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often long term, and the criterion for success of interventions best reflected in increases in mean level of population potential, expectations for rates of change must be very modest and require high levels of societal commitment. Elizabeth Taylor Vance, Ph.D. Cleveland State Universi~

References Bloom, M. A working definition of primary prevention related to social concerns. Jour~ nal of Prevention, 1980, 1, 15-23. Kandel, D.B. Longitudinal research on drug use: Empirical findings and methodological issues. New York: Halstead, 1978. Vance, E. A typology of risks and the disabilities of low status. In G.W. Albee and J.M. Joffe {Eds.) The Primary Prevention of Psychopathology. Vol. I: The Issues. Hanover, New Hampshire University Press of New England, 1977.

Reply to Critics Vance's careful reading and analysis of my "Working Definition of Primary Prevention Related to Social Concerns" leads to a helpful elaboration of the term primary prevention. Vance recognizes that m y paper is a broad review and synthesis of themes appearing in a selective interdisciplinary literature. I t is, in effect, a set of continua that represents a "prevention space" with some indications where various current writers appear to be located therein. Its major use, as I see it, is as a set of questions that any would-be preventer must answer for him or herself in order to identify what general approaches are to be taken in the preventive enterprise. Vance is correct in noting that additional information must be used in order for one to engage in a specific preventive activity. One of these, among a number of such factors, concerns the types of risks that hosts tindividuals or populations} exhibit. Vance elaborates on this in her remarks. Other equally important factors would include relevant characteristics of the agents or carriers of potential problems, as well as the characteristics of the several environments in which these events will occur. But I submit that this topic is worthy of another paper in its own right--indeed, one that would draw heavily on Vance's own {1977} scholarly paper. However, I would rather consider the "working definition" paper at the present. Are these dimensions useful in focusing one's sights on a preventable topic to which one brings the specific information about hosts, agents, and environments? I believe that the working definition can be helpful to preventers to clarify issues that have to be decided upon prior to any specific set of preventive activities. What orienting model of causation is to be used? What time

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perspective? What hosts or target groups? What types of activities will promote desired ends and which will lead to the forestalling of undesired ones? What strategies are to be used that involve active or passive agreements on the part of users? What type of evaluation will be used for monitoring and outcome evaluation? I submit that these major choice points could be very helpful in the beginning stages of a project, and perhaps as occasional reminders of the central concerns, after a project has been in operation for some time. I doubt whether this list of paradigmatic questions is complete, and I welcome additions. There may be a difference in how Vance and I are using the term "working definition." For her, i t " . . , must be one that points to enabling or operational rules for making choices and selections among the possibilities." She correctly notes that I have a more broadly orienting meaning to the term. However, I doubt whether any definition could serve the function she seeks in other than mechanical fashion. I am reminded of the Lysenko controversy in Russia where operational definitions and research choices were clearly--and unproductively--specified. Research and practice in prevention, as in any other scientific or applied science enterprise, probably would be most fully stimulated by having some common understanding of the concepts, procedures, and socially relevant problems. After that, I would leave specific choices up to the creativity of the individual who is following the empirical literature for ideas. For example, the Task Panel on Primary Prevention (President's Commission on Mental Health, 1978) offers a number of constructive leads from which we might begin fruitful preventive efforts. In short, just as there are many definitions of primary prevention, there may also be a variety of paths along which one might proceed to attain good preventive research and practice. Martin Bloom, Ph.D. Virginia Commonwealth University Richmond, Virginia