VOICES: Dr. Zili Sloboda

<h5><strong>President, Applied Prevention Science International</strong></h5>
President, Applied Prevention Science International

How would you describe evidence-based substance use prevention to persons with relatively little knowledge of it? And why is it important that prevention strategies are based on science?

We often take the ‘science’ behind day-to-day life for granted. For example, we assume that the cars, trains, or planes we ride on to get somewhere will actually start, find their way following a map or, nowadays the GPS, and successfully get us to where we want to be. This expectation is supported by decades of extensive research and testing, ensuring that these forms of transportation do their job efficiently and safely. And, if they break down, some techniques and tools can fix or even enhance them. That is our basic concept in evidence-based prevention – identifying, through research, substance use prevention programs and policies that have been shown to effectively prevent the initiation of substance use among populations exposed to the intervention compared to those who have not. In addition to learning what to do in evidence-based prevention, we also learn what not to do – again, from carefully designed rigorous research.

How do you measure the success of a prevention program, and why is it important to evaluate it?

To measure the success of a prevention program, it is important to understand when and among whom substance use is initiated and the factors and mechanisms that lead up to the initiation. Epidemiological studies provide the data needed to target populations at risk and design programs to address their needs. Each program developer translates what factors and processes ‘drive’ the problem behavior and how to intervene effectively with evidence-based (EB) strategies. For example, researchers have found that the most effective content of EB classroom curricula is teaching about the harms of psychoactive substance use and correcting misperceptions of young people that “most of their peers are using substances.” Learning that substance use is not normative and gaining effective communication and social skills help support students to not use substances. Through rigorous research designs, scientists compare students’ knowledge, attitudes, beliefs, and behaviors of those exposed to the intervention with a control group (students who were not exposed). The outcomes of these prevention studies found that those exposed to the intervention had significantly lower levels of substance use compared to those who did not receive the intervention. Implementing prevention programs that have not been evaluated may either have no impact or even be harmful. This also underscores the importance of monitoring fidelity to the original content, structure, and instructional strategy when implementing an evidence-based prevention program.

Do you recall a prevention program or project that was particularly successful in supporting the well-being and development of children?

Prevention policymakers and professionals are fortunate today to access several effective prevention programs that have demonstrated impact on substance use and other risky behaviors undermining the attainment of positive life trajectories, such as academic performance, productivity, and overall health. What has been most exciting for me was seeing how there have been successful interventions for a range of audiences. Many of these interventions are effective for different problem behaviors. So something that works to prevent substance use also works for intervening with aggressive behavior or bullying. It’s inspiring to see that we’re really making progress on a whole host of areas. Here are some examples of interventions that work for different target age groups:

  • Infancy: Health Care Setting = Nurse-Family Partnership
  • Early Childhood: School Setting = Good Behavior Game; Family Setting = Positive Family Together
  • Middle Childhood and Early Adolescence: School Setting = Life Skills Training; Unplugged; Family Setting = Strengthening the Family for Parents of Youth 10-14; Multi-Systemic Therapy
  • Late Adolescence and Adulthood: Health Care/Social Service Setting = Screening, Brief Intervention, Referral to Treatment

(More information can be found in the UNODC/WHO International Standards on Drug Use Prevention)

Key elements of prevention strategies involve supporting the healthy well-being and growth of children and youth. What are some important abilities that should be particularly paid attention to throughout developmental phases?

What do we know about child development? Why is this important to prevention? When we are born, we have our own biological and physiological characteristics. These shape how we behave and interact with our environments. Through a learning process of ‘socialization,’ we gain language skills, learn about our reference culture, and develop attitudes or belief structures that guide how we behave throughout our lives. Socialization is a lifelong process, and we are socialized by a large array of socialization agents such as our families, teachers, faith-based organizations, and the community.

Socialization is enhanced when children form warm attachments and feel bonded to the socialization agent. Conversely, having poor or failed interactions can promote feelings of alienation and may drive individuals away from family, peers, school and lead them to bond with negative persons or groups, increasing susceptibility to engage in harmful behaviors. In many ways, evidence-based prevention programs integrate these socialization influences and developmental processes to strengthen growth into positive and healthy individuals and families. In addition, the programs help parents and teachers improve their parenting and teaching skills to enhance children’s prosocial attitudes, behaviors and, life trajectories.

How could ‘Listen First’ be incorporated into prevention strategies, and what factors should be considered if one were to evaluate it?

‘Listen First’ per se is not an intervention but a means of communicating essential themes derived from research to those interested in prevention. Nevertheless, ‘Listen First’ has the potential to keep busy prevention professionals up to date with new research findings that could improve their work. Furthermore, it takes the next step in educating prevention professionals and other professionals who may be in contact with parents or children who may benefit from evidence-based prevention interventions.

To determine if ‘Listen First’ is effective, it will be important to clearly state its goals and objectives. As done with evidence-based prevention interventions, a logic model should be developed that identifies the target population and its short-, intermediate-, and long-term outcomes for these groups. For example, reach would be one short-term outcome — is ‘Listen First’ reaching its intended target audience? If ‘Listen First’ intends to enhance knowledge or impact attitudes or change/improve prevention services, these could also be assessed. Collecting this information would require asking those who read ‘Listen First’ to respond to some type of survey. Assessment procedures would have to be well thought out to prevent biases, and although challenging, an evaluation of ‘Listen First’ could be done.

Lastly, as we adjust to the ‘new normal’ with COVID-19, we are unsure what the ‘new future’ will bring. What recommendations would you give to families with children and youth who are enduring these stressful times?

I am not sure what this ‘new normal’ will be. Indeed, families with children of all ages face stresses at all levels, from their ability to meet the basic needs of food, housing, and emotional support to prepare themselves and their children for returning to work and school. This will be particularly stressful for children transitioning; going to school for the first time, moving to a new school, moving up from elementary school to middle school, high school, college, or entering the workforce. Most prevention professionals who work with parents and families urge parents to address the needs of their children but also to take care of themselves. Parents need to be mindful of their own stresses and be able to build their own resilience. Being aware of their feelings will help them empathize with their children and help them verbalize their concerns about the changes that lie ahead. It is essential to make time to listen to children about their fears, provide guidance and support to prepare them for their transitions, and this could be done perhaps at the dinner table or during family time to share each day’s events.

Zili Sloboda, ScD., President, Applied Prevention Science International, was trained in medical sociology at New York University, and in mental health and epidemiology at the Johns Hopkins University Bloomberg School of Public Health. Her research over the past 50 years has centered on substance use epidemiology, health services research, and the evaluation of substance use treatment and prevention programs. Her current focus is on prevention workforce development and the relationship between training in prevention science and its application to practice and the implementation of evidence-based prevention interventions and policies.

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