Assessing state substance abuse prevention infrastructure through the lens of CSAP's Strategic Prevention Framework

Qualitative study of states' capacity to support alcohol prevention policies during the COVID-19 pandemic in the USA

INTRODUCTION

The onset of the COVID-19 pandemic accelerated rates of alcohol purchasing and related harms in the USA. The increases followed governors' emergency orders that increased alcohol availability, including the allowance of alcohol home delivery, alcohol to-go from restaurants and bars, and curbside pickup from retailers.

METHODS

Semi-structured interviews were conducted with 53 participants involved in state-level alcohol prevention policy across 48 states. Interviewees' perspectives on changes to alcohol prevention policies during the COVID-19 pandemic, including capacity to respond to alcohol-focused executive and legislative changes to alcohol availability, were explored. Initial codes were developed collectively and refined through successive readings of transcripts using a phenomenological, action-oriented research approach. Themes were identified semantically after all transcripts were coded and reviewed.

RESULTS

Four themes were developed including: (i) alcohol prevention policies and capacity during COVID-19; (ii) industry-related challenges during COVID-19; (iii) limited pre-COVID-19 alcohol prevention capacity; and (iv) needs to strengthen alcohol prevention capacity.

DISCUSSION AND CONCLUSIONS

The pandemic exacerbated states' capacity limitations for alcohol prevention efforts and created additional impediments to public health messaging about alcohol health risks related to greater alcohol availability. Participants offered a myriad of strategies to improve alcohol prevention and to reduce alcohol-related harms. Recommendations included dedicated federal and state prioritisation, more funding for community organisations, greater coordination, consistent high-quality trainings, stronger surveillance and widespread prevention messaging. States' alcohol prevention efforts require dedicated leadership, additional funding and support to strengthen population-based strategies to reduce sustained alcohol-related harms associated with increases in alcohol availability.

Changing course: supporting a shift to environmental strategies in a state prevention system

Background

This study examines how the North Carolina state prevention system responded to a policy shift from individual-level prevention strategies to environmental strategies from the perspective of the organizations implementing the policy shift.

Methods

We use two data sources. First, we conducted interviews to collect qualitative data from key informants. Second, we used prevention provider agency expenditure data from the year the shift was announced and the following year.

Results

The interviews allowed us to identify effective features of policy change implementation in complex systems, such as the need for clear communication and guidance about the policy changes. Our interview and expenditure analyses also underscore variation in the level of guidance and oversight provided by implementing agencies to prevention providers.

Conclusions

Our analyses suggest that more active monitoring and oversight may have facilitated more consistent implementation of the policy shift toward greater use of environmental prevention strategies.

A Qualitative Community Assessment of Racial/Ethnic Sexual Gender Minority Young Adults: Principles for Strategies to Motivate Action(s) for Realistic Tasks (SMART Thinking) Addressing HIV/AIDS, Viral Hepatitis, Mental Health, and Substance Abuse

HIV/STI, substance use, and mental health issues disproportionately affect racial/ethnic sexual minority young adults. These health vulnerabilities intensify across the life course, most notably when young adults are independent college students. To identify the perspectives of racial/ethnic sexual gender minorities living on or near an urban university, we implemented an intersectionality-informed SWOT (strengths, weakness, opportunities, and threats) analysis, as a qualitative community assessment situated within in a campus-community setting. The community needs assessment was the first step in the strategic prevention framework (SPF) to co-locate substance abuse, mental health, viral hepatitis, and HIV prevention care services for Latinx and Black/African American sexual gender minority young adults at a minority-serving institution. The SWOT analysis identified principles for selecting, adapting, and implementing an evidence-based intervention. The significance of these principles demonstrates the value of intersectionality in evidence-based interventions to influence health education and behavior among racial/ethnic sexual gender minorities.

