Characterizing the substance uses prevention funding landscape in the United States

Abstract

Youth and adolescent substance use remains a persistent public health challenge in the United States; the delivery of evidence-based interventions (EBIs) is critical to improving related negative consequences. The Substance Abuse and Mental Health Services Administration funds a large portion of the implemented substance use prevention interventions in the United States by supporting a funding infrastructure that plays an important role in the adoption and scaling of interventions. Prevention intervention developers and researchers need to understand this infrastructure and its influence on local practitioners to increase the adoption of their EBIs. This study sought to identify which agencies in each state and jurisdiction are involved in funding allocation, how they prioritize and distribute funding to intervention implementers, and, subsequently, how they guide the selection of EBIs. This study used a mixed-methods, cross-sectional design to understand the infrastructure of prevention funding that underlies EBI decision-making. In 2023, we conducted surveys with 40 National Prevention Network representatives (NPNs) and 222 community-level practitioners; in early 2024, we conducted qualitative interviews with a subset of 16 NPNs. NPNs' priorities were shaped by the agencies in which they were housed and the partners with whom they collaborated. Most were located within their state's or jurisdiction's department of health or behavioral health, and many engaged in partnerships with departments of public health or education. Most NPNs reported that they prioritized school and health settings and youth populations for prevention intervention delivery. Almost all NPNs directly distributed funding to intervention implementers (community, regional, or state entities); about half distributed some funds through an intermediary that then subcontracted another entity to implement interventions. More NPNs required or recommended that funded recipients select EBIs from lists or registries (75%) than required or recommended a specific strategy for at least some of their programs (53%). Many practitioners (47%) reported that they selected a recent strategy from a list of interventions provided by their funder, but 27% received no funder guidance on intervention selection. Prevention developers and researchers could increase the adoption of EBIs by focusing them on the priority areas for NPNs, including the health, behavioral health, and education sectors. Developers need to get their EBIs onto registries or intervention lists and increase the EBIs' wide-scale dissemination. Audiences for information about specific EBIs should include NPNs, regional entities, and their funded community practitioner recipients.