Introduction

In light of the COVID-19 pandemic and worsening trends in child and adolescent emotional and mental health, concerns related to adolescent substance use have increased within the United States (US) [1, 2]. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) 2022 US National Survey on Drug Use and Mental Health, 14.3% (or 3.7 million) adolescents (12 to 17 years of age) used an illicit drug in the past year; 6.8% (or 1.8 million) people used alcohol during the past month; and 3.2% (or 834,000) adolescents binge drank [3]. The proportion of adolescents who used drugs in 2022 was higher among American Indian or Alaska Native (31.7%), Multiracial (35.1%), and Black or African American persons (26.7%) when compared to non-Hispanic Whites (25.8%) [3]. Past year drinking was highest among White youth and young adults, 12 to 20 years of age (32.3% in this age group); however, youth of color were disproportionately affected, when considered alongside their total population in the US [4, 5]. The proportion of adolescents and young adults of color who used alcohol in 2022 was highest among Multiracial (28.2% in this age group), Hispanic or Latinx (27.1% in this age group), and American Indian or Alaska Native persons (23.5% in this age group) [5]. Such rates are sobering and contribute to negative life-outcomes for adolescents and young adults.

Underage drinking has declined among adolescents and young adults (12 to 20 years of age) by 47.4% from 2002 to 2022 [5]; yet, alcohol is involved in 178,000 (approximately 120,000 male deaths and 59,000 female deaths) deaths per year [6], which is higher than the number of drug overdose deaths [7]. Moreover, excessive drinking is responsible for about 4,000 among people under the age of 21 each year [7]. The consequences of underage alcohol use are numerous including an increased risk of developing alcohol use disorder (AUD), the impact on adolescent brain development, worsened mental health conditions and illness, and a greater risk for suicidal ideations and attempts [8, 9]. Furthermore, alcohol, tobacco, and other drug use (ATOD) prevention efforts focused on Black, Indigenous, and Persons of Color (BIPOC) communities have been less than adequate [10] with less than desirable effects [11] given the increased number of access points to drugs and alcohol [12,13,14] and minimal access to quality prevention and intervention services [10, 15]. Alcohol specific prevention, while having slightly improved outcomes, compared to general ATOD prevention programming, also necessitates improvements in programming and delivery for BIPOC youth. And although community-based prevention approaches are documented, further research and development in these areas are needed.

Current trends in ATOD prevention include community-based approaches rooted in public health that involve multiple sectors working within coalitions to implement multi-level strategies [16,17,18,19]. These innovative prevention approaches have included those based on youth empowerment, Youth Participatory Action Research (YPAR), and community-based participatory research [20]. These approaches tend to benefit youth participants and improve prevention [21] and youth health equity outcomes [22]. In practice, much of the Participatory Action Research (PAR) in the ATOD prevention field has been framed through Empowerment Theory [23,24,25].

Empowerment theory has been applied across numerous disciplines [15, 23, 26,27,28]. Empowerment as a multidimensional construct has been presented [29,30,31], yet, only as a higher-order multidimensional construct, recently (see Peterson 2014) [32]. In this review, we concentrated on two existing constructs of empowerment theory: psychological empowerment and organization empowerment [31]. These dimensional constructs of empowerment theory were chosen as conceptual framings because each describe specific features that characterize individuals and organizations that are empowered, as well as processes that may facilitate youth empowerment. Both psychological empowerment and organizational empowerment have been applied in research on substance use prevention [15, 33].

Psychological empowerment was initially conceptualized by Zimmerman [31], and advanced by Christens [29]. Psychological empowerment consists of four interrelated dimensions: emotional, cognitive, behavioral, and relational. The emotional dimension of psychological empowerment involves the ways in which people feel about themselves as they engage in proactive behaviors to gain greater control of their lives in the context of changing their sociopolitical or physical environment [31]. Concepts relevant to this dimension include feelings of self-efficacy, perceived control, competence, and mastery. The cognitive dimension of psychological empowerment involves individuals critical awareness and understanding of the community or sociopolitical environment [31]. Concepts relevant to this dimension involve skill development, understanding of causal agents in communities, and knowledge of the ways in which people may mobilize the resources needed to create positive change. The behavioral dimension of psychological empowerment refers to individuals actions. These actions include civic engagement, coping behaviors, and participation in community groups and organizations [31]. The relational dimension of this theory refers to aspects of interpersonal processes and transactions that are vital to the development and exercise of social power in the sociopolitical domain [29]. Concepts relevant to this dimension include collaborative competence, facilitating others empowerment, and bridging social divisions.

