SECTION 3 Preventive medicine and public health 3. Perceived benefir 4. Perceived barriers to change D. Screening Screening programs may be used as universal prevention of its importance in predicting the likelihood of behavior in a variety of settings(e. g, primary care physician offices, change. Self-efficacy refers to confidence or a belief in one's schools, emergency rooms) to determine level of risk and competence to do what is needed to enact health-enhancing type of intervention required. For example he psed qu assessment tool (PAT)is a 20-item self-administer ionnaire for families of chronically ill children that assesses B. Public Policy 10 domains of risk factors. The pat was found to be a valid tool, with most families requiring universal prevention(con- Universal prevention efforts include policy changes fewer geted toward an entire population and serve to reduce the selective prevention(services targeted toward specific risk Cidence of mental health or behavioral disorders, Strate actor identified), and the fewest requiring indicated preven- ies shown to improve mental health outcomes include the tion(involving referral to behavioral health specialist A list of measures is useful for identifying risk of develop oving nutrition and housing ng oving access to education and health care sitivity), diagnosing or mood disorders, and assessing n Improving access to work and reducing poverty general mental health, functional impairment, and quality of life he most widely used risk factors measure Although legal approaches to substance use(e. g, incar- the 21-item Beck depression and Beck anxiety invento ceration of drug users; interdiction efforts) may prevent which provide criteria for determining the severity of symp experimentation or initial use of substances, these efforts toms (i. e, mild to profound ); individuals scoring in the mild ave been largely ineffective for stopping established use to moderate range could be candidates for selective or indi The following policies have led to decreases in rates of sub- cated prevention efforts whereas those scoring higher would stance use and related problems likely need treatment. The brief psychiatric rating scale (BPRS)is a validated 24-item diagnostic screening tool a"Sin taxes"(increasing the cost of alcohol and assessing five domains of mental health problems: thought cigarettes) disorder, withdrawal, anxiety-depression, hostility-suspicion a Reducing the availability of alcohol by regulating number and activity. Although its psychometric properties are and open hours of plac good, diagnoses must be confirmed with a more thorough a Advertising bans assessment A number of brief screening tools have also been devel In oped for assessing the presence and extent of substance use In addition to the efforts noted thus far, which would problems as well as motivation to quit. The four-item CAGE reduce suicide rates by reducing anxiet (cut down, ant er) and 24-item Mich and substance use, other suicide prevention tht gan Alcoholism Screening Test(MAST) are effective identifying problematic levels of alcohol use. t>,t The Rutgers a Reducing the toxicity of gasoline and car exhausts Alcohol Problem Index(RAPI)* is an 18-item measure that Minimizing access to high places such as rooftops and assesses dI rinking-related consequences. A revision of the MAST, the drug abuse screening test (DAST), is a 20-item a Enforcing gun control policies measure that can be used to identify individuals who are a Controlling the availability of pesticides and prescription using or at risk for using illicit substances medications.32 Also, the addiction severity index(ASI, 5th edition)is a structured interview widely used in both substance abi Selective or indicated prevention efforts might include treatment clinics and treatment research. The ASI assesses improving accessibility, affordability, and perceived helpful- severity of problems in seven domains related to drug and ness of mental health or substance abuse treatment, esp use: me ledical, employment, alcohol, drug, legal, cially for groups with limited access family/social, and psychiatric. Advantages include good psy chometric properties and guiding treatment planning. Dis C. Media Campaigns advantages of the asi are that it takes 45 minutes to Universal prevention efforts may include media campaigns administered properf e wers must be trained to ensure it i administer and inter that highlight the consequences of substance use. The Legacy A comprehensive assessment of smoking should include Foundations"Truth"campaign links smoking with serious measures of motivation, nicotine dependence, past quit healthconsequencesanddeath(http://www.thetruth.com/).attemptssmokinghistoryothersubstanceusepresenceof elevision advertisements are effective for reducing drun psychiatric conditions, and treatment preferences. All these driving crashes and related trauma. Similarly, counterman factors will affect whether a quit attempt is made and whether keting, or antitobacco advertisements, have been found to that attempt is successful. Nicotine dependence can be increase knowledge and negative beliefs about the use of assessed with the six-item Fagerstrom Test of Nicotine tobacco. Media campaigns can be similarly effective for Dependence and two-item heaviness of smoking index. Both reducing illicit substance use. measures include a question regarding the amount of time