The ICEC Cluster Trial: Integrated Community Engagement Collaborative for Youth Substance Use Prevention in Rural America

Counties assigned to this arm will participate in the Integrated Community Engagement (ICE) Collaborative. Students in grades 7 through 12 will complete annual confidential surveys, and counties will receive school-level and county-level reports summarizing alcohol, tobacco, and other drug use and associated risk and protective factors. County Prevention Coalitions will receive implementation support from Network Coordinators, including coalition development, stakeholder engagement, dissemination and interpretation of local data, strategic planning, resource development, and support for implementation of locally selected prevention strategies through a structured community engagement process

The Integrated Community Engagement (ICE) Collaborative is a community capacity-building framework designed to strengthen local prevention systems and reduce youth alcohol, tobacco, and other drug use. The intervention includes annual collection and dissemination of youth survey data, coalition development, stakeholder engagement, data-driven decision making, strategic planning, technical assistance, resource development, and implementation support. Network Coordinators housed within Regional Prevention Lead Organizations provide ongoing support to County Prevention Coalitions to facilitate community-driven prevention planning and implementation. Counties participate in repeated annual implementation cycles throughout the study period.

• ICE Collaborative

Counties assigned to this arm will participate in annual school-based surveys of students in grades 7 through 12 and will receive school-level and county-level reports describing alcohol, tobacco, and other drug use and associated risk and protective factors. Counties in this arm will not receive Network Coordinator support, coalition capacity-building activities, technical assistance, or implementation support provided through the Integrated Community Engagement Collaborative.

Annual collection of confidential school-based survey data from students in grades 7 through 12 and dissemination of school-level and county-level reports describing alcohol, tobacco, and other drug use and associated risk and protective factors. Counties assigned to this condition receive data reports but do not receive implementation support, technical assistance, coalition development activities, or Network Coordinator assistance.

Past 30-day prevalence of tobacco cigarette use, electronic cigarette use, alcohol use, drunkenness, and cannabis use among students in grades 7 through 12 will be assessed using annual school-based online surveys. Tobacco and e-cigarette use will be assessed on a 7-point scale ranging from 1=Never used, to 7=More than 20 times per day. Alcohol, drunkenness, and cannabis use will be assessed on a 7-point count scale ranging from 1=0 times, to 7=40 times+. Outcomes will be reported separately as the percentage of students reporting each substance use behavior during the previous 30 days. Higher percentages indicate greater substance use prevalence.

Lifetime prevalence of tobacco cigarette use, electronic cigarette use, alcohol use, drunkenness, and cannabis use among students in grades 7 through 12 will be assessed using annual school-based online surveys. Outcomes will be reported separately as the percentage of students reporting lifetime use of each substance or behavior. Scoring for each of those variables will range from 1=0 times, to 7= 40 times+. Higher percentages indicate greater lifetime substance use prevalence.

Family-domain scores will be assessed annually using student surveys measuring seven concepts: perceived parental support, family social support, time spent with parents, parental monitoring, social capital, parental reactions to substance use, and parental/sibling substance use. Composite scores will be calculated as follows: perceived parental support (5 items, 4-point Likert, range 4-20); family social support (3 items, 7-point Likert, range 3-21); time spent with parents (2 items, 5-point Likert, range 2-10); parental monitoring (2 items, 4-point Likert, range 2-8); social capital (2 items, 4-point Likert, range 2-8); parental reactions to substance use (5 items, 4-point Likert, range 4-16); and parental/sibling substance use (3 yes/no items). Higher scores on protective-factor measures indicate greater protection against youth substance use, while higher scores on risk-factor measures indicate greater exposure to substance use risk.

Peer-domain scores will be assessed annually using student surveys measuring five concepts: friend social support, peer substance use, peer delinquency, perceived peer respect for substance use, and perceived peer respect for delinquency. Composite scores will be calculated as follows: friend social support (3 items, 7-point Likert scale, range 3-21); peer substance use (5 items, 5-point Likert scale, range 5-25); peer delinquency (3 items, 5-point Likert scale, range 3-15); perceived peer respect for substance use (5 items, 5-point Likert scale, range 5-25); and perceived peer respect for delinquency (3 items, 5-point Likert scale, range 3-15). Higher scores on protective-factor measures indicate greater protection against youth substance use, while higher scores on risk-factor measures indicate greater exposure to substance use risk.

