Effects of the Communities That Care model in Pennsylvania on change in adolescent risk and problem behaviors

Examining Sexual Health Organizational Networks in Urban African American Communities Using Social Network Theory

PURPOSE

Collaboration among organizations offering sexual health and youth development services has the potential to provide youth with effective sexual health support. However, formally structured efforts (eg, coalition formation) may be impractical or unsuitable for low-income communities where resources are often already limited. Social network theories provide an alternative approach for building collaborative organizational networks.

APPROACH

Research aims to evaluate the barriers and facilitators to collaboration in sexual health organizational networks.

SETTING

Organizations in low income, urban, communities in Chicago and San Francisco that serve African American adolescents.

PARTICIPANTS

Providers (n = 22) from organizations that offer sexual health services and youth development services.

METHODS

Focus groups (n = 4) were conducted and analyzed utilizing a combination of coding strategies.

RESULTS

Barriers to collaboration included resource limitations and competition, differences in organizational roles and deliverables, and prejudice and stigma. Identifying common ground among organizations was found to be a facilitator to collaboration. Social network concepts in conjunction with study findings lead to the development of a practice model that hypothesizes a pathway for organizations to improve collaboration without formally structured efforts.

CONCLUSION

Our findings offer ways to encourage collaboration among organizations that support youth sexual health in low-income, urban, African American communities without relying on formal structures. Such collaborations may be critical for improving the provision of comprehensive sexual health support.

Community mobilisation approaches to preventing adolescent multiple risk behaviour: a realist review

BACKGROUND

Adolescent multiple risk behaviour (MRB) is a global health issue. Most interventions have focused on the proximal causes of adolescent MRB such as peer or family influence, with systematic reviews reporting mixed evidence of effectiveness. There is increasing recognition that community mobilisation approaches could be beneficial for adolescent health. There are gaps in the current literature, theory and implementation that would benefit from a realist approach. We use a theory-driven evidence synthesis to assess how and why community mobilisation interventions work/do not work to prevent adolescent MRB and in what contexts.

METHODS

This realist review used a six-stage iterative process, guided by the RAMESES framework. We systematically searched PubMed, MEDLINE, PsycINFO, Web of Science, CINAHL and Sociological Abstracts, from their inception to 2021. Studies were screened for relevance to the programme theory, assessed for rigour and included based on a priori criteria. Two independent reviewers selected, screened and extracted data from included studies. A realist logic of analysis was used to develop context-mechanism-outcome configurations that contributed to our programme theory.

FINDINGS

We reviewed 35 documents describing 22 separate community mobilisation intervention studies. Most studies (n = 17) had a quality assessment score of three or four (out of four). We analysed the studies in relation to three middle range theories. To uphold our theory that these interventions work by creating a social environment where adolescents are less likely to engage in MRB, interventions should: (1) embed a framework of guiding principles throughout the community, (2) establish community readiness with population data and (3) ensure a diverse coalition with the support of intervention champions. Mechanisms such as empowerment through coalition ownership over the delivery of the intervention, cohesion across the community and motivation to work collaboratively to improve adolescent health are triggered to achieve social environment shifts. However, certain contexts (e.g. limited funding) restrict intervention success as these mechanisms are not fired.

CONCLUSIONS

For community mobilisation interventions to reduce adolescent MRB, the coalitions within them must seek to alter the social environment in which these behaviours occur. Mechanisms including empowerment, cohesion and motivation lead to this shift, but only under certain contexts.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020205342.

Contextual effects of community capacity as a predictor for adolescent alcohol, tobacco, and illicit drug use: A multi-level analysis

Adolescent substance use is a major public health issue that can result in enduring physical, psychological, and social consequences. This study seeks to examine the relationship between community capacity for prevention and the 4-week prevalence rate of substance use, including tobacco, alcohol, other drugs, and binge-drinking, among students in Germany ranging from grades 5 to 11. This study employed a cross-sectional design and used baseline data from 28 communities participating in the CTC-EFF study. The sample consisted of 7210 students who were surveyed about their substance use behavior. Additionally, 158 local key informants were surveyed on ten capacity domains, which included commitment, knowledge and skills, resources, leadership, inclusiveness, prevention collaboration, sectoral-collaboration, cohesion, problem-solving skills, and needs orientation. Furthermore, a total capacity score was calculated as the mean of the ten capacity domains. To examine the associations between community capacity and substance use behavior, logistic multi-level models were utilized. The analysis shows a negative association between community capacity (total score) and any substance use (OR = 0.28, 95% CI 0.12-0.56). Specifically, higher levels of total community capacity are associated with lower odds of alcohol use (OR = 0.30, 95% CI 0.13-0.80), tobacco use (OR = 0.09, 95% CI 0.01-0.60), and binge-drinking (OR = 0.67, 95% CI (0.46-0.99). Further analyses of distinct community capacity domains indicate that higher levels of sectoral-collaboration (OR = 0.62, 95% CI 0.37-0.97), knowledge and skills (OR = 0.74, 95% CI 0.40-0.79), resources (OR = 0.52, 95% CI 0.36-0.76), and problem-solving skills (OR = 0.71, 95% CI 0.36-0.89) are associated with lower odds of any substance use. The study findings suggest that community capacity is associated with substance use behavior, emphasizing the importance of capacity building in interventions targeting the reduction of substance use among adolescents.

Community coalitions for smoke-free environments in Armenia and Georgia: A mixed methods analysis of coalition formation, implementation and perceived effectiveness

Effective models for aligning public health and civil society at the local level have the potential to impact various global health issues, including tobacco. Georgia and Armenia Teams for Healthy Environments and Research (GATHER) is a collaboration between Armenia, Georgia and U.S. researchers involving a community randomized trial testing the impact of community coalitions to promote smoke-free policy adoption and compliance in various settings. Community Coalition Action Theory (CCAT) was used to guide and describe coalition formation, implementation and effectiveness. Mixed methods were used to evaluate 14 municipality-based coalitions in Georgia and Armenia, including semi-structured interviews (n = 42) with coalition leaders and active members, coalition member surveys at two timepoints (n = 85 and n = 83), and review of action plans and progress reports. Results indicated successful creation of 14 multi-sectoral coalitions, most commonly representing education, public health, health care, and municipal administration. Half of the coalitions created at least one smoke-free policy in specific settings (e.g., factories, parks), and all 14 promoted compliance with existing policies through no-smoking signage and stickers. The majority also conducted awareness events in school, health care, and community settings, in addition to educating the public about COVID and the dangers of tobacco use. Consistent with CCAT, coalition processes (e.g., communication) were associated with member engagement and collaborative synergy which, in turn, correlated with perceived community impact, skills gained by coalition members, and interest in sustainability. Findings suggest that community coalitions can be formed in varied sociopolitical contexts and facilitate locally-driven, multi-sectoral collaborations to promote health. Despite major contextual challenges (e.g., national legislation, global pandemic, war), coalitions were resilient, nimble and remained active. Additionally, CCAT propositions appear to be generalizable, suggesting that coalition-building guidance may be relevant for local public health in at least some global contexts.

