Prevention System Mediation of Communities That Care Effects on Youth Outcomes

This study examined whether the significant intervention effects of the Communities That Care (CTC) prevention system on youth problem behaviors observed in a panel of eighth-grade students (Hawkins et al. Archives of Pediatrics and Adolescent Medicine 163:789–798 2009) were mediated by community-level prevention system constructs posited in the CTC theory of change. Potential prevention system constructs included the community’s degree of (a) adoption of a science-based approach to prevention, (b) collaboration on prevention activities, (c) support for prevention, and (d) norms against adolescent drug use as reported by key community leaders in 24 communities. Higher levels of community adoption of a science-based approach to prevention and support for prevention in 2004 predicted significantly lower levels of youth problem behaviors in 2007, and higher levels of community norms against adolescent drug use predicted lower levels of youth drug use in 2007. Effects of the CTC intervention on youth problem behaviors by the end of eighth grade were mediated fully by community adoption of a science-based approach to prevention. No other significant mediated effects were found. Results support CTC’s theory of change that encourages communities to adopt a science-based approach to prevention as a primary mechanism for improving youth outcomes.     

Variation in the Sustained Effects of the Communities That Care Prevention System on Adolescent Smoking,Delinquency, and Violence

Communities That Care (CTC) is a universal, science-based community prevention system designed to reduce risk, enhance protection, and prevent adolescent health and behavior problems community wide. CTC has been found to have sustained effects on cigarette use and delinquent and violent behaviors in grade 10 in a panel of 4,407 students followed from fifth grade in a community randomized trial. It is important to test variation in the effects of this prevention system designed to be universal to understand for whom it is most effective and whether it fails to produce change or leads to iatrogenic effects for certain categories of individuals. The present study examined variation in the sustained effects of CTC on tenth-grade cigarette use and delinquent and violent behaviors. Interaction analyses suggest that the effect of CTC did not differ between those who had high levels of community-targeted risk factors at baseline or had already engaged in substance use, delinquency, or violence at baseline versus those who had not. Although CTC reduced the prevalence of both girls’ and boys’ problem behaviors, the effect on delinquency was marginally (p?=?0.08) larger for boys than for girls.     

Testing the Universality of the Effects of the Communities That Care Prevention System for Preventing Adolescent Drug Use and Delinquency

Universal community-oriented interventions are an important component in the prevention of youth health and behavior problems. Testing the universality of the effects of an intervention that was designed to be universal is important because it provides information about how the program operates and for whom and under what conditions it is most effective. The present study examined whether the previously established significant effects of the universal, community-based Communities That Care (CTC) prevention program on the prevalence of substance use and the variety of delinquent behaviors held equally for boys and girls and in risk-related subgroups defined by early substance use, early delinquency, and high levels of community-targeted risk at baseline. Interaction analyses of data from a panel of 4,407 students followed from Grade 5 to Grade 8 in the first randomized trial of CTC in 12 matched community pairs suggests that CTC reduced students’ substance use and delinquency equally across risk-related subgroups and gender, with two exceptions: The effect of CTC on reducing substance use in 8th grade was stronger for boys than girls and the impact of CTC on reducing 8th-grade delinquency was stronger for students who were nondelinquent at baseline.     

Effects of Communities That Care on the Adoption and Implementation Fidelity of Evidence-Based Prevention Programs in Communities: Results from a Randomized Controlled Trial

This paper describes findings from the Community Youth Development Study (CYDS), a randomized controlled trial of the Communities That Care (CTC) prevention system, on the adoption and implementation fidelity of science-based prevention programming in 24 communities. Data were collected using the Community Resource Documentation (CRD), which entailed a multi-tiered sampling process and phone and web-based surveys with directors of community-based agencies and coalitions, school principals, service providers, and teachers. Four years after the initiation of the CTC prevention system, the results indicated increased use of tested, effective prevention programs in the 12 CTC intervention communities compared to the 12 control communities, and significant differences favoring the intervention communities in the numbers of children and families participating in these programs. Few significant differences were found regarding implementation quality; respondents from both intervention and control communities reported high rates of implementation fidelity across the services provided.     

Effects of the Communities That Care Model in Pennsylvania on Youth Risk and Problem Behaviors

We undertook the first broad-scale quasi-experimental evaluation of youth outcomes in communities using the Communities That Care program (Hawkins, J. D., & Catalano, R. F., Jr. San Francisco, CA, USA: Jossey-Bass Inc, Publishers, 1992a), which targets adolescent problem behaviors. We evaluated 15 risk factors and 6 outcomes (substance use and delinquent behaviors) for 38,107 youth in 2001 and 98,436 youth in 2003 in Pennsylvania schools. Multilevel analyses compared student reports in communities with CTC programs to comparable communities without CTC, while controlling for level of poverty in the community. Results favored the CTC communities at greater than chance levels in terms of lower rates of some risk factors and outcomes. In a follow-up analysis, CTC community grade cohorts were included only if the grade cohort was expected to benefit from a CTC sponsored program (based on timing of program implementation and target age of the program). Evidence of CTC effects for grade cohorts that received evidence-based programs was even stronger. These findings suggest that community coalitions can affect adolescent public health problems at a population level, especially when evidence-based programs are utilized.     

