PREVENTIONPREVENTION

RESEARCH RESEARCH

20012001

PREVENTION PREVENTION RESEARCH BRANCHRESEARCH BRANCH

The Staff:The Staff: Liz Robertson, Ph.D., ChiefLiz Robertson, Ph.D., Chief Susan David, M.P.H., Deputy ChiefSusan David, M.P.H., Deputy Chief Kathy Etz, Ph.D. Kathy Etz, Ph.D. Eve Reider, Ph.D.Eve Reider, Ph.D. Larry Seitz, Ph.D.Larry Seitz, Ph.D. Liz Cooper, Branch SecretaryLiz Cooper, Branch Secretary

RESEARCH RESEARCH OBJECTIVESOBJECTIVES

Prevent initiation of drug use; Prevent initiation of drug use; Prevent the progression of Prevent the progression of

drug use among those who use;drug use among those who use; Prevent drug-related HIV Prevent drug-related HIV

infectioninfection..

Support Extramural ResearchSupport Extramural Research Efficacy StudiesEfficacy Studies Effectiveness TrialsEffectiveness Trials Services Research Services Research Methodology StudiesMethodology Studies

PREVENTION PREVENTION SCIENCESCIENCE

EpidemiologyEpidemiologyOrigins and pathways to drug Origins and pathways to drug

abuseabuseTheoriesTheoriesResearch evidence that Research evidence that

prevention programs do workprevention programs do work

WHERE WE AREWHERE WE ARE

20 years of research 20 years of research foundfound:: Modifiable risk & protective Modifiable risk & protective

factorsfactors Points of vulnerability Points of vulnerability Some basic prevention Some basic prevention

principlesprinciples

RESEARCH EXPANSIONRESEARCH EXPANSION 1996 1996 to 2000to 2000

GRANTS BY COMPONENTSGRANTS BY COMPONENTS

ComponentsComponents % Change % Change 1991-19951991-1995 to to 1996-1996-20002000

Multi-componentMulti-component 180%180%

FamilyFamily 200%200%

SchoolSchool 100%100%

WorkWork 100%100%

ClinicClinic 600%600%

MediaMedia 1000%1000%

GRANTS BY TYPEGRANTS BY TYPE

ComponentsComponents % Change % Change 1991-19951991-1995 to to 1996-1996-20002000

CentersCenters -50%-50%

TrainingTraining 200%200%

MethodologyMethodology -33%-33%

ServicesServices 160%160%

EtiologyEtiology -300%-300%

EpidemiologyEpidemiology -100%-100%

RESEARCH EXPANSIONRESEARCH EXPANSION 1996 to 20001996 to 2000

LEVELS OF RISKLEVELS OF RISK

Universal – all persons in a Universal – all persons in a particular groupparticular group

Selective – groups at high riskSelective – groups at high risk Indicated – individuals at high Indicated – individuals at high

riskrisk

RESEARCH EXPANSIONRESEARCH EXPANSION 1996 1996 to 2001to 2001

GRANTS BY Level of RiskGRANTS BY Level of Risk

ComponentsComponents Change from 1996 - 2001Change from 1996 - 2001

UniversalUniversal 113%113%

SelectiveSelective 375%375%

IndicatedIndicated 225%225%

TieredTiered 100%100%

Special populationsSpecial populations 58%58%

Gender specificGender specific 200%200%

RESEARCH EXPANSIONRESEARCH EXPANSION 1996 1996 to 2000to 2000

SBIR PROGRAMSBIR PROGRAM

FYFY GRANTSGRANTS CONTRACTSCONTRACTS TOTALTOTAL

19961996 77 00 77

19971997 77 00 77

19981998 1111 22 1313

19991999 1111 77 1818

20002000 1313 1010 2323

THUS, CURRENT THUS, CURRENT FOCI…FOCI…

....

Broadening the components of Broadening the components of intervention intervention

More multi-component More multi-component programsprograms

More selective and indicated More selective and indicated level level programsprograms

THUS, CURRENT THUS, CURRENT FOCI…FOCI…

....

Early childhood through Early childhood through adulthoodadulthood

More independent More independent replicationsreplications

More meta-analysesMore meta-analyses

THE BOTTOM LINE…THE BOTTOM LINE…

In five years,In five years,

a a 100%100% increase in increase in grantsgrants

SNAPSHOTS OF SNAPSHOTS OF SELECTED FINDINGSSELECTED FINDINGS

FINDINGS ON PROGRAM FINDINGS ON PROGRAM COMPONENTSCOMPONENTS

Parents who smoke can lower Parents who smoke can lower the risk of smoking among their the risk of smoking among their children by engaging in anti-children by engaging in anti-smoking socialization (Jackson, smoking socialization (Jackson, et al., 1997).et al., 1997).

