Annual Meeting of the Society for Prevention Research
From Research to Policy: Advancing Prevention Science and Practice
J. Botvin, Ph.D.
Professor of Public Health and Director
Institute for Prevention Research
Weill Medical College of Cornell University
Remarks and Disclosure Statement
Good morning everyone.
And, welcome to the 11th Annual Meeting of the Society for Prevention Research.
By way of disclosure
and consistent with SPR policy, I’d like to begin by noting that I have
a financial interest in Life Skills Training, a school-based drug abuse prevention
program that I developed . Current SPR policy, passed by the SPR Board of Directors
at our fall retreat in 2001 and put into practice in January of 2002 provides
for a disclosure of any conflict of interest by SPR officers, board members, authors
of articles in SPR’s journal, Prevention Science, and presenters at our
annual conference. Information about our conflict of interest policy can be found
on our web site (www.preventionresearch.org). Pages 247 and 248 of the conference
program list conflict of interest disclosures for presenters at this year’s
The field of prevention
science continues to grow and new knowledge in prevention seems to be accumulating
at an ever-faster pace. SPR’s annual meeting this year provides an excellent
opportunity to learn of recent advances in prevention science as more than 200
researchers present the latest findings of their work on prevention science in
a variety of formats including pre-conference workshops, invited addresses at
plenary sessions, papers, symposia, posters sessions, roundtable discussions,
informal conversations, and social events such as this year’s SPR minority
scholarship dance Friday night featuring SPR’s own band, the “Mothers
As in the past,
this year’s meeting is designed to provide a forum for discussing new developments
in prevention science from around the world in areas of epidemiology, etiology,
demonstration projects, policy research, natural experiments, efficacy and effectiveness
trials, and studies of the diffusion of evidence-based prevention. The various
presentations at this year’s conference will also continue to explore issues
of gender, social class, culture, and ethnicity within the context of prevention
research. SPR’s conference also provides an opportunity to discuss the application
of new methodological developments.
AND DEVELOPMENT OF SPR
SPR began a little
more than a decade ago with the encouragement of Zili Sloboda and her colleagues
at the National Institute on Drug Abuse (NIDA). SPR was founded at a meeting of
NIDA-funded center directors and their staff hosted by Ralph Tartar at the University
of Pittsburgh. Membership in SPR has grown steadily over the years since its humble
beginnings with 19 founding members to over 600 members and nearly 650 attendees
at the 2003 conference.
of SPR’s Mission
Over the years
of SPR’s growth, the mission of SPR has expanded from its initial focus
on drug abuse prevention to a broader, multidisciplinary focus targeting a wide
range of health and behavioral problems . Recognizing that, SPR’s board
approved a revised mission statement at its retreat in October of 2001 appropriate
for SPR’s broader mission and membership.
According to the
revised mission statement: “The Society for Prevention Research is an international
organization focused upon the advancement of science-based prevention programs
and policies through empirical research. The membership of the organization includes
scientists, practitioners, advocates, administrators, and policy makers who are
concerned with the prevention of social, physical and mental health problems and
the promotion of health, safety, and well-being.”
In addition to
the clarification and expansion of our mission statement, the steady growth of
SPR, and the impressive attendance at SPR’s annual conferences, there are
a number of other notable accomplishments that help mark SPR’s coming of
age as an increasingly influential professional organization. Let me just mention
- Development of
bylaws and a governance structure consisting of officers, a board of directors,
and a (usually bloodless) transition of power every two years;
of a central office in the Washington, DC metropolitan area and beginning of an
- Increased financial
stability through several grants including a 5-year NIH R13 Conference Grant (supported
by NIMH, NIDA, NCI, NIAAA), grants from NSF and RWJ to study the Multiple Problems
of Youth (with Tony Biglan as the Principal Investigator), and a grant from SAMHSA’s
CMHS (with Shep Kellam as the Principal Investigator);
- A scientific
journal, Prevention Science, starting in March of 2000 that is published quarterly
by Kluwer/Plenum Academic Publishers;
- Policies on Conflict
of Interest (drafted by an ad hoc committee on ethics and conflict of interest,
chaired by Chris Ringwalt, and approved by the SPR board) that require disclosure
for all presenters at SPR’s annual meeting, for authors of articles published
in the journal, and for all officers and board members;
- Development of
a Strategic Plan to promote SPR’s mission approved by the Board of Directors
at our January 2003 retreat;
- A new web site
and, very recently, an e-newsletter called “SPR News” designed to
facilitate and improve communications among SPR members.
