Community Prevention in Small and Rural Towns: A Comparison of Young Adult Stayers and Movers 3 Years after High School

Introduction: Young adulthood is a time when risks for mental health and substance use increase. Concerns may be heightened in vulnerable populations, including young adults living in small and rural towns. Prior studies have demonstrated that substance use is prevalent in these areas, and access to prevention and mental health treatment and services may be more limited than in larger less rural communities. This paper focuses on a longitudinal panel of 3,363 young adults from small and rural towns followed since grade 5 as part of a randomized trial of Communities That Care (CTC), a prevention system designed to promote positive development and strengthen communities. CTC was found effective in reducing delinquency, violence, and substance use initiation through the end of high school in the panel, who have now been observed through age 21. At this age, approximately half had moved away from their original study communities. This study examined whether stayers had higher rates of substance use and mental health disorders compared to movers. Because CTC was designed to strengthen communities, the study also examined whether young adults remaining in CTC communities had better outcomes at age 21 compared to stayers in control communities.

Methods: The longitudinal panel was drawn from the 24 small and rural towns in 7 states that participated in the trial of CTC. Multilevel logistic regression analysis was used to evaluate hypotheses related to past-year prevalence of substance use (alcohol, tobacco, and marijuana use) and mental health disorders (major depression and generalized anxiety disorder). Individual-level predictors included mover/stayer status and individual covariates measured at baseline in grade 5 and in adolescence. Community-level predictors were intervention condition and community characteristics.

Results: Preliminary analyses comparing movers to stayers at age 21 indicated movers were significantly more likely than stayers to have used alcohol (78% v. 75%, AOR = 1.19, p < .01) and smoked cigarettes (44% v. 38%, AOR = 1.28, p < .05) in the past year. Stayers had significantly higher prevalence of major depression at Age 21 (7% stayers, 4% movers, AOR = 0.59, p = .000), but the prevalence of generalized anxiety disorder was the same. Stayers in CTC communities were not found to have better outcomes at age 21 compared to stayers in control communities.

Conclusions: Contrary to our hypothesis, movers, not stayers were more likely to use alcohol and tobacco at Age 21.  However, rural stayers were more likely than movers to show signs of major depression. The lack of evidence for intervention effects among stayers highlights the challenge of sustaining effects into adulthood when community prevention efforts focus on adolescence.