What works in prevention. Principles of effective prevention programs

The high prevalence of drug abuse, delinquency, youth violence, and other youth problems creates a need to identify and disseminate effective prevention strategies. General principles gleaned from effective interventions may help prevention practitioners select, modify, or create more effective programs. Using a review-of-reviews approach across 4 areas (substance abuse, risky sexual behavior, school failure, and juvenile delinquency and violence), the authors identified 9 characteristics that were consistently associated with effective prevention programs: Programs were comprehensive, included varied teaching methods, provided sufficient dosage, were theory driven, provided opportunities for positive relationships, were appropriately timed, were socioculturally relevant, included outcome evaluation, and involved well-trained staff. This synthesis can inform the planning and implementation of problem-specific prevention interventions, provide a rationale for multi-problem prevention programs, and serve as a basis for further research.     

Church youth alcohol and drug education programs

This study indicates that pastors believe that their churches should have a role in influencing the alcohol and drug use of their members; that about half of the churches in this study actually had youth alcohol and drug education programs; and that the content of these education programs and church attitudes toward substance use are affected by the degree of fundamentalism-liberalism of the church.     

Involving parents in child sexual abuse prevention programs

Conclusion The importance of involving parents in child sexual abuse prevention programs has been given much lip-service by prevention educators, but relatively little time, energy or resources in reality. This seems short-sighted at best, if the goal of these programs is truly prevention as they purport. Although the results of this study may have limited generalizability because of its sample size and its highly educated respondents, it is the first study to compare the knowledge of attending versus nonattending parents of a typical one-shot parent workshop. The results indicated that the parents as a whole were fairly well versed in the facts of sexual abuse, although as in previous studies, they did not extend the statistics on sexual abuse to their own children. However, probably the most important results were the enthusiastic responses for parent programs and involvement but in different formats, at different times, and in different environments than the current typical PTO evening, one-time meeting. Clearly child sexual abuse prevention programs should experiment with innovative ways to reach parents. If prevention programs can involve a small minority of motivated parents as they seem to be able to do, then together these parents and the educators may be able to develop methods and resources to involve the large majority of currently uninvolved parents. Such an integrated and involving community approach to the prevention of child sexual abuse seems necessary if the goal of prevention is ever going to be reached.     

Eating disorder prevention programs: a meta-analytic review

This meta-analysis of eating disorder prevention programs found that intervention effects ranged from an absence of any effects to reductions in current and future eating pathology. Certain effects persisted as long as 2 years and were superior to minimal-intervention control conditions. Larger effects occurred for selected (vs. universal), interactive (vs. didactic), and multisession (vs. single session) programs; for programs offered solely to females and to participants over age 15; for programs without psychoeducational content; and for trials that used validated measures. The results identify promising prevention programs and delineate sample, format, and design features that are associated with larger effects, but they suggest the need for improved methodological rigor and statistical modeling of trials and enhanced theoretical rationale for interventions.     

Development and evaluation of school-based violence prevention programs

Discusses key issues in developing and evaluating school-based violence prevention interventions. Schools provide a natural setting for implementing programs directed at teaching youth attitudes, knowledge, and skills to reduce their involvement in violence. Although multitudes of these programs exist, few have been rigorously evaluated. Developers of violence prevention programs need to pay particular attention to the type of violence being addressed, the target population, relevant risk and protective factors, and the target of the intervention. Conducting sound evaluations of such programs requires careful attention to the unit of randomization, treatment conditions, outcome measures, timing of data collection, and potential moderator variables. Efforts to develop effective prevention programs can be greatly facilitated by adopting an action-research strategy in which evaluation findings provide a basis for continual program refinement.     

Child sexual abuse prevention programs: a meta-analysis

Conducted a meta-analytic evaluation of the effectiveness of school-based child abuse prevention programs. Literature searches identified 27 studies meeting inclusion criteria for use in this meta-analysis. The average effect size for all programs studied was 1.07, indicating that children who participated in prevention programs performed 1.07 SD higher than control group children on the outcome measures used in the studies. Analysis of moderator variables revealed significant effects for age, number of sessions, participant involvement, type of outcome measure, and use of behavioral skills training. Most important, programs presented over 4 or more sessions that allowed children to become physically involved produced the highest effect sizes. Although most often used only with younger children, findings suggest that active, long-term programs may be more effective for children of all ages.     

Establishing enduring prevention programs: Advancing the legacy of Swampscott

The recent anniversary of the 1965 Swampscott Conference provided an opportunity to reconsider the implications of that meeting for prevention research. An unfulfilled aspect of the Swampscott legacy is the relative paucity of demonstration programs that become enduring parts of their host settings. A macrolevel, systems-oriented reformulation of Albee's (1982) prevention formula is presented to help conceptualize the linkage of prevention programs to their host settings. Finally, structural considerations necessary for weaving efforts at prevention and health promotion into adaptive, enduring organizational niches are reviewed.     

