Sustained Impact of a Community Prevention System Implemented in Middle School on Health Risking Behavior in Young Adults

Introduction: Communities That Care (CTC) is a prevention planning and capacity building system for improving behavioral health problems among youth community-wide. CTC guides communities to implement with fidelity and monitor the results of effective prevention approaches that address community-specific elevated risk factors and depressed protective factors and reduce problem behavior. It was tested in the Community Youth Development Study, a randomized trial involving 24 towns in 7 states. Intervention communities were trained in CTC and implemented evidence-based prevention programs for students in grades 5 through 9 aligned with local prevention priorities. A panel of 4,407 young adults has been followed from grade 5 through age 21 to examine CTC’s long-term efficacy. The trial has shown that CTC produced sustained reductions in youth substance use, antisocial behavior (ASB), and violence onset through the end of high school, with effects continuing in males through age 19. This presentation will share new evidence of CTC’s long-term efficacy through age 21.

Methods: At each of 9 data collection waves (age 21 retention: 91%), panel participants completed a survey about primary intervention outcomes (substance use, ASB, and violence), risk and protective factors, and secondary outcomes (e.g., mental health, sexual risk behavior). We analyzed CTC effects on lifetime onset of or abstinence from primary outcomes through age 21 among panel participants who had not onset at baseline. We used generalized linear mixed models to account for nesting and included covariates at individual (e.g., age, gender) and community (e.g., size) levels. We examined long-term intervention effects in the full sample and in males and females separately.

Results: Young adults exposed to CTC were significantly more likely to never have used gateway drugs (ARR=1.49, p =.037) or engaged in ASB (ARR=1.18, p =.034) or ever initiated violence (ARR= 0.89, p =.049). As at age 19, differences were significant for males (gateway drug use ARR = 1.661, p =.033; antisocial behavior ARR = 1.33, p = .032, violence ARR = 0.86, p = .020) but not females. Males also were more likely to never have engaged in cigarette smoking (ARR= 1.30, p =.013) or marijuana use (ARR= 1.24, p =.029) or ever have initiated inhalant use (ARR= 0.82, p =.032). Long-term effects were not found for recent ASB and substance use prevalence, substance use disorder, or secondary outcomes.

Conclusions: Eleven years after baseline, panel males from CTC communities still reported greater abstinence from several health risking behaviors, but evidence for long-term CTC effects in females was not found. Implications for refinement of CTC and effective preventive approaches for young adults will be discussed.