Diffusion of State Risk/Protection-Focused Prevention
Prevention science has emerged as a discipline built on the integration
of life course development research, community epidemiology, and preventive
intervention trials (Coie et al., 1993; Kellam & Rebok, 1992). Prevention
science is based on the premise that empirically verifiable precursors
predict the likelihood of undesired health outcomes including substance
abuse. Precursors, in individuals and their environments, include factors
that predict an increased likelihood of problems (risk factors) and those
that mediate or moderate exposure to risk in predicting decreased likelihood
of problems (protective factors). Prevention science postulates that
negative health outcomes can be prevented by reducing levels of risk
and enhancing protective factors in individuals and their environments
during the course of development (Coie et al., 1993; Institute of Medicine
[IOM], 1994). The application of this approach to populations involves
the implementation of preventive interventions designed to reduce elevated
risk factors and enhance protective factors in geographic areas and demographic
groups where levels of risk are high and levels of protection are low.
This approach provides a framework for planning and managing prevention
activities at the community and state levels. By collecting epidemiologic
data on risk and protective factors at the community and state level,
elevated risks or depressed protective factors in a given area may be
identified and prioritized. Interventions that have been shown in prior
studies to reduce the prioritized risk factors while enhancing prioritized
protective factors may then be selected and implemented. This epidemiological
risk- and protection-focused prevention planning approach represents
a promising innovation, yet little is known about the process of changing
state and community prevention systems to implement the approach, or
its effectiveness in reducing risk, increasing protection, and preventing
negative health outcomes.
This prevention services research project is a collaborative effort
of the Social Development Research Group of the University of Washington,
the Alcohol and Drug Abuse Division of the Colorado Dept. of Human Services,
the Division of Community Health and Prevention of the Illinois Dept.
of Human Services, Alcohol and Drug Abuse Services of the Kansas Dept.
of Social and Rehabilitation Services, the Maine Office of Substance
Abuse, the Office of Alcohol and Drug Abuse Programs of the Oregon Dept.
of Human Services, the Division of Substance Abuse of the Utah Dept.
of Human Services, and the Division of Alcohol and Substance Abuse of
the Washington Dept. of Social and Health Services. These state agencies
have led in developing epidemiological risk- and protection-focused prevention
planning systems, and have adopted policies and procedures to encourage
this approach. These state agencies began implementing this approach
at different times. They have progressed at different rates. The states
have used different strategies to spread the approach to local communities
and to other state agencies and organizations involved in substance abuse
prevention. This study will capitalize on this naturally occurring variation
in implementation of the risk- and protection-focused prevention planning
approach to study the diffusion of the approach and to examine relationships
between implementation of the approach and trends and levels in prevention
outcomes.
This five-year project includes two sub-studies. The first sub-study
is a qualitative analysis of the natural history of implementation of
epidemiologically-based prevention. The project will compile a twelve-year
history of prevention practices in each state through interviews with
key public officials and content analysis of state prevention planning
documents. The second sub-study examines whether implementation of the
epidemiological risk- and protection-focused prevention approach results
in different prevention outcomes than other prevention planning methods.
Communities in the collaborating states that are implementing different
prevention approaches will be compared. Outcomes will be measured at
the state and community levels using archival indicators and data from
school surveys.
The project is funded by a grant from the National Institute on Drug
Abuse, with funding support from the Center for Substance Abuse Prevention,
the Department of Education, and the Office of Juvenile Justice and Delinquency
Prevention.
For further information, contact J. David Hawkins, Ph.D., Principal
Investigator; or Michael W. Arthur, Ph.D., Project Director, at the Social
Development Research Group, University of Washington, 9725 3rd Avenue
NE, Suite 401, Seattle, WA 98115-2024. Phone: (206) 543-5711 or (206)
685-1997. Fax: (206) 543-4507