The contemporary nomological construction of organizational empowerment was conceptualized by Peterson and Zimmerman [30]. Zimmerman [34] defined organizational empowerment as efforts that create opportunities for the psychological empowerment of members, as well as the effectiveness of the organization that is necessary to achieve its goals. Peterson and Zimmerman [30] expanded this definition to present a framework that included specific features that represented empowered organizations. The framework included three components: intraorganizational, interorganizational, and extraorganizational. Intraorganizational empowerment involves the internal structure and functioning of groups that can provide the infrastructure for members to obtain goals [30]. Interorganizational empowerment refers to the connections or linkages between organizations and includes concepts such as networking and resource procurement [30]. Extraorganizational empowerment refers to the influence that groups can have on the larger environments of which they are a part [30]. Together, the features categorized within interorganizational, interorganizational, and extraorganizational components provide an understanding of organizations that are empowered. Much of the literature has focused on individual or psychological empowerment; however, the totality of empowerment theory has been used to inform, develop, and strengthen youth action in ATOD prevention and youth-engaged research, which enables youth to be active partners in change.

Youth participatory action research studies that draw on empowerment theory — moving forward described as E-YPAR to improve readability and clarity but not to introduce a new term to the literature — to inform ATOD prevention within BIPOC communities are somewhat documented within the extant literature [35,36,37,38,39]. Through this framework, youth are centered as change-agents to promote health and wellness and prevent and decrease ATOD use and other adverse health behaviors. Placing young people at the forefront of prevention efforts ensures these approaches are culturally-grounded and relevant with the guidance of youth voices. These community-engaged approaches diverge from strategies used in ATOD prevention in the past [40, 41].

Historically, prevention efforts have focused on creating individual-level change, such as youth behavior or attitude changes. The current prevention trends focus on approaches that aim to create organization-level or community-level change, often through coalition structures that involve and rely on the participation of a broad range of community partners to represent the needs and values [18, 42, 43]. Because youth are embedded in complex community environments, empowerment-based frameworks that center on youth voices are critical to effectively target the ecological contexts where ATOD occurs. Not only have E-YPAR frameworks shown promise in decreasing ATOD among youth [44], but elsewhere, outcome-based studies have demonstrated relationships between empowerment and other health behaviors [15, 45,46,47]. A growing body of literature situates youth within empowerment-based participatory ATOD prevention initiatives. However, intervention and prevention projects rarely focus exclusively on alcohol use, but rather multiple substances, which include alcohol, as well as other drug use. Specifically, no review, as far as these authors are aware, has evaluated the extant literature with a primary focus on both empowerment and BIPOC youth.

Purpose of this Review

The purpose of this review is to (1) identify studies that describe BIPOC youth engagement and empowerment in ATOD prevention activities, with an emphasis on alcohol, and (2) identify and describe outcome-based studies examining relationships between BIPOC youth empowerment, community engagement in prevention, and ATOD outcomes, with an emphasis on alcohol. Through this scoping review, we synthesized primary substances of foci, participant descriptions, objectives, participatory approaches, methodologies, youth and empowerment-focused outcomes, and documented pitfalls. As a scoping review, we focus on broadly mapping the evidence that is present within the extant research [48].

Methods

The current scoping review study is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [49].

Sources

Inclusion criteria included peer-reviewed English and Spanish language articles published from any date to April 1, 2024, that referred to adolescent and youth ATOD use. We included articles on E-YPAR projects for youth ATOD prevention, youth-led community-based participatory research, and studies addressing ATOD prevention as a primary or secondary outcome alongside empowerment constructs such as psychological empowerment and community-engaged participation. All studies described research that was either driven by BIPOC youth or study outcomes were examined among BIPOC youth (versus adult-led or in partnership with adults, and outcomes focused on adults).

Articles inconsistent with the inclusion criteria or were editorials, reviews, historical, or theoretical in nature were excluded. Additionally, we excluded articles on adult-led interventions with youth collaborators and publications from non-peer-reviewed sources.

