Crowley D Max, Jones Damon E, Coffman Donna L, Greenberg Mark T
The Center for Child and Family Policy, Duke University, Durham, NC 27705, USA.
The Prevention Research Center for Promotion of Human Development, The Pennsylvania State University, University Park, PA 16801, USA.
Prev Med. 2014 May;62:71-7. doi: 10.1016/j.ypmed.2014.01.029. Epub 2014 Feb 9.
Prescription drug abuse has reached epidemic proportions. Nonmedical prescription opioid use carries increasingly high costs. Despite the need to cultivate efforts that are both effective and fiscally responsible, the cost-effectiveness of universal evidence-based-preventive-interventions (EBPIs) is rarely evaluated. This study explores the performance of these programs to reduce nonmedical prescription opioid use.
Sixth graders from twenty-eight rural public school districts in Iowa and Pennsylvania were blocked by size and geographic location and then randomly assigned to experimental or control conditions (2002-2010). Within the intervention communities, prevention teams selected a universal family and school program from a menu of EBPIs. All families were offered a family-based program in the 6th grade and received one of three school-based programs in 7th-grade. The effectiveness and cost-effectiveness of each school program by itself and with an additional family-based program were assessed using propensity and marginal structural models.
This work demonstrates that universal school-based EBPIs can efficiently reduce nonmedical prescription opioid use. Further, findings illustrate that family-based programs may be used to enhance the cost-effectiveness of school-based programs.
Universal EBPIs can effectively and efficiently reduce nonmedical prescription opioid use. These programs should be further considered when developing comprehensive responses to this growing national crisis.
处方药滥用已达到流行程度。非医疗用途的处方阿片类药物使用成本日益高昂。尽管需要开展既有效又符合财政责任的工作，但普遍的循证预防干预措施（EBPI）的成本效益却很少得到评估。本研究探讨了这些项目在减少非医疗用途处方阿片类药物使用方面的表现。
来自爱荷华州和宾夕法尼亚州28个农村公立学区的六年级学生按规模和地理位置进行分组，然后随机分配到实验组或对照组（2002 - 2010年）。在干预社区内，预防团队从一系列循证预防干预措施中选择了一个面向家庭和学校的通用项目。所有家庭在六年级时都参加了一个基于家庭的项目，并在七年级时接受了三个基于学校的项目之一。使用倾向模型和边际结构模型评估了每个学校项目本身以及与一个额外的基于家庭的项目相结合时的有效性和成本效益。
这项工作表明，普遍的基于学校的循证预防干预措施可以有效减少非医疗用途处方阿片类药物的使用。此外，研究结果表明，基于家庭的项目可用于提高基于学校的项目的成本效益。
普遍的循证预防干预措施可以有效且高效地减少非医疗用途处方阿片类药物的使用。在制定应对这一日益严重的国家危机的全面措施时，应进一步考虑这些项目。
