Prevention scienceCoie, J. D., Watt, N. F., West, S. G., Hawkins, J. D., Asarnow, J. R., Markman, H. J., Ramey, S. L., ... Long, B. (January 01, 1993). The science of prevention. A conceptual framework and some directions for a national research program. The American Psychologist, 48, 10, 1013-22. is the application of a scientific methodology that seeks to prevent or moderate major human dysfunctions before they occur. Regardless of the type of issue on hand, the factors that lead to the problem must be identified and addressed. Prevention research is thus focused primarily on the systematic study of these potential precursors of dysfunction, also known as risk factors; as well as components or circumstances that reduces the probability of problem development in the presence of risk, also known as protective factors. Preventive interventions aim to counteract risk factors and reinforce protective factors in order to disrupt processes or situations that give rise to human or social dysfunction.
Components of prevention science Source:Mrazek, P. B., Haggerty, R. J., Institute of Medicine (U.S.)., & United States. (1994). Reducing risks for mental disorders: Frontiers for preventive intervention research. Washington, D.C: National Academy Press.
Epidemiology
The prevalence, distribution, and determinants of the problem in time and space. Epidemiological investigations can be carried out through surveillance and descriptive studies to determine its extent.
Etiology
The causes of such positive or negative outcomes, with an emphasis on risk and protective factors. Also known as the Theory of Causation.
Efficacy trials
Scientific experiments that test the preventive intervention programs ability to prevent the problem under favorable conditions. Under these optimal conditions, the researcher has control over the intervention and how it is delivered. If the test finds significant desirable effects, the intervention program is considered to be efficacious.
Effectiveness trials
Scientific experiments that test the preventive intervention programs ability to prevent the problem under real world conditions. The setting and the kinds of people in the experiment should be very similar to the actual targeted population in a particular location.
Dissemination research
Analyzes how tested and effective prevention intervention programs may be spread to reduce problems at a larger scale.
Usefulness of risk factors The term "risk factor" was first coined Dr. William B. Kannel in a 1961 article in Annals of Internal Medicine. Dr. Kannel was the epidemiologist who discovered most of the major risk factors for cardiovascular disease while working on the Framingham Heart Study in Massachusetts.
There are 2 useful ways to utilize risk factors in prevention science: To identify subpopulations more likely to develop problems which should be reached by preventive intervention. To identify malleable individual or environmental characteristics that can be changed by preventive intervention.
Further observations about risk and protective factors Different forms of dysfunction are typically related to many different risk factors, rather than a single risk factor. On the other hand, a single risk factor may lead to a variety of consequences in different settings. Risk factors have compounding effects on an individual. The risk of dysfunction seems to increase exponentially with each additional exposure to a new risk factor. Some risk factors may predict dysfunction only at specific periods of development, while others stay constant throughout one's lifespan. As a general rule, prediction is best made from proximal risk factors. Diverse disorders may share common fundamental risk factors. For example, marital discord has been found to precede both conduct problems in children and depression among women.Markman, H. J., & Jones-Leonard, D. (1985). Marital discord and children at risk: Implications for research and prevention. In W. Frankenberg & R. Emde (Eds.), Early identification of children at risk (pp. 59-77). New York: Plenum Press.
Levels of prevention In defining the level of prevention in the public health sector, R.S. Gordon, Jr. proposed 3 classifications based upon the costs and benefits of delivering the intervention to the target population group.Gordon, R. S. J. (January 1, 1983). An operational classification of disease prevention. Public Health Reports, 98, 2.
TierDefinitionUniversal preventionStrategies that involves the full population (nation, local community, school, district, etc.) based on evidence that it is likely to provide some benefit to all. It aims to prevent or delay the use of alcohol, tobacco, and other substances. All individuals, without screening, are provided with information and skills needed to prevent the problem. Also include environmental strategies such as policies that change the availability and/or price of such problematic substances.Selective preventionStrategies that involve targeted subpopulations whose risk of developing problems such as alcohol use disorder is already at an elevated level above average. Targeted groups may be identified by exposure to specific risk factors such as poor family management, family history, or impulsive behaviors. An example of selective prevention is parenting programs for children with early conduct problems.Indicated preventionStrategies that involve a screening process, and aim to identify individuals who exhibit early signs of early conduct problems and/or having an increased risk for a disorder, but currently do not have a diagnosable disorder. Identifiers may include falling grades among students, known problem consumption or conduct disorders, alienation from parents, school, and positive peer groups etc.
