International Centre for Credentialing and Education of Addiction Professionals (ICCE)

The Universal Prevention Curriculum (UPC) for Substance Use Training Series

Curriculum 1
Introduction to Prevention Science

MODULE 3—PREVENTION SCIENCE:

DEFINITIONS AND PRINCIPLES

3.1
Introduction

3.2
Training Goals

 Provide a standard definition of prevention

science
 Provide the science-base for prevention
intervention development and delivery
 Introduce you to terms and concepts that are the
foundation of prevention research and
evaluation

3.3
Learning Objectives

 Define prevention science

 Explain the three legs of prevention science and
practice: epidemiology/etiology, intervention/policy
development, and research methods
 Describe the theoretical foundations of prevention
 Describe the processes for the development of
prevention interventions
 Define terms and concepts that are the foundation
of prevention research and evaluation

3.4
Definitions and Principles of
Prevention Science

3.5
Defining Prevention Science

 The primary goal of prevention science is to improve public

health by identifying malleable risk and protective factors,
assessing the efficacy and effectiveness of preventive
interventions and identifying optimal means for
dissemination and diffusion
 The field involves the study of human development and
social ecology as well as the identification of factors and
processes that lead to positive and negative health
behaviors and outcomes
 Prevention science is the foundation for health education
and health promotion as well as preventive interventions

3.6
Prevention Science—Practice and Research

Practice Research

Prevention Science

3.7
Guiding Principles of Prevention Science

 Developmental focus
 Developmental epidemiology of the target population
 Transactional ecology
 Human motivation and change processes
 A team approach
 Ethical practices
 Continuous feedback between theoretical and empirical
investigations
 Improving the public health
 Social justice

3.8
Etiology Model: How the Interactions of Personal
Characteristics and the Micro- and Macro-Level Environments
Work

Macro-Level
Environments
Beliefs
Personal
Attitudes
Characterist
Behaviors
ics

Micro-Level
Environments

• Poverty
• Family
• Social • Genetics
• Peers
Environment • Temperament
• School
• Physical • Physiology
• Workplace
Environment

3.9
Guiding Principles of Prevention Science

 Developmental focus
 Developmental epidemiology of the target population
 Transactional ecological
 Human motivation and change processes
 A team approach
 Ethical practices
 Continuous feedback between theoretical and empirical
investigations
 Improving the public health
 Social justice

Source: Standards of Knowledge for the Science of Prevention, Society for Prevention 3.10
Research, 2011.
The Etiology Model and Human Motivation
and Change Processes

Macro-Level • Beliefs
• Attitudes
Environments Biological/
Personal Intent Behavior
Characteristics • Social and
Micro-Level Cognitive
Environments Competence
• Skills

Socialization

© Sloboda forthcoming 3.11

Socialization in Modern Societies

In complex and multicultural societies, the likelihood

that the socialization process is not always optimal
has increased:
 Complex “cultures” – mechanical vs. organic
solidarity
 Neighborhood disorganization
 Conflicts between socialization agents, e.g., home
vs. school
 Geographic mobility and immigration
 Global village syndrome
3.12
Prevention Interventions Target…

 The individual directly

 The individual’s micro- and macro-level
environments

3.13
A Socialization Perspective of Prevention—
Behavioral Interventions

Prevention specialists…
 May either train socialization agents, such as
parents and teachers
 Or directly engage in the socialization process,
thus becoming socialization agents themselves

3.14
Both Socialization and Prevention
Programming Help Individuals

 To use evidence-based practices to collect and

interpret cues within individuals’ social and
emotional context to learn and “try on” new
behaviors
 To weigh the potential outcomes for the
performance of these behaviors within their
social and emotional context

3.15
Guiding Principles of Prevention Science

 Developmental focus
 Developmental epidemiology of the target population
 Transactional ecological
 Human motivation and change processes
 A team approach
 Ethical practices
 Continuous feedback between theoretical and
empirical investigations
 Improving public health
 Social justice

Source: Standards of Knowledge for the Science of Prevention, Society for 3.16
Prevention Research, 2011.
Major Components of Prevention Science

 Epidemiology and Etiology

 Intervention Development
 Research Methodology

3.17
Prevention Intervention and
Policy Development

3.18
Prevention Intervention and Policy
Development—Assumptions (1/2)

 Prevention interventions and policies address

malleable factors specified in theoretical models of
positive and negative behavior
 Intervention and delivery systems consider
characteristics of the target population; with
interventions classified as:
 Universal – Total population at all risk levels
 Selective – Known groups at risk—e.g., children of drug
users
 Indicated – Individuals who already use drugs, but are
not yet deemed dependent
3.19
Prevention Intervention and Policy
Development—Assumptions (2/2)

