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The Institute of Medicine distinguishes between programs based on who is targeted: the entire population (universal), those
at risk (selective), or persons exhibiting the early stages of use or related problem behavior (indicated). Evaluations suggest
that although universal programs can be effective in reducing and preventing substance use, selective and indicated programs
are both more effective and have greater cost-benefit ratios. This paper tests these assumptions by comparing the impact of
these program types in reducing and preventing substance use at the individual level (i.e., those exposed to intervention
services) and in the population (i.e., those exposed and not exposed to intervention services). A meta-analysis was performed
on 43 studies of 25 programs to examine program comparability across IOM categories. When examining unadjusted effect sizes
at the individual level, universal programs were modestly more successful in reducing tobacco use, but selective and indicated
programs were modestly more successful in reducing alcohol and marijuana use. When adjusted to the population level, the average
effect sizes for selective and indicated programs were reduced by approximately half. At the population level, universal programs
were more successful in reducing tobacco and marijuana use and selective and indicated programs were more successful in reducing
alcohol use. Editors’ Strategic Implications: The authors’ focus on the public health value of a prevention strategy is compelling and provides a model for analyses of
other strategies and content areas. 相似文献
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Workplace status and risk of hypertension among hourly and salaried aluminum manufacturing employees
Jane Ellen Clougherty Ellen A. Eisen Martin D. Slade Ichiro Kawachi Mark R. Cullen 《Social science & medicine (1982)》2009
An inverse relationship between workplace status and morbidity is well established; higher job status has been associated with reduced risks of heart disease, hypertension, and injury. Most research on job status, however, has focused on salaried populations, and it remains unclear whether job status operates similarly among hourly workers. Our objectives were to examine whether hourly status itself influences risk of hypertension after adjustment for socioeconomic confounders, and to explore the role of fine-scale job grade on hypertension incidence within hourly and salaried groups. We examined data for 14,999 aluminum manufacturing employees in 11 plants across the U.S., using logistic regression with adjustment for age, sex, race/ethnicity and other individual characteristics. Propensity score restriction was used to identify comparable groups of hourly and salaried employees, reducing confounding by sociodemographic characteristics. Job grade (coded 1 through 30, within hourly and salaried groups) was examined as a more refined measure of job status. Hourly status was associated with an increased risk of hypertension, after propensity restriction and adjustment for confounders. The observed effect of hourly status was stronger among women, although the propensity-restricted cohort was disproportionately male (96%). Among salaried workers, higher job grade was not consistently associated with decreased risk; among hourly employees, however, there was a significant trend, with higher job grades more protective against hypertension. Increasing the stringency of hypertension case criteria also increased the risk of severe or persistent hypertension for hourly employees. 相似文献
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