Return on Investment in NREPP Youth Substance Abuse Prevention Programs

1. Return on Investment in NREPP Youth Substance Abuse Prevention Programs Ted R Miller, PhD, PIRE

2. COST EFFECTIVENESS

3. Walk thru BCA of a typical program • BCAs for NREPP programs • BCAs for DWI & Crime Prevention Programs

4. Cost-Benefit Analysis of School-based SA Prevention Programs • Looked at a typical school-based program • % of youth 12-14 who delay start-up due to the program • Prevention delays start of substance use by 2 years on average • # youth delaying use • % reduction in substance use

5. Total cost savings = Cost of use x % reduced • Divide the cost saving benefits by program cost • State & local government savings

6. 2 Lit Reviews: Mean of Technically Sound Non-Zero Effectiveness Estimates

7. Assume Effectiveness Drops 25% in Replication

8. Suppose We Had Universal Prevention Programming in 2002

10. Equally Large Reductions Would Occur in 2003

11. What Costs Result from Using? • Illness/Poisoning • Violent Crime • Property Crime • Public Order/Supply Crimes * • Impaired Driving • Other Injury * * Not costed for tobacco

12. What Costs Result from Using? MONETARY COSTS • Medical • Work Loss • Other Resources (Property Damage/Police) • Quality of Life – Controversial to Put a $ Value On

13. Total Savings from Universal School-based SA Prevention in 2002, Ages 12-14 (B=Billions of $)

14. Program Cost/Pupil • $220 average across 11 programs • Includes training of teachers • Teacher salaries, fringe, & overhead • Program materials

15. Return on Investment (ROI)

16. State & Local Government Savings = $1.3 Billion

17. Effectiveness vs Cost-Effectiveness • % reduction in DWI deaths measures effectiveness • BCR also considers cost • The most effective interventions sometimes have lower returns on investment (measured by BCRs)

18. BCRs for School-Based Pgms (D=drugs M=marijuana T=tobacco V=violence)

19. Lower Return on Investment • Project TND (Toward No Drugs) 0%, D • STARS for families 8% binge • Original DARE (not on NREPP) did not work

20. BCRs for Youth Development Programs (with costs & benefits computed comparably)

21. CASAstart costs more than it saves • Across Ages – razor-thin savings • Project PATHE (not on NREPP) does not work

22. Lack Costs for Indicated Programs • Use community referrals extensively • How much use of those services results • What does it cost

23. BCRs for Other Environmental Interventions (costs & benefits computed comparably)

24. 21 Minimum Drinking Age • Reduces youth DWI deaths • Reduces youth suicides • Raises age of initiation which lowers the risk of alcoholism in adulthood • Reduces % of youth who drink • Reduces % of youth who binge • Reduces sales & profits

25. Other Interventions ? • Community mobilization & capacity building: advocacy to change laws, enforcement & norms • Adults work with youth to improve outcomes • Peer-to-peer • Media: social norms • Billboard campaign • Web education/social networking

26. Underage Drinking Prevention • Aggressively enforce underage sales laws • Improve age-checking technology • Reduce outlet density • Social host policies that hold adults liable when kids drink at home parties

27. College Drinking Prevention • Restrict pitchers & schooners • Discourage happy hours • Ban all-you-can-drink hours

29. How do we sell prevention?

30. Do not create the wrong story: 3 Soundbites, 2 dozen variants, work your way back – or the 10 seconds they use may not be on your story • A press conference is not live; if you mis-speak, say it over • Beware silence • Rule of 3s • Rhyme, alliteration • Passion • Paint pictures • T-shirts

31. Plan how/when to release • People do not understand big numbers • You cannot spend some savings • Select costs to suit the audience • White on blue slides; large type size • Minimize words on slides • Do not read every # • Put a face with the $

32. Free PIRE Technical Assistance Monique Sheppard & Ted Miller Children's Safety Network Economics & Data Resource Center Enforcement of Underage Drinking Laws TA & Training Center CSAP State Epidemiological Workgroup TA 301-755-2728 sheppard@pire.org

33. Prevention Approaches Can Impact Broadly or Narrowly • Thinning Alcohol Outlet Density or Raising Alcohol Taxes changes alcohol consumption & thus reduces all alcohol-related problems • Creating Defensible Space (thru lighting, gating, etc.) only reduces violence • Evaluations often do not assess some impacts, notably for midnight driving curfew, 0-tolerance, .08

34. Some violence prevention measures will impact multiple problems. Others will not.

36. Impaired Driving Measures • No one intervention will reduce impaired driving deaths by more than 17% • We need to select a package of complementary measures

37. What Happens If We Implement Multiple Measures • Implementing one broad measure can have a large effect on the BCR for another because each reduces a % of the remaining problem

38. When combine targeted & broad measures • Large impact on a narrowly targeted segment of the problem • Minimal effectiveness reduction in the BCR for the broad-based intervention

39. DWI Deaths

43. Rules for a Sensible DWI Package • Broader measures like regional trauma systems, 20% ETOH tax, occupant restraint, & graduated licensing lose little effectiveness as targeted DWI measures are implemented • Measures tightly targeting subgroups only modestly reduce the pool of injuries/effectiveness of all-driver DWI measures

44. Multi-Problem Behaviour Is the Norm • Some Interventions Should Affect Multiple Problems • Spillover Benefits Of • DWI on Other Harm • Non-DWI on DWI • Non-ETOH Measures on ETOH

45. Which General DWI Measures Impact Consumption or Harm? • .08 maximum driver BAC • Server training • Enforcing Laws vs Serving Intoxicated Patrons (SIP Laws) • Intensive Breath Testing • Could force drinking to the home, adding domestic violence, etc.

46. Which "Youth" DWI Measures Impact Consumption or Harm? • 21 Minimum Legal Drinking Age • 0 ETOH Tolerance f/Drivers < 21 • ETOH Tax Increase • Enforcing Underage Sales Laws • Graduated Licensing w/Curfew

47. Which Hardcore DWI Measures Impact Consumption or Harm? • Jail • Mandatory offender treatment • House arrest (positive or negative effect: domestic violence ??)

48. BCRs for Youth Smoking Prevention

49. Conclusions • Some NREPP programs are better than others • Some NREPP programs should only be used in special circumstances • Often one must trade off the largest impact vs the largest return per $ spent