Introduction to Community Psychology Part IV Chapter 12 Prevention and Promotion

12 . PREVENTION AND PROMOTION Valerie Anderson , and Pate Chapter Twelve Objectives By the end of this chapter , you will be able to Understand historical perspectives on prevention and promotion the different types of prevention Identify examples of risk and protective factors Describe various aspects of prevention programs and evaluation Victoria Canada Rise for Climate by is licensed under 221

222 Leonard , lack , and ( Editors ) One notable characteristic in the of Community Psychology is the focus on prevention of problems and wellness promotion , as discussed in Chapter ( Jason , 2019 ) This occurs through addressing within a community and also through working to change systems and . As highlighted in Chapter , prevention serves as an exemplary framework for Community Psychology research and also an innovative way to approach problems . The core belief is that taking action early on can prevent more serious problems from developing in the future . Case Study Head Start , an early childhood prevention program for kids aimed to reduce the negative effects of poverty . The case study highlights the way the political and social forces of the time shaped the development of Head Start . This program represents a pivotal tale in the history of prevention , serving as an example of many of the key concepts detailed throughout this chapter . Head Start , an early childhood education program for children experiencing poverty and related stressors , was established in 1965 . Head Start was created in response to President Lyndon . famous State of the Union address in 1964 where he called for an unconditional war on poverty ( Watch the speech ) Programs from this era efforts to improve social conditions and prevent the negative outcomes associated with poverty . The purpose of Head Start programming is to reduce gaps in skills , appearing at kindergarten entry , between children experiencing poverty and their counterparts . These early disparities can continue throughout schooling and into adulthood therefore , Head Start aims to provide equitable preschool services to improve children readiness for entering school . The Head Start model adopts an ecological , approach and provides comprehensive services to children while promoting the of the whole family that extends beyond academics ( watch The Head Start Advantage for a closer look ) Head Start involvement has resulted in improved language development , academics , and skills of children by the time of kindergarten entry ( Department of Health and Human Services Administration for Children and Families , 2010 ) kindergarten is fun by is licensed under BY Since its inception over 50 years ago , Head Start has expanded and evolved greatly . See the of Head Start interactive and detailed timeline . Head Start ( and Early Head Start ) programs currently serve children from birth to years of age . According to the of Head Start , there are Head Start programs across all 50 states and several US territories .

Introduction to Community Psychology 223 HISTORICAL PERSPECTIVES Photo by Possible is licensed under EY The concept of prevention comes from the of public health . This is very different from the medical model , which refers to the framework of treating social problems in the same manner that we treat illness . Community psychologists have long been critical of the medical model , given its shortcomings in locating social problems in the individual , which are often rooted in systematic inequalities . describes key distinctions between the medical model and advocacy to address female juvenile delinquency . Two key aspects of a public health approach to problems include measuring the incidence and prevalence of disease . In Community Psychology , a public health approach requires that the focus is on measuring the incidence or prevalence of a social issue . Incidence refers to the number of new cases during a period of time ( the annual rate of new cases of depression among women , the annual rate of new individuals who experience homelessness ) Prevalence is the total number of cases in a population ( the total number of women in the population with depression , the total number of people in the population who are homeless in a particular country ) Understanding the incidence and prevalence of a social problem is a critical step to developing a prevention focus .

224 Leonard , lack , and ( Editors ) The 19605 were a critical point in time for the change in focus to prevention , rather than treatment , of individual disease ( medical model ) As seen in President speech , a focus on prevention was in the spirit of the times . During this point in history , there was a concentrated focus on social inequality and civil rights , the prevention of mental health disorders , and the establishment of innovative prevention programming in the community ( Head Start ) This time was not without debates about where to focus resources and how to social problems . For example , Albee ( 1983 ) argued forcefully against the medical model for treating mental illness . That is , no mass disorder that affects large amounts of individuals ( poverty , mental illness , homelessness ) has ever been eradicated by providing treatment to each person affected by the problem . Nor is it feasible to train enough professionals ( clinical psychologists ) to end a problem ( mental illness ) that has roots in deeper social problems such as poverty and oppression . Prevention efforts require an ideology aligned with social change , education , and primary prevention ( Albee , 1983 ) The of prevention was somewhat new to many in the of psychology . The public was also not familiar with this idea as it represented a very different way of thinking about solving problems . As one example , at a psychological convention in 1981 , Bob and Leonard , two community psychologists , had a most interesting conversation with Frank , who was a senior editor at , a major book publishing company . What often occurs at these types of meetings is that publishers and authors have discussions about possible book ideas , and and approached with the idea of an edited book in a new in psychology . seemed interested , and then and said they wanted to title the book Preventive Psychology . looked puzzled and asked them why they would want to prevent psychology . reaction was actually very typical of how many people reacted to this new way of thinking about social problems . and chuckled and said they were not trying to prevent the of psychology , but rather wanted to provide examples of how prevention could be used to address many problems that psychologists were dealing with such as addictions and school . had not thought about this approach before , and after a long discussion , he understood the exciting possibilities of this and agreed to publish the book which was titled Preventive Psychology Theory . Research and Practice . Photo by is licensed under the License Photo by Max Pixel is licensed under