The effectiveness of school-based bullying prevention programs: A systematic review

Bullying is a social phenomenon. About 30% of school children are involved in bullying as victims, bullies, or bully/victims. The victims of bullying suffer multiple negative consequences, including poor social and academic adjustment, depression, and anxiety. This paper extends Farrington and Ttofi's (2009) meta-analysis of controlled trials of 44 bullying interventions, which suggests that bullying programs are effective in decreasing bullying and victimization. We review controlled trials of bullying interventions published from June, 2009 through April, 2013, focusing on substantive results across 32 studies that examined 24 bullying interventions. Of the 32 articles, 17 assess both bullying and victimization, 10 assess victimization only, and 5 assess bullying only. Of the 22 studies examining bullying perpetration, 11 (50%) observed significant effects; of the 27 studies examining bullying victimization, 18 (67%) reported significant effects. Although the overall findings are mixed, the data suggest that interventions implemented outside of the United States with homogeneous samples are more successful than programs implemented in the United States, where samples tend to be more heterogeneous. Few studies have measured bullying with sufficient precision to have construct validity. Finding strong measures to assess the complex construct of bullying remains a major challenge for the field.     

Effectiveness of two smoking prevention programs according to type of applicator

Although research on the prevention of drug use has shown that the effectiveness of programs depends partly on who applies them, the results of studies designed to clarify this issue are contradictory. This study compared the effects on smoking, in the short and medium term, of the implementation of two school-based prevention programs, depending on the type of applicator. The sample was made up of 200 seventh-grade students distributed among five experimental conditions: four of intervention, in which the programs were implemented by teachers from the school or by external psychologists, and one of control. The results show that teachers applying the Barbacana program and psychologists applying the Construyendo Salud (Building Health) program succeeded in reducing the incidence of cigarette smoking (BR-teachers 15%; C.S-psychologists 5%) and strengthening attitudes against smoking. An interaction effect between type of program and type of applicators was clearly observed.     

Probing the effects of individual components in multiple component prevention programs

Assessing the contributions of individual components in multi-component interventions poses complex challenges for prevention researchers. We review the strengths and weaknesses of designs and analyses that may be useful in answering three questions: (1) Is each of the individual components contributing to the outcome? (2) Is the program optimal? and (3), Through what processes are the components of the program achieving their effects? Factorial and fractional factorial designs in which a systematically selected portion of all possible treatment combinations is implemented are used to address question 1. Response surface designs in which each component is quantitatively scaled are explored in relation to question 2. Mediational analysis, a hybrid of experimental and correlational approaches, is considered in relation to question 3. Design enhancements are offered that may further strengthen some of these techniques. These techniques offer promise of enhancing both the basic science and applied science contributions of prevention research.     

Weight concerns among elementary school children: a review of prevention programs

There is increasing evidence that children display high levels of weight and muscle concerns, which include body dissatisfaction and problem eating. In order to address these issues, researchers have designed and implemented prevention programs for this age group. Thirteen published studies were located and reviewed, with children aged 8-12 years from elementary schools, or equivalent. Overall, the programs were shown to be effective in improving children's knowledge at post-test and at follow-up assessments. However, there is limited evidence to show that the programs reduced or prevented body image concerns and/or problem eating. Too few studies have examined muscle concerns so no conclusions can yet be drawn about this domain. Limitations of the studies and suggestions for future prevention efforts are discussed.     

The community alcohol use scale: A scale for use in prevention programs

The Community Alcohol Use Scale (CAUS) was developed as a continuous, reliable, valid, and acceptable measure for primary prevention studies. Items were written following a comprehensive review of the literature on alcohol dependence and alcoholism. Based upon the responses of 315 respondents to the 100-item initial version of the scale, the 45-item CAUS was developed. The CAUS was then cross-validated on a local sample (n = 274) and a provincial sample (n = 745). Estimates of internal consistency were .91, .96, and .94, respectively, for the initial and cross-validation samples. Correlations of .48 and .69 were obtained between the CAUS and the Michigan Alcohol Screening Test for the initial and local cross-validation samples. In the provincial cross-validation sample a correlation of .62 was obtained between the CAUS and the Usual Weekly Alcohol Index. Preliminary cutting scores were developed to identify those at risk for alcoholism, and alcoholics. The CAUS has potential use as an evaluative and predictive instrument in a variety of primary prevention programs.     

Correlates of unhealthy weight-control behaviors among adolescents: implications for prevention programs.

