What are risk and protective factors?
Why should we talk to community members about risk and protective factors?
How do we talk to community members about risk and protective factors?
As members of coalitions or agencies involved in health promotion or community development activities, one of our goals is often to help change people's attitude toward health from one of treating existing problems to preventing those problems from happening at all. To do so effectively, however, we can't just tell people to not let the behavior happen -- we can't just say, for example, "Don't have a heart attack." Instead, we need to give people the tools they need to be able to prevent that heart attack from happening.
After a problem has occurred, we've all heard someone say, "If only we had acted sooner, we could have prevented that." To be able to do that effectively, it is important to understand when and where we could have acted. To orient people to these appropriate places, we talk about risk and protective factors.
What are risk and protective factors?
Risk and protective factors are aspects of a person's environment or personality that make it more likely (risk factors) or less likely (protective factors) that she will experience a given problem. Some risk and protective factors can be considered flip sides of the same coin. For example, a family history of alcoholism might be considered a risk factor for someone becoming an alcoholic, whereas growing up in a family without such a history may be considered a protective factor. You should talk about these risk and protective factors when you are communicating information about your project and the issue it focuses on to community members..
Most of us are aware of the risk factors for heart disease -- including lack of exercise, a high-fat diet, and smoking -- because of the huge educational campaigns that have been conducted. We may or may not have actually changed what we eat and what we do because of that knowledge, but without it, we wouldn't know where to begin.
All issues have risk and protective factors that can lead us to make our communities healthier. Some of them are well known, and have been well documented in existing literature. Others are more difficult to identify, because they are just now being studied.
Some of the risk and protective factors for adolescent substance abuse, for example, include those identified by researchers David Hawkins and Richard Catalano:
- Economic deprivation
- Availability of substances
- Family history of drug abuse
- Academic failure
- Having friends who use drugs
Some of the protective factors they have found for substance abuse include:
- Bonding -- that is, having close relationships with non-drug users
- Skills training -- children are given responsibilities at home, and are also given enough training to carry out those responsibilities
- Healthy beliefs and clear standards -- that is, being surrounded by people who have beliefs and standards which are clearly against the use of drugs .
For Hawkins and Catalano, risk and protective factors are not flip sides of the same coin; instead, they are various important influences (positive and negative) of a young person's life.
Why should you talk to community members about risk and protective factors?
There are a lot of good reasons to talk to community members about the risk and protective factors for your particular community issue, including the opportunity to reroute the universal focus toward productive mindsets, like those that follow.
Focus on prevention.By focusing on risk and protective factors, you help shift people's focus from a reactive approach to one that is preventive in nature. In the past, the focus in public health and community development has been more of a "clean-up" approach. If someone had a heart attack -- and if he survived it -- then afterwards, he was chided to stop smoking and cut down on butter. Many programs have been set up to help alcoholics dry out, and to help former drug abusers stay clean. All of this is important, of course, but alone, it's not enough. Fixing what is broken is only half the story; we must prevent the problem from happening altogether.
Focus on costs. There are both financial and social costs that can be reduced. How is that? Consider the following examples:
- When someone uses drugs, it becomes expensive to repair the resulting emotional, psychological, and monetary damage to his family. Preventing that drug use from happening at all costs much less in many ways.
- It's cheaper to help a teenager finish high school and get into college than it is to pay for the help she needs to raise a family as an unskilled worker.
- The financial and human costs of teaching youth about sexually transmitted diseases (STDs) such as AIDS are much, much lower than paying for the treatment necessary after they have contracted a disease.
Focus on benefits. By focusing on risk and protective factors, you ask the public to consider what they can do to prevent heart attacks, and how we can keep people from trying drugs at all. It's an approach with a lot of benefits. When young people stay healthy, they grow to be productive citizens who are happier, and who can better support their families, friends, and neighbors. Not only is this approach cost-effective, but, more importantly, it reduces human suffering and improves our quality of life. Treating cancer with radiation may work, but the patient's life may still be miserable. It is better, if possible, to prevent the cancer in the first place.
Focus on awareness. By talking about the risk and protective factors, you can increase the public's knowledge of your program and the issue with which you are concerned. If handled correctly, this information can give you the media coverage you are looking for to raise awareness of the issue. Why is this important? Because talking about risk and protective factors helps people understand that there is something they can do, that it's not too late, and that they really can be part of the solution. They can be part of improving -- or even saving -- people's lives. It's a pretty strong lure. Treatment is something doctors do, but almost everyone can be part of a prevention strategy. You don't need a lot of training to volunteer to work with kids at your neighborhood school, nor do you need a lot of letters behind your name to work with the Girl Scouts. Both of these activities, though, may well provide the protection necessary against unhealthy actions such as substance abuse.
