Pilot proof of concept exploring longitudinal links between minority stress, stress physiology dysregulation, and drug use in sexual minority adults

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PROJECT SUMMARY/ABSTRACT Sexual minority (SM) adults are disproportionately affected by drug use and are at greater risk for substance use disorders than their heterosexual counterparts. One explanation for the high rates of drug use and substance use disorders among sexual minorities is that increased stress related to being a SM puts SM individuals at risk for drug use. Research demonstrates that chronic stress and subsequent activation of the hypothalamic-pituitary-adrenal axis lead to allostasis, or a state of sustained stability outside of normal functioning that is necessary to meet the demands of the chronic stressor(s). Overtime, allostasis leads to allostatic load, or the cumulative “wear and tear” on the body as a result of chronic stress. Moreover, allostatic load has been linked to both the initiation and trajectories of drug use. However, no research has examined allostatic load in the context of drug use outcomes among SMs. The purpose of the proposed research is to conduct a feasibility and proof-of-concept study to examine the relationships between SM stress (e.g., discrimination experiences, internalized homonegativity), allostatic load, and drug use. The specific aims are to (1) assess the feasibility of following a sample of 40 racially/ethnically-diverse SM adults over the course of 1 year to explore the links between minority stress, allostatic load, and drug use, (2) obtain estimates of effect size that will allow the investigators to determine the required sample size for a subsequent, fully-powered study, (3) begin to explore the temporal links between minority stress, allostatic load, and drug use, and (4) provide targeted mentoring of a new investigator by an established investigator. To meet these aims, we will recruit a racially/ethnically-diverse sample of SM adults in Houston, TX. Eligible participants will complete self-report measures, including minority stress and drug use, among others, in addition to biological measures collected via blood and anthropometrics (e.g., cytokines, BMI). This innovative study will be the first to explore the links between allostatic load and drug use in this population, which has demonstrated drug-use health disparities. Moreover, it will be the first study to comprehensively test the impact of minority stress on allostatic load among SM adults. Study results will be used to develop a subsequent NIH grant application to conduct a fully-powered, 2-year longitudinal study. In addition, results will help to inform the development of individually-tailored interventions to detect, prevent, and treat addiction in this at-risk population, which will help to lessen the disease burden of drug use and addiction. The proposed research addresses the Notice of Special Interest (NOT-MD-23-001) by leveraging the University of Houston’s HEALTH Center for Addictions Research and Cancer Prevention to conduct this innovative pilot study examining how biological, behavioral, and social/environmental factors contribute to SM health outcomes and health disparities, specifically drug use and addiction.