How are risk and protective factors addressed in prevention programs?
The risk and protective factors are the primary targets of effective prevention programs used in family, school, and community settings. The goal of these programs is to build new and strengthen existing protective factors and reverse or reduce risk factors in youth.
Prevention programs are usually designed to reach target populations in their primary setting. However, in recent years it has become more common to find programs for any given target group in a variety of settings, such as holding a family-based program in a school or a church.
In addition to setting, prevention programs can also be described by the audience for which they are designed:
- Universal programs are designed for the general population, such as all students in a school.
- Selective programs target groups at risk or subsets of the general population, such as poor school achievers or children of drug abusers.
- Indicated programs are designed for people already experimenting with drugs.
In the Family - Prevention programs can strengthen protective factors among young children by teaching parents better family communication skills, appropriate discipline styles, firm and consistent rule enforcement, and other family management approaches. Research confirms the benefits of parents providing consistent rules and discipline, talking to children about drugs, monitoring their activities, getting to know their friends, understanding their problems and concerns, and being involved in their learning. The importance of the parent-child relationship continues through adolescence and beyond. (See examples of family-based programs in Examples of Research-Based Drug Abuse Prevention Programs.)
In School - Prevention programs in schools focus on childrens social and academic skills, including enhancing peer relationships, self-control, coping, and drug-refusal skills. If possible, school-based prevention programs should be integrated into the schools academic program, because school failure is strongly associated with drug abuse. Integrated programs strengthen students bonding to school and reduce their likelihood of dropping out. Most school prevention materials include information about correcting the misperception that many students are abusing drugs. Other types of interventions include school-wide programs that affect the school environment as a whole. All of these activities can serve to strengthen protective factors against drug abuse. (See examples of school-based programs in Examples of Research-Based Drug Abuse Prevention Programs.)
Recent research suggests caution when grouping high-risk teens in peer group preventive interventions. Such groupings have been shown to produce negative outcomes, as participants appear to reinforce each others drug abuse behaviors.10
In the Community - Prevention programs work at the community level with civic, religious, law enforcement, and other government organizations to enhance anti-drug norms and pro-social behaviors. Many programs coordinate prevention efforts across settings to communicate consistent messages through school, work, religious institutions, and the media. Research has shown that programs that reach youth through multiple settings can strongly impact community norms.7 Community-based programs also typically include development of policies or enforcement of regulations, mass media efforts, and community-wide awareness programs. (See community-based programs in Examples of Research-Based Drug Abuse Prevention Programs.) For example, it is important to note that some carefully structured and targeted media interventions have been proven to be very effective in reducing drug abuse.22
What are the core elements of effective research-based prevention programs?
In recent years, research-based prevention programs have proven effective. These programs were tested in diverse communities, in a wide variety of settings, and with a range of populations (for example, family-based programs in schools and churches).
As community planners review prevention programs to determine which best fit their needs, they should consider the following core elements of effective research-based programs.
- Structurehow each program is organized and constructed;
- Contenthow the information, skills, and strategies are presented; and
- Deliveryhow the program is selected or adapted and implemented, as well as how it is evaluated in a specific community.
When adapting programs to match community needs, it is important to retain these core elements to ensure that the most effective parts of the program stay intact.
The table below provides examples of these core elements of prevention programs by sample program typesfor example, Community (Universal), School (Selective), and Family (Indicated). In brief, the core elements are described below.
Structure - Structure addresses program type, audience, and setting. Several program types have been shown to be effective in preventing drug abuse. School-based programs, the first to be fully developed and tested, have become the primary approach for reaching all children. Family-based programs have proven effective in reaching both children and their parents in a variety of settings. Media and computer technology programs are beginning to demonstrate effectiveness in reaching people at both community and individual levels.
Research also shows that combining two or more effective programs, such as family and school programs, can be even more effective than a single program alone. These are called multi-component programs.
Content - Content is composed of information, skills development, methods, and services. Information can include facts about drugs and their effects, as well as drug laws and policies. For instance, in a family intervention, parents can receive drug education and information that reinforces what their children are learning about the harmful effects of drugs in their school prevention program. This opens opportunities forfamily discussions about the abuse of legal and illegal drugs.
Drug information alone, however, has not been found to be effective in deterring drug abuse. Combining information with skills, methods, and services produces more effective results. Methods are geared toward change, such as establishing and enforcing rules on drug abuse in the schools, at home, and within the community. Services could include school counseling and assistance, peer counseling, family therapy, and health care. Parental monitoring and supervision can be enhanced with training on rule-setting; methods for monitoring child activities; praise for appropriate behavior; and moderate, consistent discipline that enforces family rules.
Delivery - Delivery includes program selection or adaptation and implementation. During the selection process, communities try to match effective research-based programs to their community needs. Conducting a structured review of existing programs can help determine what gaps remain. This information can then be incorporated into the community plan, which guides the selection of new research-based programs. Chapter 4 presents brief program descriptions. More comprehensive program information is included in the complete second edition. Also, planning and program sources can be found in Selected Resources and References.
Adaptation involves shaping a program to fit the needs of a specific population in various settings. To meet community needs, scientists have adapted many research-based programs. For programs that have not yet been adapted in a research study, it is best to run the program as designed or include the core elements to ensure the most effective outcomes.
Implementation refers to how a program is delivered, which includes the number of sessions, methods used, and program follow-up. Research has found that how a program is implemented can determine its effectiveness in preventing drug abuse.
Use of interactive methods and appropriate booster sessions helps to reinforce earlier program content and skills to maintain program benefits.
How can the community implement and sustain effective prevention programs?
Following selection of its prevention plan, the community must begin to implement programs that meet its needs. In many communities, coalitions formed during the planning process remain involved in oversight; but the responsibility for running individual programs usually remains with local public or private community-based organizations. Running an effective research-based program often requires use of extensive human and financial resources and a serious commitment to training and technical assistance. Outreach efforts to attract and keep program participants interested and involved are important, especially with hard-to-reach populations. Research has shown that extra effort in providing incentives, flexible schedules, personal contact, and the public support of important community leaders helps attract and retain program participants.
How can the community evaluate the impact of its program on drug abuse?
Evaluating community prevention programs can be challenging. Community leaders often consult with evaluation experts, such as local universities or State agencies, to assist in evaluation design.
An evaluation needs to answer the following questions:
- What was accomplished in the program?
- How was the program carried out?
- How much of the program was received by participants?
- Is there a connection between the amount of program received and outcomes?
- Was the program run as intended?
- Did the program achieve what was expected in the short term?
- Did the program produce the desired long-term effects?
The community plan should guide actions for prevention over time because community needs change. Therefore, it is important to check program progress and decide if the original goals are being met. Evaluations may offer the chance to change plans and methods to better address current community problems.
What are the cost-benefits of community prevention programs?
Research has shown that preventing drug abuse and other problem behaviors can produce benefits for communities that outweigh the monetary costs. The cost-effectiveness and benefit-cost of two long-term effective interventions,26 the Strengthening Families Program: For Parents and Youth 1014 (SFP 1014), and Guiding Good Choices (GGC), produced net benefits in preventing adult cases of alcohol abuse. For every dollar spent, a $10 benefit was measured as a result of the SFP 1014 program, and a $6 benefit was the result of the GGC program. In addition, an analysis of the Skills, Opportunity, And Recognition (SOAR) program had a benefit-to-cost ratio of $4.25 for every dollar spent.1,13 An earlier study found that for every dollar spent on drug abuse prevention, communities could save from $4 to $5 in costs for drug abuse treatment and counseling.23