A prevention system that trains community leaders to identify and apply appropriate evidence-based programs may reduce substance use and other delinquent behaviors among adolescents, according to a report in the September issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.1
Risky behaviors such as alcohol use, tobacco use and delinquency have large costs to society and often begin between ages 11 and 15, according to background information in the article. “The initiation of these behaviors early in adolescence is predictive of greater risk for associated health-related diseases and disorders,” the authors write. “Advances in prevention science during the last two decades have produced a growing list of tested and effective programs and policies for preventing these behaviors, yet widespread dissemination and high-quality implementation of these effective programs and policies in communities has not been achieved.”
The Communities That Care prevention system is designed to address these issues by providing training and materials to coalitions of community stakeholders. J. David Hawkins, Ph.D., of the University of Washington, Seattle, and colleagues studied the effectiveness of the Communities That Care system in 24 small towns in seven states. In 2003, towns were matched within states and half were randomly assigned to implement the system while the other 12 towns served as controls.
Coalitions in communities that implemented the system “used epidemiological data to identify elevated risk factors and depressed protective factors in the community, and chose and implemented tested programs to address their community’s specific profile from a menu of effective programs for families, schools and youths aged 10 to 14 years,” the authors write. The programs included school-based, community-based and family-focused programs, including Life Skills Training and Big Brothers Big Sisters. “The new programs were implemented by local providers including teachers for school programs; health and human service workers for community-based, youth-focused and family-focused programs; and community volunteers for Big Brothers Big Sisters and tutoring programs.”
A panel of 4,407 fifth-grade students was surveyed annually through the eighth grade. In all grades, fewer students in communities using the system were delinquent or began drinking, smoking or using smokeless tobacco than did students in control communities. Specifically, when compared with students in Communities That Care areas, students in control groups:
- Were 60 percent more likely to begin drinking alcohol between seventh and eighth grades
- Were 41 percent more likely to initiate delinquent behavior between fifth and eighth grades
- Were more likely, as eighth-graders, to have used alcohol or smokeless tobacco within the previous 30 days or to have engaged in binge drinking within the previous two weeks
- Committed more delinquent behaviors during their eighth-grade year.
“This type-two translational research study indicates that public health can be promoted and health-risking behaviors in early adolescence can be prevented by coalitions of community stakeholders trained to use the Communities That Care system for translating the advances of prevention science into well-chosen and well-implemented prevention practices in communities,” the authors conclude. “The Center for Substance Abuse Prevention provides Communities That Care materials electronically for downloading free of charge. However, federal resources are currently unavailable to support training and technical assistance in Communities That Care for communities that seek to use it.”
“Communities That Care seeks to prevent or reduce youths’ involvement in illegal substance use and criminal activities through an evidence-based public health program,” write Francis T. Cullen, Ph.D., of University of Cincinnati, and Cheryl Lero Jonson, M.A., in an accompanying editorial.2
“This program is part of a larger, though still limited, movement to develop theoretically based, empirically grounded, practical programs capable of preventing or diminishing offending behavior,” they continue. “In the end, the viability of this movement will depend on generating interventions that can be shown to reduce offending and outperform punitive alternatives.”
The study “holds significant implications,” they conclude. “It demonstrates that Communities That Care is a conduit for organizing and then delivering effective interventions in a scientific, systematic way at the community level. Communities That Care thus is an exemplar for how to use evidence-based strategies to reduce youthful misconduct. The expanded use of this approach, especially in at-risk communities, seems worthy of further investigation.”
1. Arch Pediatr Adolesc Med. 2009;163:789-798.
2. Arch Pediatr Adolesc Med. 2009;163:866-868.