Search Strategy

To identify references, we searched databases, including PsycINFO, PubMed, Scopus, ERIC, Web of Science, and ProQuest. This was followed by an analysis of the text contained in the title, abstract, and index terms of retrieved articles. We used MeSH heading, keyword, and topic searches depending on the search engine. Our search included terms associated with the study population (separated by OR): adolescent (OR) adolescence (OR) youth (AND) terms that contained empowerment (AND) participation (OR) participatory (AND) terms that targeted he outcome: substance AND use (OR) substance (AND) abuse (OR) substance (AND) misuse (OR) alcohol (OR) alcohol use (OR) alcohol misuse (OR) alcoholism. Terms were not translated into Spanish. We also consulted existing literature and meta-analyses [50] that have examined this topic. We consulted experts within the field of empowerment and prevention science to ensure accuracy in our retrieval processes and identify pertinent literature. Special attention was given to those studies examining alcohol use; search terms remained broad to allow for the inclusion of numerous substances.

Study Selection

See PRISMA Diagram for the article selection process (Fig. 1). Four study team members (DL, KG, CV, AR) inspected all titles and abstracts according to the inclusion criteria. We recorded the author(s), journal, and year of publication from each manuscript that met the inclusion criteria. Proportionate agreement occurred 87.55% of the time during title and abstract review. During disagreements, the four authors met to discuss and reach a 100% consensus, resulting in 81 retained articles.

Fig. 1
figure 1

PRISMA flow diagram. PRISMA, preferred reporting items for systematic reviews and meta‐analyses. Note. This PRISMA diagram contains public sector information licensed under the Open Govern

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After the first round of screening, full-text reviews were conducted among the same four study team members. We engaged in the same process of resolving disagreements with two additional co-authors (RR, AP) until 100% consensus was reached. Proportionate agreement occurred 70% of the time. We then consulted experts in within the field to ensure our review was comprehensive and rigorous. The resulting 17 articles are described in the results and Table 1 and Table 2. We organized and sorted the 17 articles into two primary domains: (1) E-YPAR studies; and (2) Empowerment theory outcome-based studies. Table 2 presents themes to support recommendations for prevention research.

Table 1 Empowerment youth participatory action research (YPAR) and empowerment theory outcome-based studies (N = 17)
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Table 2 Scoping review themes from manuscripts that provide recommendations for prevention research
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Data Extraction and Analysis

Four study team members (DL, KG, CV, AR) supported the data extraction process, using guidance by Pollock and colleagues [51]. After thorough reading of each of the included studies, the data extraction table was created in Microsoft Excel with columns for each of the data elements extracted. The data elements were guided by our overall study purpose and included all elements contained in Table 1. The final data extraction table was reviewed and approved by the full team. Three study team members (DL, CV, AR) completed data extraction of all included articles independently. Then the full team conducted reviews of some extractions to ensure accuracy and met multiple times as a team to review data extracted and reconcile any conflicts [52]. To extract all data elements, the full articles were considered, though, most of the data were extracted from methods and discussion/conclusions. Extraction was an iterative process, in which the team added additional details during team meetings as needed and one reviewer (DL) made final edits to the extracted data to ensure concise and consistent language. The final extraction table was formatted into the resulting Table 1. With the extracted data in the extraction table, the team conducted basic qualitative descriptive analysis [53] and synthesized for each data element through descriptions and reported frequencies where relevant.

Results

We identified 271 article abstracts and screened them for retrieval (Fig. 1). A total of 269 original titles and abstracts were retained for screening. Of these, 189 were excluded due to topic misclassification. The remaining 80 full-text articles were screened, with 63 excluded, which resulted in the final 15 articles being included in this review. Two additional articles were included following consultation from experts within the field [54, 55]. Projects described in these articles varied regarding participant descriptions, objectives, methods, primary substances of focus, and youth and community outcomes (see Table 1). Articles were divided into two categories: (1) E-YPAR studies (n = 10) and (2) Empowerment theory outcome-based studies (n = 7).

Participant Descriptions

E-YPAR studies. The population of focus varied among the ten projects that described E-YPAR. All articles described BIPOC youth, including Native American or American Indian, Native Hawaiian [56, 57], Hispanic or Latinx [58,59,60], Asian and Pacific Islander, and nondescript underserved minority [61,62,63] and ethnically diverse youth [64]. Youth from these articles occupied multiple historically oppressed backgrounds or those with disproportionate risk across the US, including urban youth, rural and frontier youth [57, 60], tribal youth [56, 57], youth from refugee families [61, 62], youth along the US-Mexico border with mixed immigration status [58, 60], and youth in poverty [63]. Most participants were 10 to 18 years of age. One article engaged elementary school students [65], and four engaged youth and young adults older than 18 [56, 58, 61, 62].

