Care Prevention System Research Articles

Changes in roles and feelings among "Kaigoyobou leaders" responsible for community prevention activities over 10 years

Objectives Community residents experience changes over time, including those in the care prevention system, governmental expectations, and their motivations. To support community-based prevention activities, it is necessary to clarify these changes. This study used a qualitative research method to examine changes in roles and feelings among "Kaigoyobou leaders" who had been involved in community-based care prevention activities for 10 years.Methods The study participants were nine leaders (six men and three women) who had been active in community-based care prevention for approximately 10 years. Through one-hour semi-structured interviews, we explored their current activities, reasons for taking the leader training course, changes in the content of their activities since completing the course, changes in their roles in activities and feelings about the activities, and what they recognized as important in their activities. Interviews were transcribed verbatim and analyzed using a modified grounded theory approach. From the transcripts, we extracted "concepts" related to changes among the leaders and generated "categories" to summarize the concepts.Results The analysis identified 28 concepts summarized into 12 categories. The categories included: "belief in the activities" (e.g., "focusing on preventive effects"), "learning through trial and error" (e.g., "learning continuously"), "developing the activities" (e.g., "expanding the activities"), "commitment to the community" (e.g., "valuing connections with people involved in the activities"), "increasing required roles" (e.g., "taking consultations from juniors"), "relationship with the government" (e.g., "responding to requests from the government"), "benefits from the activities" (e.g., "receiving a sense of accomplishment and satisfaction from the activities"), "burden due to the activities" (e.g., "a shortage of group members"), "aging of stakeholders" (e.g., "increasing age of the participants"), "preparing for continuity" (e.g., "new people wishing to participate"), "considering ending activities" (e.g., "reducing activities due to increasing age of the leaders themselves"), and "impact of the coronavirus."Conclusion Leaders' strong belief in their activities and their ability to adapt based on successful experiences were crucial. They responded effectively to environmental changes, including evolving government relationships. Fostering leadership belief, highlighting the benefits of activities, and supporting collaborative responses to environmental changes are essential for ongoing success.

The Impact of the Communities that Care Approach in Reducing Violence and Crime Within an Urban, High-Burden Community.

Community violence and crime are significant public health problems with serious and lasting effects on young people, families, and communities. This violence and crime have significant ripple effects, affecting not just those who are directly physically injured, but also those who witness violent episodes, those who have friends or loved ones killed or injured, and those who must everyday navigate streets that they know have been frequent sites of serious violence and crime. The current study presents evidence of the impact that a data-driven, collective impact approach - the Communities that Care prevention system - can have on violence and crime outcomes within a large urban, high-burden community. Established as one of the national Youth Violence Prevention Centers (YVPC) funded by the Centers for Disease Control and Prevention, the Chicago Center for Youth Violence Prevention is among the first to implement the CTC approach in a large, urban community. The current study's findings show reductions in violence (i.e., aggravated assaults and robberies) in the Bronzeville community, compared to similar communities in Chicago.

Tobacco Use Patterns From Adolescence to Young Adulthood Among Latinx Youth From Rural Communities

PurposeTo examine patterns in adolescent and young adult tobacco use, comparing Latinx foreign-born children and children of foreign-born parents (i.e., children of immigrants(COI)) to Latinx US-born children of US-born parents (i.e., children of nonimmigrants,(CONI)) and to CONI White youth who grew up in small and rural towns. MethodsData were from youth who lived in control communities that participated in a community-randomized trial of the Communities That Care prevention system. We compared Latinx CONI (n = 154) with Latinx COI (n = 316) and with non-Latinx White CONI (n = 918). We examined tobacco use in adolescence (any adolescent use, early onset, and chronic use) and young adulthood (any past-year tobacco use, any daily smoking, any nicotine dependence symptoms) with mixed-effects logistic regressions. ResultsIn adolescence, Latinx CONI had a higher prevalence of any and chronic tobacco use relative to Latinx COI, and of any and early onset tobacco use relative to non-Latinx White CONI. In young adulthood, Latinx CONI were more likely to report tobacco use in the past year, any symptoms of nicotine dependence, and daily smoking relative to Latinx COI; and more likely to report daily smoking relative to non-Latinx White CONI. Generation differences in young adult tobacco use were explained by chronic tobacco use in adolescence. DiscussionThe study suggests targeting chronic tobacco use in adolescence to prevent disparities in tobacco outcomes among Latinx young adults from rural communities.

