Elevated rates of depression, anxiety, trauma, and personal loss due to Novel Coronavirus Disease 2019 (COVID-19) have taken a toll on individuals and families, many of whom were already stretched prior to the pandemic (American Psychological Association, 2020; Vahratian et al., 2021). Because racial ethnic minoritized groups disproportionately represented essential workers and lacked equitable access to resources that could mitigate exposure risk (Anonymous, 2020b), COVID-19 brought social inequalities and racial and ethnic inequities to the forefront of public health, exacerbating discrepancies that already existed (Bright, 2020; Singh et al., 2020). COVID-19 also caused immediate and long-term consequences for morbidity and mortality in minoritized populations, impeding health-promoting behaviors, academic performance, and emotional and physical health that forced renewed conversations acknowledging the pervasive nature of systemic racism and heightened awareness of the urgency to dismantle patterns of discrimination and oppression (Linos et al., 2022; Morsy & Rothstein, 2019).
Preventive intervention research examines the effects of an intervention on an outcome of interest to learn what strategies work best in improving health and well-being (DeLucia & Pitts, 2010). Racial and ethnic inequities elevated during COVID-19 present a pressing need for the prevention science field to examine the extent to which preventive interventions are designed to address issues of inequities and in turn promote equitable health for minoritized youth, families, and communities (Anonymous, 2022b). Doing so requires identifying practical approaches aimed at promoting positive youth development (see Anonymous, 2021a) that are (1) evidence based (i.e., show impact from evaluations with high internal validity; Anonymous, 2021b); (2) scalable (Anonymous, 2020a); and (3) culturally appropriate, or contextualized through the perspectives of the beneficiaries and considering a social, cultural and economic framework (Barrera et al., 2017; Castro et al., 2017). This need served as the impetus for the current study.
The lack of representation of racial and ethnic minoritized groups in medical research is well-documented (Fisher & Kalbaugh, 2011; Turner et al., 2022; Polo et al., 2019). A critical evaluation of this omission in the prevention science field, however, has not been undertaken – though some research examining psychosocial interventions (broadly defined as non-pharmacological interventions focused on psychological or social factors) with documented effectiveness among ethnic minoritized youth has been conducted (see Pina et al., 2019). We used data from Blueprints for Healthy Youth Development (herein referred to as Blueprints; https://www.blueprintsprograms.org/), which provides an online registry of evidence-based preventive interventions that prevent or reduce the likelihood of antisocial and violent behavior and promote a healthy course of youth development and adult maturity (Mihalic & Elliott, 2015). Examining studies recorded in the Blueprints database, we reviewed the size, nature and scope of extant research involving representation of racial and ethnic minoritized groups in preventive intervention research. In addition, following guidance from evidence standards for high-quality research establishing an intervention as efficacious or effective and ready for scale-up endorsed by the prevention science field (Gottfredson et al., 2015), we also examined setting (i.e., locale where the study was conducted) and additional sociodemographic factors. Our goals were to (1) inform decision-making regarding the generalizability of evidence-based preventive interventions, and (2) identify additional considerations of importance in guiding preventive intervention research, such as cultural adaptation and responsiveness (Thier et al., 2020). We consider implications of study findings for research, policy, and practice with a specific focus on potential inferences for future metrics to guide the prevention science field.
Race and Ethnicity Reporting in Research
Racial and ethnic minoritized participation in clinical trials is an important topic in public health discussions because this representation touches on issues of equality and the elimination of health disparities, which are core values of the field (Fisher & Kalbaugh, 2011). Turner et al. (2022) analyzed the reporting of race and ethnicity enrollment in trials of medical treatments, including drug efficacy studies, using all U.S. trials in the ClinicalTrials.gov online registry from 2000 to 2020 and found that historically, U.S. trials under-enroll racial and ethnic minoritized groups and frequently do not report the race and ethnicity of enrolled participants at all. Meanwhile, Palo et al. (2019) examined trends over a 36-year period (from 1981-2016) in the reporting and representation of various sample demographic characteristics of trials evaluating psychotherapy and psychosocial treatments for clinical depression and found that the underrepresentation of racial and ethnic minoritized youth in these types of trials remains problematic. Though authors found that reporting has improved over time, both studies concluded that the paucity of diversity has generated a data gap that skews evidence towards treatments with understudied efficacy and safety for racial ethnic minoritized populations (Palo et al., 2019; Turner et al., 2022).
The important sensitivities and controversies related to reporting of race and ethnicity noted in health research (see Flanagin et al., 2021) apply to the prevention science field. Similar to medical trials, there are major gaps in research on racial and ethnic minoritized groups that impede effectiveness of preventive interventions, including insufficient attention to protective processes that prevent and avert risk (Anonymous, 2018), discounting input from beneficiaries representing diverse communities (Supplee & Meyer, 2015), and overlooking crucial information about how to effectively translate or adapt interventions that primarily target White populations for implementation among racial and ethnic minoritized populations (Castro & Yasui, 2017; Barrera et al., 2017). Despite inclusion of racial ethnic minoritized populations, programs validated with largely White samples are often proposed to be recommended for all (Pina et al., 2019), which heightens external validity concerns about widely disseminated treatments tested for one group but exported, perhaps uncritically, to others (Thier et al., 2020).