Sample sizes varied across articles. Five articles had sample sizes of 30 or less [57, 60, 61, 63, 64]. Five studies had sample sizes of 70 or more participants [56, 58, 59, 62, 65]. Three projects presented sample sizes with either multiple cohorts, multiple levels of data collection, or participatory approaches with both youth and adults but failed to describe youth members adequately [58, 59, 62].

Empowerment theory outcome-based studies. Among the seven projects that described empowerment theory outcome-based studies, all engaged BIPOC youth from urban communities [15, 27, 33, 47, 54, 55, 66]. Studies were all located in the northeastern US [15, 27, 33, 47, 54, 55, 66]. Youth from these articles occupied several historically oppressed backgrounds, including youth living in poverty, youth living within communities with high levels of community violence, and youth with increased access to substances due to high alcohol outlet density in their communities [15, 27, 33, 47, 54, 55, 66]. Two articles engaged only BIPOC [33, 47]. Ages ranged from 11 to 18 across studies [15, 27, 33, 47, 54, 55, 66]. Sample sizes varied significantly, with the smallest sample size being 383 BIPOC youth [66] and the largest sample size being 1480 BIPOC youth [15].

Objectives

E-YPAR studies. Articles reported varying objectives to achieve goals related to youth ATOD prevention. Six articles focused on evaluating participatory action research projects [57, 60,61,62,63,64]. Two articles described raising awareness and building youth and community capacity [63, 65]. Two articles described the evaluation of intervention programs [61, 64], one examining youth and community outcomes [62].

Empowerment theory outcome-based studies. The primary objectives reported across these seven articles focused on the association between youth empowerment constructs (e.g., psychological empowerment) and ATOD use outcomes to inform primary prevention strategies [15, 27, 33, 47, 54, 55, 66].

Methods and Participatory Approaches

E-YPAR studies. Photovoice (i.e., Photovoice is a visual research methodology with the intention to foster social change. For more information see Wang and Burris [67, 68]) and traditional qualitative methods (e.g., individual interviews, focus groups) were commonly used across six studies [57, 58, 60,61,62,63]. Two articles reported traditional qualitative methods, including individual or focus group interviews and community observations [59, 65]. Four used a combination of quantitative surveys geared toward youth, adults, and community members [56,57,58, 62].

Empowerment theory outcome-based studies. These articles did not explicitly engage in participatory approaches but did examine associations between youth and ATOD outcomes to inform primary prevention strategies [15, 27, 33, 47, 54, 55, 66]. Implications for participatory prevention activities were discussed in these articles. See Table 1.

Theoretical Orientation

E-YPAR studies. Most articles described theoretical orientations (e.g., Empowerment Theory, Positive Youth Development theory) alongside participatory action research approaches. Of note, we are not proposing that participatory action research, YPAR or community-based participatory research are theoretical concepts. Instead, we are noting theories (e.g., Empowerment Theory, Positive Youth Development theory) that guided understanding alongside participatory action research methodological approaches. All studies used the term empowerment but varied in definition and theoretical conceptualization. Seven articles specified Empowerment Theory and Constructs as outcomes (e.g., self-efficacy) alongside participatory approaches, including participatory action research [59], YPAR [60,61,62], or community-based participatory research [63,64,65]. Three articles described concepts from Empowerment Theory but instead used Positive Youth Development theory as a guiding concept alongside participatory action research [57, 64] and two community-based participatory research or YPAR studies [58].

Empowerment theory outcome-based studies

All studies drew on Empowerment Theory and Constructs as their theoretical orientation [15, 27, 33, 47, 54, 55, 66]. Christens and Peterson [54] also drew on a Risk and Protective Framework [69] to conceptualize their modeling strategy and outcomes. These articles examined several dimensions of Empowerment Theory, including the intrapersonal domain of psychological empowerment (i.e., self-efficacy in policy change and leadership) [15, 33, 54, 55, 70] and the cognitive domain of psychological empowerment (i.e., power through relationships, nature of problem/political functioning, and shaping ideologies) [27].

Substances of Focus

We identified four articles that listed ATOD as the substances of focus [15, 58, 60, 65]. Six articles focused on alcohol and other drug use (AOD) [27, 54, 55, 57, 66], and two articles focused on alcohol, tobacco, and cannabis [47, 59]. Four articles emphasized tobacco use [61,62,63,64], and one article focused on alcohol use, explicitly [56].

