The research agendas of prevention scientists are geared toward multilevel solution-based strategies that are inherently actionable (Antle et al. 2012). As such, it is incumbent upon us to ensure that the “end-users” (e.g., practitioners, community stakeholders, policymakers, agency administrators) are aware of the field consensual knowledge and practices we have amassed, that drivers are in place to implement those practices into well-oiled delivery systems, and that policymakers are compelled to institutionalize what works in their districts. Engaging in the work needed to entrench prevention science into mindsets, practices, and policies is our highest calling. Ultimately, the extra effort it requires to accomplish these objectives will foster inclusiveness, diversity, and equity in our work and in our ecosystem. The following promptings speak to ways we can integrate this track into our career trajectories.
First, there is a need to develop well-tested protocols that (a) identify thresholds for translating evidence (e.g., sufficiency of the evidence, criteria for designating programs as evidence-based, field consensual knowledge), (b) instill effective communications skills, (c) teach strategies for interacting with different constituent groups (e.g., segments of the population, policymakers, community stakeholders), and (d) guide exercises to map legislative agendas to the available evidence. Learning how to effectively advocate for and support a careful, thoughtful, and evidence-based policy approach will facilitate widespread adoption and implementation of demonstrated prevention strategies and concepts.
Second, it is critical that we concertedly diversify the scientific research community which historically addresses phenomena that are outgrowths of racial and ethnic disparities. As such, ensuring that this community is representative of, and sensitive to, the diversity of populations (e.g., vulnerable, stigmatized, oppressed), focal concerns (e.g., disparities and inequalities), and contexts (e.g., poverty and other adverse conditions) is incumbent upon the field. Prevention science is currently underrepresented by Black and Brown investigators and practitioners, as reflected in the proportion that comprises the membership of the Society for Prevention Research (SPR, 2019: 62% Caucasian, 9.58% Asian, 5.10% Black, 10.32% Hispanic).
Third, research is needed to develop evidence-based strategies that build political will and support for programs and policies that increase social equity and welfare. Strategies to move the needle down this track include developing methods to raise awareness of the pervasiveness of inequities in health and promoting empathy and support for addressing them. In parallel, studies should focus on determining how to effectively increase capacity of individuals and communities to participate in intervention efforts. The work of community coalitions—composed of agencies, organizations, faith groups, and citizens—exemplifies this process of collective action designed to strengthen the social fabric (Lardier Jr. et al. 2019). And advancing and integrating the work of implementation scientists will help us to delineate best practices for imbedding large-scale efforts to reduce racial prejudice, ideologies, and stereotypes in the larger culture that frame policy preferences that underlie and perpetrate inequities.
Fourth, intervention evaluation studies can begin to model measures of implicit bias, perceptions and experiences of racism, and racist practices as outcomes. To date, very few studies examine whether effective preventive interventions reduce racism or racist practices; only interventions that are specifically designed to directly address the phenomena include these measures as outcomes (Cobbinah and Lewis 2018; Lai et al. 2014). It is possible, for example, that preventive interventions targeting other outcomes (e.g., substance use, violence, community cohesion, academic performance) may directly affect deficits in self-image due to perceptions of racism as social emotional and competency skills improve. Or intervention-related improvements may indirectly impact the implicit biases of other players in the recipients’ sphere of influence. A key question is, as the playing field is increasingly equalized, do racially driven attitudes, behaviors, and practices change accordingly? And relatedly, does (or can) the needle move in system-level practices and policies in response to the benefits demonstrated by preventive strategies? To date, research has not concertedly addressed the question of residual effects of intervention on higher-order processes. Therefore, we cannot cite evidence of the impacts of preventive intervention on the many facets and manifestations of racism or racist practices relative to individual or global attitudes, actions, or systems reforms.
Fifth, the bread and butter of prevention research has historically been on the development, implementation, and scaling of interventions. The success of this agenda as described above is remarkable. However, increasing and sustaining those impacts can be achieved by broadening the scope and scale of evidence-based interventions and focusing greater attention on identifying or developing effective methods that advance the institutionalization of those that are most efficacious and generalizable. Constraints are, in part, a function of the reality that the research process is largely dictated by time-limited grants.
On the other hand, the normalization of prevention principles and practices—otherwise called a culture of prevention in this special issue—has the greatest potential to achieve population level effects, ultimately equalizing the playing field for all segments of society. Normalization can be facilitated in two ways. First, incorporating into our daily lives the practices and principles that undergird intervention impacts—the “kernels” or active ingredients—can transform the way adults interact with each other and their children (Embry 2011). These fundamental units of programs and interventions have been shown experimentally to influence specific behaviors. Integrating a wide range of these practices and principles into daily interactions has potential to more broadly and sustainably promote health and well-being, independent of any particular intervention or grant.
The second interrelated aspect of normalization involves increasing knowledge; changing attitudes and mindsets extends from a better understanding of the science of human development and the fundamental importance of the manner in which adults interact with each other and their children (Marteau 2018). Making scientific knowledge widely accessible catalyzes change in attitudes and behaviors. Recipients of this information then become change agents themselves as they diffuse this new information to their associates, organizations, and systems within which they interact, and they disseminate it throughout their spheres of influence. As suggested by several of the papers in this special issue, the end goal should be to spur a shift in cultures, priorities, and practices that, in turn, influence policies, distribution of resources, and system level relationships. For example, incorporating these principles and practices into cross-sector service delivery systems substantially expands the scale at which benefits are achieved.
Sixth, and perhaps of greatest importance, more attention to tackling the underlying sources of exposures to social determinants of poor health outcomes has potential to exert broader impacts on the phenomena we seek to prevent than solely focusing on the attenuation of individual and family level adverse consequences of adversity. While the latter approach is no doubt critical, increased investments in science-informed practices and policies to reduce systemic inequalities, poverty, marginalization, and discrimination and to promote health equity and social welfare altogether promise to exert wide-scale impacts (Cogburn 2019; Griffith et al. 2010; Williams and Cooper 2019).
Prevention scientists, by nature, have already embraced an upstream strategy (e.g., programs that prevent substance use in adolescents, provide early education, strengthen skills to resist poor developmental outcomes, and support positive mental health) to avoid downstream costs (e.g., the financial and human burden to communities associated with treating drug addiction, juvenile delinquency, involvement in the criminal justice system, and school dropout). And when implemented effectively, the application of our well-tested practices and policies can lead to substantial cost-savings (Crowley et al. 2018). Focusing our attention further up the stream, beyond the individual, family, and even the community level, we find the roots of the problems we strive to solve in cultural, economic, linguistic, attitudinal, and structural sources. Directing our energies toward these fundamental streams of influence promises to produce transformational results.