HEALTH Research Institute

In a new Notice of Special Interest (NOSI) study, University of Houston researcher Dr. Nathan Smith plans to evaluate the impact of recent stressors linked to depression, anxiety, and substance use within Houston’s LGBTQ+ community. The study is entitled, "Pilot Proof of Concept Exploring Longitudinal Links between Minority Stress, Stress Physiology Dysregulation, and Drug Use in Sexual Minority Adults.” The initiative was awarded $154,250 through NIH/NIMHD and HEALTH–RCMI [P.I. Dr. Ezemenari Obasi]. Smith serves as UH Chair of the Department of Psychological, Health, and Learning Sciences and is the director of the CORE Lab.

“The stigma and discrimination against the queer community has always been there in our lifetime,” Smith said. “But we have seen a big backlash over the last decade. The last year has been especially acute. We also know that the number of anti-LGBTQ+ bills has more than doubled since last year—nationally as well as what is happening in Texas.”

Through Smith’s initiative, approximately 40 participants will be recruited for a pilot study. During each clinical visit, participants will complete self-report measures related to their experiences of stress as a sexual minority person, including mental health issues and substance use. Smith added that researchers will also take blood samples to assess a variety of biomarkers. In addition, researchers will evaluate anthropometrics, such as height, weight, and blood pressure.

“We’ll be using all of these biological data to combine together to create an index known as allostatic load,” Smith said. “Allostatic load is an index of the cumulative wear and tear on the body because of stress. The goal is to see if we can get these measures of stress, mental health, substance use, and biomarkers, and then start looking to see what the trends are and how those things relate over time.”

Smith underscored that the NOSI study would provide a clear methodology and hopes to replicate the study with a larger sample.

“Redoing the study with a large sample would actually give us enough power to see over time how minority stress turns into allostatic load and how allostatic load in turns translates into substance use,” Smith said.

Exploring how stressors impact the LGBTQ+ community has been a pivotal research focus and interest for Smith. HEALTH–RCMI's Founder and Director, Dr. Ezemenari Obasi has collaborated with him on several cited studies which delve more deeply into stress.

“For 20 plus years, I have been interested in the ways that stressors that we experience as queer people translate into poor health,” Smith said. “When I came to the University of Houston 10 years ago, it was serendipitous that Dr. Obasi was doing similar types of work. We were looking specifically at the links between minority stress and cortisol. Over the years, Dr. Obasi and I have developed a strong working relationship with our shared interest in the ways in which the stress of being a part of community that is marginalized translates into wear and tear on the body--and then downstream, negative health impacts.”

Smith emphasized that continued societal stigma and discrimination have dealt a deafening blow to the LGBTQ+ community, resulting in negative health outcomes. The sobering reality is that the 2023 legislative session introduced more than 550 anti-LGBTQ+ bills in 43 state houses across the U.S. More than 80 bills signed into law, making 2023 the worst year on record for anti-LGBTQ+ legislation.

“I’m really committed to health generally—but specifically to health of the LGBTQ+ community,” Smith said. “I know that all our population data shows that we are at risk for a whole host of negative outcomes. If we could get more insights into the ways that all these processes work, to explain those negative health outcomes, the more information we have, the more we can get that out there.”

Serving as a collaborator on this pivotal study, Dr. Robert-Paul Juster echoes how stigma and stress can exacerbate substance abuse among sexual minority adults. Juster is an Assistant Professor at the Department of Psychiatry and Addictology for the Faculty of Medicine at the University of Montreal.

"This is such an important topic that helps bridge the world of stress and drugs among sexual minority adults," Juster said. "Understanding the mechanism whereby stigma ‘gets under the skin and skull’ to increase stress and drug use is extremely important for understanding health disparities among sexual minority people. But this also has applications for understanding minority stress experiences beyond sexual orientation with a recruitment plan that involves the inclusion of a wide diversity of backgrounds represented in Houston and the United States more broadly."

One of the key initiatives that Smith is currently working on is examining the impact of anti-LGBTQ+ legislation on gay and transgender people.

“It is striking how much stress, despondency, hopelessness, and anger people are feeling about the current wave of LGBTQ+ legislation,” Smith said. “The policy implications of the work that I do have been influencing me for my whole professional career. I want my research to be affecting policy.”

Through Smith’s NOSI which investigates the impact of stress, the implications of this study will also provide insight about ways to manage stress more effectively.

“We know that things like mindfulness and stress reduction interventions are helpful,” Smith said. “These ways in which people are being mindful of their stress and helping them manage their stress in specific ways—this has positive outcomes for their longevity. Just because you’re having stress and stigma, this does not mean that you are going to have physiological systems that will automatically be dysregulated. There are ways that we can intervene. I think this research will have important implications for this.”

What intrinsically drives Smith is affecting policy and gaining insights about the stressors linked to the well-being and the health of LGBTQ+ communities and how to improve their overall health outcomes.

“I’ve fallen in love with research—the ability to understand the way in which people experience their social environment translates into their health, well-being, and the way they go about their lives.” Smith said. “This is fascinating to me.”

—Alison Medley

If you would like more information about this topic, please contact Alison Medley at 713.320.0933 or email aemedle2@central.uh.edu