Moving from Theory to Practice: Exploring How One Community-Based Organization Develops Youth Changemakers for Health Equity

Abstract

Community-based organizations are recognized as key stakeholders for public health, as their community expertise positions them to create tailored interventions to comprehensively address community needs that large-scale public health interventions may not address. The current study describes one youth-serving community-based non-profit’s approach to public health, where youth civic engagement is oriented by social justice coursework and integrated within youth participatory action research (YPAR) to engage youth in health equity efforts. The Social Determinants of Health (SDOH) framework and the Socioecological Model (SEM) were applied to student research outputs to understand student conceptualization of social issues and the subsequent interventions they suggest. This work explores the feasibility and depth of student-created interventions within each SDOH domain, identifying common themes in students’ conceptualizations of social problems and interventions to promote health equity. Suggestions for integrating SDOH frameworks into the YPAR curriculum to scaffold youth projects, identifying root causes of health disparities, and developing practical community-based solutions are provided.

1. Introduction

Health disparities remain a significant public health challenge, at both national and local levels, attributable to their detrimental effects on individual health outcomes (Tiwari 2024). Health disparities can affect individuals from diverse social, economic, and geographic backgrounds, and negatively impact quality of life and wellbeing (Whitman et al. 2022). However, health disparities are created and supported by inequitable systems and an unequal distribution of resources and opportunities, leading to disproportionate effects that significantly impact the quality of life of all marginalized populations (National Academies of Sciences, Engineering, and Medicine et al. 2017). This effect is further exacerbated for those with intersectional identities, where multiple layers of vulnerability and marginalization overlap to produce distinct health outcomes that require tailored interventions, specifically for those identifying as Black, female, LGBTQ+, and/or low-income (Hill 2015; Lett et al. 2020).

Social Determinants of Health (SDOH) encompass a wide range of factors that influence the conditions under which an individual develops across time, including economic stability; access to quality healthcare, education, and nutritious foods; and community and social contexts (Whitman et al. 2022). Experts in the field suggest that addressing factors of the SDOH are particularly crucial to increasing the overall wellbeing of marginalized populations, where SDOH have been shown to drive and produce health disparities (Chelak and Chakole 2023). As a result, a wide range of public health interventions have been developed at the national and regional levels to adequately address the health needs of marginalized populations (Whitman et al. 2022). While large-scale public health intervention efforts have significant positive effects on multiple dimensions of health outcomes, they often lack the ability to tailor interventions to meet the unique needs and barriers to health equity within diverse communities (American Public Health Association 2022). Considering community-based organizations in public health interventions is necessary to comprehensively address health disparities for marginalized individuals in local contexts (Haapanen et al. 2024).

Community-based, grassroots organizations are particularly well equipped to address the specific needs of their community and often work to address health disparities, promoting missions like providing quality educational youth programs, increasing access to affordable healthcare, promoting community engagement, and connecting families to community resources, among others (Griffith et al. 2010; Miller and Shinn 2005). Furthermore, community-based organizations have distinct strengths that set them apart from large-scale interventions; (1) all members of the community tend to have access to services, and not just a select group, (2) community-based organizations can reach individuals of various risk-levels, and not just those who are high-risk, and (3) community-based organizations can address environmental and social conditions that are often difficult to reach with more national-level interventions (Institute of Medicine et al. 2012). These community-based entities play a critical role in reducing health disparities and providing community members with essential resources to aid in their quality of life and ultimately influence their health outcomes (Ressler et al. 2021). Non-profit organizations are important public health stakeholders, where they are able to leverage their cultural insights to create targeted public health interventions for their community members (Tiwari 2024).

Community-based organizations that develop and implement public health interventions have community expertise and in-depth knowledge of the existing resources and organizations that exist to support the health needs of the community (Baciu et al. 2017). As a result, community-based organizations can use their positioning to develop partnerships and connect community members to services that adequately address their needs (Allen et al. 2021). Furthermore, community-based organizations can draw upon these partnerships to create youth–organization collaborative networks, promoting youth civic engagement and creating stewards of change (McLean 2019). One unique experience that community-based organizations can provide for young people to be active change agents within their community is youth participatory action research (YPAR).

YPAR, a research methodology that positions youth as experts, orients youth toward critically examining social issues relevant to their lives through rigorous research methodologies and developing creative solutions to positively impact the world around them (Malorni et al. 2022). YPAR provides a platform to privilege and uplift youth voices in conversations around health equity, where they have been shown to be key community stakeholders and creative thinkers who can create unique solutions to local, community-based social issues (Anyon et al. 2018; Ozer et al. 2020). YPAR frameworks are often guided by social justice principles, which supports youth in developing solutions to address the root causes of health inequities but does not directly support youth in identifying the root cause of these inequities. One novel approach to extend students’ abilities to contribute to the process of uncovering root causes of health disparities is integrating the SDOH framework within YPAR curriculum, which provides youth with a comprehensive framework to understand and investigate various factors that influence inequitable outcomes.

