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We examined perceived dementia risk factors among Black adults in St. Louis via a participatory approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>In 36 community\u2010based system dynamics workshops (CBSD), 234 participants co\u2010created causal loop diagrams capturing influences on dementia. We analyzed these diagrams using ecological methods to identify a shared core model and examine variation by neighborhood\u2010level deprivation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>CBSD revealed a framework for how economic hardship, especially low income and unemployment, reduces access to physical and mental healthcare, driving dementia risk. Those from more deprived areas highlighted the need for improved health education, public transportation, healthcare access, and job opportunities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>Addressing dementia disparities requires targeting modifiable social and structural drivers. Our findings emphasize the significance of tailored public health interventions that expand access to quality healthcare, reduce socioeconomic barriers, and broadly mitigate racism's pervasive impact on cognitive health.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Workshop groups from areas with higher neighborhood deprivation (as measured by the Area Deprivation Index [ADI]) were more likely to emphasize stress, poor diet, and limited healthcare access\u2014underscoring the critical influence of socioeconomic disadvantage on both lived experiences and views of dementia risk.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Across multiple feedback loops, structural racism emerged as an \u201cexternal yet ubiquitous\u201d force accelerating other drivers of dementia (e.g., poverty, insufficient community investment, and poorer\u2010quality healthcare), demonstrating the complex pathways by which discrimination exacerbates risk in Black communities.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Participants outlined multi\u2010level interventions\u2014ranging from grassroots community programs (e.g., health literacy campaigns, community wellness initiatives) to policy\u2010focused strategies (e.g., political engagement, equitable public resource allocation)\u2014to counteract the self\u2010perpetuating cycle of disadvantage and mitigate dementia risk in under\u2010resourced neighborhoods.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alz.70494","type":"journal-article","created":{"date-parts":[[2025,7,20]],"date-time":"2025-07-20T03:29:46Z","timestamp":1752982186000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Structural and social determinants of dementia risk among adults racialized as Black: Results from a community\u2010based system dynamics approach"],"prefix":"10.1002","volume":"21","author":[{"given":"Jean\u2010Francois","family":"Trani","sequence":"first","affiliation":[{"name":"School of Public Health Washington University in St. Louis St. Louis Missouri USA"},{"name":"National Pedagogical Health &amp; Solidarity National Conservatory of Arts and Crafts  Paris France"},{"name":"Institute of Public Health Washington University  St. Louis Missouri USA"},{"name":"Department of Psychology University of Johannesburg  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramkrishna K.","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Neurology Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis I. 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