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**Is State-Level Anti-Black Cultural Racism Associated with Black Youth’s Mental Health?** **Introduction:** Research consistently links internalizing and externalizing symptomatology in Black youth to discrimination, with a near exclusive focus on interpersonal racism. Despite recent calls, few studies have explored anti-Black racism at the macro level, including if and how cultural racism (i.e., a dominant culture’s values/beliefs regarding another racial group) relates to Black youth’s mental health. This is an important area of inquiry, as evidence reveals significant associations between higher community-level anti-Black cultural racism and poor health (e.g., COVID), worse therapy efficacy, and altered brain development (e.g., hippocampal volume). Building on this work, we explored associations between state-level anti-Black cultural racism and mental health symptom severity in Black youth, anticipating that Black youth from higher-racism states would report greater internalizing and externalizing symptoms. **Method:** Data were pooled across three psychotherapy trials with 112 Black youth (Mage=10.7; 53% boys) from four states. Participants’ pretreatment internalizing and externalizing symptoms (Youth Self-Report) were linked to a previously developed composite measure of anti-Black cultural racism (aggregating individual explicit anti-Black attitudes to the state level). Linear mixed-effects models (to account for youth nested in states) examined associations between anti-Black cultural racism and symptom severity (adjusting for age, gender, state income inequality, and Black/White population density). **Results:** State-level anti-Black cultural racism was significantly associated with self-reported externalizing (β=11.8, SE=4.9, p=.018) but not internalizing symptomatology, with Black youth from states with greater anti-Black attitudes reporting more severe concerns. As a negative control, we reran our analysis with 489 White youth (Mage=10.3; 54% boys) from the same trials (and thus states), finding no such associations. **Discussion:** Findings extend a growing body of literature highlighting the insidious effects of anti-Black racism. We demonstrate that greater levels of anti-Black cultural racism may undermine Black youth’s mental health, at least with respect to externalizing symptoms. It is possible that Black youth from higher-racism states are more likely to be exposed to, and may internalize, racial bias or stereotypes, such as those implicated in unjust institutional policies (e.g., school discipline) and disparate assessment practices (e.g., overdiagnosis of externalizing disorders), wherein Black youth are labeled as more defiant or aggressive than their White peers. Additionally, anti-Black cultural racism has been linked to reduced hippocampal volume in Black youth, and such alterations may contribute to externalizing behaviors. Accordingly, anti-racist approaches to mental health care, which address causes and consequences of anti-Black racism, may be particularly beneficial to Black youth in high-racism communities. **Structural Transphobia and the Availability of Gender-Affirming Mental Health Providers** **Objective:** Transgender youth face significant mental health disparities relative to cisgender youth, which may be partially attributable to structural transphobia. Scholars have rarely considered processes by which structural transphobia impacts transgender youth mental health. Structural transphobia may undermine access to appropriate mental health care, such that providers in high-stigma states are less likely to be trained in gender-affirming care. To date, research has lacked a comprehensive structural transphobia measure and data source to explore this possibility. Thus, we developed a novel measure, which we linked to public data on mental health providers. **Method:** Multiple linear regression tested the association between state-level transphobia and gender-affirming youth mental health provider availability. To measure structural transphobia, we factor-analyzed 32 state policy categories specific to transgender rights (e.g., nondiscrimination, identity documents). A one-factor solution comprising 29 indicators emerged, with higher factor scores representing lower-stigma states. Gender-affirming providers by state were identified via Psychology Today, and census data were used to calculate providers per capita. **Results:** Controlling for state income inequality, urbanicity, transgender population estimates, and unmet mental health needs, mental health provider availability was significantly associated with state-level transphobia, such that there were more gender-affirming providers per 100,000 youth in lower-stigma states (β=14.0; SE=2.24; p<0.001). **Discussion:** We offer evidence that state-level transphobia is associated with the availability of gender-affirming providers, who may be less likely to live, receive relevant training, or advertise in high-stigma states. The dearth of gender-affirming providers may exacerbate transgender youth mental health inequity in these settings. Findings underscore the need for multilevel solutions, from policy change to provider trainings.