Community-based prevention systems
Community-based models form an important component in alcohol, tobacco and illicit drug (substance) abuse prevention systems. Community models target both place-based communities and distinct sub-populations (e.g., defined by common identity, ethnicity, socioeconomic conditions or substance abuse risk). Community models recognise that substance abuse is influenced by many socioecological levels including the family, peer groups, schools, neighbourhoods, and markets.
Community-based models are often distinguished by the fact that they implement two or more components (e.g., school drug education, parent education, behavioural message interventions, and enforcement of laws). They are attractive as they enable large populations to be cost-effectively reached (Close et al, 2021) and hold the potential to involve local people in prevention initiatives. They are often a requirement for co-ordinating within specific community settings across component prevention strategies such as school drug education, parent education, behavioural message interventions, and enforcement of laws regarding the sale of alcohol and tobacco to minors.
The Universal Prevention Curriculum (UPC) includes related topics in areas such as Environment-based Prevention Interventions, Media-based Prevention Interventions and Community-based Prevention Implementation Systems. Each of these topics hold relevance for work with community models.
Evidence from systematic reviews suggest that community-based models have some evidence for preventing youth tobacco use (Carson et al, 2011). However, effects on reducing alcohol use (Walmisley et al, 2024) or illicit drug use (Gates et al, 2006) are less clearly established. Based on the existing research it is not clear whether co-ordinating multiple components in community models is cost-effective relative to pursuing any of these components on their own.
An important problem in efforts to demonstrate effectiveness is that both communities and prevention models differ in ways that make it difficult to compare across study outcomes. To provide a firmer foundation for implementation and evaluation many teams select to use a standard model. In this context, many countries have implemented and evaluated the Communities That Care model. The Communities That Care youth survey has been shown to provide a cross-nationally valid and reliable community assessment (Thurow et al, 2021) enabling the level of community risk to be accurately assessed. The Communities That Care coalition training process is well documented across 5-phases that enable implementation fidelity to be evaluated as a moderator of outcomes (e.g., Rowland et al, 2022). The Communities That Care model was successfully adapted in Australia and has demonstrated population benefits in reducing youth substance use (Toumbourou et al, 2019), police reported crime (Rowland et al, 2022) and injury hospitalisation (Berecki-Gisolf et al, 2020).
In summary, community-based models form an important component in the prevention systems available to ISSUP members. Given existing evaluations are equivocal, it is recommended that ISSUP regional groups form research partnerships and design robust evaluations to contribute to international scientific understanding of how community models work in diverse country contexts. It is recommended that regional groups collaborate to use the same evaluation surveys and models in different countries enabling cross-national studies to more confidently compare communities, processes and outcomes.
Conflict of Interest Declaration
Professor Toumbourou has a Conflict-of-Interest management plan approved at Deakin University in relation to his role as a voluntary Director of the not-for-profit Australian company Communities That Care Ltd.
References
Berecki-Gisolf, J., Rowland, B., Reavley, N., Minuzzo, B., Toumbourou, J. (2020) Evaluation of community coalition training effects on youth hospital-admitted injury incidence in Victoria, Australia: 2001–2017. Injury Prevention. 26(5), 463-470. https://doi.org/10.1136/injuryprev-2019-043386
Carson KV, Brinn MP, Labiszewski NA, Esterman AJ, Chang AB, Smith BJ. (2011) Community interventions for preventing smoking in young people. Cochrane Database Syst Rev. 2011(7):CD001291. https://doi.org/10.1002/14651858.CD001291.pub2.
Close C, Elek E, Roberts CA, Dunlap LJ, Graham PW, Scaglione NM, Palen LA, Clarke T. (2021) A National Cost Analysis of Community Interventions to Prevent Underage Drinking and Prescription Drug Misuse. Prevention Science. 22(8):1071-1085. https://doi.org/10.1007/s11121-021-01229-4.
Gates S, McCambridge J, Smith LA, Foxcroft DR. (2006) Interventions for prevention of drug use by young people delivered in non-school settings. Cochrane Database Syst Rev. (1):CD005030. https://doi.org/10.1002/14651858.CD005030.pub2.
Rowland, B., Kelly, A.B., Mohebbi, M., Kremer, P., Abrahams, C., Abimanyi-Ochom, J., Carter, R., Williams, J., Smith, R., Osborn, A., Hall, J., Hossein, T., Renner, H., Toumbourou, J.W. (2022) Evaluation of Communities That Care - Effects on Municipal Youth Crime Rates in Victoria, Australia: 2010 – 2019. 23, 24–35, Prevention Science. https://doi.org/10.1007/s11121-021-01297-6
Thurow, C. F., Nunes, C., & Schneider, D. R. (2021). Psychometrics and cultural adaptations of the Communities That Care Youth Survey: A systematic review. Journal of Community Psychology, 49(7), 2892-2904. https://doi.org/10.1186/s12889-020-09766-z
Toumbourou, J.W. Rowland, B., Williams, J., Smith, R., & Patton, G.C. (2019) Community intervention to prevent adolescent health behavior problems: Evaluation of Communities that Care in Australia. Health Psychology. 38(6), 536-544. http://dx.doi.org/10.1037/hea0000735
Walmisley U, De Jong M, George A, Okeyo I, Späth C, Siegfried N, Harker N, Tomlinson M, Doherty T. (2024) Whole-of-community and intersectoral interventions that address alcohol-related harms: A scoping review. Global Public Health. 19(1):2357211. https://doi.org/10.1080/17441692.2024.2357211.
