The second conference of the European Society for Prevention Research took place in Lisbon, Portugal on 8-9 December 2011, bringing together over 100 academics and a handful of policy makers and NGOs from 22 countries. Like its namesake in the US, the society seeks to advance the science base of activities aimed at improving human health and well-being.

David Hawkins, a leading light in the US prevention science community, presented the latest findings from a large trial of Communities that Care (CtC), showing that the system has had long-term effects on children's behavior. There were also presentations on its application in Croatia and the Netherlands. Indeed, the influence of North America was apparent throughout the conference, with several contributions reporting on European evaluations of well-regarded US programs like SFP10-14.

Of course, such activity is not always viewed positively. How can a program developed in the suburbs of New York be suitable for a rural community in Italy? At the conference, such doubts were turned into opportunities. One true test of a program is how well it fares in different contexts and when evaluated independent of the original developer. So, rather than being ‘recipients’ of American innovations, Europeans are ideal partners for US colleagues seeking to further test the potential of programs.

European innovations also went under the microscope at the conference. For example, Unplugged, a universal school-based life skills program with a particular focus on drug and alcohol misuse, has been evaluated in a cluster randomized controlled trial involving eight countries, with positive results. Hana Vonkova, from Charles University Prague, demonstrated its impact in the Czech Republic.

Other large cross-national studies, such as the one described by Majone Steketee from the Verwey-Jonker Institut, Netherlands, which focuses on the relationship between substance misuse and delinquent behavior, offered a reminder of the value of analyzing similar data gathered across multiple contexts. They can highlight policies that might work well from one setting to another, such as taxation on alcohol to reduce problematic drinking, and those that require a nuanced approach for each country, such as measures to tackle binge drinking.

Despite a strong emphasis at the conference on empirical studies of prevention efforts regarding tobacco, alcohol and drugs, reflecting the society’s origins in public health, there were also presentations on the bigger picture.

David Foxcroft, of Oxford Brookes University, UK, and President Elect of the Society, offered a new way of classifying prevention activity. He distinguished between the forms of prevention – that is, whether interventions are universal, selective or targeted – and its environmental, developmental and cognitive functions. Taxing alcohol is a good example of a universal environmental approach. Motivational interviewing to help someone stop smoking is a cognitive targeted approach.

Foxcroft argued that categorizing interventions accordingly in a two-dimension matrix shows where there is an abundance of proven approaches, for example parenting programs to improve child behaviour, and where there are gaps, notably in environmental methods, which limit opportunities to engage in negative behaviors.

The drinks industry, for instance, manipulates the environment to shape behavior. You walk into a bar: you want to buy a small beer but you find that they only sell large glasses. The music is loud, so you drink more than talk. It is also hot, so you buy another drink. Could similar thinking be applied to reduce rather than increase drinking (or other risk behaviors), particularly since, as Foxcroft argued, adjusting the environment is more cost-effective than, say, changing existing cognitions about behaviors?

In another ‘big picture’ talk, Harry Rutter, from the UK National Obesity Observatory, started with a depressing fact: in the obesity reduction field there is lots of hunch-based intervention but little evidence-based activity. Take the recent UK government initiative to make swimming free for the over-60s. This seems common sense, until you learn that the greatest health benefit from physical activity comes from getting the sedentary to be a little active. The initiative appears to have made no impact on the inactive and, somewhat perversely, made swimming free to those who were already active and willing to pay.

Rutter argued that good quality evaluation and a willingness to stop doing things that patently don’t work would start to resolve the problem but that they are not sufficient. More innovative and effective solutions could come from considering how multiple risk factors interact and their potential for unintended consequences.

In theory, for example, seat belts in cars could lead to an increase in obesity. Seat belts make people feel safe, so they tend to drive faster, which increases the risk of accidents. The roads are perceived as less safe, and people who might have cycled use the car instead. This may see extreme, but Rutter’s point was that we might need to involve people not ordinarily associated with obesity prevention, such as town planners.

Drawing inspiration from Isaiah Berlin, Rutter went on to suggest that this 'big picture' approach needs hedgehogs and foxes. Hedgehogs have one big idea. They are experts on a single topic. They know the ins-and-outs of particular complex methodologies or developmental problems. Foxes know a little about many things. They are generalists. They can work across disciplinary boundaries. All the incentives in academic life push researchers to become hedgehogs. Capacity for innovation will likely be limited until the foxes get some reward.

The conference closed with the launch of the European Standards for Drug and Alcohol Prevention, which are designed to help individuals and organizations plan, implement and evaluate interventions as well as reflect on ongoing activities.

Reference:
(1) The standards and all supporting materials are available free online at www.emcdda.europa.eu.publications/manuals/prevention-standards