Introduction to Community Psychology 225 TYPES OF PREVENTION ' by Ecuador is licensed under BY ! In the wake of these debates , an abundance of programming and empirical research surfaced . This included research on preventive interventions to reduce mental illness and social problems such as crime and homelessness . The from these studies demonstrated that taking a prevention focus is effective ( see Wells 1997 on this topic ) Primary Prevention Interventions designed to prevent the onset or future incidence of a problem Secondary Prevention An early intervention that decreases the prevalence of a specific problem Tertiary Prevention Treatment designed to improve quality of life and reduce the symptoms after a disease or disorder has developed Does not reduce incidence or prevalence Figure . Types of Prevention by Valerie Anderson , and Pate .

226 Leonard , lack , and ( Editors ) There are three types of prevention primary , secondary , and tertiary ( 1964 ) The corresponding Figure above provides an overview of these types of prevention . Primary prevention includes efforts to stop the problem from beginning in the place . For example , and Wells ( 1997 ) in a , analyzed mental health treatment studies and outcomes from prevention interventions with another area of focus drug use , physical health , academic achievement . They that programs can prevent multiple problems across different areas . This research how important it is for collaboration to occur among prevention scientists across disciplines . Collaboration and work are other key focus areas of Community Psychology . Collaboration can maximize prevention and help researchers and practitioners understand the and effects of preventive interventions . The other important from this study was that positive mental health outcomes could be achieved through interventions targeting other aspects of human development and functioning . For example , successful education programming can reduce future drug use and ( programs promoting positive physical health can boost academic achievement . Secondary prevention includes interventions that detect a disease early and prevent it from getting worse . In another , and Wells ( 1998 ) evaluated outcomes of 130 secondary prevention mental health programs for children and adolescents . They found that secondary prevention produces positive effects on young people receiving treatment for mental health through reducing problem behavior , increasing youth , and improving social and emotional adjustment . This work was groundbreaking in that it highlighted how preventive interventions can be just as effective as providing individualized psychotherapy for children and adolescents and more effective than reactive approaches to preventing problem behavior such as smoking , alcohol use , and delinquency . One case study example of secondary prevention is sexual assault prevention on college campuses . The Rape , Abuse , and Incest National Network states that women have a high likelihood of experiencing sexual assault . Secondary prevention efforts to reduce sexual assault on college campuses may include , bystander intervention training , sex education regarding consent , resource education , and increasing sexual assault survivor visibility . The Centers for Disease Control and the American Psychological Association have both published recommendations to reduce sexual violence and make college campuses safer . A life transition can be stressful , such as entering school , graduating from school or getting married , and these are excellent times for implementing secondary preventive interventions . The following Case Study 12 . illustrates one such program from youth transferring into a new school when some children are at high risk for developing academic and social problems .

