As we have seen in our earlier Nuggets(1) building a system of evidence-based prevention programs in a community to meet the needs of those who are vulnerable and that is socially equitable, is challenging. This is the first of a three-part series developed to address the question: Is Your Community Ready to Support Comprehensive Prevention Programming?
Our experiences with COVID have underscored the importance of having a ‘culture of prevention’ in place that supports efforts to intervene prior to a negative event occurring. How is ‘culture of prevention’ defined? In their article, Sloboda and David (2021) found this definition from The Association of Southeast Asian Nations (2017) in its Declaration on Culture of Prevention for a Peaceful, Inclusive, Resilient, Healthy, and Harmonious Society:
Understanding the root causes and consequences of violent extremism and other forms of violence and deviant behaviors at individual, organizational, and institutional levels through risk assessment, research, forecast, early warning, and other evidence-based methods
Adopting a mindset change from a reactive to a preventive approach
Inculcating share values such as peace, harmony, intercultural understanding, the rule of law, good governance, respect, trust, tolerance, inclusiveness, moderation, social responsibility, and diversity
Developing effective upstream preventive policies and initiatives such as transformative social protection, public information, responsible use of media, as well as strengthening the existing values-based education in schools and institutions.
Building on this definition and on the theories that are the foundation of evidence-based prevention interventions and policies, Sloboda and David developed the graphic below representing the components of a culture of prevention. It is suggested, therefore, that the culture of prevention includes the behavioral beliefs and attitudes that are held about the health behavior, the perceived normative beliefs and subjective norms regarding the health behavior, and not only having the competencies and skills to perform the health behavior but also the confidence that they can be performed.
So, not only do the people working in prevention need to be motivated, trained, and supported in their prevention efforts, but the community and population also has to recognize the seriousness of the risks, understand what needs to be done, and be ready to accept such programming as part of the culture of prevention.
A major impediment to the embrace of a culture of prevention has been the lack of science to provide the strong normative support to engage in prevention strategies, for having the appropriate skills to perform prevention activities, and, most challenging
of all, beliefs in the efficacy of prevention strategies.
In the behavioral field of prevention, one of the great successes has been the reduction in smoking in many countries here and around the world. There are important principles that arise from the tobacco experience that can help guide our thinking and planning in this area. First were the many research studies that found an association between smoking and health problems, including the groundbreaking studies that demonstrated the involuntary effects of smoking on nonsmokers—“second-hand smoke.” These were replicated across cultures and geographic boundaries (Doll and Hill 1950; 1986 Surgeon General’s Report on the Health Consequences of Involuntary Smoking; Wynder and Graham 1950). Second was the importance of having national acknowledgment of the association of smoking on health and having a significant health leader, the U.S. Surgeon General, giving this issue a lot of official attention (National Academy of Science 2007). Third, effective interventions needed to be available and ready for implementation (Holder et al. 2000; Jacobson and Wasserman 1997).
Multiple interventions were put into place, not only policies and communications, but also other types of behavioral interventions such as smoking cessation programs and school based curricula (Hopkins et al. 2001). Furthermore, efforts were made to combine prevention AND treatment in an array of services. Finally, these interventions had to be sustained over time, and their impact monitored by several agencies, including the Surgeon General’s Office, the Center for Disease Control and Prevention, and the Food and Drug Administration.
As an example outside of the U.S., in February, 2007, France implemented a smoking ban in two phases, at first for workplaces, shopping centers, airports, train stations, hospitals, and schools and, later, in meeting places (bars, restaurants, hotels, casinos, nightclubs). The impact of smoking laws and policies combined with enforcement succeeded in changing the behaviors first and then a longitudinal study by Fong et al. (2013) showed that by 2012 (5 years later), smoking decreased significantly in these public places while also building high levels of support for the bans by the public. These studies underscore the great challenge to ensure that a culture of prevention permeates everyday community life which helps to transfer healthful attitudes and behaviors from generation to generation. Thus, new science-based information contributes to establishing a culture of prevention which supports the work of the prevention workforce and its impact on the public.
1. October 5, 2020 - https://www.apsintl.org/post/etiology October 19, 2020 - https://www.apsintl.org/post/environments December 3, 2020 - https://www.apsintl.org/post/eb-programming January 21, 2021 - https://www.apsintl.org/post/ebi-registries February 4, 2021 - https://www.apsintl.org/post/fidelity-replication-prevention-ebi
February 15, 2021- https://www.apsintl.org/post/social-justice-and-ebi March 16, 2022 - https://www.apsintl.org/post/building-prevention-systems March 30, 2022 - https://www.apsintl.org/post/preventionsystems-services April 22, 2022 - https://www.apsintl.org/post/prevsystemsprofessionals May 6, 2022 - https://www.apsintl.org/post/the-system
References
Association of Southeast Asian Nations. (2017). https://asean.org/wpcontent/uploads/2017/11/9.-ADOPTION_12-NOV-ASCCEndorsed-Culture-of-Prevention-Declaration_CLEAN.pdf.
Doll, R., & Hill, B. (1950). Smoking and carcinoma of the lung; preliminary report. British Medical Journal, 2, 739–748.
Fong, G. T., Craig, L. V., Guignard, R., Nagelhout, G. E., Tait, M. K., Driezen, P., Kennedy, R. D., Boudreau, C., Wilquin, J.-L., Deutsch, A., & Beck, F. (2013). Evaluation of the smoking ban in public places in France one year and five years after its implementation: Findings from the ITC France survey. Bulletin Epidemiologique Hebdomadaire (Paris, France), 20, 217–223.
Holder, H. D., Gruenewald, P. J., Ponicki, W. R., Treno, A. J., Grube, J. W., Saltz, R. F., Voas, R. B., Reynolds, R., Davis, J., Sanchez, L., Gaumont, G., & Roeper, P. (2000). Effect of community-based interventions on high-risk drinking and alcohol-related injuries. Journal of the American Medical Association, 284, 2341–2347.
Hopkins, D. P., Briss, P. A., Ricard, C. J., Husten, C. G., Carande-Kulis, V. G., Fielding, J. E., Alao, M. O., McKenna, J. W., Sharp, D. J., Harris, J. R., Woollery, T. A., Harris, K. W., & The Task Force on Community Preventive Services. (2001). Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. American Journal of Preventive Medicine, 20, 16–66.
Jacobson, P., & Wasserman, J. (1997). Tobacco control laws: Implementation and enforcement. Santa Monica: RAND Corporation http://www.rand.org/pubs/monograph_reports/
MR841.
National Academy of Science. (2007). Ending the Tobacco Problem: A
Blueprint for the Nation. http://www.nap.edu/catalog/11795.html.