Prevention Science
Prevention Science
Prevention science is an area of scholarship and research in the medical and social sciences that aims to establish principles of prevention and to apply them using tested and effective prevention-intervention programs (Schinke et al. 2003). A major goal in prevention science is to identify health risks or protective factors, along with the conditions that exert beneficial or detrimental effects on health (Hawkins et al. 1992), including, for example, the factors and conditions that lead to alcohol, tobacco, or drug addiction. Thus, prevention science contributes to the design of interventions that can enhance health or reduce the risk of disease or disorders.
The concept of prevention focuses on changing naturally occurring disease-producing conditions by administering interventions early in the disease process to reduce, eliminate, or alter the events that produce diseases. Individuals or populations that experience prolonged exposure to a number of risk factors have a higher likelihood of developing a certain disease or disorder. Such individuals constitute a high-risk group. Strategically, interventions are implemented according to two basic approaches: (1) eliminating or reducing exposure to risk factors ; and (2) increasing exposure to protective factors. The most effective prevention interventions will incorporate both strategies.
The science of prevention emphasizes rigor in the design, testing, and implementation of the most potent (or most effective) prevention interventions. The efficacy of an intervention refers to its potency in producing a beneficial outcome under ideal conditions. Efficacy is evaluated scientifically using randomized controlled trials. The interventions developed from such trials can be taken from laboratory to community to test the intervention’s real-world effect. Randomized controlled trials examine the effect of a new intervention program when administered to an intervention group (the group that receives the improved or enhanced intervention) relative to a control group (the group that receives the standard or unimproved intervention). Under this design, researchers look for the occurrence of a greater or more beneficial posttest outcome in the intervention group as compared to the control group.
AREAS OF EMPHASIS
Prevention science focuses on the application of the principles of prevention in several areas. These areas include: (1) programs to reduce aggressive behavior in children and adolescents; (2) substance-abuse prevention programs that include teaching life skills or changing social norms; (3) community-level interventions to change laws or social ordinances to enhance public health, such as ordinances that require the use of seat belts; (4) scientific studies to test the effectiveness of prevention interventions using rigorous standards of evidence (Flay et al. 2005); and (5) various studies that generate new knowledge that adds to established principles of prevention and guides the application of these principles.
COMMUNITY PARTNERSHIPS
An important aspect of prevention science involves establishing working partnerships between prevention scientists and community members. Partners may include community members who can be described as stakeholders, or persons who have something to gain or lose from the implementation of a proposed community-based program. For example, a program that aims to reduce automobile accidents resulting from alcohol intoxication among adolescent drivers may encompass such stakeholders as parents, liquor-store owners, high school teachers, and other concerned individuals or groups within the community. Community partnerships, when well developed, set the stage for community input in the development of new prevention interventions. Such partnerships also promote community “buy in,” or a sense of local ownership that allows a prevention program to thrive within a community.
CONTEMPORARY ISSUES
The field of prevention science faces a number of challenging issues. One important issue involves finding ways to design programs that work with greater potency, that is, programs that can increase the size of the prevention effect and the magnitude of healthy change. For example, how much can a program reduce the rate of smoking among adolescents who initiate or experiment with cigarette smoking? The more potent a program, the greater the effect size. Even the most effective community-based prevention programs generally exhibit only a small effect size, that is, they produce a small degree of change on specific outcome measures, such as a drop in the smoking rate among adolescents. Accordingly, one challenge facing prevention science involves increasing a prevention program’s magnitude of effect.
Another issue involves the fidelity-adaptation controversy. Tested and effective prevention programs are generally organized into instructional manuals that provide program-delivery personnel with information and a set of activities for program sessions. Such prevention-intervention programs, when delivered exactly as prescribed within program manuals, are considered to be implemented with high fidelity. This approach contrasts with the challenge of program adaptation, which involves changing or otherwise adjusting certain aspects of a tested and effective program with specific and well-planned modifications that are necessary to make the program relevant and viable when delivered within a community (Castro et al. 2004).
Another challenge involves identifying ways in which prevention-intervention programs can be delivered broadly in several sites. A related issue involves sustainability, that is, identifying ways of keeping a prevention program in operation into the future by convincing a community group or coalition to adopt the program as their own and to maintain the program in operation. These prevention-science challenges serve as important areas for research and program development.
POLICY-ORIENTED ISSUES
Social policy involves the development of guidelines that govern the decision-making process used by lawmakers, administrators, civic leaders, and others as they work to solve social problems. Prevention science can inform policymakers with scientific information and evidence-based knowledge to help them make better decisions in the interest of promoting public health. Thus, prevention science can contribute to social policy by: (1) informing policymakers on theories of human behavior and on ways to prevent disease and promote health; and (2) offering tested and effective intervention techniques and programs that can improve health in specific ways.
On a larger community or regional scale, however, such principles cannot be fully implemented without the support of local policymakers. The development of legislation and local ordinances can endorse, institutionalize, and maintain local prevention intervention programs, including, for example, ordinances prohibiting smoking in restaurants or the mandatory use of seatbelts while driving. These are examples of the contributions of prevention science to policy-related actions; in turn, social policy can aid in the implementation of prevention-science programs within diverse sectors of the community.
FUTURE ISSUES
Future challenges facing prevention science involve finding ways to design prevention programs that are more accessible, and thus more likely to be adopted and used by greater numbers of consumers. Prevention programs must also be user-friendly and widely available at an affordable cost, and they must allow consumer feedback to constantly monitor and improve the programs and keep them relevant to changing community needs. Moreover, making prevention programs more potent, whereby they produce greater and more enduring changes on targeted outcomes, remains a major challenge for prevention science. The use of new technologies and new forms of responsiveness to diverse cultural and economic consumer groups will aid in making prevention science and its interventions more socially relevant and more effective.
Prevention science is the product of ongoing research that aims to discover stable and generalizable new knowledge and intervention approaches. In the United States, this ongoing scientific endeavor aims to increase the capacity of prevention science to effectively meet the complex public health needs of growing and increasingly diverse sectors of the American population.
SEE ALSO Addiction; Disease; Occupational Hazards; Occupational Safety; Public Health; Public Policy; Risk; Smoking
BIBLIOGRAPHY
Castro, Felipe González, Manuel Barrera, and Charles Martinez. 2004. The Cultural Adaptation of Prevention Interventions: Resolving Tensions between Fidelity and Fit. Prevention Science 5: 41–45.
Collins, Linda M., Susan Murphy, and Karen L. Bierman. 2004. A Conceptual Framework for Adaptive Prevention Interventions. Prevention Science 5: 185–196.
Flay, Brian R., Anthony Biglan, Robert Boruch, et al. 2005. Standards of Evidence: Criteria for Efficacy, Effectiveness, and Dissemination. Prevention Science 6: 151–175.
Hawkins, J. David, Richard F. Catalano, and James H. Miller. 1992. Risk and Protective Factors for Alcohol and Other Drug Problems in Adolescence and Early Adulthood: Implications for Substance Abuse Prevention. Psychological Bulletin 112: 64–105.
Kellam, Sheppard G., and Doris J. Longevin. 2003. A Framework for Understanding “Evidence” in Prevention Research Programs. Prevention Science 4: 137–153.
Schinke, Stephen, Paul Brounstein, and Stephen Gardner. 2003. Science-based Prevention Programs and Principles, 2002. DHHS Pub No. (SMA) 03–3764. Rockville, MD: U.S. Dept. of Health and Human Services.
Felipe González Castro