Preventing substance misuse through community-university partnerships: Randomized controlled trial outcomes 4 1/2 years past baseline

Background: Substance misuse by adolescents and related health issues constitute a major public health problem. Community-based partnership models designed for sustained, quality implementation of proven preventive interventions have been recommended to address this problem. There is very limited longitudinal study of such models. Purpose: To examine the long-term findings from an RCT of a community-university partnership model designed to prevent substance misuse and related problems. Design/setting/participants: A cohort sequential design included 28 public school districts in rural towns and small cities in Iowa and Pennsylvania that were randomly assigned to community-university partnership or usual-programming conditions. At baseline, 11,960 students participated, across two consecutive cohorts. Data were collected from 2002 to 2008. Intervention: Partnerships supported community teams that implemented universal, evidence-based interventions selected from a menu. The selected family-focused intervention was implemented with 6th-grade students and their families; school-based interventions were implemented during the 7th grade. Observations demonstrated intervention implementation fidelity. Main outcome measures: Outcome measures were lifetime, past-month, and past-year use of a range of substances, as well as indices of gateway and illicit substance use; they were administered at baseline and follow-ups, extending to 4.5 years later. Results: Intent-to-treat, multilevel ANCOVAs of point-in-time use at 4.5 years past baseline were conducted, with supplemental analyses of growth in use. Data were analyzed in 2009. Results showed significantly lower substance use in the intervention group for 12 of 15 point-in-time outcomes, with relative reductions of up to 51.8%. Growth trajectory analyses showed significantly slower growth in the intervention group for 14 of 15 outcomes. Conclusions: Partnership-based implementation of brief universal interventions has potential for public health impact by reducing growth in substance use among youth; a multistate network of partnerships is being developed. Notably, the tested model is suitable for other types of preventive interventions.