1.1. Theoretical Frameworks

SDOH are environmental conditions that individuals inhabit throughout their life that affect health and quality-of-life outcomes, such as education, infrastructure, healthcare, economics, and community context (WHO Commission on Social Determinants of Health and World Health Organization 2008). The SDOH framework allows us to gain a deeper understanding of the complex interplay of risk and protective factors that contribute to health disparities, particularly for those from lower socioeconomic statuses, racial and economic minorities, and those with disabilities (WHO Commission on Social Determinants of Health and World Health Organization 2008). The Office of Disease Prevention and Health Promotion (n.d.) identified five key SDOH domains that influence health outcomes: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context.

Economic stability refers to factors related to financial security, where socio-economic status directly influences the quality of food, housing, healthcare, and employment opportunities one has access to, impacting health outcomes across multiple domains. Education access and quality include factors like literacy levels and educational attainment, where access to quality educational opportunities and the ability to engage in these opportunities further influence economic stability and other health outcomes. Healthcare access and quality involve an individual’s ability to physically and financially access healthcare, the quality of care one has access to, and health literacy, which directly impacts an individual’s quality of life. Neighborhood and built environment affect health outcomes through aspects of the physical environments individuals inhabit, including community safety and violence, air and water quality, and access to recreational facilities. Social and community context refers to the complex network of relationships that influence an individual’s wellbeing through community connectedness, discrimination, and support networks (Office of Disease Prevention and Health Promotion n.d.). Each domain is intricately related, where unique combinations of risk factors across all five domains frequently influence individual health outcomes, requiring the development of multi-tiered and multi-faceted public health interventions to achieve health equity (Bigby 2011; Horowitz and Lawlor 2008).

The Socioecological Model (SEM) extends the SDOH framework, positing that individual health behavior is influenced by complex factors that are nested within different micro and macro levels, including individual, interpersonal, institutional, community, and policy levels (Bronfenbrenner 1977; Sallis and Owen 2015). The individual level encompasses individual level characteristics, including knowledge and attitudes, that influence health behavior (McLeroy et al. 1988). The interpersonal level represents an individual’s interaction with their social networks, friends, and family that have the potential to affect health and health-related decision making (Agnew and South 2014). The institutional level refers to the overarching environments social relationships take place within, including the characteristics and structure of workplaces, schools, and organizations (McLeroy et al. 1988). The community level describes the resources, institutions, social networks, and norms that comprise a neighborhood or city in which individuals live (Stokols 1996). The policy level includes federal, state, and local laws that directly influence access to and the utilization of healthcare services (Sallis and Owen 2015). These various levels provide a guide to understand the different societal levels interventions can occur at, best align interventions with outcomes of interest, and further support the criticality of multi-leveled and multi-faceted interventions to improve health outcomes (Golden and Earp 2012).

The SDOH and SEM frameworks guide the analysis of the current study. The SDOH framework was applied to student YPAR projects to understand how youth conceptualize social problems, apply solutions informed by their research, and align their interests with their coursework. The SEM framework was applied to understand the depth and breadth of student-developed interventions to various social issues. The organizational and programmatic context of students engaged in YPAR coursework is described below.

1.2. Youth Enrichment Services

1.2.1. Organizational Context

Youth Enrichment Services (YES), a community-based non-profit in Pittsburgh, strives to empower youth to become their own best resource. Offering multiple opportunities such as mentorship, education, and enrichment programs, YES opens its doors to any young person who could benefit from its resources, upholding the notion that there are no throwaway children. Over the past 30 years, YES has served over 6000 young people, where their community expertise was adapted to meet the diverse needs of youth over time.

YES equips students with the tools to be their own best resource through programs that support positive youth development and provide students with holistic support to address various needs. YES offers life skills development, cultural and social enrichment, and wellness initiatives through various program opportunities. One program highlighted within the current study, the YESSummer Learn and Earn program, is a youth employment program that offers extended opportunities to develop their academic, social/emotional, and research capacities. Students have the opportunity to participate in workshops and activities that enhance employability and workability, programs that help students prepare for college, and wellness initiatives that focus on self-care, financial independence, physical fitness, and spirituality. Furthermore, students participate in youth participatory action research (YPAR) alongside social justice coursework to build their critical thinking skills, demonstrate research acumen, and create experiences that are meaningful during the college application process.

