What is the Evidence Base for Prevention in Adolescence?
What is the Evidence Base for Prevention in Adolescence?
What is the Evidence Base for Prevention in Adolescence?
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Murdoch Children’s Research Institute<br />
February 24, 2012<br />
<strong>What</strong> <strong>is</strong> <strong>the</strong> <strong>Evidence</strong> <strong>Base</strong> <strong>for</strong><br />
<strong>Prevention</strong> <strong>in</strong> <strong>Adolescence</strong>?<br />
Richard F. Catalano, Ph.D.<br />
Bartley Dobb Professor <strong>for</strong> <strong>the</strong> Study and <strong>Prevention</strong> of Violence<br />
Director, Social Development Research Group<br />
School of Social Work<br />
University of Wash<strong>in</strong>gton<br />
sdrg.org<br />
and <strong>the</strong> author group <strong>for</strong> <strong>the</strong> <strong>Prevention</strong> article <strong>in</strong> Lancet series<br />
on Adolescent Health: Abigail Fagan, Loretta E. Gav<strong>in</strong>, Mark T.<br />
Greenberg, Charles Irw<strong>in</strong>, David A. Ross, Daniel T.L. Shek
Intervention Spectrum<br />
Treatment<br />
Source: Institute of Medic<strong>in</strong>e (2009). Prevent<strong>in</strong>g Mental, Emotional and<br />
Behavioral D<strong>is</strong>orders Among Young People. O’Connell, Boat & Warner<br />
(eds.) Wash<strong>in</strong>gton DC: National Academy Press
<strong>Prevention</strong> Science<br />
Framework<br />
Program<br />
Implementation<br />
and<br />
Evaluation<br />
Def<strong>in</strong>e <strong>the</strong><br />
Problem<br />
Identify R<strong>is</strong>k<br />
and Protective<br />
Factors<br />
Interventions<br />
Problem<br />
Response
<strong>Prevention</strong> Science<br />
Research Advances<br />
Etiology/Epidemiology of Problem Behaviors<br />
• Identify r<strong>is</strong>k and protective factors that<br />
predict problem behaviors and describe<br />
<strong>the</strong>ir d<strong>is</strong>tribution <strong>in</strong> populations.<br />
Efficacy Trials<br />
• Design and test preventive <strong>in</strong>terventions<br />
to <strong>in</strong>terrupt causal processes that lead to<br />
youth problems.<br />
<strong>Prevention</strong> Services Research<br />
• Apply lessons learned about etiology and<br />
effective <strong>in</strong>terventions <strong>in</strong> real world<br />
sett<strong>in</strong>gs.
R<strong>is</strong>k Factors <strong>for</strong><br />
Adolescent Problem Behaviors<br />
R<strong>is</strong>k Factors<br />
Substance Abuse<br />
Del<strong>in</strong>quency<br />
Teen Pregnancy<br />
School Drop-Out<br />
Violence<br />
Depression &<br />
Anxiety<br />
Community<br />
Availability of Drugs<br />
<br />
<br />
Availability of Firearms<br />
<br />
<br />
Community Laws and Norms Favorable<br />
Toward Drug Use, Firearms, and Crime<br />
<br />
<br />
<br />
Media Portrayals<br />
<br />
<br />
Transitions and Mobility<br />
<br />
<br />
<br />
<br />
Low Neighborhood Attachment and<br />
Community D<strong>is</strong>organization<br />
<br />
<br />
<br />
Extreme Economic Deprivation
R<strong>is</strong>k Factors <strong>for</strong><br />
Adolescent Problem Behaviors<br />
R<strong>is</strong>k Factors<br />
Substance Abuse<br />
Del<strong>in</strong>quency<br />
Teen Pregnancy<br />
School Drop-Out<br />
Violence<br />
Depression & Anxiety<br />
Family<br />
Family H<strong>is</strong>tory of <strong>the</strong> Problem Behavior<br />
<br />
<br />
<br />
<br />
<br />
<br />
Family Management Problems<br />
<br />
<br />
<br />
<br />
<br />
<br />
Family Conflict<br />
<br />
<br />
<br />
<br />
<br />
<br />
Favorable Parental Attitudes and Involvement <strong>in</strong><br />
<strong>the</strong> Problem Behavior
R<strong>is</strong>k Factors <strong>for</strong><br />