The Longitudinal Effect of Technical Assistance Dosage on the Functioning of Communities That Care Prevention Boards in Pennsylvania

This study examined the impact of on-site and off-site technical assistance (TA) dosage on the functioning of Communities That Care prevention boards in Pennsylvania. Data on board functioning were collected over three years from board member and TA providers. Results of path models indicated little overall impact of TA dosage on board functioning the subsequent year. However, on-site TA dosage did appear to influence board functioning for younger boards and for boards who were relatively better functioning. In addition, the stability of board functioning and off-site TA was moderate to strong, the stability of on-site TA dosage was low, and poor functioning sites did not receive more TA in the following year. Editors’ Strategic Implications: This paper is one of the first quantitative examinations of the impact of TA on community-based prevention or health promotion coalitions. The authors provide a number of implications for further study with respect to TA. Thus, it should be valuable to researchers and practitioners involved in the development and implementation of such community-based efforts.     

Effects of the Communities That Care Model in Pennsylvania on Change in Adolescent Risk and Problem Behaviors

Despite the public health burden of adolescent substance use, delinquency, and other problem behavior, few comprehensive models of disseminating evidence-based prevention programs to communities have demonstrated positive youth outcomes at a population level, capacity to maintain program fidelity, and sustainability. We examined whether the Communities That Care (CTC; Hawkins and Catalano 1992) model had a positive impact on risk/protective factors and academic and behavioral outcomes among adolescents in a quasi-experimental effectiveness study. We conducted a longitudinal study of CTC in Pennsylvania utilizing biannual surveillance data collected through anonymous in-school student surveys. We utilized multilevel models to examine CTC impact on change in risk/protective factors, grades, delinquency, and substance use over time. Youth in CTC communities demonstrated less growth in delinquency, but not substance use, than youth in non-CTC communities. Levels of risk factors increased more slowly, and protective factors and academic performance decreased more slowly, among CTC community grade-cohorts that were exposed to evidence-based, universal prevention programs than comparison grade cohorts. Community coalitions can affect adolescent risk and protective behaviors at a population level when evidence-based programs are utilized. CTC represents an effective model for disseminating such programs.     

Cost-Benefit Analysis of Communities That Care Outcomes at Eighth Grade

This paper presents a cost-benefit analysis of the Communities That Care (CTC) prevention system, a public health approach to reducing risk, enhancing protection, and reducing the prevalence of adolescent health and behavior problems community wide. The analysis is based on outcomes from a panel of students followed from Grade 5 through Grade 8 in a randomized controlled trial involving 24 communities in 7 states. Previous analyses have shown that CTC prevented the initiation of cigarette smoking, alcohol use, and delinquency by the end of 8th grade in CTC communities compared to controls. This paper estimates long-term monetary benefits associated with significant intervention effects on cigarette smoking and delinquency as compared to the cost of conducting the intervention. Under conservative cost assumptions, the net present benefit is 5,250 per youth, including5,250 per youth, including 812 from the prevention of cigarette smoking and 4,438 from the prevention of delinquency. The benefit-cost ratio indicates a return of4,438 from the prevention of delinquency. The benefit-cost ratio indicates a return of 5.30 per 1.00 invested. Under less conservative but still viable cost assumptions, the benefit-cost ratio due to prevention of cigarette smoking and delinquency increases to1.00 invested. Under less conservative but still viable cost assumptions, the benefit-cost ratio due to prevention of cigarette smoking and delinquency increases to 10.23 per $1.00 invested. Benefits from CTC’s reduction in alcohol initiation as well as broader inclusion of quality-of-life gains would further increase CTC’s benefit-cost ratio. Results provide evidence that CTC is a cost-beneficial preventive intervention and a good investment of public dollars, even under very conservative cost and benefit assumptions.     

Sustainability of Community Coalitions: An Evaluation of Communities That Care

The relationships between community coalition processes during initial 3-year state seed funding and markers of sustainability post-funding were investigated in 20 Communities That Care (CTC) sites in Pennsylvania. Coalition processes were assessed using interviews with coalition members, ratings from the research team and ratings from state technical consultants. We found members' knowledge of prevention, coalition internal functioning, and fidelity to the CTC model during early coalition functioning predictive of later sustained coalition board activity. Findings suggest domains of early coalition functioning that may be important for understanding and promoting sustainability.     

