Quality and Quantity Matter: A Latent Class Analysis of Intervention Approaches Used to Address Community-Level Prescription Drug Misuse

The Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Prevention’s (CSAP) flagship initiative is the Strategic Prevention Framework Partnerships for Success (SPF-PFS). SPF-PFS addresses underage drinking and prescription drug misuse (PDM) in over 600 communities across 49 states, 8 territories/jurisdictions, 13 tribal organizations, and the District of Columbia. CSAP encourages SPF PFS grantees (e.g., states) to support community subrecipients in “implementing a comprehensive prevention approach, including a mix of evidence- based programs, policies, and/or practices that best addresses the selected prevention priority.” In developing their comprehensive prevention approaches, each community subrecipient decides how many and which types of interventions to implement, and there is significant variability in how quickly this process occurs. The current study used latent class analysis (LCA) to identify unique groupings of SPF-PFS communities who employed similar implementation approaches to specifically address PDM.

Analyses included data from 339 community subrecipients who implemented at least one intervention specifically targeting PDM since receiving their SPF-PFS funding. Project directors in the subrecipient communities described the interventions they implemented (SAMHSA strategy type, ecological intervention target, evidence-base, implementation date) on a web-based Community Level Instrument twice each year. LCA helped identify unique patterns of intervention implementation, defined by total number of interventions implemented, lag time between funding and implementation, SAMHSA strategy type, and overall percent of interventions that were evidence-based.

Results revealed a six-class solution that included 3 early intervention groups (within 90 days of receiving funding) and 3 delayed intervention groups (> 90 days after funding). Of the early intervention groups, the smallest group (8.0% of communities) typically implemented 1-2 evidence-based environmental strategies, whereas the largest group (18.6%) implemented multiple interventions (prevention education, alternative activities, environmental strategies, media campaigns, and other information dissemination efforts) that were less likely to be evidence-based. Of the delayed intervention groups, the largest (28.6%) only implemented 1-2 interventions, but those communities did not use a predominant intervention type or many evidence-based interventions. A second group (16.8%) implemented 1-2 evidence-based prevention education programs, and the final group (19.5%) implemented multiple, evidence-based environmental strategies and comprehensive media campaigns.

Findings highlight the diversity in implementation approaches and the most frequent intervention combinations communities use to address PDM. This presentation will conclude with a discussion of why PFS communities may delay intervention implementation, why certain intervention combinations include more evidence-based approaches, and how the current findings could help in understanding patterns in community-level outcomes.