{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:28:54Z","timestamp":1786120134551,"version":"build-2736575974"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"Supplement_1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Harmful behavior such as suicide, sexual assault, intimate partner violence, and substance abuse significantly impacts the mission of the Department of Defense (DoD) by degrading unit cohesion, straining resources, and diminishing military readiness. Recent independent reviews\u2014such as the Independent Review Commission on Sexual Assault in the Military\u2014emphasize the need for institutional reform to prioritize proactive prevention over reactive responses. In promoting the adoption of integrated primary prevention activities, the Department must utilize a comprehensive, evidence-based approach targeting shared risk and protective factors to address harmful behavior before it occurs. In contrast to past efforts, which often focus on awareness, outreach, clinical practice, or response, integrated primary prevention emphasizes data-driven, culturally competent, and systems-based strategies tailored to military populations. Key principles include fostering resilience, promoting positive command climates, and leveraging community partnerships. The establishment of an integrated primary prevention workforce to support the Department further amplifies these efforts by conducting needs assessments, developing tailored prevention plans, and translating research into actionable interventions. Despite its long-term benefits, a focus on primary prevention continues to face challenges in an environment that prioritizes immediate, tangible results over proactive measures with delayed outcomes. By addressing these challenges and investing in sustainable prevention infrastructure, the DoD can enhance the well-being and readiness of its service members, ultimately reducing harmful behavior throughout the Armed Forces.<\/jats:p>","DOI":"10.1093\/milmed\/usaf646","type":"journal-article","created":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T12:43:45Z","timestamp":1766839425000},"page":"54-60","source":"Crossref","is-referenced-by-count":0,"title":["Are You Actually Doing Prevention? Differentiating Prevention, Outreach, and Awareness"],"prefix":"10.1093","volume":"191","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4694-6195","authenticated-orcid":false,"given":"Theresa Jackson","family":"Santo","sequence":"first","affiliation":[{"name":"Health Promotion and Wellness, Defense Centers for Public Health-Aberdeen, Defense Health Agency , Aberdeen Proving Ground-EA, MD 21010,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6395-7887","authenticated-orcid":false,"given":"Tim","family":"Hoyt","sequence":"additional","affiliation":[{"name":"Office of Force Resiliency, Office of the Under Secretary of Defense for Personnel & Readiness , Washington, DC 20301-4000,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"2026080616031470600_usaf646-B1","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1037\/sah0000543","article-title":"Fears of stigma perceived from unit leaders for seeking psychological services for military sexual trauma sequelae is associated with suicide risk among male service members and veterans","volume":"10","author":"Blais","year":"2025","journal-title":"Stigma Health"},{"key":"2026080616031470600_usaf646-B2","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1093\/milmed\/usaf312","article-title":"The people first task force inventory: understanding one service\u2019s activities to prevent and respond to harmful and destructive behaviors and lessons learned for application across the Department of Defense","volume":"190","author":"Shirey","year":"2025","journal-title":"Mil Med"},{"key":"2026080616031470600_usaf646-B3","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1093\/milmed\/usz194","article-title":"Development of a leader tool for assessing and mitigating suicide risk factors","volume":"185","author":"Hoyt","year":"2020","journal-title":"Mil Med"},{"key":"2026080616031470600_usaf646-B4","doi-asserted-by":"publisher","first-page":"1094","DOI":"10.1177\/0886260513506058","article-title":"Preliminary investigation of the roles of military background and posttraumatic stress symptoms in frequency and recidivism of intimate partner violence perpetration among court-referred men","volume":"29","author":"Hoyt","year":"2014","journal-title":"J Interpers