Selecting Science-Based Prevention Interventions

John D. Clapp, Ph.D.
Director, U.S. Department of Education’s Higher Education Center for Alcohol, Drug Abuse, and Violence Prevention

The U.S. Department of Education’s Higher Education Center has long embraced a systematic, comprehensive, and strategic approach to alcohol and other drug abuse (AOD) prevention for college campuses. This conceptual approach to AOD prevention is rooted in the scientific literature that has consistently illustrated, both directly and indirectly, that substance use and its attendant problems are complex and dynamic. Prevention is an ongoing endeavor.

Selecting, implementing, and evaluating science-based prevention interventions have long been one of the more challenging steps in developing college alcohol and other drug abuse prevention systems. Although alcohol-related problems have been documented on college campuses for hundreds of years, the systematic study of such problems—and interventions to address them—began a mere half century ago. Until the 1990s, the prevention field had a very limited understanding of the epidemiology (distribution of problems) and etiology (cause of problems) of substance misuse among college students. Studies examining interventions to prevent and reduce such problems are a more recent development.

Over the past decade, the field of college alcohol prevention science has greatly advanced. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) report on college drinking and its subsequent update delineated scientifically supported interventions that have been tested in college settings (Tier 1 interventions) or in community settings (Tier 2 interventions). Tier 1 interventions are primarily individually focused and include such approaches as normative feedback and expectancy challenges. Tier 2 interventions include environmental approaches that have been found effective in community settings. These approaches include driving under the influence (DUI) interventions, policies controlling availability of alcohol, and increased enforcement of underage drinking laws. Tier 3 interventions are those with logical and theoretical promise that require more evaluation (i.e., they have not yet been tested or there are mixed results), for example social norms marketing, late-night alternative activities to drinking, and parental notification. Tier 4 interventions are those found to be ineffective or, worse, they resulted in increased problems. These include interventions such as informational programs, when used alone, and blood alcohol concentration (BAC) feedback.

Noncommercial Interventions

Typically developed by researchers, most Tier 1 and 2 interventions are described in the scientific literature. Historically, this situation has posed a challenge to campus-based prevention professionals and administrators. Specifically, it is often difficult to translate technical reports about research demonstration projects into real-world settings. Many researchers and organizations like the Higher Education Center have worked with prevention professionals to “translate” research-based interventions to increase the likelihood of adoption; however, many campuses struggle in successfully selecting and implementing science-based interventions. Although such interventions are often available to campuses at no charge or a nominal charge, campuses must dedicate the necessary resources to adopt and sustain these interventions. One major challenge is that many interventions for campus settings are not “packaged” products that one can simply purchase and implement; instead, they represent general approaches to specific AOD behaviors and problems that must be matched to local circumstances.

Commercial Products

Over the past few years, several commercial Web-based alcohol intervention products have become available to colleges and universities. Such interventions typically incorporate elements of Tier 1 interventions. They all target individual students. New products and revisions of current products will no doubt increase in coming years.

The availability of such products can be viewed as both a benefit and a challenge to the college prevention field. On the benefit side, commercial interventions can be implemented quickly, require less on-site development, and, depending on the product, can have a solid science base. On the challenge side, such interventions may not address the specific needs of a campus, can be expensive, and may be implemented unevenly. One common concern is that administrators with limited resources and understanding of AOD problems may well view such products as the “solution” to their campus’ needs at the expense of other essential interventions.

Selecting Interventions

Regardless of the commercial or noncommercial nature of an intervention, the adoption of any prevention technology must be carefully considered relative to several factors, including need, available resources, the science-base supporting the intervention, and how such an intervention fits into an overall prevention strategy. Although a comprehensive “how-to” manual is beyond the scope of this essay, the Higher Education Center has numerous resources (at no cost!) available to help with each of the processes described below.

First, campuses should systematically determine the type, frequency, and magnitude of the alcohol-related problems related to their student body, campus, and adjacent community. Although conducting a methodologically sound problem analysis or needs assessment can be challenging, it is critical to effective prevention. A clear understanding of the problems that require intervention will help in the selection of science-based interventions, guide program evaluation, and protect against misallocation of resources. Each campus is unique and no single intervention can be expected to address every alcohol problem.

Second, campuses will benefit from engaging in a strategic planning process that addresses the unique problems identified relative to (1) the available science-based approaches to address them; (2) the resources available to develop (or purchase), implement, and sustain such interventions; (3) how all the selected approaches conceptually complement or, occasionally, compete with each other; (4) how any new approach complements or replaces a current approach (during this process it is useful to assess the effectiveness and scientific basis for current efforts); and (5) the political facilitators and barriers to implementation of any new prevention approach.

Given the above, consider the following guidelines when choosing any new prevention intervention:

1. Prevention interventions should be based on local assessment data and strategically applied. How does the intervention “fit” with your campus’ specific needs and overall strategic approach? Do you have baseline data documenting the problem and local contributing factors? Do you have a logic model to help you understand the causes of the problem?
2. Prevention interventions should be science based. What is the evidence supporting the specific intervention? Is the intervention conceptually consistent with one of the NIAAA Tier 1 or 2 interventions? Has the intervention been tested in a randomized controlled prevention trial? (If a commercial product, the intervention should be conducted by someone other than the company or the company’s consultants.) Have such studies been replicated across multiple campus settings and yielded the same results? What is the effect size (the impact or size of the reduction in the problem) demonstrated in such studies? What is the cost benefit of the intervention (the price associated with a specific decline in a problem)?
3. Prevention interventions should target multiple levels of the social ecological model and be part of a comprehensive system. Is the intervention target specific or universal? Target-specific interventions focus on high-risk groups (e.g., athletes, adjudicated students, etc.) and are often secondary prevention approaches (i.e., interventions that occur in response to AOD-related problems). Universal interventions target the entire population (e.g., policies, mass media campaigns, etc.) and are typically primary prevention approaches (i.e., interventions designed to prevent AOD-related problems before they start). In general, a prevention program should correspond with efforts to address factors in the surrounding environment that are contributing to AOD-related problems (e.g., easy access to AOD, lack of enforcement of existing laws and policies, aggressive marketing of alcohol to students, etc.).
4. Prevention interventions should be adaptable. Is the intervention adaptable to your unique campus characteristics? For both commercial and noncommercial interventions, have the developers identified the key components that must be implemented to have fidelity to the original research-based intervention? For commercial interventions, will the product be modified to your specific needs and regularly updated (e.g., inserting your campus norms and policies, etc.)?

The Higher Education Center encourages you to use the above guidelines to carefully consider any intervention before committing your limited resources. Because not every intervention will meet the standards of a truly science-based strategy, and interventions may not exist to address every problem, innovation and the development of new interventions are sometimes required. In such cases, the Higher Education Center is available to help you weigh important conceptual and practical considerations. In a time of limited resources and fiscal retrenchment, adopting or adapting interventions based on sound science is crucially important. Again, no single intervention can reasonably be expected to address every AOD problem. A thoughtful, strategic, science-based, and sustained approach is the best long-term approach to prevention.

To discuss this article or other matters related to alcohol, other drug, or violence prevention in higher education with colleagues in the field, visit the HEC/Forum.