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The Institute of Medicine distinguishes between programs based on who is targeted: the entire population (universal), those
at risk (selective), or persons exhibiting the early stages of use or related problem behavior (indicated). Evaluations suggest
that although universal programs can be effective in reducing and preventing substance use, selective and indicated programs
are both more effective and have greater cost-benefit ratios. This paper tests these assumptions by comparing the impact of
these program types in reducing and preventing substance use at the individual level (i.e., those exposed to intervention
services) and in the population (i.e., those exposed and not exposed to intervention services). A meta-analysis was performed
on 43 studies of 25 programs to examine program comparability across IOM categories. When examining unadjusted effect sizes
at the individual level, universal programs were modestly more successful in reducing tobacco use, but selective and indicated
programs were modestly more successful in reducing alcohol and marijuana use. When adjusted to the population level, the average
effect sizes for selective and indicated programs were reduced by approximately half. At the population level, universal programs
were more successful in reducing tobacco and marijuana use and selective and indicated programs were more successful in reducing
alcohol use. Editors’ Strategic Implications: The authors’ focus on the public health value of a prevention strategy is compelling and provides a model for analyses of
other strategies and content areas. 相似文献
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WANGENSTEEN OH 《Wisconsin medical journal》1949,48(7):591-597
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