Advertisement

The Journal of Primary Prevention

, Volume 30, Issue 2, pp 89–107 | Cite as

A Preliminary Study of the Population-Adjusted Effectiveness of Substance Abuse Prevention Programming: Towards Making IOM Program Types Comparable

  • Stephen R. ShamblenEmail author
  • James H. Derzon
Original Paper

Abstract

The Institute of Medicine distinguishes between programs based on who is targeted: the entire population (universal), those at risk (selective), or persons exhibiting the early stages of use or related problem behavior (indicated). Evaluations suggest that although universal programs can be effective in reducing and preventing substance use, selective and indicated programs are both more effective and have greater cost-benefit ratios. This paper tests these assumptions by comparing the impact of these program types in reducing and preventing substance use at the individual level (i.e., those exposed to intervention services) and in the population (i.e., those exposed and not exposed to intervention services). A meta-analysis was performed on 43 studies of 25 programs to examine program comparability across IOM categories. When examining unadjusted effect sizes at the individual level, universal programs were modestly more successful in reducing tobacco use, but selective and indicated programs were modestly more successful in reducing alcohol and marijuana use. When adjusted to the population level, the average effect sizes for selective and indicated programs were reduced by approximately half. At the population level, universal programs were more successful in reducing tobacco and marijuana use and selective and indicated programs were more successful in reducing alcohol use. Editors’ Strategic Implications: The authors’ focus on the public health value of a prevention strategy is compelling and provides a model for analyses of other strategies and content areas.

Keywords

Meta-analysis Universal Selective Indicated Methodology IOM Public health 

Notes

Acknowledgments

The authors would like to thank Jude Vanderhoff for his assistance in coding research reports needed for these analyses. The authors would also like to thank David Collins and Chris Ringwalt for their insightful comments on an earlier draft of this manuscript.

