Structural stressors, neurocognition in reward-related decision making and substance use risk in Puerto Rican early adolescents at two sites: study design.

Background: Structural stressors (SS) or mutually reinforcing systems that prevent groups of individuals from accessing opportunities and resources, can impact one's health. Indicators of SS include area-level group differences in income, education and exposure to violence. SS are fundamental causes of health disparities and can be indexed by area-level measures. Area-level SS may influence substance use risk in adolescents and future substance use disorders (SUDs). SUDs often start during adolescence, a critical risk period and an ideal time for prevention and intervention efforts. Since SUD risk can be influenced by the experience of the prior generation, it is important to take into account familial risk when trying to understand the role of SS on substance use risk. Improved understanding of the relationship between SS and neurocognitive mechanisms of substance use risk could inform novel approaches to prevention and intervention. Methods: We will enroll participants who are part of the Boricua Youth Study (BYS), an intergenerational, representatively sampled cohort of Puerto Rican families living in the South Bronx, New York and San Juan, Puerto Rico that has been followed for 20+ years. Working with BYS will allow us to control for familial SUD risk with prospectively captured parental SUD data and examine the how SS is related to substance use risk in two disadvantaged contexts. This article describes a pilot study focused on providing proof of the concept that specific area-level indicators of SS, including measures of income, education and exposure to violence, relate to neurocognitive mechanisms of substance use risk, including steeper delay discounting and reduced reward-related neural activity in reward-sensitive brain regions. Analyses will test a relationship between SS and neurocognitive mechanisms of substance use risk. Discussion: Results will reflect associations between area-level, substance use-relevant SS and neurocognitive mechanisms of substance use risk in adolescents. If proof of concept is obtained, the next phase of the study will examine structural and family-level factors that may buffer the negative impact of SS. The goal of this research is to guide novel approaches to structural-, family- and individual-level prevention of SUD. Clinical trial registration: https://clinicaltrials.gov/study/NCT06221839, identifier: NCT06221839.