The Prevention Framework and Evaluating Program Effectiveness

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The Prevention Framework and Evaluating Program
Effectiveness
Dr. Hugo A. Míguez www.geocities.com/hugomiguez
Program of Psychiatric Epidemiology National
Council of Scientifical and Technical Research
(Conicet). Argentina
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Objective To unite drug research with program
delivery to improve the effectiveness of the
prevention intervention
The Argentinean project which seeks to fulfill
this objective is called CENTERS FOR LOCAL
RESEARCH (CEL)
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Centers for Local Research Cel- Prevention-Resea
rch units organized by programmatic
areas www.geocities.com/cel50 www.sada.gba.gov.
ar/listado.htm
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• The Centers are set up in
• Community programs run by churches,
• NGOs, or municipal government.
• Schools.
• Health Centers
• Statewide/Provincial addiction programs

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The Centers for Local Research CEL carry out
studies to inform all three levels of prevention
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High-risk population Regular or frequent use or
dependency
Indicated Prevention
Medium-risk population Experimental or
sporadic substance use
Selective Prevention
Evaluation for Universal Prevention (prevention
and health promotion)
General population Do not use/abuse
Universal Prevention
Availability
Social Tolerance
VULNERABILITY
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Universal Prevention
PROJECT Prevention- following up on the results
of Legislation to regulate the availability of
alcohol
Example Regulation No. 13.178 of 2004 in the
province of Buenos Aires, related to the trade
and salesof alcoholic beverages
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Universal Prevention
Instruments and Qualitative Results
Instrument Standard SADA forms

• 2004 Achieved 25 reduction in the number of
  locations selling alcoholic beverages

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Universal Prevention
Instruments and Qualitative Results
Instruments CEL workshops about attitudes among
children ages 11-12 years
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Universal Prevention
Results CEL workshops about attitudes (11-12
year-olds)
Example 1 from childhood to adolescence
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Universal Prevention
Example 2 position of pleasant /disagreable
regarding drinking and alcohol abuse (in
preparation)
(0)
(-1)
(1)
(2)
(-2)
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Universal Prevention
PROJECT Health Promotion - follow-up to
determine the effect health promotion programs
have on family ties
Example community prevention programs in
critical areas of the Buenos Aires province
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Universal Prevention
Instruments and Results surveys
Do you feel that your family supports you when
you are having problems?
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Universal Prevention
Do you feel that your family supports you when
you are having problems?
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High-risk population Regular or frequent use or
dependency
Indicated Prevention
Evaluation in Selective Prevention
Moderate-risk population Sporadic or
experimental use
Selective Prevention
Does not use General Population
Universal Prevention
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Selective Prevention
Project Campaign to reduce use among youth ages
16-17 in the weekend recreational setting
Example evaluation of socio-cultural norms
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Selective Prevention
Instruments and Qualitative Results
Instruments Surveys administered by the CEL about
ideal norms of use in youth ages 16-17
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PBA 2005
Selective Prevention
Imagine that in a get-together with friends it
is your turn to buy stuff to make the spiked
punch drink. How much white wine would you
estimate people would drink at the party?
Amount per person

A one-liter bottle or more
A one-liter bottle for every two people
A one-liter bottle for every three people
A one-liter per four people
One-liter per five
I dont know
Estimated alcohol content

100 cc or more





PBA 2005
40.4
19.5
7.7
3.2
1,5.
27.8
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PBA 2005
Selective Prevention
Imagine that instead of punch, your friends
decide to throw the party using vodka drinks
instead, and they ask your opinion as to how much
to buy. How much would you calculate you would
need for people to drink at the party?
Amount of vodka per person
A half bottle or more, for two people


A half a bottle for three people
A half bottle for four people
A half bottle for five people
A half bottle for six people
I dont know
Total
PBA 2005
54.8
9.7
6.5
1.6
2.5
24.9
100.0
Estimated Alcohol Content
100 cc or more








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PBA 2005
Selective Prevention
Your friends just cant decide and now they
change to make beer the drink for the party. In
liter bottles, how much do you think they should
buy for the party?
Beer per person (liter bottles)

2 bottles or more

1 bottle
Half bottle per person
Less than half a bottle per person
I dont know
Total
Estimated alcohol content

100 ccor more






PBA 2005
68.9
12.7
4.0
1.7
12.8
100.0
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Ideal norms of drinking (straight alcohol
content in cubic centimeters) From the
Observatory of the Province of Buenos Aires base
1427
Selective Prevention
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Selective Prevention
What should a kid who doesnt use drugs do if he
is hanging out with his friends and they invite
him to smoke marijuana with them?
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Selective Prevention
Instruments and Qualitative Results
Instruments CEL workshops on substance use/abuse
situations for kids ages 16-17 years
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Selective Prevention
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Selective Prevention
Control Group
Experimental Group
16. Male, age 17Middle-classParty. Chics,
alcohol and some drugs. Someone is vomiting.
11. Female, age 18Middle-classCouples sitting
in a plaza, drinking beer and smoking.
1. Female, age 17Lower-middle class Penguins
resting
6. Female, age 19Middle-classReflections on
isolation.
17. Female, age 17Middle-classIt is a group of
punks. Theyve come to break glass and bother
people. They throw bottles at the shop windows
and the old ladies.
12. Male, age 20Middle-classIt is a film of
dolphins playing.
2. Male, age 18Middle-class Friends from high
school camping.
7. Female, age 17Middle-classFive friends
walking by an art gallery.
13. Male, age 19Middle-upper classThey are
pilgrims on a difficult journey.
18. Male, age 18Lower-middle classTheyre
leaving a rock concert. They were taking drugs
and now they are cracking open some beers.
3. Male, age 16Middle-classIt is a family in
the Sahara.
8. Male, age 18Middle-upper classA group of
workers walking in the morning.
14. Male, age 18Middle-classStudents at a
party drinking beer..
4. Male, age 19Middle-upper classThey are
sculptures.
9. Female, age 17Middle-upper classPeople
leaving the movie theater.
19. Male, age 20Middle-classThere was a fight.
Bottles on the floor left by the guys that
fought.
15. Female, age 17Middle-upper classThe
destruction of the world. It is the future of the
day after. The thrown bottles are laying
around, like the people.
5. Female, age 17Middle-classA group of
friends comforting each other
10. Female, age 18Middle-classYoung people
waiting for a recital to begin.
20. Female, age 19Middle-classIt is a couple,
disgusted with each other, and he is getting
drunk.
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High-risk Regular, frequent or dependent users
Indicated Prevention
Evaluation in Indicated Prevention
Moderate-risk population Sporadic or experimental
users
Selective Prevention
General PopulationDoes not use
Universal Prevention
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Indicated Prevention
Project Campaign to reduce the custom of
sharing needles
Example Evaluation of socio-cultural norms
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Indicated Prevention
DRUGS DRUGS
Yes No
HIV Yes VD VD-
HIV No V-D V-D-
VD
V-D
-Needle exchange- Ds. Pair unoffensive-dangerous

VD-
V-D-
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Indicated Prevention
DRUGS DRUGS
Yes No
HIV Yes VD VD-
HIV No V-D V-D-
VD
V-D
-Needle sharing- Ds. Pair Cool - Uncool
VD-
V-D-
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Indicated Prevention
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SynthesisPrevention and Evaluation
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EvaluatingEffectiveness in the
fieldsofbeliefsand attitudes
Local Focus