Prevention Programs

Prevention programs seek to promote positive health and behavior outcomes and reduce negative health and behavior outcomes. Such outcomes can include substance abuse, violence, educational achievement, employment, and physical and mental health. These outcomes do not occur in a vacuum but instead are affected by many different individual and contextual factors, such as gender, personality, family structure, and community values. Prevention programs may be designed to target one or more factors, many of [Page 1730]which vary with age. Those creating prevention programs must consider a developmental perspective in both the design and timing of programs. This entry includes a discussion of the types of prevention programs, how prevention programs are developed and assessed using mediation analysis, as well as examples of prevention programs across the life span.

Prevention programs can be classified into three types: universal, selective, and indicated. Universal prevention programs seek to prevent a negative outcome in the general population, such as a public service television advertisement to help deter people from texting while driving. Selective prevention programs seek to prevent a negative outcome in specific subpopulations that may be at risk, such as a program offered to pregnant women to prevent gestational diabetes. Indicated prevention programs focus on treating and preventing further development of a disease in those who are experiencing the disease already, such as a weight-loss program for diabetic adults. Note that prevention programs also include policy, such as legislation intended to prevent injuries or fatalities from traffic accidents, and guidelines such as the U.S. National Institutes of Health recommendations on infant care.

The development of prevention programs is often informed by epidemiological research on the prevalence of a disease in the population as well as associated protective and risk factors. Epidemiological studies can also uncover how risk factors and disease prevalence differ across demographic groups, so that prevention programs can be directed toward specific groups. For example, an epidemiological study may find the highest incidence of childhood obesity in low-income areas across the population, suggesting that programs to prevent childhood obesity should target low-income communities.

Understanding the antecedents of health and behavior outcomes is important in the design of prevention programs. Based on theory and prior research, most prevention programs seek to change an outcome variable by first changing an intermediary variable (or mediator), which in turn affects the outcome. For example, a school-based program to prevent smoking may try to change students’ perceptions of smoking norms, which in turn decreases their likelihood of beginning to smoke. Conceptual theory is concerned with the variables (mediators) that cause the outcome. In this example, the conceptual theory is that social norms predict smoking. Action theory is concerned with how the intervention changes the mediator. In the smoking prevention example, the intervention might include an action theory component that first has students estimate what percentage of their classmates smoke and then reveal the actual percentage of smokers. Many students overestimate the prevalence of smoking among their peers. Correcting this misperception by providing evidence that smoking is not as popular as imagined will help to change social norms about smoking. The action theory is that correcting normative expectations about the number of smokers will change the smoking norm.

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