Introduction to Community Psychology 227 A group of community psychologists designed an intervention for transferring elementary students which included an orientation to the new school and a program buddy at the new school . Also , those transferring students who were assessed as having some early academic were provided tutoring twice a week , over the entire academic year . For some youth , the tutorial aspect of the intervention focused on working directly with the children for another group of children , the intervention focused on working with both the children and their parents . One year after the intervention ended , only children in the schools with the parental involvement condition continued to improve in their math and reading grades . The continuing increase in reading grades following the intervention suggests that students receiving both school and home tutoring the most from the comprehensive intervention . This intervention demonstrates the value of providing comprehensive prevention interventions at critical points in a child life course ( et , 1992 ) centennial school 41 by Schools is licensed under Tertiary prevention treats disease or social problems with the goal to improve quality of life and reduce symptoms of the problem after it has developed . Tertiary prevention differs from primary and secondary prevention in that it does not focus on reducing the incidence or prevalence of a disease or social problems , but rather on treating the problem once it arises . For example , as depicted in the video An Ounce of Prevention parenting programs that increase key parenting characteristics , such as parental warmth , and support parents abilities to manage disruptive behaviors during early childhood , can prevent child maltreatment and future behavioral concerns in children . The video describes the impact of such a tertiary prevention effort for a Mexican immigrant family facing several risks that may place children at greater risk for maltreatment and future behavioral distress , including underlying medical factors and poverty . These programs can be delivered to families on an individual or group basis ( Incredible , Triple Positive Parenting ) in the community . The Ounce of Prevention video further depicts four prevention and promotion programs for young children , middle school adolescents , unemployed adults , and elderly people . These programs highlight each of the different types of prevention discussed above and why these programs are advantageous for their respective populations . The video includes interviews of the participants and program developers , footage of program activities , and a discussion of program outcomes . Indeed , an ounce of prevention can reduce a host of problematic behaviors and outcomes later in life .

Leonard , lack , and ( Editors ) Promoting maintaining health Providing necessary treatment after illness Managing illness , coping Figure . The Institute oi Medicine Prevention by Valerie Anderson , and Pare The Institute of Medicine also has developed for prevention efforts . One key distinction in this is that tertiary prevention is no longer considered a type of prevention , but rather an intervention strategy . Indicated prevention refers to programming that targets people who have detectable early signs of maladjustment that foreshadow social , physical , or mental health problems . For example , the of pediatrics has increased attention to decreasing the prevalence of childhood obesity in order to prevent adult obesity . et al . 2013 ) describe an indicated prevention approach that employed an intensive treatment that included a combination of dieting , exercise , and behavioral ( parent skill training ) strategies that targeted 669 obese and overweight youth across three cities in the US . Researchers measured the change in weight that was necessary to alter the status of overweight or obese youth to . Results showed that despite some differences by age and initial weight , even a small decrease in weight was enough to move children into the status after one year . this underscores that preventive efforts during childhood may need only a small investment of resources to produce important changes . Another example of indicated prevention programs targeting substance use among youth can be found . Selective prevention involves programming that targets individuals who do not show any indication of the problem , but are at high risk for the development of the problem . For example , Head Start can be considered a type of selective prevention because many programs aim to provide comprehensive supports ( schooling , interventions ) to children experiencing risk factors that place children at risk for later academic and , such as poverty or developmental delays .

Introduction to Community Psychology 229 Universal prevention , which is similar to primary prevention , targets all of the people in a given population . universal prevention programs that target behavioral and functioning at the school or level are an example of a universal prevention approach to increasing access to services . These programs are a direct response to literature which indicated that the unmet behavioral and mental health needs of children increase the risk for term declines in mental health , academic , and social functioning ( Egger , 2005 , 2004 ) One such prevention approach to population health that has demonstrated immediate and behavioral , academic , and societal , the PAX Good Behavior Game , is described in Case Study . FAX Peace Productivity ' aPP I I . 00 . I I PAX Good Behavior Game Image by Institute The PAX Good Behavior is a set of universal prevention strategies , rooted in decades of behavioral science that are implemented by classroom teachers in schools . PAX aims to create a positive , safe , and nurturing classroom environment for learning and interactions . This nurturing environment enhances children behavioral skills , such as and with other classmates , and can improve learning outcomes in children . PAX is an example of universal prevention because it targets and all students in a classroom or school , including the students who are exhibiting signs of behavioral learning concerns as well as those who are not exhibiting these concerns . Click here to learn more about the good behavior game and watch Dennis , president and senior scientist at Institute talk about PAX . In addition to immediate changes in the classroom , such as fewer instances of discipline referrals , studies have shown that children who were in PAX classrooms during elementary school were less likely to use tobacco and other substances and more likely to experience better behavior and mental health in high school and young adulthood ( Anthony , 2002 Wilcox et , 2008 ) Learn more about some of the short and of PAX . PAX Good Behavior Game images reproduced with permission from Institute

230 Leonard , lack , and ( Editors ) Which Classrooms Do You Want Your Kids or Grandkids ?

Benefits of PAX compared to control classrooms in the same schools when the students were in their early 20 after years of to PAX In or and grade . Relative Difference ( High school graduation All boys All girls College attendance All boys Decreased Student Control PAX Relative PAX Outcomes Groups Classrooms Classrooms My special 195 education services 433 245 All boys 19 Regular smoking Aggressive boys 33 cocaine use girls EEK