Adolescent Problem Behaviors<br />
Depression & Anxiety<br />
Violence<br />
School Drop-Out<br />
Teen Pregnancy<br />
Del<strong>in</strong>quency<br />
Substance Abuse<br />
R<strong>is</strong>k Factors<br />
School<br />
<br />
<br />
<br />
<br />
<br />
<br />
Academic Failure Beg<strong>in</strong>n<strong>in</strong>g <strong>in</strong> Late Elementary<br />
School<br />
Lack of Commitment to School
R<strong>is</strong>k Factors <strong>for</strong><br />
Adolescent Problem Behaviors<br />
R<strong>is</strong>k Factors<br />
Substance Abuse<br />
Del<strong>in</strong>quency<br />
Teen Pregnancy<br />
School Drop-Out<br />
Violence<br />
Depression & Anxiety<br />
Individual/Peer<br />
Early and Pers<strong>is</strong>tent Ant<strong>is</strong>ocial Behavior<br />
<br />
<br />
<br />
<br />
<br />
<br />
Rebelliousness<br />
<br />
<br />
<br />
Friends Who Engage <strong>in</strong> <strong>the</strong> Problem Behavior<br />
<br />
<br />
<br />
<br />
<br />
Favorable Attitudes Toward <strong>the</strong> Problem<br />
Behavior<br />
<br />
<br />
<br />
<br />
Early Initiation of <strong>the</strong> Problem Behavior<br />
<br />
<br />
<br />
<br />
<br />
Constitutional Factors
Protective Factors<br />
Individual Character<strong>is</strong>tics<br />
– High Intelligence<br />
– Resilient Temperament<br />
– Competencies and Skills<br />
In each social doma<strong>in</strong> (family, school, peer<br />
group and neighborhood)<br />
– Prosocial Opportunities<br />
– Re<strong>in</strong><strong>for</strong>cement <strong>for</strong> Prosocial Involvement<br />
–Bond<strong>in</strong>g<br />
– Healthy Beliefs and Clear Standards
R<strong>is</strong>k and Protective Factors<br />
Shap<strong>in</strong>g Child and<br />
Adolescent Development<br />
Community<br />
Peers<br />
School<br />
Parents<br />
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
R<strong>is</strong>k Snowstorm: and Protective Extended Exposure Factors<br />
Snowball: R<strong>is</strong>k Accumulates<br />
Positive Substance Use Norms and<br />
Models of Problem Behavior without<br />
Protection<br />
Shap<strong>in</strong>g Child and<br />
through Early Developmental<br />
Adolescent Development<br />
Challenges without Protection<br />
Community<br />
Peers<br />
School<br />
Parents<br />
Toumbourou and Catalano, 2005<br />
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Prevalence of 30 Day Alcohol Use<br />
by Number of R<strong>is</strong>k and Protective Factors<br />
Six State Student Survey of 6th-12th Graders, Public School<br />
Students<br />
100%<br />
Prevalence<br />
90%<br />
80%<br />
70%<br />
60%<br />
50%<br />
40%<br />
30%<br />
20%<br />
10%<br />
Number of<br />
Protective Factors<br />
0 to 1<br />
2 to 3<br />
4 to 5<br />
6 to 7<br />
8 to 9<br />
0%<br />
0 to 1 2 to 3 4 to 5 6 to 7 8 to 9 10+<br />
Number of R<strong>is</strong>k Factors
Prevalence of Any O<strong>the</strong>r Illicit Drug Use<br />
(Past 30 Days)<br />
By Number of R<strong>is</strong>k and Protective Factors<br />
100%<br />
Six State Student Survey of 6th - 12th Graders,<br />
Public School Students<br />
90%<br />
Prevalence<br />
80%<br />
70%<br />
60%<br />
50%<br />
40%<br />
30%<br />
Number of<br />
Protective<br />
Factors<br />
0 to 1<br />
2 to 3<br />
4 to 5<br />
6 to 8<br />
20%<br />
10%<br />
0%<br />
0 to 1 2 to 3 4 to 5 6 to 8 9 or More<br />
Number of R<strong>is</strong>k Factors
Prevalence of “Attacked to Hurt”<br />
By Number of R<strong>is</strong>k and Protective Factors<br />
60%<br />
50%<br />
Prevalence<br />
40%<br />
30%<br />
20%<br />
Protection, Level 0<br />
Protection, Level 1<br />
Protection, Level 2<br />
Protection, Level 3<br />
Protection, Level 4<br />
10%<br />
0%<br />
R<strong>is</strong>k, Level<br />
0<br />
R<strong>is</strong>k, Level<br />