1.2.2. Summer Study for Success

Summer Study for Success is one component of YES’Summer Learn and Earn program. A total of five courses were offered, informed by the SDOH, including Beyond the Block: Environmental Climate Justice, Good to Go: Health Justice, More than Money: Economic Justice, The Stories We Share: Justice in the Arts, and The Success Setup: Educational Justice. In Beyond the Block: Environmental Climate Justice, students learn the importance of advocacy and activism to address environmental threats. In Good to Go: Health Justice, students explore the importance of health literacy and its relevance among all healthcare stakeholders. In More Than Money: Economic Justice, students learn how the economy critically affects the stability and efficacy of communities, and specifically marginalized individuals. In The Stories We Share: Justice in the Arts, students explore how powerful art is when used as a mechanism for justice. In Success Setup: Educational Justice, students identify how current policies and educational structures can impact “dreams deferred.”

Table 1. Course description and SDOH alignment.

Course	Course Description	SDOH Alignment
Beyond the Block: Environmental Climate Justice	Highlights how advocacy and activism are critical to address threats to the environment.	Neighborhood and Built Environment
Good to Go: Health Justice	Explores the criticality of health literacy and challenges surrounding justice among all healthcare stakeholders, including patients, hospitals, providers, and insurance companies.	Healthcare Access and Quality
More than Money: Economic Justice	Highlights the critical role that economics plays in the stability and efficacy of communities, particularly made-marginalized communities and communities of color.	Economic Stability
The Stories We Share: Justice in the Arts	Explores the nuance and power of art as a mechanism for justice through an investigative lens.	Social and Community Context
The Success Setup: Educational Justice	Identifies how existing policies and educational structures can lead to “dreams deferred”.	Education Access and Quality

provides a full description of the course offerings and their alignment with the SDOH framework.

Within Summer Study for Success, students gained a plethora of skills, knowledge, and experiences. Students learned how to utilize different research and data collection methods to better aid in the project research process, such as survey creation, to gather information about their topic. Students also gained data analytic skills which they used to understand how the data they collected could support justice-based advocacy efforts. To present their findings, students developed infographics and creative outputs, such as poems, short films, photography, and newsletters. Summer Study for Success allowed students to uniquely learn about the research process through a justice-centered lens.

Overall, Summer Study for Success supported student knowledge development of social justice-related topics and the negative implications of health inequities on society. Such a program also impacted how youth perceived themselves as community change agents and thought about their roles as catalysts for health behavior change within neighborhood contexts (Youth Enrichment Services 2024). A course overview with the session sequence and weekly objectives is outlined in Figure 1.

1.3. Current Study

YES, a community-based non-profit in Pittsburgh, developed a summer learning program that utilizes the SDOH and Moncloa and Smith’s (2018) Social Justice Youth Development framework to inform YPAR projects. Summer Study for Success, integrated within YES’ summer youth employment program, is a joint social justice learning lab and YPAR program that incorporates student-centered learning to support skill development, sparks students’ interests and passions, and promotes active learning. In an effort to explore how youth voices can inform local public health interventions, this case study leverages YPAR project outputs to explore the following research questions: (1) What public health disparities and interventions are students interested in, and how do they vary across SDOH domains? (2) How can community-based organizations best support youth in becoming key changemakers in their community? Student project artifacts are analyzed using the SDOH and SEM frameworks, where their contributions as key community stakeholders are discussed.

2. Methods

2.1. Participants

The Summer Study for Success program was one component of YES’ summer youth employment program in Pittsburgh. Instructors were recruited from University of Pittsburgh, Carnegie Mellon University, and Pittsburgh Area High Schools and were compensated by a stipend. Of the 5 instructors who taught the classes, the highest level of education completed were master’s degrees (n = 2) and bachelor’s degrees (n = 3).

Of the 109 students in YES’ Summer Learn and Earn program, 70 participated in Summer Study for Success. Students within YES’Summer Learn and Earn who did not participate in Summer Study for Success were frequently involved in other program experiences or had availability conflicts that prevented engagement in academic enrichment programming. Students were recruited from Pittsburgh Public Schools and the surrounding areas, including middle and high schools, and were compensated hourly for sessions attended. Students participated in one course over the summer, where student placements were based upon student preference ratings. Student enrollment varied by course as follows: Beyond the Block: Environmental Climate Justice (n = 13), Good to Go: Health Justice (n = 15), More than Money: Economic Justice (n = 13), The Stories We Share: Justice in the Arts (n = 16), and The Success Setup: Education Justice (n = 13). Student grade levels ranged from 8th to 11th grade, where the majority of students attended 9th grade (35.71%, n = 25) and 10th grade (31.43%, n = 22). Student ages ranged between 14 and 19 (M = 15.91 years, SD = 1.09). Students’ gender status included 52.86% male-identifying individuals (n = 37), 45.71% female-identifying individuals (n = 32), and 1.43% non-binary individuals (n = 1). Overall, the majority of students were Black or African American (88.57%, n = 62), while four students identified as multiracial (5.71%); two students identified as other (2.86%), and one student chose not to disclose (1.43%).

