Primary Prevention of Drug Overdoses in Rural Low-Resource and Tribal Communities: A Cluster Randomized Trial

Area of Science:

• Public Health
• Adolescent Health
• Substance Use Prevention

Background:

• Adolescent substance use, particularly in rural and tribal communities, presents significant public health challenges.
• Early intervention is crucial to prevent the escalation of substance use during formative years.

Purpose of the Study:

• To evaluate the effectiveness of the Connect intervention in reducing substance use among rural and tribal adolescents in northeastern Oklahoma.
• To assess the intervention's impact on alcohol, cannabis, and prescription opioid misuse.

Main Methods:

• A 2-arm cluster randomized trial involving 919 students across 20 high schools in northeastern Oklahoma (2021-2024).
• Data collection included self-reported substance use over 30-day periods.
• Statistical analysis utilized rate ratios (RR) and confidence intervals (CI) to compare intervention and control groups.

Main Results:

• The Connect intervention group showed significant reductions in alcohol use (18%), binge drinking (26%), cannabis use (11%), and prescription opioid misuse (40%) compared to the control group.
• Control group participants followed a trajectory of increasing substance use, while the intervention group exhibited stable or decreasing use patterns.
• Reductions were statistically significant (P < .05) across all measured substances.

Conclusions:

• The Connect intervention is effective in preventing the escalation of substance use among rural and tribal adolescents.
• This program offers a promising model for substance use prevention in underserved adolescent populations.
• Findings support the implementation of targeted interventions in high-risk communities.