IN PREVENTION SCIENCE
Over the past 20
years, there has been a surge of interest in prevention and a corresponding increase
in prevention research. This research has focused on the prevention of social
and health problems as well as the promotion of positive youth development. Prevention
research has targeted a diversity of problems (such as tobacco, alcohol, and drug
abuse; HIV/AIDS, teen pregnancy, aggression and violence; mental health), populations
(youth and adults, students and parents, different racial and ethnic subgroups),
in a variety of settings (schools, home, workplace) and employed a range of intervention
modalities (e.g., those involving the school, family, community, and policies)
along the prevention spectrum including universal, selective, and indicated approaches.
In multiple areas, prevention research has progressed from developmental epidemiology
and etiology to small-scale pilot studies to large-scale randomized trials. Here
are some examples of note-worthy prevention research conducted by SPR members.
Research by SPR
members has shown that theory-driven, preventive interventions can have wide-ranging
benefits. As an example, consider the Seattle Social Development Project, conducted
by David Hawkins, Richard Catalano and their colleagues at the University of Washington’s
Social Development Research Group. They used the social development strategy to
design the SOAR program of teacher, parent and child focused interventions in
grades 1 through 6.
When compared with
controls children in the full intervention group showed positive effects during
the intervention period and by age 21, nine years after the intervention ended,
reported significantly better outcomes on a range of health and behavior including
productive engagement in work and school, less risky sexual behavior, fewer young
women who had given birth and fewer symptoms of mental health problems . These
findings underscore the importance of long-term, follow-up studies of preventive
interventions as well as the importance of measuring a broad set of outcomes that
are predicted by the risk and protective factors addressed in specific prevention
has been conducted to test prevention approaches designed for middle and/or junior
high school students in schools . Research by my own group at Cornell has shown
that a universal school-based prevention program targeting adolescents can prevent
tobacco, alcohol, and illicit drug use and impact on risk and protective factors
associated with substance use. School-based prevention is effective when implemented
by adult providers such as teachers and members of project staff as well as when
implemented by same-age or older peer leaders. School-based prevention produces
both short-term and long-term reductions in substance use, relative to untreated
controls. Booster sessions can maintain and, in some cases, enhance initial prevention
effects. Although tailoring can increase effectiveness, even without tailoring
this research demonstrates that it is possible to prevent substance use with a
broad range of adolescents from different ethnic/racial groups (white, black,
Hispanic) and populations (suburban, urban, and rural). In addition to producing
durable prevention effects lasting until the end of high school, this prevention
approach can not only impact on early-stage drug use but also on more serious
levels of drug involvement such as pack-a-day cigarette smoking, binge drinking,
and regular (weekly) poly-drug use.
and Policy Prevention Approaches
Mary Ann Pentz
and her colleagues at the University of Southern California have been working
on different prevention fronts over the years including multi-component community
programs (Project STAR), policy, and diffusion research. STAR has involved whole
cities in prevention and produced the longest sustained prevention effects on
drug use that I’m aware of, with effects evident among young adults in their
late twenties who participated in the intervention when they were in their early
teens. She is also studying sustainability and cost-effectiveness.
Tony Biglan and
his associates at the Oregon Research Institute have used a variety of research
methods in their prevention research. For example, in one study testing a community-based
“reward and reminder” campaign designed to reduce illegal tobacco
sales, they used single case design methods to develop an intervention to reduce
illegal sales of tobacco to young people. The graphs on this slide describe the
intervention and the next slide show results from four of eight communities and
illustrate the study design. The x axis in all graphs is the percent of retail
outlets willing to sell to minors. Then Biglan and his colleagues replicated this
study in the entire state of Wyoming.
