Participation in Universal Prevention Programs.

We analyze family decisions to participate in community-based universal substance-abuse prevention programs through the framework of expected utility theory. Family functioning, which has been shown to be a good indicator of child risk for substance abuse, provides a useful reference point for family decision making. Our results show that well-functioning families (with children at low risk for substance use) should have the lowest incentive to participate, but that high-risk families may also opt out of prevention programs. For programs that are most effective for high-risk youth, this could be a problem. Using data from the Strengthening Families Program and the Washington Healthy Youth Survey, we empirically test the implications of our model and find that at least for one measure of family functioning those families with children most likely to be at risk for substance use are opting out of the program.