Sexting Among Australian Adolescents: Risk and Protective Factors

Although consensual sending of sexts between adolescents is considered developmentally appropriate, it may also entail a range of negative consequences. Current sexting research lacks a comprehensive theoretical framework identifying a range of risk and protective factors underpinning adolescent consensual sending of sexts across individual, interpersonal, and distal levels. Further, there is a lack of systematic evaluation of how the importance of these factors may vary across adolescent age. This study investigated the utility of the Social Development Model to predict a range of risk and protective factors across individual, family, peer, school, and community-level factors. The sample included 1302 teenagers from Victoria, Australia (M_age = 14.54, SD = 1.14, 50.8% girls). Results indicated that 146 (11.7%) participants sent a sext (76 boys and 70 girls). Logistic regression analyses revealed that the Social Development Model accounted for 45.8% of variance in sexting, with greater likelihood of sending sexts being associated with older age, prior sexual activity, school sector, physical activity, lifetime substance use, greater depressive symptoms, sensation seeking, and perceived substance availability in the community. Multigroup analyses revealed that lifetime substance use was associated with a greater likelihood of sending sexts among younger teens. Among older adolescents, adaptive coping was associated with reduced engagement in sexting, while higher parental overcontrol and family conflict increased the odds of sending sexts. Overall, sexting is associated with a range of modifiable factors potentially amenable to intervention.

Life-course predictors of homelessness from adolescence into adulthood: A population-based cohort study

INTRODUCTION

Internationally, the prevalence of young adult homelessness is concerning. Few data on life-course predictors from longitudinal studies exist, limiting our capacity to inform prevention strategies at the population-level.

METHODS

Data were drawn from a state representative population-based sample of young adults from Victoria, Australia participating in the International Youth Development Study (IYDS; N = 927, 54% female). Participants were recruited in state-representative secondary school samples at Grade 7 (age 13, 2002), with follow-up in Grades 9 (age 15) and 11 (age 17) and at ages 21, 23 and 25. Using longitudinal path modelling, we conducted a series of analyses testing life-course predictors of young adult homelessness across multiple socializing contexts, and the interrelationships among them.

RESULTS

The rate of young adult homelessness was 5.5%. Path modelling showed higher levels of family conflict at ages 13 and 15 uniquely predicted homelessness by age 25. This effect remained after accounting for other risk factors in peer-group (e.g., interactions with antisocial peers), school (e.g., low academic performance), and community contexts (e.g., low neighborhood attachment). Peer drug use and interaction with antisocial peers at age 15 mediated the association between family conflict at age 13 and homelessness by age 25.

CONCLUSIONS

Findings point to the vulnerability of early adolescents to family conflict. This vulnerability heightens risk for young adult homelessness. Findings strengthen the case for both primary prevention programs that build healthy relationships between family members from early on in adolescence and for investment in homelessness prevention at key developmental periods.

Community utilization of risk and protective factor data for prevention planning in Chile and Colombia

Many effective community health service delivery systems implemented in the USA assess risk and protective factors (RPFs) for youth problem behaviors in a community, and report these data back to local coalitions for prevention planning. This study examined whether community prevention coalitions in Chile and Colombia perceived these reports of RPFs-based on the results of the Communities That Care Youth Survey-to be understandable, valid, useful, and worth disseminating. Thematic content analysis was used to analyze qualitative data collected from 7 focus groups with 75 coalition members. Results indicated heterogeneity between and within coalitions in terms of participants' understanding of RPFs. However, most participants found reports of RPFs to be easy to understand, thorough, 'true' to their communities, and useful for diagnosing and prioritizing needs, action planning, and mobilizing others in their communities. Findings suggest the viability of preventive systems that rely on community-level RPF data, for use in Latin America.

Protocol for a hybrid type 3 cluster randomized trial of a technical assistance system supporting coalitions and evidence-based drug prevention programs

BACKGROUND

Over 5000 community anti-drug coalitions operating in the USA serve as a cornerstone of federal drug prevention. These coalitions, however, have demonstrated effectiveness in preventing substance use only when they use technical assistance (TA) and implement evidence-based programs (EBPs). The absence of TA and EBP implementation by coalitions is a key research-to-practice gap. The Coalition Check-Up TA system is designed to fill this gap by supporting community coalition implementation of EBPs. Existing TA models for evidence-based coalition approaches are resource intensive and coalition model specific. The Coalition Check-Up is a lower cost strategy that works with a variety of types of coalitions to support sustainable implementation of EBPs. This study protocol describes a hybrid type 3 effectiveness-implementation trial applying Wandersman's Interactive Systems Framework to test the effects of the Coalition Check-Up on coalition EBP implementation capacity and outcomes. The Interactive Systems Framework outlines how the prevention support system-especially TA-bolsters EBP dissemination and implementation.

METHODS

Using a cluster randomized controlled design, this trial will test the overall effectiveness of the Coalition Check-Up, including how it contributes to EBP implementation and prevention of youth substance use. The first aim is to estimate the impact of the Coalition Check-Up on coalitions' capacity to do their work. We will recruit 68 anti-drug coalitions for random assignment to the Coalition Check-Up or "TA as usual" condition. We will evaluate whether the Coalition Check-Up improves coalition capacity using measures of coalition member responses about team processes, coalition network composition, and collaborative structure. Our second aim is to estimate the impact of the Coalition Check-Up on implementation of EBPs, and our third aim is to estimate the impact of the Coalition Check-Up on youth substance use.

DISCUSSION

This project will clarify how the Coalition Check-Up, a scalable approach to TA due to its low cost, affects coalition capacity to support EBP implementation. Analyses also provide insight into causal pathways from the prevention support system to the prevention delivery system outlined by the Interactive Systems Framework. Results will build the evidence-base for how to support community coalitions' sustainable implementation of evidence-based prevention programs and policies.

TRIAL REGISTRATION

Clinicaltrials.gov registration number NCT04592120 . Registered on October 19, 2020.

The Challenges of Promoting Social Inclusion through Sport: The Experience of a Sport-Based Initiative in Italy

Social inclusion is broadly recognized as a priority to accomplish at an international level. While the influence of sport toward this social mission has been largely debated, literature lacks contributions capturing the challenges of sport when promoting social inclusion. Based in case study methodology, the investigation explores the impact of a multi-stakeholder sport initiative developing social inclusion for socially vulnerable youth and the related challenges of the intervention through in-depth interviews with diverse program stakeholders. The main findings indicated the emergence of four challenges: limited transferability of program outcomes for youth in living conditions of severe vulnerability; drop-out of youth in living conditions of severe vulnerability; limited sustainability of program social workers; lack of sports club management skills. The work highlights some limits of sport-based programs for social inclusion and discusses some implications for practice to maximize the societal impact of such interventions.

