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

Abstract

<b>Objectives.</b> To determine the Connect intervention's effectiveness in reducing substance use among rural and tribal adolescents in northeastern Oklahoma. <b>Methods.</b> We conducted a 2-arm cluster randomized trial from 2021 to 2024, with 10 high schools per condition. <b>Results.</b> At baseline, 919 students were enrolled (mean age = 15 years), and the majority were American Indian or White. Alcohol-use days during the past 30 days was reduced by 18% per survey wave in the intervention compared with the control condition (rate ratio [RR] = 0.82; 95% confidence interval [CI] = 0.72, 0.93; t = -3.02; <i>P</i> = .003), binge drinking was reduced by 26% (RR = 0.74; 95% CI = 0.64, 0.86; t = -3.90; <i>P</i> < .001), cannabis use was reduced by 11% (RR = 0.89; 95% CI = 0.80, 1.00; t = -2.03; <i>P</i> = .04), and prescription opioid misuse was reduced by 40% (RR = 0.60; 95% CI = 0.43, 0.85; t = -2.86; <i>P</i> = .004). Model-predicted means revealed the control condition followed the expected developmental trajectory of increased substance use and the intervention condition showed a flat or decreasing use pattern. <b>Conclusions.</b> The Connect intervention prevented the typical escalation of substance use during adolescence. <b>Trial Registration.</b> ClinicalTrials.gov NCT04839978. Registered on April 9, 2021. Version 10, April 30, 2025. (<i>Am J Public Health</i>. 2025;115(9):1508-1517. https://doi.org/10.2105/AJPH.2025.308205).