Phases of alcohol problem prevention research

We build on precedents from other health research to present a phases model of research for alcohol problem prevention that accommodates the special c haracteristics of this research. We propose a five-level model, in which re search moves along a series of relevant continua: from basic to more and mo re applied research; from descriptive hypothesis-generating pilot studies t o full-fledged, methodologically sophisticated, hypothesis-testing studies; from smaller to larger samples for testing; from greater to lesser control of experimental conditions; from more artificial "laboratory" environments to real-world geographically defined communities; from testing the effects of single prevention strategies to more complex studies of multiple strate gies integrated into intervention systems; and from research-driven outcome studies to "demonstration" projects that evaluate the capacity of various types of communities to implement prevention programs based on prior evalua tions. The five phases of research are: (1) foundational research to define and determine the prevalence of specific alcohol-involved problems, establ ish causal factors and processes that yield the specific problems or increa se the risk of a problem, and provide the foundations for the development o f effective prevention interventions; (2) developmental (preliminary effect iveness) studies to develop and test the likely effectiveness, safety, and costs of new interventions or to assess the effectiveness, safety, and cost s of an existing intervention; (3) efficacy studies to determine the effect s, safety, and costs of an intervention under optimal conditions of impleme ntation (or availability or enforcement) and acceptance (or adoption at the community, organizational, or group level; or participation, compliance, o r adherence at the individual level); (4) effectiveness studies of the real -world effectiveness of preventive interventions with purposeful or natural variation in implementation and acceptance; and (5) demonstration studies of the effects of interventions when widely disseminated. The proposed phas es model for alcohol problem prevention research presented herein differs i n significant ways from the models established by other National Institutes of Health agencies. Greater emphasis is placed on natural experiments, on methods development along the whole research continuum, on collapsing or co mbining research phases when appropriate, on recognizing the critical impor tance of behavioral parameters early as well as late in the research sequen ce, and on extending the research continuum to embrace diffusion and dissem ination (i,e., technology transfer) studies. We also include examples of ph ased research in existing alcohol studies and a discussion of relevant issu es, including cost, special populations, methods, and dissemination. If sys tematically followed, this model has the potential to contribute to wider t esting and dissemination of prevention interventions of known effectiveness .