Table 2 Table of characteristics and extracted data

Kristjansson et al. 2020 [22, 50] (Iceland)

Icelandic Prevention Model (IPM)

Description

In response to the high rates of adolescent substance use in Iceland, policymakers and social scientists came together to explore bottom-up collaborative approaches to substance use prevention and developed the Icelandic Prevention Model (IPM). Grounded in theories of social deviance, rather than behaviour change models, IPM was based on the theory that most individuals are capable of deviant acts, but only under certain environmental and social circumstances will those acts become common patterns among dominant groups of adolescents. The goal of the approach from the outset was to mobilise society as a whole in the struggle against adolescent substance misuse, with emphasis on community engagement and collaboration leading to long-standing and gradual environmental and social change rather than short-term solutions.

Coalition information

Results

The evaluation demonstrated a significant difference in group trends over time in smoking and alcohol use, parental monitoring, party lifestyle, and participation in organised sports, with the treatment group being favoured in all instances. Since the original development of the model, Iceland has led the decline in substance use in all of Europe. In 2015, the rate of ever smoking tobacco was 46% among 10th grade adolescents in Europe but had plunged to 16% in Iceland; average rates of current alcohol use were 48% in Europe but 9% in Iceland; and average rates of lifetime use of cannabis substances remained at 16% in Europe, similar to 1999, but declined to 5% in Iceland. Iceland had also witnessed large reductions in risk factors and strengthening of protective factors. For example, 10th grade students reporting parents knowing with whom they spend time in the evenings increased from ~ 50% in 2000 to just over 74% in 2016.

1. A model of ‘guiding principles’ that are flexible and not prescriptive in terms of intervention choice, but guide communities through a framework they can continually come back to.

2. A diverse coalition of policymakers, experts and local people.

3. Commitment to data collection and establishing community readiness

4. Weaving the guiding principles throughout different systems (e.g. schools, family, policy)—multi-component approach

5. High adolescent substance use

6. Developing a whole-country approach (relatively small country and an island)

7. Focus on social theories and risk and protective factors over and above risk behaviour change

• Community empowerment

• Credibility—through strong consideration of local data (e.g. annual surveys)

• Flexibility and relevance to each community

• Collaboration and strengthening connections between family, school and community (establishing cohesion and unified focus)

• Intervention champions (mechanism resource)

1. Model of guiding principles integrated into all fractions of adolescent life (context) ➔ empowered community members and local stakeholders to make their own decisions that align with the principles (mechanism) ➔ resulting in successful implementation outcomes and then improvements in protective factors and reductions in adolescent substance use (outcomes).

2. Model of guiding principles integrated into all fractions of adolescent life (context) ➔ encourage strong collaboration across schools, families, policy and practice, all ‘on the same page’, bolstered by the mechanistic resource or intervention champions who worked to maintain collaboration ➔ resulting in successful implementation outcomes and then improvements in protective factors and reductions in adolescent substance use (outcomes).

3. Commitment to establishing community readiness ➔ using relevant and timely data through surveys (resource) which enhance the credibility of the approach (mechanism reaction) and ensured the community would respond well to the intervention ➔ resulting in successful implementation outcomes and then improvements in protective factors and reductions in adolescent substance use (outcomes).

4. A diverse coalition of policy and prevention stakeholders and community members ➔ balances expertise and knowledge with community relevance and empowerment—ability to enact change and collaborate ➔ resulting in successful implementation outcomes and then improvements in protective factors and reductions in adolescent substance use (outcomes).

^***

Libuy et al. 2023 [51] (Chile)

Icelandic Prevention Model delivered in Chile

Description

In 2018, six municipalities in Greater Santiago, Chile, implemented the Icelandic prevention model, including

structured assessments of prevalence and risk factors of substance use in 10th grade high school students every 2 years. Totally, 7538 participants were surveyed in 2018 and 5528 in 2020, nested in 125 schools from the six municipalities. The survey underwent a process of cultural and linguistic adaptation involving members of the municipal prevention teams, experts, and piloting among adolescents to ensure understanding, adequacy, and representation of relevant substances commonly used by adolescents in Chile

Coalition information

No information about the coalition(s), but if implementing the IPM, coalitions should be a mixture of community members and stakeholders with policy and prevention expertise.

Results

Lifetime alcohol use decreased from, past-month alcohol use decreased from, and lifetime cannabis use decrease from. Several risk factors improved between 2018 and 2020: staying out of home after 10 p.m., alcohol use in friends, drunkenness in friends, and cannabis use in friends. However, other factors deteriorated in 2020: perceived parenting, depression and anxiety symptoms, and low parental rejection of alcohol use. The decrease of substance use prevalence in adolescents was attributable at least in part to a reduction of alcohol use in friends. This could be related to social distancing policies, curfews, and homeschooling during the pandemic in Chile that implied less physical interactions between adolescents. The increase of depression and anxiety symptoms may also be related to the COVID-19 pandemic. The factors rather attributable to the prevention intervention did not show substantial changes (i.e. sports activities, parenting, and extracurricular activities). In conclusion, the study showed a marked reduction of alcohol and cannabis use in adolescents in six municipalities of the Greater Metropolitan Region of Santiago in Chile, which have started to implement the Icelandic prevention model since 2018. However, these results can be influenced by measures to control the pandemic, and are not necessarily attributable to the effectiveness of the model. The implementation of the prevention model is an ongoing process, that in the future may need the transfer of further components.

1. A model of ‘guiding principles’ that are flexible and not prescriptive in terms of intervention choice, but guide communities through a framework they can continually come back to.

2. Commitment to data collection, establishing community readiness and transferability of the intervention to Latin America.

3. Focus on social theories and risk and protective factors over and above risk behaviour change

• Community empowerment

• Credibility—through strong consideration of local data (e.g. annual surveys)

• Flexibility and relevance to each community

• Collaboration and strengthening connections between family, school and community (establishing cohesion and unified focus)

1. Model of guiding principles integrated into all fractions of adolescent life (context) ➔ empowered community members and local stakeholders to make their own decisions (relevant to the Latin America context) that align with the principles (mechanism) ➔ resulting in successful implementation outcomes and then improvements in protective factors and reductions in adolescent substance use (outcomes).

2. Commitment to establishing community readiness and adapting the intervention to Latin America ➔ using relevant and timely data through surveys and collaborating with Iceland colleagues (resource) which enhance the credibility of the approach (mechanism reaction) and ensured the community would respond well to the intervention ➔ resulting in successful implementation outcomes and then improvements in protective factors and reductions in adolescent substance use (outcomes).

3. Implementation alongside Covid-19 pandemic measures ➔ supported some mechanisms (collaborations across policy and schools) and made others a challenge (e.g. extracurricular activities) ➔ A challenge to determine whether it was pandemic measures or the intervention that impacted on risk and protective factors and reductions in substance use.

