Sustained Prevention of Substance Use in Rural and Tribal Youth: Post High School Results From a Cluster Randomized Trial

Purpose: Connect, a universal preventive intervention, effectively reduced substance use by the end of high school. The aim of this study is to examine substance use 6 months post high school graduation. Methods: Online survey of young adults (n = 410) who participated in a 2-arm cluster randomized trial from 2021 to 2024, with 10 high schools per condition on or near the Cherokee Nation Reservation. Results: We found statistically significantly lower odds of alcohol use (odds ratio [OR] = 0.48; 95% confidence interval [CI] = 0.29, 0.79; p = .004), binge drinking (OR = 0.52; 95% CI = 0.29, 0.94; p = .029), vaping cannabis (OR = 0.38; 95% CI = 0.17, 0.84; p = .016), and vaping nicotine (OR = 0.35; 95% CI = 0.17, 0.70; p = .003) in the past 30 days in the intervention condition as compared to the control condition at 6 months post high school graduation. Discussion: Connect sustained substance use reduction after high school.