Teen prescription drug abuse is a significant and growing problem. The latest national figures show that over 15% of 12th graders in the U.S. used at least one type of prescription drug for non-medical use in the past year. Research has shown that prescription drugs that can be abused are often readily available to teens either from family members in the home or from friends. This R21 application builds on previous research and proposes a two-year feasibility study to adapt and implement an integrated community prevention model (to include community mobilization, a home environmental strategy, and a medical environmental strategy) to reduce the availability of prescription drugs in the home for abuse by teens. The research setting will be one county in Southern Appalachian Tennessee in which prescription drug abuse is reported to be a problem. Our proposed environmental strategies will incorporate learnings from a recent NIDA-funded integrated community prevention model that was implemented in Alaska to reduce availability of harmful legal products (inhalants, over-the-counter drugs, household products, and prescription drugs). The specific aims are to (1) adapt and implement an integrated community prescription drug abuse prevention model that targets prescription drug abuse among teens, and (2) assess change in proximal outcomes (community engagement, advocacy by physicians'office and pharmacy staff, and the availability of prescription drugs in the home) believed to mediate intervention effects on teen prescription drug abuse. We will also assess what aspects of implementation quality (e.g., reach, dosage, fidelity) may explain the change. The research design for assessing change in the proximal outcome of teens'perceived availability of prescription drugs for abuse is a pre-post intervention-group-only design that will utilize data from a panel of students in grades 5, 7, 9, and 11 at baseline who will be surveyed at two time points in consecutive school years. Analyses of the other proximal outcomes will utilize data from participating parents, physicians'office staff, and pharmacy staff who participate in environmental strategies. Activities in both the home environmental strategy and the medical environmental strategy will be directed toward reducing availability of prescription drugs for abuse by teens in the home. Based on learnings from previous research, key contributing factors are posited to be norms, including concern over the problem of teen prescription drug abuse, and rules, regulations and policies. Our proposed set of complementary approaches, including a medical environmental strategy designed to support the home environmental strategy, represents a new and innovative prevention approach to the problem of teen prescription abuse. The significance of this study is its potential to adapt an integrated community prevention model to help prevent teens'abuse of prescription drugs. PUBLIC HEALTH RELEVANCE: Prescription drug abuse among teens is a significant and growing problem. This study seeks to adapt and implement an integrated community prevention model including community mobilization and environmental strategies (a medical environmental strategy designed to support a home environmental strategy) focused on reducing availability of these drugs in the home. If the approach is successful, it could help address this serious public health problem.