Journal of Primary Prevention, 213), Spring, 1982
Primary Prevention Research: Barriers, Needs and Opportunities EMORY L. COWEN
Let me begin with an assertion and then a value judgment. Assertion: Primary prevention's language, concepts and rhetoric are cons ahead of its research base. Value judgment: That's a very bad situation and, if not corrected soon, the field will suffer enormously, if not strangulate. This editorial addresses two obvious questions stemming from that view: 1) what factors contribute to the alleged imbalance? and 2) what can be done to redress it? Before engaging those questions, however, I need to pose another--so naive, on the surface, that some will find it offensive. But I'm deadly serious about it: What is primary prevention and primary prevention research? Certainly we are not lacking for consensually validated abstract definitions of the concept (e.g., Bower, 1969; Caplan, 1964; Goldston, 1977; Cowen, 1980), each of which, with only minor variations, underscores the goals of optimizing psychological well-being and preventing psychological maladjustment and disorder. But because they are, indeed, abstract definitions, devoid of operational specificity, people take liberties of looseness and overinclusiveness in translating them into concrete programs and research studies (Cowen, 1977a, 1980). I have found that many (most) things that people call primary prevention aren't really primary prevention at all. Indeed, in my (many) cynical moments I've come to think that the single most important functional variable that determines whether a written product is seen, and thought of, as primary prevention, is whether its author so labels it. Overly elasticized use of the term primary prevention does the field a disservice. Tautly defined, primary prevention offers mental health the most genuine set of alternatives it has ever had. To water those Requests for reprints should be addressed to the author, c/o Department of Psychology, University of Rochester, Rochester, NY 14627. 0278-095X(82}1300-0131500.95
131
©1982 Human Sciences Press
132
Journal of Primary Prevention
down is to abandon that essential contrast and to leave only old wine in new bottles. My strong preference is to define primary prevention narrowly and restrictively, that is, to maximize its contrast with past mental health ways. At the minimum, I believe that a program aspiring to the good name "primary prevention" must meet three structural requirements: 1) It must be group- or mass-, rather than individually-oriented {even though some of its activities may involve individual contacts}. 2) It must have a before-the-fact quality, i.e., be targeted to groups not yet experiencing significant maladjustment {even though they may, because of their life situations or recent experiences, be at risk for such outcomes). 3) It must be intentional, i.e., rest on a solid, knowledge-base suggesting that the program holds potential either for improving psychological health or preventing maladaptation. Those structural qualities, need not restrict the content, methodology {e.g., competence building, stress inoculation, environmental engineering, use of support groups} or target-groups {e.g., age, sociodemographic background} of primary prevention programs. On the other hand all they do is to identify programs that can legitimately aspire to primary prevention status. To be primary prevention requires one further {often overlooked} critical element, data showing positive p r o g r a m effects. Thus viewed, the quintessential kernel of primary prevention is to develop programs {interventions, manipulations} that enhance psychological well-being or prevent psychological misfortune, and the "guts" of primary prevention research is to do outcome studies assessing whether those goals have been achieved. Primary prevention programs, of course, do not develop either in a vacuum or through divine visitation. They come from a nourishing, supportive knowledge-base--a fertile soil, elsewhere (Cowen, 1980} called its "generative base." By that is meant a research substrate demonstrating relationships, correlationally, epidemiologically or however, between situations, experiences, characteristics or qualities, and positive (or negative) psychological outcomes. Although a small fraction of such research is done with the specific goal in mind of paving the way for primary prevention programs, the lion's share of it is done for reasons that have little to do with primary prevention's conceptual matrix. Generative studies should be seen as ore to be mined by astute primary preventionists. But the ore must first be discovered. Currently, it is widely scattered in fields at least as diverse as psychology, sociology, family relations, education, political science,
Emory L. Cowen
133
