Frequently Asked Questions

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How is the Strategic Prevention Framework Different from Other Approaches?

 The five steps of the framework are very similar to other approaches for prevention planning.  Efforts such as CSAP’s “Achieving Outcomes,” “Getting to Outcomes,” and to a large degree, “Guidelines and Benchmarks for Prevention Programming” endorse this program planning approach.  However, an important difference is the high degree of emphasis that the SPF places on targeting population-level change through outcomes-based prevention, focusing on both consequences and consumption. 


What is Population-Level Change?

Population-level change focuses on change for entire populations.  By entire populations, we mean collections of individuals who have one or more personal or environmental characteristics in common.  The SPF process works towards influencing whole communities, not just 1, 50, or 200 individuals who participate in a prevention program. This framework is a public health approach to the prevention and reduction of substance-related problems.


What is Outcomes-based Prevention?

Outcomes-based prevention is an approach to prevention planning that begins with a solid understanding of a substance abuse problem, progresses to the identification and analysis of factors and conditions that contribute to the problem, and then matches intervention approaches to these factors and conditions. Hopefully, this will lead to positive changes in the identified problem. Outcomes-based prevention focuses on reducing the negative consequences of substance abuse by using data to identify consequences, consumption patterns, and causal factors associated with substance abuse.  It is based on the explicit assumption that communities must know what their problems are, which factors cause those problems in their communities, and which strategies are effective in reducing those causal factors and conditions.  It is a logical approach, grounded in data collectionand clear linkages between consequences, consumption, causal (contributing) factors and conditions, and strategies. These terms will be continually reinforced throughout this guidance document.


What are Consequences?

Consequences are defined as the social, economic and health problems associated with the use of alcohol, tobacco, and illicit drugs.  Some examples are: alcohol-related car crashes and deaths, cirrhosis of the liver, fetal alcohol syndrome, tobacco-related cancers and respiratory diseases, and drug overdose.


What is Consumption?

Consumption includes overall consumption, acute or heavy consumption, consumption in risky situations (e.g., drinking and driving) and consumption by high-risk groups (e.g., youth, young adults, and pregnant women).  The way in which people drink, smoke and use drugs is linked to particular substance-related consequences.


What are Intervening Variables?

Intervening Variables (IVs, also known as risk and protective factors are the factors that cause or contribute to substance-related consequences and consumption in communities. It answers the question -Why? (See the box below for examples.)   When creating a SPF strategic plan, we need evidence not only for the consequences/consumption patterns, but also for the intervening variables we believe are the causes of the substance abuse.  It is through positively influencing intervening variables that we achieve population-level changes in substance consumption and consequences.

 Examples of Intervening Variables

  • Availability of substances (retail and social)
  • Promotion of substances
  • Social norms regarding substance use
  • Enforcement of alcohol, tobacco, and drug laws and policies

Source: examples from "A General Causal Model to Guide Alcohol, Tobacco and Illicit Drug Prevention: Assessing the Research Evidence."  Multi-State Technical Assistance Workshop. Washington, DC. March 16, 2006.


What are Causal or Contributing Factors?

Causal or Contributing Factors refer to the community, school, family, and individual/peer characteristics that are thought to increase the likelihood of inappropriate or excessive substance use, leading to undesirable socialand health consequences.When creating a SPF logic model and strategic plan, (sub-recipients), communities need evidence not only for the consequences/consumption patterns, but also for the intervening variables and Contributing Factors (CF’s) (local conditions that answer the question Why here?), communities believe are the causes of the substance abuse.

Some examples of contributing factors for the intervening variable of social norms regarding substance use include the attitude and belief that alcohol use and binge drinking is what kids do, and it is not a party without alcohol.

Once intervening variables and contributing factors are identified, the next step is to select appropriate strategies to address the issues in your communities.

The basic outcomes-based prevention model is as follows:

Consequences & Consumption ↔Intervening Variable↔Contributing Factors↔Strategies

←Planning, Monitoring, Evaluation, & Re-Planning→

It is through positively influencing intervening variables and contributing factors that we achieve population-level changes in substance consumption and consequences.


Why Environmental Approaches to Substance Abuse Prevention?

Fisher (1999) identifies four significant advantages associated with environmental approaches to substance use prevention:

  • Broad Reach

Environmental interventions create changes in conditions for entire populations of individuals rather than changes in individuals, one person at a time.

  • Substantial Effects

Because environmental strategies affect entire populations of individuals, they also result in more substantial effects due to larger reductions in risk.

  • Immediate and Enduring Effects

Once an environmental strategy is implemented, such as enforcing the law, the protective effects can be immediate. Results can also be self-sustaining, with minimal additional effort. Finally, changes in and other social conditions can also result in changes in attitudes so that substance use is viewed less favorably or is not tolerated as it may have been before.

  • Cost-Effectiveness and Ease of Maintenance

Although there are costs associated with implementing environmental strategies, these costs are generally lower than for many traditional prevention interventions, such as school-based education. Further, in many cases, once an environmental strategy is implemented, such as a new law or ordinance, no costs are associated with maintaining the strategy. (