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Asgeirsdottir et al. 2021 [52] (Lithuania)

Icelandic Prevention Model in Lithuania

Description

With the aim of improving the social conditions of young people in Lithuania and to decrease substance use related harms, in 2006 the Lithuanian cities Kaunas, Klaipeda and Vilnius begun implementing the IPM via their participation in the Youth in Europe project in cooperation with Icelandic Centre for Social Research and Analysis (ICSRA) and the Stockholm-based European Cities against Drugs Organization.7–9 The implementation of the IPM was aligned with the IPM in Iceland, including the key pillars of the model.1,4,5 In all the cities, the work has been evidence-based, surveys have been carried out on a regular basis and data collected and processed using ICSRA standards. Survey findings have been disseminated throughout communities and schools and results presented to parents and other local stakeholders. Municipal administration and community stakeholders have set goals, and formed policy and practice based on the study findings. Major focus areas include emphasis on increasing parental monitoring, parental involvement, youth participation in organised and supervised leisure activities, and preventing unsupervised parties and late outside hours among young people. Data collected from repeated, comparative cross-sectional self-report surveys conducted among a total of 30 572 10th graders in the cities of Kaunas, Klaipeda and Vilnius, Lithuania, from 2006 to 2019, were analysed. Cochran– Armitage test for linear trend and analysis of variance for linear trend was used to assess time-trends in prevalence of substance use and mean levels of primary prevention variables over time.

Coalition information

No information about the coalition.

Results

Following the implementation of IPM rates of cigarette smoking and the use of alcohol, cannabis and amphetamine has decreased among 10th graders in Lithuania’s three largest cities and simultaneously preventive variables targeted have improved. Similar to Iceland, primary prevention variables were related to substance use in the expected direction, with the exception of organised sports participation, which was not associated with less likelihood of alcohol, cannabis and amphetamine use

1. A model of ‘guiding principles’ that are flexible and not prescriptive in terms of intervention choice, but guide communities through a framework they can continually come back to.

2. Commitment to data collection, establishing community readiness and transferability of the intervention to Latin America.

• Community empowerment

• Credibility—through strong consideration of local data (e.g. annual surveys)

1. Commitment to model of guiding principles integrated into all fractions of adolescent life (context) ➔ empowered community members and local stakeholders to make their own decisions (relevant to the Baltic country context) that align with the principles (mechanism) ➔ resulting in successful implementation outcomes and then improvements in protective factors and reductions in adolescent substance use (outcomes).

2. Commitment to establishing community readiness and adapting the intervention to Lithuania ➔ using relevant and timely data through surveys and collaborating with Iceland colleagues (resource) which enhance the credibility of the approach (mechanism reaction) and ensured the community would respond well to the intervention ➔ resulting in successful implementation outcomes and then improvements in protective factors and reductions in adolescent substance use (outcomes).

^***

Shrestha 2019 (USA) [53]

Community Prevention and Wellness Initiative (CPWI)

Description

The primary long-term outcome of interest for CPWI is reducing youth behavioural problems, especially underage drinking among 8th and 10th graders. Five step process similar to SPF. Once CPWI communities are selected, they take part in a five-step strategic planning process that uses survey and archival data to help community coalitions coordinate, assess, plan, implement, and evaluate youth substance use prevention services. CPWI communities are expected to conduct programmes in a culturally competent manner, build community capacity for prevention programming, and maintain a long-term vision for sustainability during planning and implementation efforts.

Coalition information

• Pre-existing coalitions and new coalitions (but funding is specifically for youth problems)

• 6 coalitions across 18 communities, with between 8–12 individuals on each

• Mix of strategic leaders, community residents and young people

Results

CPWI was effective in reducing adolescent alcohol use and some family and community risk factors. Higher rates of cigarette use in CPWI communities and mixed results for marijuana and combined use.

1. Relaxed social norms towards marijuana use

2. Coalitions form (or are pre-existing) then apply for funds specifically for adolescent health risk behaviour

3. Established funding structure and public health approach on a national level

• Technical assistance

• Prevention training

• Motivation for intervention delivery

• Single focus (clarity)

• Organisation

1. Relaxed social norms towards some adolescent health risk behaviours (e.g. through marijuana legalisation) (context) ➔ motivation to engage with community strategies limited (mech) ➔ difficulty in reducing health risk behaviours

2. Coalition is specifically formed for the purpose of rallying around the problem of high rates of adolescent health risk behaviours (context) ➔ the coalition will have a single focused aim, which leads to greater organisation and empowerment through clarity (mech) ➔ positive implementation/health risk behaviour outcomes (outcome)

3. Established funding structure, time spent on community readiness and a history of adolescent public health (context) ➔ technical assistance and prevention training will be provided to trigger motivation for the intervention delivery (mech) ➔ resulting in positive outcomes (outcome)

^****

Galai et al. 2018 [54] (Thailand)

Connect to Protect (C2P) Thailand

Description

This approach works to mobilise the community, through the formation of coalitions, composed of local leaders from various sectors, that develop and implement structural changes at the community level to address key health issues: illicit drug use (methamphetamine) and HIV risk behaviours (risky sex and drug use), alcohol use, cannabis use, selling MA in 14–24-year-olds.

Coalition information

• A local community coalition was assembled in each of the intervention districts.

• Representatives from the local communities, public health and education sectors, police officials and religious leaders.

Results

Reduction in methamphetamine use in both intervention and control with no meaningful difference. Shift in approach from legal to public health framework. Activities were triggered in both intervention and control communities.

1. Community problems with adolescent MRB

2. Societal context (i.e. developing country, ‘war on drugs’ legal framework)

3. Coalition newly formed of local ‘leaders’

4. Lack of public health delivery system

5. Rural town

6. Limited funding

• Motivation through shame and fear

• Low understanding of prevention science

• Developing and designing own approaches

1. Community problems ➔ motivation ➔ implementation outcomes and unintended consequences

2. Societal context/legal framework and public health delivery system ➔ low understanding of prevention science ➔ implementation outcomes and ineffective programmes for adolescent MRB

3. Limited funding ➔ difficulty developing and designing programmes among the coalition ➔ low motivation and organisation ➔ ineffective against adolescent MRB outcomes

4. Coalition members community leaders in a newly formed coalition ➔

^***

Hallfours et al. 2002 (USA) [23]

Fighting Back, from The Robert Wood Johnson Foundation

Description

Fighting Back, initiated by RWJF promoted the notion of comprehensive approach adolescent health risk behaviours.

The aim was that local political, business, and grass-roots leaders all come together around a community “table” to assess the substance abuse problems in their community and to develop a comprehensive, coordinated response. Although communities were encouraged to devise their own programmes based on local context and needs, they were required to develop a single, community-wide system of prevention and treatment, which at minimum included: (1) public awareness; (2) prevention, targeted especially at youth and children; (3) early identification and intervention; and (4) treatment and relapse prevention

Coalition composition

Newly formed coalition with community representatives and strategic leaders.

Results

Strategies aimed at either youth or community/ prevention outcomes showed no effects, while strategies to improve adult-focused outcomes showed significant negative effects over time, compared to matched controls. Coalitions with a more comprehensive array of strategies did not show any superior benefits, and increasing the number of high-dose strategies showed a significant negative effect on overall outcomes.

1. National framework supporting community mobilisation

2. Funding structure for coalition-based prevention activities and technical assistance

3. Grassroots coalitions applying for funds (community representatives/strategic leaders on coalition)

• Flexibility over own strategies

• Ownership and commitment to intervention

• Empowerment through designing own strategies

• Motivation to continue with intervention

1. Coalition starts with community members applying for funds in a grassroots way (context) ➔ design and develop their own chosen strategies relevant to the community problem of adolescent health risk behaviours, leading to a sense of ownership, empowerment, flexibility and commitment to intervention ➔ positive community level and health risk behaviour outcomes

RIVAL THEORY 2.1: Coalition starts with community members applying for funds in a grassroots way (context) ➔ design and develop their own chosen strategies relevant to the community problem of adolescent health risk behaviours ➔ lack of structure, oversight and knowledge of evidence based programmes ➔ implementation of ineffective programmes and no change in youth outcomes

2. Funding available to be applied for by coalitions ➔ technical assistance and the delivery of a wide range of strategies, leading to stronger motivation for the intervention as coalition and community members know there is sustainability in their efforts ➔ leading to positive community level and implementation outcomes.

