Icelandic Prevention Model in Rural Appalachian Communities: Gauging Stakeholder Experience with the Core Processes Three Years into County-Level Implementation

<i>Background:</i> This study assessed stakeholder experience with the core processes of The Integrated Community Engagement (ICE) Collaborative, a primary prevention approach addressing adolescent substance use in rural West Virginia, after three years of county-level implementation. <i>Objectives:</i> Guided by the Icelandic Prevention Model (IPM), the ICE Collaborative aims to enhance cooperation between researchers, policy makers, local practitioners, and community members and facilitate a paradigm shift in youth and community substance use prevention. This shift involves moving away from strategies focused on the repeated allocation of short-term grants that fund time-limited programs to a long-term, holistic, and sustainable approach overseen by local practitioners and coalitions. <i>Results:</i> We conducted qualitative interviews and focus groups with 33 stakeholders during the fall of 2022. Data analyses generated six major themes: 1) It Takes a Village to Prevent Adolescent Substance Use, 2) Improving Understanding and Commitment to Prevention Through Outreach, 3) Enhancing Student Engagement and Program Accessibility, 4) Addressing the Chronic Underfunding of Prevention and Youth Development Programs, 5) Acknowledging Family Contexts and Family Member Substance Use as Risk Factors, and 6) ICE/IPM Inspiring Solution-based Conversations, Goal Setting, and Strategy Selection. <i>Conclusions:</i> Stakeholders reported multiple positive characteristics of ICE for their communities and applauded the long-term focus and access to local data. Several suggestions for improved strategies were also reported. Results are discussed in line with the theoretical underpinnings of the IPM and current discourse around community health promotion in rural areas.