How do you talk to community members about risk and protective factors?
So, how do you go about informing the public of these risk and protective factors? It's really quite easy, and probably can be slipped into your current media and communications plan without too much effort. You should:
Know the important risk and protective factors for your issue. Write a list of all of the factors ranked in order of importance. This list might be only for internal use in your agency to clarify the issues involved for yourself or your fellow staff members. It might also be something you'll want to make public, as we'll see later in this section.
Document each risk or protective factor for your issue.The last thing you want to occur is to be talking about a risk factor and not be able to answer the question, "How do we know that it's really a risk factor?" Through published research (such as the example on adolescent substance abuse given above) or studies of your own, you should be able to give a scientifically valid response to any naysayers you might encounter.
Decide what, exactly, you want to achieve by talking about risk and protective factors.
Do you want to raise awareness of the issue or of your organization?
Then you will want to speak (or write) clearly and concisely about the factors you are discussing. Explain clearly:
- What these terms mean. For most people outside the fields of public health and community development, the terms risk factor and protective factor are just a jumble of jargon that is difficult to understand and can quickly turn your audience off. Use friendly, everyday language to explain them. Alternatively, you might want to get rid of the shoptalk altogether. A skilled communicator might start by listening to a group's concerns and asking them what is causing the problem, as opposed to talking about risk factors. Instead of protective factors, he might also talk about the things people can do to help lessen the problem.
- What the risk and protective factors (or whatever you have chosen to call them) are for your problem. Here, you can use the list of factors you developed in step one above.
- What the significance of the problem is for your community. Going barefoot may well be a risk factor for contracting certain types of intestinal worms in the tropics, but if you live in Alaska, where these worms don't exist, it won't be of much concern. Show people why the problem is important for them and for their neighbors.
- What your organization is, and what you are doing to correct the problem. Explain why your organization exists, its history, and the activities you are engaged in to solve the problem. This is a great chance for you to further understanding of your program and to garner additional support. Capitalize on the interest you have generated -- you might gain some enthusiastic volunteers in the process!
Do you want people to take action?
Then you will want to give clear, feasible suggestions as to what may be done. Do this immediately after stating each risk or protective factor to emphasize that the issue is a solvable problem, as well as to make sure the factor is still at the front of people's minds. For example, if your goal is to change people's diets in an attempt to reduce the likelihood of cardiovascular disease, you might use the following in an article on health tips in your community newsletter.
Studies have shown that eating too much red meat is a risk factor for cardiovascular disease. What can you do to put yourself at a lower risk for this life-threatening disease?
- Eat red meat no more than once or twice a week.
- Don't waste those occasions you do eat red meat on a greasy hamburger at the office cafeteria. Save them instead for special occasions, such as a steak on your anniversary or enjoying your neighbor's annual barbecue.
- Think chicken and fish are boring? Think again! Expand your repertoire of recipes using chicken or fish. The following recipe is for salmon steaks marinated in lemon-wine sauce. Delicious!
Choose your battle.Talk about those factors that you have determined are important in your community, and for which you intend to suggest a solution. Spending a lot of time on a risk factor you don't intend to do anything about may make you look ineffectual. Therefore, you may not want to speak about every risk and protective factor you have uncovered. If your plan is to try to reduce teen pregnancy by implementing sexual education in schools, for example, you'll want to talk more about lack of knowledge as a risk factor than about the need to boost girls' self esteem. That doesn't mean playing down the other, no less important, factors, or ignoring them altogether. It just means focusing on the ones you plan on tackling.
There are two exceptions to this: when you are talking to a very specific audience (such as grantmakers who are looking for a holistic view of your problem and program), or when you are simply intending to give a brief overview of risk and protective factors. At both of these times, it is appropriate to discuss all of the known risk factors for your issue.
Know your audience, and tailor your message to those with whom you are communicating. For example, a local businesswoman may not be able to do anything directly about the fact that many young people have friends who use drugs, but she might be able to offer mentoring or possible job opportunities to at-risk youth.
