System-level interventions to disrupt structural racism and improve Black adolescent health outcomes

Abstract

Structural racism and discrimination (SRD) is a fundamental cause of health inequities that emerge during adolescence and persist throughout adulthood. This scoping review systematically synthesizes the evidence on policy and community-level interventions designed to disrupt SRD exposure among Black adolescents and mitigate its impact on their health behaviors and outcomes. Following PRISMA-ScR guidelines, we searched five databases for peer-reviewed intervention studies published through October 2025. Of 3417 abstracts screened, 9 studies met inclusion criteria. We examined the study characteristics, theoretical frameworks, implementation strategies, and effectiveness of interventions targeting three primary mechanisms of SRD exposure for adolescents. The majority focused on neighborhood and social integration interventions, with limited representation of resource-based and school-based approaches. Culturally grounded, community-engaged interventions buffered SRD's negative effects on mental health, empowered youth as change agents, and removed structural barriers to health-promotive resources. The review identified several gaps in the research, including methodological and theoretical rigor, geographic contexts, and follow-up. Findings underscore the potential of culturally grounded, multilevel interventions to reduce inequities across mental health, physical health, and social outcomes for Black youth. This review highlights the need to expand systems-level interventions that address the root causes of the persistent racial health inequities experienced by Black youth.