Reducing Risks for Mental Disorders Frontiers for Preventive Intervention Research (1994) / Chapter Skim
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Pages 31-52
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From page 31... ...
Lassoes ~ neon sin
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From page 33... ...
In addition, This chapter is based, in large part, on presentations at a workshop, convened by the Institute of Medicine, that focused on findings from prevention programs in physical health that might be applicable for mental health. (See Appendix C for participants and agenda of the meeting.)
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From page 34... ...
had not been established experimentally, and the amount of change, or malleability, in the risk factors that was achievable from a community campaign was certainly not known. The prevention programs-called the Stanford Three-Community Study and the Stanford Five-City Project have demonstrated notable success in risk factor reduction through preventive interventions before the onset of illness.
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In the face-to-face component of the program, individuals identified as being at especially high risk received eight lessons (totaling 15 hours) of skills training, conducted in both .
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Over a five-year period beginning in 1980, two medium-sized California cities received continual exposure to general education punctuated by four or five separate risk factor education campaigns per year (Farquhar, Fortmann, Flora, Taylor, Haskell, Williams et al., 1990~. Three similar cities served as a control group, with the combined population of all sites reaching approximately 350,000.
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Prevention of Physical Illness 1 37 demonstrated the effectiveness of the intervention in reducing risk factors and suggested that similar programs could be tried. Although knowledge of risk factors increased in both the experimental and the control cities, the improvement in the experimental group was significantly greater in all follow-up surveys.
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Public Health Service, 1964~. Since then, various organizations have conducted a large number of prevention programs, and there has been a series of public policy actions aimed at reducing smoking, such as restricting advertising, increasing public education, and requiring warning labels on tobacco products.
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And there were interventions focused on four special populations: African-Americans, Hispanics, women, and smokeless tobacco users. At the time these trials began, the attributable risk of smoking (the rate of a disease or other outcome in exposed individuals that can be attributed to the exposure)
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When the investigators convened after the trials concluded, they agreed that school-based smoking prevention programs had had consistently positive effects, although the effects were modest and limited in scope. The programs have been particularly effective in delaying the onset of tobacco use, but less successful in targeting use by high-risk and minority groups (Glynn, 1989~.
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The agency moved ahead with a variety of prevention programsoften in the face of considerable opposition from the automobile industry and other groups with vested economic interests. The efforts addressed the numerous factors that can play a role in causing injuries or contributing to their severity, and targeted a spectrum of audiences, including individuals, communities, businesses, regulatory agencies, and legislators.
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From page 42... ...
One result is called the Haddon Matrix (Haddon, 1972~. This concept holds, among other things, that with any injury, there is a triad of factors at work: human factors, factors involving the vehicle and related equipment, and factors involving the physical and social environments.
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From page 43... ...
Second, achieving a better understanding of mental disorders can help inform efforts to prevent such violent acts as homicide and suicide. Intertwined in this issue as well is the frequent association of alcohol and drugs with violent or abusive behavior.
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For years, this issue had been approached strictly as a political or philosophical matter, with the debate polarized into those who favored some form of gun control and those who were against it. Beginning in the early 1980s, the CDC set about to change the nature of the debate by studying the problem scientifically, beginning with epidemiological studies, moving to analyses of risk factors and possible causes, and then developing an array of possible interventions and looking at their effectiveness.
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conducting more detailed studies to describe the relative power of different risk factors, individually and in combination, and to describe
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Indeed, preventive intervention trials-based on sound scientific theory and carefully conducted and evaluated may themselves help to delineate mechanisms and to quantify the relative impact of various risk factors. The Stanford group's program illustrates the value of this approach to prevention.
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Over the years, researchers have delineated many of the mechanisms and relative risks involved but had the Stanford group waited for fuller understanding of how and to what degree risk factors had an effect, their prevention insights might have been delayed by a decade or more. In addition, in classic epidemiological terms, the amount of morbidity and mortality from vehicular injuries that could be affected by Haddon's proposed changes was certainly not known at the time intervention policies were adopted.
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This saturation can develop into what might be called environmental synergy, in which the sum of the messages becomes greater than their parts. · Preventive interventions should focus on the community, both in planning and in implementation.
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Prevention of Physical Illness 1 49 should occur as the program is being developed (formative evaluation) , while it is being conducted (process evaluation)
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However, the cost of not beginning to design and implement mental health intervention programs may be even greater. Given the successes in prevention of physical illness, the energies of citizens and communities can surely be harnessed to prevent mental disorders.
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(1990) Effects of communitywide education on cardiovascular disease risk factors: The Stanford Five-City Project.
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From page 52... ...
American Journal of Public Health; 77~10~: 134~1341. Prevention of Violence and Injuries Due to Violence.
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