Long-term Impacts and Benefit-Cost Analysis of the Communities That Care Prevention System at Age 23, 12 Years After Baseline

This study estimated sustained impacts and long-term benefits and costs of the Communities That Care (CTC) prevention system, implemented and evaluated in a longitudinal cluster-randomized trial involving 24 communities in seven states. Analyses utilized reports from a longitudinal panel of 4407 participants, followed since the study's baseline in grade 5, with most recent follow-up 12 years later at age 23. Impacts on lifetime abstinence from primary outcomes of substance use and antisocial behavior were estimated using generalized linear mixed Poisson regression analysis, adjusted for individual and community-level covariates. Possible cascading effects on 4-year college completion, major depressive disorder, and generalized anxiety disorder through age 23 were evaluated as secondary outcomes. CTC had a statistically significant global effect on primary outcomes and also on combined primary and secondary outcomes. Among primary outcomes, point estimates suggested absolute improvements in lifetime abstinence of 3.5 to 6.1% in the intervention arm and relative improvements of 13 to 55%; 95% confidence intervals revealed some uncertainty in estimates. Among secondary outcomes, 4-year college completion was 1.9% greater among young adults from intervention communities, a 20% relative improvement. Mental health outcomes were approximately the same across trial arms. Although CTC had small sustained effects through age 23, benefit-cost analyses indicated CTC was reliably cost beneficial, with a net present value of $7152 (95% credible interval: $1253 to $15,268) per participant from primary impacts and $17,919 ($306 to $39,186) when secondary impacts were also included. It remained cost beneficial even when impacts were adjusted downward due to the involvement of CTC's developer in the trial. Findings suggest that broader dissemination of CTC could improve public health and individual lives in the long term and generate positive net benefits to society.

A Latent Class Analysis of Prevention Approaches Used to Reduce Community-Level Prescription Drug Misuse in Adolescents and Young Adults

The Substance Abuse and Mental Health Services Administration's Strategic Prevention Framework Partnerships for Success (PFS) program supports community-based organizations (CBOs) across the United States in implementing evidence-based prevention interventions to reduce substance use in adolescents and young adults. Little attention has been paid to how CBOs combine interventions to create comprehensive community-specific prevention approaches, or whether different approaches achieve similar community-level effects on prescription drug misuse (PDM). We used PFS evaluation data to address these gaps. Over 200 CBOs reported their prevention intervention characteristics, including strategy type (e.g., prevention education, environmental strategies) and number of unique interventions. Evaluation staff coded whether each intervention was an evidence-based program, practice, or policy (EBPPP). Latent Class Analysis of seven characteristics (use of each of five strategy types, use of one or more EBPPP, and number of interventions implemented) identified six prevention approach profiles: High Implementation EBPPP, Media Campaigns, Environmental EBPPP, High Implementation Non-EBPPP, Prevention Education, and Other Information Dissemination. All approaches except Media Campaigns and Other Information Dissemination were associated with significant reductions in community-level PDM. These approaches may need to be paired with other, more direct, prevention activities to effectively reduce PDM at the community level. However, similar rates of change in PDM across all 6 prevention approaches suggests only weak evidence favoring use of the other four approaches. Community-based evaluations that account for variability in implemented prevention approaches may provide a more nuanced understanding of community-level effects. Additional work is needed to help CBOs identify the most appropriate approach to use based on their target communities' characteristics and resources.

A Comparison of Cut Points for Measuring Risk Factors for Adolescent Substance Use and Antisocial Behaviors in the U.S. and Colombia

As the identification and targeting of salient risk factors for adolescent substance use become more widely used globally, an essential question arises as to whether U.S.-based cut points in the distributions of these risk factors that identify "high" risk can be used validly in other countries as well. This study examined proportions of youth at "high" risk using different empirically derived cut points in the distributions of 18 measured risk factors. Data were obtained from large-scale samples of adolescents in Colombia and the United States. Results indicated that significant (p < 0.05) differences in the proportions of "high" risk youth were found in 38.9% of risk factors for 6th graders, 61.1% for 8th graders, and 66.6% for 10th graders. Colombian-based cut points for determining the proportion of Colombian youth at "high" risk were preferable to U.S.-based cut points in almost all comparisons that exhibited a significant difference. Our findings suggest that observed differences were related to the type of risk factor (e.g., drug specific vs. non-drug specific). Findings from this study demonstrate the need for collecting large-scale national data on risk factors for adolescent substance use and developing country-specific cut points based on the distributions of these measures to avoid misidentification of youth at "high" risk.

Scaling up and scaling out: Consilience and the evolution of more nurturing societies

This paper argues that diverse disciplines within the human sciences have converged in identifying the conditions that human beings need to thrive and the programs, policies, and practices that are needed to foster well-being. In the interest of promoting this view, we suggest that this convergence might usefully be labeled "The Nurture Consilience." We review evidence from evolutionary biology, developmental, clinical, and social psychology, as well as public health and prevention science indicating that, for evolutionary reasons, coercive environments promote a "fast" life strategy that favors limited self-regulation, immediate gratification, and early childbearing. However, this trajectory can be prevented through programs, practices, and policies that (a) minimize toxic social and biological conditions, (b) limit opportunities and influences for problem behavior, (c) richly reinforce prosocial behavior, and (d) promote psychological flexibility. The recognition of these facts has prompted research on the adoption, implementation, and maintenance of evidence-based interventions. To fully realize the fruits of this consilience, it is necessary to reform every sector of society. We review evidence that free-market advocacy has promoted the view that if individuals simply pursue their own economic well-being it will benefit everyone, and trace how that view led business, health care, education, criminal justice, and government to adopt practices that have benefited a small segment of the population but harmed the majority. We argue that the first step in reforming each sector of society would be to promote the value of ensuring everyone's well-being. The second step will be to create contingencies that select beneficial practices and minimizes harmful ones.

Public Health Benefits 16 Years After a Statewide Policy Change: Communities That Care in Pennsylvania

Communities That Care (CTC), an evidence-based prevention system, has been installed outside of a research context in over 500 communities worldwide. Yet, its effectiveness in a non-research context is unknown. Using a repeated cross-sectional design with propensity score weighting at the school district-level, the purpose of this study was to examine the effect of widespread diffusion of CTC across Pennsylvania on adolescent substance use, delinquency, and depression. Anonymous youth survey data were collected from 6th, 8th, 10th, and 12th grade students every other year from 2001 to 2011. Three-hundred eighty-eight school districts participated in one to six waves of data collection during that time, resulting in a total of 470,798 student-reported observations. The intervention school districts received programming provided by CTC coalitions. Outcome measures were lifetime and past 30-day alcohol, tobacco, marijuana, and other drug use. Lifetime and past year participation in delinquency and current depressive symptoms were also analyzed. Analyses revealed that CTC school districts had significantly lower levels of adolescent substance use, delinquency, and depression. This effect was small to moderate, depending on the particular outcome studied. Overall effects became stronger after accounting for use of evidence-based programs; there are likely differences in implementation quality and other factors that contribute to the observed overall small effect size. Future research needs to unpack these factors.

