The Community Youth Development Study: A Test of Communities That Care

Study Overview
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Brief Summary
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The Community Youth Development Study is an experimental test of the Communities That Care (CTC) prevention planning system. It has been designed to find out if communities that were trained to use the CTC system improved public health by reducing rates of adolescent drug use, delinquency, violence, and risky sexual behavior when compared to communities that did not use this approach. The primary purpose of the current continuation study is to investigate whether CTC has long-term effects on substance use, antisocial behavior, and violence, as well as secondary effects on educational attainment, mental health, and sexual risk behavior in young adults at ages 26 and 28. The continuation study also examines (a) how the interaction of social, normative, and legal marijuana contexts creates variation in the permissiveness of individuals' marijuana environments from late childhood to young adulthood and (b) whether, when, and for whom permissive marijuana environments increase marijuana and ATOD use and misuse from age 11 to 28 and interfere with the adoption of adult roles.

Detailed Description
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Preventing alcohol, tobacco, and other drug use; delinquency; violence; and health-risking sexual behavior among adolescents is a national priority. While advances in prevention science over the past two decades have produced a growing list of tested and effective programs and policies for preventing these behaviors, widespread dissemination and high-quality implementation of these effective programs and policies in communities has not been achieved. The development and testing of approaches for translating prevention research findings into effective community prevention service systems with long-term impact is important to achieving reductions in the prevalence of adolescent health and behavior problems that are sustained into adulthood. The Community Youth Development Study (CYDS) is a community-randomized trial of the effects of Communities That Care (CTC) on community prevention systems and adolescent risk, protection, and behavioral health outcomes. The current continuation study is evaluating the long-term effects of CTC on a panel of 4,407 young adults at ages 21 and 23 who have been surveyed regularly since the trial started when they were in grade 5. 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 programs that address community-specific elevated risk factors and depressed protective factors and reduce problem behavior. The CTC system is hypothesized first to produce improvements in key characteristics of community prevention service systems, which, in turn, reduce community levels of risk, increase protective factors, and lower rates of youth problem behaviors. The CYDS communities were matched in pairs within state, on population size, racial and ethnic diversity, economic indicators, and crime rates. One community from each matched pair was assigned randomly by a coin toss to either the intervention or control condition. Starting in 2003, intervention communities received training, technical assistance, and materials and funding needed to install the CTC prevention system in years 2-5 (2004-2008), hire a community coordinator, and implement 2-5 tested preventive interventions. Selected interventions addressed local prevention priorities established by communities after reviewing local epidemiological data on youth risk factors, protective factors and problem behaviors. Control communities received no training or technical assistance from the study. Technical assistance and study-provided funding to intervention communities ended after 5 years. The initial CYDS trial (2003-2008) evaluated the efficacy of CTC in reducing levels of risk, increasing levels of protection, and reducing levels of drug use and other problem behaviors in adolescents from Grades 5 through 9. It also tested the effects of CTC on prevention service system transformation (e.g., increases in a science-based approach to prevention, collaboration among prevention service organizations, support for prevention, community norms against drug use and delinquency, and use of the Social Development Strategy to guide interactions with youth) as reported by key community leaders and members of CTC coalitions. The first continuation study (2009-2013) assessed the effects of installation and implementation of CTC when panel youth were in Grades 10 through Age 19. During this period, panel youth passed through high school, the developmental period of greatest risk for delinquent and violent behavior, and a period of greatly increasing substance use and problems related to substance use. The study evaluated the long-term effects of CTC on adolescent and young adult risk and problem behaviors, including primary outcomes of substance use and abuse, delinquency, crime, and violence. It also evaluated the sustainability of the CTC prevention system without the study-provided funding and support that were offered during the implementation of CTC in the 12 intervention communities during the initial efficacy trial. The second continuation study (2013-2017) investigated the long-term effects of CTC on young adult substance use and misuse, crime, violence, and incarceration 11 and 13 years following CTC's initial installation. It also evaluated possible effects on a number of secondary outcomes salient in young adulthood, including HIV/AIDS sexual risk behavior, depression and suicidality, anxiety and other mental health disorders, and educational attainment. Panel youth were surveyed twice during the study, at ages 21 and 23. The third continuation study (2018-2023) further investigates the long-term effects of CTC on the study's primary outcomes of substance use and misuse, crime, violence, and incarceration 16 and 18 years after CTC was installed in intervention communities. As in the prior continuation, it will also evaluate possible long-term effects on salient secondary outcomes, including HIV/AIDS sexual risk behavior, depression and suicidality, anxiety and other mental health disorders, and educational attainment. Another major aim of this study is to examine the normative and legal environment around marijuana use in the U.S., which is becoming more permissive, raising concern that it will increase youth and young adult marijuana and other drug use and associated negative consequences including addiction. Understanding how marijuana use norms and behaviors in multiple social contexts (e.g., peer, family, and community) interact with the legal marijuana context and impact drug use behavior from age 11 to 28 will assist in the identification of malleable targets for interventions and public health approaches to prevent the possible negative outcomes of increasing permissiveness towards marijuana use. Panel participants will be surveyed twice, at ages 26 and 28.

