Promoting Resilience and Reducing Health Disparities: Towards a Shift-and-Persist Intervention - Stark racial/ethnic disparities in chronic disease reflect greater exposure to deleterious contextual stressors, such as low socioeconomic status. Over the life course, these stressors “get under the skin” via maladaptive psychological and behavioral coping and persistent activation of stress response systems, leading to differentials in chronic disease burden (e.g., diabetes, cancer). By adolescence, contextual stressors can produce the physiological, behavioral, and psychological precursors to chronic conditions among racial/ethnic minority youth. More specifically, research shows that Hispanic and Black youth experience up to two times higher odds of low-grade inflammation compared to White youth. Additionally, recent trends show that racial/ethnic minority adolescents exhibit greater prevalence of substance use behaviors (e.g., 57% past-month alcohol use among Black 12th graders, 41% among Hispanics, and 32% among Whites) and poor mental health (e.g., adjusted risk ratio of 1.42 for suicidality among Black youth relative to White youth). Thus, effective coping skills in adolescence are critical to ameliorating the early signals of chronic disease and pre-empting chronic disease progression. Shift-and-persist (S&P) coping, where one reappraises life stressors (i.e., shifting), while finding meaning and maintaining optimism (i.e., persisting), shows promise as a successful coping strategy to mitigate the early signs of chronic disease among adolescents, yet more investigation is needed prior to designing S&P coping interventions for racial/ethnic minority youth. During the K99 period, the PI engaged in training on advanced statistical analyses, biopsychosocial models of health, and participatory intervention design and evaluation and completed the following aims: 1) identified socioecological assets that bolster S&P utilization over adolescence 2) assessed linkages between the utilization of S&P over adolescence and prospective psychological, behavioral, and physical health outcomes, and how these associations varied by different contexts of risk. Building on the training and mentored research during the K99 phase, the R00 period will focus on designing a digital S&P coping single-session intervention for youth populations in collaboration with a youth advisory board, and then conducting a feasibility study of the resulting intervention to evaluate its feasibility, acceptability, and proximal effects. Together, the findings from this program of research will uncover key factors that contribute to the long-term development of S&P coping, provide further clarity on the responsiveness of S&P coping over time to stressors that shape youth’s health outcomes, and contribute to evidence regarding intervention modalities that can enhance S&P coping. Additionally, this award will enable the PI to establish an independent research program focused on developing and evaluating evidence-based health interventions that target contextual drivers of adolescent health disparities, positioning the PI to successfully secure an R01.
