LAUSR

Background Traditional health education efforts rarely align with youth social justice values. The Bigger Picture (TBP), a public health literacy campaign that uses spoken word art to promote health, leverages a social justice approach to activate youth around the social determinants of type 2 diabetes (T2D). Objective We examine the impact of TBP on health-related mindsets and expectations; sense of belonging; and civic engagement among youth in urban, low-income high schools. Study Design, Setting, Participants In this cluster-randomized study students from 3 high schools received a T2D-related arts-based program and students from 3 comparison schools received a non-health related arts-based program. Both programs were delivered in classrooms and extracurricular clubs over the course of 3 semesters (with the final semester modified due to coronavirus-related school closures). Measurable Outcome/Analysis We conducted interviews with adults (n = 32; 27 unique participants) and youth (n = 15) from both intervention and comparison schools who participated in programming. In addition, we performed a content analysis of student poems (n = 10) related to T2D in intervention schools. Results Students in both intervention and comparison schools listed factors like genetics, sugar consumption, diet, income, and neighborhood access to nutrition and physical activity as contributors to T2D. In more cases, however, students in intervention schools were able to draw connections between race/ ethnicity and poor access to basic health-promoting resources. Students in both programs had a high sense of belonging at school and confidence in civic engagement. One instance of T2D-related civic engagement was reported in intervention schools. Content analysis of TBP students’ poems revealed youth's detailed understanding the role that government and corporate influence, access, individual behavior, and sociocultural factors play in developing T2D. Conclusion Future studies might explore program scalability, and how the integration of civic engagement opportunities into TBP curriculum might impact student's capacity to actively participate in creating social positive change around the social determinants of T2D.