2.2. Procedure

Summer Study for Success was implemented over the course of eight weeks, where students attended learning labs twice a week for three hours each, totaling six hours a week, where they worked in groups of two to three students on a research project of their choice. The learning lab culminated in a gallery style research symposium where students presented their infographics. The SDOH framework was applied post hoc to their research infographics to understand student perceptions of social problems and identify common themes across student projects. While student projects may have encompassed elements across multiple SDOH domains, each project was assigned one domain that best aligned with the project topic to allow for high-level comparison across participants. To further assess the depth and breadth of each project’s student-developed solution, the SEM framework was applied to define the intervention level (i.e., individual, interpersonal, institutional, community, policy) at which each solution was intended to intervene. Each student group designed and employed various data collection methodologies, where they recruited participants from a variety of settings and demographic backgrounds to participate in their study. However, the majority of student projects leveraged convenience samples within YES students and staff or members of their community to participate in their studies.

3. Results

Student projects (N = 24) focused on a wide variety of social issues that varied in alignment with the SDOH domains, including eight projects within social and community context (33.33%), five projects within education access and quality (16.67%), four within healthcare access and quality (20.83%), five within neighborhood and built environment (20.83%), and two within economic stability (8.33%). Overall, students identified solutions to their social problem at a variety of intervention levels, including individual (n = 1, 4.17%), interpersonal (n = 1, 4.17%), institutional (n = 5, 20.83%), community (n = 2, 8.33%), policy (n = 4, 16.67%), and multilevel (n = 5, 20.83%). Six students did not identify a solution to their social problem (25%), which is reflective of flexibility in what sections each presentation included and not of the addressability of the social problem students identified. Student-project topics and their proposed intervention level are organized by SDOH domain below. Full descriptions of student projects, including their findings, proposed solutions, and SDOH domain alignment and intervention level, are described in

Table 2. Student project description and SDOH alignment (N = 24).