This study aimed to identify correlates of unhealthy weight-control behaviors in adolescents to guide the development of programs aimed at the primary prevention of disordered eating. A model explaining unhealthy weight-control behaviors was tested among 4,746 adolescents using structural equation modeling. Models fit the data well and explained 76% of the variance in unhealthy weight-control behaviors among girls and 63% among boys. Weight-body concerns were a strong correlate of unhealthy weight-control behaviors in both girls and boys. Models also emphasized the importance of weight-specific social norms within the adolescent's proximal environment. Findings suggest the importance of addressing weight-body concerns within prevention programs and extending interventions beyond classroom settings to ensure changes in weight-related norms among peer groups and family members.     

Risk-factor research and prevention programs for anxiety disorders: a translational research framework

The aim of the present essay is to discuss the interconnection between risk-factor research and prevention program development for panic-spectrum psychopathology. We argue that prevention of panic-spectrum psychopathology specifically, and anxiety disorders more generally, is likely to be best advanced through active, systematic translation of basic, risk-factor research. After operationalizing key terminology, we present some exemplar risk-factor candidates for panic-spectrum psychopathology, summarize research related to their role as risk-factors for panic problems, and link this discussion to risk-factor nomenclature. We then present a translational framework for extrapolating extant knowledge on these and other potential risk-factors for panic-spectrum psychopathology with respect to the development of preventative interventions. The proposed translational framework is intended to describe a forward-feeding process by which risk-factor research could be used by clinical researchers to inform prevention programs; and reciprocally, how such prevention knowledge could be most effectively utilized to drive new, clinically focused risk-factor research.     

The effectiveness of drug treatment programs in reducing criminal behavior: a meta-analysis

The main aim of this paper is to assess the effectiveness of drug treatment programs in reducing criminal behavior. The research is based on a systematic review and meta-analysis of evaluations of drug treatment programs. The research investigated various drug treatment programs including methadone treatment, therapeutic communities, post-release supervision for drug-misusing offenders, and drug courts, and focused on drug treatment programs that were primarily concerned with heroin, crack and cocaine misuse. The main outcome variable analyzed was reoffending following treatment as measured by self-reports or official records. The study was based on a meta-analysis of 28 evaluations of drug treatment programs. The meta-analysis involved calculating individual effect sizes for each study and weighted mean effect sizes for groups of studies. The mean odds of offending following treatment were significantly lower among clients of the drug treatment programs than among the comparison groups. However, the results varied by type of program, type of evaluation methods used, and characteristics of clients.     

Predicting participation in premarital prevention programs: the health belief model and social norms

The development of effective programs to prevent marital dysfunction has been a recent focus for marital researchers, but the effective dissemination of these programs to engaged couples has received relatively little attention. The purpose of this study is to determine which factors predict couples' participation in premarital counseling. Predictive factors were derived from the health prevention literature, with a particular focus on the health belief model (HBM). Couples' beliefs and attitudes about premarital counseling were assessed at least six months before their wedding, and participation was assessed after their wedding. Results indicate that the strongest predictors of couples' participation were couples' perceptions of barriers to counseling and whether they had counseling recommended to them. These variables predicted participation even after controlling for important demographic variables. Recommendations for recruiting engaged couples for premarital counseling are made based on the findings.     

Tailoring sex-education programs to adolescents--a strategy for the primary prevention of unwanted adolescent pregnancies

The data for this paper were derived from 88 unstructured interviews conducted with a purposive sample of adolescents from September 1978 through July 1979. We content analyzed all interview abstracts with particular emphasis on the comments and suggestions made by adolescents in regard to sex education in order to ascertain their needs. Three areas in need of immediate revision were identified--curriculum, format, and lecturer. Respondents also provided a variety of suggestions which can be used by educators and planners in developing and implementing sex-education programs; thereby making programs sensitive to the expressed needs and wants of adolescents. This qualitative study supports the findings of many quantitative studies which found that many adolescents do not have, yet want, sensitive sex-education programs.     

Alberta's suicide prevention training programs: a retrospective comparison with Rothman's developmental research model

Developmental research is used to transform existing knowledge into applied programs. A social research and development (R&D) method, developed by Rothman for the human service professions, is compared with the method used to develop the Suicide Prevention Training Programs in Alberta, Canada. A retrospective review compares the development of these programs, which have since been implemented both nationally and internationally, with Rothman's model; discusses social R&D as a transformation methodology; and draws conclusions about the probable success of using developmental research methods in the human services. The review finds that the Alberta method closely paralleled the phases of Rothman's model. Results show that the transformation of knowledge about suicide into widely disseminated suicide prevention training programs can be attributed to the application of social R&D principles. The study concludes that the use of developmental research methods to establish human service programs should increase the probability of their success.