Participants were recruited via advertisements on Facebook and Instagram from July to October 2018 with an advertisement budget of $1500 and a participant incentive budget of $500. Two separate advertisements were used to recruit transgender and cisgender adolescents. All ads included pictures of racially/ethnically diverse adolescents (see Supplemental Fig. 1) and targeted U.S. users aged 14–18 years. The transgender ad included additional targeting to identify users associated with “Interests” labels such as Gender Identity, Genderqueer, and Transgender Activism. No additional targeting was used for the cisgender ad.
Clicking the ad opened the survey webpage, where participants provided assent and then completed anonymous questionnaires hosted on a secure server. Within the assent form, participants were informed that the study was voluntary, they could stop participating at any time, and they could skip any question. Participants used their own electronic device (e.g., mobile phone, tablet, computer). To ensure that study participation did not place transgender adolescents at risk of stigmatization and rejection by family members, we conducted our study with a waiver of parental permission. As an additional safety measure, participants viewed a message regarding safety and security before starting the survey (see Fig. 1). Participants who endorsed lifetime suicidality were provided with information about 24-h mental health hotlines they could contact immediately following the suicide items. All participants were provided with nationwide resources for suicidality, mental health crises, substance use, sexual assault and abuse, and eating disorders in the online informed consent and following completion of the survey. Participants who completed the survey were provided the opportunity to enter a drawing for a $50 electronic gift card (10 participants were randomly selected). The University of Pittsburgh’s Human Research Protection Office approved this study.