Project Number	Project Topic	Project Description	Results	Proposed Solution	SDOH Classification	Intervention Level
1	Energy Burden in Low-Income Neighborhoods	Explores energy burden disparities between low-income and high-income households in [Redacted] through a survey (N = 13).	Findings suggest that participants vary in estimated utility costs each month, between $100 to $300, and most expensive utility bill, including gas, water/sewer, and electric.	N/A	Economic Stability	N/A
2	Health and Socioeconomic Status	Explores disparities in physical health outcomes between low and high SES children through a survey (N = 44).	Findings suggest that participants from both middle and low SES backgrounds struggled to afford medical treatment.	Expand the range of healthcare cost related resources for middle- and lower-class families to improve healthcare access.	Economic Stability	Community
3	Expanding Black History Classes in Public Schools	Explores the importance of expanding Black history classes in public schools and their impact on Black students through a survey (N = 38).	Findings suggest that participants believe Black history classes are important for students to learn about African American culture.	Raise awareness about the importance of Black history classes to public school boards and principals to expand Black history classes in public schools.	Education Access and Quality	Multilevel (Interpersonal, Institutional)
4	Expanding Black History Classes in Public Schools	Explores availability of and interest in Black history education in schools through a survey (N = 34).	Findings suggest that students are interested in having access to multiple Black history classes and for multiple grade levels.	N/A	Education Access and Quality	N/A
5	Young, Gifted, and Black	Explores inequitable access to advanced education opportunities for black youth through a survey (N = 41).	Findings suggest that Black students are underrepresented in gifted classes, lack adequate support in advanced educational settings, and are intentionally given less challenging tasks.	Offer enrichment programs in public schools tailored to the needs of gifted Black scholars to improve access to advanced education.	Education Access and Quality	Institutional
6	Historically Black Colleges and Universities (HBCUs) Funding	Explores how and why funding should be increased for HBCUs through a survey (N = 32).	Findings suggest that participants believe that the government, non-profits, and the community should be responsible for contributing to increased HBCU funding.	Special committee in the government to improve funding for HBCUs.	Education Access and Quality	Policy
7	Student Debt Injustice	Explores the impact of student debt on the wealth gap for women and minority students through a survey (N = 89).	Findings suggest that while the majority of participants worry about affording college, it does not affect their choice in attending.	N/A	Education Access and Quality	N/A
8	Mental Health Literacy	Explores teen mental health literacy through a survey (N = 30).	Findings suggest that teens are unfamiliar with mental health misdiagnosis and feel their mental health concerns are dismissed.	Develop and implement a curriculum in schools focused on mental health and misdiagnoses to improve mental health literacy.	Healthcare Access and Quality	Institutional
9	Teen Vaping	Explores teen vaping frequency and health effect knowledge through a survey (N = 44).	Findings suggest the majority of participants know someone who vapes and are frequently unaware of the health consequences of vaping.	Provide visual representations in anti-vaping campaigns to increase awareness of the negative effects of vaping.	Healthcare Access and Quality	Individual
10	Black Maternal Mortality	Explores healthcare quality and negative pregnancy-related outcomes in Black women through semi-structured interviews (N = 4).	Findings suggest that pregnant Black women’s concerns are frequently disregarded by healthcare professionals.	Record patient-provider interactions and increase the number of Black healthcare professionals to improve pregnancy-related outcomes for Black women.	Healthcare Access and Quality	Multilevel (Interpersonal, Institutional)
11	Mental Health and Music	Explores the application of music to combat negative emotions through a survey (N = 41).	Findings suggest that students frequently listen to music in response to negative emotions, and report positive emotions after listening.	Offer free music app subscriptions in schools to students to combat negative emotions and cultivate positive coping strategies.	Healthcare Access and Quality	Institutional
12	Child Nutrition	Explores racial disparities within the relationship between diet and access to nutritious foods through a survey (N = 20).	Findings suggest that teens believe there are racial disparities in diet type (healthy, unhealthy) and participants often lack access to healthy foods.	Expand healthy food options for low-income families at food banks and schools to improve access to healthy food.	Neighborhood and Built Environment	Institutional
13	Environmental Racism	Explores the disproportionate effects of environmental racism on marginalized populations and addressing environmental injustice through a survey (N = 23).	Findings suggest that participants believe politicians need to invest in environmental justice and climate resilient infrastructure in marginalized communities.	Increase awareness of environmental injustice and support petitions and protests to actualize environmental justice.	Neighborhood and Built Environment	Multilevel (Interpersonal, Policy)
14	Renewable Energy	Explores [Redacted] residents’ beliefs regarding renewable energy and utility affordability through a survey (N = 15).	Findings suggest that the majority of participants would be interested in using solar panel energy in their homes, but are worried about initial costs.	Ensure renewable energy options are accessible for all communities and increase awareness about residents’ options to improve use of renewable energy.	Neighborhood and Built Environment	Multilevel (Interpersonal, Policy)
15	Power Grid Reliability and Efficiency	Explores safe and efficient ways to transfer energy in response to increased energy demands through a survey (N = 21).	Findings suggest that the majority of participants are unfamiliar with energy transfer but acknowledge that the U.S. faces increased energy demands.	Update power grids to better store and transport the increased energy needs of the U.S.	Neighborhood and Built Environment	Policy
16	Access to Outdoor Green Spaces	Explores difference in access to outdoor recreation space based on average community income through a survey (N = 12).	Findings suggest that students from various [Redacted] neighborhoods generally have access to parks near their home, but they may not be safe.	City-led effort to provide more funding for green spaces and access to equipment and water fountains in low-income neighborhoods.	Neighborhood and Built Environment	Community
17	Violence and Substance Abuse	Explores the disproportionate impact of violence and substance abuse on low-income communities through a survey (N = 48).	Findings suggest that participants have family members that struggle with substance abuse, and they tend to live in communities that experience violence.	N/A	Social and Community Context	N/A
18	Pedophilia	Explores how social media lacks measures to prevent pedophiles from interacting with children through a survey (N = 23).	Findings suggest that participants are frequently exposed to inappropriate behavior from social media influencers.	Increase restrictions on social media influencers and content accessible to children.	Social and Community Context	Policy
19	Reproductive Coercion	Explores the relationship between domestic violence partnerships and reproductive coercion through a survey.	The findings suggest that participants believed that reproductive coercion negatively affects women’s mental and physical health.	Increase accessibility of couples counseling and awareness of reproductive coercion to address domestic-violence related outcomes.	Social and Community Context	Interpersonal
20	LGBTQIA Identities	Explores the negative effects of inadequate LGBTQIA representation through a survey.	The findings suggest that participants are disappointed by the frequency of hate crimes due to the victim’s sexual orientation.	N/A	Social and Community Context	N/A
21	Human Trafficking	Explores the causes and negative effects of human trafficking through a survey (N = 21).	The findings suggest that participants believe that local government officials need to take additional measures to address human trafficking.	Increase the volunteers at anti-trafficking organizations and organizations to improve protective factors for people at risk of being trafficked.	Social and Community Context	Institutional
22	Police Brutality and Discrimination	Explores police violence and the lack of consequences for police brutality, specifically for Black people, through a survey.	The findings suggest that participants have personally experienced racism and discrimination by the police. Participants expressed that there is a lack of police held accountable in their neighborhoods.	N/A	Social and Community Context	N/A
23	Black Lives Matter Movement	Explores the positive effects of the Black Lives Matter movement, including increased awareness of police brutality and police reforms through a survey (N = 45).	The findings suggest that participants’ awareness of police brutality and discrimination increased following the Black Lives Matter movement, and most believe that the best way to address police brutality is through improving hiring practices.	Increase awareness to foster greater accountability for law enforcement and support reforms in police hiring practices.	Social and Community Context	Multilevel
24	Workplace Discrimination	Explores workplace discrimination and racial disparities in pay through a survey (N = 75).	Findings suggest that participants believe there needs to be stricter anti- discrimination laws in order to address racial and gendered pay disparities.	U.S. government-led implementation of more rigorous anti-discrimination laws in the workplace to address workplace discrimination	Social and Community Context	Policy

