found that three risk factors—parental mental illness, a mother–stepfather home, and maternal inattention—were significant predictors of more than one problem outcome when controlling for all other risk factors (Cohen, Brook, et al., 1990). Other risk factors had specific effects. For example, somatic risk, social isolation, and lax rules had a specific relation with internalizing problems; parental sociopathy and power-assertive punishment had specific effects on externalizing problems; and neighborhood crime and residential instability had significant relations with substance abuse.

An implication of the findings on specific versus general effects of risk and protective factors is that evaluations of interventions with groups at risk for multiple mental, emotional, and behavioral problems should be designed to detect effects on multiple problem outcomes. For example, parental divorce is associated with other risk factors, such as interparental conflict, parental mental health problems, and harsh and inconsistent parenting. It is also associated with multiple problem outcomes, including substance abuse problems, internalizing and externalizing problems, and academic problems. The potential for multiple benefits from preventive interventions increases the likelihood that they will reduce the burden of disorder on the affected individuals and be a cost-effective investment for society.

Another implication is that preventive interventions should be based on as clear an understanding as possible of the relations between the targeted risk factors and the outcomes of concern. Identification of a risk factor that is specifically associated with some disorders, after the effects of other risk factors and comorbid disorders have been accounted for, increases confidence that it is potentially a causal factor and that modifying that risk will lead to a reduction in the rate of onset of that specific disorder. Prevention strategies that are targeted to high-risk groups would require an understanding of the pathways of risk and protective processes that lead to specific disorders in the risk group and identifying the potentially modifiable processes.

Risk and Protective Factors Influence Each Other and Mental, Emotional, and Behavioral Disorders Over Time

Research in developmental psychopathology (Cichetti and Toth, 1992; Masten, 2006) and resilience (Luthar, 2003) has described multiple models—main effect, moderational, and mediational models—by which risk and protective factors influence each other and the development of emotional and behavior problems over time. Design of prevention interventions should be based on a solid theory grounded in one of these models. In main effect models, risk factors are related to higher levels of disorder, and protective factors have a counterbalancing relation to lower levels of dis-



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