WHICH EVIDENCE-BASED PREVENTION PROGRAMS ALSO TARGET HEALTH PROMOTION?
The Need for Integrating Prevention and Health
There are several reasons why substance abuse prevention programs which also aim to increase health enhancing behaviors are essential for advancing the overall health of our youth, families, and communities.
First, the majority of youth in America experience multiple, co-existing health risk habits, such as substance use and physical inactivity. Second, programs that integrate the prevention of alcohol, tobacco, and drug use with the promotion of health enhancing habits like physical activity, healthy eating, sleep, and stress management are likely to result in broader physical and mental health improvement. This is due to the interrelated nature of health behaviors and underlying mediating risk and protective factors.
Third, integrated programs can be more cost-effective than narrowly targeted prevention or health programs which aim to improve only one, or a small set of related behaviors or behavior problems. Lastly, prevention programs addressing healthy behaviors and their positive outcomes such as improved self-image are likely to increase program participation and satisfaction over interventions that target just risk behaviors and provide primarily negative harm or fear content.
Review of Evidence-based Prevention Programs Targeting Health
We wanted to find out which evidence-based prevention programs also place a major focus on improving the health promoting behaviors of their clients. To answer this question, we conducted a review of evidence-based substance abuse prevention programs listed on the Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-based Programs and Practices (NREPP).
To begin, we conducted a search of NREPP’s data base (http://www.nrepp.samhsa.gov/) using the search criteria “Substance Abuse Prevention.” Next, we selected keywords representing critical health promoting behaviors to narrow our search results and determine which substance abuse prevention interventions also aim to promote critical healthy habits.
Keywords included physical activity and exercise, healthy eating and nutrition, stress management and stress control, and sleep. Lastly, we reviewed program descriptions of all selected interventions to determine if targeted healthy behaviors were described as a key component of the programs.
Prevention Programs Which Also Targeted Health Promotion
A total of 110 substance abuse prevention programs are currently listed on NREPP. The largest number of prevention programs which targeted health promotion behaviors addressed stress management or stress control (n=13), followed by healthy eating or nutrition (n=9), physical activity or exercise (n= 7), and sleep (n=2).
Of these programs, only the brief intervention InShape addressed all four health promoting habits examined. Two programs targeted three of four health habits. The brief intervention SPORT addressed physical activity/exercise, healthy eating/nutrition, and sleep, while the five-intervention Healthy Workplace program targeted physical activity/exercise, healthy eating/nutrition, and stress management/control.
In addition, four prevention programs addressed physical activity/exercise and healthy eating/nutrition. These programs included the eight-session, school-based ATHNEA (Athletes Targeting Healthy Exercise & Nutrition Alternatives) program, the 13-session, school-based ATLAS (Athletes Training and Learning to Avoid Steroids) program, the 12-unit Healthy Alternatives for Little Ones (HALO) program, and the Michigan Model for Health school-based health education curriculum.
Very few evidence-based substance abuse prevention programs emphasize targeting key health promoting behaviors, including physical activity/exercise, healthy eating/nutrition, stress management/control, or sleep. Each of these health habits is essential to the physical and mental health and positive development of our nation’s young people. They are also likely to directly and indirectly influence the successful prevention and reduction of alcohol, tobacco and drug use and problems among youth and adults.
Of the seven prevention programs we identified as addressing at least two of the health enhancing behaviors examined, two were brief universal prevention interventions targeting youth and young adults (SPORT and InShape, respectively). Two multi-session programs were developed for school-aged female and male athletes (ATHNEA and ATLAS, respectively). The other three programs included a multiple intervention program for worksite settings (Healthy Workplace), a multi-unit program for children in child care (HALO), and a comprehensive K-12th grade health education curriculum (Michigan Model for Health).
Only two prevention programs were designed to increase sleep among young people (SPORT and InShape). Both SPORT and InShape are also the only two prevention programs listed on NREPP which target positive images of youth participating in healthy habits. In addition, only two interventions addressed stress management/control, along with physical activity/exercise and healthy eating/nutrition (Healthy Workplace and InShape).
It is possible that additional evidence-based prevention programs listed on NREPP address one or more health enhancing habits, but did not highlight them in their descriptions. It is also possible that other integrated prevention and health programs exist, but are not listed on NREPP. That said, it is unlikely that there are other research-based substance abuse programs which integrate and emphasize all or most of the key health enhancing habits of physical activity, healthy eating, stress management, and sleep.
The bottom line for prevention and health providers who are interested in promoting the broader health and well-being of youth and adults is to take a close look at evidence-based programs which integrate prevention with health promotion.
For providers working with adolescents, the two options are the school-based health education Michigan Model for Health curriculum, and the brief universal prevention intervention SPORT. In addition, for prevention and health providers interested in advancing the health of school-aged athletes, ATHNEA and ATLAS are the choices to explore.
For providers interested in integrated prevention and health programs for children, the only program until recently was HALO, designed for young children ages 2-6 years. A new option, however, is the SPORT program, which was recently adopted for use with elementary school-aged children.
For those wanting to advance the behavioral and physical health of young and older adults, the choices for consideration are the Healthy Workplace program for adults in worksite settings, and the universal brief prevention intervention InShape for young adults. Regardless of the program you choose, we recommend starting with an evidence-based intervention shown to have successfully integrated prevention with health promotion, such as the seven programs identified in this review.
Integrated Programs Websites
Healthy Workplace: http://www.centerforworkforcehealth.com/
Michigan Model for Health: http://www.emc.cmich.edu/mm/