The Impact of Comprehensive Community Initiatives on Population-Level Child, Youth, and Family Outcomes: A Systematic Review

Comprehensive community initiatives (CCIs) represent a popular method for creating systemic change, yet there is a dearth of evidence on their effectiveness (Zaff, Pufall Jones, Donlan, Lin, & Anderson, 2016). This article presents a systematic review of the evidence on the population-level impact of CCIs, focusing specifically on documented effects from studies using an experimental or quasi-experimental design. Of 1,947 articles identified through a database and hand search, 25 articles examining six different CCIs-most of which employed prevention science frameworks-met the review inclusion criteria. The results of this review show that CCIs can strengthen protective factors and reduce risk factors, delay initiation of and reduce substance use, and reduce the likelihood of, and delay engagement in, violent and/or delinquent behaviors. Impacts have been documented as soon as one year after initial intervention, and as early as 7^th grade, with effects sustained as long as seven years post-intervention, and as late as a year post-high school. However, relative to the prevalence of CCIs as a practical intervention, the evidence base is small, potentially dated, and focused on a narrow set of outcomes and populations. Recommendations for interpreting the evidence base are discussed, including methodological limitations and implications for future work.

Community Interventions to Promote Mental Health and Social Equity

(Reprinted with permission from Current Psychiatry Reports (2020) 21: 35).

Scaling up Evidence-Based Interventions in US Public Systems to Prevent Behavioral Health Problems: Challenges and Opportunities

A number of programs, policies, and practices have been tested using rigorous scientific methods and shown to prevent behavioral health problems (Catalano et al., Lancet 379:1653-1664, 2012; National Research Council and Institute of Medicine, 2009). Yet these evidence-based interventions (EBIs) are not widely used in public systems, and they have limited reach (Glasgow et al., American Journal of Public Health 102:1274-1281, 2012; National Research Council and Institute of Medicine 2009; Prinz and Sanders, Clinical Psychology Review 27:739-749, 2007). To address this challenge and improve public health and well-being at a population level, the Society for Prevention Research (SPR) formed the Mapping Advances in Prevention Science (MAPS) IV Translation Research Task Force, which considered ways to scale up EBIs in five public systems: behavioral health, child welfare, education, juvenile justice, and public health. After reviewing other efforts to scale up EBIs in public systems, a common set of factors were identified as affecting scale-up in all five systems. The most important factor was the degree to which these systems enacted public policies (i.e., statutes, regulations, and guidance) requiring or recommending EBIs and provided public funds for EBIs. Across systems, other facilitators of scale-up were creating EBIs that are ready for scale-up, public awareness of and support for EBIs, community engagement and capacity to implement EBIs, leadership support for EBIs, a skilled workforce capable of delivering EBIs, and data monitoring and evaluation capacity. It was concluded that the following actions are needed to significantly increase EBI scale-up in public systems: (1) provide more public policies and funding to support the creation, testing, and scaling up of EBIs; (2) develop and evaluate specific frameworks that address systems level barriers impeding EBI scale-up; and (3) promote public support for EBIs, community capacity to implement EBIs at scale, and partnerships between community stakeholders, policy makers, practitioners, and scientists within and across systems.

Design and outcome measures for the AB InBev Global Smart Drinking Goals evaluation

We describe the rationale for and design of an independent evaluation of the Global Smart Drinking Goals (GSDG) program. The primary purpose of this program, supported by the AB InBev Foundation, is to reduce harms associated with alcohol use by 10%. Our evaluation focuses on the effects of prevention strategies sponsored by the Foundation that are being implemented in six city pilots located in as many countries. These strategies are designed to reduce heavy episodic drinking, underage drinking, drink driving, and alcohol-related violence. Each city pilot has been matched with a comparison city in which the GSDG program will not be implemented. In this quasi-experimental community trial, we will assess each city pilot's progress toward reaching its harm reduction goals, relative to its comparison city, by means of annual adult and youth surveys. We will then supplement these analyses with the use of pertinent local archival data, where available. We discuss several challenges related to this evaluation and its quasi-experimental design. These include operating in a fluid and unpredictable environment in regard to the implementation, adaptation, and (on occasion) abandonment of the prevention strategies selected by each city pilot. We also discuss issues concerning our decision to accept funding from the alcohol industry and the measures we have taken to ensure the independence of our evaluation.

The Ultimate Goal of Prevention and the Larger Context for Translation

Type II translational research tends to emphasize getting evidence-based programs implemented in real world settings. To fully realize the aspirations of prevention scientists, we need a broader strategy for translating knowledge about human wellbeing into population-wide improvements in wellbeing. Far-reaching changes must occur in policies and cultural practices that affect the quality of family, school, workplace, and community environments. This paper describes a broad cultural movement, not unlike the tobacco control movement, that can make nurturing environments a fundamental priority of public policy and daily life, thereby enhancing human wellbeing far beyond anything achieved thus far.

Community Interventions to Promote Mental Health and Social Equity

PURPOSE OF REVIEW

We review recent community interventions to promote mental health and social equity. We define community interventions as those that involve multi-sector partnerships, emphasize community members as integral to the intervention, and/or deliver services in community settings. We examine literature in seven topic areas: collaborative care, early psychosis, school-based interventions, homelessness, criminal justice, global mental health, and mental health promotion/prevention. We adapt the social-ecological model for health promotion and provide a framework for understanding the actions of community interventions.

RECENT FINDINGS

There are recent examples of effective interventions in each topic area. The majority of interventions focus on individual, family/interpersonal, and program/institutional social-ecological levels, with few intervening on whole communities or involving multiple non-healthcare sectors. Findings from many studies reinforce the interplay among mental health, interpersonal relationships, and social determinants of health. There is evidence for the effectiveness of community interventions for improving mental health and some social outcomes across social-ecological levels. Studies indicate the importance of ongoing resources and training to maintain long-term outcomes, explicit attention to ethics and processes to foster equitable partnerships, and policy reform to support sustainable healthcare-community collaborations.

Teacher support within an ecological model of adolescent development: Predictors of school engagement

There is a need to further understand the development of student engagement. Ecological models of adolescent development state that proximal factors, such as teacher support, should strongly influence student engagement. Theoretical models also explain concurrent influences from the individual, family, peer, and community contexts. The current study applied an ecological model to the development of five indicators of students' engagement in school. Six hundred and sixty-five full-time Grade 11 students and an additional 54 students who had dropped out of school from Victoria, Australia, completed a Communities That Care survey in term 3 of Grade 10 and term 3 of Grade 11. Grade 10 risk and protective factors from the school (e.g., teacher support), individual (e.g., academic grades, prior engagement), family (e.g., family management practices), peer (e.g., antisocial peer affiliation), and community contexts (e.g., community disorganization) were modeled as predictors of five indicators of Grade 11 engagement (academic engagement, emotional engagement, school discipline, absences from school, and school dropout). Teacher support at Grade 10 had bivariate associations with Grade 11 academic engagement (r = 0.37), emotional engagement (r = 0.35), absences from school (r = -0.14), and school discipline responses (OR = 0.64). The full ecological models explained between 22 and 34% of the variance in engagement; however, teacher support did not predict engagement. Prior engagement and academic grades explained the greatest proportion of variance in students' engagement. Factors from the family, peer, and community contexts made unique contributions to some indicators of engagement. The findings suggest that there is a need to consider student engagement as a long-term process. Implications for improving students' engagement are discussed within an individualized stage-environment fit model of adolescent development.

