A number of data collection systems designed to monitor selected substance abuse behaviors and consequences are in place in the United States. Some of these systems provide only national-level data, while others provide data disaggregated by state and in some cases by sub-state units such as counties or communities. Less progress has been made in identifying a key set of epidemiologic indicators across the three major substance categories (i.e., alcohol, tobacco, and illicit drugs), and assembling them in a manner designed to effectively support substance abuse prevention planning at the state and local levels.
A recent federal initiative funded by the U.S. Center for Substance Abuse Prevention (CSAP) seeks to accelerate progress in this area through its Strategic Prevention Framework (SPF). The framework is intended to stimulate the prudent use of available data, and the development of additional data resources, for: 1) identifying statewide priorities for substance abuse prevention, 2) informing resource allocation decisions, 3) monitoring state and local trends in substance abuse and related consequences, and 4) evaluating state and local prevention efforts. This article describes the underlying rationale and issues considered in developing the database, some of the challenges and limitations in applying the data to prevention planning processes, and current strategies employed by CSAP to guide states and communities in effectively using the data in their substance abuse prevention planning and monitoring efforts.
KEY WORDS: Data collection, prevention, monitor, alcohol, tobacco, illicit drugs.
Background on the strategic prevention framework
In 2003, the United States Substance Abuse and Mental Health Services Administration (SAMHSA) unveiled its newly formulated approach to state and community substance abuse prevention. The Strategic Prevention Framework (SPF) described a specific process involving five major steps to be implemented at both the state and community level (SAMHSA, 2008a). These five steps are identified in the following graphic.
To help operationalize the SPF in states and communities, the Center for Substance Abuse (CSAP) has awarded SPF State Incentive Grants (SPF-SIGs) to 42 states, territories, and tribal governments (hereafter referred to as states) over the past 3 years. This grants program supports an array of activities by states to help communities plan, deliver, and sustain effective substance abuse prevention strategies. In almost all of the participating states, the agencies involved provide guidance and funding to a selected subset of communities throughout the state. Across the states, grantee "communities" are defined geographically in a variety of ways, including by county, city or town, and school district. It is primarily at the community level where the prevention strategy planning and implementation activities occur. The goals of the grants program are to: (1) prevent the onset and reduce the progression of substance abuse, including childhood and underage drinking; (2) reduce substance abuse-related problems in communities; and (3) build prevention capacity and infrastructure at the state and community levels.
Underlying these grants is a public health approach that first seeks to identify priority foci for substance abuse prevention efforts using population-level epidemiologic data. The strategies then selected and implemented are those that can be expected to reduce rates of substance use and related consequences at the state and/or community level, as opposed to achieving outcomes at the individual program level only (i.e., among program participants). Many prior initiatives that have focused on program-level outcomes have failed to examine whether program effects translate into improvements discernable at the population level. Given that many prevention programs are delivered to small groups of program participants only, it is unlikely that such programs could have significant impacts on population-level indicators of the problems they are designed to address. …