%0 Journal Article %J Prev Sci %D 2014 %T The onset of STI diagnosis through age 30: results from the Seattle Social Development Project Intervention. %A Hill, Karl G %A Bailey, Jennifer A %A Hawkins, J D %A Catalano, Richard F %A Kosterman, Rick %A Oesterle, Sabrina %A Abbott, Robert D %K Adolescent %K Adult %K Child %K Female %K Health Promotion %K Humans %K Interviews as Topic %K Longitudinal Studies %K Male %K Outcome Assessment (Health Care) %K Parent-Child Relations %K Risk-Taking %K Sexually Transmitted Diseases %K Social Adjustment %K Unsafe Sex %K Urban Population %K Washington %X

The objectives of this study were to examine (1) whether the onset of sexually transmitted infections (STI) through age 30 differed for youths who received a social developmental intervention during elementary grades compared to those in the control condition; (2) potential social-developmental mediators of this intervention; and (3) the extent to which these results differed by ethnicity. A nonrandomized controlled trial followed participants to age 30, 18 years after the intervention ended. Three intervention conditions were compared: a full-intervention group, assigned to intervention in grades 1 through 6; a late intervention group, assigned to intervention in grades 5 and 6 only; and a no-treatment control group. Eighteen public elementary schools serving diverse neighborhoods including high-crime neighborhoods of Seattle are the setting of the study. Six hundred eight participants in three intervention conditions were interviewed from age 10 through 30. Interventions include teacher training in classroom instruction and management, child social and emotional skill development, and parent workshops. Outcome is the cumulative onset of participant report of STI diagnosis. Adolescent family environment, bonding to school, antisocial peer affiliation, early sex initiation, alcohol use, cigarette use, and marijuana use were tested as potential intervention mechanisms. Complementary log-log survival analysis found significantly lower odds of STI onset for the full-intervention compared to the control condition. The lowering of STI onset risk was significantly greater for African Americans and Asian Americans compared to European Americans. Family environment, school bonding, and delayed initiation of sexual behavior mediated the relationship between treatment and STI hazard. A universal intervention for urban elementary school children, focused on classroom management and instruction, children's social competence, and parenting practices may reduce the onset of STI through age 30, especially for African Americans.

%B Prev Sci %V 15 Suppl 1 %P S19-32 %8 2014 Feb %G eng %R 10.1007/s11121-013-0382-x %0 Journal Article %J Prev Sci %D 2014 %T Prevention system mediation of Communities That Care effects on youth outcomes %A Brown, Eric C %A Hawkins, J D %A Rhew, Isaac C %A Shapiro, Valerie B %A Abbott, Robert D %A Oesterle, Sabrina %A Arthur, Michael W %A Briney, John S %A Catalano, Richard F %K Adolescent %K Adolescent Behavior %K Child %K Female %K Humans %K Juvenile Delinquency %K Longitudinal Studies %K Male %K Negotiating %K Residence Characteristics %K Social Welfare %K Social Work %K Substance-Related Disorders %K United States %X

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.

%B Prev Sci %V 15 %P 623-32 %8 2014 Oct %G eng %N 5 %R 10.1007/s11121-013-0413-7 %0 Journal Article %J Prev Sci %D 2014 %T Variation in the sustained effects of the Communities That Care prevention system on adolescent smoking, delinquency, and violence. %A Oesterle, Sabrina %A Hawkins, J D %A Fagan, Abigail A %A Abbott, Robert D %A Catalano, Richard F %K Adolescent %K Adolescent Behavior %K Adolescent Health Services %K Alcohol Drinking %K Community Health Services %K Female %K Humans %K Juvenile Delinquency %K Male %K Prevalence %K Program Evaluation %K Risk Factors %K Risk Reduction Behavior %K Smoking %K United States %K Violence %X

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.