Effect of the Communities That Care Prevention System on Adolescent Handgun Carrying

There is little information on upstream community-based interventions that reduce the prevalence of handgun carrying among adolescents, especially those growing up in rural areas. To test whether Communities That Care (CTC), a community-based prevention system focusing on risk and protective factors for behavioral problems early in life, reduces handgun carrying prevalence among adolescents growing up in rural areas. Community-randomized trial of 24 small towns in 7 states assigned randomly to the CTC or control group with outcomes assessed from 2003 to 2011. Participants were youths attending public schools in grade 5 who received consent from their parents to participate (77% of the eligible population) and were repeatedly surveyed through grade 12 with 92% retention. Analyses were conducted from June to November 2022. A coalition of community stakeholders received training and technical assistance to install CTC, used local epidemiologic data to identify elevated risk factors and low protective factors for adolescent behavioral problems, and implemented tested preventive interventions for youth, their families, and schools. Handgun carrying (never vs at least once) operationalized in 2 ways: (1) prevalence of past-year handgun carrying, and (2) cumulative prevalence of handgun carrying from grade 6 through grade 12. Overall, the 4407 study participants' mean (SD) age was 12 (.4) years in both CTC (2405 participants) and control (2002 participants) communities in grade 6; about one-half of participants in each group were female (1220 [50.7 %] in the CTC group and 962 [48.1%] in the control group). From grade 6 through grade 12, 15.5% of participants in CTC communities and 20.7% of those in control communities reported carrying a handgun at least once. Youths in CTC communities were significantly less likely to report handgun carrying at a given grade than those in control communities (odds ratio [OR], 0.73; 95% CI, 0.65-0.82). The most pronounced effects were observed in grade 7 (OR, 0.70; 95% CI, 0.42-0.99), grade 8 (OR, 0.58; 95% CI, 0.41-0.74), and grade 9 (OR, 0.65; 95% CI, 0.39-0.91). Cumulatively from grade 6 through grade 12, youths in CTC communities were significantly less likely to report handgun carrying at least once than those in control communities (OR, 0.76; 95% CI, 0.70-0.84). Overall, CTC reduced the prevalence of past-year handgun carrying by 27% at a given grade and by 24% cumulatively through grade 12. In this study, CTC reduced the prevalence of adolescent handgun carrying in participating communities. ClinicalTrials.gov Identifier: NCT01088542.

Trajectories of Handgun Carrying in Rural Communities From Early Adolescence to Young Adulthood