Introduction to Community Psychology 231 PROMOTION Photo by is licensed under the License Related to the key concept of primary prevention is promotion . Promotion involves empowering individuals to increase control of their health and through literacy and programming . Community psychologists that the goal of preventing problems can be done through promoting . Generally , there are two approaches to promotion . The is through reducing the chances that the problem will arise . The second is through increasing skills , strengths , and of individuals and settings to reduce the risk for problems arising . analyses of promotion have shown that efforts that focus on health promotion are very compared to reactive or approaches ( Wells , 1997 ) Community psychologists argue that promotion must also take into consideration ecological approaches to improving the human condition . That is , those who are interested in preventing social problems and promoting human and must call attention to the relationship between broader social forces and rates of disease and social distress seen in communities ( Albee , 1983 ) For example , Case Study describes a advocacy program developed by community psychologists to promote among girls in the juvenile justice system .

232 Leonard , lack , and ( Editors ) Resilience , Opportunity , Safety , Education , Strength is a program in New York City that pairs a trained advocate with girls involved with or for juvenile justice system involvement . The program works to provide the girls with resources and education , personal goals , developing skills , encouraging engagement with various social ( school , family , peers ) and promotion to reduce justice system involvement . Resilience , Opportunity , Safety , Education , Strength aims to learn more about girls needs . Research shows that those girls who have participated in this program reported greater resilience and self fewer risk behaviors , including violence , crime , and substance use and decreased negative emotions such as depression , anxiety , and anger ( Allen , 2016 ) Learn more about ROSES . Risk and Protective Factors by is licensed under me License Another key concept is the role of risk and protective factors . Risk factors are variables that are related to an increased risk for developing a disease or problem . While the term comes from a public health perspective , community psychologists use risk factors to understand factors associated with increased risk for various social problems such as homelessness , juvenile delinquency , or violence . For example , Figure below depicts some of the most common risk factors , especially among children and adolescents , which prevention programs need to consider in reducing the development of social problems . Case Study provides a example of risk factors for human , a pervasive problem around the globe . In contrast to risk factors , protective factors include variables that are related to a decreased risk for developing a disease or a social problem . Protective factors can include variables such as positive relationships , academic achievement , parental support , and strong economic conditions . Photo by is licensed under the License

Introduction to Community Psychology 233 Socioeconomic life Scholastic Racial Injustice Alienation and Isolation UV Figure . Risk Anderson , and Pate 234 Leonard , lack , and ( Editors ) Human is a serious social problem in the US and around the world . Human involves the use of force , fraud , or coercion for commercial sex or involuntary labor ( Victims Protection Act of 2000 ) For sex cases , there are a number of risk factors for youth . Taking an ecological perspective , these can include factors related to an individual characteristics as well as social , behavioral , and broader community risk factors . Figure below includes a list of risk factors for human . Thus , the most effective prevention programming , such as The Prevention Project program , should target the most vulnerable population ( female youth ) engaged in social or behavioral correlates of sex ( running away ) or involved with community systems and programs such as the juvenile justice system or foster care , or social problems more generally , like poverty . The most effective types of services tend to be integrated and target multiple risk factors . Family Foster glut Issues , Away i Care Figure . Risk Emmy for Human by Valerie Anderson , and Pale Photo by is licensed under the License unite System ment Substance . Disability

Introduction to Community Psychology 235 PREVENTION RESEARCH AND PROGRAMMING Photo by is licensed under The Institute of Medicine ( 1994 ) developed a model for problem assessment , intervention , and dissemination strategies . For example , this research cycle includes assessing the prevalence of risk and protective factors of a problem area , developing prevention innovations , researching the effectiveness of those innovations , and disseminating innovations into the community . Figure below outlines each aspect of the preventive intervention research cycle .

