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Methods: CTC was tested in a randomized controlled trial of 24 communities across 7 states, matched in pairs within state. The study followed 4407 5th-grade students annually through 12th grade. Students reported on their current and lifetime substance use and on their delinquent and violent behavior in the past year. Multi-level analyses to account for students being nested in communities and communities being nested in matched pairs were used to analyze the data.
Results: By grade 12, significantly fewer students in CTC communities compared to students in control communities had ever used drugs (including alcohol, tobacco, marijuana, and other illicit drugs; adjusted odds ratio [AOR]=.69, p=.015). With respect to specific substances, students in CTC communities were significantly less likely than students in control communities to ever have smoked cigarettes (AOR=.80, p=.047) and tried alcohol (AOR=.70, p=.047), but they did not differ significantly in rates of lifetime binge drinking, marijuana use, or other illicit drug use. The prevalence of past-month drug use in the 12th grade did not differ by condition. Twelfth-graders in CTC communities also were significantly less likely than twelfth-graders in control communities to have ever engaged in delinquent behavior (AOR=.78, p=.031) or violent acts (AOR=.78, p=.016). However, Grade 12 rates of past-year delinquency and violence did not differ significantly by condition.
Conclusion: Using the CTC system can produce enduring reductions in community-wide rates of initiation of health-risking behaviors among adolescents beyond the years of supported implementation, potentially contributing to long-term public health benefits.