^***

Brown 2015 [55] and Feinberg 2010 [56] and Chilenski 2019 [57] and Feinberg 2004 [58] (USA)

Communities that Care (CTC) Pennsylvania

Description

The CTC strategy is an intervention approach focused on adolescents aged 10–14 years, providing guidance through training and technical assistance to (1) organise members of communities into collaborative coalitions, (2) develop coalition capacities such as the knowledge and skills to use a science-based approach to prevention, (3) conduct an epidemiological assessment of adolescent risk and protective factors to identify community needs, (4) prioritise community needs and select evidence-based programmes (EBPs) to address those priorities, and (5) implement EBPs and monitor community prevention efforts and outcomes to ensure a high-quality implementation and the achievement of goals. The majority of the programmes are school-based. Since 1994, the Pennsylvania Commission for Crime and Delinquency (PCCD) has funded the development and training of over 125 CTC coalitions. Supporting the success of CTC coalitions are coalition mobilisers and technical assistance providers. Coalitions hire a mobiliser to help organise day-to-day operations.

Coalition composition

127 coalitions—mixed sizes and compositions although the aim is to include a mix of strategic partners and community residents. There is an oversight body the coalitions report to.

Results

Community coalitions can affect adolescent risk and protective behaviours at a population level when evidence-based programmes are utilised. CTC represents an effective model for disseminating such programmes. 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 programmes; 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.

1. National framework supporting community mobilisation

2. Funding structure for coalition-based prevention activities and technical assistance

3. Step by step process to follow to mobilise community and deliver strategies

4. Small (often rural) towns with distinct ‘community’ boarders

• Menu of evidence based programmes

• Motivation to continue (funding provided and previous success)

• Trust and credibility of programmes menu

• Low flexibility (to design own strategies)

1. National funding structure (context) ➔ coalition can pay for technical assistance and the delivery of a wide range of strategies (resources) ➔ stronger motivation for the intervention as coalition and community members know there is sustainability in their efforts (mech reasoning) ➔ positive community level and implementation outcomes.

2. There is a long history and established method for adolescent health coalitions (context) ➔ a menu of strategies and school-based programmes (mech resource) ➔ promotes trust among coalition and community members (reasoning) ➔ leading to successful implementation and reductions in adolescent health risk behaviours.

3. There is a long history and established method for adolescent health coalitions (context) ➔ a menu of strategies and school-based programmes (mech resource) ➔ limits flexibility and empowerment of the coalition members (reasoning) ➔ the focus is largely on the evidence based programmes to deliver successful outcomes, not the community members. Whatever they choose will hopefully lead to successful outcomes

4. Small (often rural) towns with distinct ‘community’ boarders ➔ clarity and focus on schools in a defined area ➔ strong sense of ‘community’ and the needs ➔ easier to determine outcomes and assign them to intervention

^****

Fagan 2009 [59] and Oesterle-2015 [60] and Oesterle-2018 [61] and Hawkins 2012 (USA) [62]

Communities that Care (CYDS)

Description

Communities That Care (CTC) is a system for guiding communities to choose, install, and monitor tested and effective preventive interventions to address elevated risks and suppressed protective factors affecting youth aged 10–14 years. The CTC system is expected to produce community-wide changes in prevention system functioning, including increased adoption of a science-based approach to prevention and increased use of tested, effective preventive interventions that address risk and protective factors prioritised by the community. The majority of the programmes delivered are school-based. Coalitions chose to deliver 18 school based programmes implemented across 12 communities.

Coalition composition

516 members over 12 coalitions, which includes strategic partners and community residents. 24 small towns in 7 states, matched within state.

Results

Several implementation and health risk behaviour outcomes over many years, most seeing a reducing in risk behaviours. For example, the results indicated that intervention communities enacted, on average, 90% of the core components of the CTC system, and achieved high rates of implementation fidelity when replicating school, afterschool, and parent training programmes [59]. In 2012, mean levels of targeted risks increased less rapidly between grades 5 and 10 in CTC than in control com- munities and were significantly lower in CTC than control communities in grade 10. The incidence of delinquent behaviour, alcohol use, and cigarette use and the prevalence of current cigarette use and past-year delinquent and violent behaviour were significantly lower in CTC than in control communities in grade 10 [62]. In 2015, CTC had an overall effect across lifetime measures of the primary outcomes for males, but not for females or the full sample, although lifetime abstinence from delinquency in the full sample was significantly higher in CTC communities (ARR = 1.16) [60]. Finally, in 2018, The CTC system increased the likelihood of sustained abstinence from gateway drug use by 49% and antisocial behaviour by 18%, and reduced lifetime incidence of violence by 11% through age 21 years. In male participants, the CTC system also increased the likelihood of sustained abstinence from tobacco use by 30% and marijuana use by 24%, and reduced lifetime incidence of inhalant use by 18%. No intervention effects were found on past-year prevalence of these behaviours (Oesterle et al. 2018).

1. National framework supporting community mobilisation

2. Funding structure for coalition-based prevention activities and technical assistance

3. Step by step process to follow to mobilise community and deliver strategies

4. Small (often rural) towns with distinct ‘community’ boarders

• Community champions of the intervention

• Collaboration with schools

• Menu of evidenced based programmes to select

• Credibility of programmes and wider intervention

• Ownership of coalition members

• Low flexibility (over developing own programmes)

• Motivation and empowerment

1. National history and funding structure that supports community mobilisation ➔ community members (champions) act as catalysts for the intervention (mechanism) and there are leaders to motivate the community and maintain focus throughout schools upon adolescent health behaviours (mechanism reasoning) ➔ successful implementation and health risk behaviour outcomes.

2. If there is funding available at a government or local level for technical assistance and support (context) ➔ this fosters credibility and early support for the intervention (reasoning) ➔ leading to positive health behaviour outcomes

3. Funding structure to support community mobilisation (context) ➔ ensures training available for community members (resource) ➔ which maintains ownership over the project and empowers people in the community (reasoning) ➔ leading to successful implementation

4. Having a menu of strategies (mech resource) ➔ within the context of key community stakeholders and residents on the coalition (context) ➔ promotes empowerment as the coalition members, who may have little public health experience, can feel confident in choosing from a menu instead of designing their own programmes (reasoning) ➔ leading to positive health behaviour outcomes

5. The structure and methodology of a programme like CTC (mech resource) ➔ within the supportive societal context of adolescent health prevention (context) ➔ promotes credibility, organisation and motivation (mech reasoning) ➔ for quicker success in implementation and health behaviour outcomes (outcomes)

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Toumbourou et al. 2019 [63] (Australia)

Communities that Care Australia

Description

The Australian license to implement the CTC process was purchased from the U.S. developer in 1999 and a company was formed to offer the technical assistance and resources to Australian communities. The Australian implementation of CTC was initiated using the training manuals and technical resources available in 2002, with the developer providing training updates in later years. The evidence-based programmes available for CTC sites in Australia are regularly updated by the Australian Research Alliance for Children and Youth, Prevention Science Network and listed on a searchable website (http://whatworksforkids.org.au). As relevant to adolescents, the initially developed action plans in all four communities have focused on the prevention of adolescent alcohol use (and in three communities other drug use was also targeted).

