Project STRIVE (STudents RIsing above) - Offsetting the health and mental health costs of resilience

PROJECT SUMMARY Students in marginalized communities who `strive' to rise above adversity to achieve academic success are considered `resilient'. However, youths' resilience in one domain (i.e. academic) can come at a cost in other domains including physical and mental health morbidities that are under-identified and under-treated.

Previous research suggests that Black, Indigenous and People of Color (BIPOC) who exhibit a “striving persistent behavioral style” in the face of adversity evince later health morbidities. Ironically, the same self- regulatory skills that promote academic achievement amid chronic stress can also result in physiological

dysregulation that harms health and mental health1–3. Self-regulatory processes that involve emotion suppression, experiential avoidance, and unmodulated perseverance can culminate in allostatic load which fuels health disparities1,4 and internalizing symptoms of depression and anxiety5. The proposed mechanistic trial will utilize mindfulness training to permit examination of questions about

the causal role of emotion regulation strategies linked to the striving persistent behavioral style in driving mental health and health morbidities among BIPOC78. The proposed Project STRIVE (STudents RIsing aboVE) will identify BIPOC students who are academically resilient in the face of disadvantage and will offer a

tailored mindfulness intervention targeting self-regulation processes as a putative mechanism to interrupt the links between the striving persistent behavioral style and negative health outcomes. We propose a multisite randomized trial randomizing 504 high achieving, socioeconomically disadvantaged Black, Latinx and Asian

American students in 18 schools to receive a mindfulness intervention or an attention control condition focused on study skills. The study will: (1) test the effects of the STRIVE intervention on putative self-regulation mechanisms (emotion suppression, experiential avoidance, and unmodulated perseverance) among. (2) test

the effects of the STRIVE intervention on health and mental health outcomes at 12-month post-treatment, including biomarkers of allostatic load (cortisol, blood pressure, body-mass-index, waist/hip/neck circumference), health complaints, and internalizing symptoms, and (3) examine the mechanistic model linking

striving persistent behavioral style and health outcomes within the STRIVE trial. If successful, this trial will build toward a scalable, secondary preventive intervention with potential for preventing both health and mental health disparities among underserved BIPOC youth at the population-level.