Linking physical environment in physical education classes and adolescents' life skills: evidence from Chinese secondary schools.

The Southwestern United States Borderlands region, encompassing southern New Mexico and adjacent areas, is characterized by high rurality, deeply rooted Hispanic and American Indian communities, and substantial migrant Hispanic/Latino populations. These communities face a devastating SUD crisis compounded by pervasive health disparities, creating urgent need for innovative, rigorously evaluated solutions [–]. Despite this burden, underrepresented populations remain largely excluded from clinical trials, limiting both the generalizability of research findings and the translation of evidence-based treatments into affected communities [–]. Documented patterns of exclusion are well-established: racial and ethnic minorities, including Hispanic/Latino and American Indian populations, have been consistently underenrolled relative to their disease burden across trial types; [,] rural populations face structural barriers including geographic distance from trial sites, limited research infrastructure, and historical mistrust that compound their exclusion []; and in SUD-specific research, individuals with polysubstance use are frequently excluded through restrictive eligibility criteria that prioritize single-substance diagnoses, reducing generalizability to real-world clinical populations [–]. Underrepresentation in clinical trials stems from multiple intersecting factors: limited knowledge about clinical research, mistrust of researchers, inadequate healthcare access, geographic constraints, and socioeconomic barriers including poverty and discrimination based on race, gender, and sexual orientation [–,,,,]. Although tools for increasing research engagement exist, no prior resource specifically aimed at advancing inclusion of diverse and minority populations in SUD clinical trials employed a conceptual framework integrating health beliefs, research literacy, and vulnerability. To address this gap, an interdisciplinary team of epidemiologists, social workers, anthropologists, and public health professionals from the University of New Mexico (UNM) and New Mexico State University (NMSU) developed the EXPLORE Toolkit. The Toolkit employs a strengths-based approach to community engagement, addressing equity, stigma, and participation barriers while promoting culturally sensitive, community-centered research practices. It serves researchers, community health workers (CHWs), and other frontline workers seeking to engage underrepresented populations in clinical trials throughout the region and beyond.