The present evaluation focused on the first four Australian coalitions that completed all five phases of the CTC process. The first three communities initiated activities from 2001 to 2002. ‘Champions’ from these three municipalities approached CTC following national publicity about the process. All three communities were able to successfully raise state-government funding to complete the process. An independent process evaluation reported these communities successfully completed all five phases of the CTC process in one or more locations within their community (Kellock 2007). After completing their first five-phase cycle (in 2007), CTC Mornington Peninsula were supported by their local government to complete a further two cycles of the process.

Coalition composition

Usually a combination of community residents and strategic partners and may have civil servants They work with youth advisory boards. Individuals approach CTC and formed coalitions that then gained state-government funding. Coalitions report to an oversight Board.

Results

Implementation of the CTC process in Australia was associated with more rapid community reductions in adolescent health behaviour problems. Supporting community coalitions to adopt evidence- based interventions appears a feasible means for health psychologists to improve the health of large adolescent populations and prevent related chronic health problems in later life. Thus, an important implication arising from the current report is the feasibility of using community coalition models to enhance social capital as a means of contributing to public health.

1. High rates of adolescent health risk behaviours

2. Strong focus on adolescent health in Australia—national campaign about the intervention

3. New and established coalitions

4. CTC process interwoven within local authority and national public health strategies and personnel

5. Time spent adapting the USA programme to Australian context

• Community, local authority and strategic champions

• Motivation through collaboration

• Menu of evidence based programmes

1. High rates of health risk behaviours and history of adolescent health focus in Australia (context) ➔ champions working within local authorities, or community members on the board (mech resource) to spread the word about CTC and prevention strategies ➔ positive implementation outcomes and reductions in risk behaviours (outcomes).

2. A mix of new and established coalitions were formed using the CTC framework that were interwoven within local authority and national public health strategies and personnel (context) ➔ motivation and collaboration with established colleagues, schools and community members to take on board CTC ➔ positive implementation outcomes and reductions in risk behaviours (outcomes).

3. Time spent adapting USA programme to Australian context and making local authorities and communities aware of the intervention ➔ trust and credibility balanced with tailored resources ➔ positive implementation outcomes and risk behaviour outcomes.

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Jonkman et al. 2005 [64], 2009 [65] and Steketee et al. 2013 [66] (Netherlands)

Communities that Care Netherlands

Description

Adaptation of CTC to Netherlands. The Dutch data were collected from 10 cities which implemented CTC during 2000–2006. With a grant from the Dutch government, 3 of the 10 cities started in 2000 with the implementation of the prevention system. Since 2004, their prevention work has been financed by their municipalities. The other seven communities have initiated implementation of CTC at different times between 2004–2006. The roll of the Dutch national state in implementing CtC was substantial, which is in line with the historical tradition of Dutch social policy. It was the state through the Ministries mentioned above that took the initiative of limited trial implementation. CTC staff were trained and certified through an agreement with the US distribution company of CTC. Communities That Care staff delivered training to community boards and provided technical assistance, mostly by direct contact and general meetings. Each CTC community in the Netherlands has a full-time local coordinator. Communities in the Netherlands did not receive annual financial support for programme implementation.

Before the programme could be implemented the American student survey used by CTC USA had to be translated and adapted (as little as possible) to the Dutch situation. Some adaptations had to be made based on cultural differences between the United States and the Netherlands. For example we considered that according to Dutch youth culture there were too many questions on drug use and weapons and too little on protective factors. The instrument was tested and piloted for relevance and comprehension before using it as a research tool.

Coalition composition

47 coalition members across the 5 CTC coalitions. Service professionals with CTC as part of their job roles. The aim to involve community members and young people. 10 neighbourhoods (5 intervention and 5 control neighbourhoods) located in 5 cities in the provinces.

Results

Implementation and Board functioning outcomes (evaluation outcomes contained in a Dutch document). CTC communities appear to be working in a more targeted fashion to address risk and protection, increased demand for tested programmes, creation of infrastructure to support the national databank of programmes. There was a greater degree of challenge or barriers to implementation in the NL than in the US.

1. No history or structure of intervention approaches to adolescent health risk behaviours

2. Limited history of community mobilisation and coalition approaches

3. Civil servants as sole coalition members

• Limited menu of tested strategies to select from

• Low motivation and trust in strategies

• Low collaboration

• Split focus between job role and CTC

1. If the societal context is such that there is not a history of intervention approaches towards adolescent MRB (context) ➔ the menu of tested strategies will not be strong enough (resource) ➔ and coalition members will not be motivated by or trust alternative strategies tested in other settings (reasoning) ➔ slow collaboration and poor implementation outcomes

2. Community coalition made up largely of civil servants as a voluntary part of their role (context) ➔ split focus on other problems and not a strong enough focus on the embedded community problem of adolescent health risk behaviours and the health promotion approach will not be fired to a great enough extent (resource) ➔ low levels of organisation and motivation among the coalition ➔ poor implementation outcomes

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Crow, France and Hacking (UK) [67]

Communities that Care UK

Description

Adaptation of the USA CTC intervention for the UK context, intended for secondary school youth aged 12–16 years. Communities That Care (CTC) projects seek to improve community security by reducing the risk of young people becoming involved in problem behaviours. The eventual aim of CTC is to reduce four problems among young people: failure at school, school-age pregnancy, drug abuse, and youth crime. Thus, the success of CTC is to be judged by reference to these four measures. However, CTC is a long-term programme that affects children as they grow up, and it may therefore be 10 years or more before its full impact can be evaluated. Each area allocated £150,000 to be used to employ a co-ordinator, training and technical support. The surveys were given to all the children attending schools that covered the CTC areas.

Coalition composition

Unclear size and details of the coalition. Intended to be a mix of community members and strategic partners. 3 areas in the pilot each with a coalition.

Results

The evaluation revealed mixed success in delivering CTC in UK. For example, there was a lack of partnership working in Northside site which made it difficult to move forward; tense history between local people and professional workers; Westside had a history of community partnership - moved forward. CTC UK needs to recognise the diverse starting positions and develop different implementation models for different types of communities. Clearly, as the evidence from this evaluation has shown, ‘no one model fits all’ and a range of different models that can be used in different situations will create opportunities to build on communities’ strengths while recognising their weaknesses. Getting and maintaining a core group of local people was achieved as a result of involving these people from the very beginning, either prior to the programme being funded, or at the Community Orientation meetings. Spending more time in the early stages to search out and identify groups and individuals therefore had positive benefits.

1. No history or structure of community-led intervention approaches to adolescent health risk behaviours

2. Lack of understanding or processes to establish community readiness

3. Civil servant staff solely on coalitions

4. Limited funds and intervention delivery structure

5. Historical mistrust between local authorities and local community

6. Lack of distinct communities

• Low motivation

• Low empowerment and community grounding

• Understanding of prevention science

• Split focus

• Low community identification

1. No history of adolescent health prevention work or established interventions (such as CTC in USA) (context) and low community readiness ➔ low motivation and acceptance of the strategies within the community ➔ implementation outcomes are not met.