Selective and indicated prevention strategies might involve more intensive interventions and thus involve greater cost to the participants, since their risk and thus potential benefit from participation would be greater.
Guidelines for prevention The following guidelines for prevention science was established by an undergraduate social welfare class titled "Advances in Prevention Science: Bridging the Gap from Science to Service" at the University of Washington in Seattle during the winter quarter of 2012. It was taught by Dr. J. David Hawkins, one of the developers for the Social Development Model.
Foundation guidelines Start prevention early before a problem arises. Prevention interventions should include and reach those at high risk for the problem. Address malleable risk factors for the problem to be prevented. Strengthen malleable protective factors against the problem. Base prevention program in a clear and believable theory of change. Ensure adequate financing for full implementation by utilizing cost-benefit analyses.
Intervention guidelines Specify clear goals with specific and measurable objectives. Build a community of support for the intervention (parents, teachers, community members, policy makers, etc.). Choose interveners who are trusted, respected people whom recipients will listen to and develop a relationship with. Provide a standard protocol or manual for intervention activities that is easily available. Allow flexible implementation of protocol to meet needs of the program. Provide proper and adequate training for the interveners on the program protocols. Provide referrals to other services if needed by participants. Make services available and accessible to clients in their local community. Ensure intervention is culturally competent for the target population. Specify the duration of the intervention and provide sufficient amount to achieve a positive behavior change. Document all activities occurring during the program in order to monitor fidelity.
Convincing evidence guidelines The preventive intervention has been tested in a randomized controlled trial; or with an interrupted time series design with enough data points before and after intervention to allow threats to internal validity of results to be ruled out; or with a quasi-experimental design with a comparison group in which the researchers have ruled out plausible threats to internal validity. The population in which the preventive intervention was tested was properly described. The trial found outcomes that were statistically significant improvements for the intervention group compared to the control group. The trial experienced little or no differential attrition from intervention versus control condition. Longitudinal follow up of participants and controls found sustained effects. The intervention was found to be most effective with those at highest risk of the problem. Results have been replicated in two or more trials. Trial may or may not be conducted by an independent evaluator.
Effects on adolescent health Behavior problems are major causes of adolescent morbidity and mortality, and Prevention Science has led to the identification of tested and effective preventive interventions. Longitudinal studies have provided an understanding of risk and protective factors across the life course for many of these problem behaviors. An article by Richard Catalano, director of the University of Washington's Social Development Research Group, was recently published in the medical journal The Lancet, whereby Catalano and his colleagues provided examples of cost-effective social programs that have undergone rigorous research to show that implementing such programs can prevent a variety of behavioral problems and conditions contributing to poor health in today's youth. The paper was published on April 25, 2012 as part of a series on adolescent health.Catalano, R. F., Fagan, A. A., Gavin, L. E., Greenberg, M. T., Irwin, C. E., Ross, D. A., & Shek, D. T. (April 28, 2012). Worldwide application of prevention science in adolescent health. The Lancet, 379, 9826, 1653-1664. Samples of their recommended programs are: The Nurse Family Partnership program, which provides regular home visits with nurses to poor, first-time mothers. The program led to 43 percent fewer subsequent pregnancies and decreased the mothers' welfare use, smoking and arrests. As the children grew up, they drank less alcohol, were less likely to be arrested and had fewer sex partners than children whose mothers were not in the program. The Gatehouse Project, including a curriculum focused on building social, problem-solving and coping skills in schoolchildren and more positive classroom and school-wide environments, led to decreased smoking and other substance use and delayed the onset of sexual intercourse in adolescents. In low-income countries, the Conditional cash transfer programs, paid school fees and gave about $10 a month to mothers to ensure their children attend school. As a result, more girls stayed in school and adolescent pregnancies declined.
Case study: nurse family partnership The Nurse Family Partnership (NFP) is an evidence-based community health program that was developed by Dr. David Olds in Elmira, New York in 1977. NFP provides regular home visits by specially trained public health nurses to low-income, unmarried pregnant women with no previous live births. The nurses teach positive health related behaviors, competent care of children, and maternal personal development encompassing family, education, and economic self-sufficiency, instilling confidence and empowering them to achieve a better life for their children and themselves. All of these services are free and voluntary, and goes on until the first-born child reaches 2 years of age.
Evidence of effectiveness