Systems Modeling to Improve Adolescent Health and Well-being

Our overarching goal is to identify and assess potential programs and interventions that improve conditions within neighborhoods, schools, and peer networks, with the aim of reducing adolescent substance use and strengthening psychological well-being. We will leverage data from The Context Study, a large (n= 7,174), seven wave panel study of public-school children in three predominantly rural counties in North Carolina with varied demographic composition. At wave one, all 6th, 7th, and 8th graders attending a public school in the three counties were eligible; the final wave occurred when participants were in 10th-12th grade. Context includes extensive panel data on peer networks and comprehensive residential geocodes for participants. We have linked these data to students’ school and administrative records, Census, Google Maps, and the American Community Survey to construct measures of neighborhood and school conditions. Guided by the NC State Health Improvement Plan and prior systems-focused research, we will use Context data, structured group model building, and an agent-based model (ABM) to project the long-term impact of interventions that target adverse factors that influence adolescent health. Our specific aims are: Aim 1: Develop a systems-level conceptual model of the social and neighborhood contexts that shape adolescent substance use and psychological well-being. Using structured model-building workshops with local stakeholders to develop a causal loop diagram of the system and identify candidate programs and interventions that could improve adolescent health outcomes, including measurable indicators such as depressive symptoms, stress levels, and risk behaviors. Aim 2: Use ABM to compare the expected long-term outcomes of various types and combinations of candidate programs and interventions. Using information from our structured model building workshops, leveraging national models and a representative synthetic population to develop an ABM to examine spatial and temporal effects on adolescent substance use and psychological well-being. We will validate the model and conduct sensitivity analyses to evaluate robustness of model results to uncertainty in model structures and parameters, and project the impact of the most promising strategies. Aim 3: Determine key implementation factors of candidate programs and interventions. For selected candidate programs and interventions, we will conduct focus groups and in-depth interviews with local stakeholders to gain insight on feasibility, acceptability, and scalability. We will analyze these data and develop intervention maps of the most promising strategies. This project will identify and project the potential impact of programs and interventions that support ongoing public health strategies to improve rural adolescent health.