Harold Holder and
his colleagues at Prevention Research Center in Berkeley have shown that alcohol-involved
trauma can be reduced using a multi-component community intervention. In a national
prevention trial that included communities in California and South Carolina, the
intervention produced significant reductions in heavy drinking, driving after
drinking too much, BAC positive drivers, nighttime injury crashes, and alcohol
involved assaults. Moreover, based on traffic crashes alone, cost/benefit analyses
indicated that each $1 invested paid off with $2 in savings.
work at the University of Minnesota’s School of Public Health is designed
to discover effective community and policy interventions to reduce alcohol related
social and health problems. Recent studies include adolescent drinking prevention,
community organizing efforts, community prevention trials, alcohol-involved traffic
crashes, training of alcohol outlet managers and servers, natural experiments
with changes in state and local alcohol policies, and public opinion surveys.
Prevention and Diffusion Research
Dick Spoth and
his colleagues at Iowa State University are conducting very interesting research
combining efficacy and diffusion research. For example, their prevention research
testing the efficacy of a family-focused prevention approach (Iowa Strengthening
Families Program) has shown a number of positive prevention effects including
reductions shown on lifetime drunkenness. Their work has also begun examining
a partnership model that offers the potential for building capacity for diffusion
of evidence-based prevention programs. This involves two different delivery systems:
(1) the cooperative extension system, housed at the ISU land grant university
and (2) the public school system. The cooperative extension system has agents
in nearly every county of every state in the country. The Cooperative Extension
Service and the public school system have independent, multilevel program delivery
networks reaching every community or district in the country. Such a model offers
considerable potential as a delivery system with extensive penetration to promote
the adoption, implementation, and institutionalization of evidence-based prevention.
Progress in identifying
risk and protective factors, understanding the developmental course of those etiologic
factors and the specific problems being targeted, and demonstrating the efficacy
of particular prevention approaches has also been accompanied by advances in prevention
methodology—such as methods for handling multi-level data, missing data,
transitions across developmental stages.
Linda Collins and
her colleagues at Penn State and Michigan have been working to improve prevention
methodology. Their work is perhaps best know for developing methods for prevention
scientists to handle missing data and model latent subgroups and stages. More
recently, they have focused on the design and evaluation of adaptive interventions.
not all prevention programs and policies are effective, a growing number of high
quality studies show that at least some prevention approaches work with some problems
and under some conditions. As the empirical literature has grown, so too has a
sense of optimism about the potential of prevention.
of scientific evidence supporting specific prevention programs and policies has
led to increasing efforts to disseminate the most effective approaches in order
to influence prevention practice and ultimately ameliorate the health and social
problems being targeted. As prevention scientists, we are reasonably adept at
the dissemination of our research findings through the conventional science dissemination
outlets (such as peer reviewed journals and scientific conferences). The process
of conducting research and then dissemination the findings to other researchers
generally leads to more research, but does little to influence prevention practice.
For our research to have an impact on health and well-being, however, we must
do more to influence practitioners.
by leading scientific committees and institutions have now concluded that the
risk for certain mental and behavioral disorders can be decreased, and that a
growing number of prevention approaches can be effective when properly implemented.
This has sparked a number of significant efforts by leading federal agencies with
missions related to prevention (such as the National Institute on Drug Abuse,
the US Department of Education, SAMHSA’s Center for Substance Abuse Prevention
and Center for Mental Health Services, and the US Justice Department’s Office
of Juvenile Justice and Delinquency Prevention) to influence prevention practice
by promoting evidence-based prevention approaches. These include organizing and/or
sponsoring national or regional conferences intended to disseminate information
about effective prevention approaches to educators, state and local leaders, and
No doubt one of
the greatest catalysts for change in the way prevention is conducted throughout
the country came from initiatives by several major federal agencies to identify
prevention programs for which this is credible empirical evidence of effectiveness.