Race and Culture
Scientists have come to the consensus that race is not biological; it is socially constructed (Smedley & Smedley, 2005). In general, ethnicity has historically referred to a person’s cultural identity (e.g., language, customs, religion) and, while all groups have ethnicities (e.g., Caribbean, creole-speaking Blacks), race is characterized as broad categories of people that are divided arbitrarily but based on ancestral origin and physical characteristics. Though race and ethnicity have no biological meaning, the terms have important – albeit contested – social meanings (Flanagin et al., 2021). Culture can be viewed as the totality of a group’s knowledge, often transmitted from elders to children (Barrera et al., 2013). “Having a culture” means that members share a collective system of values, beliefs, expectations, and norms, including traditions and customs, as well as sharing established social networks and standards of conduct that define them as a cultural group (Betancourt & Lopez, 1993).
Adaptation occurs as preventive interventions move from efficacy trials, in which program developers typically supervise implementation, to effectiveness trials where developers are less involved (Gottfredson et al., 2015), and into the dissemination phases of the evidence continuum, characterized as exploration, preparation, implementation, and sustainment (Brown et al., 2017). Research on cultural adaptation, however, often equates “culture” with “racial and ethnic minoritized group status.” Such a focus may be derived from assumptions of homogeneity, without regard for heterogeneity of subgroups within a larger racial ethnic group based on nationality, socio-economic status, religious background, geographic residence, immigration status, and other issues that complicate “cultural” adaptation (Barrera et al., 2013).
Standards of Evidence in Prevention Science
Preventive interventions serve diverse populations in terms of race, ethnicity, culture, and other sociodemographic factors. In disseminating empirical evidence to policy and practice, questions are continually raised about the extent to which the results of the available impact trials can be generalized to new populations, settings, and points in time. As decision-makers choose among a plethora of preventive interventions, a key element of their decision is whether or not a given program will work in their community, which might be different from the population included in the impact trial (Supplee & Meyer, 2015).
Guidelines (Anonymous, 2021b) and checklists (Grant et al., 2018; Higgins et al., 2011; Schulz et al., 2010) exist for assessing threats to the internal validity of trials (i.e., the ability to make causal inferences), but these tools do not provide information on the context and potential applicability of research to local settings (Glasgow et al., 2006). Equally important is evaluating external validity, since the concerns of practitioners and policymakers relate to applicability of findings from preventive intervention trials (Bryan et al., 2021; Supplee & Meyer, 2015). External validity is also increasingly salient as developers of preventive interventions wrestle with implementation barriers (Walker et al., 2017). To minimize the risk of over- or under-ascribing an intervention’s utility to be scaled up, methodological standards of evidence for the prevention science field require specifying target populations and settings and identifying for whom interventions work and under what conditions (Gottfredson et al., 2015). Even so, the prevention science field has not endorsed a specific set of standards to assess external validity, making it difficult to support decision-makers in this respect (Supplee & Meyer, 2015).
Current Study
This paper used the Blueprints database to conduct a methodological study (i.e., a study that evaluates the design, conduct, analysis and/or reporting of other studies; Lawson et al., 2020) of race and ethnicity reporting and representation in preventive intervention research. We tracked reporting of gender, economic disadvantage, and geographic location, but focused particularly on the race and ethnicity of participants. The decision to use Blueprints was motivated by its range of youth behavioral outcomes representing multiple disciplines (e.g., criminal justice, child welfare, public health, mental health, education, labor/employment, etc.) and our unrestricted access to the database. To our knowledge, the only prior research resembling our study synthesized biomedical/health (Turner et al., 2022) or clinical-level depression (Palo et al., 2019) outcomes of trials predominantly focused on adults and solely conducted in the U.S. The present study examined reports and refereed journal articles of evaluations completed both within and outside the U.S. We included prevention interventions primarily focused on youth and evaluated using randomized control trials (RCTs) or quasi-experimental design studies (QEDs) encompassing a range of outcomes relevant to the prevention science field. In a review of evaluations entered into the Blueprints database over the past decade (2010-2021), our primary research questions included: (1) How prevalent were culturally tailored preventive interventions (i.e., ones developed for specific populations)?, (2) What percent of evaluation studies reported sample characteristics?, and (3) How well represented were racial and ethnic minority groups in samples of evaluation studies? We posed three secondary questions: (1) Has reporting of race, ethnicity, and sociodemographics improved over time? (2) Was reporting related to study quality (i.e., methodological soundness and beneficial effects)? (3) Was study quality related to culturally tailored programs?