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. 2025 Jun 27:14:e73070.
doi: 10.2196/73070.

Associations Among Minority Stress, Allostatic Load, and Drug and Alcohol Use in Sexual Minorities: Protocol for the Queer Health Study-a Longitudinal Feasibility Evaluation

Nathan Grant Smith  1 , Tzuan A Chen  1 , Robert-Paul Juster  2   3   4 , Ezemenari M Obasi  5 , Jacob S Crocker  1
Affiliations

Associations Among Minority Stress, Allostatic Load, and Drug and Alcohol Use in Sexual Minorities: Protocol for the Queer Health Study-a Longitudinal Feasibility Evaluation

Nathan Grant Smith et al. JMIR Res Protoc. .

Abstract

Background: Substance use rates among sexual minorities are disproportionately greater than that of their heterosexual counterparts. Minority stress theory posits that one explanation for disproportionate substance use in sexual minority populations is a result of increased social stress associated with holding a minoritized identity. This minority stress has been linked to a myriad of negative mental health outcomes, including alcohol and drug use. In addition, emerging research has begun to demonstrate links between minority stress and stress physiology dysregulation. While animal and human models have demonstrated links between stress physiology dysregulation and substance use outcomes, to date, no studies have examined the role that stress physiology plays within a minority stress framework in predicting substance use among sexual minorities. The Queer Health Study was designed to explore the longitudinal links among minority stress, stress physiology (specifically, allostatic load, the cumulative "wear and tear" on the body and brain as a result of chronic stress), and substance use.

Objective: This study aims to assess the feasibility of collecting longitudinal data to explore the temporal links between minority stress processes, allostatic load, and drug and alcohol use, as well as to obtain estimates of effect size to determine the appropriate sample size necessary to conduct a fully powered longitudinal study.

Methods: This feasibility study is a 3-wave longitudinal design consisting of a self-report survey, researcher-assisted Timeline Followback to assess for drug and alcohol use, and blood and anthropometric data collection to measure allostatic load at each of the time points. A total of 40 ethnically and racially diverse sexual minority adult participants (aged 18-60 years) will be enrolled.

Results: The study received University of Houston institutional review board approval on July 31, 2023 (STUDY00004277). Recruitment began in June 2024. As of February 2025, the initial sample of 46 participants completed the time 1 visit, and time 2 visits are ongoing. We estimate that all study activities will be completed by July 2025.

Conclusions: Results can inform the development of targeted prevention and treatment interventions. In addition, this research will provide an innovative framework for exploring diverse risk and resilience factors impacting addiction in this at-risk population. Ultimately, results have important implications for public health and have the potential to reduce the many dire economic and health consequences of drug use and addiction.

International registered report identifier (irrid): DERR1-10.2196/73070.

Keywords: LGBTQ+; allostatic load; biomarkers; health disparity; minority stress; sexual and gender minorities; substance use.

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Conflict of interest statement

Conflicts of Interest: EMO is the founder and sole owner of HEALTH Equity Empowerment, LLC.

Figures

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Figure 1
Conceptual model.
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