Typically government agencies formed expert panels assigned to evaluate the evidence
supporting existing prevention programs and policies to identify those for which
there was sufficient evidence of effectiveness to designate them as “exemplary”
or “model” programs. Programs that did not meet the prescribed threshold
test of effectiveness were either given an alternate designation of “promising”
or not listed at all. These government lists of evidence-based programs began
with the now-famous NIDA “red book.” Other initiatives to identify
evidence-based prevention programs include the US Department of Education’s
Expert Panel on Safe and Drug-Free Schools, CDC’s “Research to the
Classroom” initiative identifying effective HIV/AIDS and smoking prevention
programs, OJJDP’s Blueprints initiative identifying effective violence and
drug abuse prevention programs, and CSAP’s National Registry of Effective
Programs (NREP) initiative to promote the use of effective drug abuse prevention
In addition to
identifying effective prevention programs and policies and conducting conferences
to disseminate information on what works, there have been two major government-supported
efforts to promote the use of evidence-based prevention programs by funding initiatives
to take evidence-based prevention to scale. These include OJJDP’s Blueprints
replication projects lead by Del Elliott and his team at the University of Colorado
and CSAP’s dissemination initiatives combining CSAP’s National Center
for the Advancement of Prevention (NCAP) working together with regional CSAP-funded
Centers for the Application of Prevention Technology (CAPTs) and with states through
CSAP’s State Incentive Grants (SIGs). All of these efforts have had a growing
impact on prevention practice throughout this country.
associated with disseminating information about evidence-based prevention programs
and promoting their adoption, it is becoming clear that there are also important
challenges related to implementation. One such challenge concerns implementation
fidelity. If prevention programs are not implemented with adequate fidelity, it
is unlikely that they will be effective. In fact, research shows that high fidelity
leads to superior outcomes, while poor fidelity leads to decreased effectiveness.
In addition to the fact that difficulties in achieving high fidelity are widely
reported in field settings, recent studies by Hallfors & Godette, by Denise
Gottfredson, and one by Ringwalt have heightened concerns about fidelity. This
raises the specter that as evidence-based prevention programs are taken to scale,
they may not result in the outcomes expected due to poor fidelity in natural settings.
For example, research by Ringwalt shows that while the majority of teachers followed
the prevention curriculum guide “somewhat closely,” only about 12%
followed it “very closely.” Why is fidelity such a problem?
Well, there are
a number of potential barriers to fidelity in schools and other real-world settings.
These include a lack of training and support, limited resources, classroom overcrowding,
classroom management and disciplinary problems, low teacher morale and burnout,
multiple competing demands, and insufficient time due to an increased emphasis
on basic academic areas and preparation for standardized testing.
Work by Del Elliott
and his colleagues at the University of Colorado with the Blueprints initiative,
funded by OJJDP, documents the importance of implementation fidelity by not only
showing that superior outcomes are obtained when programs are implemented with
fidelity. More importantly, they have demonstrated that, with effort, high fidelity
can be achieved. For example, they found that by emphasizing fidelity they were
able to obtain fidelity rates of between 81% and 86% with the LST program across
different years and study cohorts. High levels of fidelity were also found in
their project involving violence prevention programs. So clearly, contrary to
the conventional wisdom among prevention providers, high fidelity is possible--even
in real-world settings.
appear to be associated with increased fidelity. First, the importance of implementation
fidelity and its relationship to effectiveness should be emphasized. Second, prevention
providers be provided with a working understanding of the underlying theory or
logic of a particular prevention approach. Third, program providers should receive
adequate training so that they have the requisite knowledge and skills to properly
implement an evidence-based prevention program. Fourth, it also helps to monitor
program implementation as well as to provide ongoing support and technical assistance.
Local support by
a school principle or advocate for a particular prevention model also appears
to be a critical ingredient in both fidelity and sustainability. Work by Mark
Greenberg and his team at Penn State have not only examined issues related to
fidelity and effectiveness, but have also begun to look at the very important
issue of sustainability. For example, research with the PATHS program underscores
the importance of principal support in school-based interventions. Kids who received
that PATHS program in schools with high levels of principal support showed a greater
decrease in aggression than those with low principal support. Several factors,
including fidelity of implementation, play a role in determining sustainability.
and Risks of Adaptation
In one sense, the
flip side of the fidelity issue concerns the perceived need for adaptation or
tailoring. While the pursuit of implementation fidelity offers the benefit of
improved effectiveness, adaptation offers potential benefits as well. Those who
argue for adaptation, maintain that some obvious benefits of adaptation include
the potential for tailoring programs to local needs, increasing acceptability
and “buy in,” and increasing cultural relevance. On the other hand,
adapting evidence-based prevention programs by deleting material carries with
it the risk of inadvertently deleting one or more essential elements and undermining
effectiveness. While adapting proven programs by adding untested material or modifying
aspects of any evidence-based prevention program also has the potential of undermining
effectiveness by including material that may, inadvertently, actually increase
risk. At this point, little is known about the benefits/risks of adapting evidence-based
prevention programs to different populations. But, research is currently underway
to study this important issue. For example, Felipe Castro is studying adaptation
to improve the intervention’s cultural relevance and its effectiveness when
applied with members of special sub-populations, including Hispanics/Latinos,
and other racial/ethnic or cultural groups.
