Reducing Risky Behavior In 10-14 Year Olds

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A randomized trial of Communities That Care (CTC), an evidence-based substance-use community-focused prevention system, showed significant reductions in the initiation of alcohol use, tobacco use, binge drinking, and delinquent behavior among middle schoolers as they progressed from the fifth through the eighth grades.

The four-year trial, called the Community Youth Development Study, began in 2003 and has been supported by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health. The positive results, published in the Archives of Pediatrics and Adolescent Medicine, demonstrate that community-based coalitions using customized evidence-based approaches can prevent the early initiation of substance abuse and delinquent behavior among youth.

"The results of this trial confirm that tools do exist that give communities the power to reduce risk for multiple problem behaviors across a community," said NIDA Director Dr. Nora Volkow. "What makes Communities That Care unique is that it enables communities to identify their own special issues so they can hand pick the right prevention programs."

Prevention research has produced programs with efficacy in reducing the risk of substance abuse among youth, but the process of getting these programs into communities has been difficult. CTC helps individual communities identify prevalent risk factors for future substance use among their youth and choose evidence-based programs to address those risk factors across the community. Recent research shows that for each dollar invested in research-based prevention programs, a savings of up to $10 in treatment for alcohol or other substance abuse can be seen.

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"If you want to prevent problems, address those risk factors that are elevated in the community with programs or policies that have already been tested and shown to be effective in similar populations," explained Dr. J. David Hawkins, founding director of the Social Development Research Group at the University of Washington and lead author of the study.

To evaluate the CTC program, researchers studied a group of 4,407 fifth graders from 24 communities in Colorado, Illinois, Kansas, Maine, Oregon, Utah and Washington. Twelve communities were randomly assigned to undergo CTC training and implementation, and 12 served as the control communities that did not implement CTC. In the CTC communities, stakeholders including educators, business and public leaders, health workers, religious leaders, social workers and other community volunteers received six training sessions over a year to help them identify the dominant risk and protective factors for substance use in their areas.

The coalitions then chose and implemented from two to five evidence-based prevention programs tailored to their risk factors, from a menu of tested and effective prevention strategies. The strategies focus on a variety of topics depending on community need, including alcohol and drugs, violence prevention, reducing family conflict, life skills training, HIV/AIDS prevention, dating safety, tobacco, and anger management. The youth were surveyed annually for four years concerning their risky behaviors to determine the impact of delivering programs through the CTC system.

By the eighth grade, students in the CTC communities were 32 percent less likely to begin using alcohol, 33 percent less likely to begin smoking, and 33 percent less likely to begin using smokeless tobacco than their peers in the control communities. Students from CTC communities were also 25 percent less likely to initiate delinquent behavior, itself a risk factor for future substance use and an important target for prevention.

"This shows that a coalition of community stakeholders armed with tools solidly grounded in prevention science can prevent middle schoolers from starting to use tobacco, starting to drink, and starting to engage in delinquent behavior," said Dr. Hawkins. "That's what's really remarkable — that the effects are community-wide."

The researchers plan to track the children from all 24 communities through the year following high school, to monitor the sustainability of the effects of CTC and whether the communities continue to employ their chosen prevention programs.

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