Advancing Methods for Multilevel Interventions to Support Health Equity for Urban American Indian/Alaska Native and Black Youth

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PROJECT SUMMARY/ABSTRACT This K01 Mentored Research Scientist Development Award will provide the candidate, Nicole R. Tuitt, DrPH, with advanced training and structured mentoring to facilitate her transition to research independence. The candidate's goal is to become an independent investigator with expertise in state-of-the-art approaches in the development and evaluation of culturally relevant, strengths-based multilevel interventions which aim to reduce substance use and sexual health disparities among urban American Indian and Alaska Native (AIAN) and Black youth. The proposed scope of work will fill a gap in existing literature on multilevel approaches to reduce substance use and sexual health inequities among youth of color. The inability of efforts to reduce adolescent substance use and sexual health disparities to yield sustained improvements likely stem from failure to account for mutually-reinforcing structural disadvantages and multifaceted mechanisms that include all socioecological levels that underlie adolescent health inequities. Most risk reduction strategies focus only at the individual and interpersonal levels. Developing and operationalizing a strengths-based conceptual framework grounded in the socioecological model is critical to inform a multilevel intervention to reduce substance use and sexual risk- taking among urban AIAN and Black youth. The candidate will employ a transformative, sequential mixed methods approach to accomplish the following specific aims, each training goal is matched with the aim in which the researcher will apply her new skills. AIM 1: Examine multilevel determinants of substance use and sexual risk-taking among Black and AIAN high youth (ages 14-18) in Denver Metro, CO. Training: (1) Advance expertise in theoretical and methodological foundations in social and spatial epidemiology to understand the impact of structural contexts on risk and resilience to adolescent substance use and sexual risk-taking; and (2) multilevel structural equation modeling, with geographic contexts, to explore the direct, indirect, and interactive relationships across levels. AIM 2. Engage urban AIAN and Black youth to elucidate distinct conceptual frameworks of risk and resilience to substance use and sexual risk-taking guided by findings from Aim 1; and identify the most critical levels on which to intervene. Training: (1) Develop skills in scenario-based qualitative interviewing (SBI) to engage youth to interpret quantitative data in the development of conceptual frameworks of risk and resilience. The K01 award will position Dr. Tuitt as a trained researcher with expertise on the influence of structural disadvantages on adolescent substance use and sexual risk-taking as well as multilevel approaches. Given her shift away from a focus on individual behaviors to structural factors, expertise in SBI, social and spatial epidemiology, and multilevel SEM will ensure the candidates successful transition into an independent researcher and will situate her to strengthen the field of adolescent health equity research and prevention science.