Substance Use: Community Interventions involving Coalitions or Partnerships to Prevent Substance Use among Youth

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends community interventions involving coalitions or partnerships to prevent substance use among youth. Most studies were conducted in rural or suburban communities. Evidence from the systematic review shows interventions reduce both initiation and use of the following:

  • Cannabis
  • Tobacco
  • Alcohol, including binge drinking
  • Illegal substances

Some studies also found reductions in one or more antisocial behaviors among youth.

The full CPSTF Finding and Rationale Statement and supporting documents for Substance Use: Community Interventions involving Coalitions or Partnerships to Prevent Substance Use among Youth are available in The Community Guide Collection on CDC Stacks.

Intervention

Coalitions and partnerships are two organizational approaches to engaging communities in a coordinated substance use prevention effort (SAMHSA 2022, Hutchinson et al. 2021). Community interventions involving coalitions or partnerships to prevent substance use are multi-component initiatives targeting adolescents (ages 10-17 years) or young adults (ages 18-24 years).

Coalition and partnership approaches must have both a community-based organization and two or more interventions selected and implemented to reduce substance use demand, underage access, or both in the community. Interventions may focus on a specific substance of importance to the community or address risk and protective factors related to substance use in general.

Organization of these initiatives include one of the following structures:

  • Community coalitions include relevant community-based organizations, agencies, leaders, and members of the community tasked with identifying and implementing the community prevention initiative
  • Community partnerships involve research or implementation organizations engaging with recruited community members, leaders, and organizations on the community prevention initiative

Community coalitions and partnerships both:

  • Engage members of the community in selecting prevention interventions
  • Receive implementation support
  • Include technical assistance

Coalitions and partnerships selected two or more of the following community interventions to address local substance use prevention priorities:

  • School-based interventions
  • Family-based interventions
  • Community-based interventions
  • Retailer education to reduce sales of alcohol, tobacco, or cannabis to underage youth
  • Enforcement activities directed at underage sales or use of alcohol, tobacco, or cannabis
  • Policy advocacy

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review that examined the effectiveness of interventions in preventing substance use among youth. The review included 11 studies identified in a systematic search (search period January 1990-May 2023).

Study Characteristics

  • Studies were conducted in the United States (8 studies), Australia (1 study), and The Netherlands (1 study)
  • Studies included randomized controlled trials (4 studies), controlled before-after evaluations (3 studies), and other designs with a concurrent comparison group (3 studies)
  • Studies included rural communities (9 studies), suburban communities (4 studies) and urban communities (5 studies). Only two U.S. studies included urban communities
  • Study initiatives targeted general substance use prevention (7 studies) or focused on alcohol prevention (4 studies)
  • Interventions selected by coalitions and partnerships included school-based programs (11 studies), family-based programs (9 studies), and community-based activities (7 studies)
  • Study initiatives including or focused on alcohol prevention included interventions directed at retailers (5 studies), enforcement or underage sales restrictions (5 studies), and policy advocacy (4 studies)

Summary of Results

The systematic review included 11 studies.

Interventions reduced overall substance use among youth including:

  • Initiation of use of one or more substances by 4.0% (6 studies)
  • Rates or frequency of use of one or more substances by 7.0% (7 studies)

Interventions reduced initiation of use for a variety of substances among youth including:

  • Cannabis by 4.0% (5 studies)
  • Tobacco by 3.3% (5 studies)
  • Alcohol by 3.7% (5 studies)
  • Illegal substances by 6.7% (4 studies)

Interventions reduced measures of use among youth for the following substances:

  • Cannabis by 8.6% (6 studies)
  • Tobacco by 9.7% (5 studies)
  • Alcohol by 5.0% (7 studies)
  • Binge drinking by 6.8% (9 studies)

Interventions also reduced self-reported antisocial behaviors related to delinquency or violence (5 studies) and to alcohol use (2 studies).

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

Based on results from this review, findings are applicable to community substance use prevention initiatives directed by coalitions or partnerships in the United States. Findings are applicable to community initiatives including general substance use prevention or focused on alcohol use prevention and initiatives that include two or more interventions delivered in schools, provided to families, and implemented in the community.

Evidence Gaps

CPSTF identified the following questions as priorities for research and evaluation:

  • How effective are these interventions when implemented in urban communities?
  • How effective are interventions when implemented in communities with historically disadvantaged racial and ethnic populations?
  • How effective are interventions when implemented in communities with lower household incomes?
  • How effective are interventions in reducing development of substance use disorders?
  • How effective are interventions in reducing prescription drug misuse?

Remaining questions for research and evaluation identified in this review include the following:

  • How effective are interventions in reducing polysubstance use among youth?
  • How effective are interventions in reducing vaping initiation and use among youth?
  • How effective are interventions when focused on substance use prevention in young adults?
  • How effective are interventions in improving mental health outcomes?
  • How effective are interventions in improving educational outcomes?
  • How does effectiveness differ when evidence-based interventions selected by the coalition or partnership are modified to enhance cultural or community relevance?

Implementation Considerations and Resources

Most interventions provided training sessions for recruited coalition and partnership members. Training sessions covered a range of topics including member roles and process steps, substance use issues, use of data for identifying local prevention priorities, and guidance on evidence-based prevention (Flewelling et al. 2005, Eddy et al. 2012).

Involvement of community members in decision-making roles may enhance health equity relevance of the community response (Komro et al. 2017). Initiatives should consider cultural relevance of the interventions selected for implementation (Bo et al. 2023).

CPSTF also recommends intervention approaches related to the following:

The following resources provide implementation guidance for community-wide initiatives including coalitions and partnerships:

The following resources provide technical assistance and guidance for specific intervention options:

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.