Characterizing patterns of handgun carrying among adolescents and young adults can inform programs to reduce firearm-related harm. Longitudinal patterns of handgun carrying among rural adolescents have not been identified. To assess specific points of intervention by characterizing patterns of handgun carrying by youths in rural communities from early adolescence to young adulthood and to quantify how age at initiation, duration, and frequency of carrying differ across identified patterns. This cohort study uses the control group of the community-randomized trial of the Communities That Care prevention system, conducted among public school students in 12 rural communities across 7 states. Participants self-reported their handgun carrying at 10 data collection points from 12 to 26 years of age (2005-2019). Data were analyzed from January to July 2021. Handgun carrying in the past 12 months. Latent class growth analysis was used to estimate handgun carrying trajectories. In this longitudinal rural sample of 2002 students, 1040 (51.9%) were male; 532 (26.6%) were Hispanic, Latino, Latina, or Latinx; 1310 (65.4%) were White; and the highest level of educational attainment of either parent was a high school degree or less for 649 students (32.4%). The prevalence of handgun carrying in the last 12 months ranged from 5.3% (95 of 1795) to 7.4% (146 of 1969) in adolescence and increased during the mid-20s (range, 8.9% [154 of 1722] to 10.9% [185 of 1704] from 23 to 26 years of age). Among the participants who reported handgun carrying at least once between 12 and 26 years of age (n = 601 [30.0%]), 320 (53.2%) reported carrying a handgun in only 1 wave. Latent class growth analysis indicated 6 longitudinal trajectories: never or low probability of carrying (1590 [79.4%]), emerging adulthood carrying (166 [8.3%]), steadily increasing carrying (163 [8.1%]), adolescent carrying (53 [2.6%]), declining carrying (24 [1.2%]), and high probability and persistent carrying (6 [0.3%]). The earliest mean (SD) age at initiation of handgun carrying occurred in both the adolescent and declining carrying groups at the ages of 12.6 (0.9) and 12.5 (0.7) years, respectively. More than 20% of some groups (emerging adulthood [age 26 years: 49 of 154 (31.8%)], steadily increasing [age 26 years: 37 of 131 (28.2%)], declining [age 13 years: 7 of 23 (30.4%)], and high probability and persistent carrying [age 15 years: 3 of 6 (50.0%)]) reported carrying 40 times or more in the past year by the age of 26 years. This study found distinct patterns of handgun carrying from adolescence to young adulthood in rural settings. Findings suggest that promoting handgun safety in rural areas should start early. Potential high-risk trajectories, including carrying at high frequencies, should be the focus of future work to explore the antecedents and consequences of handgun carrying in rural areas.

Study protocol: a non-randomised community trial to evaluate the effectiveness of the communities that care prevention system in Germany

BackgroundThe Communities That Care (CTC) prevention planning and implementation system trains communities throughout a five-phase cycle to (1) build capacity for prevention, (2) adopt science-based prevention, (3) assess the prevention needs of adolescents living in the community, (4) select, and (5) implement evidence-based programs according to their needs. After CTC proved to be effective and cost-effective in the U.S., it is being used by an increasing number of communities in Germany. The aim of this study is to evaluate the effectiveness and cost-effectiveness of CTC in Germany.MethodsCommunities in CTC-phases 1 to 3 (n = 21) and individually-matched comparison communities (n = 21) were recruited for a non-randomised trial. To assess long-term outcomes, (1) a cohort of 5th Grade students will be surveyed biennially concerning behaviours (antisocial behaviour and substance use) and well-being as well as risk and protective factors. Additionally, (2) biennial cross-sectional surveys will be conducted in 6th, 8th, 10th, and 11th Grade in each community. To assess short-term outcomes, a cohort of ten key informants per community will be surveyed biennially concerning adoption of science-based prevention, collaboration, community support and community norms. (4) In a cross-sectional design, all ongoing prevention programs and activities in the communities will be assessed biennially and data will be collected about costs, implementation and other characteristics of the programs and activities. (5) To monitor the CTC implementation, the members of the local CTC-boards will be surveyed annually (cross-sectional design) about team functioning and coalition capacity. Data analysis will include general and generalised mixed models to assess the average treatment effect of CTC. Mediation analyses will be performed to test the logical model, e.g., adoption of science-based prevention as a mediator for the effectiveness of the CTC approach.DiscussionThis is the first controlled study to evaluate the effectiveness of a comprehensive community prevention approach in Germany. Evaluating the effectiveness of CTC in Germany is an important prerequisite for further diffusion of the CTC approach.Trial registrationThis study was registered with German Clinical Trial Register: DRKS00022819 on Aug 18, 2021.

Development and Implementation of Businesses That Care in Zacatecas, Mexico.

As part of the Global Smart Drinking Goals campaign launched in 2018 in 6 “City Pilots” around the world, the Businesses That Care (BTC; Empresas Que se Cuidan in Spanish) prevention system was developed and implemented in Zacatecas, Mexico. BTC is a private business sector adaptation of the Communities That Care prevention system. BTC is designed to address underage alcohol use through a combination of a company-led prevention system, an adapted family-based prevention program with parents employed at participating companies, and environmental prevention strategies for company employees. BTC was designed to be congruent with other health and safety efforts in the region (e.g., media campaign, road safety, and school prevention efforts). This study presents the feasibility and adoption of the BTC system in Zacatecas. Process implementation measures indicated successful participant recruitment, retention, and adherence to intervention protocols. The first 4 stages of BTC implementation were completed within 14 months, with Stage 5 being interrupted by the COVID-19 pandemic. BTC Prevention Committee members, made up of employees from BTC participating companies, received 9 out of 10 BTC trainings/workshops during this time. Results provide evidence of the acceptability and feasibility for private companies to implement a prevention system approach for reducing youth alcohol use.