Project and Study Outcomes

E-YPAR studies. Articles reported numerous positive effects of youth involvement in E-YPAR on ATOD indicators and prevention outcomes. Participating youth displayed increased knowledge and greater risk perception regarding tobacco [61,62,63,64], alcohol, and other drug use [57, 59, 60, 65]. Six studies indicated increased awareness among youth in their communities and a desire to engage in social action and change to facilitate prevention strategies [56, 58,59,60,61,62], particularly marketing campaigns (e.g., social media, project specific websites, billboards) [58, 62]. Other outcomes included the identification of protective factors [60], changes in beliefs, perceptions, and values [62], and the development of research skills to facilitate sustainability and continued social change toward the development of prevention strategies [64].

These articles, found positive results with youth participating in sociopolitical and environmental prevention activities through, in most instances, collective action. Further, several studies have identified adult allies or mentors in facilitating and supporting youth action in prevention strategies [58, 60, 61] and increasing their critical awareness and knowledge development [57, 61, 64]. All studies noted youths input regarding alcohol and ATOD improved prevention efforts.

Empowerment theory outcome-based studies. Articles reported several variables implicated in youth empowerment and empowerment theory (e.g., community participation, psychological sense of community, ethnic identity) as being associated with either lower levels of ATOD or risk perception. All articles specifically described the association between intrapersonal psychological empowerment and ATOD outcomes [15, 27, 33, 47, 54, 55, 66]. Two articles described the association between intrapersonal psychological empowerment, ATOD use, and sexual risk behavior outcomes [33, 47]. Across all studies, implications for ATOD prevention among BIPOC youth were provided. See Table 1.

Prevention Recommendations

EYPAR studies

Prevention recommendations were relatively consistent across all studies, emphasizing youth engagement and being multi-generational (i.e., adult allies and youth working collaboratively). All articles focused on consciousness-raising activities and referred to Paulo Freires work [71] in this conceptualization.Footnote 1 Six articles focused on these efforts through PhotoVoice, with five taking a multi-level community collaborative approach [57, 60,61,62,63], and one considered the use of social media in prevention [58]. Two articles focused on prevention work being culturally responsive and specific to Hispanic or Latinx communities and youth [58] and Native Hawaiian communities and youth [57]. Themes related to recommendations are presented in Table 2, highlighting goals and activities focused on ATOD prevention.

Empowerment theory outcome-based studies

Similarly, prevention recommendations from these articles were relatively consistent across all studies, emphasizing youth engagement and multi-generational collaborations. However, two studies noted a specific emphasis on BIPOC girls [33, 47], and two other studies highlighted ways to support youth connection to racial-ethnic communities to facilitate alignment of prevention activities and positive youth end outcomes [15, 66]. Themes related to recommendations are presented in Table 2.

Alcohol-specific prevention recommendations

EYPAR studies

Alcohol specific prevention recommendations were minimal. Two articles discussed alcohol and alcohol use prevention [56, 59]. Ehlers et al. [56] noted that billboards and other community outreach activities, such as participatory processes (e.g., information campaigns), raised community awareness regarding youth alcohol use, as well as built capacity to sustain these participatory efforts. They further added that involving American Indian / Native American youth and adults in each step of the designing and implementation of alcohol prevention and intervention is important to ensure that the work is culturally responsive, relevant, and effective to the target population [56].

In a sperate study, Gosin et al. [59] drew attention to the importance of researcher-community partnerships in developing effective drug and alcohol prevention programs and how participatory action research accomplished the goal of ensuring direct participation of school community experts as consultants and collaborators. Therefore, the primary recommendation concerns the incorporation of participatory action research in the implementation of programs to prevent youth drug and alcohol use. Moreover, engaging teachers and students in multiple stages of development is important to identify curriculum that is representative of specific cultures and community.

Empowerment theory outcome-based studies

No studies specifically examined alcohol use as a primary outcome for prevention-intervention research.

Discussion

This scoping review aimed to describe youth engagement and empowerment in ATOD prevention activities. These studies emphasized alcohol prevention, and identified outcome-based studies that examined relationships among youth empowerment, community engagement, and ATOD outcomes. This review summarized the extant published evidence regarding E-YPAR prevention initiatives and outcome studies that examined empowerment within BIPOC youth communities. We synthesized the methodologies and implications for E-YPAR and ATOD prevention.

