Long-Term Effects of Communities That Care on Substance Use, Antisocial Behavior and College Completion at Age 23

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 6 through 9 aligned with local prevention priorities. A panel of 4,407 young adults has been followed since grade 5 to evaluate CTC’s long-term effects on health-risking behaviors and educational attainment. This presentation documents CTC’s long-term efficacy based on the most recent panel reports, obtained at age 23.

Methods: Panel participants completed a survey about primary intervention outcomes (substance use, antisocial behavior (ASB), and violence), risk and protective factors, and secondary outcomes (e.g., educational attainment, mental health, sexual risk behavior) at each of 10 data collection waves conducted regularly between ages 10 and 23 (age 23 retention = 88%). We analyzed CTC effects on (a) lifetime initiation of or abstinence from primary outcomes through age 23 among panel participants who had not onset at baseline, and (b) four-year college completion. We used generalized linear mixed models to account for nesting and included individual- and community-level covariates. We evaluated long-term intervention effects in the full sample and among males and females.

Results: Young adults exposed to CTC in middle school were significantly more likely to have never used any drugs (ARR=1.46, p =.045), gateway drugs, (ARR=1.58, p =.043), and alcohol (ARR=1.56, p =.009), or ever initiated inhalant use (ARR=0.87, p =.042). They were also more likely to have completed four-year college (ARR=1.26, p =.045). Effects on sustained abstinence from ASB (ARR=1.14, p =.088) and violence initiation (ARR=1.07, p =.122) were not statistically significant in the full sample, but there were effects on males (ASB: ARR=1.29, p = .032; violence: ARR=1.14, p = .049). Effects on substance use also were stronger among males, but effects on educational attainment were stronger among females.

Conclusions: Young adults from CTC communities continued to provide evidence for sustained intervention effects on substance use, ASB, and violence at age 23, 13 years after initial exposure to CTC. New evidence of CTC’s effect on college completion also was observed. Findings further support CTC as an effective approach to improving public health in a sustained manner.