I. Purpose
The purpose of this module is to provide information and skills necessary to engage in community prevention activities.
II. Learning
... [Show More] Objectives
At the end of the training, the health care professional will have had an opportunity to:
• Define community-based prevention.
• Discuss types and levels of prevention.
• Compare frameworks for preventive interventions.
• Identify risk and protective factors associated with substance use disorders.
• Cite theories of behavioral change.
• Discuss cultural influences on prevention.
• Define the role of the health professional in prevention.
• Discuss general and specific strategies for community-based prevention.
• Identify evaluation aims for community-based programs.
III. Chronology Approximately 1 Hour 30 Minutes
Introduction and objectives 5 Minutes
Definitions, types and levels of prevention 15 Minutes
Frameworks for preventive interventions 15 Minutes
Prevention principles 10 Minutes
Risk and protective factors and resiliency 15 Minutes
Role of health practitioner 5 Minutes Designing effective prevention programs,
theories of change, cultural competence,
general and specific strategies, evaluation 20 Minutes
Summary and evaluation 5 Minutes
IV. Facilitator Materials
• Power Point Slides (lecture and discussion)
V. Participant Materials
• Handouts
• References
Module IX: Community-Based Substance Abuse Prevention
Slide 1: Title Slide - Community-Based Substance Abuse Prevention Introduction
This is the title slide.
Slide 2: Learning Objectives
Health Care Professionals will have the opportunity to:
• Define community-based prevention.
• Discuss types and levels of prevention.
• Compare frameworks for preventive interventions.
• Identify risk and protective factors associated with substance use disorders.
• Cite theories of behavioral change.
• Discuss cultural influences on prevention.
Slide 3: Learning Objectives (continued)
Health Care Professionals will be able to:
• Define the role of the health care professional in prevention.
• Discuss general and specific strategies for community-based prevention.
• Identify evaluation aims for community-based prevention programs.
Slide 4: Introduction
There are compelling reasons why community-based prevention of substance use and abuse should be a major focus for all health professionals. The combined effects of tobacco, alcohol, and other drugs take a greater toll on the health and well-being of Americans than any other single preventable health problem. While the Monitoring the Future (MTF) (2004) survey indicates an almost 7 percent decline from 2003 to 2004 of any illicit drug use in the post month by 8th, 10th, and 12th grades, other areas raise of drug use concern. There was a significant increase in OxyContin use by adolescents during this period and lifetime inhalant use for 8th graders also increased significantly. NIDA’s Community Epidemiology Work Group (CEWG) publishes emerging trends in drug abuse for 21 major U.S. metropolitan areas. The CEWG data for 2002 indicate that cocaine/crack was endemic in all of the areas, heroin indicators continued to be high, prescription opiates appear increasingly in drug indicator data, methamphetamine abuse continues to spread and marijuana is the most frequently used illicit drug in CEWG areas. (Community Epidemiology Work Group, 2003).
Studies indicate that 119 million Americans (50.1% aged 12 or older were current alcohol users in 2003 and 70.8 million (29.8%) Americans 12 or older were current smokers during that time (Substance Abuse Mental Health Services Administration, 2004). As indicated by these data substance use disorders occur across the lifespan, so preventive interventions must be targeted for individuals at risk in all age groups. Such interventions should take into consideration the unique developmental tasks of each age group and the risk and protective factors that influence the health behaviors of individuals and communities. According to Perry, “the question in prevention is not why but how” (Perry, 1996). Individuals of all ages are members of communities and there is increasing evidence that the most effective prevention strategies are community-based (Burgoyne, 1991). Moreover, the underlying premise of Healthy People 2010 is that the health of the individual is almost inseparable from
the health of the larger community, the state, and the nation (U.S. Department of Health and Human Services, 2000). The role of the health professional is to join with community stakeholders to increase the capacity of the community to provide science-based preventive interventions (Marcus, 2000, Chinman, et al 2005; Spoth & Greenberg, 2005). This module provides an overview of community-based prevention: definitions, levels of prevention, selected frameworks and strategies for designing community-based prevention, a summary of the literature related to risk and protective factors, and a brief outline of the role of the health professional in these endeavors.
Slide 5: Definition of Prevention
Prevention literally means to keep something from happening. There are, however, different interpretations about what that “something” is; first incidence, frequent use, heavy use, relapse, disability associated with a disorder, or the risk condition itself. According to Pentz (1999), the broadest interpretation related to substance abuse disorders is “blocking the progression of use to abuse, whether in adults or youth.” Defined in strictest terms prevention refers to preventing onset of any use. Because this may not be realistic, clinicians and researchers define preventive interventions as “any program that has as its goal either delay of onset, delay of progression from lower to higher use prevalence (frequency) or consumption (amount) or decrease in use prevalence and consumption” (Pentz, 1999, p 535). The Center for Substance Abuse Prevention (CSAP) definition of prevention states that it is “a proactive process that empowers individuals and systems to meet the challenge of life events and transitions by creating and reinforcing conditions that promote healthy behaviors and lifestyles” (CSAP, 1994). Early prevention activities, primarily education, focused on the individual rather than the environment. Prevention science is now understood to be far more complex and to involve integration of epidemiological, etiological and preventive intervention research. Prevention can be defined holistically as an anticipatory process that prepares and supports individuals, families, communities, and systems in the creation and reinforcement of health behaviors and lifestyles and the conditions that promote them.
Slide 6: Prevention Activities Classified
Preventive interventions are classified by approach to drug abuse control (demand vs. supply reduction), level of prevention (universal, selective, indicated) and focus (direct focus on drug use resistance and harm reduction vs. indirect focus on life skills and building protective factors).
In the traditional public health conceptualization of levels of prevention (primary prevention is targeted at protecting individuals who have not yet begun to use substances, secondary prevention (or early intervention) targets persons in early stages of substance abuse to reduce and/or eliminate use, and tertiary prevention (treatment) seeks to end dependency and addiction and/or ameliorate the negative effects of substance use (Commission on Chronic Illness, 1957; CSAP, 1991). Since this 1957 public health classification of levels of prevention was formulated, there is new appreciation for the complex interplay between and among environmental, cognitive, physical, psychological, social and spiritual factors and health outcomes. A second framework has been used since 1990 to supplement the initial public health classification. That framework, embedded in the Mental Health Intervention Spectrum (Figure 1), categorizes interventions as: universal (delivered to the general
population), selective (targeted for “at risk” populations), and indicated (aimed at high risk individuals who may have minimal but detectable signs or symptoms of the disorder) (Gordon, 1983; Mrazek & Haggerty, 1994). [Show Less]