architecture, public health and environmental engineering. Generative research is important in its own right. It is different {not better or worse; not more, or less, important} from true l"executive"} primary prevention research. It forms a pipeline from which future primary prevention programming and research will flow. Although that generative base will continue, eternally, to need building, enough of it is already in place to justify diverse, promising primary prevention programs. If the preceding seems roaming and diffuse las well it may be}, I beg your indulgence. My focal issues remain as stated at the outset. However, without declaring a set of ground rules for pursuing them, any attempt to do so would only build a Tower of Babel. The reader need not feel saddled permanently by my autistic biases and assumptions. Accepting them, if only on faith for the moment, provides an "if-then" basis for further discussion: if there is merit to those assumptions what then can be said about current gaps in primary prevention research and how to remedy them? Consider first deterrents to research. To say that there can be no primary prevention research without a primary prevention program will strike most people as a "blinding glimpse of the obvious. ''1 This must be stressed since to date it has been the most significant {albeit insidious} de facto deterrent to such research {Cowen, 1980}. The term primary prevention has much pizzazz and allure these days; it is Zeitgeisty. Many people, for different reasons, wish to join the "country club." Some {often those who are working on minor variations of rutted thema from mental health's orthodoxy} either do not understand, or ignore, primary prevention's definition. Others, with a better intellectual understanding of it, package programs in primary prevention vestments without troubling to consider all of the tnecessary} "fancy details" of the term's definition. Since programs reported by those two groups are not primary prevention, research based on them, however elegant or fascinating, cannot be primary prevention research. To breathe a little life into that abstract point, let me cite two relevant instances from my personal experience: In September 1976, I chose to speak about primary prevention in my APA Division 27 (Community Psychology} Presidential Address. Presumably, the audience of more than 150 people was interested in, if not knowledgeable about, the topic. As the talk started I collected some data. I had everyone present identify {on a form provided} what 1There can be brilliant, incisive, heuristic, much needed generative research, but not "executive" primary prevention research.
134
Journal of Primary Prevention
they considered to be the single "most important contribution to primary prevention in mental health." Of the more than 200 responses, taking every possible liberty imaginable, I could relate no more than thirty percent, even remotely, to the area of primary prevention te.g., most of those were books and concept paperst as defined above, and no more than two percent to primary prevention research. I'm painfully aware, indeed to the point of embarrassment, that the study in question tCowen, 1977b} was, in a word, "lousy." Not only is it cited less often than any primary prevention paper I've ever written but, in candor, I'm the only person who ever cites it. Notwithstanding its profound shortcomings, however, the study contains a mesage that is not well recognized, understood or accepted: we're awfully short on good primary prevention research. My second example, at risk of embarrassing "management," involves this journal. The Journal's first number contained what seemed, by title and intent, to be a useful feature called the Primary Prevention Program Clearinghouse IJournal of Prevention, 1980, I(1}, 57-62}. Its stated purpose was to enhance communication about primary prevention by publishing brief {50-word} abstracts of primary prevention programs. Less clear, was the nature of the review process for making that determination. The section included 30 abstracts. I tried valiantly to measure each abstract by the metric of the abovestated restrictive definition of primary prevention--admittedly a rough chore based on a 50-word abstract. My naive impressions were that all abstracts related to mental health, less than half (many of which lacked an evaluation component} met the present narrow definitional standards for primary prevention programs and only 1 of the 30 might have been a research demonstration of primary prevention effects. That frustrating exercise punctuates my earlier assertion that an author's decision to call something primary prevention may be the single most important determinant of whether it is so classified and cited. Alas, when things appear in print under the banner of primary prevention, they are often reified as such and are used as models for other "primary prevention" work, thus adding confusion to an already muddied concept. The key message of this section, once again, is that we cannot have primary prevention research studies without primary prevention programs; the latter must be based on exacting definitional standards that offer a bona fide contrast to mental health's past insufficient ways. Although lack of definitional tautness poses a mammoth barrier to primary prevention programming and research, that's not the only problem. Assuming that a prospective primary prevention program
Emory L. Cowen
135