2. Lack of diversity on the coalition, with mostly civil servant staff and few community members (context) ➔ a good understanding of prevention science to compliment technical assistance (mech resource) ➔ but collaboration and empowerment will not be triggered under these circumstances (mech reasoning) ➔ strategies not grounded in the local context or accepted by the community ➔ poor implementation outcomes.

3. Lack of funding for the pilot intervention to continue after a short time (context) ➔ technical assistance and prevention science training cannot continue (resource) ➔ low motivation from community coalition as they are aware that there is no sustainability in the efforts (reasoning) ➔ poor implementation outcomes.

4. If there are infrastructure issues and a lack of history of adolescent health risk behaviour interventions (context) ➔ motivation (mech reasoning) ➔ may not be triggered (or take a long time) for implementing an adapted intervention like CTC (resource) ➔ leading to poor or slow implementation success.

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Bannister and Dillane 2005 [68] (UK)

Communities that Care Scottish Pilot

Description

Adaptation of CTC to UK context. CTC is a long-term early intervention programme that aims to ameliorate the risk factors and enhance the protective factors that international research evidence has shown to influence the likelihood that a young person will: experience school failure, school-age pregnancy, or sexually transmitted diseases; engage in drug abuse; or become involved in violence and crime. Guided by a co-ordinator and various training exercises, CTC programmes are community-led. CTC places local residents and representatives (service managers and agents) of the statutory and voluntary bodies engaged in the prevention and management of the problem behaviours exhibited by young people at the heart of its decision-making structures.

Coalition composition

Unclear coalition composition. Primarily civil servants.

Results

CTC not successfully transferred to Scottish context. Challenges and hypothesised reasons included: lack of commitment because of concerns of lack of funding at the end of the pilot, opinions that CTC programmes should be integrated into broader policy contexts such as SIPS, out-of-date programmes and process, mismatch between governance and geographical areas, length of time to collect data.

1. If the national context is such that there is no history of adolescent health prevention work or established interventions (such as CTC in USA)

2. No funding post pilot

3. Civil servants on coalition

4. Communities chosen not reflective of local authority jurisdiction

• Lack of technical assistance and prevention science training due to low funds (resource)

• Low motivation from community coalition and local authority members

• No sustainability of efforts

• Split focus between CTC and other community issues

• Limited menu of programmes

• Time to collect data

1. No history of adolescent health prevention work or established interventions (context) ➔ split focus with other local community issues, lack of trust in the intervention and low commitment and motivation from key leaders and community members ➔ slow progress and poor implementation outcomes.

2. Civil servants as community coalition members ➔ empowerment and ownership not triggers ➔ poor implementation outcomes

3. No funding post pilot (context) ➔ low motivation from community coalition and local authority members as they are aware that there is no sustainability in the efforts ➔ poor implementation outcomes.

4. Communities not coinciding with local authority jurisdiction ➔ Confusion and lack of community identification ➔ poor implementation outcomes

^**

Manger 1992 [69], Harachi 1996 (USA) [70]

TOGETHER! Communities for Drug Free Youth (Adopting the Communities that Care strategy)

Description

In May 1988, the authors initiated a risk-focused community mobilisation project for drug abuse prevention. That project, TOGETHER! Communities for Drug Free Youth, is a state-wide collaboration initially involving 28 Washington communities. The project uses current research on risk and protective factors for adolescent drug abuse as its foundation. Through training and technical assistance, communities have been mobilised to design and implement comprehensive, risk-focused plans for adolescent drug abuse prevention. TOGETHER! adopted the Communities That Care community mobilisation strategy for risk-focused prevention of adolescent substance abuse.

Coalition composition

244 individuals across 36 coalitions for 36 communities, 31 remaining active after 1996. Participants represented a diverse cross-section of the communities. Most teams had a least one member from each of the following: education/early childhood education, parents, local business, local government, service organisations, existing coalitions, and law enforcement/crime prevention. Less frequently, teams had participants representing the following: recreational organisations, youth juvenile justice, the media, drug treatment providers, religious groups, and specific ethnic minority groups.

Results

Process results were reported. The activities that teams had implemented over the first year were assessed to evaluate the extent to which they were either risk focused or used the social development strategy. Three teams had not implemented any activities. The remaining teams had implemented the following activities (a team may be included more than once):

• Implemented or increased support to parenting programmes for drug abuse prevention (7 teams)

• Lobbied for a variety of school-based programmes (11 teams)

• Advocated or lobbied for policy change (5 teams)

• Conducted a community forum or workshop on prevention (5

• teams)

• Sponsored a drug-free, dance for community youth (5 teams)

• Conducted a one time or annual drug-free, community event (7 teams)

TOGETHER! successfully mobilised a number of community teams to engage in prevention planning and action using a risk-reduction approach. The process evaluation data suggest that higher implementation rates may be produced if community planning teams are provided with greater direction and training with regard to accountability and organisational development issues. Technical assistance to teams should take into account turnover in team membership and provide teams with the capacity to train new members in the research base for risk-reduction approaches to prevention.

1. National framework supporting community mobilisation

2. Funding structure for coalition-based prevention activities and technical assistance

3. Step by step process to follow to mobilise community and deliver strategies

4. Coalitions of interested stakeholders and community leaders

• Menu of strategies

• Credibility and trust in process

• Motivation

• Limited flexibility

• Organisation and collaboration

1. Funding available at a government or local level for technical assistance and support (context) ➔ credibility and early support for the intervention (reasoning) ➔ positive implementation outcomes

2. Having a menu of strategies (mech resource) ➔ within the context of key community stakeholders and residents on the coalition (context) ➔ limits flexibility but provides structure for the coalition that they can follow and feel secure that it will lead to implementation success ➔ promotes sustainability beyond the trial period (implementation outcomes).

3. The structure and methodology of a programme like CTC (mech resource) ➔ within the supportive societal context of adolescent health prevention (context) ➔ promotes credibility, organisation and motivation (mech reasoning) ➔ for quicker success in implementation and health behaviour outcomes (outcomes).

^***

Collins et al. 2007 [71] (USA)

Kentucky Initiatives for Prevention (KIP)

Description

Kentucky received a $9 million State Incentive Grant (SIG) from the federal Centre for Substance Abuse Prevention. The Kentucky SIG, called the Kentucky Incentives for Prevention (or KIP) Project, had as its goals (a) strengthening the state youth substance use-prevention system, (b) strengthening the prevention systems within local communities that receive funding, and (c) increasing the health and well-being of youth 12 to 17 years of age by reducing posited risk factors, increasing protective factors, and reducing the use of alcohol, tobacco, and other drugs. The SIG grant was awarded by CSAP to the Kentucky governor’s office and was administered by the Kentucky Division of Substance Abuse (DSA).

Coalition composition

19 coalitions across various counties in Kentucky.

Results

Short-term results (using 8th grade data) showed no significant decreases in six prevalence of substance use outcomes—and, in fact, a significant though small increase in prevalence of use of one substance (inhalants). Sustained results (using 10th grade data), however, showed significant, though small decreases in three of six substance use outcomes—past month prevalence of cigarette use, alcohol use, and binge drinking. We found evidence that the sustained effects on these three prevalence outcomes were mediated by two posited risk factors: friends’ drug use and perceived availability of drugs. Finally, we found that the number of science-based prevention interventions implemented in schools within the coalitions did not moderate the effects of the coalitions on the prevalence of drug use.