 Effective prevention is the result of

collaborations
 Existing platforms for prevention often can be
embedded in existing service settings
 Standardization is important and requires
monitoring for fidelity and quality of service
delivery
 Effective prevention should be sustained with
sustainability considered early during
implementation
3.20
Stages of Intervention Design

 Adopting a theoretical foundation to guide the

intervention
 Identifying the target group
 Selecting a theoretical framework
 Developing intervention objectives
 Building the program using a multidisciplinary team
 Methods and strategies
 Tailoring interventions
 Intervention settings
 Pilot testing, implementation, and evaluation
Source: Rohrbach, 2014 3.21
Identification of Vulnerable and “At-Risk”
Populations

 Individual assessments—Examples
 Problem-oriented Screening Instrument for Teenagers
 Drug Use Screening Inventory

 Surveys
 School-based surveys (e.g., Monitoring the Future Study,
European School Survey Project on Alcohol and Other
Drugs)
 Household surveys
 Surveys of specific vulnerable groups (e.g., homeless

 Community Indicators
 Archival data
3.22
 Building Interventions
Based on Substance Use
Prevention Theories

3.23
Selecting a Theoretical Framework

 Provides an understanding of the determinants

of behavior
 Makes clear the mechanisms being used to
produce the outcome of interest
 Informs the selection of the intervention
approach to achieve these outcomes

3.24
Stages of Research in Prevention Research
Cycle

Source: Preventing Mental, Emotional and Behavioral Disorders Among Young People: Progress and 3.25
Possibilities. (2009). Washington, D.C.: Institute of Medicine, National Academy of Sciences
Substance Use Prevention Theories (1/3)

 Over the past three decades, substance use

prevention in the United States has been
informed by theory
 Prevention theories center around:
 Theories of etiology
 Theories of human development
 Theories of human behavior
Learning theories
Theories of behavior change

3.26
Substance Use Prevention Theories (2/3)

During the 1980s these theories were taken from other disciplines
and other fields
 Social Learning Theory (Bandura, 1977)—Human beings learn
through observation
 Problem Behavior Theory (Jessor and Jessor, 1977)—Multiple
risky behaviors have the same or common roots
 Ecology of Human Development (Bronfenbrenner, 1979, 2005)
—Systems outside of the individual influence individual behavior
 Theory of Planned Behavior (Ajzen 1991)—Beliefs about
behavioral outcomes, beliefs about normative expectations
about behavior and beliefs about barriers/enhancers to
performance of the behavior influence engagement in the
behavior
3.27
Substance Use Prevention Theories (3/3)

More recently, prevention scientists have developed theories

that are unique to prevention science. Here are five examples
of such theories:
 Theory of Triadic Influence (Flay, 1999; Flay and Petraitis,
1997, 2003)—influence of cultural, social, and individual
factors
 Risk and Protective Factors (Hawkins et al., 1992)—Societal
and cultural and interpersonal factors
 Positive Youth Development (Catalano et al., 1999)—
Enhancing and reinforcing positive development
 Resilience Theory (Werner and Smith, 1982; Bernard, 2004)
 Nurturing Environments (Biglan and Hinds, 2009)
3.28
Developing Intervention Objectives: Forming
the Content of the Intervention

 Most of the theories mentioned have been

translated into theoretical models
 These theoretical models generally include an
outcome or behavior of interest and those
factors that explain the performance of the
behavior
 These models not only include specific factors
but also the relationship between and among
the factors

3.29
Theory of Planned Behavior

Source: http://people.umass.edu/aizen/tpb.diag.html#null-linkrce: 3.30

Program “X”: A School-Based Substance Use
Prevention Curriculum

3.31
 Developing and Adapting
Evidence-Based Substance
Use Prevention
Interventions and Policies

3.32
Building the Program: Methods and Strategies

 Methods: Theory-informed processes for

influencing change in the determinants of
behavior and environmental conditions
 Strategies: Practical applications of the
theoretical approach

3.33
Aspects of a Prevention Intervention or Policy

There are three aspects of a prevention

intervention or policy:
 Structure
 Content
 Delivery

3.34
Tailoring Interventions

The concept of shaping the intervention activities

to meet the needs of the target group is generally
referred to as “tailoring”
 Cultural beliefs
 Values
 Language
 Visual images