passes muster on all exacting definitional requirements, what else can go wrong? Plenty! Conducting primary prevention programs is anything but a "piece of cake." More often than not such programs are complex, time-consuming and require substantial resources for: a) entr6e and negotiations with host systems; b) conceptualizing and writing {sometimes elaborate} curricula, and training and supervising personnel in their use; and c) actually running an effective program. Such undertakings are not for the faint-hearted. Some folks with prime program-development interests see research as a burdensome "add-on" to already catastrophic program demands. However understandable, that reality constrains research and often becomes a vector that favors "quick-and-dirty" evaluations over rigorous painstaking ones. 2 Compounding that felony, another defining quality of primary prevention programs (and research} is that they tend to unfold in community settings. As such, they are vulnerable to the base-rate {research-weakening} vicissitudes of community contexts, e.g., difficulties in locating adequate control groups, program-change and subject-loss in midstream, and competition, indeed sometimes antagonism, between program and research needs {Cowen, Lorion, & Dorr, 1974; Cowen, 1978; Cowen & Gesten, 1980}. Research in primary prevention is not a specially blessed area in heaven; it must conform to the same quality-control standards that apply to other research areas. Yet the immutable realities of a program's environmental context often mar the quality of its research evaluations and restrict conclusions about its effectiveness. And, sometimes, even impeccably designed and conducted studies do not produce "desired" outcomes {i.e., demonstration of positive primary prevention effects}. However honorable such failures, they add up to the same conclusion {i.e., primary prevention has been attempted but not shown} and the same consequence {i.e., the need to go back to the drawing board}. That can happen for many reasons. Perhaps the program's generative base was weak or poorly translated into program practices. The derivative intervention may not have been well calibrated to the qualities (e.g., age, cultural background} of its targets, or it may not have been well conducted. Whatever the reason, research findings can be no better than the program itself. There are, in other words, many different ways in which primary prevention programs and their evaluations can go astray. Good primary prevention research requires that many complex pieces fall 2It is not t h a t rigorous, p a i n s t a k i n g evaluation research is an end in and of itself. As Sarason (1981} points out in a recent p e n e t r a t i n g analysis, to permit the false God of rigor to smother the applicability and meaningfulness of research findings to real issues, in a real world, is to win a minor skirmish and lose a global conflagration.
136
Journal of Primary Prevention
into place just right. No one ever said that that would be easy {and if they did, they were surely misguided). Positive research data in this area is not likely to be plucked from trees covered with abundant ripe fruit. Rather, we must expect lots of hard work and many frustrations and disappointments will be the orders of the day and that a just God in heaven will not always reward the deserving for heroic effort. Another point to consider in pondering deterrents to good primary prevention research is that even though such programs have common structural features their stuff {content) and the requirements of their supporting research are quite varied. For example, developing and evaluating a program to teach transitional coping skills and to establish mutual support-groups for newly divorcing adults taps a very different knowledge-base and technology than a program to teach 9-year-olds realistic goal-setting and self-evaluation techniques, or one designed to engineer class environments that promote the adaptation and learning of 14-year-olds. Not only do such endeavors differ greatly from each other, but collectively they implicate different knowledgebases and technologies from those that comprise mental health's current armamentarium. The preceding is in no way to suggest that primary prevention programming or research call for qualitatively different skills from those already known to psychology and the other social sciences. Rather they point to the need for significant recombinations of backgrounds, knowledge-bases and skills. Until such recombinations emerge, and are reflected in training opportunities, only a very few people will have the array of concepts, program development and research skills, needed to bring about appreciable progress in the field. Each of the preceding concerns adds fuel to a current significant functional reality, the woeful shortage of concrete models of sound primary prevention programs with supporting research documentation. Words that well describe our current need are: "modeling" and "catalyzing," indeed even "pump-priming." Although primary prevention's current generative base cannot be fairly described as robust, it is sufficient to justify development of diverse primary prevention programs. The field could profit enormously from a small cluster of heuristic program-demonstrations each based on: a) a structurally demanding, "pure" definition of primary prevention, and b} supporting research documentation--in other words, from the "modeling" of excellence in primary prevention. The greater the substantive diversity of such demonstrations the better. Primary prevention today is coasting, ~vith felicity on the fumes of its exuberance. It can, perhaps, continue to do so for a while, but not
Emory L. Cowen
137
forever. Although its battles can be joined at the level of debate and rhetoric, they will be won or lost in the empirical pits. There is much to be done in primary prevention research. In the long run that task will be facilitated by an emphasis on a taut, demanding definition of the concept that maximizes its contrast with regnant tradition in mental health and by the effective modeling of a relatively small number of different types of empirically verified programs. That must happen if primary prevention is to have a more robust, credible, contributory tomorrow.