1. History of coalition interventions and a strong focus on adolescent health risk behaviour

2. Funding structure to support process

• Menu of strategies

• Technical assistance

• Organisation

• Trust

• Low flexibility and ownership

1. Long history of coalition interventions and a strong focus on adolescent health risk behaviour through funding structures (context) ➔ technical assistance, menus of strategies, regularly meetings and prevention science training (mech resource) ➔ limits flexibility and ownership over the intervention as the coalition are restricted to the set of programmes they can deliver (mech reasoning) ➔ promotes organisation and trust in the established programme (mech reasoning) ➔ to successful implementation and eventually beneficial adolescent health outcomes.

^***

Flewelling et al. 2005 [20] (USA)

New Directions

Description

Vermont’s SIG, New Directions ~ ND!, represented a major shift in the state’s approach to substance abuse prevention through its funding of community coalitions rather than individual programmes. The ND project was based on the premise that effective communitywide prevention of adolescent substance use requires coordination among multiple organisations and institutions, encompassing a comprehensive mix of prevention activities. To that end, full-time coalition coordinators were hired and trained in principles of effective community mobilisation in order to increase local sense of community, enhance mobilisation capacity, and increase community readiness for coordinated research-based prevention activities.

Coalition composition

23 Coalitions across Vermont. Mixture of strategic leaders with political leverage and community residents.

Results

Across the communities served by these coalitions, greater reductions in student substance use prevalence were achieved, relative to the remainder of the state, for all nine substance use measures examined. The greatest relative reductions were observed for past-30-day use of marijuana and cigarettes (both p, .05). These findings suggest that collaborative community-based efforts implemented within a supportive framework such as Vermont’s New Directions project can have a meaningful impact on the prevalence of substance use behaviours among youth.

1. Community readiness processes prior to coalition selection

2. Funding structure on a national and state level

3. Mixture of strategic and community residents

4. Funded technical assistance

• Flexibility

• Empowerment

• Community and intervention champions

• Organisation

1. Considerable time and planning is spent on community readiness (context) ➔ motivation and acceptance will be triggered in the community when the strategies are rolled out (mech resource) ➔ successful implementation and reduction in adolescent health risk behaviours

2. Shift in public health approach (from individual to community-level) (context) ➔ supportive environment and resources with all elements of the system working to ensure the success of the intervention ➔ strong motivation at all levels (mech reasoning) ➔ positive implementation and health risk behaviour outcomes.

3. Funding (context) ➔ ensures training available for coalition (resource) ➔ which maintains motivation leading to successful implementation

4. If community residents select/design strategies that they believe to be the most appropriate for their community (context) ➔ enhanced flexibility and empowerment (mech reasoning) ➔ commitment and motivation from the community to the tailored programmes ➔ positive outcomes

4.1 RIVAL THEORY: If community residents select/design strategies that they believe to be the most appropriate for their community (context) ➔ misunderstanding of prevention focus and lack of confidence or ability to design effective strategies ➔ unclear outcomes

5. Community members and key stakeholders are on the coalition (context) ➔ they are able to enhance public visibility of the intervention (from trusted people in the community) and prepare the community for programmes (mech) ➔ leading to positive outcomes out of the collaboration

^***

Berkley Patton 2004 [72] Paine Andrews 1996 (USA) [73]

Project Freedom (Lawrence)

Description

Project Freedom model was funded by the Kansas Health Foundation. Three Kansas sites were awarded grants. Founding participants of the Project Freedom of Lawrence coalition were five community residents, primarily from the local school district, who had come together to write the grant and conduct the pre-planning activities to include in the Project Freedom of Lawrence proposal. $50,000 planning first year, then $100,000 each year for three years for activities. The coalition also generated resources from in-kind donations and cash funding for the support of coalition functioning and institutionalisation. Over the course of four years, the coalition secured $112,000 in funding from various sources (e.g. City of Lawrence alcohol tax funds, Office of Juvenile Justice) and achieved close to 150 units of resources generated, which was primarily in-kind donations. Its aim was to bring about changes in programmes, policies, and practices that would reduce use of alcohol, tobacco and illegal drugs among 12–17 year olds.

Coalition composition

7 community members on coalition, including young people (but expanded to include hired staff) 273 coalition members in wider cohort.

Results

The Project Freedom of Lawrence coalition successfully replicated the model for community mobilisation (i.e. planning, implementation, evaluation, institutionalisation) used by the original Project Freedom, yet only achieved modest positive outcomes. Project Freedom of Lawrence created 68 community changes over a four-year period. Substance use increased for all drugs in the first two years of implementation (i.e. 1993, 1994). Decreases in the last year of grant funding (1997) were found for any and regular use of tobacco for all participating grades (6th, 8th and 10th graders). In summary, the Project Freedom of Lawrence coalition successfully replicated the model for community mobilisation (i.e. planning, implementation, evaluation, institutionalisation) used by the original Project Freedom, yet only achieved modest positive outcomes compared to the original effort.

1. History of coalition prevention, established framework

2. Community formed in grassroots process and then apply for funds (not already established or part of local authority)

3. Funding structures at local and national level

• Community champions of the intervention

• Flexibility, ownership over strategies design and choice

• Technical assistance

• Motivation due to sustainability

1. If community members (champions) who act as catalysts for the intervention are few (mechanism) ➔ even within a context supportive of community mobilisation approaches like the USA (context) ➔ change and implemented strategies may take longer than planned, as there are no leaders to motivate the community (mechanism reasoning) ➔ leading to poor health risk behaviour outcomes (outcomes).

2. If the coalition starts with community members applying for funds in a grassroots way (context) ➔ the community are able to design and develop their own chosen strategies relevant to the community problem of adolescent health risk behaviours (mechanism resource) ➔ sense of ownership, empowerment and flexibility (reasoning) ➔ ensuring commitment to the intervention and leading to positive community level and health risk behaviour outcomes (outcome).

3. If there is funding available at a government or local level for grassroots organisations or local authorities to apply for (context) ➔ coalition can pay for much needed technical assistance and the delivery of a wide range of strategies (resources) ➔ stronger motivation for the intervention as coalition and community members know there is sustainability in their efforts (mech reasoning) ➔ positive community level and implementation outcomes.

^***

Fawcett et al. 1997 [74], Lewis et al. 1995 (USA) [75]

Project Freedom (Wichita)

Description

Coalition members implemented community initiatives such as store clerk education, Coalition building was the overarching strategy used by Project Freedom, with emphases on coordinating resources and referrals and filling gaps in services. The coalition attempted to serve as a catalyst, not as a service agency. Its aim was to bring about changes in programmes, policies, and practices that would reduce use of alcohol, tobacco and illegal drugs among 12–17 year olds. This required the development of task forces that represented multiple sectors of the community, such as schools, social service organisations, and criminal justice.

Coalition composition

No specific details about the coalition composition. Project Freedom had input from over 100 organisations and individuals in the community.

