摘要：We examined the diffusion of the D.A.R.E program to reduce use of illicit drugs among school-aged children and youths and the diffusion of syringe exchange programs to reduce HIV transmission among injection drug users. The D.A.R.E program was diffused widely in the United States despite a lack of evidence for its effectiveness; there has been limited diffusion of syringe exchange in the United States, despite extensive scientific evidence for its effectiveness. Multiple possible associations between diffusion and evidence of effectiveness exist, from widespread diffusion without evidence of effectiveness to limited diffusion with strong evidence of effectiveness. The decision theory concepts of framing and loss aversion may be useful for further research on the diffusion of public health innovations. IN A GLOBALIZED HEALTH environment, where there is a rapid spread of both new infectious diseases and poor health practices (e.g., smoking and overeating), the importance of the diffusion of effective public health innovations cannot be underestimated. HIV/AIDS and the injection of illicit psychoactive drugs are 2 of the most important current global health problems. 1 , 2 We examined the diffusion of 2 innovations for addressing these problems: the Drug Abuse Resistance Education (D.A.R.E.) program, which is intended to reduce or eliminate psychoactive drug use among school-aged children and youths, and syringe exchange programs, which are intended to reduce the transmission of HIV among injection drug users (IDUs). While diffusion of public health innovations is a complex process, the relative advantage of an innovation—the effectiveness of the innovation compared with the alternatives—is critical to its diffusion. 3 The more effective an innovation, the more it should diffuse. For this analysis, we considered program effectiveness, as assessed through scientific research, to be the prime determinant of relative advantage. The diffusion process can be quite complex, with multiple possible diffusion pathways and with different associations between evidence for effectiveness and extent of diffusion (or lack of diffusion).