.

3.1. Economic Stability

Only two projects aligned with economic stability, including energy burden in low-income neighborhoods (P1) and health and socioeconomic status (P2). While these projects tended to be interdisciplinary in focus, assessing topics that aligned with the healthcare access and quality and neighborhood and built environment domains, they centered the impact of income-related disparities on individual outcomes. For instance, project one (P1) examined energy burden disparities between low-income and high-income neighborhoods, but did not propose a solution to this social problem. Project two (P2) explored disparities in children’s health-related incomes based upon socioeconomic status, where they found that healthcare costs had a negative impact on health outcomes for children from both middle and low SES backgrounds, suggesting the need of a community-level intervention to improve healthcare access. Overall, while economic stability included two interventions, elements of this SDOH factor can be seen across the domains, where income is frequently related to disparities in a variety of outcomes. A sample project that best illustrates this domain, P2, can be found in Figure 2.

3.2. Education Access and Quality

Projects that fit within the education access and quality domain (n = 5) examined the experiences of Black youth in public school and post-secondary education, including the following project topics: expanding Black history classes in public schools (P3, P4), young, gifted, and Black (P5), historically Black colleges and university (HBCU) funding (P6), and student debt injustice (P7). Students explored education access in public schools, where student projects investigated the importance of Black history classes and access to advanced education for gifted Black students. Education access was further explored in the post-secondary education context, where funding differences to HBCUs in comparison to predominantly white universities was identified as an important barrier to quality and equitable education. Students were also interested in the consequences of student debt for women and minority students, particularly as it relates to the wealth gap.

Out of the five projects within this domain, only three projects proposed a solution to address the student-identified social problem, including multilevel (n = 1), institutional (n = 1), and policy (n = 1). One student project approached expanding Black history classes through a multilevel solution. For example, project three (P3) proposed raising awareness to public school boards about the importance of Black history classes in an effort to expand Black history instruction, leveraging an interpersonal intervention to inspire institutional level change. Project five (P5) further proposed an institutional level change to public education, where enrichment programs that are inclusive to the needs of Black students could be leveraged to support education access. However, project six (P6) identified a policy level solution when addressing quality education access in the context of post-secondary education, where funding for HBCUs could be secured through a specialized government committee. Overall, student projects within this domain brought attention to barriers specific to marginalized populations, including minorities and women, and identified solutions that targeted institutions and policy to address education access and quality. A sample project that best illustrates this domain, P5, can be found in Figure 3.

3.3. Healthcare Access and Quality

Healthcare access and quality encompassed projects (n = 4) that spanned issues relevant to today’s youth, including teen vaping (P9) and mental health literacy (P8), where students collected data about teens’ knowledge of mental health literacy and the health effects of vaping. Further, another student project applied their experiential knowledge of mental health solutions that are relevant to teens, where they explored the effects of listening to music on negative emotions (P11). Lastly, one student group conducted interviews to understand why and how Black women frequently receive negative pregnancy-related outcomes and healthcare quality, where they discovered most participants’ concerns were disregarded and not taken seriously by healthcare professionals (P10).

To address the social problems, students identified solutions that were related to healthcare access and quality. The majority of student groups selected institutional-level solutions (n = 2), suggesting students recognized the implications of structures and institutions on individual-level health outcomes. For example, two student groups reflected on the potential of schools to address students’ mental health, proposing school-provided music subscription platforms and curriculum to improve students’ mental health literacy. Another student group provided a tiered strategy that incorporated elements from both institutional and interpersonal-level interventions, where recording patient–provider interactions and increasing the number of Black healthcare professionals created a two-pronged approach to address pregnancy-related health outcome disparities for Black women. However, teen vaping was addressed through individual-level intervention, where students suggested that increasing awareness of the negative effects of vaping may serve as a deterrent against teen vape use. A sample project that best illustrates this domain, P10, can be found in Figure 4.

