ABSTRACT Black and Latinx people in the United States (US) suffer disproportionately high levels of substance use and mental health disorders. Further, racial and ethnic minoritized groups have decreased access to behavioral health treatment services than white people. Emergent literature has zeroed in on how structural factors can impact various health outcomes. In this application, our main objective is to understand the connection between behavioral health outcomes, structural racism, and an urgent and escalating contemporary issue: natural disasters. Therefore, in response to RFA-DA-23-013 we propose our project, “The Contribution of Structural Racism to the Effects of Natural Disaster on Behavioral Health Outcomes (SALENDO)” study. The objective of this study is to clarify the overlapping effects of structural racism, natural disaster exposure and risk, and behavioral health. Our specific aims are: 1) Evaluate temporal and geographic correlations of structural racism, utilizing indices at the concentration of extremes (ICE) measures, natural disaster susceptibility, and rates behavioral health-related emergency department visits/inpatient hospitalizations/overdoses by county in Texas (TX) and Louisiana (LA); 2) Examine how Hurricane Harvey shaped behavioral healthcare utilization and overdose fatalities and the role that structural racism played in these consequences; and 3) Interpret and actionize data in collaboration with impacted communities.

PROJECT NARRATIVE We will examine the temporal and geographic correlations of structural racism, natural disaster susceptibility, and rates of behavioral health outcomes in Texas and Louisiana. Additionally, we will assess how Hurricane Harvey shaped behavioral health outcomes and the extent to which these outcomes differ based on county levels of structural racism. Finally, we will engage in collaborative data analysis with community members in Houston to optimize interpretation and actionability of results.