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


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.


Meta-analysis Universal Selective Indicated Methodology IOM Public health 



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.


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

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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

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