Increasing financial and health equity among low income black youth and young adults

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PROJECT SUMMARY Black Emerging Adults (BEA), ages 18-24, in the U.S. experience higher levels of poverty, illness, and discrimination than White youth. These exposures to harm, coupled with the lack of supportive services to address and mitigate poverty and structural inequities, result in health inequities. BEA experience high mental health service needs, but much less service utilization than White youth, have higher rates of STI and less access to family planning. Disrupting the social determinants of poverty that systematically affects BEA, can have a transformative impact on a healthy transition into adulthood during a critical time in their development. Guaranteed basic income (GBI) is an economic strategy that could redress financial inequities and transform the mental and physical health outcomes of BEA, which has shown tremendous promise in adults populations and youth in families receiving income, but little is known about how GBI program would work when cash is transferred unconditionally and directly to Black emerging adults and what critical supports would be needed to ensure GBI is most effective. We propose a randomized controlled crossover trial in which 300 low-income BEA are allocated to receive a $500/month GBI either during the first twelve months of follow-up (phase I) or to receive GBI in the second 12 months of a total of 24 months follow-up (phase II). All participants, regardless of randomization arm, will be offered enrollment in financial capability programs -- peer learning circles and financial coaching -- to bolster GBI effectiveness. Participants will also receive a cell phone-based real-time monitoring and response intervention (RTMR), which will ensure that BEA with unmet health service needs receive referrals. The RTMR system will simultaneously provide critical, time-sensitive information for community agencies and policy makers to address documented service gaps. All components will be co- designed and monitored by our Community Working Group, comprised of representatives from an extensive network of partnering community agencies, city officials, and youth who have been active in the financial capability space. Together these intervention components support BEA on the individual-level (GBI, coaching, RTMR), interpersonal-level (peer learning circles), community-level (GBI & RTMR), and at the societal level (policy impacts of GBI, RTMR). We will determine the impacts of GBI and GBI+multi-level supports on BEA’s investment in their future (education, employment training), mental health (depressive symptoms and anxiety), and unmet mental health and sexual/reproductive health service needs. We will also include a nested qualitative component to explore mechanisms of impact on financial, mental and physical health. This study leverages a strong multi-disciplinary community and research partnership; multilevel intervention components that address the most urgent inequities that impact the trajectory of BEA during their transition to adulthood and independence; and provides urgent experimental data with findings that could inform service provision and policy to advance health equity.