Community Based Prevention: Does the Communities That Care (CTC) Methodology Apply to Germany?

Introduction: ‘Communities That Care’ (CTC) is a strategic approach supporting prevention planning on community level. CTC was developed in the U.S. and transferred to Germany recently. Within the CTC-framework the prevention needs of communities are identified by the prevalence of risk and protective factors assessed in a youth survey. To effectively communicate prevention needs to stakeholders a format as simple as possible is recommended. Therefore a dichotomization of risk and protective factor scales is required. Arthur et al. (2007) proposed the median +/- 0.15*mean absolute deviation (MAD) as a method to establish valid cut-points for these scales by maximizing the balance of specificity and sensitivity. In this talk, we present analyses concerning the transferability of this approach when applying the methods proposed by Arthur et al. (2007) in a German sample.

Methods: The study was designed as a representative survey with school classes as its primary sampling unit stratified by grades (6 to 11) and by school type. Participating schools were drawn proportional to the population of the communities in Lower Saxony, Germany. Self-reported data from N=1.423 students aged 11-18 years of the 2013 German CTC-sample were analyzed regarding sensitivity and specificity of risk and protective factors as well as criterion validity using logistic regressions. Problematic substance use was used as criterion.

Results: In general, specificity was larger than sensitivity for risk and protective factors and higher values were observed for peer-individual factors. Specifically, only for 6 out of 22 risk factors a balance between sensitivity and specificity was found (e.g., ‘sensation seeking’, ‘poor family management’). For the protective factors, only the scale ‘belief in moral order’ showed an acceptable balance. Odds ratios were moderate and larger for younger students and for peer-individual factors. The results of the 2013 sample will be compared to those of the sample of 2015 (N=2250).

Conclusion: Although the CTC youth survey is a promising and useful tool for focused prevention planning and risk and protective factors seem to be of universal validity, the measurement of those as well as the method to compute cut-points need to be examined thoroughly and adjusted if necessary when transferred to other countries.