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A National Cost Analysis of Community Interventions to Prevent Underage Drinking and Prescription Drug Misuse


This prospective cost analysis addresses a gap in the prevention literature by providing estimates of the typical real-world costs to implement community interventions focused on preventing underage drinking and prescription drug misuse. The study uses cost data reported by more than 400 community subrecipients participating in a national cross-site evaluation of the Substance Abuse and Mental Health Services Administration’s Strategic Prevention Framework Partnerships for Success grant program during 2013–2017. Community subrecipient organizations completed an annual Web-based survey to report their intervention costs. The analysis compares the relative startup and annual ongoing implementation costs of different prevention strategies and services. Partnerships for Success communities implemented a wide variety of interventions. Annual ongoing implementation was typically more costly than intervention startup. Costs were generally similar for population-level interventions, such as information dissemination and environmental strategies, and individual-level interventions, such as prevention education and positive alternative activities. However, population-level interventions reached considerably more people and consequently had much lower costs per person. Personnel contributed the most to intervention costs, followed by intervention supplies and overhead. Startup costs for initial training and costs for incentives, ongoing training, and in-kind contributions (nonlabor) during ongoing implementation were not typically reported. This study informs prevention planning by providing detailed information about the costs of classes of interventions used in communities, outside of research settings.

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We thank the Strategic Prevention Framework Partnerships for Success (PFS) grantees and subrecipients for their participation in the PFS cross-site evaluation and express our gratitude to Rick Harwood and Chris Ringwalt for the feedback they provided on earlier drafts of this paper. Chelsea Burfeind and Alex Buben assisted with collecting and processing data used in these analyses.


This research was conducted by RTI International under contract number HHSS283201200006I/HHSS28342003T from the Substance Abuse and Mental Health Services Administration. The views expressed in this article represent the analyses and conclusions of the individual authors and may not reflect the opinions, official policy, or position of the US Department of Health and Human Services, the Substance Abuse and Mental Health Services Administration, or the Center for Substance Abuse Prevention.

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Correspondence to Elvira Elek.

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Close, C., Elek, E., Roberts, C.A. et al. A National Cost Analysis of Community Interventions to Prevent Underage Drinking and Prescription Drug Misuse. Prev Sci 22, 1071–1085 (2021).

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  • Economic
  • Cost
  • Prevention
  • Interventions
  • Underage drinking
  • Prescription drug misuse