References Bower, E.M. Slicing the mystique of prevention with Occam's razor. American Journal of Public Health, 1969, 59, 478-484. Caplan, G. Principles of preventive psychiatry. New York: Basic Books, 1964. Cowen, E.L. Baby-steps toward primary prevention. American Journal of Community Psychology, 1977(a), 5, 1-22. Cowen, E.L. Psychologists and primary prevention: Blowing the cover story. American Journal of Community Psychology, 1977(b}, 5, 481-489. Cowen, E.L. Some problems in community program evaluation research. Journal of Consulting and Clinical Psychology, 1978, 46, 792-805. Cowen, E.L. The wooing of primary prevention. American Journal of Community Psychology, 1980, 8, 258-284. Cowen, E.L., & Gesten, E.L. Evaluating community programs: Tough and tender perspectives. In M. Gibbs, J.R. Lachemneyer & J. Sigal (Eds.}, Community psychology: Theoretical and empirical approaches. New York: Gardner Press, 1980. Cowen, E.L., Lorion, R.P., & Dorr, D. Research in the community cauldron: A case report. Canadian Psychologist, 1974, 15, 313-325. Goldston, S.E. Defining primary prevention. In G.W. Albee & J.M. Joffe (Eds.}, Primary prevention of psychopathology: The issues, Vol.1. Hanover, N.H.: University Press of New England, 1977. Sarason, S.B. Psychology misdirected. New York: Free Press, 1981.
Primary Prevention Research: Barriers, Needs and Opportunities EMORY L. COWEN
Let me begin with an assertion and then a value judgment. Assertion: Primary prevention's language, concepts and rhetoric are cons ahead of its research base. Value judgment: That's a very bad situation and, if not corrected soon, the field will suffer enormously, if not strangulate. This editorial addresses two obvious questions stemming from that view: 1) what factors contribute to the alleged imbalance? and 2) what can be done to redress it? Before engaging those questions, however, I need to pose another--so naive, on the surface, that some will find it offensive. But I'm deadly serious about it: What is primary prevention and primary prevention research? Certainly we are not lacking for consensually validated abstract definitions of the concept (e.g., Bower, 1969; Caplan, 1964; Goldston, 1977; Cowen, 1980), each of which, with only minor variations, underscores the goals of optimizing psychological well-being and preventing psychological maladjustment and disorder. But because they are, indeed, abstract definitions, devoid of operational specificity, people take liberties of looseness and overinclusiveness in translating them into concrete programs and research studies (Cowen, 1977a, 1980). I have found that many (most) things that people call primary prevention aren't really primary prevention at all. Indeed, in my (many) cynical moments I've come to think that the single most important functional variable that determines whether a written product is seen, and thought of, as primary prevention, is whether its author so labels it. Overly elasticized use of the term primary prevention does the field a disservice. Tautly defined, primary prevention offers mental health the most genuine set of alternatives it has ever had. To water those Requests for reprints should be addressed to the author, c/o Department of Psychology, University of Rochester, Rochester, NY 14627. 0278-095X(82}1300-0131500.95
131
©1982 Human Sciences Press
132
Journal of Primary Prevention
down is to abandon that essential contrast and to leave only old wine in new bottles. My strong preference is to define primary prevention narrowly and restrictively, that is, to maximize its contrast with past mental health ways. At the minimum, I believe that a program aspiring to the good name "primary prevention" must meet three structural requirements: 1) It must be group- or mass-, rather than individually-oriented {even though some of its activities may involve individual contacts}. 2) It must have a before-the-fact quality, i.e., be targeted to groups not yet experiencing significant maladjustment {even though they may, because of their life situations or recent experiences, be at risk for such outcomes). 