Community Readiness to Adopt the Communities That Care Prevention System in an Urban Setting

INTRODUCTION

This manuscript highlights initial activities from a 5-year project to build a community coalition focused on the promotion of family, school, and community connectedness; academic investment; and social and emotional well-being among black male youth and their families, as well as the prevention and reduction of risk behaviors. Project activities were planned according to the step-by-step coalition-based prevention system, Communities That Care.

METHODS

During Year 1 (2013/2014), semi-structured interviews were conducted with 14 community members (parents, school administrators and teachers, and community leaders and volunteers) to evaluate readiness to adopt Communities That Care. Participants were asked to (1) define community; (2) identify community strengths; (3) recommend methods to strengthen community relationships; (4) envision ideal coalition functions; (5) identify current community resources; (6) recommend prevention targets and methods; (7) identify potential barriers to coalition participation; and (8) assess overall community readiness to adopt Communities That Care. Analyses were conducted in Year 3 (2015/2016).

RESULTS

Participants expressed eagerness and readiness to adopt Communities That Care. They identified community strengths and local resources that could contribute to coalition success, as well as potential barriers to participation and group cohesion that if left unaddressed could diminish coalition impact. Participants believed that links between multiple environments (home, school, community) should be strengthened in order to promote the well-being of youth. They envisioned the Communities That Care coalition as a task force of community members with varying talents invested in youth across their entire life course.

CONCLUSIONS

Community members' insights may be used to guide implementation of Communities That Care by this coalition and others.

SUPPLEMENT INFORMATION

This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.

Implementing the Communities That Care Prevention System: Challenges, Solutions, and Opportunities in an Urban Setting

INTRODUCTION

Communities That Care, refined and tested for more than 25years, offers a step-by-step coalition-based approach to promote well-being and prevent risk behaviors among youth. Communities That Care guides coalitions to identify and prioritize underlying risk and protective factors; set specific, measurable community goals; adopt tested, effective prevention programs to target selected factors; and implement chosen programs with fidelity. Communities That Care has been implemented in a variety of communities, but has only recently begun to be systematically evaluated in diverse, urban communities.

METHODS

This paper presents a process evaluation of Communities That Care implementation within a Midwestern ethnically diverse, urban community. In-depth surveys of 25 black male youth aged 8-14years and their caregivers were conducted to determine the degree to which coalition-selected priorities aligned with the experience of black families. Implementation and survey data were collected in 2014-2017 and analyzed in 2017-2018.

RESULTS

Roughly 30% of youth reported ever being bullied or bullying someone else on school property; this aligned with the coalition's decision to focus on positive social skills and bullying prevention. Additional data aligned with the coalition's intent to expand its community action plan to encompass other priorities, including family transitions and mobility. For example, roughly one third of caregivers went on welfare and one third of families moved to a new home or apartment in the past year.

CONCLUSIONS

In communities whose residents have experienced historical and current inequities, an effective community prevention plan may need to address structural as well as social determinants of well-being among youth and their families.

SUPPLEMENT INFORMATION

This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.

Long-Term Effects of the Communities That Care Trial on Substance Use, Antisocial Behavior, and Violence Through Age 21 Years

OBJECTIVES

To evaluate whether the effects of the Communities That Care (CTC) prevention system, implemented in early adolescence to promote positive youth development and reduce health-risking behavior, endured through age 21 years.

METHODS

We analyzed 9 waves of prospective data collected between 2004 and 2014 from a panel of 4407 participants (grade 5 through age 21 years) in the community-randomized trial of the CTC system in Colorado, Illinois, Kansas, Maine, Oregon, Utah, and Washington State. We used multilevel models to evaluate intervention effects on sustained abstinence, lifetime incidence, and prevalence of past-year substance use, antisocial behavior, and violence.

RESULTS

The CTC system increased the likelihood of sustained abstinence from gateway drug use by 49% and antisocial behavior by 18%, and reduced lifetime incidence of violence by 11% through age 21 years. In male participants, the CTC system also increased the likelihood of sustained abstinence from tobacco use by 30% and marijuana use by 24%, and reduced lifetime incidence of inhalant use by 18%. No intervention effects were found on past-year prevalence of these behaviors.

CONCLUSIONS

Implementation of the CTC prevention system in adolescence reduced lifetime incidence of health-risking behaviors into young adulthood. Clinicaltrials.gov identifier: NCT01088542.

A Systematic Review of Life Skill Development Through Sports Programs Serving Socially Vulnerable Youth

PURPOSE

Despite the strong belief in sports programs as a setting in which socially vulnerable youth can develop life skills, no overview exists of life skill development in sports programs serving this youth group. Therefore, the present systematic review provides an overview of the evidence on life skill development in sports programs serving socially vulnerable youth and, insofar as it was investigated in the included studies, of the conditions conducive to life skill development in these sports programs.

METHOD

Potentially relevant studies published during 1990 to 2014 were identified by a search in 7 electronic databases. The search combined terms relating to (a) sport, (b) youth AND socially vulnerable, and (c) life skills. Eighteen of the 2,076 unique studies met the inclusion criteria.

RESULTS

Each included study reported that at least 1 life skill improved in youth who participated in the studied sports program. Improvements in cognitive and social life skills were more frequently reported than were improvements in emotional life skills. Only a few of the included studies investigated the conditions in the studied sports programs that made these programs conducive to life skill development.

CONCLUSIONS

Sports programs have the potential to make a difference in the life skill development of socially vulnerable youth. This conclusion needs to be treated with some caution, because the studies experienced many challenges in reducing the risk for bias. Several alternative research strategies are suggested for future studies in this field.

Effects of Sectoral Diversity on Community Coalition Processes and Outcomes

Collaboration with diverse partners is challenging but essential for the implementation of prevention programs and policies. Increased communication with partners from diverse sectors may help community coalitions overcome the challenges that diversity presents. We examined these issues empirically in a study of 17 substance use prevention coalitions in Mexico. Building on coalition and workgroup literatures, we hypothesized that sectoral diversity would improve outcomes but undermine coalition processes. Conversely, we expected uniformly positive effects from higher levels of intersectoral communication. Data are from a 2015 survey of 211 members within the 17 community coalitions. Regression models used sectoral diversity and intersectoral communication to predict coalition processes (cohesion, leader-member communication, efficiency) and outcomes (community support, community improvement, sustainability planning). Sectoral diversity was negatively associated with coalition processes and was not associated with coalition outcomes. Intersectoral communication was positively associated with two of the three measures of coalition outcomes but not associated with coalition processes. Our findings concur with those from prior research indicating that sectoral diversity may undermine coalition processes. However, more communication between sectors may facilitate the coalition outcomes of community support and sustainability planning. Skilled team leaders and participatory decision making may also help coalitions promote intersectoral communication, thereby engaging diverse community sectors to implement preventive interventions and actualize sustained public health impact.