Leonard , lack , and ( Editors ) Identify problem or disorder ( and information to determine extent . With an emphasis on risk and protective factors , review relevant , both from outside prevention and from existing preventive intervention programs . Design , conduct , and analyze pilot studies and confirmatory and replication trials of the preventive intervention programs . Design , conduct , and analyze trials of the prevention intervention program . Facilitate implementation and ongoing evaluation of the preventive intervention program in the community Figure . The Preventive Intervention Research Cycle by Valerie Anderson , and Pate There are a number of challenges to conducting prevention research and using these models since they identify what needs to be done but provide very little detail on how these things will happen . Most models , such as the Institute of Medicine framework , focus on the functions that are part of the innovation , implementation , and dissemination process , but not on the systems that support these functions . To address this gap , and colleagues ( 2008 ) proposed a framework that describes relevant systems to help bridge the gap . The Interactive Systems Framework works to connect step four ( conducting trials of the program ) and step ( implementing the program in the community ) of the Institute of Medicine model . Figure below details the critical components of the Interactive Systems Framework to bridge this gap . For example , and colleagues ( 2012 ) used the Interactive Systems Framework to understand the relationship between program capacity and implementation in settings . They examined eight sites that received the Good Behavior Game ( described in Case Study ) Aligned with the Prevention Support System element of the Interactive Systems Framework , the staff was trained and received weekly

Introduction to Community Psychology 237 support in implementing the intervention . It was found that settings that were more organized and maintained strong links to individuals or organizations scored higher in program and quality . Funders can utilize the Interactive Systems Framework to identify what kinds of support they should provide for the Prevention Synthesis and Translation System element similarly , practitioners can gather information from that same component for what they need as well as from the Prevention Support System element . Additionally , practitioners can see what they need to do to build capacity from the perspective of the Prevention Delivery System component . The Prevention synthesis and The Prevention Prevention an 31 mi system Support System De System Condenses information Provides training , I about technical . and or Id translates it into other support to wor . users in the formats Figure a . Critical Components Interactive Systems Framework by Valerie Anderson , and Pate Program evaluation is a cornerstone of Community Psychology research and action . Broadly , program evaluation involves measuring the effectiveness of interventions and policies . This can include both processes ( how were intervention activities implemented ) and outcomes ( did the intervention achieve the outcome objectives ) Community psychologists engaged in prevention and promotion research and action use logic models to guide these efforts . To read more about program evaluation , check out these resources from the Centers for Disease Control and the Community Tool . Conducting program evaluations is a key way that community psychologists can measure whether or not our prevention and promotion efforts are having the intended effect .

238 Leonard , lack , and ( Editors ) CRITIQUES OF THE PREVENTION PARADIGM by is licensed under License Even though prevention and promotion are seminal concepts in Community Psychology , they are not without drawbacks . Community psychologists have outlined two key critiques . First , prevention and promotion is limited in its focus on empowerment ( 1981 ) argued that prevention is in part because it is derived from a needs model , rather than a rights model . Further , argued prevention programs may not be enough to change social institutions , but rather just add on to what is already in place . made the case that empowerment is a better model because it prioritizes rights and offers a more transformative perspective to change social problems . Second , Miller and ( 2005 ) outlined another critique of prevention and promotion the failure to adopt prevention programming is rooted in in implementation and dissemination . Miller and ( 2005 ) described potential problems with the Institute of Medicine model of dissemination and potential ways community psychologists can directly counteract these problems in their dissemination efforts . They four distinct problems in disseminating prevention and promotion innovations . First , many communities have limited capacity ( as shown in the video link ) to implement a program causing dissemination failure . The context in which organizations licensed um , function shapes that capacity , so folks interested in disseminating programs must take into account ecological factors . Second , often times there is an incongruence of lack of compatibility consistency between the setting and the prevention program . Third , Miller and argued that there is a presumption that innovations that prove their worth in a controlled , experimental setting are better than what they might replace when implemented . They referred to this as innovation bias that wrongly characterizes communities as passively waiting to adopt a prevention program rather than themselves . Finally , they

Introduction to Community Psychology 239 argued that the Institute of Medicine prevention and promotion model proposes an overly simplistic model of . It assumes that the evidence of the success of an innovation in a controlled , experimental setting is to promote decisions about adopting the innovation in practice . We know that many other considerations are also relevant in the of community agencies . Miller and ( 2005 ) proposed two potential solutions to these pitfalls of the Institute of Medicine framework . Rather than curating innovations in the context of a university and then translating them to a different environment in the community , community psychologists should identify promising prevention and promotion interventions already functioning in communities and study those to understand their effectiveness . Finally , they proposed that researchers should focus less on programs and more on powerful ideas that can improve the quality of life . This focus on powerful ideas may actually come from the process of understanding how prevention and promotion programs work in communities by specifying the core elements of a program that could be applied in other community . Thus , we should be learning from communities and disseminating their prevention and promotion efforts that work . Despite these critiques , prevention is still an important framework in Community Psychology and has the potential to create sustainable change in communities . Looking at precipitating factors , an attempt is made to make meaningful changes in environmental or personal factors to eliminate the barriers to success and wellness . Disease and community disorder will always require reactive responses and treatment however , one goal of Community Psychology is to prevent some of it . Prevention lowers the demand for treatment and allows for increased access to resources that individuals may otherwise not have access to . As noted in this chapter , prevention also has the potential to reduce societal costs in the long run , which means resources can continue being spread for a greater amount of time . UP ra bic Production Lab 2017 by David is licensed under This chapter outlined the importance of prevention and promotion as key concepts in Community Psychology . We highlighted the historical and contemporary perspectives on prevention and promotion including different types of prevention ( primary , secondary , tertiary ) risk and

