk of sexual violence (SV) and intimate partner violence (IPV) among sexual minority (SM) youth in the United States. The study looks at both supportive laws (such as bans on conversion therapy and anti-bullying protections) and restrictive laws (such as limits on gender-affirming care) passed between 2017 and 2025. The main questions it aims to answer are:

Part 1:

• Do supportive SGM laws lower the risk of SV/IPV among SM youth?
• Do restrictive SGM laws raise the risk of SV/IPV among SM youth?
• Does the social climate in a state (such as levels of stigma toward SGM people) change how these laws affect SM youth?

Part 2:

-How do SGM youth themselves describe the ways that laws and social climates affect their safety and wellbeing?

Part 1 - Quantitative analysis: Researchers will use existing, publicly available survey data from the Youth Risk Behavior Surveillance System (YRBSS) to compare changes in SV/IPV risk among SM youth across states that adopted different types of SGM laws over the period of 2017-2025. No participants are enrolled for this part.

Part 2 - Qualitative interviews: Researchers will conduct one-on-one interviews with approximately 30 SGM youth ages 13-18 living across U.S. states with varying levels of adoption of supportive SGM laws. Each youth will take part in one 60-minute interview. Youth will be asked about their views on how laws and social climates affect safety, stigma, and access to resources. Youth will not be asked to share personal experiences of violence.

Study Overview

• Status: Not yet recruiting
• Conditions: Sexual Violence; Intimate Partner Violence (IPV)
• Intervention / Treatment: Other: Enumerated anti-bullying state legislation; Other: Conversion therapy state legislation; Other: Gender-affirming care state legislation

Detailed Description

Quantitative Component (Aims 1-2):

SM youth are identified using the YRBSS sexual identity item, which asks respondents "Which of the following best describes you?" Respondents indicating gay, lesbian, bisexual, describing their sexual identity some other way, or questioning are categorized as SM. Respondents indicating heterosexual (straight) are categorized as non-SM.

Primary outcomes are three individual-level YRBSS items measuring past 12-month sexual violence (SV) victimization and past 12-month intimate partner violence (IPV) victimization (physical and sexual).

Policy exposures are constructed as state-level binary indicators (present versus absent) for three types of SGM laws: gender-affirming care laws, conversion therapy bans, and enumerated identity-based anti-bullying laws. Exposure data are drawn from legal epidemiology datasets available through LawAtlas.org for years 2016, 2018, 2020, 2022, and 2024 with a one-year lag between exposure measurement and outcome assessment to ensure policies are implemented before outcome measurement. Outcome data are drawn from YRBSS survey including 29 states for the years 2017, 2019, 2021, 2023, 2025 representing 98 state-years with a total sample of approximately 357,040 youth.

Aim 1 employs a difference-in-differences (DiD) approach in a quasi-experimental framework using mixed effects DiD Poisson models to estimate the effect of SGM law adoption on SV/IPV risk among SM youth. Separate models are estimated for each law type and each outcome. Time-varying state-level covariates include population size, percentage below poverty line, and state-level demographic composition of race/ethnicity and age. Sensitivity analyses include Goodman-Bacon decomposition, doubly robust estimators, and imputation-based estimators to address potential treatment effect heterogeneity across adoption timing. Parallel pre-trends are assessed using lag and lead models with bounds adjusted for any non-parallel pre-trends. Exploratory analyses examine effects among specific racial/ethnic SM youth subgroups (Black, Hispanic/Latino, Native American/Alaska Native, and mixed race SM youth), reporting point estimates with 95 percent confidence intervals without formal hypothesis testing to provide directional evidence.

Aim 2 builds on the Aim 1 models by adding an interaction term between state-level SGM law adoption and social climate to test whether policy effects on SV/IPV risk differ based on state-level stigma toward SGM populations. Social climate is measured using publicly available survey data from the Public Religion Research Institute (PRRI) American Values Atlas collected from a nationally representative sample of approximately 22,000 adults annually from all 50 states 2016-2024. Respondents are asked the degree to which they favor allowing same-sex couples to marry legally, with responses dichotomized as favorable or unfavorable and summarized as the proportion with favorable attitudes at the state level (continuous). State-level estimates are derived using a multilevel regression and poststratification (MRP) approach with maximum likelihood modeling and poststratification based on demographics and state characteristics from the American Community Survey. Using model output, relative risks are calculated for meaningful cut-offs in SM social climate (for example, quartiles) using average marginal effects.