Systematic review of universal school-based 'resilience' interventions targeting adolescent tobacco, alcohol or illicit substance use: A meta-analysis

Universal school-based interventions that address adolescent 'resilience' may represent a means of reducing adolescent substance use, however previous systematic reviews have not examined the effectiveness of such an intervention approach. A systematic review was undertaken to 1) assess whether universal school-based 'resilience' interventions are effective in reducing the prevalence of tobacco, alcohol or illicit substance use by adolescents, and 2) describe such effectiveness per intervention characteristic subgroups. Eligible studies were peer-reviewed reports (1994-2015) of randomised controlled trials including participants aged 5-18years that reported adolescent tobacco, alcohol or illicit substance use, and implemented a universal school-based 'resilience' intervention (i.e. those addressing both individual (e.g. self-esteem) and environmental (e.g. school connectedness) protective factors of resilience). Trial effects for binary outcomes were synthesised via meta-analyses and effect sizes reported as odds ratios. Subgroup (by intervention type, prevention approach, setting, intervention duration, follow-up length) and sensitivity analyses (excluding studies at high risk of bias) were conducted. Nineteen eligible studies were identified from 16,619 records (tobacco: n=15, alcohol: n=17, illicit: n=11). An overall intervention effect was found for binary measures of illicit substance use (n=10; OR: 0.78, 95%CI: 0.6-0.93, p=0.007,Tau²=0.0, I²=0%), but not tobacco or alcohol use. A similar result was found when studies assessed as high risk of bias were excluded. Overall intervention effects were evident for illicit substance use within multiple intervention characteristic subgroups, but not tobacco and alcohol. Such results support the implementation of universal school-based interventions that address 'resilience' protective factors to reduce adolescent illicit substance use, however suggest alternate approaches are required for tobacco and alcohol use. PROSPERO registration: CRD42014004906.

Assessment of Risk and Protection in Native American Youth: Steps Toward Conducting Culturally Relevant, Sustainable Prevention in Indian Country

BACKGROUND

This study constitutes a building block in the cultural adaptation of Communities That Care (CTC), a community-based prevention system that has been found to be effective in reducing youth problem behaviors.

METHODS

Using the data from the CTC normative survey dataset that consists of more than quarter million youth nationwide, this study examines the reliability and validity of scores derived from the Communities That Care Youth Survey (CTC-YS), one of the primary assessment tools for gathering community data on risk and protective factors related to problem behaviors including substance use. The reliability and criterion validity analyses are conducted overall for the nationwide sample of youth as well as for the student subsample of Native American youth.

RESULTS

The results of this study indicate that the existing CTC-YS assessments of risk and protective factors in the domains of community, family, school, and peer groups as well as within individuals yield scores that are reliable and valid within the Native American sample of youth.

CONCLUSIONS

This study informs the third step in the CTC prevention planning process, which involves the assessment of risk and protective factors to be targeted in preventive interventions. The question of how the assessment of risk and protective factors among Native American youth might be further improved and a description of efforts related to the cultural adaptation of the CTC program currently underway are also addressed in the discussion.

Scaling Up a Multifaceted Violence Prevention Package: County-Level Impact of the North Carolina Youth Violence Prevention Center

OBJECTIVE

Multifaceted approaches to youth-violence prevention package evidence-based programs into initiatives that yield large-scale impact. This study assessed the impact of a package of evidence-based violence prevention programs, implemented as part of the North Carolina Youth Violence Prevention Center, on county-level violence indicators.

METHOD

Using growth-curve modeling, the target county was compared to all other counties in North Carolina and a comparison county.

RESULTS

Results reveal downward trends on several county-level indicators (i.e., undisciplined/delinquent complaints, total delinquent complaints, juvenile arrests-aggravated assaults, and short-term suspensions) throughout the intervention period. However, statistical tests were unable to confirm that intervention-period scores on youth-violence indicators were significantly different than expected scores given the relationship between pretest and intervention-period scores in other North Carolina counties.

CONCLUSIONS

Although additional administrative data points are needed to support the hypotheses, this study provides preliminary evidence of the effectiveness of North Carolina Youth Violence Prevention Center interventions.

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.

Beneficial Action within Altruistic and Prosocial Behavior

This article integrates knowledge from health psychology, life course development, and social psychology to outline a theoretical framework for identifying, investigating, promoting, and evaluating beneficial action. Beneficial action is defined as a subset of prosocial (motivated to benefit others that may include self-interest) and altruistic (prosocial motivation without self-interest) behavior that uses consequential (scientific) knowledge to increase freedom within the global population. Beneficial action theory seeks to increase political and social actions that are planned and evaluated to ensure key tasks in human development. Central among these is the broadening of social identity to ensure that the human potential to use science to modify the natural environment achieves benefits for the global population. This article presents a theoretical framework for conceptualizing the psychological processes that underlie the development, application and evaluation of beneficial action for individuals and populations. The need to conceptualize beneficial action arises from 3 related observations. First, the certainty of knowledge of the beneficial outcome of a specific human action increases the moral motivation to engage in that action. For example, there is consensus among psychologists and other professions that it is unethical to engage in therapeutic practices that have evidence for neutral or harmful consequences. Second, due to the rapid increase in scientific knowledge, the range of human action that has scientifically ascertainable consequences is rapidly expanding. Third, advancing scientific knowledge means that human actions have increasingly powerful consequences for humanity and the natural world, warranting careful consideration of how to ensure global population benefits.

Evidence-Based Prevention for Adolescent Substance Use

Due to the significant consequences of adolescent substance use behaviors, researchers have increasingly focused on prevention approaches. The field of prevention science is based on the identification of predictors of problem behaviors, and the development and testing of prevention programs that seek to change these predictors. As the field of prevention science moves forward, there are many opportunities for growth, including the integration of prevention programs into service systems and primary care, an expansion of program adaptations to fit the needs of local populations, and a greater emphasis on the development of programs targeted at young adult populations.

Universal Prevention Exposure as a Moderator of the Community Context: Findings from the PROSPER Project

This study examined how participation in a universal family skills-building program may interact with community risks and resources to produce youth outcomes. Prior research has noted community-level variability in risk and protective factors, but thus far no study has examined the role that participation on a community-wide intervention may play in moderating the effects of community risks or resources. The study included 14 communities (seven in Iowa, seven in Pennsylvania) that implemented a family focused evidence-based program as part of the PROSPER project. Community level variables included both risk factors (percent of low income families, the availability of alcohol and tobacco, norms regarding adolescent substance use, incidence of drug-related crimes) and community resources (proactive school leadership, availability of youth-serving organizations, and student involvement in youth activities). The proximal youth and family outcomes included youth perceptions of their parents' management skills, parent-child activities, and family cohesion. Results indicated that the Strengthening Families Program:10-14 may have moderated the impact of the community risks and resources on community-level youth outcomes; risk levels meaningfully associated with community-level change in program participants, though these results varied somewhat by outcome. Generally, higher levels of resources also meaningfully associated with more positive change after participating in the family-focused intervention. These results suggest that the effect of some evidence-based programs may be even stronger in some communities than others; more research in this area is needed.

