Prevention actions and activities make a difference: a structural equation model of coalition building

Abstract

An important goal of the Cross-Site Evaluation of the Community Coalitions Program was to advocate coalition building that would increase prevention activities and reduce substance abuse within the community. This study examined the factors that affected the coalition-building process and the community-based outcomes. The model for building coalitions consisted of various components such as coalition structure, characteristics, capacity, and prevention activities. The hypothesized model for building coalitions assumed that prevention activities and community actions influenced substance abuse behavioral outcomes and related health outcomes directly and indirectly through their influence on immediate and intermediate outcomes. The model was tested using data collected over three years (1996–1998) from coalitions that participated in the Community Coalitions Program. The results of this study provide evidence to support the hypothesized model for building coalitions. Specifically, coalitions that focused on prevention activities and community actions experienced community-based reductions in substance abuse behaviors and related health problems.

Introduction

Substance abuse has become one of the most troubling issues facing the U.S. The gravity of this issue is clearly shown in the findings from a recent poll conducted by the Harvard School of Public Health and The Robert Wood Johnson Foundation (RWJ) which indicated that adults rank drug abuse as the number one problem confronting American children today.

Substance abuse represents a major threat to the health and safety of all Americans and exerts high costs to society. The annual economic costs of the abuse and misuse of illicit drugs, alcohol, and tobacco were estimated to be US$257 billion (Edmunds et al., 1997). The cost of medical services for drug users is estimated to be US$3.2 billion annually (Edmunds et al., 1997). It has been estimated that the annual cost of health care could be reduced by US$90.4 million if alcohol and other drug problems were prevented before they started (U.S. Department of Health and Human Services, 1992).

Beyond the economic costs, the effects of substance abuse among American youths is of particular concern. The use of alcohol and drugs among youths continues to increase steadily. In 1997, over 36% of high school seniors had used marijuana in the past month, more than double the percentage reporting past-month use of marijuana in 1992. Not only are drugs used more often but alcohol consumption among youths has also increased. Approximately 44% of all college students are binge drinkers, consuming five or more drinks at a time (Wechsler et al., 1994). As many as 360,000 undergraduates will ultimately die from alcohol-related causes (Eigen, 1991).

In the face of the persistent increase in substance abuse and its associated social costs it has become increasingly important to develop effective preventive strategies. Current theory suggests that “successful prevention can only occur with the proper community systems, involving: widespread norms in support of eradicating substance abuse, not only among individuals but also in schools, families, and workplaces; efforts joining the resources of residents and service agencies; coordinated responses to substance abuse problems; and broad community participation, ranging from grassroots groups to coverage by the media” (Yin & Kaftarian, 1997, p. 294). This paper presents an outcome evaluation of community-based prevention programs that engage communities in prevention efforts and reduce substance abuse.