Long-term Impacts and Benefit–Cost Analysis of the Communities That Care Prevention System at Age 23, 12 Years After Baseline

This study estimated sustained impacts and long-term benefits and costs of the Communities That Care (CTC) prevention system, implemented and evaluated in a longitudinal cluster-randomized trial involving 24 communities in seven states. Analyses utilized reports from a longitudinal panel of 4407 participants, followed since the study's baseline in grade 5, with most recent follow-up 12 years later at age 23. Impacts on lifetime abstinence from primary outcomes of substance use and antisocial behavior were estimated using generalized linear mixed Poisson regression analysis, adjusted for individual and community-level covariates. Possible cascading effects on 4-year college completion, major depressive disorder, and generalized anxiety disorder through age 23 were evaluated as secondary outcomes. CTC had a statistically significant global effect on primary outcomes and also on combined primary and secondary outcomes. Among primary outcomes, point estimates suggested absolute improvements in lifetime abstinence of 3.5 to 6.1% in the intervention arm and relative improvements of 13 to 55%; 95% confidence intervals revealed some uncertainty in estimates. Among secondary outcomes, 4-year college completion was 1.9% greater among young adults from intervention communities, a 20% relative improvement. Mental health outcomes were approximately the same across trial arms. Although CTC had small sustained effects through age 23, benefit-cost analyses indicated CTC was reliably cost beneficial, with a net present value of $7152 (95% credible interval: $1253 to $15,268) per participant from primary impacts and $17,919 ($306 to $39,186) when secondary impacts were also included. It remained cost beneficial even when impacts were adjusted downward due to the involvement of CTC's developer in the trial. Findings suggest that broader dissemination of CTC could improve public health and individual lives in the long term and generate positive net benefits to society.

남북한 보건의료 및 방역체계에 대한 비교 연구

A Comparative Study on Health Care and Disease Prevention System in North and South Korea Gyeongil Joo* Abstract: In response to current situation of COVID-19, this study had a comparative analysis on health care and disease prevention system in North and South Korea The purpose of this study is to maximize the strength and supplement the weakness of health care system in North and South Korea and to contribute on establishing an integrated health care system and constructing a health community in the Korean Peninsula This study conducted a comparative analysis on development of health care resources, systematization of health care and preventive resources, and medical service delivery system in North and South Korea through various literature materials and interviews with North Korean defectors and the results were as follows The North Korean health care system including free treatment system became nominal and is operating disease prevention system through lock down and shut down On the other hand, South Korea secures the right of choice in medical service by focusing on treatment and it operates transparent disease prevention system by disclosing information While this study holds significance in understanding realistically health care system of North-South for narrowing the gap in health care level between North and South Korea and suggesting methods for improving medical care and disease prevention system, there should be further researches with in-depth exploration on North Korean health care system through focus group interview on numerous North Korean defectors Key Words: South Korea, North Korea, Health Care System, Infectious Disease, Disease Prevention System □ 접수일: 2020년 3월 29일, 수정일: 2020년 4월 19일, 게재확정일: 2020년 4월 20일＊ 고려대학교 정부학연구소 선임연구원(Researcher, Korea Univ , Email: jki360@naver com)

Initiation Age, Cumulative Prevalence, and Longitudinal Patterns of Handgun Carrying Among Rural Adolescents: A Multistate Study

