In a period of increased accountability and reduced prevention resources, the effective targeting of those limited resources is critical. One way in which limited resources are focused is to identify and provide services to those most at risk for later substance use. Risk status, or propensity, is typically estimated from correlational evidence. Using meta-analytic techniques this paper examines the evidence that 29 of the 35 constructs specified by the CTC risk and protective factor model are related to alcohol, tobacco, or marijuana use. While these factors are generally demonstrated to be predictive of substance use, the strength of relation is modest. Ten factors show a significantly different strength of relation with tobacco than with alcohol and marijuana. Given the correlations observed and the rate of substance use in the population, providing only selective intervention services likely ignores the majority of those who will later use substances. Although selection improves the percentage of those receiving services who are likely to benefit from services, the evidence summarized in this study suggests selective interventions will omit many of those who will likely use substances. Given typical base and selection rates, smaller program effects on universal populations may keep a greater number of youth from becoming alcohol, tobacco, or marijuana involved. Editors’ Strategic Implications: The data make a strong and provocative argument for primary prevention of youth substance abuse that should be heard by policymakers and service providers involved in strategic planning and appropriate deployment of resources.
Using correlational evidence to select youth for prevention programming