Among the E-YPAR studies, most articles focused on either ATOD, alcohol and other drugs (AOD), or tobacco use specifically, with one study focused specifically on alcohol use. All studies engaged BIPOC youth with diverse intersecting geographic locations and identities. Across this research, empowerment-based participatory approaches through participatory action research, YPAR, or community-based participatory research were valid methods for engaging BIPOC youth in prevention activities. While numerous objectives were reported across studies to meet the goal of promoting youth ATOD prevention and reducing youth ATOD use, most focused on developing community assessments [56, 57, 59, 62], increasing community and youth capacity [56, 57, 59], bridging youth-adult partnerships [15, 56, 65], and developing culturally-responsive prevention approaches [56,57,58, 65].

Results support engaging BIPOC youth as active leaders of community ATOD prevention efforts. With some variation across projects in the methods by which youth engaged in participatory programming (e.g., PhotoVoice, environmental scans, social media, and billboard creation), youth were identified as actively involved in projects that included, but were not limited to, identifying community problems and raising awareness about those problems [57,58,59,60,61,62,63,64,65]. The single alcohol-only-focused study noted cultural responsiveness and multi-generational allies as essential components to raising awareness and mobilizing community support [56]. Gosin et al. [59]while examining multiple substances, specifically noted the role of community partnerships in developing effective drug and alcohol prevention programs and how participatory action research facilitated engagement of school community experts as consultants and collaborators. This framing of youth — particularly BIPOC youth alongside adult and multigenerational-allies — as providing expertise and leadership runs counter to traditional notions of youth engagement and prevention [22, 41, 74,75,76]. Frequently, youth are positioned as sources of stress and worry, as well as a group of people who need to be "changed" and lack agency — i.e., governed by hormones and peers [15, 22, 76]. Therefore, BIPOC youth sharing power with adult allies is key to ensuring that youth voices are raised-up in societal spaces that they are typically barred from accessing (e.g., political circles, community forums, and coalitions) [22, 77,78,79].

Multiple objectives were described across studies to meet the goal of empowerment-based ATOD prevention by and for youth. Most studies described E-YPAR as the primary prevention activity [56, 58,59,60,61,62, 64, 65]. For instance, Edberg et al. detailed that the Adelante Project not only empowered youth to engage in PhotoVoice, as well as web-based and social media prevention strategies, but also impacted adult and youth alcohol use [58]. Ehlers et al. found that youth were engaged in raising awareness of alcohol use in their tribal communities through billboards and other participatory processes [56]. This project further facilitated knowledge development and social awareness among adults and youth in the community [56]. Though it is clear that participatory methods are beneficial to developing and disseminating youth-driven ATOD prevention programming, these studies also highlight the notion that this work has the potential to impact the youth themselves and enhance their own knowledge, skills, and motivation [57,58,59,60,61,62,63,64,65], as well as increase their sense of purpose and perceived support from adults [15, 33, 56, 58, 59, 61, 62]. It also has the potential to align BIPOC youth with adult-allies, which is well-described in the extant literature as a source of facilitating youth engagement, youth-driven prevention strategies, and youth action for policy change [17, 41, 80, 81].

E-YPAR studies

Across E-YPAR studies, youth experienced several positive outcomes as a result of engagement in these prevention activities. For instance, all studies indicated that youth learned about environmental approaches to ATOD prevention and could dialogue about preventive measures [56,57,58,59, 61,62,63,64,65]. Other studies (n = 8) added that youth developed a critical awareness of social, political, economic and policy level conditions that perpetuate inequality, particularly as it relates to ATOD use and prevention in BIPOC communities [56,57,58, 60,61,62,63, 65]. Such conditions that were described in studies included, but were not limited to, the perpetuation of tobacco selling establishments and access [61, 62]; racial composition of the community and the type and level of access [64]; and public policies that disinvested from communities of color [60, 63].