240 Leonard , lack , and ( Editors ) protective factors , and the various aspects of prevention programs and the techniques needed to evaluate such programming . As seen throughout the chapter based on the wide range of childhood obesity prevention efforts to examining risk factors for human are a vast number of social issues community psychologists can explore with an eye towards prevention and promotion . These are important to use to target change across multiple levels ( individuals , groups , settings , social systems ) in order to prevent negative outcomes and promote . Critical Thought Questions . What role do risk factors play in promotion ?

Why is that important ?

How have historical debates on prevention and promotion shaped the way we view their usefulness currently ?

How does each type of prevention impact problems experienced in society or by members of society ?

What aspects must we consider regarding prevention research and programming ?

Take the Chapter 12 View the Chapter 12 Lecture Slides REFERENCES Albee , 1983 ) Preventing psychopathology and promoting human potential . American Psychologist , 37 , 1964 ) Principles of Preventive Psychiatry . New York , NY Basic Books . Egger , A . 2005 ) research update review the epidemiology of child and adolescent psychiatric disorders I . Methods and public health burden . of the American Academy Adolescent Psychiatry , 44 ( 10 ) I . Wells , 1997 ) Primary prevention mental health programs for children and adolescents a review . American of Community Psychology , 25 , I . A . Wells , 1998 ) Evaluation of indicated preventative intervention ( secondary prevention ) mental health programs for children and adolescents . American of Community Psychology , 26 , A . Epstein , 2013 ) Indicated prevention of adult obesity How much weight change is necessary for normalization of weight status in children ?

AMA Pediatrics , 167 ( Childs , Caldwell , Craig , Smith , 2012 ) Using the Interactive Systems Framework in understanding the relation between program capacity and implementation in afterschool settings . American of Community Psychology , 50 , 2019 ) Introduction to the of

Introduction to Community Psychology 241 Community Psychology . In , 81 ( Introduction to Community Psychology Becoming an agent of change . Retrieved from chapter , Turner , 81 Lardon , 1992 ) Helping Transfer Students . San Francisco , CA . 81 Allen , 2016 ) An ecological model for intervention for juvenile girls Development and preliminary prospective evaluation . Feminist Criminology , 11 ( Miller , 81 , 2005 ) Learning from communities Overcoming in dissemination of prevention and promotion efforts . American Journal of Community Psychology , 35 ( 81 The Institute of Medicine , Committee on Prevention of Mental Disorders , Division of Sciences and Mental Disorders . 1994 ) Reducing risks for mental disorders Frontiers for preventive intervention research . Washington , National Academy Press . 2004 ) Meeting the challenges of the future Integrating public health and public education for mental health promotion . Journal of Educational and Psychological Consultation , 15 ( I . 1981 ) In praise of paradox A social policy of empowerment over prevention . American Journal Psychology , 81 Anthony , 2002 ) A randomized controlled trial of two primary school intervention strategies to prevent early onset tobacco smoking . Drug and Alcohol Dependence , 66 ( Department of Health and Human Services Administration for Children and Families . 2010 ) Directory of program services . Washington , of Public Affairs . Retrieved from images Victims Protection Act of 2000 . 22 7101 . Duffy , Stillman , Saul , 2008 ) Bridging the gap between prevention research and practice The interactive systems framework for dissemination and implementation . American Journal of Community Psychology , 41 , Wilcox , Brown , Wang , 81 Anthony , 2008 ) The impact of two universal randomized classroom interventions on young adult suicide ideation and attempts . Drug and Alcohol Dependence , 95 ,

242 Leonard , lack , and ( Editors ) Photo by is licensed the License