1<br />
R<strong>is</strong>k, Level<br />
2<br />
R<strong>is</strong>k, Level<br />
3<br />
R<strong>is</strong>k, Level<br />
4
Prevalence of Mental and Social Problems<br />
by Number of R<strong>is</strong>k Factors<br />
50<br />
40<br />
%<br />
30<br />
20<br />
10<br />
depressive<br />
symptomatology<br />
deliberate self harm<br />
homelessness<br />
early sexual activity<br />
0<br />
0-1 2-3 4-6 7-9 >=10<br />
R<strong>is</strong>k factors<br />
Bond, Thomas, Toumbourou, Patton,<br />
and Catalano, 2000
Number of School Build<strong>in</strong>g R<strong>is</strong>k<br />
Factors and Probability of Meet<strong>in</strong>g<br />
WASL Standard (10 th Grade Students)<br />
Probability of Meet<strong>in</strong>g Standard<br />
1.0<br />
0.9<br />
0.8<br />
0.7<br />
0.6<br />
0.5<br />
0.4<br />
0.3<br />
0.2<br />
0.1<br />
0.0<br />
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16<br />
Number of R<strong>is</strong>k Factors<br />
Math Read<strong>in</strong>g Writ<strong>in</strong>g<br />
Arthur and Brown, 2006
Number of School Build<strong>in</strong>g Protective<br />
Factors and Probability of Meet<strong>in</strong>g<br />
WASL Standard (10 th grade students)<br />
Probability of Meet<strong>in</strong>g Standard<br />
1.0<br />
0.9<br />
0.8<br />
0.7<br />
0.6<br />
0.5<br />
0.4<br />
0.3<br />
0.2<br />
0.1<br />
0.0<br />
0 1 2 3 4 5 6 7<br />
Number of Protective Factors<br />
Math Read<strong>in</strong>g Writ<strong>in</strong>g<br />
Arthur and Brown, 2006
Why a Place <strong>Base</strong>d Approach?<br />
Communities Vary <strong>in</strong> R<strong>is</strong>k Exposure<br />
Neighborh ood #2<br />
In su f fic ie nt n um b e r of<br />
st u de n ts <strong>in</strong> th <strong>is</strong> are a.<br />
No s tu den ts<br />
<strong>in</strong> t h<strong>is</strong> a re a .<br />
Neighborhood #1 Neighborh oo d #3<br />
John A. Pollard , P h.D. Developmental Research and Pr ograms
<strong>Prevention</strong> Science<br />
Research Advances<br />
Etiology/Epidemiology of Problem Behaviors<br />
• Identify r<strong>is</strong>k and protective factors that<br />
predict problem behaviors and describe<br />
<strong>the</strong>ir d<strong>is</strong>tribution <strong>in</strong> populations.<br />
Efficacy Trials<br />
• Design and test preventive <strong>in</strong>terventions<br />
to <strong>in</strong>terrupt causal processes that lead<br />
to youth problems.<br />
<strong>Prevention</strong> Services Research<br />
• Apply lessons learned about etiology<br />
and effective <strong>in</strong>terventions <strong>in</strong> real world<br />
sett<strong>in</strong>gs
Effectiveness of <strong>Prevention</strong><br />
Policies and Programs<br />
Reviewed <strong>in</strong> 7 Areas<br />
Violence<br />
Substance M<strong>is</strong>use (exclud<strong>in</strong>g Tobacco)<br />
HIV/STI<br />
Un<strong>in</strong>tended Pregnancy<br />
Traffic Crashes and R<strong>is</strong>ky Driv<strong>in</strong>g<br />
Obesity<br />
Mental Health
<strong>What</strong> <strong>is</strong> an efficacious <strong>in</strong>tervention?<br />
Evaluation Quality<br />
• At least one randomized<br />
controlled trial OR a quasiexperimental<br />
trial without design<br />
flaws<br />
Impact<br />
• Impact on adolescent problem<br />
behavior<br />
• Absence of any negative effects<br />
Intervention Specificity<br />
• Population of focus <strong>is</strong> clearly<br />
def<strong>in</strong>ed<br />
• R<strong>is</strong>k and protective factors that<br />
program seeks to change are<br />
identifiable<br />
Implementation Tools<br />
• Tra<strong>in</strong><strong>in</strong>g materials are available<br />
• In<strong>for</strong>mation on <strong>the</strong> f<strong>in</strong>ancial and<br />
human resources required
<strong>Prevention</strong> Policy Example<br />