References

Note: An asterisk indicates that the study was included in the meta-analysis

  1. Baker, J. A., Kamphaus, R. W., Horne, A. M., & Winsor, A. P. (2006). Evidence for population-based perspectives on children’s behavioral adjustment and needs for service delivery in schools. School Psychology Review, 35, 31–46.Google Scholar
  2. *Bauman, K. E., Foshee, V. A., Ennett, S. T., Pemberton, M., Hicks, K. A., King, T. S., et al. (2001). Influence of a family program on adolescent tobacco and alcohol use. American Journal of Public Health, 91, 604–610.Google Scholar
  3. *Borsari, B., & Carey, K. B. (2000). Effects of a brief motivational intervention with college student drinkers. Journal of Consulting and Clinical Psychology, 68, 728–733.Google Scholar
  4. *Botvin, G. J., Baker, E., Dusenbury, L., Botvin, E. M., & Diaz, T. (1995). Long-term follow-up results of a randomized drug abuse prevention trial in a White middle-class population. Journal of the American Medical Association, 273, 1106–1112.Google Scholar
  5. *Botvin, G. J., Baker, E., Dusenbury, L., Tortu, S., & Botvin, E. M. (1990). Preventing adolescent drug abuse through a multimodal cognitive-behavioral approach: Results of a three-year study. Journal of Consulting and Clinical Psychology, 58, 437–446.Google Scholar
  6. *Botvin, G. J., Baker, E., Renick, N., Filazzola, A. D., & Botvin, E. M. (1984). A cognitive-behavioral approach to substance abuse prevention. Addictive Behaviors, 9, 137–147.Google Scholar
  7. *Botvin, G. J., Dusenbury, L., Baker, E., James-Ortiz, S., Botvin, E. M., & Kerner, J. (1992). Smoking prevention among urban minority youth: Assessing effects on outcome and mediating variables. Health Psychology, 11, 290–299.Google Scholar
  8. *Botvin, G. J., & Eng, A. (1982). The efficacy of a multicomponent approach to the prevention of cigarette smoking. Preventive Medicine, 11, 199–211.Google Scholar
  9. *Botvin, G. J., Eng, A., & Williams, C. L. (1980). Preventing the onset of cigarette smoking through life skills training. Preventive Medicine, 9, 135–143.Google Scholar
  10. *Caplan, M., Weissber, R. P., Grober, J. S., Sivo, P. J., Grady, K., & Jacoby, C. (1992). Social competence promotion with inner-city and suburban young adolescents: Effects on social adjustment and alcohol use. Journal of Consulting and Clinical Psychology, 80, 56–63.Google Scholar
  11. Caulkins, J. P., Rydell, C. P., Everingham, S. S., Chiesa, J., & Bushway, S. (1999). An ounce of prevention, a pound of uncertainty: The cost-effectiveness of school-based drug prevention programs. Santa Monica, CA: RAND.Google Scholar
  12. Conduct Problems Prevention Research Group. (2000). Merging universal and indicated prevention programs: The Fast Track model. Addictive Behaviors, 25, 913–927.CrossRefGoogle Scholar
  13. *Cook, R. F., Back, A., & Trudeau, J. (1996a). Substance abuse prevention in the workplace: Recent findings and an expanded conceptual model. Journal of Primary Prevention, 16, 319–339.Google Scholar
  14. *Cook, R. F., Back, A. S., & Trudeau, J. (1996b). Preventing alcohol use problems among blue-collar workers: A field test of the working people program. Substance Use and Misuse, 31, 255–275.Google Scholar
  15. *Cook, R. F., Back, A. S., Trudeau, J. V., & McPherson, T. L. (2002). Integrating substance abuse prevention into health promotion programs in the workplace. In J. Bennett & W. Lehman (Eds.), Beyond drug testing: Innovative approaches to dealing with employee substance abuse (pp. 97–134). Washington, DC: American Psychological Association.Google Scholar
  16. *Cook, R. F., Hersch, R. K., Back, A. S., & McPherson, T. L. (2004). The prevention of substance abuse among construction workers: A field test of a social-cognitive program. Journal of Primary Prevention, 25, 337–357.Google Scholar
  17. Cuijpers, P. (2003). Examining the effects of prevention programs on the incidence of new cases of mental disorders: The lack of statistical power. American Journal of Psychiatry, 160, 1385–1391.PubMedCrossRefGoogle Scholar
  18. Derzon, J. H. (2007). Using correlational evidence to select youth for preventive interventions. Journal of Primary Prevention, 28, 421–447.PubMedCrossRefGoogle Scholar