A Tool for Assessing a Community's Capacity for Substance Abuse Care

Evidence-based programs for prevention and intervention in substance abuse are increasing. Community needs assessments and health rankings provide descriptions of local behavioral health needs but do not provide public health practitioners and policy makers with guidelines on the number of programs, health care practitioners, or interventions needed in the local substance abuse care system. This article presents a new framework for measuring and assessing the substance abuse care system in a community. The assessment can inform resource allocation across the continuum of care to more equitably and efficiently distribute interventions and care. We conducted 2 literature reviews and synthesized our findings to create a community assessment methodology and needs calculator, CAST (calculating for an adequate system tool). We reviewed 212 articles to produce an inventory of community and social correlates of behavioral health, components of a substance abuse care system, and numerical values for guidelines for estimating community needs. CAST produces community-specific assessments of the capacity of the components of a community substance abuse care system. CAST generates recommendations by the application of social and community determinants of health as risk coefficients to each estimate of component need. CAST can assist public health practitioners in evaluation and improvement of the capacity of community-based, substance abuse care systems. By using recommendations for component needs across the continuum of care, community leaders can use CAST to prioritize resource allocation more effectively and efficiently.

Reducing Binge Drinking in Adolescents through Implementation of the Strategic Prevention Framework

The Strategic Prevention Framework (SPF) is a conceptual model that supports coalition-driven efforts to address underage drinking and related consequences. Although the SPF has been promoted by the U.S. Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Prevention and implemented in multiple U.S. states and territories, there is limited research on the SPF's effectiveness on improving targeted outcomes and associated influencing factors. The present quasi-experimental study examines the effects of SPF implementation on binge drinking and enforcement of existing underage drinking laws as an influencing factor. The intervention group encompassed 11 school districts that were implementing the SPF with local prevention coalitions across eight Kansas communities. The comparison group consisted of 14 school districts that were matched based on demographic variables. The intervention districts collectively facilitated 137 community-level changes, including new or modified programs, policies, and practices. SPF implementation supported significant improvements in binge drinking and enforcement outcomes over time (p < .001), although there were no significant differences in improvements between the intervention and matched comparison groups (p > .05). Overall, the findings provide a basis for guiding future research and community-based prevention practice in implementing and evaluating the SPF.

Performance assessment of the Thai National Center for Pharmacovigilance

BACKGROUND

The Thai National Pharmacovigilance Center (NPVC) has operated since 1983, but its performance has never been formally assessed.

OBJECTIVE

The paper aimed to present the main findings of performance assessment of the Thai NPVC.

METHODS

A survey was conducted. Data from January 2011-December 2013 were collected. The performance was assessed through four indicator domains.

RESULTS

The NPVC has a clear mission to guide its roles and responsibilities. The center has a well-established structure, adequate budget, qualified personnel, and good IT infrastructure, but it has no in-house IT personnel.Safety surveillance function was considered excellent. The Thai adverse drug reaction database accumulate a number of quality reports. Typically, new signals of traditional or herbal medicines could be generated from the database.The risk management process was well established and carried out. The National Drug Safety Advisory Sub-Committee was composed of qualified representatives from related disciplines. Not only do these committee members make safety decisions, but they also provide key safety messages and communicate these to their member audiences.The risk communication function was evaluated to be unsatisfactory. It was not effectively distributed to individual health care professionals.

CONCLUSIONS

The overall performance of the Thai NPVC was considerably good. The findings suggested that risk communication should be improved. Moreover, organizational performance should be routinely evaluated. If possible, benchmarking with international pharmacovigilance centers should also be performed.

A Social Network Analysis of a Coalition Initiative to Prevent Underage Drinking in Los Angeles County

In 2011, the Los Angeles County Department of Public Health began a prevention services initiative to address problems dealing with alcohol and other drugs across the County. A major component of the strategy included the formation of eight coalitions. Defined by geographic borders, each coalition consisted of multiple service provider organizations, and were mandated to implement customized plans that would focus on preventing underage drinking by addressing availability and accessibility of alcohol. In this study, we collect survey data and observe coalition meetings to study the interactions within and between coalitions. We are informed by network tie strength theories to supplement our view of how organizations communicate. We apply social network analysis to learn how the multi-coalition network is functioning, and identify important unrealized connections. Our findings suggest there are many potential connections between coalitions that are not being leveraged.