Evaluation of Community-Level Effects of Communities That Care on Adolescent Drug Use and Delinquency Using a Repeated Cross-Sectional Design

The Communities That Care (CTC) prevention system has shown effects on reducing incidence and prevalence of problem behaviors among a panel of youth followed from 5th through 12th grade. The present report examines whether similar intervention effects could be observed using a repeated cross-sectional design in the same study. Data were from a community-randomized trial of 24 US towns. Cross-sectional samples of sixth, eighth, and tenth graders were surveyed at four waves. Two-stage ANCOVA analyses estimated differences between CTC and control communities in community-level prevalence of problem behaviors for each grade, adjusting for baseline prevalence. No statistically significant reductions in prevalence of problem behaviors were observed at any grade in CTC compared to control communities. Secondary analyses examined intervention effects within a “pseudo cohort” where cross-sectional data were used from sixth graders at baseline and tenth graders 4 years later. When examining effects within the pseudo cohort, CTC compared to control communities showed a significantly slower increase from sixth to tenth grade in lifetime smokeless tobacco use but not for other outcomes. Exploratory analyses showed significantly slower increases in lifetime problem behaviors within the pseudo cohort for CTC communities with high, but not low, prevention program saturation compared to control communities. Although CTC demonstrated effects in a longitudinal panel from the same community-randomized trial, we did not find similar effects on problem behaviors using a repeated cross-sectional design. These differences may be due to a reduced ability to detect effects because of potential cohort effects, accretion of those who were not exposed, and attrition of those who were exposed to CTC programming in the repeated cross-sectional sample.     

The Application of Meta-analysis within a Matched-pair Randomized Control Trial: An Illustration Testing the Effects of Communities That Care on Delinquent Behavior

Use of meta-analytic strategies to test intervention effects is an important complement to traditional design-based analyses of intervention effects in randomized control trials. In the present paper, we suggest that meta-analyses within the context of matched-pair designs can provide useful insight into intervention effects. We illustrate the advantages to this analytic strategy by examining the effectiveness of the Communities That Care (CTC) prevention system on 8th-grade delinquent behavior in a randomized matched-pair trial. We estimate the intervention effect within each of the matched-pair communities, aggregate the effect sizes across matched pairs to derive an overall intervention effect, and test for heterogeneity in the effect of CTC on delinquency across matched pairs of communities. The meta-analysis finds that CTC reduces delinquent behavior and that the effect of CTC on delinquent behavior varies significantly across communities. The use of meta-analysis in randomized matched-pair studies can provide a useful accompaniment to other analytic approaches because it opens the possibility of identifying factors associated with differential effects across units or matched pairs in the context of a randomized control trial.     

Sustained Institutional Effects of an Evidence-based HIV Prevention Intervention

Limited data are available as to what happens in institutions involved in behavioral intervention trials after the trial has ended. Specifically, do the trainers continue to administer the behavioral intervention that had been the focus of the trial? To address this question, we examined data in grade six schools before a year-long behavioral intervention had been delivered in some schools (and a year-long control condition in others) and data obtained again 6 and 7 years later in the same two sets of schools. Data were derived from the baseline surveys of two interventions: (1) national implementation of the evidence-based Focus on Youth in the Caribbean (FOYC) intervention in 2011; and (2) the randomized, controlled trial of the FOYC intervention in 2004/2005. Cross-sectional, longitudinal comparisons and random coefficient regression analysis were conducted to evaluate long-term intervention effects. Results indicate that grade six students in 2011 from schools in which the FOYC intervention had been implemented in 2004/2005 had a higher level of HIV/AIDS knowledge, increased reproductive health skills, increased self-efficacy regarding their ability to prevent HIV infection, and greater intention to use protection if they were to have sex compared to their counterparts from schools where no such training took place. We concluded that new cohorts of students benefited from the extensive training and/or experience in teaching the FOYC curriculum received by teachers, guidance counselors and administrators in schools which had delivered the FOYC intervention as part of a randomized trial several years earlier. The findings suggest that teachers who previously were trained to deliver the FOYC intervention may continue to teach at least some portions of the curriculum to subsequent classes of students attending these schools.     

Early effects of Communities That Care on targeted risks and initiation of delinquent behavior and substance use.

PURPOSE: Communities That Care (CTC) is a prevention system designed to reduce levels of adolescent delinquency and substance use through the selection and use of effective preventive interventions tailored to a community's specific profile of risk and protection. This article describes early findings from the first group-randomized trial of CTC. METHODS: A panel of 4407 fifth-grade students was surveyed annually through seventh grade. Analyses were conducted to assess the effects of CTC on reducing levels of targeted risk factors and reducing initiation of delinquent behavior and substance use in seventh grade, 1.67 years after implementing preventive interventions selected through the CTC process. RESULTS: Mean levels of targeted risks for students in seventh grade were significantly lower in CTC communities compared with controls. Significantly fewer students in CTC communities than in control communities initiated delinquent behavior between grades 5 and 7. No significant intervention effect on substance use initiation by spring of seventh grade was observed. CONCLUSIONS: CTC's theory of change hypothesizes that it takes from 2 to 5 years to observe community-level effects on risk factors and 5 or more years to observe effects on adolescent delinquency or substance use. The early findings indicating hypothesized effects of CTC on targeted risk factors and initiation of delinquent behavior are promising.     

