A community driven modeling approach for identifying community & policy-level interventions to address the impact of structural racism and discrimination on adolescent substance use and mental health

Project Summary Our overarching goal is to identify and assess policy and community-level interventions that counteract the effects of SRD within neighborhoods, schools, and peer networks, on adolescent substance use and mental health outcomes. We will leverage data from The Context Study, a large (n= 7,174), seven wave panel study of

public-school children in three racially diverse, predominantly rural counties in North Carolina. At wave one, all 6th, 7th, and 8th graders attending a public school in the three counties were eligible; the final wave occurred when participants were in 10th-12th grade. Context includes extensive panel data on peer networks and

comprehensive residential geocodes for participants. We have linked these data to students’ school and criminal records, Census, county tax-value property assessments, Google Maps, and the American Community Survey to construct measures of SRD. Guided by the NC State Health Improvement Plan to increase health equity and

empirical evidence, we will use Context data, group model building, and an agent-based model (ABM) to project the long-term impact of policy and community-level interventions (e.g., resource distribution, social integration, and school discipline policies) that target SRD and its consequences on adolescent substance use and mental

health. Our specific aims are: Aim 1: Develop a detailed theoretical model of the systems rooted in SRD that drive adolescent substance use and mental health outcomes and determine how these may be addressed through policy and community-level interventions. We will use a community-based systems dynamics approach

to convene a group model building workshop with diverse community stakeholders to develop a causal loop diagram of the system and identify a set of community co-created candidate policy and community-level interventions that could modify the system and reduce the impact of SRD. Aim 2: Use ABM to compare the

expected long-term outcomes of various types and combinations of candidate policy and community-level interventions to address SRD and its effects on adolescent substance use and mental health. We will use information from the group model building workshops and leverage national models and a representative

synthetic population to develop an ABM to examine spatial and temporal effects of SRD on adolescent health. We will validate the model on Context data, conduct sensitivity analyses to evaluate the robustness of model results to uncertainty in model structures and parameters, and project the impact of candidate interventions. Aim

3: Determine key implementation factors of candidate policy and community-level interventions. For selected interventions, we will conduct focus groups and in-depth interviews with community stakeholders to gain insight on implementation factors including feasibility, acceptability, and scalability. We will analyze these data and

develop intervention maps of the most promising candidate interventions. Identifying and projecting systems- level interventions that disrupt adolescent exposure to SRD has strong potential to move the field beyond individually focused solutions and ultimately support strategies to reduce adolescent health inequities.