Preventing alcohol, tobacco, and other drug use, delinquency, violence, and risky sexual behavior among adolescents is a national priority [1
]. Although advances in prevention science over the past 2 decades have produced a growing list of tested and effective programs and policies for preventing these behaviors [3
], widespread dissemination and high-quality implementation of these effective programs and policies in communities has not been achieved [7
]. The development and testing of approaches for translating prevention research findings into effective community prevention service systems is important to achieve reductions in the prevalence of adolescent health and behavior problems [11
Communities That Care (CTC) [13
] is a prevention system that empowers communities to address adolescent health and behavior problems through a focus on empirically identified risk and protective factors. The CTC system is manualized, and includes training events and guides for community leaders and board members. CTC is designed to mobilize community leaders and a community prevention coalition (called “community prevention board” in CTC) to identify elevated risk factors and depressed protective factors in the community, and to select and implement a set of tested preventive interventions to reduce elevated risk factors and promote protective factors. Repeated assessments of community risk and protective factors are used for on-going evaluation of CTC communities’ prevention systems and to guide future prevention planning.
CTC is installed in communities through a series of six training events delivered over the course of 6 to 12 months by certified CTC trainers. All CTC training materials are available on the Internet [15
]. Through the series of CTC training events and community board actions prescribed in CTC, the CTC system is expected to produce community-level changes in prevention service system characteristics, including greater adoption of science-based prevention, increased collaboration among service providers, and increased use of tested and effective preventive interventions that address risk and protective factors prioritized by the community. These changes in prevention service systems are expected to produce changes in the risk factors targeted by the preventive interventions chosen by the community. These reductions in risk factors in the community are expected, in turn, to reduce adolescent delinquent behaviors and substance use among young people in the community. According to CTC’s theory of change, it should take from 2 to 5 years to observe community-level changes in targeted risk factors in CTC communities, and from 5 to 10 years to observe community-level changes in substance use and delinquency outcomes [16
The Community Youth Development Study (CYDS) [17
] is the first community-randomized trial of CTC. The initial 5-year experimental study is currently being conducted in 24 communities across seven states nationally. To test the effects of CTC in achieving observable reductions in targeted risk factors, delinquent behavior, and substance use within the 5 years of this study as hypothesized by CTC’s theory of change, the intervention communities in CYDS were asked to focus their prevention plans on interventions for youths aged 10 to 14 years (grades 5–9) and their families. It was hypothesized that, if widely implemented during this period of developmental transition, tested and effective preventive interventions chosen by communities through the CTC system would produce measurable communitywide effects on targeted risk and protective factors and on the prevalence of delinquent behavior and substance use. CTC boards selected policies and programs from a menu of tested preventive interventions found to be effective with this age group included in “Communities That Care Prevention Strategies Guide” [18
]. Each intervention included in the menu (1) has demonstrated positive effects in reducing one or more risk factors and in reducing delinquent behavior or substance use in an adequately controlled experimental or quasi-experimental study; (2) has training, technical assistance, and manuals available to guide the implementation of the policy or program; and (3) has been found to have effects on youths aged 10 through 14.
In the CYDS, CTC training and implementation began in the summer of 2003. Intervention communities received six CTC trainings from certified CTC trainers. Community leaders were oriented to the CTC system and identified or created a coalition of diverse stakeholders to implement CTC. Coalition members were trained to use data from surveys of community students collected in 1998, 2000, and 2002 in a prior study [19
] to prioritize risk factors to target with preventive actions, to choose tested prevention policies and programs that address the community’s targeted risk factors, to implement these interventions with fidelity, and to monitor implementation and outcomes of newly installed preventive interventions. In addition, CYDS implementation staff provided technical assistance through weekly phone calls, written e-mails and reports, and site visits to intervention communities at least once per year. By June of 2004, intervention communities had selected preventive interventions to address their prioritized risks and had created strategic plans to implement these interventions. The 12 intervention communities selected 13 different tested and effective prevention programs to implement during the 2004 –2005 school year and 16 programs to implement during the 2005–2006 school year. Implemented programs included school-based programs (All-Stars, Life Skills Training, Lion’s Quest Skills for Adolescence, and Program Development Evaluation Training), community-based youth-focused programs (Participate and Learn Skills, Big Brothers/Big Sisters, Stay Smart, and academic tutoring), and family-focused programs (Strengthening Families 10–14, Guiding Good Choices, Parents Who Care, and Family Matters) [20
]. Communities contracted with the developers of these interventions or their designated training organizations for the specific trainings required to implement their selected interventions. Once training was completed, the new programs were implemented by local providers, including teachers, human services workers, and community volunteers. About half the programs were chosen by multiple communities, and many programs were delivered more than once during the year. For example, Guiding Good Choices was provided 38 times (i.e., 38 cycles) across six communities. In total, 13 programs were delivered in 95 cycles in 2004 –2005, and 16 programs were delivered in 156 cycles during 2005–2006 [21
Previous analyses have found that, by 18 months after initial training began, the CTC system had been successfully implemented with fidelity in intervention communities [20
], and that tested and effective preventive programs were selected and well implemented in the intervention communities during the 2004 –2005 school year [21
]. Further, analyses have found significant between-condition differences favoring the CTC communities in levels of adoption of science-based prevention and in levels of community collaboration 1.5 years after introducing CTC in intervention communities [22
]. Given these findings, it is appropriate to ask whether CTC has affected levels of risk and delinquency and substance use outcomes among adolescents in these communities. The current study investigates the effects of CTC on average levels of targeted risk factors and on the initiation of delinquent behavior and substance use in a panel of students followed from grade 5 through grade 7 in CTC communities and control communities, after approximately 1.67 years of implementation of new prevention programs in CTC communities.