Qualitative Component (Aim 3):

Aim 3 participants are purposively sampled from states representing three strata of SGM-affirming policy adoption: high, medium, and low, with up to 10 youth per stratum. Within each stratum, constructed sampling quotas aim to include approximately 4 cisgender boys, 4 cisgender girls, and 2 transgender or nonbinary youth, and to ensure that at least half of participants identify as a racial or ethnic minority. This approach supports exploration of intersectional mechanisms and addresses known limitations of surveillance data in capturing diverse SGM youth experiences. Qualitative data are analyzed using thematic analysis to identify mechanisms through which state-level policies and social climates may affect SV/IPV risk among SGM youth. These findings contextualize and interpret the population-level quantitative results from Aims 1 and 2.

• Study Type: Observational
• Enrollment (Estimated): 30

Contacts and Locations

• Study Contact: Name: Sabrina C Boyce, PhD; Phone Number: 916-709-1123; Email: boyce.sabrina@berkeley.edu
• Study Contact Backup: Name: Ricardo B Vera Monroy, MS; Phone Number: 619-277-8303; Email: rveramonroy@berkeley.edu

Study Locations

• United States
  • California
    • Berkeley, California, United States, 94710-1754
      • University of California, Berkeley
      • Contact: Sabrina C Boyce, PhD; Phone Number: 916-709-1123; Email: boyce.sabrina@berkeley.edu
      • Contact: Ricardo B Vera Monroy, MS; Phone Number: 619-277-8303; Email: rveramonroy@berkeley.edu
      • Principal Investigator: Sabrina C Boyce, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: N/A

• Sampling Method: Non-Probability Sample

Study Population

SGM youth ages 13-18 recruited through outreach via research team and partners' networks of community based organizations across U.S. states selected to represent high, medium, and low adoption of SGM-affirming policies.

Description

Inclusion Criteria:

• Ages 13-18 years
• Resides in a U.S. state selected for the study
• Self-identifies as a sexual and/or gender minority (for example, lesbian, gay, bisexual, pansexual, queer, questioning, asexual, nonbinary, transgender, or another non-heterosexual or non-cisgender identity)
• Able to complete the interview in English
• Sufficient literacy to review age-appropriate assent materials

Exclusion Criteria: No additional exclusion criteria beyond not meeting inclusion criteria

Study Plan

How is the study designed?