3) It must be intentional, i.e., rest on a solid, knowledge-base suggesting that the program holds potential either for improving psychological health or preventing maladaptation. Those structural qualities, need not restrict the content, methodology {e.g., competence building, stress inoculation, environmental engineering, use of support groups} or target-groups {e.g., age, sociodemographic background} of primary prevention programs. On the other hand all they do is to identify programs that can legitimately aspire to primary prevention status. To be primary prevention requires one further {often overlooked} critical element, data showing positive p r o g r a m effects. Thus viewed, the quintessential kernel of primary prevention is to develop programs {interventions, manipulations} that enhance psychological well-being or prevent psychological misfortune, and the "guts" of primary prevention research is to do outcome studies assessing whether those goals have been achieved. Primary prevention programs, of course, do not develop either in a vacuum or through divine visitation. They come from a nourishing, supportive knowledge-base--a fertile soil, elsewhere (Cowen, 1980} called its "generative base." By that is meant a research substrate demonstrating relationships, correlationally, epidemiologically or however, between situations, experiences, characteristics or qualities, and positive (or negative) psychological outcomes. Although a small fraction of such research is done with the specific goal in mind of paving the way for primary prevention programs, the lion's share of it is done for reasons that have little to do with primary prevention's conceptual matrix. Generative studies should be seen as ore to be mined by astute primary preventionists. But the ore must first be discovered. Currently, it is widely scattered in fields at least as diverse as psychology, sociology, family relations, education, political science,
Emory L. Cowen
133
architecture, public health and environmental engineering. Generative research is important in its own right. It is different {not better or worse; not more, or less, important} from true l"executive"} primary prevention research. It forms a pipeline from which future primary prevention programming and research will flow. Although that generative base will continue, eternally, to need building, enough of it is already in place to justify diverse, promising primary prevention programs. If the preceding seems roaming and diffuse las well it may be}, I beg your indulgence. My focal issues remain as stated at the outset. However, without declaring a set of ground rules for pursuing them, any attempt to do so would only build a Tower of Babel. The reader need not feel saddled permanently by my autistic biases and assumptions. Accepting them, if only on faith for the moment, provides an "if-then" basis for further discussion: if there is merit to those assumptions what then can be said about current gaps in primary prevention research and how to remedy them? Consider first deterrents to research. To say that there can be no primary prevention research without a primary prevention program will strike most people as a "blinding glimpse of the obvious. ''1 This must be stressed since to date it has been the most significant {albeit insidious} de facto deterrent to such research {Cowen, 1980}. The term primary prevention has much pizzazz and allure these days; it is Zeitgeisty. Many people, for different reasons, wish to join the "country club." Some {often those who are working on minor variations of rutted thema from mental health's orthodoxy} either do not understand, or ignore, primary prevention's definition. Others, with a better intellectual understanding of it, package programs in primary prevention vestments without troubling to consider all of the tnecessary} "fancy details" of the term's definition. Since programs reported by those two groups are not primary prevention, research based on them, however elegant or fascinating, cannot be primary prevention research. To breathe a little life into that abstract point, let me cite two relevant instances from my personal experience: In September 1976, I chose to speak about primary prevention in my APA Division 27 (Community Psychology} Presidential Address. Presumably, the audience of more than 150 people was interested in, if not knowledgeable about, the topic. As the talk started I collected some data. I had everyone present identify {on a form provided} what 1There can be brilliant, incisive, heuristic, much needed generative research, but not "executive" primary prevention research.