  19. Derzon, J. H., Hansen, W., & Dusenbury, L. (2005, May). Meta-analysis and the development of prevention science. Paper presented at the Annual Meeting of the Society for Prevention Research, Washington, DC.Google Scholar
  20. *Dietz, D., Cook, R., & Hersch, R. (2005). Workplace health promotion and utilization of health services: Follow-up data findings. Journal of Behavioral Health Services & Research, 32, 306–319.Google Scholar
  21. Dishion, T. J., Kavanagh, K., Schneiger, A., Nelson, S., & Kaufman, N. K. (2002). Preventing early adolescent substance use: A family-centered strategy for the public middle school. Prevention Science, 3, 191–201.PubMedCrossRefGoogle Scholar
  22. Dishon, T. J., McCord, J., & Poulin, F. (1999). When interventions harm: Peer groups and problem behavior. American Psychologist, 54, 755–764.CrossRefGoogle Scholar
  23. Felix, E. D., Furlong, M. J., Sharkey, J. D., & Osher, D. (2007). Implication for evaluating multi-component, complex prevention initiatives: Taking guidance from the safe school/health students initiative. Journal of School Violence, 6, 3–22.CrossRefGoogle Scholar
  24. *Flay, B. R., & Allred, C. G. (2003). Long-term effects of the positive action program. American Journal of Health Behavior, 27(S1), S6–S21.Google Scholar
  25. *Flynn, B. S., Worden, J. K., Secker-Walker, R. H., Badger, G. J., Geller, B. M., & Costanza, M. C. (1992). Prevention of cigarette smoking through mass media intervention and school programs. American Journal of Public Health, 82, 827–834.Google Scholar
  26. *Flynn, B. S., Worden, J. K., Secker-Walker, R. H., Chir, B., Pirie, P. L., Badger, G. J., et al. (1997). Long-term responses to higher and lower risk youths to smoking prevention interventions. Preventive Medicine, 26, 389–394.Google Scholar
  27. *Flynn, B. S., Worden, J. K., Secker-Walker, R. H., Pirie, P. L., Badger, G. J., Carpenter, J. H., et al. (1994). Mass media and school interventions for cigarette smoking prevention: Effects 2 years after completion. American Journal of Public Health, 84, 1148–1150.Google Scholar
  28. Furlong, M. J., Jones, C., Lilles, E., & Derzon, J. (in press). Think smart, stay safe: Aligning elements within the multi-level approach to school violence prevention. In M. R. Shinn, H. M. Walker, & G. Stoner (Eds.), Interventions II: Interventions for achievement and behavior problems: Preventive and remedial approaches. Bethesda, MD: National Association of School Psychologists.Google Scholar
  29. *Goldberg, L., Elliot, D. L., Clarke, G., MacKinnon, D. P., Moe, E., & Cheong, J. (2000). The adolescents training and learning to avoid steroids program: Preventing drug use and promoting health behaviors. Archives of Pediatrics and Adolescent Medicine, 154, 332–338.Google Scholar
  30. Gordon, R. (1987). An operational classification of disease prevention. In J. A. Steinberg & M. M. Silverman (Eds.), Preventing mental disorders (pp. 20–26). Rockville, MD: Department of Health and Human Services.Google Scholar
  31. Hansen, W. B., Derzon, J., Dusenbury, L, Bishop, D., Campbell, K., & Alford, A. (2009). Operating characteristics of prevention programs: Connections to drug etiology. In L. M. Scheier (Ed.), Handbook of drug use etiology. Washington, DC: American Psychological Association.Google Scholar
  32. *Hansen, W. B., & Graham, J. W. (1991). Preventing alcohol, marijuana, and cigarette use among adolescents: Peer pressure resistance training vs. establishing conservative norms. Preventive Medicine, 20, 414–430.Google Scholar
  33. *Hansen, W. B., Malotte, C. K., & Fielding, J. E. (1988). Evaluation of a tobacco and alcohol abuse prevention curriculum for adolescents. Health Educational Quarterly, 15, 93–114.Google Scholar
  34. *Hawkins, J. D., Catalano, R. F., Kosterman, R., Abbott, R., & Hill, K. G. (1999). Preventing adolescent health-risk behaviors by strengthening protection during childhood. Archives of Pediatric and Adolescent Behavior, 153, 226–234.Google Scholar
