Inside the Black Inside the Black Box of Box of

Prevention:Prevention:

Implications for Health Implications for Health PromotionPromotion

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Prevent (pri vent) vt. [ L. praevenire, to anticipate.] 1. To act in anticipation of. 2. To keep from happening. Prevention (pri ven shn) n. The act of preventing.

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Possible Prevention Possible Prevention ImpactsImpacts

Positive Positive ProcessesProcesses

IncreaseIncrease Keep Keep from from DecreasiDecreasingng

Slow the Slow the Rate of Rate of DecreaseDecrease

Negative Negative ProcessesProcesses

ReduceReduce Keep Keep from from increasinincreasingg

Slow the Slow the rate of rate of increaseincrease

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Rationale of Health Rationale of Health PromotionPromotion

Public HealthPublic Health

EconomicEconomic

Common SenseCommon Sense

Moral ImperativeMoral Imperative

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Classic Model of Assessing Classic Model of Assessing EffectivenessEffectiveness 

   

         

 

 

 

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Traditional Traditional Health Health EducationEducation

DiffusionDiffusion Stages of Stages of ChangeChange

BehaviourBehaviour

SkillsSkills

AttitudesAttitudes

KnowledgeKnowledge

DialogueDialogue

AdoptionAdoption

TrialTrial

InterestInterest

AttentionAttention

AwarenessAwareness

MaintenanceMaintenance

ActionAction

PreparationPreparation

ContemplationContemplation

Pre-Pre-contemplationcontemplation

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Norm Climate Threshold Norm Climate Threshold ModelModel

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Norm climate: The constellation of norms,

attitudes, practices in ones perceived social environment.

 

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Characteristics of the Characteristics of the modelmodel

No visible change at firstNo visible change at first Growing awareness/dialogueGrowing awareness/dialogue Increased visibilityIncreased visibility ModellingModelling Shifting precursersShifting precursers Threshold reachedThreshold reached Change is outside in/inside outChange is outside in/inside out Generational forgetting if we stopGenerational forgetting if we stop Takes timeTakes time

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No Visible Change at FirstNo Visible Change at First

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Growing Public InterestGrowing Public Interest

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Reach ThresholdReach Threshold

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Norm Climate Shift

Precursor Change

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Time Can be Short or Time Can be Short or LongLong

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Generational Forgetting Generational Forgetting Can OccurCan Occur

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Increased Difficulty As Increased Difficulty As Prevalence Prevalence

Decreases/IncreaseDecreases/Increase

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Norm Climate Is Affected Norm Climate Is Affected by Environmental by Environmental

ConstraintsConstraints

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Essential ElementsEssential Elements

ConsistencyConsistency

DurabilityDurability

ComprehensivenessComprehensiveness

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Norm Climate Threshold Norm Climate Threshold ModelModel

   

Threshold Point

Desired Effect (Reduction in this case)      

 

Sustained messages and policies over TIME

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Evidences of The Model at Evidences of The Model at Work:Work:

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1. At Least Three Ex Post 1. At Least Three Ex Post Facto CasesFacto Cases

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2. Reverse Seems True:2. Reverse Seems True:E.g.,E.g.,

Trends in Cannabis use, Trends in Cannabis use, 1990’s1990’s

0

5

10

15

20

25

30

35

40

BC 1992 BC 1998 US 1992 US 1998

BC %US %

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3. Looking At Qualities of 3. Looking At Qualities of “Programs” That have Appear to “Programs” That have Appear to Achieve an End Stage Change:Achieve an End Stage Change:

ComprehensiveComprehensive EnduringEnduring Many channelsMany channels Over timeOver time

Even with these, effects erode over time, Even with these, effects erode over time, showing evidence of need for on-going, showing evidence of need for on-going, outside –in effort to shift norm climateoutside –in effort to shift norm climate

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4. Epidemiological 4. Epidemiological Guidelines for Establishing Guidelines for Establishing Cause - EffectCause - Effect

Time-orderedTime-ordered Shown across issuesShown across issues Shown across studiesShown across studies Based on sound scientific Based on sound scientific

reasoningreasoning Consistently seenConsistently seen

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RecommendationsRecommendations

Do not expect Do not expect single programs to single programs to have end effectshave end effects

Realize change is Realize change is slow and not linearslow and not linear

Reduce Reduce expectations of expectations of separate programs separate programs and policiesand policies

Ensure a Ensure a consistent consistent messagemessage

Think in years, Think in years, not weeks or not weeks or months, of months, of durationduration

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