Family-Centered Prevention Attenuates the Association Between Structural Racism Risk and Black Adolescents' Low Self-regulation and Externalizing Behaviors: Secondary Analysis of a Randomized Clinical Trial.

Converging evidence underscores the influence of structural racism on the emergence of externalizing behaviors among Black youth. Recent studies suggest that family-centered prevention may attenuate some of the effects of structural racism on youth mental health. Hypotheses were tested regarding the potential of the Strong African American Families (SAAF) preventive intervention (ClinicalTrials.gov Identifier: NCT03590132) to (a) attenuate the influence of structural racism on low self-regulation, (b) attenuate the influence of low self-regulation on externalizing behaviors, and (c) disrupt the pathway from structural racism to externalizing behaviors via low self-regulation. Hypotheses were tested with data from 472 Black youth (mean age = 11.61 at pre-test) and their caregivers participating in a randomized prevention trial. Structural racism was indexed according to a cumulative risk model based on census-level indicators of Black-White disparities in labor force participation, housing, educational attainment, poverty, and a measure of racial segregation. Consistent with hypotheses, we found that SAAF buffered the influence of structural racism risk on low self-regulation. A significant buffering effect was not detected on the path from low self-regulation to externalizing behaviors. Conditional indirect effect analysis suggested that attending SAAF disrupted the pathway linking structural racism to externalizing behaviors via low self-regulation. Study findings underscore the potential benefits of widespread dissemination of family-centered prevention targeting evidence-based protective processes designed for Black youth. Clinical Trial: Registered at Clinicaltrials.gov, NCT03590132, July 5, 2018.