Violence"},{"key":"2026080616031470600_usaf646-B5","volume-title":"Defense Suicide Prevention Office: Annual Report on Suicide in the Military, Calendar Year 2023","year":"2024"},{"key":"2026080616031470600_usaf646-B6","volume-title":"Office of Drug Demand Reduction: Annual Report Regarding Overdoses by Certain Members of the Armed Forces","year":"2025"},{"key":"2026080616031470600_usaf646-B7","volume-title":"Sexual Assault Prevention and Response Office: Annual Report on Sexual Assault in the Military, Fiscal Year 2024","year":"2025"},{"key":"2026080616031470600_usaf646-B8","volume-title":"U.S. Department of Defense: Report on Child Abuse and Neglect and Domestic Abuse in the Military for Fiscal Year 2023","year":"2024"},{"key":"2026080616031470600_usaf646-B9","first-page":"7","article-title":"Challenging prevailing models of US army suicide","volume":"50","author":"Hoyt","year":"2020","journal-title":"Parameters"},{"key":"2026080616031470600_usaf646-B10","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1080\/08995605.2017.1422949","article-title":"The readiness imperative for reducing sexual violence in the US armed forces: respect and professionalism as the foundation for change","volume":"30","author":"Klein","year":"2018","journal-title":"Mil Psychol"},{"key":"2026080616031470600_usaf646-B11","doi-asserted-by":"publisher","first-page":"101736","DOI":"10.1016\/j.avb.2022.101736","article-title":"Conflict resolution workshops for service members and families: the potentials of alternatives to violence project (AVP) to address military domestic violence","volume":"66","author":"Hodges","year":"2022","journal-title":"Aggress Violent Behav"},{"key":"2026080616031470600_usaf646-B12","volume-title":"Fort Hood Independent Review Committee: Report of the Fort Hood Independent Review Committee","year":"2020"},{"key":"2026080616031470600_usaf646-B13","volume-title":"Independent Review Commission on Sexual Assault in the Military: Hard Truths and the Duty to Change: Recommendations From the Independent Review Commission on Sexual Assault in the Military","year":"2021"},{"key":"2026080616031470600_usaf646-B14","volume-title":"Suicide Prevention and Response Independent Review Committee: Preventing Suicide in the U.S. Military: Recommendations From the Suicide Prevention and Response Independent Review Committee","year":"2022"},{"key":"2026080616031470600_usaf646-B15","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1093\/milmed\/usae135","article-title":"The suicide prevention and response independent review committee (SPRIRC): translating recommendations into actions","volume":"189","author":"Hoyt","year":"2024","journal-title":"Mil Med"},{"key":"2026080616031470600_usaf646-B16","doi-asserted-by":"publisher","first-page":"e243","DOI":"10.1093\/milmed\/usae332","article-title":"Organizational capacity for sexual assault prevention within a US army installation","volume":"190","author":"Hazlett","year":"2025","journal-title":"Mil Med"},{"key":"2026080616031470600_usaf646-B17","volume-title":"U.S. Department of Defense: Prevention Plan of Action 2.0, 2022-2024","year":"2022"},{"key":"2026080616031470600_usaf646-B18","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1080\/08995605.2021.1968289","article-title":"Combat and operational stress programs and interventions: a scoping review using a tiered prevention framework","volume":"36","author":"Cooper","year":"2024","journal-title":"Mil Psychol"},{"key":"2026080616031470600_usaf646-B19","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1177\/0095327X16646645","article-title":"Integrating two theoretical models to understand and prevent military and veteran suicide","volume":"43","author":"Wolfe-Clark","year":"2017","journal-title":"Armed Forces Soc"},{"key":"2026080616031470600_usaf646-B20","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1080\/08995605.2018.1479551","article-title":"Conclusion of the special issue on sexual harassment and sexual assault in the US military: what have we learned, and where do we go from here?","volume":"30","author":"Thomsen","year":"2018","journal-title":"Mil Psychol"},{"key":"2026080616031470600_usaf646-B21","doi-asserted-by":"crossref","DOI":"10.7249\/RR1352","volume-title":"Improving Oversight and Coordination of Department of Defense Programs That Address Problematic Behaviors among Military Personnel","author":"Marquis","year":"2017"},{"key":"2026080616031470600_usaf646-B22","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1111\/sltb.12324","article-title":"A