Table 3.

Tertiary outcomes, items, response options, and coding procedures.

Tertiary outcome		Items	Response options	Coding procedure
Bullying and cyberbullying victimization
	Bullying victimization [98,99]	How many times did these things happen to you in the last 30 days?—other students picked on me; other students called me names; I got hit and pushed by other students; I was threatened by other students; students spread rumors or told lies about me; I was excluded or kept out of a group of friends on purpose.	Never; 1 or 2 times; 3 or 4 times; 5 or 6 times; 7 or more times	Mean score
	Cyberbullying victimization, adapted from [100]	How often did the following things happen to you in the last month?—someone made rude comments about me online; someone spread rumors about me online, whether they were true or not; someone made aggressive or threatening comments to me online; someone sent a text message that said rude or mean things about me	Not sure; Never; Rarely; Occasionally; Often	Mean score
Loneliness
	Loneliness [101]	Indicate how often each of the statements below is descriptive of you—I feel in tune with the people around me (reverse coded); I lack companionship; I do not feel alone (reverse coded); I feel part of a group of friends (reverse coded); I am no longer close to anyone; I feel left out; I feel isolated from others; I can find companionship when I want it (reverse coded)	4-point Likert scale: Never; Rarely; Sometimes; Often	Mean score
Mental health issues
	Stress [103,109]	For each item, mark the description that best represents how often you have felt or thought that way during the past month—Been upset because of something that happened unexpectedly; Felt that you were unable to control the important things in your life; Felt nervous and ― “stressed”; Felt confident about your ability to handle your personal problems; Felt that things were going your way; Found that you could not cope with all the things that you had to do; Been able to control irritations in your life; Felt that you were on top of things; Been angered because of things that were outside of your control; Felt difficulties were piling up so high that you could not overcome them	5-point Likert scale: Never; Almost never; Sometimes; Fairly often; Very often	Mean score
	Anxiety [104,105]	During the past 7 days, I have: Felt moments of sudden terror, fear, or fright; Felt anxious, worried, or nervous; Had thoughts of bad things happening such as family tragedy, ill health, loss of a job, or accidents; Felt a racing heart, sweaty, trouble breathing, faint, or shaky; Felt tense muscles, felt on edge or restless, or had trouble relaxing or trouble sleeping; Avoided, or did not approach or enter situations about which I worry; Left situations early or participated only minimally because of worries; Spent lots of time making decisions, putting off making decisions, or preparing situations, because of worries; Sought reassurance from others because of worries; Needed help to cope with anxiety (eg, alcohol or medication, superstitious objects, or other people)	5-point Likert scale: Never; Occasionally; Half the time; Most of the time; All of the time	Mean score
	Depression [106]	How often have you been bothered by each of the following symptoms during the past 7 days?—Feeling down, depressed, irritable, or hopeless; Little interest or pleasure in doing things; Trouble falling asleep, staying asleep, or sleeping too much; Poor appetite, weight loss, or overeating; Feeling tired, or having little energy; Feeling bad about yourself—or feeling that you are a failure, or that you have let yourself or your family down; Trouble concentrating on things like school work, reading, or watching TV; Moving or speaking so slowly that other people have noticed; Or the opposite—being so fidgety or restless that you were moving around a lot more than usual; Thoughts that you would be better off dead, or of hurting yourself in some way	4-point Likert scale: Not at all; Several days; More than half the days; Nearly every day	Mean score
	Suicidal ideation, adapted from [110]	During the past month, did you ever seriously consider attempting suicide?	Yes; No	Dichotomously as yes or no
	Suicide plan, adapted from [110]	During the past month, did you make a plan about how you would attempt suicide?	Yes; No	Dichotomously as yes or no
	Suicide attempt, adapted from [110]	During the past month, how many times did you actually attempt suicide?	0 times; 1 time; 2 or 3 times; 4 or 5 times; 6 or more times	Dichotomously as yes or no, similar to prior research [6]
Substance use
	Alcohol use [110]	During the past 30 days, on how many days did you have at least one drink of alcohol?	0 days; 1 or 2 days; 3 to 5 days; 6 to 9 days; 10 to 19 days; 20 to 29 days; All 30 days	Count variable using midpoints (eg, “1 or 2 days” equals 1.5), similar to prior research [7]
	Binge alcohol use [111]	During the past 30 days, on how many days did you have 5 or more drinks of alcohol in a row (within a couple of hours)?	0 days; 1 day; 2 days; 3 to 5 days; 6 to 9 days; 10 to 19 days; 20 or more days	Count variable using midpoints (eg, “1 or 2 days” equals 1.5), similar to prior research [7]
	Cigarette smoking [110]	During the past 30 days, on how many days did you smoke cigarettes? During the past 30 days, on the days you smoked, how many cigarettes did you smoke per day?	For the question pertaining to number of days: 0 days; 1 or 2 days; 3 to 5 days; 6 to 9 days; 10 to 19 days; 20 to 29 days; All 30 days. For the question pertaining to number of cigarettes: I did not smoke cigarettes during the past 30 days; Less than 1 cigarette per day; 1 cigarette per day; 2 to 5 cigarettes per day; 6 to 10 cigarettes per day; 11 to 20 cigarettes per day; More than 20 cigarettes per day	Continuously by multiplying frequency by quantity, similar to prior research [10]
	Electronic cigarette use [110]	During the past 30 days, on how many days did you use an electronic vapor product?	0 days; 1 or 2 days; 3 to 5 days; 6 to 9 days; 10 to 19 days; 20 to 29 days; All 30 days	Count variable using midpoints (eg, “1 or 2 days” equals 1.5)
	Marijuana use [110]	During the past 30 days, how many times did you use marijuana? (Marijuana is also called grass, pot, or weed.)	0 times; 1 or 2 times; 3 to 9 times; 10 to 19 times; 20 to 39 times; 40 or more times	Count variable using midpoints (eg, “1 or 2 days” equals 1.5)
Internalized sexual and gender minority stigma
	Internalized gender minority stigma, adapted from [107,108]	Pride subscale contains 8 items (reverse coded); Passing subscale contains 7 items; Alienation subscale contains 3 items; Shame subscale contains 8 items; To obtain the specific scale items, please contact Robert WS Coulter and Walter O Bockting	7-point Likert Scale: Strongly disagree; Disagree; Somewhat disagree; Neither agree nor disagree; Somewhat agree; Agree; Strongly agree	Mean score for each subscale separately
	Internalized Sexual Minority Stigma, adapted from [107,108]	Pride subscale contains 8 items (reverse coded); Passing subscale contains 7 items; Alienation subscale contains 3 items; Shame subscale contains 8 items; To obtain the specific scale items, please contact Robert WS Coulter and Walter O Bockting	7-point Likert Scale: Strongly Disagree; Disagree; Somewhat Disagree; Neither Agree nor Disagree; Somewhat Agree; Agree; Strongly Agree	Mean score for each subscale separately