Estimating the impact of the school-to-prison pipeline on adolescent health: racialized,spatial disparities in policing, school discipline, substance use, and mental illness

PROJECT SUMMARY: Over 10 million students in the US attend schools with police but no counselor, nurse, psychologist, or social worker. Yet, more than a third of the low proportion of adolescents who receive the substance use treatment they need (6%) access it only at school; they are disproportionately Black and low- income. Schools are thus crucial public health intervention targets for substance use and mental health treatment, prevention, and health equity therein. But instead, many adolescents experience school as a school- to-prison pipeline; a set of policies and practices that criminalize adolescents and ensnare them in the legal system rather than provide support for underlying educational and developmental needs. School-based arrests increased 300-500% and exclusionary school discipline (suspensions and expulsions) doubled over the past 40 years. Black students are more than three times as likely to be suspended or expelled as white students, all else equal, and students removed from school are more than twice as likely to be arrested in the same month than those not removed. Our preliminary evidence suggests that the school-to-prison pipeline is a previously unidentified population driver of adolescent substance use and mental illness. Moreover, the pipeline coincides with rises in aggressive community policing in schools’ surrounding communities. However, there is no research on the public health implications of these intersecting trends. In the proposed R01, we will collaborate with the New York City Office of School Health (OSH) to quantify relationships between aggressive community policing, school discipline, and student substance use/mental illness in NYC. We will create a unique geocoded 2000- 2022 dataset linking all police stops/arrests; school- and student-level exclusionary discipline; restricted school- level Youth Risk Behavior Survey (YRBS) data (e.g., tobacco, alcohol, cannabis, other drug use); and OSH’s database of student health services records (e.g., nurse, counselor visits, referrals to mental health/substance use treatment). We will (Aim 1) characterize direct and mediated relationships between community policing and school discipline on school-level and (Aim 2) student-level substance use and mental health outcomes; and test (Aim 3) whether the intensity of policing around schools modifies the relationship between school discipline and student substance use/mental health. In all aims, we will test whether structural and institutional racism in policing and school discipline modify hypothesized relationships. This high-impact project responds to NIDA’s interest in improving SUD treatment for vulnerable populations in schools and the juvenile justice system, as well as leveraging data science to improve SUD prevention. Our diverse, interdisciplinary team, led by an early-stage investigator PI, has expertise in substance use, psychiatric, and social epidemiology; school health; the sociology of racialized disparities in population health, education, and policing; spatial epidemiology/health geography; and data science. Findings will be utilized by policymakers and project stakeholders (including city, state, and federal policymakers) working to end the school-to-prison pipeline and prevent adolescent substance use/mental illness.