Preventing Eating-Related and Weight-Related Disorders: Collaborative Research, Advocacy, and Policy Change

1. Prevention, Prevention Science, and an Ecological Perspective: A Framework for Programs, Research, and Advocacy

chapter one Prevention, Prevention Science, and an Ecological Perspective: A Framework for Programs, Research, and Advocacy Michael P. Levine, Kenyon College Gail L. McVey, The Hospital for Sick Children, University of Toronto There are many detailed analyses of the current and increasingly complex state of affairs in the prevention of negative body image, disordered eating , and related conditions such as abuse of steroids and food supplements (Becker, Stice, Shaw, & Woda, 2009; Holt & Ricciardelli, 2008; Levine & Smolak, 2006, 2008, 2009; Piran, 2005, 2010; Sinton & Taylor, 2010; Wilksch & Wade, 2009; Yager & O’Dea, 2008). This chapter examines the field of prevention science, with an eye towards improving programming, research, dissemination, and advocacy in the prevention of eating disorders. Special attention is given to innovative socio-ecological models, derived from feminist principles that appear to have important implications for the synchronous prevention of eating disorders, obesity, and other mental health disorders. Challenges associated with the implementation of multi-level interventions for multiple, intersecting problems are discussed, as are directions for future research. Moving towards Prevention Science Eating disorders prevention began in earnest in the mid-1990s––that is, less than 20 years ago. In contrast, prevention theory and research have been a focus of public health, community psychology, and psychiatry, social work, cardiovascular health, and substance abuse for two to three times longer (Levine & Smolak, 2006, Chapters 1, 9, & 10). Indeed, there is a body of knowledge demonstrating that prevention can work. For example, 1 9 2 0 M i c h a e l P. L e v i n e , Ga i l L . M c V e y school-based prevention programs that are interactive and engaging and that emphasize positive peer norms, resistance skills, media literacy, stress management, and other life skills have been shown to prevent initiation and escalation of the use of tobacco, alcohol, and other drugs by adolescents ages 11 through 13 (effect size = ~ .15; Botvin & Griffin, 2002; Tobler et al., 2000). Over the past twenty years, this and similar facts, theories, and methods have become the foundation of a broad and significant development in the general field of prevention called “prevention science” (Committee on the Prevention of Mental Disorders and Substance Abuse, 2009, Chapter 10; Reese, Wingfield, & Blumenthal, 2009; Weissberg, Kumpfer, & Seligman, 2003). Technically, the prevention sciences (plural) are a set of disciplines that apply scientific methods to an understanding of the etiology, development , and prevention of physical and psychological disorders as well as of other social problems such as youth crime (see Table 1). Albee’s (1983) non-specific vulnerability-stressor model of risk, resilience, and prevention contributes several important lessons in prevention science (see Levine & Smolak, 2006, Chapter 7). This ecological model emphasizes that psychological, health, and social problems result from the interaction between individuals and their larger environments, as shaped by familial, academic, social, cultural, economic, and political factors. The powerful role of socio-economic, socio-political, and other socio-cultural factors in the development of cumulative risks and in the maintenance of disorder, illness, and health has two immediate and significant implications. First, prevention work is necessarily an integratable 1: prevention science’s six core principles of effective programming 1. Uses a research-based risk and protective factor framework that involves families, peers, schools, and communities as partners to target multiple outcomes. 2. Is long-term, age-specific, and culturally appropriate. 3. Fosters development of individuals who are healthy and fully engaged through teaching them to apply social-emotional skills and ethical values in daily life. 4. Aims to establish policies, institutional practices, and environmental supports that nurture optimal development. 5. Selects, trains, and supports interpersonally skilled staff to implement programming effectively. 6. Incorporates and adapts evidence-based programming to meet local community needs through strategic planning, ongoing evaluation, and continuous improvement. Source: All principles are direct quotations (italics removed) from different paragraph headings in Weissberg , Kumpfer, and Seligman (2003). Principle 1 is quoted from page 428; the remaining principles are quoted from page 429. P r e v e n t i o n , P r e v e n t i o n S c i e n c e , a n d a n E c o l o g i c a l P e r s p e c t i v e 2 1 tion of science and social justice (see Kenny, Horne, Orpinas, & Reese, 2009; Levine & Maine, 2010; Piran, 2001). Second, all of the phases of the prevention...