Abstract Background Structural stigma, including discriminatory laws, inequitable policies, and negative attitudes, has been conceptualized as the general societal climate and institutional conditions that shape sexual minorities’ lives, mental, and physical health. While multidimensional indices have been used globally, U.S.-based studies have largely relied on single indicators (e.g., a law or policy; presence of resources). This scoping review aimed to identify structural sexual minority stigma indicators relevant to the U.S. context, to inform comprehensive, multidimensional future operationalizations. Methods Systematic database searches in PubMed, PsycINFO, and JSTOR, and snowball techniques resulted in 70 articles. After duplicate deletion and abstract review, 25 unique indices were long-listed relevant to structural sexual minority stigma at country or state level (i.e., macro level). School (district) and county (i.e., exo level) indicators were excluded. Results From the long-listed indices, a total of 112 legal and policy indicators were narrowed down to relevant 33 macro-level indicators and grouped across seven domains: criminal justice, hate crime protections, non-discrimination, religious refusal, relationship recognition, parenting, and youth laws and policies. Two different quantifications of population attitudes were identified that aggregated social and policy opinions across states regarding sexual minority adoption, hate crimes, health benefits, labor and housing, public speaking or teaching, marriage, sodomy, and civil unions. Discussion While a large variety of legal and attitudinal indicators was identified, few U.S.-based studies used multidimensional operationalizations (e.g., law, policy, opinion) needed to reduce risk of confounding bias through population-attitudes-to-law/policy backdoor pathways. To further advance the science on structural sexual minority stigma and health globally, future studies may benefit from multidimensional approaches. Key messages • With many legal and attitudinal indicators identified, few studies used multidimensional operationalizations (e.g., law, policy, opinion) needed to reduce risk of confounding bias. • To further advance the science on structural sexual minority stigma and health globally, future studies may benefit from multidimensional approaches.