134
Journal of Primary Prevention
they considered to be the single "most important contribution to primary prevention in mental health." Of the more than 200 responses, taking every possible liberty imaginable, I could relate no more than thirty percent, even remotely, to the area of primary prevention te.g., most of those were books and concept paperst as defined above, and no more than two percent to primary prevention research. I'm painfully aware, indeed to the point of embarrassment, that the study in question tCowen, 1977b} was, in a word, "lousy." Not only is it cited less often than any primary prevention paper I've ever written but, in candor, I'm the only person who ever cites it. Notwithstanding its profound shortcomings, however, the study contains a mesage that is not well recognized, understood or accepted: we're awfully short on good primary prevention research. My second example, at risk of embarrassing "management," involves this journal. The Journal's first number contained what seemed, by title and intent, to be a useful feature called the Primary Prevention Program Clearinghouse IJournal of Prevention, 1980, I(1}, 57-62}. Its stated purpose was to enhance communication about primary prevention by publishing brief {50-word} abstracts of primary prevention programs. Less clear, was the nature of the review process for making that determination. The section included 30 abstracts. I tried valiantly to measure each abstract by the metric of the abovestated restrictive definition of primary prevention--admittedly a rough chore based on a 50-word abstract. My naive impressions were that all abstracts related to mental health, less than half (many of which lacked an evaluation component} met the present narrow definitional standards for primary prevention programs and only 1 of the 30 might have been a research demonstration of primary prevention effects. That frustrating exercise punctuates my earlier assertion that an author's decision to call something primary prevention may be the single most important determinant of whether it is so classified and cited. Alas, when things appear in print under the banner of primary prevention, they are often reified as such and are used as models for other "primary prevention" work, thus adding confusion to an already muddied concept. The key message of this section, once again, is that we cannot have primary prevention research studies without primary prevention programs; the latter must be based on exacting definitional standards that offer a bona fide contrast to mental health's past insufficient ways. Although lack of definitional tautness poses a mammoth barrier to primary prevention programming and research, that's not the only problem. Assuming that a prospective primary prevention program
Emory L. Cowen
135
passes muster on all exacting definitional requirements, what else can go wrong? Plenty! Conducting primary prevention programs is anything but a "piece of cake." More often than not such programs are complex, time-consuming and require substantial resources for: a) entr6e and negotiations with host systems; b) conceptualizing and writing {sometimes elaborate} curricula, and training and supervising personnel in their use; and c) actually running an effective program. Such undertakings are not for the faint-hearted. Some folks with prime program-development interests see research as a burdensome "add-on" to already catastrophic program demands. However understandable, that reality constrains research and often becomes a vector that favors "quick-and-dirty" evaluations over rigorous painstaking ones. 2 Compounding that felony, another defining quality of primary prevention programs (and research} is that they tend to unfold in community settings. As such, they are vulnerable to the base-rate {research-weakening} vicissitudes of community contexts, e.g., difficulties in locating adequate control groups, program-change and subject-loss in midstream, and competition, indeed sometimes antagonism, between program and research needs {Cowen, Lorion, & Dorr, 1974; Cowen, 1978; Cowen & Gesten, 1980}. Research in primary prevention is not a specially blessed area in heaven; it must conform to the same quality-control standards that apply to other research areas. Yet the immutable realities of a program's environmental context often mar the quality of its research evaluations and restrict conclusions about its effectiveness. And, sometimes, even impeccably designed and conducted studies do not produce "desired" outcomes {i.e., demonstration of positive primary prevention effects}. However honorable such failures, they add up to the same conclusion {i.e., primary prevention has been attempted but not shown} and the same consequence {i.e., the need to go back to the drawing board}. That can happen for many reasons. Perhaps the program's generative base was weak or poorly translated into program practices. The derivative intervention may not have been well calibrated to the qualities (e.g., age, cultural background} of its targets, or it may not have been well conducted. Whatever the reason, research findings can be no better than the program itself. There are, in other words, many different ways in which primary prevention programs and their evaluations can go astray. Good primary prevention research requires that many complex pieces fall 2It is not t h a t rigorous, p a i n s t a k i n g evaluation research is an end in and of itself. As Sarason (1981} points out in a recent p e n e t r a t i n g analysis, to permit the false God of rigor to smother the applicability and meaningfulness of research findings to real issues, in a real world, is to win a minor skirmish and lose a global conflagration.