Reciprocal relations between coalition functioning and the provision of implementation support

Community coalitions have been promoted as a strategy to help overcome challenges to the dissemination and implementation of evidence-based prevention programs. This paper explores the characteristics of coalitions that enable the provision of implementation support for prevention programs in general and for the implementation of evidence-based prevention programs with fidelity. Longitudinal cross-lagged panel models were used to study 74 Communities That Care (CTC) coalitions in Pennsylvania. These analyses provide evidence of a unidirectional influence of coalition functioning on the provision of implementation support. Coalition member knowledge of the CTC model best predicted the coalition's provision of support for evidence-based program implementation with fidelity. Implications for developing and testing innovative methods for delivering training and technical assistance to enhance coalition member knowledge are discussed.

Evaluating Youth Development Programs: Progress and Promise

Advances in theories of adolescent development and positive youth development have greatly increased our understanding of how programs and practices with adolescents can impede or enhance their development. In this paper the authors reflect on the progress in research on youth development programs in the last two decades, since possibly the first review of empirical evaluations by Roth, Brooks-Gunn, Murray, and Foster (1998). The authors use the terms Version 1.0, 2.0 and 3.0 to refer to changes in youth development research and programs over time. They argue that advances in theory and descriptive accounts of youth development programs (Version 2.0) need to be coupled with progress in definitions of youth development programs, measurement of inputs and outputs that incorporate an understanding of programs as contexts for development, and stronger design and evaluation of programs (Version 3.0). The authors also advocate for an integration of prevention and promotion research, and for use of the term youth development rather than positive youth development.

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.

Achieving successful evidence-based practice implementation in juvenile justice: The importance of diagnostic and evaluative capacity

Evidence-based programs (EBPs) are an increasingly visible aspect of the treatment landscape in juvenile justice. Research demonstrates that such programs yield positive returns on investment and are replacing more expensive, less effective options. However, programs are unlikely to produce expected benefits when they are not well-matched to community needs, not sustained and do not reach sufficient reach and scale. We argue that achieving these benchmarks for successful implementation will require states and county governments to invest in data-driven decision infrastructure in order to respond in a rigorous and flexible way to shifting political and funding climates. We conceptualize this infrastructure as diagnostic capacity and evaluative capacity: Diagnostic capacity is defined as the process of selecting appropriate programing and evaluative capacity is defined as the ability to monitor and evaluate progress. Policy analyses of Washington State, Pennsylvania and Louisiana's program implementation successes are used to illustrate the benefits of diagnostic and evaluate capacity as a critical element of EBP implementation.

Comparing the Functioning of Youth and Adult Partnerships for Health Promotion

Youth partnerships are a promising but understudied strategy for prevention and health promotion. Specifically, little is known about how the functioning of youth partnerships differs from that of adult partnerships. Accordingly, this study compared the functioning of youth partnerships with that of adult partnerships. Several aspects of partnership functioning, including leadership, task focus, cohesion, participation costs and benefits, and community support, were examined. Standardized partnership functioning surveys were administered to participants in three smoke-free youth coalitions (n = 44; 45 % female; 43 % non-Hispanic white; mean age = 13) and in 53 Communities That Care adult coalitions (n = 673; 69 % female; 88 % non-Hispanic white; mean age = 49). Multilevel regression analyses showed that most aspects of partnership functioning did not differ significantly between youth and adult partnerships. These findings are encouraging given the success of the adult partnerships in reducing community-level rates of substance use and delinquency. Although youth partnership functioning appears to be strong enough to support effective prevention strategies, youth partnerships faced substantially more participation difficulties than adult partnerships. Strategies that youth partnerships can use to manage these challenges, such as creative scheduling and increasing opportunities for youth to help others directly, are discussed.

CREATE-ing capacity to take developmental crime prevention to scale: A community-based approach within a national framework

Developmental crime prevention is founded on the long-term outcomes and economic efficiency of about 50 promising or model programs for fostering healthy child and youth development and for preventing crime. However, few if any of these programs have been successfully implemented on a large scale, a problem that is the focus of Type 2 (T2) Translation Research within prevention science. This paper describes one approach to building capacity for population-level community-based developmental prevention using the CREATE model that we developed as an outcome of the Pathways to Prevention Project that operated in a disadvantaged region of Brisbane between 2002 and 2011. CREATE is an acronym: Collaborative; Relationships-driven; Early in the pathway; Accountable; Training-focused; Evidence-driven. CREATE is being used to develop, in T2 Translation terms, a prevention support system (PSS) for the Communities for Children (CfC) program, a prevention delivery system that is operated by the Department of Social Services in 52 communities across Australia. The aim is to build the capacity for schools and community agencies to transcend system silos; foster ethical practices and respectful relationships; and deliver goal-directed, quantitatively evaluated, evidence-based resources that address the needs of families with complex needs, promote child wellbeing and prevent antisocial and criminal behaviours. The PSS combines web-based interactive electronic resources for schools and community agencies serving children in CfC communities with systems and processes established by project personnel called Collective Impact Facilitators who build the skills and knowledge of community coalitions to use the electronic resources and implement CREATE effectively. This capacity building exercise is being evaluated through a comprehensive array of pre- and post-measures of coalition functioning. The PSS integrates with national prevention infrastructure developed by DSS, including a Data Exchange System, an Expert Panel, and an Information Exchange.

Risikofaktoren für problematischen Substanzkonsum von Jugendlichen – Zur Anwendbarkeit des Communities That Care Schülersurveys auf kommunaler Ebene

Zusammenfassung. Zielsetzung: „Communities That Care“ (CTC) ist ein strategischer Ansatz, der die kommunale Präventionssteuerung unterstützt. Auf Basis eines Schülersurveys werden anhand der Prävalenz von Risikofaktoren Präventionsbedarfe priorisiert. Für die Bestimmung eines validen Schwellenwertes für die Risikofaktoren wurde der Median + 0.15*median absolute deviation (MAD) vorgeschlagen ( Arthur et al., 2007 ). Im vorliegenden Beitrag wird die Übertragbarkeit dieser Berechnungsart für Risikofaktoren für problematischen ‚Substanzkonsum‘ hinsichtlich Sensitivität, Spezifität und Kriteriumsvalidität an einer deutschen CTC-Stichprobe überprüft. Zudem wird die Anwendung der Schwellenwerte an einem Praxisbeispiel illustriert. Methodik: Basierend auf einer repräsentativen niedersächsischen CTC-Stichprobe, wurden die Daten von N = 1.423 Schülerinnen und Schülern (52,9 % weiblich) aus den Klassenstufen sechs bis elf im Alter von 12 – 18 Jahren (M = 14,29; SD = 1,74) in die Analysen miteingeschlossen. Ergebnisse: Der verwendete Schwellenwert führte nur teilweise zu einer annehmbaren Balance zwischen Sensitivität und Spezifität. Die Kriteriumsvalidität ist insbesondere für die individuellen Risikofaktoren hoch. Schlussfolgerungen: Der CTC-Schülersurvey ist ein vielversprechendes Instrument für die gezielte Planung und Steuerung von Präventionsmaßnahmen auf kommunaler Ebene. Für die Bestimmung valider Schwellenwerte für Deutschland sind weitere Untersuchungen nötig.

