Starting early – a focus on primary prevention

Family enjoy time outdoors

The advantages of prevention efforts in a number of settings across a community are increasingly being proven. Community members know their communities best and have a huge opportunity to affect change.

What is primary prevention?

Working to prevent, rather than treat, harm gives the best long-term hope of reducing alcohol and drug (AOD) problems. Primary prevention efforts aim to tackle the causes of AOD problems to protect people from developing a problem in the first place.

Preventing AOD problems before they occur is known as ‘going upstream’. Intervening ‘upstream’ of a problem means to get in early and remove the risk factors and increase the protective factors that can lead to people misusing drugs and to an array of health (including mental health) problems.

What are risk and protective factors?

Risk and protective factors are underlying factors that influence an individual to avoid or engage in harmful behaviour. For example, influences that are known to facilitate or predict use of alcohol and other drug use are known as ‘risk factors’, while influences that are known to inhibit or reduce the likelihood of alcohol or other drug use are protective factors1.

Some examples of risk factors for alcohol misuse include an early start in alcohol use, living in a household or community where alcohol is readily available, community norms that tolerate and expect alcohol use among

youth and adults and a family history where alcohol abuse and unsafe drinking is modelled. Some examples of protective factors for the same behaviour include close family ties, effective communication between children and parents, opportunities for social connection and peer support for avoiding alcohol misuse.

Risk and protective factors operate in the individual, family, school, peer group and whole community and at each stage of life. These factors help to identify who is at greatest risk and enable development of prevention programs or strategies that target vulnerable populations.

How do you go about primary prevention?

The prevention of illness or disability requires the identification of modifiable risk and protective factors and the implementation of strategies to eliminate or reduce these risk factors and/or maximise and increase the protective factors2.

The more a program reduces risk factors and increases protective factors, the more it is likely to succeed in preventing substance abuse among children and youth.

Features of effective prevention programs

Many of the harms that result from AOD use are health impacts. Well planned prevention programs have made enormous contributions to improving the quality and duration of people’s lives.

Effective AOD prevention programs reduce the demand for AOD and therefore strengthen individuals, foster healthy connections between people, and build stronger communities. This in turn reduces the prevalence of many personal and social problems.

Effective AOD prevention can be achieved through education, health promotion and community development initiatives, and by reducing the supply of AOD via legislation, regulation and policy. Primary prevention activities can range from early support for new parents, to mental health programs for young people, to school retention strategies for teens, or connecting people to their community through employment, volunteer or other community-based activities.

While selectively targeting these groups can appear to be the most direct approach — and indeed extra support for individuals experiencing the greatest disadvantage is important — those components need to be implemented within a broader ‘upstream’ approach when developing your project. The evidence is that it is not sufficient to reduce drug related health problems by simply targeting high-risk groups.

Coordinated programs are more effective because messages are reinforced when they are received in a number of settings and are more likely to lead to behaviour change. Further, coordinated approaches are more likely to be cost-efficient because they minimise duplication of effort and resources.

Principles/key messages

The following guiding principles will contribute to the success of your primary prevention efforts.

  • Community activities are best focused on primary or ‘upstream’ prevention where programs aim to protect people from developing an AOD-related problem.
  • Successful prevention campaigns and programs have shown that multiple strategies lead to the greatest change. Therefore, your program could involve multiple strategies such as lobbying for a change to relevant laws or policies, or providing education in the community to build support for this change.
  • Find out what strategies have worked in the past or elsewhere. There is now a strong body of evidence about best practice in community prevention that needs to be considered when planning prevention initiatives.
  • Further, when identifying and communicating AOD problems, credible data and research needs to be used rather than relying on people’s perceptions or media reports.
  • Grassroots community prevention programs can have a significant impact on reducing AOD problems, so involve the people who will be affected by your program. Consulting with stakeholders and the target audience early in the planning stages can have a huge impact on a prevention program’s success.
  • Save time and effort by working together to establish how your program links with others. It’s important for communities to work together on prevention programs rather than individuals trying to develop their own approaches that don’t leverage related initiatives.
  • Setting realistic objectives and writing down a program plan can help ensure everyone is on the same page, objectives are more likely to be achieved and the program can be evaluated, which is important when trying to gain further funding.
  1.  Loxley, W., Toumbourou, J.W., Stockwell, T., Haines, B., Scott, K., Godfrey, C. et al. (2004). The prevention of substance use, risk and harm in Australia: a review of the evidence. Canberra: Australian Government Department of Health and Ageing
  2. National Public Health Partnership (NPHP) (2006). The Language of Prevention. Melbourne.