PurposeAdolescent handgun carrying is a behavioral marker for youth interpersonal conflicts and an intervention point for violence prevention. Our knowledge about the epidemiology of adolescent handgun carrying mainly pertains to urban settings. Evidence on the initiation age, cumulative prevalence, and longitudinal patterns of this behavior and on handgun-related norms and peer behavior among male and female rural adolescents is scant. MethodsWe used data from the control arm of the Community Youth Development Study, a community-randomized controlled trial of the Communities That Care prevention system. Annually, 1,039 males and 963 females were surveyed from Grade 6 (2005) to age 19 years (2012) in 12 rural towns across seven U.S. states. ResultsIn Grade 6, 11.5% of males and 2.8% of females reported past-year handgun carrying. Between Grade 6 and age 19 years, 33.7% of males and 9.6% of females reported handgun carrying at least once. Among participants who ever reported handgun carrying, 34.0% of males and 29.3% of females did so for the first time in Grade 6. Among participants who ever reported handgun carrying, 54.6% of males and 71.7% of females did so only one time over the seven study assessments. Greater proportions of participants who reported handgun carrying than those who did not do so endorsed prohandgun norms and had a peer who carried among both males (Grade 10: prevalence difference = 57%; 95% CI: 46%–67%) and females (Grade 10: prevalence difference = 45%; 95% CI: 12%–78%). ConclusionsRural adolescent handgun carrying is not uncommon and warrants etiologic research for developing culturally appropriate and setting-specific prevention programs.

A Primary Care Prevention System for Behavioral Health: The Behavioral Health Annual Wellness Checkup.

Behavioral health problems are involved in the majority of primary care visits. These behavior disorders (e.g., depression, anxiety, smoking, insomnia, etc.) are costly, burdensome to both the patient and the healthcare system, and result in greater medical utilization/cost and poorer future health outcomes. Integrated behavioral healthcare has been proposed as a model for more efficiently addressing the burden of behavioral health problems. While this model has demonstrated some promise in the treatment of behavioral health problems, as well as in the reduction in costs and improvement in healthcare outcomes, the primary prevention of behavioral health problems in this delivery model has been relatively neglected. The present paper discusses the potential value of incorporating the prevention of behavioral health problems into the annual physical/wellness checkup and proposes a detailed system for how this might be accomplished. Limitations, future research, and costs associated with increased prevention in a primary care context are discussed.

Implementing the Communities That Care Prevention System: Challenges, Solutions, and Opportunities in an Urban Setting

Communities That Care, refined and tested for more than 25years, offers a step-by-step coalition-based approach to promote well-being and prevent risk behaviors among youth. Communities That Care guides coalitions to identify and prioritize underlying risk and protective factors; set specific, measurable community goals; adopt tested, effective prevention programs to target selected factors; and implement chosen programs with fidelity. Communities That Care has been implemented in a variety of communities, but has only recently begun to be systematically evaluated in diverse, urban communities. This paper presents a process evaluation of Communities That Care implementation within a Midwestern ethnically diverse, urban community. In-depth surveys of 25 black male youth aged 8-14years and their caregivers were conducted to determine the degree to which coalition-selected priorities aligned with the experience of black families. Implementation and survey data were collected in 2014-2017 and analyzed in 2017-2018. Roughly 30% of youth reported ever being bullied or bullying someone else on school property; this aligned with the coalition's decision to focus on positive social skills and bullying prevention. Additional data aligned with the coalition's intent to expand its community action plan to encompass other priorities, including family transitions and mobility. For example, roughly one third of caregivers went on welfare and one third of families moved to a new home or apartment in the past year. In communities whose residents have experienced historical and current inequities, an effective community prevention plan may need to address structural as well as social determinants of well-being among youth and their families. This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.

Community Readiness to Adopt the Communities That Care Prevention System in an Urban Setting

