Prevention System’s Benefits Exceed Cost and Has Sustained Effects

July 2012
Photo shows a teenage girl walking alone in a schoolyard and glancing over her shoulder at a pair of teens behind her.

Each $1 that towns invested in Communities That Care (CTC) during a 5-year randomized trial of the prevention system set the stage for a return of $5.30, according to Drs. Margaret Kuklinski, J. David Hawkins, and colleagues at the University of Washington. The researchers based their estimate on the reductions in smoking and delinquency observed during the fourth year of the study among eighth-graders whose towns implemented CTC in the trial and the projected total costs of smoking, delinquency, and crime over individuals’ lifetimes. The real cost advantage of CTC may be larger, the researchers note, as the intervention also delayed youths’ initiation of alcohol use and binge drinking. Some of the benefits will accrue to the towns that implemented CTC in the trial; the rest will go to the youths whose behaviors were positively affected by the system, their families, and other individuals and systems with which they come into contact throughout their lives.

In the first stage of the trial, middle-school students in towns that used CTC demonstrated less delinquency, less initiation of alcohol and tobacco use, and less binge drinking than students in comparison towns (“Prevention Program Averts Initiation of Alcohol and Tobacco Use”). A new stage of the same trial, with 4,407 youths who joined the trial when they were in 5th grade, found that those who lived in CTC towns continued to smoke less, engage in fewer delinquent behaviors, and use less alcohol in 10th grade, compared with youths from control towns. For example, among youths who had not yet initiated problem behaviors by 5th grade, those in CTC towns were 38 percent less likely to report initiating alcohol use and 46 percent less likely to initiate cigarette use in 10th grade than students in control communities.

These results, a year after the end of the intervention phase of the trial, bode well for the long-term efficacy of the system. Taken together, the findings of Drs. Hawkins and Kuklinski indicate that CTC has enduring, cost-effective benefits that may alter the course of adolescent behavior and bolster public health. For more information on CTC, see


Hawkins, J.D., et al. Sustained decreases in risk exposure and youth problem behaviors after installation of the Communities That Care prevention system in a randomized trial. Archives of Pediatrics and Adolescent Medicine 166(2):141-148, 2012. Full Text Available

Kuklinski, M.R., Briney, J.S., Hawkins, J.D., and Catalano, R.F. Cost-benefit analysis of Communities That Care outcomes at eighth grade. Prevention Science 13(2):150-161, 2012. Abstract Available

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