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Don C. Des Jarlais, PhD, Zili Sloboda, PhD, Samuel R. Friedman, PhD, Barbara Tempalski, PhD, Courtney McKnight, MPH and Naomi Braine, PhD

Don C. Des Jarlais, Courtney McKnight, and Naomi Braine are with the Beth Israel Medical Center, New York, NY. Zili Sloboda is with the Institute for Health and Social Policy, University of Akron, Ohio. Samuel R. Friedman and Barbara Tempalski are with the National Development and Research Institutes, New York, NY.

Correspondence: Requests for reprints should be sent to Don Des Jarlais, Beth Israel Medical Center, 160 Water Street, 24th Floor, New York, NY 10038 (e-mail: dcdesjarla{at}aol.com).

ABSTRACT

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.

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