Shifting the Landscape in Primary Substance Use Prevention for Rural America: The Integrated Community Engagement (ICE) Collaborative Cluster Trial - Summary Abstract Rural vs urban adolescents have higher rates of substance use, driven by social, economic, and geographic risk factors. Adolescent use is a central vulnerability factor driving substance misuse and addiction problems in resource-poor, rural communities across the United States. Despite the existence of evidence-based interven- tion programs (EBIs) to reduce substance use, rural communities face unique challenges in adopting and sus- taining programs due to resource limitations and a mistrust of external expertise. Research underscores the need for implementation approaches that center local needs, voices, and priorities. This presents both a chal- lenge and an opportunity for implementation science: how to develop testable, principle-based implementation models that center flexibility, local autonomy, and context. Trials that systematically operationalize community capacity building interventions and evaluate their impact on youth are virtually non-existent. The Integrated Community Engagement (ICE) Collaborative is coalition-based intervention for developing substance use pre- vention capacity in rural communities; adapted for rural US communities based on the highly efficacious Ice- land Prevention Model; it centers local decision making and sustainability. A pilot test supported its promise in enhancing implementation network role structure and clarity, as well as promoting data-driven decision-mak- ing, multilevel stakeholder engagement, and locally relevant practice and policy. These enhancements allowed communities to affect adolescents’ exposure to socioecological risk and protective processes, which proximally drive substance use. We propose to evaluate the efficacy of ICE in a cluster trial of 36 rural counties random- ized to ICE or an active control. Both will participate in school-level data collection and receive practice-based data reports; however, active control communities will not have the systematic implementation support pro- vided to ICE counties. The 10-step ICE intervention (treatment counties) and school surveys (all counties) oc- cur each year for 4 years. The Prevention Research Center (PRC) at West Virginia University, directed by PI Kristjansson, will implement the proposed research. The PRC has a 20+ year history of partnerships with WV school systems and the Bureau for Behavioral Health; more than 40k students from 40+ counties have partici- pated in PRC research studies in the past 12 years. Study aims are to test hypotheses regarding: (1) the effi- cacy of ICE in reducing adolescent substance use onset relative to those in the active control. We expect ICE will affect substance use, indirectly, via reduced youth exposure to [a] substance use risk factors, and [b] in- creased exposure to protective factors; and (2) the efficacy of ICE in enhancing implementation network struc- ture, processes, and outcomes. We expect ICE communities will have increased role structure and clarity, data-driven decision-making, collaboration and cohesion, multilevel stakeholder engagement, and strategic planning over time compared to control communities. Implementation network changes will support substance use deterrence by increasing funding/resource acquisition, targeted investments, and implementation of EBIs.
