Abstract
BackgroundThis cluster randomised control trial is designed to evaluate whether the Communities That Care intervention (CTC) is effective in reducing the proportion of secondary school age adolescents who use alcohol before the Australian legal purchasing age of 18 years. Secondary outcomes are other substance use and antisocial behaviours. Long term economic benefits of reduced alcohol use by adolescents for the community will also be assessed.MethodsFourteen communities and 14 other non-contiguous communities will be matched on socioeconomic status (SES), location, and size. One of each pair will be randomly allocated to the intervention in three Australian states (Victoria, Queensland and Western Australia). A longitudinal survey will recruit grade 8 and 10 students (M = 15 years old, N = 3500) in 2017 and conduct follow-up surveys in 2019 and 2021 (M = 19 years old). Municipal youth populations will also be monitored for trends in alcohol-harms using hospital and police administrative data.DiscussionCommunity-led interventions that systematically and strategically implement evidence-based programs have been shown to be effective in producing population-level behaviour change, including reduced alcohol and drug use. We expect that the study will be associated with significant effects on alcohol use amongst adolescents because interventions adopted within communities will be based on evidence-based practices and target specific problems identified from surveys conducted within each community.Trial registrationThe trial was retrospectively registered in September, 2017 (ACTRN12616001276448), as communities were selected prior to trial registration; however, participants were recruited after registration. Findings will be disseminated in peer-review journals and community fora.
Highlights
This cluster randomised control trial is designed to evaluate whether the Communities That Care intervention (CTC) is effective in reducing the proportion of secondary school age adolescents who use alcohol before the Australian legal purchasing age of 18 years
Community-led interventions that systematically and strategically implement evidence-based programs have been shown to be effective in producing population-level behaviour change, including reduced alcohol and drug use
Based on pilot work done in Australia and CTC trial work done in the United States of America (USA), we hypothesise that: compared to control communities, participants in intervention communities will maintain at least a 15% lower rate of frequent youth alcohol use throughout the secondary school age period
Summary
The communities that care intervention There are five phases to the CTC framework; these provide structure and benchmarking intervention implementation, monitoring and evaluation steps and processes (see https://www.communitiesthatcare.org.au/ 5-phases-ctc). Brief Communication in Schools have been shown to be effective in reducing alcohol consumption [8] This strategy targets teenagers and their parents and will be delivered during 3 school classroom lessons, promoting the following three messages: 1) Based on scientific evidence, the National Health and Medical Research Council (NHMRC) guideline recommends that children should not drink before the age of 18. Primary outcome data in control and intervention sites will be collected in the school setting using the CTC youth survey. Data collection in control communities The control communities will be observed using: (1) the longitudinal school survey with 3 waves of data (see Fig. 1, flow); (2) monitoring of underage alcohol sales and (3) and archive record assessments. Using (generalised) structural equation models, analysis of whether effects intervention processes on multiple outcomes (e.g. alcohol and drug use; violence; school completion) are mediated by changes in patterns of adolescent alcohol use will be assessed, after adjusting for other risk factors. The NHMRC will have no role in the implementation or management of the intervention, collection, management, analysis or interpretation or the publication of the trial data
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