stakeholder support in a program, external relationships with the organization, and compatibility between the culture and the innovative program (Glisson, 2002; Glisson, Dukes, and Green, 2006). Because such organizational change approaches have been successful in delivering mental health services, it may be a useful model to promote the adoption of prevention services as well.

Despite the potential for preventing MEB disorders through the implementation of evidence-based programs, there are limitations to relying exclusively on this approach. First, as noted above, evidence remains limited about the ability of existing evidence-based programs to be effective for populations other than those that participated in the original evaluations of these programs. Moreover, implementation may be hampered if the original evidence was limited to efficacy trials rather than scientific evaluation based on characteristics as close to real-world conditions as possible. In addition, the widespread adoption, implementation, and maintenance of evidence-based programs will require a significant public investment. This section delineates additional strategies that can complement the implementation of evidence-based programs.

Nationwide efforts to reduce cigarette smoking (Biglan and Taylor, 2000; Institute of Medicine, 2007b), one of the most successful public health efforts of the 20th century, illustrate the potential of public education strategies. The prevalence of smoking among adults has decreased by 58.2 percent since 1964, and smoking initiation by adolescent and young adults has also decreased (Institute of Medicine, 2007b). Although multiple factors contributed to this remarkable decline, one contributor is the information that has been communicated to the public about the harm of tobacco use.

At least two levels of government have adopted information and education strategies. At the local level, many school boards have required smoking prevention as a component of health education programs. At the federal level, Congress has mandated the publication of regular surgeon general’s reports on smoking and health and, since 1966, has required warning labels on cigarette packs. The first surgeon general’s report on smoking (U.S. Department of Health, Education, and Welfare, 1964) had an immediate and profound impact: In the first three months after its issuance, cigarette consumption fell by 15 percent. During a brief period, from 1967 to 1970,