3.4. Neighborhood and Built Environment

Projects that are best aligned with the neighborhood and built environment domain (n = 5) spanned a wide variety of project topics, including child nutrition (P12), environmental racism (P13), renewable energy (P14), power grid reliability and efficiency (P15), and access to outdoor green spaces (P16). Student projects frequently centered the experiences of marginalized communities and explored racial disparities relevant to [Redacted] communities, where students began to understand the connections between disproportionate outcomes and existing infrastructure in the community. For example, one group highlighted the connection between diet and access to healthy foods, where low-income communities typically have less affordable and fewer healthy food options. Furthermore, another group highlighted the importance of not only being able to access equitable community spaces and services but also ensure that those spaces are safe for community members.

Student-identified solutions to the social problem explored within each project encompassed multiple intervention levels, including institutional (n = 1), community (n = 1), policy (n = 1), and multilevel (n = 2), pointing to students’ recognition of the diverse and multilevel interventions needed to address SDOH factors. Students described solutions that highlighted the importance of adjusting existing systems, rather than targeting individual level factors, to address risk factors related to neighborhood and the built environment. For example, two groups proposed increasing awareness of environmental injustice and renewable energy options in an effort to, or in combination with, changing policy to best address community members’ needs. Overall, student projects within this domain brought attention to racial disparities within their community and emphasized the importance of solutions that target multiple intervention levels, particularly for complimenting interpersonal approaches to influence policy-related interventions. A sample project that best illustrates this domain, P14, can be found in Figure 5.

3.5. Social and Community Context

The majority of student projects covered social issues within the social and community context domain (n = 8), where topics examined various forms of violence, discrimination, and social movements. Five projects centered topics surrounding violence and crime, including violence and substance abuse (P17), pedophilia (P18), reproductive coercion (P19), human trafficking (P21), and LGBTQIA identities (P20). Students examined violence and its relationship with risk behaviors that impact health outcomes, where they situated violence as a particularly prevalent issue within low-income neighborhoods and in the context of social identities. For example, one group explored the relationship between substance abuse and violence, where they found that those who struggled with substance abuse tended to live in communities that experienced increased violence rates. Another group examined reproductive coercion in the context of domestic violence, where reproductive coercion was associated with negative effects to women’s physical and mental health. Students whose project centered LGBTQIA identities reflected on the connection between inadequate social media representation and frequency of hate crimes.

Two projects explored discrimination in different social contexts, including police brutality and discrimination (P22) and workplace discrimination (P24), and the associated negative impacts on health outcomes. For instance, one group explored pay differences due to discriminatory work practices, which have the potential to produce intergenerational poverty and negate one’s ability to accumulate wealth. Project twenty-two (P22) further explored discrimination, where they not only examined the negative effects of police brutality and discrimination for students within their community, but also explored practices that sustained harmful police practices over time, including a lack of accountability and consequences. Furthermore, students also explored the importance of social movements in addressing police brutality, where they examined the Black Lives Matter Movement (P23) and how it worked to address police brutality through police reforms and changes in hiring practices.

Students discussed a variety of approaches to address their social problem and promote social justice, including interpersonal (n = 1), institutional (n = 1), policy (n = 2), and multilevel (n = 1). One group suggested increasing awareness about reproductive coercion in an effort to prevent negative health outcomes for women. Furthermore, another group suggested increasing awareness about police brutality to create greater accountability for law enforcement, in an effort to create police reforms on an institutional level. Increasing the number of volunteers at anti-trafficking organizations was provided as an institutional solution to address human trafficking, suggesting community organizing may be beneficial to improve health outcomes. Some students identified policy-level solutions to address social issues, such as creating restrictions on children’s access to social media and implementing anti-discrimination laws in the workplace. A sample project that best illustrates this domain, P23, can be found in Figure 6.

4. Discussion

This work extends the current literature on community-based organizations public health interventions by applying the SDOH framework to understand youth participatory action research projects. While much of the existing literature evaluates the effectiveness of large-scale public health interventions, few studies examine community-based organizational efforts to promote health equity. Furthermore, few studies apply the SDOH framework to understand how community-based organizations address health disparities, particularly through positioning youth as changemakers within this space. Exploring youth research projects provided a case study to understand the application of SDOH within the YPAR curriculum, social justice issues of interest to youth, and the types of interventions they tend to select to promote health equity. While research on youths’ YPAR engagement is robust (Anyon et al. 2018), scholarship on SDOH-grounded YPAR projects with youth is limited. As such, this work contributes to the YPAR literature and demonstrates how SDOH can support youth in developing thoughtful critiques of the root cause of social issues and innovative solutions.