Aggregating Indices of Risk and Protection for Adolescent Behavior Problems: The Communities That Care Youth Survey

PurposeTo facilitate research on adolescent risk and protection regarding behavior problems, and to facilitate community decision-making regarding resource allocation for intervention programs, by creating a reduced set of coherent aggregate indices of adolescent risk and protection.MethodsWe examined the 31 risk and protective factor scales in the Communities That Care Youth Survey (CTC-YS). Data came from two waves of the CTC-YS administered to sixth through 12th graders in Pennsylvania (2001 n = 43,842; 2003 n =101,988). Factor analysis and calculation of internal reliability were used to create aggregate indices of risk/protective factor domains. Correlations of aggregate indices with each other and with problem behaviors (antisocial behavior, substance use) were examined.ResultsTheory and empirical results led to the creation of seven coherent indices: Community Cohesion, Family Cohesion, Family Risk, School Support for Prosocial Activities, Antisocial Peer Domain, Attitudes toward Risky Behavior, Risky Behavioral Tendencies. Four scales were not included in the aggregate index (Religiosity, Academic Performance, Personal Transitions and Mobility, and Early Initiation of Drug Use and Antisocial Behavior). The indices were related to each other and to adolescent problem behaviors (antisocial behavior and substance use) in expected ways. Results were consistent across waves of data.ConclusionsThe construction of theoretically meaningful and empirically defensible aggregate measures of adolescent risk and protective factors is possible, although analyses of other data sets and further discussion are warranted. The use of aggregate indices by researchers and communities is recommended as a way to facilitate research and decision-making.     

医防分设规范运作放开医疗倾斜防保

为寻求乡镇卫生院生存与发展出路 ,探索卫生行政机关职能转换可行性途径 ,1999年 6月射阳县海河中心卫生院进行了医防管理体制分设 ,推行以国有资产参股、职工控股、管理层持大股为特征的股份合作制改革试点。1　基本做法1.1　健全组织领导 ,开展学习。县卫生局、海河中心卫生院分别成立“卫生改革领导小组”。编印《卫生改革辅导材料》,采取集中和分散相结合的学习方法 ,利用三个月的时间 ,组织职工反复学习有关改革文件、材料 ,并邀请县体改委进行深入动员 ,组织职工广泛开展讨论 ,使全体员工逐步知晓股份合作制的一般知识 ,党和国家有关…     

Predictive Validity of Established Cut Points for Risk and Protective Factor Scales from the Communities That Care Youth Survey

Community coalitions are a popular strategy to coordinate activities and resources to prevent adolescent substance use and delinquent behavior. Despite early evidence of their lack of effectiveness, a new generation of community coalitions has shown positive results in preventing youth substance use and delinquency. This success can be attributed to coalition decision making focused on reducing local risk factors and increasing local protective factors through the use of evidence-based prevention programs. A previous study using cross-sectional data established cut point values for scales measuring risk and protective factors on the Communities That Care Youth Survey (CTCYS) to identify high levels of risk and low levels of protection in communities on each scale. The current study extended this previous research by using longitudinal data to assess the validity of risk and protective factor cut point values in predicting substance use and delinquent behavior 1?year after risk and protection were measured. The findings demonstrate the predictive validity of cut points for risk and protective factor scales measured by the CTCYS and suggest their utility in guiding prevention efforts.     

Testing Communities That Care: The Rationale,Design and Behavioral Baseline Equivalence of the Community Youth Development Study

Recent advances in prevention science provide evidence that adolescent health and behavior problems can be prevented by high-quality prevention services. However, many communities continue to use prevention strategies that have not been shown to be effective. Studying processes for promoting the dissemination and high-quality implementation of prevention strategies found to be effective in controlled research trials has become an important focus for prevention science. The Communities That Care prevention operating system provides manuals, tools, training, and technical assistance to activate communities to use advances in prevention science to plan and implement community prevention services to reduce adolescent substance use, delinquency, and related health and behavior problems. This paper describes the rationale, aims, intervention, and design of the Community Youth Development Study, a randomized controlled community trial of the Communities That Care system, and investigates the baseline comparability of the 12 intervention and 12 control communities in the study. Results indicate baseline similarity of the intervention and control communities in levels of adolescent drug use and antisocial behavior prior to the Communities That Care intervention. Strengths and limitations of the study's design are discussed.