title: Fighting back against substance abuse: are community coalitions winning?
abstract: OBJECTIVE
  Federal initiatives continue to provide strong support for community antidrug coalitions, but whether this approach actually reduces substance abuse is not clear. This paper examines the strategies that coalitions in a large national demonstration program (Fighting Back) chose to develop, the degree to which they implemented these strategies, and evidence regarding their effects.
  
  
  METHODS
  Coalition strategy implementation was coded and ranked for 12 Fighting Back sites. Effect sizes (intervention over time) for outcomes related to substance use, alcohol and other drug treatment, and community/prevention indicators were also ranked by site. Using rank order correlation, three directional hypotheses compared strategy dose to outcomes.
  
  
  RESULTS
  None of the hypotheses were supported. Strategies aimed at either youth or community/prevention outcomes showed no effects, while strategies to improve adult-focused outcomes showed significant negative effects over time, compared to matched controls. Coalitions with a more comprehensive array of strategies did not show any superior benefits, and increasing the number of high-dose strategies showed a significant negative effect on overall outcomes.
  
  
  CONCLUSIONS
  Comprehensive community coalitions are intuitively attractive and politically popular, but the potential for adverse effects must be considered. Efforts to evaluate implementation processes as well as to correlate strategies with theoretically corresponding outcomes are a critical but neglected aspect of prevention research.
authors.affiliation: Pacific Institute for Research and Evaluation, Chapel Hill, North Carolina 27514, USA. hallfors@pire.org
authors.forename: Denise
authors.initials: D
authors.lastname: Hallfors
authors.forename: Hyunsan
authors.initials: H
authors.lastname: Cho
authors.forename: David
authors.initials: D
authors.lastname: Livert
authors.forename: Charles
authors.initials: C
authors.lastname: Kadushin
mesh_terms: D000293:Adolescent; D000328:Adult; D003256:Community Participation; D006801:Humans; D016015:Logistic Models; D010043:Outcome and Process Assessment, Health Care; D011322:Primary Prevention; D015397:Program Evaluation; D011634:Public Health; D018709:Statistics, Nonparametric; D019966:Substance-Related Disorders / Q000517:prevention & control*; D014481:United States