Long-term Effects of Communities That Care on Young Adults from Small Towns

描述（由申请人提供）：拟议研究的主要目的是调查关怀社区（CTC）预防系统对青少年药物滥用和滥用的长期影响；在一项随机试验中首次安装 CTC 后 11 和 13 年后的犯罪、暴力和监禁情况。还将审查 CTC 对成年早期显着的次要结果的长期影响，包括艾滋病毒/艾滋病性危险行为；性传播感染（STI）；沮丧;和教育程度。这项研究将是首批检验社区预防系统长期影响的研究之一，并将调查重要的调节机制，包括接触 CTC 以及 CTC 影响在风险相关和人口亚群（包括拉丁裔/年轻人）中的普遍性。该研究的第二个目的是通过研究成人角色的采用模式及其与药物滥用和其他年轻人结果的关系，来研究小城镇和农村城镇青年向成年的过渡。小社区面临着独特的挑战，即许多最有前途的年轻人离开了，并且没有为社区的健康和未来做出贡献。那些留下来的年轻人可能面临许多危害健康的行为。然而，在小城镇和农村城镇，预防、保健和治疗服务却较少且不易获得。该研究的目标将通过为期 4 年的社区青年发展研究（CYDS；PI：Hawkins，#5R01DA15183-8）的延续来实现，这是一项在 7 个州的 24 个社区进行的 CTC 随机试验，评估了 CTC 在 5 年实施阶段首次安装后 6 至 10 年内以及技术援助和研究提供的资金结束后的可持续性和影响。每年都会对这些社区的 5 年级学生 (n=4407) 进行调查，直至 12 年级。后续研究将跟踪该小组直至青年期；在 21 岁和 23 岁时再收集两波数据。如果研究表明 CTC 对结果产生持久的改善，并持续到成年早期，那么它将证明 CTC 对长期个人和公共健康的持久贡献，这可能会进一步增加其既定的成本效益。拟议的研究还有可能增加对小城镇青年（研究不足和服务不足的人群）向成年过渡和相关健康风险行为的了解。 CTC 可以成为小型和农村社区的重要工具，帮助那些高中毕业后留在社区的年轻人成为有生产力和有贡献的公民。

DESCRIPTION (provided by applicant): The primary purpose of the proposed research is to investigate the long-term effects of the Communities That Care (CTC) prevention system on young adult substance use and misuse; crime, violence, and incarceration 11 and 13 years following CTC's initial installation in a randomized trial. Long-term effects of CTC will be examined also on secondary outcomes salient in young adulthood, including HIV/AIDS sexual risk behaviors; sexually transmitted infections (STIs); depression; and educational attainment. This study will be one of the first to examine the long-term effects of a community prevention system and will investigate important moderating mechanisms, including exposure to CTC and universality of CTC effects across risk- related and demographic subgroups, including Latino/a young adults. A second aim of the study is to examine the transition to adulthood among youth from small and rural towns by examining patterns in the adoption of adult roles and their associations with substance misuse and other young adult outcomes. Small communities face the unique challenge that many of their most promising young adults move away and do not contribute to the health and future of the community. Those young adults who stay may be at higher risk for many health- risking behaviors. Yet services for prevention, health care, and treatment are less available and less accessible in small and rural towns. The aims of the study will be accomplished through a 4-year continuation of the Community Youth Development Study (CYDS; PI: Hawkins, #5R01DA15183-8), a randomized trial of CTC in 24 communities across 7 states that assessed the sustainability and effects of CTC 6 to 10 years following its initial installation during the 5-year implementation phase and after technical assistance and study-provided funding ended. A panel of 5th graders (n=4407) in these communities has been surveyed annually through 12th grade. The continuation study will follow this panel into young adulthood; collecting two more waves of data at ages 21 and 23. If the study shows that CTC produces enduring improvements in outcomes that last into young adulthood, it will demonstrate CTC's lasting contribution to long-term individual and public health, which could further increase its established cost-benefit. The proposed study also has the potential to increase knowledge about the transition to adulthood and associated health-risking behaviors among youth from small towns, an understudied and underserved population. CTC could be an important tool for small and rural communities in preparing those young adults who remain in the community after high school to become productive and contributing citizens.