Overall, the SDOH framework created flexibility within social justice coursework and supported students’ holistic understanding of the root cause of various social issues. Furthermore, the SDOH framework provided youth with a critical understanding of health disparities, providing youth with the knowledge and expertise necessary to be social justice advocates. However, the interdisciplinary nature of the five SDOH domains posited by the Office of Disease Prevention and Health Promotion (n.d.) presented challenges when analyzing student projects, creating difficulties when aligning projects to domains, and teasing apart the nuance of each social issue and their meaning for health outcomes. While the SDOH domains provided a broad framework to inform social justice-related coursework and youth projects, a more comprehensive conceptual model is needed to improve its relevance to be used within practice-based settings and qualitative data analysis.

Youth selected a variety of topics for their projects, showcasing the depth and breadth of students’ interest in social issues. The majority of projects aligned with the social and community context, indicating youth may be most interested in addressing health disparities that impact social environments and relationships. Furthermore, students often chose projects that examined systemic inequities relevant to their lives, demonstrating youth interest in advancing social justice. Education access and quality and healthcare access and quality proved to be of interest to students, where students chose topics that were relevant to themselves and their community, including teen vaping, teen mental health, and accessing quality education in secondary school and colleges. These findings suggest that students may have more familiarity with and an in-depth understanding of issues that affect students their age, providing them with a critical perspective in generating creative solutions for this age group. Less common were student projects whose main focus was economic stability, indicating the need to further push students to tease apart the role economic status has in influencing health disparities. However, elements of economic stability appeared in other projects, where this domain may be more interdisciplinary than others.

Student-created solutions to social issues spanned a variety of intervention levels and types, with particular emphasis on institutional, policy, and multilevel solutions. These findings indicate students understood the root causes behind social issues to be the result of inequitable structures and systems that require interventions at multiple ecological levels to fully address the problem, reflecting the current literature that suggests multi-leveled interventions are critical in achieving health equity (Bigby 2011; Golden and Earp 2012). This further highlights the potential of social justice and SDOH framing to push students to think beyond individual and interpersonal level root causes. However, policy and institutional interventions are often challenging and difficult to navigate, which may require more scaffolding and include processes out of the scope of a short-term YPAR program. Instead, community-based organizations frequently aim to address social issues relevant to youth, providing a potential avenue for youth to plug into their communities, learn about best practices in addressing health equities, and actualize social justice initiatives on a local level. Pushing youth to develop solutions at the community-level may provide for more impact solutions and create opportunities for community engagement that extend beyond the end of YPAR programming.

Understanding how youth translate their knowledge building around inequitable systems and health disparities into tangible action and sustained advocacy are goals of future scholarship. Youth within this project gained positive benefits from engaging in health-related YPAR work. In fact, they learned how to facilitate justice-related community health conversations, as evidenced by their community stakeholder engagement at the final research colloquium (Youth Enrichment Services 2024). These individuals expressed growing commitment to making changes within their communities (Youth Enrichment Services 2024). Young people reported that, as their awareness of health inequities and possible interventions expanded throughout the program, they began to see themselves as helpful guides informing solutions to health disparities in their communities. Despite these positive program outcomes, less is known about how youths’ engagement in such YPAR programs influence long-term youth advocacy and community-level behavioral health changes. Existing research sheds some light on this and suggests youth residents have the capacity to ignite change within community contexts (Pinedo et al. 2024; Pinetta 2023); however, work in this area is still developing and outside of the scope of the reported study. Future scholarship will continue exploring how YPAR programs, like the one this study describes, influence youths’ roles as community change agents and disrupters of health inequities.

5. Conclusions

SDOH frameworks integrated within the YPAR curriculum have the potential to positively impact youth understanding of real-world social issues and develop tangible solutions to solve them. In order to best support youth in becoming changemakers for health equity, YPAR should center solutions at the community-level to improve intervention impact, develop youths’ professional networks, and incorporate assessment measures to understand how youths’ engagement in such programs facilitate changemaking behavior for youth and communities. Integrating youth into community-level solutions offers them a tangible and viable intervention point. Furthermore, community-level solutions create a stepping stone for youth to engage in social issues at the institutional or policy levels, where community-based grassroots efforts often garner increased attention over time. This work also provides practical implications for applying SDOH frameworks within YPAR programs. Future work should extend SDOH frameworks to support youth understanding of SDOH and their application in practice-based settings to tangibly impact health behaviors in communities. Additional work should also consider the intersectional nature of SDOH and how these overlapping nuances can exacerbate the health disparities of individuals living in marginalized and vulnerable communities and influence how youth make sense of SDOH within their neighborhoods as agents of change.