Despite the impressive
progress made to the field of prevention in recent years, considerably more work
is needed to advance both the science and practice of prevention. For example,
research is needed to refine current prevention approaches, test new approaches,
identify mediating mechanisms, understand the factors associated with poor fidelity
and how to surmount them, determine whether adaptation is necessary to make prevention
programs suitable to different populations as well as how to adapt evidence-based
prevention programs without undermining their effectiveness, determine the effectiveness
of current prevention approaches with minority populations, test the optimal combination
of prevention modalities together to create effective comprehensive prevention
strategies, and extend current prevention findings to multiple problem behaviors.
Other important next steps are to increase the adoption and use of proven prevention
approaches, develop and test new dissemination structures and systems, develop
and test new blended research models that test evidence-based prevention in natural
SPR STRATEGIC PLAN
After careful consideration
and considerable discussion, SPR’s board of directors has developed a Strategic
Plan to guide our efforts to advance the science and practice of prevention in
a manner consistent with SPR’s mission. SPR’s board of directors has
identified as a major priority the promotion of research to further the understanding
of how evidence-based programs and policies can be effectively taken to scale.
So in my remaining
time, I’d like to briefly describe some key elements of our Strategic Plan
in terms of the three main strategies that SPR is advocating and related action
1: Promote federal and state-level initiatives on integration of research and
To move the field
forward with respect to dissemination and effectiveness research, more coordination
and integration of research and practice will be needed. This will require major
new initiatives in which funding for prevention research by NIH is coordinated
with those of the practice-oriented agencies of the federal government so that
research informs us about how best to get effective practices widely implemented.
This research would experimentally evaluate strategies for disseminating and effectively
implementing the programs and policies that practice-oriented agencies are charged
with fostering. It is our intention that this research would lead to the development
and utilization of a more effective set of dissemination practices.
We therefore call
on the federal government to allocate funds to create funding opportunities in
which a practice agency’s funding and dissemination processes are studied
in ways designed to foster more effective dissemination. A parallel process should
be encouraged at the state level.
Action Steps for Strategy 1
strategies will require partnerships with federal, state, and local policy makers
and the development of a common framework for thinking and communicating about
how to improve the dissemination of effective practices and ensure high quality
implementation of those practices. Some action steps have already been taken,
while others are planned for the future. Action steps include:
Step 1: Appoint a committee for promoting Strategy 1.
A committee has been formed consisting of David Hawkins (chair), Gil Botvin, Denise
Hallfors, Zili Sloboda and Pat Mrazek (staff person who is assisting with development
of the work plan).
Step 2: Seek support from SAMSHA as a practice agency to collaborate
with SPR to advance a shared vision of advocating prevention research and prevention
Gil Botvin, David Hawkins, and Jennifer Lewis met with Mr. Charles Currie, SAMHSA’s
Adminstrator and his senior staff to begin this process.
Step 3: Convene a meeting of key agencies and brainstorm possible
Planning is underway.
Step 4: Partner with national prevention constituency organizations
(e.g., NPN, NASADAD, CADCA) and get on agenda of their meetings to give presentations
on dissemination and effectiveness issues and to develop a consensus about the
importance of promoting high quality research on dissemination and implementation
and to determine how these organizations can partner with SPR.
Last November, two members of the Strategic Planning Task Force, Tony Biglan and
David Hawkins gave a presentation at NPN’s meeting in San Diego.
2: Develop standards for the level of rigor required for confident conclusions
about the efficacy of prevention practices.
