Public Health Benefits 16Years After a Statewide Policy Change: Communities That Care in Pennsylvania
Public Health Benefits 16Years After a Statewide Policy Change: Communities That Care in Pennsylvania
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DOI：
10.1007/s11121-019-01028-y
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发表时间：
2019-08-01
影响因子：
3.5
通讯作者：
Lew, Daphne
中科院分区：
文献类型：
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作者：
Chilenski, Sarah M.;Frank, Jennifer;Lew, Daphne
社区护理（CTC）是一个基于证据的预防系统，已在全球500多个社区安装在研究背景之外。然而，它在非研究背景下的有效性是未知的。本研究采用重复横截面设计，在学区水平上使用倾向得分加权，目的是检验CTC在宾夕法尼亚州广泛扩散对青少年物质使用、犯罪和抑郁的影响。从2001年到2011年，每隔一年对六年级、八年级、十年级和十二年级的学生进行匿名青少年调查。在此期间，388个学区参与了一到六次数据收集，总共产生了470,798份学生报告的观察结果。干预学区接受了由反恐中心联盟提供的方案。结果测量终生和过去30天的酒精、烟草、大麻和其他药物使用情况。终生和过去一年参与犯罪和当前抑郁症状也进行了分析。分析显示，CTC学区的青少年药物使用、犯罪和抑郁水平明显较低。根据研究的具体结果，这种影响从小到中等不等。考虑到使用循证方案后，总体效果变得更强；实施质量和其他因素可能存在差异，导致观察到的总体效应较小。未来的研究需要解开这些因素。
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.