Serving as an Associate Professor at the University of Miami, Dr. Eric C. Brown directs the Implementation Science track for the Department’s Ph.D. program in Prevention Science. Brown’s background in international studies and research design makes him uniquely suited to develop, implement, and assess community and education-based preventive interventions throughout North America and South America. Spanning from 1995 to 2023, Brown’s publications have expanded in terms of discipline and participant demographics, with many of his recent works assessing community-based programs' ability to mitigate public health issues within Latin America. Admittedly, this interest stems from a cultural connection he inherited through his Colombian mother. Visiting Colombia firsthand, Brown witnessed vast inequalities in the distribution of services and power. His following trips throughout elementary, junior, and high school continue to drive his work. I found Brown’s passion for prevention science fascinating, even more so when I discovered he has implemented different strategies in larger communities facing inequity. Whether in or outside of Latin America, communities continue to struggle with violence, corruption, or drug use. Consequently, it is essential to improve our understanding of existing community-based prevention strategies. Brown generously agreed to an interview in which I asked for community outcomes and methodological specifics. 

Abby: Could you give me an overview of preventative science, given that it is an emerging field within Public Health?

Preventive science aims to answer questions like, “Can we take any precautions to prevent diseases from occurring?” Brown explains that within preventative science, there is a niche area referred to as implementation science. In the case of COVID-19, the vaccine was discovered at a record-breaking pace. Ultimately, the failure was found in implementing the vaccine, as public health professionals were unprepared for the public to object to the vaccine for fear of their health. This was a result of numerous factors, including misinformation. Individuals in rural and marginalized communities often did not have access to the vaccine due to language barriers or an inability to overcome the distance to vaccination sites. 

Abby: From your implementation science research, I have gathered that you are familiar with the Communities That Care (CTC) prevention system. CTC uses community tools to address specific issues and encourage prevention, which community stakeholders oversee. What was the selection process for choosing stakeholders? And why did you decide to make them such a pivotal part of the prevention program? 

After obtaining his PhD, Brown contributed to a study by a principal investigator, Jay David Hawkins. Hawkins founded the CTC alongside Richard F. Catalano. The research Brown conducted alongside Hawkins involved communities at large rather than a specific institution, like a prison, to gauge the pressing concerns of a more diverse group. The core element in this work was the creation of a coalition, or individuals who work alongside one another to pursue a mutually beneficial goal. These coalitions exist to provide the larger community with the skills and resources needed to mitigate the pressing issues identified earlier in the research. Serving as stakeholders, the selected coalition is comprised of students, teachers, media, local businesses, press, youth recreational leaders, and faith-based organizations alike. Essentially, various pillars of society combine to represent the community via a targeted coalition tech network. Empowering these groups is simple, with researchers guiding the coalition's choices to ensure they are based in science and likely to benefit the community. Researchers encourage that coalitions collect their own data and use select tools, like survey instruments, to assess the existing resources and the resources they need to obtain. This is the heart of the CTC prevention system and how stakeholders are selected. Further, this prevents the phenomenon of helicopter research, where researchers exist in a community and allow it to revert to its condition prior to the research. 

This has proven effective, as Brown notes the results from a community randomized trial found significant changes in communities that use CTC versus those that did not. One Colombian community that utilized CTC was aided in the collection and interpretation of data, all of which led the coalition to discover that the elected mayor failed to improve the community as they had claimed during their election 4 years prior. In empowering the coalition, researchers taught the community to advocate for themselves using science-based research. Brown is unaware of how the mayor responded, given that CTC discourages interactions with research once a study is concluded. 

Ideally, all studies result in limited contact with the coalitions empowered to effectively foster independence and long-term success. Researchers continually receive updates on the progress of each community to measure the sustainability over long periods, however. These updates are three to five years following a research team’s interaction with a community, and detail the number of positions that exist within the coalition and the frequency and activity of the coalition. 

Take the COVID-19 vaccine, for instance. While effective, the vaccine required that the patient get repeated booster shots to continue its success. 

Abby: Throughout the updates you have received, would you say the majority of the communities that participate in CTC continue to implement coalitions and community-based empowerment? 

Unfortunately, Brown maintains that communities fail to continue coalition implementation due to more pressing concerns. Gang violence and political corruption are rampant in a portion of the communities CTC has been introduced to. Such structural violence leads to an unequal distribution of sources, with gangs producing and selling illegal substances to maintain an influx of resources and wealth within a community, thus causing a coalition to fail. 

Structural violence and the previous failures experienced by communities battling structural violence should not impact the selection process of potential CTC communities. Struggling communities can be aided in numerous ways, such as decreasing risk factors for drug and alcohol use. Low community attachment is one factor that contributes to the increased risk of substance use. Other factors, like poverty, can be mitigated given that one is in a bonded community. If an individual is not able to bond with their community, it is difficult to mitigate other contributing factors. In Havana, Brown explains that a community suffered from this exact problem. Following a survey, the research team found that the low levels of community involvement from immigrants who struggled to connect with the larger population. To aid these connections, the team provided numerous community-based activities and resources, including bike riding, street parades, matching apparel, and youth classes. These interventions allow teams to mitigate other risk factors and improve connections that are struggling to form in a community. 

Communities, whether institutions like prisons or neighborhoods at large, can improve with empowerment and guidance from research teams. In providing average citizens, like students or religious leaders, with resources and education, they can identify areas of concern and address said areas independently. This, in turn, fosters sustainability and allows for a community to flourish over extended periods.