Official Title
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The Interplay of Social, Normative, and Legal Marijuana Environments and Marijuana and ATOD Use From Late Childhood to Young Adulthood

Conditions
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Substance Abuse, Juvenile Delinquency, Sexual Behavior, Criminal Behavior, Violence, Depression, Anxiety, Suicide, Sexually Transmitted Infection, Educational Attainment

Intervention / Treatment
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* Behavioral: Communities That Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Resident at baseline in one of the 24 participating communities Student in the Class of 2011 panel sample or in grades 6, 8, 10, or 12 during a survey year Community leader or prevention service provider in one of the participating communities Exclusion Criteria: Unable to read and comprehend consent materials and/or survey questions in either english or spanish

Ages Eligible for Study
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Minimum Age: 10 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: No intervention<br>Communities in the no intervention arm received no intervention from the project and continued to implement prevention services as usual. | |
| Experimental: Communities That Care Intervention<br>Communities randomly assigned to the experimental condition received 5 years of training and technical assistance (from 2003 to 2008) to implement the Communities That Care (CTC) prevention system in their communities. They also received 5 years of funding to support a full-time community coordinator and 4 years of seed money to implement tested and effective prevention programs selected as a result of their CTC process. | Behavioral: Communities That Care<br>* The Communities That Care (CTC) system provides communities training and ongoing technical assistance in a structured process for conducting prevention needs assessments using epidemiological data on levels of risk and protective factors for adolescent problem behaviors, selection of tested and effective preventive interventions shown to address community-prioritized factors, implementation of these interventions with fidelity, and evaluation of the community's progress toward its goals. The CTC system is designed to produce a plan for prevention services that is tailored to the needs of each community. CTC is installed in five phases through a manualized series of training events designed to build the capacity of communities to install and sustain the system over time.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Targeted risk and protective factors, substance use, delinquency, violence | Surveys of the panel starting in 5th grade (2004) and continuing in grades 6-10, grade 12, and at ages 19, 21, and 23 are used to assess the impact of the intervention on risk and protective factors targeted by communities, substance use, delinquency, and violence. Cross-sectional surveys of all youth in grades 6, 8, 10, and 12 in all participating communities, conducted every 2 years from 2002 through 2012, are also used to assess the impact of the intervention on these primary outcomes. | Baseline through thirteen-year follow-up (age 23) | 
| CTC coalition functioning, prevention system transformation, evidence-based program (EBP) implementation | Structured telephone interviews with key community leaders, CTC coalition members, and prevention services providers (Community Key Informant Survey, Coalition Board Interview, Community Resource Documentation Survey) conducted in 2001-02, 2004-05, 2007-08, 2009-10, and 2011-12 are used to assess intervention effects on CTC coalition functioning, prevention system transformation, and evidence-based prevention program implementation. | Baseline through eight-year follow-up (age 18) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Substance use disorder, depression and generalized anxiety disorder, sexual risk behavior | Secondary outcomes salient in late adolescence and young adulthood were added to the self-report longitudinal survey beginning at the nine-year follow-up (age 19). | Nine- through thirteen-year follow-up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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substance use, delinquency, risky sexual behavior, risk factors, protective factors, prevention, community coalitions, systems transformation, violence