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