Number of groups / cohorts

6

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
YRBSS state-representative cohort 2017; First year of primary analytic population for quantitative analyses examining the effect of state-level SGM law adoption on SV/IPV risk (Aims 1-2).	Other: Enumerated anti-bullying state legislation; The interventions in this study are being studied as a natural experiment and are not assigned or implemented by the study. In any given cohort year, some states are exposed to the legislation of interest and others are not, as assessed using data from LawAtlas.org and categorized by the research team. Enumerated anti-bullying state legislation is state-level legislation that prohibits bullying in educational settings and that explicitly includes sexual orientation and gender identity as protected classes.; Other: Conversion therapy state legislation; The interventions in this study are being studied as a natural experiment and are not assigned or implemented by the study. In any given cohort year, some states are exposed to the legislation of interest and others are not, as assessed using data from LawAtlas.org and categorized by the research team. Conversion therapy state legislation is state-level legislation that prohibits the practice of conversion therapy, a practice that attempts to change a person/client's sexual orientation or gender identity to conform to prevailing cisgender and/or heterosexual norms.; Other: Gender-affirming care state legislation; The interventions in this study are being studied as a natural experiment and are not assigned or implemented by the study. In any given cohort year, some states are exposed to the legislation of interest and others are not, as assessed using data from LawAtlas.org and categorized by the research team. Gender-affirming care state legislation is state-level legislation regarding the use of healthcare tailored to support the patient's gender identity (may prohibit or protect the right to use this type of healthcare)
YRBSS state-representative cohort 2019; Second year of primary analytic population for quantitative analyses examining the effect of state-level SGM law adoption on SV/IPV risk (Aims 1-2).	Other: Enumerated anti-bullying state legislation; The interventions in this study are being studied as a natural experiment and are not assigned or implemented by the study. In any given cohort year, some states are exposed to the legislation of interest and others are not, as assessed using data from LawAtlas.org and categorized by the research team. Enumerated anti-bullying state legislation is state-level legislation that prohibits bullying in educational settings and that explicitly includes sexual orientation and gender identity as protected classes.; Other: Conversion therapy state legislation; The interventions in this study are being studied as a natural experiment and are not assigned or implemented by the study. In any given cohort year, some states are exposed to the legislation of interest and others are not, as assessed using data from LawAtlas.org and categorized by the research team. Conversion therapy state legislation is state-level legislation that prohibits the practice of conversion therapy, a practice that attempts to change a person/client's sexual orientation or gender identity to conform to prevailing cisgender and/or heterosexual norms.; Other: Gender-affirming care state legislation; The interventions in this study are being studied as a natural experiment and are not assigned or implemented by the study. In any given cohort year, some states are exposed to the legislation of interest and others are not, as assessed using data from LawAtlas.org and categorized by the research team. Gender-affirming care state legislation is state-level legislation regarding the use of healthcare tailored to support the patient's gender identity (may prohibit or protect the right to use this type of healthcare)
SGM Youth Interview Participants; Sexual and gender minority youth ages 13-18 enrolled for one-on-one qualitative interviews exploring perceptions of how state-level policies and social climates affect safety, stigma, and access to resources (Aim 3).	Other: Enumerated anti-bullying state legislation; The interventions in this study are being studied as a natural experiment and are not assigned or implemented by the study. In any given cohort year, some states are exposed to the legislation of interest and others are not, as assessed using data from LawAtlas.org and categorized by the research team. Enumerated anti-bullying state legislation is state-level legislation that prohibits bullying in educational settings and that explicitly includes sexual orientation and gender identity as protected classes.; Other: Conversion therapy state legislation; The interventions in this study are being studied as a natural experiment and are not assigned or implemented by the study. In any given cohort year, some states are exposed to the legislation of interest and others are not, as assessed using data from LawAtlas.org and categorized by the research team. Conversion therapy state legislation is state-level legislation that prohibits the practice of conversion therapy, a practice that attempts to change a person/client's sexual orientation or gender identity to conform to prevailing cisgender and/or heterosexual norms.; Other: Gender-affirming care state legislation; The interventions in this study are being studied as a natural experiment and are not assigned or implemented by the study. In any given cohort year, some states are exposed to the legislation of interest and others are not, as assessed using data from LawAtlas.org and categorized by the research team. Gender-affirming care state legislation is state-level legislation regarding the use of healthcare tailored to support the patient's gender identity (may prohibit or protect the right to use this type of healthcare)
YRBSS state-representative cohort 2021; Third year of primary analytic population for quantitative analyses examining the effect of state-level SGM law adoption on SV/IPV risk (Aims 1-2).	Other: Enumerated anti-bullying state legislation; The interventions in this study are being studied as a natural experiment and are not assigned or implemented by the study. In any given cohort year, some states are exposed to the legislation of interest and others are not, as assessed using data from LawAtlas.org and categorized by the research team. Enumerated anti-bullying state legislation is state-level legislation that prohibits bullying in educational settings and that explicitly includes sexual orientation and gender identity as protected classes.; Other: Conversion therapy state legislation; The interventions in this study are being studied as a natural experiment and are not assigned or implemented by the study. In any given cohort year, some states are exposed to the legislation of interest and others are not, as assessed using data from LawAtlas.org and categorized by the research team. Conversion therapy state legislation is state-level legislation that prohibits the practice of conversion therapy, a practice that attempts to change a person/client's sexual orientation or gender identity to conform to prevailing cisgender and/or heterosexual norms.; Other: Gender-affirming care state legislation; The interventions in this study are being studied as a natural experiment and are not assigned or implemented by the study. In any given cohort year, some states are exposed to the legislation of interest and others are not, as assessed using data from LawAtlas.org and categorized by the research team. Gender-affirming care state legislation is state-level legislation regarding the use of healthcare tailored to support the patient's gender identity (may prohibit or protect the right to use this type of healthcare)