Directly tied to
the utilization of effective practices is the dissemination of accurate knowledge
about what these practices are. If incorrect information is disseminated, effective
practices are unlikely to be selected. The increase in rapid dissemination of
information (both scientific and non-scientific) through web sites has increased
the likelihood that users will encounter conflicting information about the effectiveness
of different practices. This situation can lead to confusion and frustration among
users, and may even lead to misguided decisions about effective practices.
SPR is in a unique
position to influence the information that is disseminated to practitioners and
policy makers regarding effective practices and policies. As a group of researchers
whose mission is to promote effective prevention practice, we can influence the
field by developing a consensus among our members about what should constitute
sufficient evidence of effectiveness and providing these guidelines to other groups
involved in creating and maintaining information databases of effective practices.
Steps for Strategy 2
We have identified
several action steps to accomplish Strategy 2. Once again, I’m pleased to
report that we’ve already made progress.
Step 1: Develop a broad consensus regarding the meaning of evidence
and the need common set of standards of evidence.
With funding from SAMHSA’s Center for Mental Health Services and under the
leadership of Shep Kellam (a past president of SPR), SPR undertook a project on
the nature of evidence in prevention research and programs. That work culminated
in a report by Shep Kellam and Dori Langevin which is scheduled to be published
in Prevention Science this coming fall.
Step 2: Develop a linkage with the Campbell collaboration.
We have developed a linkage with the Campbell collaboration through through Bob
Boruch, who held a pre-conference workshop at this year’s conference on
the Campbell collaboration and its work.
Step 3: Promote an understanding of standards of evidence among
SPR’s members through a session at SPR’s annual meeting.
A session was scheduled and conducted at this year’s SPR conference that
described work being conducted by the Campbell collaboration (Bob Boruch, presenter)
and SAMHSA’s NREP initiative (Steve Schinke, presenter).
Action Step 4: Appoint an ad hoc SPR committee to identify
standards of evidence appropriate for prevention science.
A Standards of Evidence committee was formed consisting of Brian Flay (chair),
Steven Schinke, Tony Biglan, Felipe Castro, Denise Gottfredson, Shep Kellam, and
Bob Boruch (consultant). The committee held its first meeting at this year’s
3: Develop and promote use of data systems to measure trends in positive youth
development and factors that influence positive youth development at state and
of new knowledge about factors related to implementation quality and effective
dissemination would be greatly facilitated by state and local data systems that
measure trends in positive youth development and factors that influence positive
youth development. To be useful for studying effectiveness and dissemination,
these data collection systems would have to systematically capture information
on the types of prevention practices attempted and the quality of implementation
of these practices as well as on the outcomes associated with these practices
-- risk and protective factors and child health and behavior indicators. Such
prevention surveillance systems would enable studies of variation in the quality
of implementation, correlates of implementation quality, and how this variability
relates to program outcomes.
Steps for Strategy 3
Three action steps
have been identified for Strategy 3. Although some progress has been made, more
work clearly needs to be done.
Step 1: Form a committee of SPR members to develop consensus about
what type of community-level assessment of risk and protective factors and child
health and behavior indicators would be useful.
An ad hoc committee has been formed to develop a consensus about community-level
assessment consisting of Kathy Etz, Tracy Harachi, David Hawkins, Shep Kellam,
and Pat Mrazek (staff).
Step 2: Review the work that Tony Biglan is conducting on a related
SPR project that is funded by the National Science Foundation concerning the multiple
problems of youth and use it to guide SPR’s efforts to accomplish Strategy
A conference organized by Tony Biglan on this topic took place in February, 2003.
The committee is in the process of reviewing the work resulting from that conference.
Step 3: Partner with appropriate federal and state agencies on this
Planning for this action step is underway.
a long way since SPR was founded back in 1991, with a mere 19 members. We’ve
developed and grown as a professional organization, we’ve participated in
the development of the field of prevention science, and the development of effective
prevention approaches targeting an impressive array of health and social problems.
Although much remains
to be done, we have good reason to feel a growing sense of pride regarding the
quality of prevention science and optimism regarding its potential to enhance
the health and well being of millions of people across the US and, indeed, throughout
In closing, let
me once again thank Zili Sloboda and the other members of the Conference Planning
Committee for all of their hard work in putting together such an outstanding program.
I’m confident that this year’s conference will prove to be informative,
stimulating, and fun. So, welcome… and enjoy the conference!