School-domain scores will be assessed annually using student surveys measuring five concepts: supportive adults in school, supportive peers in school, motivation to learn and grow, school connectedness, and school absenteeism. Composite scores will be calculated as follows: supportive adults in school (5 items, 5-point Likert scale, range 5-25); supportive peers in school (4 items, 5-point Likert scale, range 4-20); motivation to learn and grow (5 items, 5-point Likert scale, range 5-25); school connectedness (composite score derived from survey items); and school absenteeism (2 items, 6-point count scale, range 2-12, with response options from none to 7 or more days). Higher scores on protective-factor measures indicate greater protection against youth substance use, while higher scores on risk-factor measures indicate greater exposure to substance use risk.

Leisure-time domain scores will be assessed annually using student surveys measuring three concepts: late outside hours, structured recreational activities, and unstructured activities. Composite scores will be calculated as follows: late outside hours (2 items, 8-point count scale, range 2-16, with responses from never to 7 or more days); structured recreational activities (7 items, 9-point frequency scale, range 7-63, with responses from less than once per week to seven times per week); and unstructured activities (6 items, 5-point frequency scale, range 6-30, with responses from never to four or more times per week). Higher scores on protective-factor measures indicate greater protection against youth substance use, while higher scores on risk-factor measures indicate greater exposure to substance use risk.

Implementation integrity and consistency will be assessed using the ICE Implementation Integrity and Consistency Assessment (ICE-IICA). Scores from 126 yes/no questions (scored 0/1) represent the percentage of required implementation activities completed across the ICE implementation process within each county. Higher scores indicate greater adherence to and consistency of implementation.

County Prevention Coalition Role structure and clarity will be assessed using the Efficient Practices subscale of the Internal Coalition Effectiveness Instrument (ICEI). Higher scores indicate more efficient coalition practices.

County Prevention Coalition Role structure and clarity will be assessed using the Coalition Efficiency subscale of the Communities That Care Coalition Functioning Survey (CFS). Higher scores indicate clearer coalition roles.

County Prevention Coalition Cohesion and collaboration will be assessed using 10 items from the Relationships and Participation subscales of the Internal Coalition Effectiveness Instrument (ICEI). Higher scores indicate greater levels of collaboration, teamwork, and coalition member relationships.

County Prevention Coalition Cohesion and collaboration will be assessed using the Cohesion and Participation Benefits subscales of the Communities That Care Coalition Functioning Survey (CFS) measured on a 5-point Likert scale with a total range from 10-50. Higher scores indicate greater cohesion and perceived benefits of participation.

County Prevention Coalition Relational coordination will be assessed using 6 items the Relational Coordination Survey measured on a 5-point Likert scale with a total range from 6-30. Higher scores indicate stronger communication, shared goals, shared knowledge, and mutual respect among coalition members and partner organizations.

County Prevention Coalition Relational coordination will be assessed using 6 items the Relational Coordination Survey measured on a 5-point Likert scale with a total range from 6-30. Higher scores indicate stronger communication, shared goals, shared knowledge, and mutual respect among coalition members and partner organizations.

County Prevention Coalition Stakeholder engagement will be assessed using the Community Impact Scale (CIS) and coalition records documenting stakeholder participation. The CIS assesses stakeholder satisfaction, perceived benefits, motivation, engagement, and knowledge gained measured on a 5-point Likert scale with a total range from 10-50. Higher scores indicate greater stakeholder involvement and engagement in coalition activities.

County Prevention Coalition Data-driven decision-making capacity will be assessed using an adapted version of the 3D-ME Inventory, the Data-Driven Decision-Making Questionnaire (DDDM-Q), and coalition records documenting dissemination and use of local survey data. In total 9 items will be applied and scored on a 5-point Likert scale with a range between 9 and 45. Higher scores indicate greater capacity to use data to guide coalition planning, resource allocation, and implementation decisions.