  35. *Hawkins, J. D., Catalano, R. F., Morrison, D. M., Abbott, R. D., & Day, L. E. (1992). The Seattle Social Development Project: Effects of the first four years on protective factors and problem behaviors. In J. McCord & R. Tremblay (Eds.), The prevention of antisocial behavior in children (pp. 139–161). New York: Guilford.Google Scholar
  36. Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. New York: Academic Press.Google Scholar
  37. *Henggeler, S. W., Clingempeel, W. G., Brondino, M. J., & Pickrel, S. G. (2002). Four-year follow-up of multisystemic therapy with substance-abusing and substance-dependent juvenile offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 868–874.Google Scholar
  38. *Henggeler, S. W., Rowland, M. D., Randall, J., Ward, D. M., Pickrel, S. G., Cunningham, P. B., et al. (1999). Home-based multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis: Clinical outcomes. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1331–1339.Google Scholar
  39. *Kellam, S. G., & Anthony, J. C. (1998). Targeting early antecedents to prevent tobacco smoking: Findings from an epidemiologically based field trial. American Journal of Public Health, 88, 1490–1495.Google Scholar
  40. Kulis, S., Nieri, T., Yabiku, S., & Stromwall, L. (2005, August). Prevention as intervention: The success of a universal prevention program among early adolescent substance users. Paper presented at the annual meeting of the American Sociological Association, Philadelphia, PA.Google Scholar
  41. Lipsey, M. W., & Wilson, D. B. (1993). The efficacy of psychological, educational, and behavioral treatment: Confirmation from meta-analysis. American Psychologist, 48, 1181–1209.PubMedCrossRefGoogle Scholar
  42. *Lochman, J. E., & Wells, K. C. (2002). The coping power program at the middle-school transition: Universal and indicated prevention effects. Psychology of Addictive Behaviors, 16(4S), S40–S54.Google Scholar
  43. *LoSciuto, L., & Taylor, A. S. (2000). Across ages: An intergenerational approach to drug prevention. Unpublished manuscript.Google Scholar
  44. *Marlatt, G. A., Baer, J. S., Kivlahan, D. R., Dimeff, L. A., Larimer, M. E., Quigley, L. A., et al. (1998). Screening and brief intervention for high-risk college student drinkers: Results from a 2-year follow-up assessment. Journal of Consulting and Clinical Psychology, 66, 604–615.Google Scholar
  45. *Marsiglia, F. F., Kulis, S., Dustman, P., & Nieri, T. (2002). Final report: Keepin’ it REAL prevention curriculum implementation. Unpublished manuscript.Google Scholar
  46. Masterman, P. W., & Kelly, A. B. (2003). Reaching adolescents who drink harmfully: Fitting intervention to developmental reality. Journal of Substance Abuse Treatment, 24, 347–355.PubMedCrossRefGoogle Scholar
  47. *McCormick, B., & Aseltine, R. H. (2000). Final report: Across ages. Unpublished manuscript.Google Scholar
  48. *McNeal, R. B., Hansen, W. B., Harrington, N. G., & Giles, S. M. (2004). How all stars works: An examination of program effects on mediating variables. Health Education & Behavior, 31, 165–178.Google Scholar
  49. Miller, T. R., Hendrie, D., & De la Torre, A. (2007). Substance abuse prevention dollars and cents: A cost-benefit analysis. Bethesda, MD: Substance Abuse and Mental Health Services Administration.Google Scholar
  50. *Morehouse, E., & Tobler, N. S. (2000). Preventing and reducing substance use among institutionalized adolescents. Adolescence, 35(137), 1–28.Google Scholar
  51. Mrazek, P. J., & Haggerty, R. J. (1994). Reducing risks for mental disorders: Frontiers for preventive intervention research. Washington, DC: National Academy Press.Google Scholar
  52. National Survey on Drug Use and Health. (1999). National survey on drug use and health, 1999 [Computer file]. ICPSR version. Research Triangle Park, NC: Research Triangle Institute.Google Scholar
  53. Pentz, M. (1994). Target population and interventions in prevention research: What is high risk? In A. Cazares & L. A. Beatty (Eds.), Scientific methods for prevention intervention research. NIDA Research Monograph (Vol. 139, pp. 75–93). Washington, DC: Substance Abuse and Mental Health Services Administration.Google Scholar
