Foundations of Prevention: Epidemiology

1. Foundations of Prevention:Epidemiology J. David Hawkins, Ph.D. Social Development Research Group School of Social Work University of Washington jdh@u.washington.edu SWL 579 September 26, 2007

2. Who are you? Where are you from? • What school or department? • What did you do before starting your current degree program? • What is your substantive interest area? • Are you currently engaged in research? • What do you expect from this course?

3. The Mental Health Intervention Spectrum for Mental Disorders Treatment Prevention Case Identification Standard Treatment for Known Disorders Maintenance Compliance with long-term treatment (goal: reduction in relapse and recurrence) Indicated Selective After-care (including rehabilitation) Universal Source: Institute of Medicine (1994). Reducing risks for mental disorders: Frontiers for preventive intervention research. Patricia J. Mrazek & Robert J. Haggerty, Eds. Washington DC: National Academy Press

4. EPIDEMIOLOGY ETIOLOGY EFFICACY EFFECTIVENESS DISSEMINATION 2. With an emphasis on risk and protective factors, review relevant information-both from fields outside prevention and from existing preventive intervention research programs 3. Design, conduct, and analyze pilot studies and confirmatory and replication trials of the preventive intervention program 4. Design, conduct, and analyze large-scale field trials of the preventive intervention program 5. Facilitate large-scale implementation and ongoing evaluation of the preventive intervention program in the community. 1. Identify problem or disorder(s) and review information to determine its extent The preventive intervention research cycle. Preventive intervention research is represented in boxes three and four. Note that although information from many different fields in health research, represented in the first and second boxes, is necessary to the cycle depicted here, it is the review of the information, rather than the original studies, that is considered to be part of the preventive intervention research cycle. Likewise, for the fifth box, it is the facilitation by the investigator of the shift from research project to community service program with ongoing evaluation, rather than the service program itself, that is part of the preventive intervention research cycle. Although only one feedback loop is represented here, the exchange of knowledge among researchers and between researchers and community practitioners occurs throughout the cycle.

5. Components of Prevention Science • Epidemiology – what is the prevalence in time and space of well being and its predictors; of problems and their predictors? • Etiology – what causes positive or negative outcomes? • Efficacy trials-can preventive interventions actually prevent problems under favorable conditions? • Effectiveness trials- can preventive interventions prevent problems under real world conditions? • Diffusion research- How can tested, effective prevention interventions be disseminated to reduce problems at scale? Mrazek and Haggerty , 1994.

6. Seattle School District Washington Assessment of Student Learning (WASL) Test Results(2003)Proportion of Students Meeting Standards READINGMATH 7th Grade 33.9% 47.9% 10th Grade 34.9%53.1% Seattle Public Schools Data Profile: District Summary, Dec. 2003 http://www.seattleschools.org/area/siso/distsummary/distsum.html

7. 2006 Monitoring the Future Prevalence Rates, 8th Grade

8. Onset of Alcohol UseCommunities That Care Trial Adjusted Hazard p < .05 OR = 0.63

9. Prevalence of Current Alcohol Use In Panel In Control and CTC Communities 21.4 p < .05 16.4 Percentage 3.3 ns 3.1 Note. Observed rates averaged across 40 imputations. ns = nonsignificant. N = 4407.

11. Past Year Antisocial Behavior

12. Prevalence of Drug Use and Antisocial Behavior Among 8th Grade Students in Tooele (2002) and Utah (2003)

13. Prevalence of Drug Use Among 8th Grade Students in Tooele (2002) and US (Monitoring The Future 2002)

14. TSP Chronic Violent Offenders

15. Seattle Social Development Project Proportion of self-reported high rate offenders Proportion of crime committed by high rate offenders Proportion of officially recorded offenses committed by high rate offenders Proportion of officially referred high rate offenders

16. Proportion of Florida Students who Smoked Cigarettes in Last 30 Days Compared with U.S. Averages

17. Alcohol Use Among Florida Students Compared with U.S. Averages Source: Monitoring the Future Study 2001

18. Marijuana Use Among Florida Students Compared with U.S. Averages Source: Monitoring the Future Study 2001

19. Percentages of surveyed Florida middle and high school students who reported being drunk or high at school in past 12 months – 2000 vs. 2001

22. “Monitoring The Future” StudyMarijuana: Trends in Perceived Availability, Perceived Risk of Regular Use, & Prevalence of Use in the Past 30 Days for 12th Graders USE RISK & Availability Use: % using once or more in past 30 days (on left-hand scale) Risk: % saying great risk of harm in regular use (on right-hand scale) Availability: % saying fairly easy or very easy to get (on right-hand scale)

23. Average Age of First Use of Drugs Among Florida Students in 2001 Age in Years

24. TSP Prevalence of Serious Violence

25. Hazard rate for initiating serious violence, by age,National Youth Survey

26. SSDP Prevalence of Drug Use from Age 10 to 27

27. TSP’s Alcohol and marijuana use initiation SSDP ages 10 – 18. Males vs females Ethnic groups

28. TSP Denver Relationship between age of onset (self report) and age of first arrest for Chronic Violent Offenders

29. Trajectories of Binge Drinking in Adolescence

30. Health Consequences of Trajectories of Binge Drinking • Youths in these different adolescent binge drinking trajectories had different health outcomes at age 24. Chronic bingers were almost 4 times as likely as non-bingers to be overweight or obese by age 24. Oesterle et al. (2004)

31. Trends in prevalence of serious violence among 12th graders, 1980-1998 Entries are 3-year running averages of the prevalence of each of the specified acts. The violence index is defined as the percent committing any of the specified following five acts, with no missing data allowed: hit an instructor or supervisor; gotten into a serious fight in school or at work; taken part in a fight where a group of your friends were against another group; hurt somebody badly enough to need bandages or a doctor (assault with injury); used a knife or gun or some other thing (like a club) to get something from a person (robbery with a weapon). 95% confidence intervals for the violence index are all less than ± 2.5%; for assault, less than ± 2%; for robbery, less than ± 1.1%.

32. Arrest ratesof youth age 10-17 for serious violent crime, by type of crime, 1980-1998

33. Differences in self-reported violent behavior by sex and race, 1983, 1993, 1998

34. Differences in arrest rates by sex and race, 1983, 1993, 1998

35. Firearm and non-firearm related homicides by youth, 1980-1997

36. Trends in youth violence since 1983

37. Society for Prevention Research 18th Annual Meeting: Denver, CO June 1 -4, 2010 (Abstracts due October 26, 2009) Information: www.preventionresearch.org

38. 2006 Monitoring the Future Prevalence Rates, 12th Grade

39. United States Adult Correctional Populations Source: Source: Bureau of Justice Statistics, http://www.ojp.usdoj.gov/bjs/glance/corr2.htm Bureau of Justice Statistics Correctional Surveys (The Annual Probation Survey, National Prisoner Statistics, Survey of Jails, and The Annual Parole Survey)

40. United States Incarceration Rate 1980-2005 Source: Bureau of Justice Statistics, http://www.ojp.usdoj.gov/bjs/glance/incrt.htm Note: Number of sentenced inmates incarcerated under State and Federal jurisdiction per 100,000.