Minority stress theory extends the social causation hypothesis by suggesting that social situations do not lead directly to poor health for minority individuals, but that difficult social situations cause stress for minority individuals, which accrues over time, resulting in long-term health deficits. Furthermore, minority stress theory distinguishes between distal and proximal stress processes. Distal stress processes are external to the minority individual, including experiences with rejection, prejudice, and discrimination. Proximal stress processes are internal, and are often the byproduct of distal stressors; they include concealment of one's minority identity, vigilance and anxiety about prejudice, and negative feelings about one's own minority group. Together, distal and proximal stressors accrue over time, leading to chronically high levels of stress that cause poor health outcomes. Thus, minority stress theory has three primary tenets: Minority status leads to increased exposure to distal stressors. Minority status leads to increased exposure to proximal stressors, due to distal stressors. Minority individuals suffer adverse health outcomes, which are caused by exposure to proximal and distal stressors. These three tenets of the minority stress theory have been tested in over 134 empirical studies, most of which examined racial and sexual minority populations. Generally, the studies have confirmed that difficult social situations are associated with stress among minority individuals, and that minority stress helps to explain health disparities. Evidence of key concepts Minority status and distal stressors The first tenet of minority stress theory holds that being in a minority group is associated with increased exposure to distal stressors, such as prejudice and discrimination. Indeed, despite significant improvement over the past several decades, numerous studies have confirmed that minority individuals continue to face high rates of distal stressors. For example, in large-scale national surveys, LGBTQ+ individuals report high rates of prejudice and discrimination across the lifespan. One survey found that one-fourth of LGB adults have experienced victimization related to their sexual orientation, and another found that as many as 90% of LGBTQ+ youth report hearing prejudiced remarks at school. Similarly, up to 60% of African Americans report experiencing distal stressors throughout their lives, ranging from social rejection at school to housing discrimination and employment discrimination. In one study, 37 African American respondents recalled over 100 discrete experiences with racist prejudice in a two-year period. In another study, 98% of Black participants reported experiencing at least one incidence of prejudice in the past year. Rates of exposure to distal stressors are