YRBSS state-representative cohort 2023; Fourth year of primary analytic population for quantitative analyses examining the effect of state-level SGM law adoption on SV/IPV risk (Aims 1-2).	Other: Enumerated anti-bullying state legislation; The interventions in this study are being studied as a natural experiment and are not assigned or implemented by the study. In any given cohort year, some states are exposed to the legislation of interest and others are not, as assessed using data from LawAtlas.org and categorized by the research team. Enumerated anti-bullying state legislation is state-level legislation that prohibits bullying in educational settings and that explicitly includes sexual orientation and gender identity as protected classes.; Other: Conversion therapy state legislation; The interventions in this study are being studied as a natural experiment and are not assigned or implemented by the study. In any given cohort year, some states are exposed to the legislation of interest and others are not, as assessed using data from LawAtlas.org and categorized by the research team. Conversion therapy state legislation is state-level legislation that prohibits the practice of conversion therapy, a practice that attempts to change a person/client's sexual orientation or gender identity to conform to prevailing cisgender and/or heterosexual norms.; Other: Gender-affirming care state legislation; The interventions in this study are being studied as a natural experiment and are not assigned or implemented by the study. In any given cohort year, some states are exposed to the legislation of interest and others are not, as assessed using data from LawAtlas.org and categorized by the research team. Gender-affirming care state legislation is state-level legislation regarding the use of healthcare tailored to support the patient's gender identity (may prohibit or protect the right to use this type of healthcare)
YRBSS state-representative cohort 2025; Fifth year of primary analytic population for quantitative analyses examining the effect of state-level SGM law adoption on SV/IPV risk (Aims 1-2).	Other: Enumerated anti-bullying state legislation; The interventions in this study are being studied as a natural experiment and are not assigned or implemented by the study. In any given cohort year, some states are exposed to the legislation of interest and others are not, as assessed using data from LawAtlas.org and categorized by the research team. Enumerated anti-bullying state legislation is state-level legislation that prohibits bullying in educational settings and that explicitly includes sexual orientation and gender identity as protected classes.; Other: Conversion therapy state legislation; The interventions in this study are being studied as a natural experiment and are not assigned or implemented by the study. In any given cohort year, some states are exposed to the legislation of interest and others are not, as assessed using data from LawAtlas.org and categorized by the research team. Conversion therapy state legislation is state-level legislation that prohibits the practice of conversion therapy, a practice that attempts to change a person/client's sexual orientation or gender identity to conform to prevailing cisgender and/or heterosexual norms.; Other: Gender-affirming care state legislation; The interventions in this study are being studied as a natural experiment and are not assigned or implemented by the study. In any given cohort year, some states are exposed to the legislation of interest and others are not, as assessed using data from LawAtlas.org and categorized by the research team. Gender-affirming care state legislation is state-level legislation regarding the use of healthcare tailored to support the patient's gender identity (may prohibit or protect the right to use this type of healthcare)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Past 12-Month Sexual Violence Victimization	Binary self-reported YRBSS item indicating sexual violence victimization in the past 12 months. Risk ratios estimated comparing states with and without specific SGM laws.	Past 12 months at each biennial YRBSS survey administration (repeated cross-sectional assessments from 2017 to 2025)
Past 12-Month Intimate Partner Violence Victimization	Binary composite of two self-reported YRBSS items indicating physical dating violence or sexual dating violence in the past 12 months, coded as victimization if either item is endorsed. Risk ratios estimated comparing states with and without specific SGM laws.	Past 12 months at each biennial YRBSS survey administration (repeated cross-sectional assessments from 2017 to 2025)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Past 12-months Suicidality	Binary composite of three self-reported YRBSS items indicating suicidality in the past 12 months (serious consideration of attempting suicide, planning, and attempts). Risk ratios estimated comparing states with and without specific SGM laws.	Past 12 months at each biennial YRBSS survey administration (repeated cross-sectional assessments from 2017 to 2025)
Past 12-month Bullying	Binary composite of two self-reported YRBSS items indicating in-person or electronic bullying victimization in the past 12 months. Risk ratios estimated comparing states with and without specific SGM laws.	Past 12 months at each biennial YRBSS survey administration (repeated cross-sectional assessments from 2017 to 2025)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Past 12-Month SV/IPV Victimization Among Racial/Ethnic Minority SM Youth Subgroups	Exploratory analyses estimating risk ratios for effects of SGM law adoption on past 12-month SV and IPV among specific racial/ethnic SM youth subgroups (Black, Hispanic/Latino, Native American/Alaska Native, and mixed race). Point estimates reported with 95 percent confidence intervals without formal hypothesis testing to provide directional evidence	Past 12 months at each biennial YRBSS survey administration (repeated cross-sectional assessments from 2017 to 2025)
Youth-Reported Perceptions of How State-Level Sexual and Gender Minority (SGM) Policies and Social Climates Affect Safety, Stigma, and Access to Resources	Memos and qualitative themes identified through thematic analysis of semi-structured interviews with SGM youth exploring how state-level policies and social climates shape perceived safety, experiences of stigma, and access to supportive resources	During a single 60-minute interview session at enrollment

Collaborators and Investigators

• Sponsor: University of California, Berkeley
• Collaborators: University of Michigan; Tulane University; Centers for Disease Control and Prevention
• Investigators: Principal Investigator: Sabrina C Boyce, PhD, University of California, Berkeley

Study record dates

Study Major Dates

• Study Start (Estimated): August 1, 2026
• Primary Completion (Estimated): September 1, 2027
• Study Completion (Estimated): September 1, 2029

Study Registration Dates

• First Submitted: July 22, 2026
• First Submitted That Met QC Criteria: July 22, 2026
• First Posted (Actual): July 27, 2026

Study Record Updates

• Last Update Posted (Actual): July 29, 2026
• Last Update Submitted That Met QC Criteria: July 27, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: sexual violence; Conversion therapy; dating violence; Gender-affirming care; Anti-bullying laws; Youth Risk Behavior Surveillance System; Sexual minority youth
• Other Study ID Numbers: 2026-01-19304; U01CE003753 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Sharing individual-level qualitative data would pose re-identification risk given the small sample size and the need to protect vulnerable youth discussing sensitive topics related to safety, stigma, and policy experiences.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No