Among studies specific to alcohol use, changes were identified in youth drinking behavior [56, 59] and youth perception of alcohol use risk [57]. While there were some community outcomes described (e.g., changes in youth smoking; and changes in adult perceptions regarding alcohol use) [57, 62], most studies did not discuss large-scale impacts, nor macro-level policy or other changes in the sociopolitical or physical environment. Several studies made important attempts at sociopolitical change (but failed) in actually getting policy implemented. This limitation in terms of large-scale impact points to the need for studies describing the participatory process over time at both the individual level among youth, and at the community level. Moreover, it is vital that participatory research studies continue to document environmental change strategies (e.g., policies focused on advertising restrictions, changing hours of operations for alcohol establishments, compliance checks). Extant participatory research studies have recognized that not only have youth and community members felt empowered through these efforts, but these environmental change strategies can impact community norms, regulations, as well as access and availability of substances [25, 50, 82]. Well-conceived participatory environmental change approaches alongside implemented policies at the local, state and national levels can effectively reduce community level ATOD use and associated outcomes. These E-YPAR studies offer lessons that intersect with findings generated within the identified Empowerment theory outcome-based studies.

Empowerment Theory Outcome-based Studies

Empowerment theory outcome-based studies displayed the role of youth empowerment in reducing ATOD and changing risk perceptions [15, 27, 33, 47, 54, 55, 66]. Authors also noted intersecting concepts within E-YPAR, such as engaging adult allies and providing culturally responsive prevention programming [15, 27, 33, 47, 54, 55, 66]. There was an emphasis on connecting youth with ethnically-racially diverse mentors, which may augment their own sense of cultural identity. Prior research has noted the benefits of ethnically-racially diverse mentors in facilitating not only cultural identity but also bridging BIIPOC youths perspectives on health and wellness, as well as prevention knowledge with a more systems focused-approach to conceptualizing social change as it relates to ATOD prevention [38, 83,84,85,86,87,88]. Opara et al. specifically emphasized the need for tailored, targeted and culturally responsive ATOD prevention programming; more precisely, they added that prevention efforts need to consider intersecting identities, such as gender-specific prevention (i.e., working with BIPOC girls) [33, 47]. Importantly, these findings buttress outcomes generated among identified E-YPAR studies in that these research projects indicate the critical importance of empowering youth at both the individual and organizational-levels through, for example, ethnically-racially diverse mentors, as well as ensure ATOD prevention initiatives are responsive to socio-cultural and gender-based identities.

Study Strengths and Limitations

This review has numerous strengths. Importantly, we used PRISMA guidelines to demonstrate the quality of the review, allow readers to assess strengths and weaknesses, promote replicability, and structure the format of this review. We believe this review adds valuable insight to the expanding literature on youth empowerment, broadly, and more specifically, youth empowerment ATOD prevention through participatory designs. The review is not without limitations.

First, the exclusion of articles from non-peer-reviewed sources, book chapters, and masters and doctoral theses may have eliminated some important and influential examples of E-YPAR and community-based participatory research ATOD prevention and youth outcome studies. Second, while we included both English and Spanish articles in our search parameters, we did not identify articles in Spanish that aligned with study inclusion criteria; articles written in Spanish and conducted in Spanish-speaking countries likely exist but fall outside the scope of the US academic databases. Consequently, we may have missed important contributions from Spanish-speaking countries and countries with youth who speak languages other than English and Spanish. Third, most of the studies focused on empowerment-based outcomes were conducted on the East Coast of the US, which limits access to diverse populations and communities both within the US and nationally. Fourth, publication bias remains an ongoing threat in academic literature as studies with limited or negative findings are likely unpublished, resulting in a bias toward effective E-YPAR and community-based participatory research ATOD prevention and youth-focused empowerment ATOD outcome studies. In addition, there are likely numerous studies being conducted across the US and US territories that are, or have been, funded by federal agencies such as SAMHSA and philanthropic organizations such as the Kellogg Foundation that have not been published. This may be due to potential capacity issues such as limited or no experience publishing research in academic journals that favor academic writing (often at a PhD level). Federal and philanthropic agencies should consider ways in which to build capacity in this area to ensure dissemination of findings to broader audiences; this limitation may also speak to the importance of pairing with academic institutions to facilitate evaluation and dissemination of research findings in ways that are synergistic and respectful of diverse communities. Fifth, we utilized a comprehensive list of search terms, but these terms may have limited the scope of identified articles. Sixth, many studies that might have fit our criteria fell off due to being part of larger projects that might have been disseminated in forms not included here (e.g., policy briefs, white papers). A single article may only capture one part or aspect of the larger project and not fit our search criteria parameters. Therefore, E-YPAR and community-based participatory research ATOD prevention articles retained in this review cannot be identified as a total representation. However, we feel more confident regarding those studies that are youth-focused empowerment SU outcome studies.

Implications for Substance use Research and Practice

Youth engagement in ATOD prevention initiatives is critical to ensuring effectiveness, relevance, and ultimately improved health outcomes [89]. This review provides examples of youth-engaged processes for specific BIPOC communities, which could guide prevention organizations and systems looking to engage youth authentically in their prevention efforts. With many variations of YPAR approaches and many studies with limited generalizability, future research might consider longitudinal examination of the overarching guidelines of the different models, how fidelity is measured [90], and effectiveness to determine generalizable outcomes. Furthermore, none of the projects in this review changed policy, which impacts the success of sociopolitical and environmental prevention strategies. It is paramount to publish studies that describe the implementation of participatory approaches to ATOD prevention, as well as policy change. Such research may provide a roadmap for future ATOD prevention projects.

With regard to youth engagement in the research process, specific to E-YPAR studies, programs need to emphasize more intentional power sharing and focus on equitable decision-making. Empowering youth at the individual or psychological level is important to encouraging self-efficacy and motivation; collectively empowering youth at the organizational level will facilitate larger scale prevention efforts and allow for sustainability as this sort of work becomes imbedded within organization culture. This means that adults must acquiesce or give-up power to empower youth voice [76, 91, 92]. Researchers need to expand these efforts and roles for youth in prevention programming, as well as emphasize power sharing to promote youth voice to enhance ATOD prevention programming and outcomes.

Another area of expansion concerns BIPOC youth working alongside adult-allies and focusing on cultural capital of communities to facilitate empowerment. Future studies are needed to engage BIPOC youth alongside adult-allies collaboratively from within their communities in ATOD prevention research. Doing so will provide mentoring but also facilitate youth empowerment to engage actively in social change. Furthermore, given the complex ecological environments of BIPOC youth and their communities, ATOD prevention project directors and investigators are urged to draw on, as Yosso [93] describes, youth and community "cultural capital" or the funds of knowledge that are available within cultural groups and often dismissed as less-than when compared to the hegemony of larger society. Such work and approaches, particularly alongside adult-allies, will help promote culturally-adaptive and focused ATOD prevention programs within BIPOC communities [94, 95]. Therefore, to make progress toward youth health equity, future research needs to consider the cultural adaptations required to implement YPAR prevention programs that are responsive to specific BIPOC youth communities [94].

With alcohol accessed through numerous sources including family and households [5], as well as community access points such as alcohol outlets (e.g., bars, liquor stores, gas stations etc.) [12,13,14, 96, 97], future studies need to document multi-level E-YPAR projects emphasizing individual-level, organizational and environmental prevention strategies related to alcohol use. In addition, with the increased utilization of social media platforms like TikTok that have targeted marketing campaigns, research is continuing to document the insidious relationship between marketing and advertising exposure on these platforms and adolescent use [98, 99]. Therefore, it may be critical that E-YPAR projects, similar to the Adelante Project, identify ways to transcend traditional on-the-ground prevention programming and make improved efforts to put forward innovative prevention initiatives on social media platforms. Local, state, federal, and philanthropic grantees are encouraged to expand available monies to adequately fund and support E-YPAR ATOD prevention initiatives in BIPOC communities. Federal grant programs are also encouraged to move away from "forced-fit" evidence-based programs to ensure culturally responsive models are considered for competitive funding. As this review displays, while E-YPAR principles have shown promise as part of a broader environmental ATOD prevention strategy, researchers and program planners often overlook these YPAR initiatives for not being rigorously field-tested or evaluated.

Conclusion

E-YPAR provides youth with opportunities to engage in an alternative space within ATOD prevention. While not perfect, these spaces strive for greater social justice and work toward propelling youth forward to inform ATOD prevention research, policy change, and intervention science. Much of ATOD prevention is hierarchically structured (e.g., funding is provided to programs that implement evidence-based programs for youth). This hierarchy has been inadequately questioned or adjusted to consider the voices and perspectives of BIPOC youth.

Consequently, ATOD prevention has fallen short of the impact that is possible. It is, therefore, reasonable that ATOD prevention efforts for BIPOC youth be continuously interrogated to question who it is serving and if those most impacted are engaged in the process. As this review showed, there are several E-YPAR initiatives in ATOD prevention that have actively engaged BIPOC youth and their communities. Still, these initiatives remain few in the scientific literature without discussing long-term impacts. Nonetheless, this review provides some direction for future research. More holistic, egalitarian, youth-driven approaches must be developed to ensure effective environmental ATOD prevention strategies are implemented for and by BIPOC youth.