Discussion
Findings from this longitudinal community randomized trial indicate that the CTC prevention system significantly reduced the prevalence of handgun carrying among youths growing up in rural areas. Youths in CTC communities were less likely to report handgun carrying in each wave of the study and cumulatively from grade 6 through grade 12 than those in control communities.The intervention effects were more pronounced in grades 7, 8, and 9, grades in which CTC communities were actively implementing CTC. As participants became older (ie, grades 10-12), the differences in the past-year prevalence of handgun carrying between youths in the 2 groups of communities diminished. It is important to note that in this trial, little preventive programming targeted the high school years, and few students in the longitudinal panel were exposed to tested and effective EBIs beyond grade 9.In recent years, historic investments have been made to support community violence intervention (CVI) programs that focus on reducing shootings by establishing relationships with people at the center of firearm-related harm in communities.The CTC prevention system presents a prime example of such strategies. CTC is a data- and community-driven prevention system designed to assist communities in selecting and implementing EBIs aligned with their strategic prevention priorities for improving the health of youths community-wide, which are based on local data identifying elevated risks and low protective factors in the community.Findings of this study provide the first empirical evidence on the impact of CTC on handgun carrying among youths growing up in rural areas. This is especially important considering evidence on the association between adolescent handgun carrying and a multitude of behavioral indicators of exposure to violence and perpetration (eg, bullying, use of weapons to get money) in rural communities, some of which may involve the use of firearms specifically.