Section 4. Talking About Risk and Protective Factors Related to Community Issues

As members of coalitions or agencies involved in health promotion or community development activities, one of our goals is often to help shift people's thinking about 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 avoid a behavior or outcome -- we can't just say, for example, "Don't have a heart attack." Instead, we need to help people understand the factors that may increase or reduce risk and the actions that can support prevention.

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 circumstances, environment, relationships, or individual characteristics that may make it more likely (risk factors) or less likely (protective factors) that they will experience a given problem. Some risk and protective factors may appear to be related. For example, a family history of alcohol use disorder may be considered a risk factor for developing alcohol-related problems, while supportive family relationships and healthy norms around substance use may be protective. 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, some dietary patterns, and smoking -- because of the large 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.

Many community issues have risk and protective factors that can help us understand where prevention efforts may be useful. Some of them are well known and have been well documented in existing literature. Others are more difficult to identify or continue to be studied.

Some of the risk and protective factors for adolescent substance use, for example, include those identified by researchers David Hawkins and Richard Catalano:

• Economic hardship
• Availability of substances
• Family history of substance use problems
• Academic difficulties
• Having friends who use substances

Some of the protective factors they have found for substance use include:

• Bonding -- that is, having close relationships with people who do not use substances
• Skills training -- children are given age-appropriate responsibilities at home, and are also given enough support and training to carry out those responsibilities
• Healthy beliefs and clear standards -- that is, being surrounded by people who communicate clear expectations about substance use.

For Hawkins and Catalano, risk and protective factors are not simply flip sides of the same coin; instead, they are various important influences, both positive and negative, in 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 shift attention toward productive approaches 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, much of public health and community development focused on responding after problems had already occurred. If someone had a heart attack -- and survived it -- then afterwards, they might be urged to stop smoking or change their diet. Many programs have been set up to help people with alcohol or other substance use disorders begin and maintain recovery. All of this is important, of course, but alone, it's not enough. Responding to existing problems is only part of the story; whenever possible, we also want to prevent problems before they occur.

Focus on costs. There are both financial and social costs that prevention may help reduce. Consider the following examples:

• Substance use problems can create emotional, psychological, social, and financial costs for individuals and families. Effective prevention may reduce some of those costs before serious problems develop.
• Supporting a young person in completing high school and pursuing further education, training, or employment opportunities may reduce later economic hardship and the need for additional services.
• Providing young people with accurate information about sexually transmitted infections (STIs), including HIV, can help prevent infections and reduce the human and financial costs associated with illness and treatment.

Focus on benefits.  By focusing on risk and protective factors, you ask the public to consider what they can do to reduce the likelihood of heart disease, substance use problems, and other preventable conditions. It's an approach with a lot of potential benefits. When young people have opportunities and support to stay healthy, they are better positioned to pursue their goals and support their families, friends, and neighbors. Prevention can reduce human suffering and improve quality of life. Treatment for serious illness can be demanding, so when a condition can be prevented, prevention can spare people from some of those burdens.

Focus on awareness. By talking about risk and protective factors, you can increase the public's knowledge of your program and the issue with which you are concerned. If handled effectively, this information can also help raise broader awareness of the issue. Talking about risk and protective factors helps people understand that there may be things they can do, that prevention is possible, and that they can be part of the solution. Clinical treatment may require trained professionals, but many prevention strategies also depend on community involvement. You don't need specialized credentials to volunteer with children at your neighborhood school or participate in a youth organization. Activities like these may help strengthen protective relationships and supports in young people's lives.

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? This information can often be incorporated into your existing media and communications plan. You should:

Know the important risk and protective factors for your issue. Write a list of the factors and consider which are most important to your effort. 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. You should be prepared to answer the question, "How do we know that it's really a risk or protective factor?" Through published research, such as the example on adolescent substance use given above, or appropriate studies of your own, you should be able to provide credible evidence for the factors you discuss.

