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Objectives. We examined whether the Communities That Care (CTC) system sustained effects 1.5 years after study funding ended on prevention system constructs expected to be important for community-level reductions in drug use and antisocial behaviors among youths.
Methods. Data were from a community trial of 24 towns in the United States randomized to either the CTC intervention or control conditions. Participants were 928 community key leaders interviewed at 1 to 4 waves from 2001 to 2009. Intervention activities, including training and technical assistance, were conducted between 2003 and 2008 in the CTC communities.
Results. Leaders from CTC communities reported higher levels of adoption of a science-based approach to prevention and a higher percentage of funding desired for prevention activities in 2009 than did leaders in control communities. CTC communities showed a higher increase over time in community norms against adolescent drug use as well as adoption of a science-based approach compared with control communities.
Conclusions. These findings indicated that CTC implementation produced enduring transformation of important prevention system constructs in intervention communities, which might, in turn, produce long-term reductions in youth problem behaviors. (Am J Public Health. 2013;103:529-535. doi:10.2105/AJPH. 2011.300567)
Despite evidence for effectiveness of preventive interventions to reduce the occurrence of drug use and delinquent behaviors among youths,1,2 few communities have implemented such interventions as part of community-wide strategies. Approaches that address prevention of youth problem behaviors through community system-level changes have the potential for significant public health impact.3-5 Consistent with this, the federal government identified systems thinking and evidence-based practices, research, and evaluation as 2 priorities for public health improvement for the next decade.6
A recent review identified that a common feature of successful strategies for reducing alcohol use or availability of alcohol to adolescents is reliance on local coalitions to develop and implement prevention plans.5 For example, Communities Mobilizing for Change on Alcohol (a program using coalition-based efforts to change community policies, practices, and norms related to underage alcohol use) showed a reduction of alcohol provision to minors and arrests for drunk driving among 18- to 20-year-old drivers.7,8 The Midwestern Prevention Project, which combined coalitionled strategies with school-based prevention activities, demonstrated reductions in pastmonth cigarette and alcohol use among middle school students.9 Not all coalition-based efforts have proven successful, however. For...