Over 4400 students participated in this community-randomized trial from 24 communities across 7 states.
Communities That Care (CTC) is a community-based prevention system that focuses on risk and protective factors for behavioral problems for children and adolescents. According to a recent study published in Jama Network Open, CTC reduced the prevalence of handgun carrying among adolescents in rural areas.
CTC is made up of a coalition of stakeholders that implement evidence-based interventions (EBIs) altered to community-based needs, with the overall objective achieving positive impacts on youth development. Study authors state that handgun carrying is a key factor for youth violence in urban areas, but more information is needed in rural settings. Community stakeholders received training and technical assistance to install CTC. Local epidemiologic data identified elevated risk factors and low protective factors for adolescent behavior problems.
The community-randomized trial (NCT01088542) was a secondary analysis of the Community Youth Development Study (CYDS), a trial of the CTC prevention system that began in 2003. The secondary analysis, conducted from June to November 2022, included data through 2011.
Participants from 24 communities across Colorado, Illinois, Kansas, Maine, Oregon, Utah, and Washington were randomly assigned to the CTC or control group. Participants were public school students in 5th grade that received consent from parents (77% of the eligible population). These students were repeatedly surveyed through 12th grade with 92% retention, according to the study authors. Never carrying a handgun vs carrying a handgun at least once was operationalized in 2 ways; prevalence of past-year handgun carrying and cumulative prevalence of handgun carrying from 6th through 12th grade.
In all, 4407 eligible students, with a mean (SD) age of 12 (.4) years participated in the study. The CTC group had 2405 students and the control group had 2002 students. About half of the participants in each group were female (1220 [50.7% in CTC group and 962 [48.1%] in control group.)
Overall, CTC decreased past-year prevalence of handgun carrying by 27% at a given grade. Cumulatively, through grade 12, CTC reduced handgun carrying by 24%. Across 6th to 12th grade, 15.5% of participants in CTC communities and 20.7% in control communities reported carrying a handgun at least once. CTC community youths were significantly less likely to report carrying a handgun at a given grade than students in control communities, authors stated (odds ratio [OR], 0.73; 95% CI, 0.65-082). Cumulatively from 6th to 12th grade, students in CTC communities were significantly less likely to report handgun carrying at least once compared to control community participants (OR, 0.76; 95% CI, 0.70-0.84). Grades 7 (OR, 0.70; 95% CI, 0.42-0.99), 8 (OR, 0.58; 95% CI, 0.41-0.74), and 9 (OR, 0.65; 95% CI, 0.39-0.91) were grades in whichthe most pronounced effects were observed.
All analyses in the study were based on self-reported data, a limitation according to study authors, who state these data are subject to social desirability and recall basis. Another limitation was the study did not ask how the students acquired the handgun, from whom they acquired it from, or why they were carrying it. Communities studied had 50,000 residents or less and did not necessarily represent the entire country, authors wrote.
The CTC prevention system reduced the prevalence of handgun carrying among students surveyed in the study, up to 7 years after installation. According to the study, investigators concluded that these findings, “highlight the potential for effective community-based nonpunitive programs that influence risk and protective factors early in life to exert downstream prevention effects on high-risk firearm behavior and in turn firearm-related harm.”
Rowhani-Rahbar A, Oesterle S, Gause EL, et al. Effect of the communities that care prevention system on adolescent handgun carrying: a cluster-randomized clinical trial. JAMA Netw Open. 2023;6(4):e236699. doi:10.1001/jamanetworkopen.2023.6699