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 many people outside the fields of public health and community development, the terms risk factor and protective factor may sound like technical jargon. Use clear, everyday language to explain them. Alternatively, you might want to avoid the technical terms altogether. A skilled communicator might start by listening to a group's concerns and asking what may be contributing to the problem, rather than immediately talking about risk factors. Instead of protective factors, they might talk about the conditions, relationships, or actions that can help reduce 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 be a risk factor for contracting certain types of intestinal worms in some tropical areas, but if those worms aren't present in your community, it won't be a local concern. Show people why the problem is important for them and for their neighbors.
• What your organization is, and what you are doing to address the problem. Explain why your organization exists, its history, and the activities you are engaged in to address the problem. This is a good chance to increase understanding of your program and build additional support. The interest you generate may also bring in new volunteers.

Do you want people to take action?

Then you will want to give clear, feasible suggestions about what may be done. Do this soon after stating each risk or protective factor to emphasize that people have options for responding and to make sure the factor is still at the front of their minds. For example, if your goal is to encourage healthier eating patterns in an attempt to reduce the likelihood of cardiovascular disease, you might use something like the following in an article on health tips in your community newsletter.

Choose your focus. Talk about those factors that you have determined are important in your community and that your effort intends to address. Spending a lot of time on a risk factor you don't intend or have the capacity to address may distract from your goals. Therefore, you may not want to speak about every risk and protective factor you have uncovered. If your plan is to reduce pregnancies among adolescents by implementing sexuality education in schools, for example, you'll probably want to spend more time discussing the factors that your program is actually designed to address. That doesn't mean minimizing other important factors or ignoring them altogether. It simply means focusing your communication on the areas where your effort plans to act.

There are two exceptions to this: when you are talking to a very specific audience, such as grantmakers who are looking for a broader 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 may be appropriate to discuss the full range of well-supported factors related to your issue.

Know your audience, and tailor your message to those with whom you are communicating. For example, a local businessperson may not be able to directly change the fact that some young people have friends who use substances, but they might be able to offer mentoring, internships, or possible job opportunities to young people who could benefit from additional support.

Think about what else you're saying. When discussing a sensitive topic, a poorly planned turn of phrase can do a great deal of harm. You might have the best intentions when you send home a list of risk and protective factors for substance use, pregnancies among adolescents, or violence with a class of fourth graders. The student or parent reading the list, however, might understand it differently. If a student recognizes several risk factors in their own life, they may feel labeled or believe that a negative outcome is inevitable; a parent may feel judged or blamed. Those reactions can undermine trust and make shared goals harder to achieve. Make clear that risk factors indicate increased likelihood, not certainty, and that people and communities also have strengths and protective factors they can build upon.

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 a recent escalation in youth violence. This doesn't need to be a lengthy explanation; 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 give young people more safe and positive options. 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 conversations about risk and protective factors can happen in many settings.
• Brochure/Flier/Fact sheet. All of these are good ways to get information to a broad audience. Specifically, these are useful when you want to give an overview of risk and protective factors or suggest practical ways people can reduce risks or strengthen protective factors. They are less helpful when you want detailed feedback or are trying to mobilize people to take part directly in your coalition.
• Editorials or articles in the local paper or your newsletter. These have many of the same advantages and disadvantages as brochures, fliers, and fact sheets. Publishing through local newspapers, newsletters, websites, or other community media can help you reach a broad audience, but sensitive topics should be presented carefully and respectfully. Be sure to provide a way for people 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 questions people might have. Further, a good presentation can motivate people to act. You can provide a sign-up sheet, QR code, or another simple way for interested people to get involved before they leave. A possible disadvantage is that you may reach a smaller audience than you would through some written or digital communications.

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? Did your message avoid stigmatizing or blaming people affected by the issue? How will you assess these things and use what you learn to improve future communication?

In Summary

Talking about risk and protective factors, in short, is an excellent way to help people begin to think about prevention. Instead of focusing only on treatment and response after problems occur, more of our efforts can be directed toward preventing problems and strengthening the conditions that protect people and communities. Allow yourself to imagine, just for a second, the possibility of a world with far less of the problem you have been struggling to overcome. Maybe it's a world without child abuse; a world where alcohol use disorder no longer causes so much harm; or a world where people can safely walk through their communities 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.