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Mulawa MI, Docherty SL, Bailey DE, Gonzalez-Guarda RM, Lipkus IM, Randolph SD, Yang Q, Pan W. A Hybrid Pragmatic and Factorial Cluster Randomized Controlled Trial for an Anti-racist, Multilevel Intervention to Improve Mental Health Equity in High Schools. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:486-496. [PMID: 38175459 PMCID: PMC11239747 DOI: 10.1007/s11121-023-01626-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/05/2024]
Abstract
Systemic racism is pervasive in US society and disproportionately limits opportunities for education, work, and health for historically marginalized and minoritized racial and ethnic groups, making it an urgent issue of social justice. Because systemic racism is a social determinant of health prevalent across multiple social and institutional structures, it requires multilevel intervention approaches using effective designs and analytic methods to measure and evaluate outcomes. Racism is a fundamental cause of poor health outcomes, including mental health outcomes; thus, mental health services and programs that address racism and discrimination are key to promoting positive mental health of racial and ethnic minority youth. While multilevel interventions are well-suited for improving outcomes like youth mental health disparities, their evaluation poses unique methodological challenges, requiring specialized design and analytic approaches. There has been limited methodological guidance provided to researchers on how to test multilevel interventions using approaches that balance methodological rigor, practicality, and acceptability across stakeholder groups, especially within communities most affected by systemic racism. This paper addresses this gap by providing an example of how to rigorously evaluate a hypothetical, theoretically based, multilevel intervention promoting mental health equity in three US school systems using an anti-racist approach intervening at the macro- (i.e., school system), meso- (i.e., school), and micro- (i.e., family and student) levels to improve mental health in adolescents. We describe the design, sample size considerations, and analytic methods to comprehensively evaluate its effectiveness while exploring the extent to which the components interact synergistically to improve outcomes. The methodological approach proposed can be adapted to other multilevel interventions that include strategies addressing macro-, meso-, and micro-levels of influence.
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Affiliation(s)
- Marta I Mulawa
- Duke University School of Nursing, Duke University, Durham, NC, USA.
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Sharron L Docherty
- Duke University School of Nursing, Duke University, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Donald E Bailey
- Duke University School of Nursing, Duke University, Durham, NC, USA
| | | | - Isaac M Lipkus
- Duke University School of Nursing, Duke University, Durham, NC, USA
| | | | - Qing Yang
- Duke University School of Nursing, Duke University, Durham, NC, USA
| | - Wei Pan
- Duke University School of Nursing, Duke University, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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King AL, Bell-Huff C, Airhihenbuwa C, Ogletree S, Wright C. The EMPOWER program: a history and guide for increasing diversity using integrated research and education. ADVANCES IN PHYSIOLOGY EDUCATION 2024; 48:395-406. [PMID: 38385193 DOI: 10.1152/advan.00123.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/05/2024] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Abstract
The prevalence and pervasive nature of emerging chemicals of concern have created widespread environmental injustice apprehensions in vulnerable communities. To alleviate and address these concerns, identifying, engaging, and training a diverse environmental health research workforce will be critical and necessary steps to combat and prevent the consequences of environmental injustice. While there is an obvious need to enhance diversity in environmental health research, this process is hampered by facets of systemic racism that reduce access to educational resources needed to build interest and knowledge in students and teachers. We present here a historical perspective to offer a guide for building programs and relationships with underserved schools to help overcome limiting factors that have plagued certain public school systems. With the proper training and mentorship, the untapped workforce present within these schools will be empowered to understand and address current and emerging environmental health and safety threats. Through this transformative 8-week high school research program, we will develop well-prepared, ethical researchers committed to scientific inquiry, intensive fieldwork, and collaborative problem solving to address environmental health challenges. Following the four-step risk assessment process, students, teachers, and faculty mentors will work collaboratively to identify toxicants, potential hazards and risks, and environmental disparities in urban neighborhoods, which provides the necessary training to formulate critical thinking skills for use in academic or nonacademic careers.NEW & NOTEWORTHY The Engaging Multidisciplinary Professional Opportunities for Women in Environmental Research (EMPOWER) program is a one-of-a-kind research summer experience for minority female high school students in the state of Georgia. In addition, this program provides high school teachers with hands-on experiences that can be adapted to use in the classrooms. This combination of lab and field research immerses participants in understanding urban environmental exposures and their health effects. The EMPOWER program was established to meet the critical need for increasing diversity in science, technology, engineering, and mathematics.
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Affiliation(s)
- Adrienne Lester King
- School of Public Health, Georgia State University, Atlanta, Georgia, United States
| | - Cristi Bell-Huff
- Chemical Insights Research, UL Research Institutes, Marietta, Georgia, United States
| | - Collins Airhihenbuwa
- School of Public Health, Georgia State University, Atlanta, Georgia, United States
| | - Susan Ogletree
- College of Education and Human Development, Georgia State University, Atlanta, Georgia, United States
| | - Christa Wright
- School of Public Health, Georgia State University, Atlanta, Georgia, United States
- Chemical Insights Research, UL Research Institutes, Marietta, Georgia, United States
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