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11th Annual Meeting of the Society for Prevention Research

Presidential Address

From Research to Policy: Advancing Prevention Science and Practice

Gilbert J. Botvin, Ph.D.
Professor of Public Health and Director
Institute for Prevention Research
Weill Medical College of Cornell University


Welcoming 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 ( Pages 247 and 248 of the conference program list conflict of interest disclosures for presenters at this year’s conference.

Conference Overview

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 of Prevention.”

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.


Membership Growth

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.

Expansion 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 a few:

  • Development of bylaws and a governance structure consisting of officers, a board of directors, and a (usually bloodless) transition of power every two years;
  • Establishment of a central office in the Washington, DC metropolitan area and beginning of an organizational infrastructure;
  • 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.


General Overview

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.

Theory-driven Preventive Interventions

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 programs.

School-Based Prevention

Considerable research 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.

Community-Based 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.

Alex Wagenaar’s 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.

Family-Focus 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.

Prevention Methodology

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.


From Science to Practice

Although clearly 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.

The accumulation 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.

Federal Dissemination Initiatives

Several reports 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 prevention specialists.

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 programs.

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.

Implementation Fidelity

Beyond challenges 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.

Several factors 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.

Benefits 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.

Next Steps

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 practice settings.


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 steps.

Strategy 1: Promote federal and state-level initiatives on integration of research and practice

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

Implementing these 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:

Action Step 1: Appoint a committee for promoting Strategy 1.

Progress: 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).

Action 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 practice.

Progress: Gil Botvin, David Hawkins, and Jennifer Lewis met with Mr. Charles Currie, SAMHSA’s Adminstrator and his senior staff to begin this process.

Action Step 3: Convene a meeting of key agencies and brainstorm possible initiatives

Progress: Planning is underway.

Action 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.

Progress: 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.

Strategy 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.

Action 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.

Action Step 1: Develop a broad consensus regarding the meaning of evidence and the need common set of standards of evidence.

Progress: 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.

Action Step 2: Develop a linkage with the Campbell collaboration.

Progress: 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.

Action Step 3: Promote an understanding of standards of evidence among SPR’s members through a session at SPR’s annual meeting.

Progress: 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.

Progress: 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 SPR conference.

Strategy 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 local levels.

The development 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.

Action 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.

Action 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.

Progress: 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).

Action 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 3.

Progress: 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.

Action Step 3: Partner with appropriate federal and state agencies on this strategy.

Progress: Planning for this action step is underway.


We’ve come 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 the world.

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!

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