Results

The largest effects were noted with alcohol; showing reductions in reported regular use from 25.1 to 21.9% in Sedgwick County compared to 25.2 to 23.3% state-wide. More modest effects were noted with marijuana; from 7.5 to 7.1% in Sedgwick County compared to 6.1 to 6.2% state-wide. Similarly small effects were noted with cocaine; from 2.1 to 1.6% in Sedgwick County compared to 2.0 to 1.9% state-wide. Reported regular use of cigarettes increased in Sedgwick County from 24.3 to 25.3%, a slightly higher increase than that observed state-wide (from 22.2% to 22.9%). Smokeless tobacco use increased somewhat in Sedgwick County, from 7.1% to 9.1%, while state-wide reported use decreased from 10.2 to 9.9%. These preliminary findings suggest that implementation of Project Freedom’s action plan, and the community changes that were produced, may have brought about improvements in community- level indicators. Of course, other correlated events that occurred before or during the coalition’s efforts, such as DUI-prevention grants, may have accounted for the observed changes in community-level indicators.

1. City/urban area

2. Pre-existing coalition designed to deal with a range of community issues

3. High levels of adolescent health risk behaviour

• Community champions

• Motivation

• Commitment to intervention

• Split focus between intervention and other community issues

• Awareness of community issues related to adolescent health risk behaviours (gang behaviour and substance use)

• Knowledge of policy level interventions

• Political leverage

• Organisation and momentum

1. If within the city context (context) ➔ champions or key leaders who are driving the intervention leave (mech resource) ➔ motivation may slip as there is no catalyst for steady and ongoing commitment to the project (mech reasoning) ➔ poorer implementation outcomes.

2. If the coalition is pre-existing, with a new remit of adolescent health risk behaviours and new members (context) ➔ there may be a split focus and it may be challenging to put energy and motivation into the intervention while there are other community issues (mechs) ➔ leading to slower implementation success and potentially less impact on health risk behaviours (outcomes).

3. Coalitions and community members within a city context (context) ➔ may have greater awareness of substance use and gang related community issues ➔ stronger to enact change in this population (mech) ➔ positive implementation and health risk behaviour outcomes.

4. If the coalition is pre-existing (context) ➔ the members may have greater political and community influence and knowledge about policy-level interventions (resource) ➔ leading to a range of strategies (not just school-based programmes) ➔ enabling greater organisation and momentum to see reductions in adolescent MRB).

^**

Spoth 2007 [76], 2011 [77] & Chilenski 2016 (USA) [78]

PROSPER

Description

A three-component community-university partnership model guided the implementation of evidence-based interventions (EBIs), as described in detail previously. The three components of the PROSPER model consist of local community teams, state-level university researchers, and a Prevention Coordinator team in the land grant university Cooperative Extension System. Prevention Coordinators served as liaisons between the community-based teams and university researchers, providing continuous, proactive technical assistance to the community teams.

Coalition composition

8–12 on each community team, across 28 school districts in Iowa and Pennsylvania. Community teams were comprised of a Cooperative Extension staff team leader, a public school representative co-leader, and representatives of local human service agencies, along with other local community stakeholders (e.g. youth and parents).

Results

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.

1. Established funding structure on a national and state level

2. History of established method for prevention in coalition and community work

3. Mixture of strategic, community and youth partners

• Motivation

• Awareness of sustainability

• Menu of evidence based strategies (confidence)

• Trust and credibility of the intervention process

• Limited flexibility

• Focus on the strategies

1. If there is funding available at a government or local level (context) ➔ coalition can pay for much needed technical assistance and the delivery of a wide range of strategies (resources) ➔ stronger motivation for the intervention as coalition and community members know there is sustainability in their efforts (mech reasoning) ➔ positive community level and implementation outcomes.

2. A long history and established method for adolescent health coalitions (context) ➔ a menu of strategies and school-based programmes (mech resource) ➔ promotes trust among coalition and community members (reasoning) ➔ leading to successful implementation

3. A long history and established method for adolescent health coalitions (context) ➔ a menu of strategies and school-based programmes (mech resource) ➔ limits flexibility and empowerment of the coalition members (reasoning), ➔ the focus is largely on the evidence based programmes to deliver successful outcomes, not the community members and issues ➔ whatever they choose has been evaluated and should lead to positive outcomes if implemented correctly

^***

Brown-2017 [79] (Mexico)

Red de Coaliciones Comunitarias de Mexico (The Network of Community Coalitions in Mexico)

Description

The model employed to train the coalition members to develop their action plans was the Strategic Prevention Framework (SPF), which is a cyclical 5-step process for implementing sustainable evidence-based practices to prevent youth substance use. The Community Anti-Drug Coalitions of America (CADCA) provided training that emphasised comprehensive action using seven individual and environmental change strategies—(1) provide information, (2) enhance skills, (3) provide support, (4) enhance access/reduce barriers, (5) change consequences, (6) change physical design and (7) change policies. Thus, rather than drawing from a list of evidence- based programmes, the coalitions were taught how to identify strategies that could address the fundamental causes and local conditions behind the community problems prioritised in their community diagnosis. Coalitions sought community and population level changes through the comprehensive implementation of best practices for the seven community change strategies. Coalitions were provided with $10,000 per year for activities.

Coalition composition

Approximately 316 individuals over 17 coalitions, made up of strategic partners, community residents and youth.

Results

Coalition functioning outcomes. The results failed to support the first hypothesis that sectoral diversity would have a positive impact on coalition outcomes of community support for the coalition, community improvement from coalition activities, and coalition sustainability planning. This null result may be in part because at the time of the study these coalitions were only 1–3 years old. Although sectoral diversity was not associated with coalition outcomes, higher levels of intersectoral communication were, in two of the three outcome measures. Coalitions with members who sought advice from more members in other sectors perceived higher levels of support by community leaders and organisations.

If Mexican coalitions want to address problems with a lack of effective and trustworthy law enforcement, the strategies used will need to be vastly different from those taken by drug prevention coalitions in the United States, which often focus on implementing school- and community-based programmes [62].The Mexican coalitions also face lower levels of support for community prevention activities and fewer community champions, making it challenging to build the momentum necessary to take action. Mexican coalitions may need to focus additional energy on building community support for their implementation efforts to be successful. However, this push to move forward is in some tension with the current study, which implies that coalition leaders may need more time to build a collective identity and to create and solidify communication practices.

1. Distrust between community and law enforcement

2. Lack of prevention and intervention delivery structure

3. Community level problems connected with adolescent risk behaviours (e.g. drug use in family parks)

• Lack of community champions

• Split focus

• Lack of understanding of prevention science

• Ownership (over designing own strategies)

1. If there is a lack of trust between community and law enforcement and lack of a prevention structure (context) ➔ community champions not be fired (mech resource) ➔ making it challenging to build momentum and take action towards adolescent health risk behaviours

2. Community-level problems related to adolescent health risk behaviours (e.g. drug use in family parks) (context) ➔ community residents motivated to design their own strategies to change the physical environment (resource) ➔ positive coalition functioning as coalition members have a sense of ownership over the intervention ➔ this does not necessarily lead to positive health risk behaviour outcomes and may result in a split focus on community issues (mech)

^***

Cheadle et al. 2001 [80] (USA) Minority Youth Health Project

Description

The intervention consisted of a paid community organiser in each neighbourhood who recruited a group of residents to serve as a community action board. Key variables included perceptions of neighbourhood mobilisation by youth, parents, and key neighbourhood leaders.

Coalition composition

A mix of both strategic partners and community residents across 4 communities. Unclear size of coalitions.

