Community coalitions as a system: effects of network change on adoption of evidence-based substance abuse prevention.
OBJECTIVE
We examined the effect of community coalition network structure on the effectiveness of an intervention designed to accelerate the adoption of evidence-based substance abuse prevention programs.


METHODS
At baseline, 24 cities were matched and randomly assigned to 3 conditions (control, satellite TV training, and training plus technical assistance). We surveyed 415 community leaders at baseline and 406 at 18-month follow-up about their attitudes and practices toward substance abuse prevention programs. Network structure was measured by asking leaders whom in their coalition they turned to for advice about prevention programs. The outcome was a scale with 4 subscales: coalition function, planning, achievement of benchmarks, and progress in prevention activities. We used multiple linear regression and path analysis to test hypotheses.


RESULTS
Intervention had a significant effect on decreasing the density of coalition networks. The change in density subsequently increased adoption of evidence-based practices.


CONCLUSIONS
Optimal community network structures for the adoption of public health programs are unknown, but it should not be assumed that increasing network density or centralization are appropriate goals. Lower-density networks may be more efficient for organizing evidence-based prevention programs in communities.
Valente
Thomas W
TW
Institute for Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Alhambra, CA 91803, USA. tvalente@usc.edu
Chou
Chich Ping
CP
Pentz
Mary Ann
MA
D019985:Benchmarking; D019058:Community Networks / Q000458:organization & administration*; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006265:Health Care Coalitions / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D019966:Substance-Related Disorders / Q000517:prevention & control*