This manuscript highlights initial activities from a 5-year project to build a community coalition focused on the promotion of family, school, and community connectedness; academic investment; and social and emotional well-being among black male youth and their families, as well as the prevention and reduction of risk behaviors. Project activities were planned according to the step-by-step coalition-based prevention system, Communities That Care. During Year 1 (2013/2014), semi-structured interviews were conducted with 14 community members (parents, school administrators and teachers, and community leaders and volunteers) to evaluate readiness to adopt Communities That Care. Participants were asked to (1) define community; (2) identify community strengths; (3) recommend methods to strengthen community relationships; (4) envision ideal coalition functions; (5) identify current community resources; (6) recommend prevention targets and methods; (7) identify potential barriers to coalition participation; and (8) assess overall community readiness to adopt Communities That Care. Analyses were conducted in Year 3 (2015/2016). Participants expressed eagerness and readiness to adopt Communities That Care. They identified community strengths and local resources that could contribute to coalition success, as well as potential barriers to participation and group cohesion that if left unaddressed could diminish coalition impact. Participants believed that links between multiple environments (home, school, community) should be strengthened in order to promote the well-being of youth. They envisioned the Communities That Care coalition as a task force of community members with varying talents invested in youth across their entire life course. Community members' insights may be used to guide implementation of Communities That Care by this coalition and others. This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.

Long-Term Effects of the Communities That Care Trial on Substance Use, Antisocial Behavior, and Violence Through Age 21 Years.

To evaluate whether the effects of the Communities That Care (CTC) prevention system, implemented in early adolescence to promote positive youth development and reduce health-risking behavior, endured through age 21 years. We analyzed 9 waves of prospective data collected between 2004 and 2014 from a panel of 4407 participants (grade 5 through age 21 years) in the community-randomized trial of the CTC system in Colorado, Illinois, Kansas, Maine, Oregon, Utah, and Washington State. We used multilevel models to evaluate intervention effects on sustained abstinence, lifetime incidence, and prevalence of past-year substance use, antisocial behavior, and violence. The CTC system increased the likelihood of sustained abstinence from gateway drug use by 49% and antisocial behavior 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 behaviors. Implementation of the CTC prevention system in adolescence reduced lifetime incidence of health-risking behaviors into young adulthood. Clinicaltrials.gov identifier: NCT01088542.

Effects of Exposure to the Communities That Care Prevention System on Youth Problem Behaviors in a Community-Randomized Trial: Employing an Inverse Probability Weighting Approach.

Earlier intention-to-treat (ITT) findings from a community-randomized trial demonstrated effects of the Communities That Care (CTC) prevention system on reducing problem behaviors among youth. In ITT analyses, youth were analyzed according to their original study community's randomized condition even if they moved away from the community over the course of follow-up and received little to no exposure to intervention activities. Using inverse probability weights (IPWs), this study estimated effects of CTC in the same randomized trial among youth who remained in their original study communities throughout follow-up. Data were from the Community Youth Development Study, a community-randomized trial of 24 small towns in the United States. A cohort of 4,407 youth was followed from fifth grade (prior to CTC implementation) to eighth grade. IPWs for one's own moving status were calculated using fifth- and sixth-grade covariates. Results from inverse probability weighted multilevel models indicated larger effects for youth who remained in their study community for the first 2 years of CTC intervention implementation compared to ITT estimates. These effects included reduced likelihood of alcohol use, binge drinking, smokeless tobacco use, and delinquent behavior. These findings strengthen support for CTC as an efficacious system for preventing youth problem behaviors.

Testing the Question-Behavior Effect of Self-Administered Surveys Measuring Youth Drug Use

PurposeConcern that asking about a specific behavior could elicit that behavior is often cited as a reason that communities and schools should not administer surveys about youth drug use. In this study, we investigated if this question-behavior effect exists related to substance use. We examined if simply asking a student about their current drug use leads to an increase in drug use 1 year later. MethodThis study tests the validity of the question-behavior effect on youth drug use in a longitudinal panel of 2,002 elementary school students. The sample of students was drawn from the Community Youth Development Study, a community-randomized test of the Communities That Care prevention system. If the prevalence of self-reported drug use in sixth grade in a sample surveyed in fifth and sixth grades was higher than in an accretion sample surveyed only in sixth grade, the difference could indicate a question-behavior effect. ResultsResults from logistic regression analyses did not provide any evidence of a question-behavior effect on 30-day or lifetime prevalence of alcohol, tobacco, inhalant, or marijuana use reported in sixth grade. ConclusionsAsking youth about drug use in a survey did not increase the rates of self-reported drug use measured 1 year later. The absence of evidence of a question-behavior effect should ease concerns of communities and schools when administering surveys asking youth about their drug use.