  54. *Pentz, M. A., Dwyer, J. H., MacKinnon, D. P., Flay, B. R., Phil, D., Hansen, W. B., et al. (1989). A multicommunity trial for primary prevention of adolescent drug abuse: Effects on drug use prevalence. Journal of the American Medical Association, 261, 3259–3266.Google Scholar
  55. *Perry, C., Williams, C., Veblen-Mortenson, S., Toomey, T., Komro, K., Anstine, P., et al. (1996). Project Northland: Outcomes of a community-wide alcohol use prevention program during early adolescence. American Journal of Public Health, 86, 956–965.Google Scholar
  56. Pollard, J., Catalano, R., Hawkins, J. D., & Arthur, M. (1998). Development of a school-based survey measuring risk and protective factors predictive of substance abuse, delinquency and other problem behaviors in adolescent populations. Unpublished manuscript.Google Scholar
  57. *Santisteban, D. A., Coatsworth, J. D., Perez-Vidal, A., Kurtines, W. M., Schwartz, S. J., LaPerriere, A., et al. (2003). Efficacy of brief strategic family therapy in modifying Hispanic adolescent behavior problems and substance use. Journal of Family Psychology, 17, 121–133.Google Scholar
  58. *Smith, C., & Kennedy, S. D. (1991a). Final impact evaluation of the friendly persuasion program of girls incorporated. Unpublished manuscript.Google Scholar
  59. *Smith, C. & Kennedy, S. D. (1991b). Final impact evaluation of the friendly persuasion targeted substance abuse education program of girls incorporated. Unpublished manuscript.Google Scholar
  60. *Spoth, R. L., Redmond, C., & Shin, C. (2001). Randomized trial of brief family interventions for general populations: Adolescent substance use outcomes 4 years following baseline. Journal of Consulting and Clinical Psychology, 69, 1–15.Google Scholar
  61. *Spoth, R. L., Redmond, C., Trudeau, L., & Shin, C. (2002). Longitudinal substance initiation outcomes for a universal preventive intervention combining family and school programs. Psychology of Addictive Behaviors, 16, 129–134.Google Scholar
  62. Sprague, J., Walker, H. M., Sowards, S., Van Bloem, C., Eberhardt, P., & Marshall, B. (2003). In M. R. Shinn, H. M. Walker, & G. Stoner (Eds.), Interventions for academic and behavior problems II: Preventive and remedial approaches (pp. 295–314). Bethesda, MD: National Association of School Psychologists.Google Scholar
  63. Substance Abuse and Mental Health Administration. (2003). Science-based prevention programs and principles, 2002. Rockville, MD: United States Department of Health and Human Services.Google Scholar
  64. Substance Abuse and Mental Health Services Administration. (2007). SAMHSA Model Programs: Effective substance abuse and mental health programs for every community. Retrieved August 10, 2007 from http://www.modelprograms.samhsa.gov/.
  65. Tobler, N. S., Roona, M. R., Ochshorn, P., Marshall, D. G., Streke, A. V., & Stackpole, K. M. (2000). School-based adolescent drug prevention programs: 1998 meta-analysis. Journal of Primary Prevention, 20, 275–336.CrossRefGoogle Scholar
  66. *Wagenaar, A. C., Murray, D. M., Gehan, J. P., Wolfson, M., Forster, J. L., Toomey, T. L., et al. (2000). Communities mobilizing for change on alcohol: Outcomes from a randomized community trial. Journal of Studies on Alcohol, 61, 1–11.Google Scholar
  67. Walker, H. M., Horner, R. H., Sugai, G., Bullis, M., Sprague, J., Bricker, D., et al. (1996). Integrated approaches to preventing antisocial behavior patterns among school-age children and youth. Journal of Emotional and Behavioral Disorders, 4, 194–209.CrossRefGoogle Scholar
  68. *Werch, C. E., Pappas, D. M., Carlson, J. M., Edgemon, P., Sinder, J. A., & DiClemente, C. C. (2000). Evaluation of a brief alcohol prevention program for urban school youth. American Journal of Health Behavior, 24, 120–131.Google Scholar
  69. Winslow, E. B., Sandler, I. N., & Wolchik, S. (2005). Building resilience in all children: A public health approach. In S. Goldstein & R. B. Brooks (Eds.), Handbook of resilience in children (pp. 337–356). New York: Springer.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Pacific Institute for Research and Evaluation, Louisville CenterLouisvilleUSA
  2. 2.Battelle Memorial InstituteArlingtonUSA

Personalised recommendations