Effects of the Communities That Care Prevention System on Boys' and Girls' Health-Risk Behaviors 9 Years after Baseline in a Community-Randomized Trial

Introduction: Science-based prevention planning systems that bring together a comprehensive coalition of community stakeholders have been shown to advance the use of effective policies, programs, and practices and prevent adolescent health-risking behaviors community-wide. However, little is known about the lasting impact of such community prevention efforts on individuals who were exposed to them. If community prevention systems can move a community’s youth onto healthier trajectories, they could greatly contribute to long-term improved individual and public health. This presentation will report the results from a test of the effects of the Communities That Care (CTC) prevention system on youth health-risk behaviors in late adolescence 9 years post baseline in a community-randomized trial and 4 years after training, technical assistance, and financial support to CTC communities had ended.

Methods: Data came from a community-randomized trial of CTC in 24 small towns in 7 states, matched in 12 pairs within state and assigned randomly to the control or CTC condition in 2003. The study followed a panel of 5th-graders attending public schools in 2003-04 in study communities. In 2012, 1 year after on-time high school graduation when panel members were, on average, 19 years old, 91% (n=3986) of the still-living sample completed the survey. Data were analyzed using generalized mixed regression models to account for the nesting of the data.

Results: Analyses showed that boys in CTC communities compared to boys in control communities were significantly more likely to never have smoked cigarettes (39% vs. 32%; adjusted risk ratio [ARR] = 1.22; 95% CI: 1.01, 1.46) and never have engaged in delinquent behavior (31% vs. 24%; ARR=1.38; 95% CI: 1.08, 1.76). There were no significant differences in the expected direction by intervention group for boys or girls in any other primary outcomes (cumulative incidence of substance use and prevalence of recent substance use, substance use disorder, delinquency, violence, incarceration, convictions) or secondary outcomes (high school graduation, college attendance, depression, suicidality, sexual risk behaviors, teenage pregnancy). The presentation will also discuss unexpected findings for girls.

Conclusions: Nine years post baseline, CTC showed few long-term effects on youth health risk behaviors when adolescents followed in this study were, on average, 19 years old. However, boys’ increased abstinence from smoking and delinquency through age 19 was achieved with minimal exposure beyond grade 9 to tested and effective prevention programs selected through the CTC process.