136
Journal of Primary Prevention
into place just right. No one ever said that that would be easy {and if they did, they were surely misguided). Positive research data in this area is not likely to be plucked from trees covered with abundant ripe fruit. Rather, we must expect lots of hard work and many frustrations and disappointments will be the orders of the day and that a just God in heaven will not always reward the deserving for heroic effort. Another point to consider in pondering deterrents to good primary prevention research is that even though such programs have common structural features their stuff {content) and the requirements of their supporting research are quite varied. For example, developing and evaluating a program to teach transitional coping skills and to establish mutual support-groups for newly divorcing adults taps a very different knowledge-base and technology than a program to teach 9-year-olds realistic goal-setting and self-evaluation techniques, or one designed to engineer class environments that promote the adaptation and learning of 14-year-olds. Not only do such endeavors differ greatly from each other, but collectively they implicate different knowledgebases and technologies from those that comprise mental health's current armamentarium. The preceding is in no way to suggest that primary prevention programming or research call for qualitatively different skills from those already known to psychology and the other social sciences. Rather they point to the need for significant recombinations of backgrounds, knowledge-bases and skills. Until such recombinations emerge, and are reflected in training opportunities, only a very few people will have the array of concepts, program development and research skills, needed to bring about appreciable progress in the field. Each of the preceding concerns adds fuel to a current significant functional reality, the woeful shortage of concrete models of sound primary prevention programs with supporting research documentation. Words that well describe our current need are: "modeling" and "catalyzing," indeed even "pump-priming." Although primary prevention's current generative base cannot be fairly described as robust, it is sufficient to justify development of diverse primary prevention programs. The field could profit enormously from a small cluster of heuristic program-demonstrations each based on: a) a structurally demanding, "pure" definition of primary prevention, and b} supporting research documentation--in other words, from the "modeling" of excellence in primary prevention. The greater the substantive diversity of such demonstrations the better. Primary prevention today is coasting, ~vith felicity on the fumes of its exuberance. It can, perhaps, continue to do so for a while, but not
Emory L. Cowen
137
forever. Although its battles can be joined at the level of debate and rhetoric, they will be won or lost in the empirical pits. There is much to be done in primary prevention research. In the long run that task will be facilitated by an emphasis on a taut, demanding definition of the concept that maximizes its contrast with regnant tradition in mental health and by the effective modeling of a relatively small number of different types of empirically verified programs. That must happen if primary prevention is to have a more robust, credible, contributory tomorrow.
References Bower, E.M. Slicing the mystique of prevention with Occam's razor. American Journal of Public Health, 1969, 59, 478-484. Caplan, G. Principles of preventive psychiatry. New York: Basic Books, 1964. Cowen, E.L. Baby-steps toward primary prevention. American Journal of Community Psychology, 1977(a), 5, 1-22. Cowen, E.L. Psychologists and primary prevention: Blowing the cover story. American Journal of Community Psychology, 1977(b}, 5, 481-489. Cowen, E.L. Some problems in community program evaluation research. Journal of Consulting and Clinical Psychology, 1978, 46, 792-805. Cowen, E.L. The wooing of primary prevention. American Journal of Community Psychology, 1980, 8, 258-284. Cowen, E.L., & Gesten, E.L. Evaluating community programs: Tough and tender perspectives. In M. Gibbs, J.R. Lachemneyer & J. Sigal (Eds.}, Community psychology: Theoretical and empirical approaches. New York: Gardner Press, 1980. Cowen, E.L., Lorion, R.P., & Dorr, D. Research in the community cauldron: A case report. Canadian Psychologist, 1974, 15, 313-325. Goldston, S.E. Defining primary prevention. In G.W. Albee & J.M. Joffe (Eds.}, Primary prevention of psychopathology: The issues, Vol.1. Hanover, N.H.: University Press of New England, 1977. Sarason, S.B. Psychology misdirected. New York: Free Press, 1981.
