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

项目总结 在美国，18-24岁的黑人新兴成年人(BEA)经历了更高水平的贫困、疾病和 比白人青年更受歧视。这些暴露在伤害中，再加上缺乏支持服务 解决和减轻贫困和结构性不平等，导致健康不平等。BEA体验高心理 卫生服务需求，但服务利用率比白人青年低得多，性传播感染的比率更高，而 获得计划生育服务。破坏系统地影响东亚银行的贫困的社会决定因素，可以 在他们成长的关键时期，对健康地过渡到成年有变革性的影响。 保证基本收入(GBI)是一种经济战略，可以纠正金融不平等并转变 BEA的心理和身体健康结果，它在成年人中显示出巨大的希望 以及有收入的家庭中的年轻人，但人们对GBI计划在现金 无条件地、直接地向黑人新兴成年人转移，以及需要哪些关键支持来 确保GBI是最有效的。我们提出了一项随机对照交叉试验，其中300名低收入者 东亚银行将在前12个月的后续行动中(第一阶段)或 在总共24个月的随访中的第二个12个月接受GBI(第二阶段)。所有参与者，无论 随机化ARM，将提供经济能力计划的注册-同行学习圈和 财务指导--增强GBI的有效性。参与者还将收到基于手机的实时 监测和反应干预(RTMR)，这将确保卫生服务需求未得到满足的BEA 接收推荐。RTMR系统将同时提供关键的、对时间敏感的信息 社区机构和政策制定者解决记录在案的服务差距。所有组件都将联合- 由我们的社区工作组设计和监督，由来自广泛的 由社区机构、城市官员和活跃在金融领域的年轻人组成的合作网络 能力空间。这些干预组件共同支持个人层面的BEA(GBI、教练、 )、人际层面(同伴学习圈)、社区层面(GBI和rTMR)和社会层面 (GBI、rTMR的政策影响)。我们将确定GBI和GBI+多级别支持对BEA的影响 对他们未来的投资(教育、就业培训)、心理健康(抑郁症状和焦虑)、 以及未得到满足的精神健康和性/生殖健康服务需求。我们还将包括嵌套的 定性部分，探索对经济、心理和身体健康的影响机制。本研究 利用强大的多学科社区和研究伙伴关系；多层次干预组件 这解决了在BEA向成年期过渡期间影响BEA轨迹的最紧迫的不平等问题 和独立性；并提供紧急实验数据，其结果可以为服务提供和 促进卫生公平的政策。

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.