Think about what else you're saying. When discussing a sensitive topic, a poorly planned turn of a sentence can do a great deal of harm. You might have the best of intentions in mind when you send home a list of risk and protective factors (for substance abuse, or teen pregnancy, or violence) with a class of fourth graders. The student or parent reading the list, however, might understand it differently. If the student has several of the risk factors on the list, she might feel like there is something wrong with her; a parent might become angry and resentful. Hurt feelings and indignation may result, helping no one and making common goals even harder to attain.
Decide which form of communication is most appropriate and most feasible for you to use when discussing risk and protective factors.
- One-on-one discussion. You can always talk casually about risk and protective factors when you are discussing your issue with someone. This could take the form of an informal conversation that occurs at the grocery store with a neighbor who is concerned about the recent escalation in youth violence. This doesn't need to be a treatise; it can be as simple as: "You're right, it really has gotten worse. It's a shame we don't have more after-school activities [meaning, this is a protective factor] to keep kids busy and off the streets. You don't have any ideas about what activities we could do, do you?" This discussion could also take the form of a more formal talk with another coalition leader. The important thing to remember is that it's always a good time to talk about risk and protective factors.
- Brochure/Flier/Fact sheet. All of these are good ways to get a lot of information to a broad audience. Specifically, these are excellent when you just want to give an overview of risk and protective factors, or when you want to suggest ways to reduce personal risk factors, such as in the example of cardiovascular disease given above. They are less helpful when you want specific feedback, or you are trying to mobilize people to do something with your coalition.
- Editorials or articles in the local paper or your newsletter. These have many of the same advantages and disadvantages of brochures, fliers, and fact sheets. If you are writing for the local newspaper, especially, you will reach a very wide audience, but keep in mind that local newspaper can often be battlegrounds if messages are presented inappropriately. Also, be sure to list a phone number or another way to contact you for feedback or more information.
- Presentations. A final way to communicate information about risk and protective factors is by giving presentations on them as they relate to the issue with which you are working. In addition to providing information, this gives you the added advantage of being able to answer any questions people might have. Further, a good presentation can excite people to action. You have the possibility of "gettin' 'em while they're hot" with a sign up sheet (or similar tool) at the back of the room in which you present. A possible disadvantage is you may reach a smaller audience than you would with a written document.
Evaluate what you have done. Consider how you will determine if your communication has been a success. Does your audience have a clear understanding of risk and protective factors? Did you motivate them to act? How will you decide on these things?
Talking about risk and protective factors, in short, is an excellent way to help people begin to think about prevention. Instead of focusing on treatment, more of our efforts can be directed towards preventing problems from occurring at all. Allow yourself to imagine, just for a second, the possibility of a world without the problem you have been struggling to overcome. Maybe it's a world without child abuse; a world where even the word 'alcoholic' has disappeared; or a world where you could safely walk down the streets of any city at any hour of the day or night. This world (where you've worked yourself out of a job!) is one that's worth all of us giving our best efforts to achieve. To reach it, we need to focus our efforts at the places where they will do the most good.
Benson, P. (1996). A national initiative to embrace kids. Brotherhood Bond.
Dryfoos, J. (1990). Adolescents at risk. New York, NY: Oxford Press.
Green, L. W. (1992). Promoting comprehensive interventions. In H.D. Holder & J . M. Howard (Eds.), Community prevention of alcohol problems: Methodological issues. Westport, CT, and London: Praeger.
Gardner, S. E., Green, P. F., & Marcus, C., (Eds.). (1994). Signs of effectiveness II. Preventing alcohol, tobacco, and other drug use: A risk factor/resiliency-based approach. Washington, D.C.: U.S. Department of Health and Human Services.
Hawkins, J. D., & Catalano, R. (1993). Communities that care. San Francisco, CA: Jossey Bass.
Kansas Department of Social and Rehabilitation Services and Alcohol and Drug Abuse Services. (1994). Directions. [Brochure]. Topeka, KS: Author.
Massachusetts Department of Public Health, Bureau of Substance Abuse Services. (1994). Community organizing for prevention: The first steps. Boston, MA: Author. [Available from The Medical Foundation, 95 Berkeley Street, Boston, MA 02116]
U.S. Department of Health and Human Services, CDC: National Center for Chronic Disease Prevention and Health Promotion, Work Group on Heath Promotion and Community Development. (1995). Evaluating community efforts to prevent cardiovascular disease. Atlanta, GA: U.S. Department of Health and Human Services.
U.S. Department of Health and Human Services. Planned approach to community health: Guide for the local coordinator. Atlanta, GA: U.S. Department of Health and Human Services, Department of Health and Human Services, Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion