Starting upstream: Rethinking how public health supports young people

When GCH Assistant Professor Rochelle Davidson Mhonde began working with adolescent survivors of sexual violence, she saw the ripple effects of their trauma: depression, anxiety, substance abuse, and other health challenges. “Survivors often know what support they need to heal. But when they don't receive it, the consequences can compound far beyond the original harm," she said. 

Trying to understand why some young people disclose their trauma while others don't led Davidson Mhonde upstream, studying the families, communities, cultural beliefs, and institutional access that influence whether survivors feel safe speaking up. 

Across the College of Public Health, faculty are approaching the same fundamental question from different angles: How can we intervene earlier, when prevention has the greatest potential to make a difference? At a time when many young people are facing rising rates of loneliness, isolation, anxiety, and other public health concerns, George Mason researchers are working to redefine what prevention looks like. 

Listening to young people about what they need 

Traditionally, most prevention approaches are built around what adults believe young people need. More and more, college researchers are asking young people themselves to help create solutions. 

“Young people know best what works for them and what doesn’t,” said Rima Nakkash, GCH professor and chair. “They can bring in their lived experience to inform interventions that are going to improve their health.” 

This approach starts with recognizing young people’s strengths. “In general, research on youth has been looking from a deficit approach," Nakkash said. "But rather than seeing them as a problem that needs to be solved, we're viewing them as a positive contributor to society." 

In one ongoing project supported by the Virginia Foundation for Healthy Youth, PhD in Public Health student Omolayo Anjorin, GCH Professor Kenneth Griffin, and Nakkash are examining why LGBTQ+ young adults vape at higher rates than their peers. Their research points to experiences like discrimination and rejection that increase stress and make vaping more likely as a coping mechanism. 

What was missing from existing prevention programs, according to participants? "The first thing they said was, 'We want to see someone like us,'" Nakkash said. That feedback has helped Nakkash and her team rethink who delivers prevention messages and the language they use. 

In some cases, researchers are also finding that young people can take on much larger roles.   

One NIH-funded study co-led by Nakkash is testing whether young Syrian refugees can be trained as community mental health workers to deliver an evidence-based World Health Organization intervention. Researchers are measuring effects both for the people receiving support and the young adults delivering it. 

The idea grew from a previous study when youth facilitators unexpectedly reported improvements in their own mental health after helping younger children, Nakkash said. 

She hopes the concept could eventually expand access to mental health care in rural settings and other low-resource communities where providers are scarce. 

Finding the hidden barriers 

Effective prevention starts with understanding what influences young people's decisions. 

In Davidson Mhonde's work with survivors of sexual trauma, one lesson has become clear: a young person's choice to seek help doesn't begin after an assault. It begins years earlier, through family conversations about sex, consent, and sexual violence. If a parent has expressed victim-blaming beliefs, for example, their child may already know they're not the safest person to tell. 

“My current focus is to understand how these beliefs become internalized within communities and relationships that shape survivor support," she said, "and how we can work with those communities to design interventions that shift belief systems and strengthen support." 

Innovating with new tools 

Researchers are also asking how technology can help reach young people earlier and on their own terms. 

In addition to youth vaping, Griffin is exploring whether virtual reality (VR) can prepare students for difficult moments before they happen. In collaboration with National Health Promotion Associates, the research team is developing and evaluating immersive VR scenarios that let college students practice responding to situations involving substance misuse and violence in a low-stakes setting. Early results—which led to additional funding from the Centers for Disease Control—suggest the approach improves both decision-making and violence prevention attitudes. 

"VR can provide virtual role-play and skills practice to supplement existing evidence-based prevention programs," Griffin said. 

GCH Professor Jhumka Gupta is working to shorten the years-long delay many young people with endometriosis face before receiving a diagnosis. Funded by the U.S. Department of Health and Human Services, her SurrEndo project uses an app-based interactive game to help Black and Latina adolescents and young adults recognize symptoms, reduce stigma, and build confidence to advocate for themselves in the health care system. 

“If we want to reach young people, we have to find ways that feel natural to them, with technology they’re already using,” she said. 

Davidson Mhonde sees similar potential with her own work. She’s exploring evidence-based digital tools, including chatbots, that could allow young survivors of sexual violence to anonymously disclose their abuse and connect with resources at their own pace. 

"When young people are able to disclose in safe, supportive environments, the health outcomes are overwhelmingly better," she said.  

Seeing young people differently 

The work across the College of Public Health shares a common belief: Prevention works best when researchers recognize young people's strengths and involve them in creating solutions. Instead of focusing only on risk factors, they're asking what strengths, relationships, and experiences young people already bring to the table. 

Davidson Mhonde believes young people aren't just the focus of research—they're partners in it. "When we build interventions with young people instead of for them, we're much more likely to create lasting change," she said.