Community effort brings lasting drop in smoking, delinquency, drug use

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Delaying the age when kids try alcohol or smoking decreases the likelihood that they will become dependent later in life. Effective interventions exist, but community disagreements about which programs to try can stymie decisions.

Communities That Care, a prevention system developed by University of Washington researchers, leads communities through the decision-making process, facilitating evidence-based choices of prevention programs known to work.

The researchers' latest study shows that tenth graders in towns using Communities That Care were less likely to have tried drinking or smoking compared with teens living in towns that had not adopted the system. Delinquent behavior, including stealing, vandalism and physical fights, decreased too.

"What's exciting about this paper is that these decreases in alcohol use, smoking and violence were apparent even after outside support for the Communities That Care system ended. It shows that community coalitions can make a sustained difference in their youngsters' health community-wide," said J. David Hawkins, lead author and director of the study and founding director of the UW's Social Development Research Group, affiliated with the UW School of Social Work.

The study was published online Oct. 3 in Archives of Pediatrics & Adolescent Medicine.

For five years, Hawkins and his colleagues tracked the behaviors of 4,407 youths growing up in 24 small- to moderate-size towns in Colorado, Illinois, Kansas, Maine, Oregon, Utah and Washington. Half of the towns had been randomly assigned to receive training in the Communities That Care system and were compared with towns of similar size and demographics that were not using the system.

In Communities That Care towns, kids in fifth through ninth grades participated in programs aimed to mitigate risk factors such as family conflict, low commitment to school and academic difficulties. The programs were chosen by a community coalition in each town from a list of preventive interventions known to work.

The list was compiled by the UW researchers, who instructed the towns to choose programs based on surveys of community students that identified the particular risk factors most prevalent in their community.

"This is so they don't waste their time and money on programs that aren't effective," said Sabrina Oesterle, co-author of the paper and research associate professor in the UW School of Social Work. "This is an approach that can have sustained improvements in teen outcomes community-wide."

The current study uses survey results from students followed from fifth grade through the end of tenth grade, a year after external support for Communities That Care ended. Teens growing up in the towns using the prevention system had half the odds of ever having smoked a cigarette by tenth grade and had 21 percent lower odds of currently smoking in tenth grade compared with teens growing up in the towns without the system. They also had 38 percent lower odds of ever trying alcohol and 21 percent lower odds of initiating delinquent behavior by tenth grade.

The tenth graders in the Communities That Care towns also reported 17 percent lower odds of engaging in delinquent behavior, such as stealing, vandalism and selling drugs, and 25 percent lower odds of engaging in violence, including physical fights.

"We want to do the right thing to help our kids grow up to be healthy and lead productive lives, but historically, we haven't demanded that the programs that we employ to do this are tested and proven effective," said Hawkins, who developed Communities That Care with Richard Catalano, a co-author and director of the Social Development Research Group.

"This is a systematic way for coalitions of stakeholders to evaluate the risks to youths in their communities, and choose effective prevention programs to promote the well being of their teens," Hawkins said.

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