FINDINGS ON PROGRAM FINDINGS ON PROGRAM COMPONENTSCOMPONENTS

Intervening as early as grade Intervening as early as grade one to decrease aggression and one to decrease aggression and increase academic success increase academic success substantially reduces substantially reduces subsequent substance abuse, subsequent substance abuse, depression and anti-social depression and anti-social behavior (Ialongo, et al., 1999).behavior (Ialongo, et al., 1999).

FINDINGS ON AUDIENCEFINDINGS ON AUDIENCE

Gender significantly affects Gender significantly affects drug offers and types of offers drug offers and types of offers (Moon, et al., 2000).(Moon, et al., 2000).

FINDINGS ON AUDIENCEFINDINGS ON AUDIENCE

Programs adapted to address Programs adapted to address the needs of specific ethnic the needs of specific ethnic audiences have greater effects audiences have greater effects in reducing substance use than in reducing substance use than universal non-adapted universal non-adapted programs (Botvin, et al.,1997).programs (Botvin, et al.,1997).

FINDINGS ON PROGRAM FINDINGS ON PROGRAM IMPLEMENTATIONIMPLEMENTATION

Providing accommodations Providing accommodations to families helps to attract to families helps to attract and retain them in and retain them in preventive interventions preventive interventions (Spoth, et al., 1999).(Spoth, et al., 1999).

FINDINGS ON PROGRAM FINDINGS ON PROGRAM IMPLEMENTATIONIMPLEMENTATION

Grouping anti-social youth in Grouping anti-social youth in interventions can lead to interventions can lead to unintended negative effects unintended negative effects such as increases in substance such as increases in substance use and violence (Dishion et al., use and violence (Dishion et al., 1999).1999).

Family

Surrounding Context

Cultural, Economic and Political Factors

School

Peers

Time

ROLE OF MODIFIERS ROLE OF MODIFIERS

MODERATORS

MODIFIABLE RISKS INTERVENTIO

N

EARLY CHILDHOODEARLY CHILDHOOD

MODIFIABLE RISKS

INTERVENTION

Inability to Inability to shareshareInappropriate Inappropriate

parental parental expectationsexpectationsInconsistent Inconsistent disciplinediscipline

Child social Child social practicepracticeEarly Early educationeducationParent skill Parent skill trainingtraining

ELEMENTARY SCHOOL ELEMENTARY SCHOOL AGEAGE

MODIFIABLE RISKS

INTERVENTION

School School transitiontransitionTeacher rules &Teacher rules &

expectationsexpectationsLack of parental Lack of parental

involvementinvolvement

Organized Organized classroom classroom Consistently Consistently applied rulesapplied rulesParent/teacher Parent/teacher communicationcommunication

MIDDLE SCHOOL AGEMIDDLE SCHOOL AGE

MODIFIABLE RISKS

INTERVENTION

Shy/Shy/aggressive aggressive behaviorbehaviorSchoolSchoolfailurefailureProblem Problem behaviorbehaviorPoor parental Poor parental

monitoringmonitoring

Social Social competencecompetenceAcademic skillsAcademic skillsProsocial Prosocial opportunitiesopportunitiesParent skillsParent skills

ADOLESCENCEADOLESCENCE

MODIFIABLE RISKS

INTERVENTION

Anti-social Anti-social peerpeerLack of school Lack of school

commitmentcommitmentFamily Family conflictconflict

Social & Social & academic skillsacademic skillsRefusal skillsRefusal skillsParent trainingParent trainingFamily therapyFamily therapy

NEW DIRECTIONSNEW DIRECTIONS

CROSSING THE GREAT DIVIDE

SELECTIVE AND SELECTIVE AND INDICATED POPULATIONSINDICATED POPULATIONS

Clinical populationsClinical populationsExternalizing disordersExternalizing disorders Internalizing disordersInternalizing disorders

Multi-risk children and Multi-risk children and familiesfamilies

HIV PREVENTIONHIV PREVENTION

Primary prevention Primary prevention Selective populationsSelective populations Indicated populationsIndicated populations

BASIC PREVENTIONBASIC PREVENTION

Next generation of Next generation of research:research: What worksWhat works For whom and For whom and Under what conditionsUnder what conditions

PREVENTION PREVENTION SERVICESSERVICES

Existing systems for preventionExisting systems for prevention Funding sourcesFunding sources Program selectionProgram selection Cost-benefits/effectiveness Cost-benefits/effectiveness Service availability, access, and Service availability, access, and

deliverydelivery

Prevention!

Go Prevention!

GO PREVENTION!

GoGo Prevention!

Go Prevention!

Go Prevention

Go Prevention

Go Prevention

Go PreventionGo Prevention

Go Prevention!

Go Prevention!

Go Prevention!

Go Prevention

Go Prevention!