Ra<strong>is</strong><strong>in</strong>g <strong>the</strong> M<strong>in</strong>imum<br />
Legal Dr<strong>in</strong>k<strong>in</strong>g Age<br />
Ra<strong>is</strong>e M<strong>in</strong>.<br />
Legal<br />
Dr<strong>in</strong>k<strong>in</strong>g Age<br />
Reduced Alcohol<br />
Consumption,<br />
Reduced Crashes<br />
Crash Injury, and<br />
Fatalities<br />
Traffic Crashess<br />
R<strong>is</strong>ky Alcohol<br />
Use<br />
Dr<strong>in</strong>k Driv<strong>in</strong>g<br />
Problem<br />
Wagenaar and Toomey, 2002<br />
Response
Poor Birth<br />
And Early<br />
Childhood<br />
Outcomes<br />
<strong>Prevention</strong> Program Example<br />
Nurse Family<br />
Partnership<br />
R<strong>is</strong>k: Poor Diet<br />
And Drug Use<br />
Prot.: Parent<strong>in</strong>g<br />
Competence<br />
And Bond<strong>in</strong>g<br />
Protocol <strong>for</strong><br />
Nurse V<strong>is</strong>its<br />
Dur<strong>in</strong>g<br />
Pregnancy And<br />
2 yrs. Post Birth<br />
Mom: Less welfare<br />
More employment,<br />
Fewer Arrests and<br />
Subsequent Births,<br />
Wide Rang<strong>in</strong>g Approaches Have Been<br />
Found To Be Efficacious<br />
<strong>Prevention</strong> Programs/Policies<br />
1. Prenatal & Infancy Programs(eg., NFP)<br />
2. Early Childhood Education<br />
3. Parent Tra<strong>in</strong><strong>in</strong>g<br />
4. After-school Recreation<br />
5. Mentor<strong>in</strong>g with Cont<strong>in</strong>gent<br />
Re<strong>in</strong><strong>for</strong>cement<br />
6. Cognitive Behavior Therapy<br />
7. Classroom Organization, Management<br />
and Instructional Strategies<br />
8. Classroom Curricula<br />
Violence<br />
<br />
<br />
<br />
Drug Use<br />
<br />
<br />
<br />
<br />
HIV STI<br />
Un<strong>in</strong>tended Pregnancy<br />
<br />
Vehicle Crash R<strong>is</strong>k<br />
Obesity<br />
<br />
<br />
<br />
<br />
Mental Health
Wide Rang<strong>in</strong>g Approaches Have Been<br />
Found To Be Efficacious<br />
<strong>Prevention</strong> Programs/Policies<br />
9. Community <strong>Base</strong>d Skills Tra<strong>in</strong><strong>in</strong>g/Motivational<br />
Interview<strong>in</strong>g<br />
10. Cash Transfer <strong>for</strong> School Fees/Stipend<br />
11. Multicomponent Positive Youth Development<br />
12. Policies (eg., MLDA)<br />
13. Community Mobilization<br />
14. Medical Intervention<br />
15. Law En<strong>for</strong>cement<br />
16. Family Plann<strong>in</strong>g Cl<strong>in</strong>ic<br />
Violence<br />
<br />
<br />
Drug Use<br />
<br />
<br />
HIV STI<br />
<br />
<br />
Un<strong>in</strong>tended Pregnancy<br />
<br />
<br />
<br />
<br />
<br />
Vehicle Crashes<br />
<br />
<br />
Obesity<br />
Mental Health
Criteria <strong>for</strong> Selection of<br />
Illustrative Programs<br />
• Randomized or quasi-experimental designs<br />
• Stat<strong>is</strong>tically significant effect on problem<br />
behaviors dur<strong>in</strong>g adolescence at least one<br />
year post <strong>in</strong>tervention<br />
• Operate dur<strong>in</strong>g childhood or adolescence<br />
• Examples address both snowball and<br />
snowstorm r<strong>is</strong>k patterns<br />
• Some diversity <strong>in</strong> global context
Illustrative Efficacious <strong>Prevention</strong><br />
Policies<br />
Age 12-18<br />
• Adolescent Access to Contraceptives (Br<strong>in</strong>d<strong>is</strong><br />
et al., 2003; Foster et al., 2006; Boonstra et al., 2010; Guldi, 2008;<br />
Zavodny, 2004; Kearney & Lev<strong>in</strong>e, 2009)<br />
• Graduated Driver Licens<strong>in</strong>g (Shope, 2007)<br />
• Increased Taxes on Alcohol (Wagenaar et al., 2009;<br />
Elder et al., 2010)<br />
• M<strong>in</strong>imum Legal Dr<strong>in</strong>k<strong>in</strong>g Age 21 (Wagenaar &<br />
Toomey, 2002)