%B Prev Sci %V 15 %P 138-45 %8 2014 Apr %G eng %N 2 %R 10.1007/s11121-013-0365-y %0 Journal Article %J JAMA Pediatr %D 2014 %T Youth problem behaviors 8 years after implementing the Communities That Care prevention system: A community-randomized trial. %A Hawkins, J D %A Oesterle, Sabrina %A Brown, Eric C %A Abbott, Robert D %A Catalano, Richard F %K Adolescent %K Adolescent Behavior %K Adolescent Health Services %K Alcohol Drinking %K Child %K Community Health Services %K Female %K Humans %K Juvenile Delinquency %K Male %K Prevalence %K Program Evaluation %K Risk Factors %K Risk Reduction Behavior %K Smoking %K Substance-Related Disorders %K United States %K Violence %X

IMPORTANCE: Community-based efforts to prevent adolescent problem behaviors are essential to promote public health and achieve collective impact community wide. OBJECTIVE To test whether the Communities That Care (CTC) prevention system reduced levels of risk and adolescent problem behaviors community wide 8 years after implementation of CTC.

DESIGN, SETTING, AND PARTICIPANTS: A community-randomized trial was performed in 24 small towns in 7 states, matched within state, assigned randomly to a control or intervention group in 2003. All fifth-grade students attending public schools in study communities in 2003-2004 who received consent from their parents to participate (76.4% of the eligible population) were included. A panel of 4407 fifth graders was surveyed through 12th grade, with 92.5% of the sample participating at the last follow-up.

INTERVENTIONS: A coalition of community stakeholders received training and technical assistance to install CTC, used epidemiologic data to identify elevated risk factors and depressed protective factors for adolescent problem behaviors in the community, and implemented tested and effective programs for youths aged 10 to 14 years as well as their families and schools to address their community's elevated risks. MAIN OUTCOMES AND MEASURES Levels of targeted risk; sustained abstinence, and cumulative incidence by grade 12; and current prevalence of tobacco, alcohol, and other drug use, delinquency, and violence in 12th grade.

RESULTS: By spring of 12th grade, students in CTC communities were more likely than students in control communities to have abstained from any drug use (adjusted risk ratio [ARR] = 1.32; 95% CI, 1.06-1.63), drinking alcohol (ARR = 1.31; 95% CI, 1.09-1.58), smoking cigarettes (ARR = 1.13; 95% CI, 1.01-1.27), and engaging in delinquency (ARR = 1.18; 95% CI, 1.03-1.36). They were also less likely to ever have committed a violent act (ARR = 0.86; 95% CI, 0.76-0.98). There were no significant differences by intervention group in targeted risks, the prevalence of past-month or past-year substance use, or past-year delinquency or violence.

CONCLUSIONS AND RELEVANCE: Using the CTC system continued to prevent the initiation of adolescent problem behaviors through 12th grade, 8 years after implementation of CTC and 3 years after study-provided resources ended, but did not produce reductions in current levels of risk or current prevalence of problem behavior in 12th grade. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01088542.

%B JAMA Pediatr %V 168 %P 122-9 %8 2014 Feb %G eng %N 2 %R 10.1001/jamapediatrics.2013.4009 %0 Journal Article %J Arch Pediatr Adolesc Med %D 2012 %T Sustained decreases in risk exposure and youth problem behaviors after installation of the Communities That Care prevention system in a randomized trial. %A Hawkins, J D %A Oesterle, Sabrina %A Brown, Eric C %A Monahan, Kathryn C %A Abbott, Robert D %A Arthur, Michael W %A Catalano, Richard F %K Adolescent %K Adolescent Behavior %K Adolescent Health Services %K Child %K Community Health Services %K Humans %K Incidence %K Juvenile Delinquency %K Multivariate Analysis %K Outcome Assessment (Health Care) %K Prevalence %K Risk Reduction Behavior %K Smoking %K Substance-Related Disorders %K United States %K Violence %X

OBJECTIVE: To test whether the Communities That Care (CTC) prevention system reduced levels of risk and adolescent problem behaviors community-wide 6 years after installation of CTC and 1 year after study-provided resources ended.

DESIGN: A community randomized trial.

SETTING: Twenty-four small towns in 7 states, matched within state, randomly assigned to control or intervention condition in 2003.

PARTICIPANTS: A panel of 4407 fifth-grade students was surveyed annually through 10th grade from 2004 to 2009.

INTERVENTION: A coalition of community stakeholders received training and technical assistance to install CTC, used epidemiologic data to identify elevated risk factors and depressed protective factors in the community, and implemented programs to address their community's elevated risks from a menu of tested and effective programs for youths aged 10 to 14 years, their families, and schools.

