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Cheryl Merzel, DrPH and Joanna D’Afflitti, MPH

The authors are with the Center for Applied Public Health, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY.

Correspondence: Requests for reprints should be sent to Cheryl Merzel, DrPH, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032 (e-mail: cm449{at}columbia.edu).

Contemporary public health emphasizes a community-based approach to health promotion and disease prevention. The evidence from the past 20 years indicates, however, that many community-based programs have had only modest impact, with the notable exception of a number of HIV prevention programs.

To better understand the reasons for these outcomes, we conducted a systematic literature review of 32 community-based prevention programs. Reasons for poor performance include methodological challenges to study design and evaluation, concurrent secular trends, smaller-than-expected effect sizes, limitations of the interventions, and limitations of theories used.

The effectiveness of HIV programs appears to be related in part to extensive formative research and an emphasis on changing social norms.

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