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社区护理（CTC）预防系统对年轻人药物使用和滥用的长期影响；犯罪，暴力和监禁在CTC首次安装后的11到13年的随机试验中。还将审查CTC对青年期突出的次要结局的长期影响，包括艾滋病毒/艾滋病性风险行为；性传播感染；抑郁症;还有受教育程度。这项研究将是第一个检查社区预防系统的长期影响的研究之一，并将调查重要的调节机制，包括暴露于CTC和CTC效应在风险相关和人口统计亚组中的普遍性，包括拉丁裔/年轻成年人。这项研究的第二个目的是，通过审查采用成人角色的模式及其与药物滥用和其他青年结果的关系，审查来自小城镇和农村的青年向成年过渡的情况。小社区面临着独特的挑战，许多最有前途的年轻人搬走了，对社区的健康和未来没有贡献。那些留下来的年轻人可能会有很多危害健康的行为。然而，在小城镇和农村，预防、保健和治疗服务的提供和获取较少。该研究的目的将通过社区青年发展研究（CYDS; PI: Hawkins, #5R01DA15183-8）的4年延续来实现，这是一项在7个州的24个社区进行的CTC随机试验，评估CTC在最初安装后6至10年的可持续性和效果，在5年实施阶段，在技术援助和研究提供的资金结束后。每年对这些社区的一组五年级学生（n=4407）进行调查，直到12年级。继续研究将跟随这个小组进入青年期；在21岁和23岁时又收集了两波数据。如果这项研究表明，CTC在持续到青年期的结果方面产生了持久的改善，它将证明CTC对长期个人和公众健康的持久贡献，这可能进一步提高其既定的成本效益。这项拟议的研究也有可能增加对小城镇青年（一个未被充分研究和服务不足的人群）向成年期过渡和相关健康风险行为的认识。CTC可以成为小型和农村社区的一个重要工具，帮助那些高中毕业后仍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.