Best Practices for Alcohol, Tobacco and Other Drug Prevention Beth Welbes, MSPH University of Illinois Center for Prevention Research and Development
Objectives To describe the individual and environment factors that influence ATOD use and problems; To identify characteristics of effective and ineffective ATOD prevention strategies; and To discuss the lessons learned from outcome evaluations of implementing evidence based ATOD prevention programs in Illinois.
Evolution of Evidence Based ATOD Prevention Development of criteria to define science based prevention in the late 1990 s Lists of model, effective, promising programs by federal agencies based on evaluation findings Realization that selection and implementation matter as much as the program
Steps for Strategic and Effective ATOD Prevention Work in collaboration with other community stakeholders Identify problem ATOD consumption and consequences Determine what factors contribute to problem ATOD consumption Identify programs, policies and practices that target desired changes that have been tested or are grounded in theory Implement the programs, policies and practices in ways that maximize results (fidelity to model or research)
Potential Collaborators IL Dept of Human Services; Substance Abuse Prevention Programs- Comprehensive Grant Provider ATOD focused coalitions/ collaboratives Public Health Departments School Health Personnel
Consequences and Consumption Patterns Overall Consumption Acute, heavy consumption Consumption in risky situations Drinking and driving Smoking around young children Consumption by high risk groups Youth, College Students, Older Groups Pregnant women Substance-Related Consequences and Use
Environmental Intervening/Causal Factors Intervening Factors Environmental Factors Economic availability of substances (price) Retail availability of substances Social availability of substances Promotion of substances (advertising) Community Norms regarding use Enforcement of Laws and Policies Substance-Related Consequences and Use
Individual Intervening/Causal Factors Intervening Factors Individual Level Factors Substance-Related Consequences and Use Perceptions of risk or disapproval associated with use Biological/genetic predisposition Ties with pro-social institutions Parent expectations/connections General Strain Theory (response to stressors)
Interconnectedness of ATOD Intervening Factors Enforcement Norms Availability (Price, Retail, Social) Promotion Individual factors ATOD use ATOD related Problems Birckmayer et al. (2004). A general causal model to guide alcohol, tobacco, and illicit drug prevention: Assessing the research evidence. J. Drug Education 34(2) 121-153.
Choosing Strategies Strategies Intervening Factors Substance-Related Consequences and Use Must address the problem identified Must address the intervening factor(s) believed to be involved
Types of Prevention Strategies Universal - targets all people in a community or population Selected - targets those at higher than average risk for involvement with health problems and problems behaviors (one or more risk factors) Indicated - targets those who are already manifesting signs & symptoms of health and behavioral problems
Strategy does NOT match Intervening Factor Strategies Middle school curriculum Mentoring Program Intervening Factors Alcohol easily available in bars Little enforcement of drinking driving laws Substance-Related Consequences and Use Motor Vehicle Related Crashes
Strategy Matches Intervening Factor and Strategies Intervening Factors Problem Substance Use Related Problems Reduce Access Easy Access to Alcohol High Rates of Binge Drinking High Rate of Alcohol- Related Crashes Curriculum to Increase Knowledge about Risk Low Perceived Risk of Alcohol Use High Rates of Drinking and Driving Eliminating Tail-Gating Parties; Promoting No-Alcohol Parties Checkpoints Social Norms Encouraging Binge Drinking Little Enforcement of Drinking and Driving
Criteria for Evidence Based Programs Based on a well defined theory or model Degree to which target population received sufficient dosage Quality and appropriateness of data collection and analysis procedures Degree to which there is strong evidence of a causal link
A Practical Approach: Where s the Evidence Lower Evidence Higher Evidence Anecdotal, recognized, newspaper articles, etc Single pre/post evaluation Controlled study in peer reviewed journal Expert consensus in peer reviewed journal Multiple replicated studies in peer reviewed journals
Limitations of Evidence Based Programs Designed and tested in highly controlled environments (difficult to replicate) Some are associated with significant cost Programs were tested in a different population than your community context
Option 1: Select A Demonstrated Program or Practice Replicate demonstrated programs or practices as designed May include adaptations to better meet the needs of the population May bump up against situational barriers to implementation
Locating Demonstrated Programs and Practices National Registry of Effective Prevention Programs (SAMHSA) http://modelprograms.samhsa.gov/pdfs/comparisonmatrix.pdf Blueprints for Prevention (OJJDP) http://www.colorado.edu/cspv/blueprints/ Safe and Drug Free Schools (USDOE) http://www.ed.gov/admins/lead/safety/exemplary01/panel_pg2.h tml Centers for Disease Control and Prevention http://www.cdc.gov/hiv/pubs/hivcompendium/hivcompendium.pdf Research literature
Types of Adaptations Adjusting to risk level of the population or environment Different age level of participants Materials modified to address language differences Methods or materials changed to fit traditions or culture of the population Major adaptations to dosage or duration due to system or institutional structure (grade configuration, class time limits, etc)
Considerations for Model Programs: Balancing Fidelity & Adaptation Stay consistent with the theory base behind the program Consult with the program developer on significant adaptations Gather information to support the rationale and effectiveness of the
Option 2: Innovation Guided by Science Implement new programs or practices based on evidenced-based principles More difficult to carry off with quality (investigation and critical thinking) Most important for practices where traditional evaluation designs are less practical
Elements of Good Prevention Practice Comprehensive programming (multi domain/multi component) Theory driven & scientifically justified Sufficient program intensity/duration (intense enough and long enough for the goal and population) Implemented by well-trained staff (well-developed skills to implement)
Elements of Good Prevention Practice cont d Appropriate timing (developmentally appropriate and targeted) Varied instructional methods (educational programs) Culturally relevant
Strategies with Limited Impact Exclusive focus on self-esteem Neutral information about drugs Drug-free recreation without structure Single events (rallies, assemblies, speakers, etc) Testimonials from recovering addicts when targeting children and adolescents
Lessons Learned from Illinois Outcome Evaluations Programs with multiple years of exposure are more likely to produce outcomes Adaptations that significantly condense program duration are less likely to produce outcomes Model programs are just a likely to work in racially and economically diverse environments
Lessons Learned from Illinois Outcome Evaluations Communities have found creative ways to sustain efforts (e.g. fines for alcohol violations fund continued compliance checks) Detecting delays in ATOD onset or slower escalation requires a comparison group and time for trends to differentiate