systematic review of mass media campaigns for suicide prevention: understanding their efficacy and the mechanisms needed for successful behavioral and literacy change","volume":"47","author":"Torok","year":"2017","journal-title":"Suicide Life Threat Behav"},{"key":"2026080616031470600_usaf646-B23","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1177\/10778012221092476","article-title":"A popular approach, but do they work? A systematic review of social marketing campaigns to prevent sexual violence on college campuses","volume":"29","author":"Lee","year":"2023","journal-title":"Violence Against Women"},{"key":"2026080616031470600_usaf646-B24","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1093\/milmed\/usaf330","article-title":"Evaluation of components to include in a crosscutting prevention model adaptable for use across diverse military settings","volume":"190","author":"Cassalia","year":"2025","journal-title":"Mil Med"},{"key":"2026080616031470600_usaf646-B25","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1177\/15291006231221978","article-title":"Preventing sexual violence: a behavioral problem without a behaviorally informed solution","volume":"25","author":"Porat","year":"2024","journal-title":"Psychol Sci Public Interest"},{"key":"2026080616031470600_usaf646-B26","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1177\/01632787241291043","article-title":"Strategic interagency capacity building for primary prevention of harmful behaviors in the military: current and future directions","volume":"47","author":"Gallagher","year":"2024","journal-title":"Eval Health Prof"},{"key":"2026080616031470600_usaf646-B27","volume-title":"U.S. Department of Defense: DoD Policy on Integrated Primary Prevention of Self-Directed Harm and Prohibited Abuse or Harm (Department of Defense Instruction 6400.09)","year":"2020"},{"key":"2026080616031470600_usaf646-B28","volume-title":"U.S. Department of Defense: DoD Integrated Primary Prevention Policy for Prevention Workforce and Leaders (Department of Defense Instruction 6400.11)","year":"2022"},{"key":"2026080616031470600_usaf646-B29","volume-title":"Office of People Analytics: Defense Organizational Climate Survey","year":"2025"},{"key":"2026080616031470600_usaf646-B30","volume-title":"U.S. Department of Defense: 2023 On-Site Installation Evaluation Summary","year":"2023"},{"key":"2026080616031470600_usaf646-B31","volume-title":"Community Preventive Services Task Force: The Community Guide","year":"2023"},{"key":"2026080616031470600_usaf646-B32","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1016\/j.evalprogplan.2014.08.004","article-title":"Evidence-based programs registry: blueprints for healthy youth development","volume":"48","author":"Mihalic","year":"2015","journal-title":"Eval Program Plann"},{"key":"2026080616031470600_usaf646-B33","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1037\/0003-066x.58.6-7.449","article-title":"What works in prevention: principles of effective prevention programs","volume":"58","author":"Nation","year":"2003","journal-title":"Am Psychol"},{"key":"2026080616031470600_usaf646-B34","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1177\/15248380241305567","article-title":"Integrating implementation science in interpersonal violence research and practice: a systematic review of barriers and facilitators of implementation","volume":"27","author":"Sabri","year":"2026","journal-title":"Trauma Violence Abuse"},{"key":"2026080616031470600_usaf646-B35","doi-asserted-by":"publisher","first-page":"e20192268","DOI":"10.1542\/peds.2019-2268","article-title":"Applying behavioral economics to enhance safe firearm storage","volume":"145","author":"Hoskins","year":"2020","journal-title":"Pediatrics"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/191\/Supplement_1\/54\/70491102\/usaf646.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/191\/Supplement_1\/54\/70491102\/usaf646.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T20:03:28Z","timestamp":1786046608000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/191\/Supplement_1\/54\/8752085"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":35,"journal-issue":{"issue":"Supplement_1","published-online":{"date-parts":[[2026,8,6]]},"published-print":{"date-parts":[[2026,8,1]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usaf646","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2026,7]]}}}