Prevention science


Prevention science 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 scienceMrazek, 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:
  1. To identify subpopulations more likely to develop problems which should be reached by preventive intervention.
  2. To identify malleable individual or environmental characteristics that can be changed by preventive intervention.

    Further observations about risk and protective factors

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.
TierDefinition
Universal preventionStrategies that involves the full population based on evidence that it is likely to provide some benefit to all. It aims to prevent or delay the abuse of alcohol, tobacco, and other drugs. 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 abuse or dependence 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

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.

Samples of their recommended programs are:
The 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

Three randomized controlled trials were conducted with 3 diverse populations in Elmira, New York ; in Memphis, Tennessee ; and in Denver, Colorado. These research studies provide evidence on the positive and effective outcomes of NFP. Follow-up research still continues today, which studies the long-term outcomes for both mothers and children in these trials.

Study 1: Elmira, NY

300 women in a semi-rural community, who had agreed to be part of the study were randomly assigned to either a group that will participate in the Nurse-Family Partnership, or a control group that was only provided developmental screening and referral to treatment for their child. Approximately 90% of the women were caucasian; 60% were from low-income families; 60% unmarried. Average age of the women in the study was 19.
Effects on child
Versus the control group:
Versus the control group:
There was a long-term follow-up of children whose mother was part of the initial NFP effectiveness study. There was low attrition as the data on the outcomes described above were obtained for 77%-83% of the initial sample group, and follow-up rates were similar for both treatment and control groups.

Study 2: Memphis, TN

743 women who had agreed to participate in the study were randomly assigned to either a treatment group that would be given the opportunity to participate in the Nurse Family Partnership, or a control group that was only provided free transportation to scheduled prenatal medical appointments, and developmental screening, as well as referrals to treatment for their child under the age of 2 years old. 92% of the women were African-American; 85% came from households with income on or under the poverty line; 98% were unmarried; average age was 18.
Effects on child at age 2
Versus the control group:
Versus the control group:
For nurse-visited children in the subsample whose mothers had low psychological resources prior to the program participation, research found that the children made improvements in academic performance. The effects on academic performance were sustained over the follow-up period, including grades 4–6. Compared to the control group in the same subsample:
Versus the control group:
This was a large study with follow-up all the way till the first child reached age 12. There was low-moderate attrition; data obtained were for 74-85% of the original sample, and follow-up rates were similar for both the treatment and control groups.

Study 3: Denver, CO

490 women who had agreed to participate in the program was randomly assigned to either a treatment group that would be given the opportunity to participate in the Nurse Family Partnership, or a control group that was only provided developmental screening and referrals to treatment for their child under the age of 2 years old. 46% were Mexican-American; 36% were caucasian; 15% African American; 84% were unmarried; average age was 20.
Effects on child at age 4
Versus the control group, the subsample of children whose mothers had low psychological resources prior to participating in the program made sizable gains in researcher assed language development; behavioral adaptation ; executive functioning ;
Effects on mother when child reached age 4
Versus the control group:

National Prevention Science Coalition

was formed in 2013 as a 501 non-profit organization to promote the application of validated, science-based findings to wide-scale, effective implementation of prevention practices and policies. In doing so, they address several areas of concern, such as mental and behavioral health, education, and environmental influences. Additionally, they address adverse social conditions that contribute to both behavioral problems and major chronic illnesses that originate in childhood and become compounded in adulthood. Given that behavioral, mental and physical health problems are highly concentrated in high poverty neighborhoods, the NPSC has prioritized the reduction of poverty and its ill effects. Criminal and juvenile justice issues are also a matter of concern to them. Effective prevention of these multiple problems requires fostering environments from the prenatal period onward that nurture child and adolescent successful development.
The NPSC, directed by Dr. Diana Fishbein and Dr. John Roman, is composed of scientists, educators, practitioners and clinicians, policy makers, foundation representatives, and affiliated organizations, housed at the Pennsylvania State University. They work in a nonpartisan manner with Congressional offices and Caucuses and collaborate with like-minded groups and federal agency administrators in a mutual advisory capacity. They invite individuals and organizations to join in this effort. There is no cost to membership; involvement at any level is welcomed. To register, click here: http://www.npscoalition.org/register

Society for Prevention Research

is an organization dedicated to advancing scientific investigation on the etiology and prevention of social, physical and mental health, and academic problems and on the translation of that information to promote health and well being. The multi-disciplinary membership of SPR is international and includes scientists, practitioners, advocates, administrators, and policy makers who value the conduct and dissemination of prevention science worldwide. The official publication of the organization, called Prevention Science, serves as an interdisciplinary forum designed to disseminate new developments in the theory, research and practice of prevention. Prevention sciences encompassing etiology, epidemiology and intervention are represented through peer-reviewed original research articles on a variety of health and social problems, including but not limited to substance abuse, mental health, HIV/AIDS, violence, accidents, teenage pregnancy, suicide, delinquency, STD's, obesity, diet/nutrition, exercise, and chronic illness. The journal also publishes literature reviews, theoretical articles, and papers concerning new developments in methodology.

Washington State Institute for Public Policy

located in Olympia, Washington, estimates the cost-effectiveness of diverse prevention programs with scientifically rigorous standards applied consistently across a wide variety of social issues relevant to state legislators. Cost-benefit analyses are important to show the economic benefit to the state and to tax-payers, as well as provide a standard to compare between different programs with similar goals and outcomes. Furthermore, cost-effective programs are more likely to be funded and approved by policy makers.

Blueprints for Violence Prevention

is a project of the Center for the Study and Prevention of Violence at the University of Colorado that provides a list of effective violence, drug, and crime prevention programs. The Blueprints mission is to identify truly outstanding violence and drug prevention programs that meet a high scientific standard of effectiveness. In doing so, Blueprints serves as a resource for governments, foundations, businesses, and other organizations trying to make informed judgments about their investments in violence and drug prevention programs. Blueprints staff systematically and continuously review the research on violence and drug abuse programs to determine which are exemplary and grounded in evidence. To date, it has assessed more than 900 programs. Blueprints' standards for certifying model and promising violence prevention programs are widely recognized as the most rigorous in use. Program effectiveness is based upon an initial review by Blueprints staff and a final review and recommendation from a distinguished Advisory Board, composed of experts in the field of violence prevention.

Social Research Unit

The is an independent charity based in Dartington, England, dedicated to improving the health and development of children in Europe and North America. They do so by utilizing research to first establish potential causes of impairment, and then to develop and disseminate appropriate information to the widest international audience regarding their findings about responding more effectively to risk.

Social Development Research Group

The is a nationally recognized interdisciplinary team of researchers based in Seattle, Washington that seek to promote youth development, as well as prevent and treat health and behavior problems among young people through identifying risk and protective factors and understanding the effects of promotive and preventive interventions that address these factors. Academic success and positive development as well as drug abuse, delinquency, risky sexual behavior, violence, mental health problems and school dropout are among the outcomes studied. In 1979, J. David Hawkins and Richard F. Catalano began to develop the Social Development Model which provides the theoretical basis for this approach to promotion and prevention which underlies much of the group's research.