Community coalition-driven interventions to reduce health disparities among racial and ethnic minority populations

BACKGROUND

Racial and ethnic disparities in health status are pervasive at all stages of the life cycle. One approach to reducing health disparities involves mobilizing community coalitions that include representatives of target populations to plan and implement interventions for community level change. A systematic examination of coalition-led interventions is needed to inform decision making about the use of community coalition models.

OBJECTIVES

To assess effects of community coalition-driven interventions in improving health status or reducing health disparities among racial and ethnic minority populations.

SEARCH METHODS

We searched MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Social Science Citation Index, Dissertation Abstracts, System for Information on Grey Literature in Europe (SIGLE) (from January 1990 through September 30, 2013), and Global Health Library (from January 1990 through March 31, 2014).

SELECTION CRITERIA

Cluster-randomized controlled trials, randomized controlled trials, quasi-experimental designs, controlled before-after studies, interrupted time series studies, and prospective controlled cohort studies. Only studies of community coalitions with at least one racial or ethnic minority group representing the target population and at least two community public or private organizations are included. Major outcomes of interest are direct measures of health status, as well as lifestyle factors when evidence indicates that these have an effect on the direct measures performed.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed risk of bias for each study.

MAIN RESULTS

Fifty-eight community coalition-driven intervention studies were included. No study was considered to be at low risk of bias. Behavioral change outcomes and health status change outcomes were analyzed separately. Outcomes are grouped by intervention type. Pooled effects across intervention types are not presented because the diverse community coalition-led intervention studies did not examine the same constructs or relationships, and they used dissimilar methodological designs. Broad-scale community system level change strategies led to little or no difference in measures of health behavior or health status (very low-certainty evidence). Broad health and social care system level strategies leds to small beneficial changes in measures of health behavior or health status in large samples of community residents (very low-certainty evidence). Lay community health outreach worker interventions led to beneficial changes in health behavior measures of moderate magnitude in large samples of community residents (very low-certainty evidence). Lay community health outreach worker interventions may lead to beneficial changes in health status measures in large samples of community residents; however, results were not consistent across studies (low-certainty evidence). Group-based health education led by professional staff resulted in moderate improvement in measures of health behavior (very low-certainty evidence) or health status (low-certainty evidence). Adverse outcomes of community coalition-led interventions were not reported.

AUTHORS' CONCLUSIONS

Coalition-led interventions are characterized by connection of multi-sectoral networks of health and human service providers with ethnic and racial minority communities. These interventions benefit a diverse range of individual health outcomes and behaviors, as well as health and social care delivery systems. Evidence in this review shows that interventions led by community coalitions may connect health and human service providers with ethnic and racial minority communities in ways that benefit individual health outcomes and behaviors, as well as care delivery systems. However, because information on characteristics of the coalitions themselves is insufficient, evidence does not provide an explanation for the underlying mechanisms of beneficial effects. Thus, a definitive answer as to whether a coalition-led intervention adds extra value to the types of community engagement intervention strategies described in this review remains unattainable.

A systematic review of sexual health interventions for adults: narrative evidence

Recent work has explored the intersection between sexual health (as construed by the World Health Organization and others) and public health domains of action in the United States of America. This article reports the narrative results of a systematic review of sexual health intervention effects on public health-relevant outcomes. To qualify, interventions had to be based on the principles (1) that sexual health is intrinsic to individuals and their overall health and (2) that relationships reflecting sexual health must be positive for all parties concerned. Outcomes were classed in domains: knowledge, attitudes, communication, health care use, sexual behavior, and adverse events. We summarized data from 58 studies (English language, adult populations, 1996-2011) by population (adults, parents, sexual minorities, vulnerable populations) across domains. Interventions were predominantly individual and small-group designs that addressed sexual behaviors (72%) and attitudes/norms (55%). They yielded positive effects in that 98% reported a positive finding in at least one domain; 50% also reported null effects. The most consistently positive effects on behaviors and adverse events were found for sexual minorities, vulnerable populations, and parental communication. Whether via direct action or through partnerships, incorporating principles from existing sexual health definitions in public health efforts may help improve sexual health.

Transforming prevention systems in the United States and the Netherlands using Communities That Care Promising prevention in the eyes of Josine Junger-Tas

Josine Junger-Tas introduced the Communities That Care (CTC) prevention system to the Netherlands as a promising approach to address the growing youth violence and delinquency. Using data from a randomized trial of CTC in the United States and a quasi-experimental study of CTC in the Netherlands, this article describes the results of a comparison of the implementation of CTC in 12 U.S. communities and 5 Dutch neighborhoods. CTC communities in both countries achieved higher stages of a science-based approach to prevention than control communities, but full implementation of CTC in the Netherlands was hampered by the very small list of prevention programs tested and found effective in the Dutch context.

Science-based prevention through communities that care: a model of social work practice for public health

This article describes a public health orientation to drug and alcohol abuse prevention; reviews the state of the science underlying a risk and protective factor approach to alcohol and drug abuse prevention; describes Communities That Care, a community practice model that makes use of this evidence; and considers how this model reflects four important principles of social work practice. The intent of this article is to provide guidance to social workers who support the National Association of Social Work's intention to make prevention practice central to the provision of alcohol and drug abuse services by social workers.

The role of a state-level prevention support system in promoting high-quality implementation and sustainability of evidence-based programs

Although numerous evidence-based programs (EBPs) have been proven effective in research trials and are being widely promoted through federal, state, and philanthropic dollars, few have been "scaled up" in a manner likely to have a measurable impact on today's critical social problems. The Interactive Systems Framework for Dissemination and Implementation (ISF) explicates three systems that are critical in addressing the barriers that prevent these programs from having their intended public health impact. In this article we describe the relevance of these systems in a real-world context with a specific focus on the Prevention Support System (PSS). We expand on the ISF model by presenting funders and policy-makers as active and engaged stakeholders, and demonstrate how a state-level PSS has used empirical evidence to inform general and program-specific capacity-building and support interactions among researchers, funders, and practitioners in Pennsylvania. By embracing this expanded ISF framework as a conceptual model for the wide-scale dissemination and support of EBPs, and recognizing the need for a distinct state-level PSS, Pennsylvania has created an infrastructure to effectively address the primary barriers to moving from lists of EBPs to achieving population-level public health improvement.

A state agency-university partnership for translational research and the dissemination of evidence-based prevention and intervention

This article describes a decade-long partnership between the Prevention Research Center at Penn State and the Pennsylvania Commission on Crime and Delinquency. This partnership has evolved into a multi-agency initiative supporting the implementation of nearly 200 replications of evidence-based prevention and intervention programs, and a series of studies indicating a significant and sustained impact on youth outcomes and more efficient utilization of system resources. We describe how the collaboration has developed into a sophisticated prevention support infrastructure, discuss the partnership and policy lessons learned throughout this journey, and identify remaining issues in promoting this type of research-policy partnership.