OUTCOME MEASURES: Levels of risk and incidence and prevalence of tobacco, alcohol, and other drug use; delinquency; and violent behavior by grade 10.

RESULTS: Mean levels of targeted risks increased less rapidly between grades 5 and 10 in CTC than in control communities and were significantly lower in CTC than control communities in grade 10. The incidence of delinquent behavior, alcohol use, and cigarette use and the prevalence of current cigarette use and past-year delinquent and violent behavior were significantly lower in CTC than in control communities in grade 10.

CONCLUSIONS: Using the CTC system can produce enduring reductions in community-wide levels of risk factors and problem behaviors among adolescents beyond the years of supported implementation, potentially contributing to long-term public health benefits.

TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01088542.

%B Arch Pediatr Adolesc Med %V 166 %P 141-8 %8 2012 Feb %G eng %N 2 %R 10.1001/archpediatrics.2011.183 %0 Journal Article %J Health & Place %D 2011 %T Drug use and risk among youth in different rural contexts. %A Rhew, Isaac C %A Hawkins, J D %A Oesterle, Sabrina %K Adolescent %K Adolescent Behavior %K Child %K Cross-Sectional Studies %K Female %K Humans %K Male %K Risk Assessment %K Rural Population %K Substance-Related Disorders %K United States %K Urban Population %X

This study compared levels of drug use and risk and protective factors among 18,767 adolescent youths from communities of less than 50,000 in population living either on farms, in the country but not on farms, or in towns. Current alcohol use, smokeless tobacco use, inhalant use, and other illicit drug use were more prevalent among high school-aged youths living on farms than among those living in towns. Prevalence of drug use did not significantly vary across youths living in different residential contexts among middle school youths. While risk and protective factors showed associations of similar magnitude with drug use across residential location, high school students living on farms were exposed to greater numbers of risk factors across multiple domains than were students living in towns. The findings suggest that outreach to farm-dwelling youths may be particularly important for interventions seeking to prevent adolescent drug use in rural settings.

%B Health & Place %V 17 %P 775-83 %8 2011 May %G eng %N 3 %R 10.1016/j.healthplace.2011.02.003 %0 Journal Article %J J Stud Alcohol Drugs %D 2011 %T Men's and women's pathways to adulthood and associated substance misuse. %A Oesterle, Sabrina %A Hawkins, J D %A Hill, Karl G %K Adolescent %K Adolescent Behavior %K Adolescent Development %K Adult %K Educational Status %K Female %K Humans %K Longitudinal Studies %K Male %K Parenting %K Prospective Studies %K Risk Factors %K Sex Factors %K Single Person %K Smoking %K Substance-Related Disorders %K Urban Health %K Washington %K Young Adult %X

OBJECTIVE: Social role transitions have been linked to changes in substance use and misuse during young adulthood. This study examined how commonly observed pathways to adulthood, defined by education, employment, marriage, and parenthood, were associated with alcohol, tobacco, and marijuana misuse from ages 18 to 33.

METHOD: Data came from a longitudinal panel of 412 men and 396 women recruited when they were in fifth grade in Seattle public schools in 1985. Participants were followed through age 33 in 2008, with 92% retention.

RESULTS: Young adults who had little postsecondary education and remained unmarried through age 30 generally had the highest rates of substance misuse. Those who were involved in postsecondary education and postponed family formation had the lowest rates, particularly with respect to daily smoking and nicotine dependence. Parenting during the young adult years was associated with lower rates of substance misuse for both men and women. However, taking on parenting responsibilities early, during the late teen years and early 20s (observed mostly for women), was associated with higher rates of tobacco misuse. Differences in substance misuse by pathways to adulthood were fairly constant across the young adulthood years and were already observed at age 18, suggesting that substance misuse patterns are established early.

CONCLUSIONS: Young adults may change their substance use only partially in response to new freedoms and responsibilities in young adulthood. Preventive efforts should include a focus on early initiation of substance use and educational experiences that move people into life trajectories and associated substance misuse patterns.

%B J Stud Alcohol Drugs %V 72 %P 763-73 %8 2011 Sep %G eng %N 5