Introduction High sexually transmitted infection (STI) rates among African American adolescents living in disadvantaged communities represent a complex public health problem that has remained unsolved despite the efforts of governments (both state and federal) and communities. Systems thinking is an approach that can give new insight into why previous attempts to tackle this problem have failed and how to design more impactful and sustainable interventions in the future. In this paper, we introduce a system dynamics framework that describes increasingly impactful levels of leverage that public health actions might target to reduce incidence of sexually transmitted infections among adolescents in disadvantaged communities. Then, we use the levels of leverage framework to describe why previous interventions to reduce high STI rates among African American adolescents from disadvantaged communities have had minimal success as well as to suggest some interventions that are likely to have a higher impact. We propose several previously overlooked targets for interventions that are aligned with existing feedback loops affecting STI outcomes, and provide substantial opportunities for creating long-lasting reductions in STI rates.
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