(Source: Rohrbach, 2014) 3.35

Fidelity and Adaptation (1/2)

Definitions:
 Fidelity—the delivery of a manualized
prevention intervention program as prescribed
or designed by the program developer
 Adaptation—the modification of program content
to accommodate the needs of a specific
consumer group

Castro, FG, Barrera, M, and Martinez, Jr., CR., 2004 3.36

Fidelity and Adaptation (2/2)

Program Assessment
New Target Group Consequences
Characteristics

Inability to understand program

Language English Other
content

Conflicts in beliefs, values, and/or

Ethnicity White Other
norms
Logistical and environmental
Urban/rural Urban Rural
barriers affecting participation
Risk Factor Number Few factors/moderate Several factors/high Insufficient effect on multiple or
and Severity severity severity most severe risk factors
Family Stability Stable family systems Unstable family systems Limited compliance
Consulted with community
Community No community ‘buy-in”, resistance,
on program design and/or Not consulted
Consultation low participation rates
administration

Absence of infrastructure and

Community organizations to address
Moderate Low
Readiness substance abuse problems and to
implement programs

Castro, FG, et al. 2004. 3.37

Large-Group Exercise: Program “X”: A School-
Based Substance Use Prevention Curriculum

3.38
Fidelity vs. Adaptation

The Substance Abuse and Mental Health Services

Administration recommends:
 Change capacity before changing the program
 Consult with the program developer
 Retain core components
 Be consistent with evidence-based principles
 Add, rather than subtract

3.39
An Interaction of Personal Characteristics and the Micro- and
Macro-Level Environments, Socialization and Points of
Intervention

Macro-Level • Beliefs
• Attitudes
Environments Biological/
Personal Intent Behavior
Characteristics • Social and
Micro-Level Cognitive
Environments Competence
• Skills

Points of Intervention

Socialization

©Sloboda, forthcoming 3.40

Intervention Settings

Select a setting in which it will be appropriate and

feasible to implement the intervention
 Schools
 Religious facilities (churches, temples, etc)
 Community centers
 Clinics
 Workplace

3.41
Targeting the Intervention/Policy

Characteristics of the target population

 Age
 Gender
 Geographic location
 Reach
 Vulnerability and risk
 Universal
 Selective
 Indicated
3.42
Small-Group Exercise: Community Problem

Within workgroups
 Identify the problem
 Who will be the target for an intervention
 Specify where the intervention will take place
(setting)—could be multiple settings
 Specify what the focus of the intervention will
be, e.g., addressing normative beliefs,
perceptions of risk/harm, perceptions of social
acceptability
3.43
Prevention Research
Methodologies

3.44
Prevention Research Methodology (1/2)

Research methodology=An array of tools and

techniques including:
 Study design
 Sampling methodologies
 Sample recruitment, maintenance and retention
 Statistical analyses

3.45
Prevention Research Methodology (2/2)

 The purpose of prevention research methods is three ‐fold:

 Identifying factors, processes, and mechanisms associated to
behaviors that have positive and negative health‐related outcomes in a
population
 Understanding how identified factors, processes and mechanisms are
related to positive and negative health‐related outcomes and how they
are distributed across:
 Stages of development
 Populations
 Geographic areas
 Assess the efficacy, effectiveness, and dissemination of prevention
interventions
 Prevention researchers incorporate both qualitative and
quantitative approaches in their studies
3.46
Research Methodologies − Assumptions

 Prevention research is guided by the theories or

conceptual frameworks that underlie the research question
or the intervention/policy. These frameworks inform:
 Research design
 Measurement
 Analyses

 Employ a multidisciplinary approach

 Use of rigorous and multiple research methodologies
 Use appropriate data analyses
 Establish and monitor safety and protection of human
subjects
3.47
Why is Prevention Science Important to Substance Use
Prevention Specialists Internationally?

Prevention science is important to practice:

 Defines a field of prevention that includes its own language and
methods that are standardized and can be shared across regions
 Creates a link between research and practice
 Provides a strong foundation for the development and delivery of
effective prevention interventions and policies
 Links etiologic factors, processes, and mechanisms to prevention
interventions and policies
 Is cost effective when evidence-based interventions and policies
are implemented with fidelity and are sustained over time
 Professionalizes the field of prevention science with two strong
arms: research and application/practice

3.48
Module 3 Evaluation
15 minutes
3.49