Results

The MY Health Project did not produce a measurable effect on community mobilisation in the four neighbourhoods where intervention activities were carried out. It is uncertain whether this was because of a lack of strength of the interventions or problems detecting intervention effects using the surveys available. The uncertainty underlying these results provides further support for the argument that large-scale randomised trials may not be the best way of evaluating community-based health interventions. Community mobilisation activities may not have been strong enough relative to the size of the neighbourhoods to produce visible, population-level changes. The mobilisation campaign took longer than expected to implement, partly because of a change in strategy from using existing neighbourhood leaders to a more grass roots approach. In addition, because they were new to serving on organised community boards, the CAB members may have taken longer to become organised and choose projects to implement.

1. Seven city co-operative agreement (urban areas)

2. Grassroots approach (new coalition created)

3. Lack of oversight structure and no established framework

4. Unsure of community readiness levels (no assessment done)

5. Provided grants for activities and staff to assist

• Community empowerment

• Community pride and identification with neighbourhood

• Flexibility and community ownership over intervention activities

1. Grassroots approach whereby coalitions are formed at the start of the trial ➔ flexibility to implement a wide variety of activities ➔ differing levels of success between neighbourhoods and challenge to measure the effects in an RCT ➔ unclear about improvements in health risk behaviours

2. Community readiness activities not strong enough relative to neighbourhood size ➔ low community empowerment and neighbourhood identification ➔ weak community coalitions, no community champions and low trust in intervention activities ➔ null health risk behaviour outcomes

3. Urban areas chosen as part of participation in collaboration and proportion of youth of colour (not community readiness measures) ➔ community boundaries not clear, low identification with neighbourhoods ➔ challenging to measure differential effects between neighbourhoods

4. Provided grants for activities and staff to assist ➔ motivated to implement activities in the community ➔ potential for positive implementation and health risk behaviour outcomes

4.1 RIVAL THEORY: Provided grants for activities and staff to assist (without training on sustaining the coalition) ➔ decisions and oversight still lie with community residents, leading to a lack of structure and focus on prevention activities ➔ difficult to measure the implemented strategies and most disbanded after the trial period.

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Keene Woods et al. 2014 [81] and Keene Woods 2009 [82] thesis (2 documents to extract from)

The Youth Community Coalition (YC2)

Description

The Youth Community Coalition (YC2) of Columbia, Missouri, was formed in 2003 by the Columbia Housing Authority to address local community needs. In 2004, the coalition began to focus on adolescent substance use prevention after receiving funding from the Drug-Free Communities Program grant. In 2009, the coalition was selected to participate in the NIDA Coalition Research Project (NCRP) funded by the National Institute on Drug Abuse of the National Institutes of Health, as part of a larger research study. The coalition was not provided funding as part of the study, receiving only the intervention and travel reimbursement for participation. The Community Change Intervention consisted of two components: (a) in-person training in core competencies using a field-tested curriculum and (b) tele- phone-based TA for implementing priority key processes identified by the coalition.

Coalition composition

Over 70 organisations and individuals represented across the coalitions. Mixture of strategic partners and community residents.

The coalition was already active but was then selected for training and implementing key processes for youth substance use.

Results

Over the 2-year intervention period, there were 36 community changes facilitated by the coalition to reduce risk for adolescent substance use. Results showed that the coalition facilitated an average of at least 3 times as many community changes (i.e. program, policy and practice changes) per month following the intervention. Action planning was found to have accelerated the rate of community changes implemented by the coalition. After the intervention there was increased implementation of three key prioritised coalition processes: Documenting Progress/ Using Feedback, Making Outcomes Matter, and Sustaining the Work. A 1-year probe following the study showed that the majority of the community changes were sustained. Factors associated with the sustainability of changes included the continued development of collaborative partnerships and securing multiyear funding.

1. Pre-existing coalition selected for additional purpose/training

2. Framework and funding for coalition-based prevention work in communities

3. Funding provided to coalition for training and to deliver change

4. Oversight body and established process

• Motivation

• Trust and credibility of coalition model

• Organisation

• Focused on a common goal

• Confidence based on experience working on coalitions

• Low flexibility

1. Pre-existing community coalition selected for additional adolescent health risk behaviour training ➔ strong focus on the goal of reducing adolescent health risk behaviours using prevention science ➔ organisation and trust ➔ positive community changes and implementation outcomes

2. Pre-existing community coalition selected from a societal framework of 5000 coalitions ➔ trust in the coalition method and credibility in its members ➔ positive community changes and implementation outcomes

3. Funding provided to coalition members for training and to deliver change ➔ motivation around a common goal ➔ positive community changes and implementation outcomes

4. A framework and resources provided by oversight body ➔ trust, capability and motivation to complete the framework (low flexibility) ➔ positive community changes and implementation outcomes

^***

Shaw et al. 1997 [83] (USA)

The Gloucester Prevention Network

Description

The Gloucester Prevention Network is a comprehensive community ATOD prevention partnership with multiple coordinated community prevention activities, including several peer education programmes in the schools.

Coalition composition

10 thematic coalitions working towards one goal. Mixture of strategic partners and community residents. Coalitions had already been working for some time.

Results

The results suggest that the comprehensive coalition approach was effective for all substance use outcomes with the exception of marijuana use. A number of coalitions developed peer educator programmes in schools, which were seen as key elements in modifying young people’s behaviour towards alcohol and other drugs. There was a decrease in alcohol behaviour for boys but not girls, which is not easily explained. Boys were more involved in youth sports leagues so the prevention programmes there may have led to a greater impact on young men in the community. Gender differences in health risk behaviours were not accounted for in intervention delivery. Normative changes in community systems reinforced changes in students’ behaviour and attitudes. Many community events were alcohol free and tougher driving while intoxicated laws were enforced. Religious coalitions and local businesses were involved in initiatives. These community strategies created a climate where changes in adolescent behaviours were more likely to occur.

1. High rates of adolescent health risk behaviours

2. Societal context that supports public health as a delivery system

3. Focused effort to include youth in intervention from the start

4. Wider structural and financial framework for preventing adolescent health risk behaviours

5. Coalition mixture of strategic partners and community residents

6. Youth consultation approach

• Systems approach (weaving prevention into community issues)

• Ownership and collaboration

• Empowerment among youth

• Tailoring of strategies

• Prevention science training

• Trust in sustainability (due to funds)

1. High rates of adolescent health risk behaviours AND the societal context that supports public health as a delivery system (context) ➔ a multi-level or systems approach can be triggered (mech resource) including multiple activities that provide the environment for young people to change their behaviour ➔ ownership and collaboration within the community as prevention is woven into all community issues (e.g. events being alcohol free) ➔ successful implementation resulting in positive community and health risk behaviour outcomes.

2. High rates of adolescent health risk behaviour AND youth are heavily involved in the intervention activities through consultation (context) ➔ empowerment among young people and specifically tailored strategies (mech) ➔ positive implementation outcomes and reductions in adolescent health risk behaviours (outcomes).

3. A wider structure (financial and societal) geared towards reducing adolescent health risk behaviours (context) ➔ prevention science training can be provided and decisions are made on empirical adolescent public health data (mech) ➔ empowerment within the community as the funds are there to tackle the problem (reasoning) ➔ positive outcomes.

4. Within the context of deprived communities with high levels of health risk behaviours (context) that there are already gender differences within health risk behaviours (e.g. boys having higher rates of substance use than girls) ➔ sports clubs delivered without gender considerations ➔ greater reductions in boys’ health risk behaviour engagement.

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