Adaptation and Implementation of a Science-Based Prevention System in Colombia: Challenges and Achievements.

During the last 2 years, the Colombian government and the Nuevos Rumbos Corporation have been implementing an adapted version of the Communities That Care (CTC) prevention system, called Comunidades Que se Cuidan (CQC) in Spanish, for use in Colombia. This brief report presents the process of implementing CQC and identifies some of the main challenges and achievements of implementing the system in eight communities in Colombia. Preliminary results of a pilot study of CQC implementation in Colombia show that prevention system development, including a focus on measuring community risk and protection, can be established successfully in Latin American communities despite a lack of rigorously tested prevention programs and strategies. Moreover, mobilizing community coalitions toward science-based prevention, with a focus on examining local risk and protective factor data, can spur development and evaluation of prevention efforts in Latin America.

Assessing Sustained Effects of Communities That Care on Youth Protective Factors.

The Communities That Care (CTC) prevention system seeks to build community capacity for a science-based approach to the promotion of healthy youth development. Prior research shows the positive effects of CTC on youth protective factors during CTC implementation. This research tests sustained effects of CTC on youth protective factors 1 year after external support to communities for CTC implementation ended. Data come from a community-randomized trial of CTC in 24 communities across 7 states. A panel of 4,407 youth in CTC and control communities was surveyed annually from Grade 5 through Grade 10. Youth reported their exposure to protective factors identified in the social development model. Global test statistics are calculated to examine effects of CTC across 15 protective factors in 5 domains (community, school, family, peer, and individual) assessed in Grade 10, 1 year after study support for CTC implementation ended. Analyses also examine variation in sustained effects by gender and baseline risk levels. Global effects of CTC on protective factors across all domains are not sustained in Grade 10. However, sustained domain-specific effects are observed in the individual domain for males, in the peer domain for females, and in the individual domain for youth with low-to-medium risk at baseline. Greater emphasis on strengthening protective factors during high school might be needed to sustain broad effects of CTC on protective factors observed during middle school.

Effects of Communities That Care on Males' and Females' Drug Use and Delinquency 9 Years After Baseline in a Community-Randomized Trial.

This study tested sustained effects of the Communities That Care (CTC) prevention system on health-risking behaviors 9 years after baseline in a community-randomized trial involving 24 towns in seven states. Earlier analyses found sustained effects on abstinence from drug use and delinquency through Grade 12 in a panel of fifth graders. At age 19, 91 % (n = 3986) of the living panel completed the survey. Data were analyzed using generalized linear mixed models. The prevalence of lifetime and current substance use and delinquency were the primary outcomes. Secondary outcomes included substance use disorders, major depression, suicidality, educational attainment, and sexual risk behaviors. CTC had a significant 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). Males in CTC communities also continued to show greater lifetime abstinence from cigarette smoking (ARR = 1.22). CTC did not have a sustained effect on current substance use and delinquency nor did it improve the secondary outcomes at age 19 for either gender. Communities using CTC may need to extend their prevention planning to include the high school years to sustain effects on drug use and delinquency beyond high school for both genders. ClinicalTrials.gov identifier: NCT01088542.

Silent War to Emerging or Re-emerging Respiratory Infection Diseases Badly Kept in Mind

Recently, a man aged 44 years from South Korea who flew to Hong Kong on May 26, subsequently traveled to Huizhou, Guangdong Province, had drawn the worldwide attention. First laboratory-confirmed case of middle east respiratory syndrome (MERS) finally landed in China, 3 years after the first identification of MERS coronavirus (MERS-CoV) in Saudi Arabia, 2012.[1] In reality actually, MERS did not attract much attention in China till now although we had alerted about the possibility of its importation, or even pandemic.[2] A similar phenomenon has happened in South Korea, lacking of awareness among health care workers and the general public, contributing to suboptimal infection prevention and control measures in health facilities, and finally cause the outbreak of MERS in South Korea and the exported case to China. Fortunately, we have won out in the battle, and no additional cases have been identified among close contacts in China (n = 75). Meanwhile, we still have lingering fears as there are sporadic infections and outbreaks all over the world.