Investing in Infrastructure: A Mixed-Methods Cost Analysis of Implementation Strategies to Address Emerging Youth Drug Trends.

Objective: Schools engaged in prevention efforts struggle to respond quickly and effectively to changing drug use trends due to insufficient investment in infrastructure at local, state, and national levels. This results in preventable morbidity and mortality among adolescents. This study estimated the costs associated with implementing Rapid Adaptation to Prevent Drug use (RAPD), infrastructure-building implementation strategies, using mixed methods to optimize data collection feasibility, quality and support a comprehensive understanding of outcomes.

Methods: We conducted semi-structured interviews in Step 1 (pre-pilot trial) to inform the initial cost data collection approach. During Step 2, we used activity-based costing, conducted sensitivity analysis, and estimated budget impacts of replication. Step 3 included interviews with pilot participants to contextualize the results and verify time reporting.

Results: Thirty-four school personnel participated in Step 1 interviews and four health coordinators and six teachers participated in the pilot study. We identified cost drivers and pragmatic constraints related to effective time-cost data collection and developed an activity-based costing data collection plan. The estimated costs for deploying RAPD (Step 2) were $6,215/school. We estimated the budget impact of replication to be $5,551/school with 52% of the cost during the pre-implementation phase. In Step 3 interviews participants identified financial and staffing resources as central challenges to infrastructure development.

Conclusion: This study uses a mixed methods approach, including an exploratory sequential design, to proactively guide microcosting. By identifying potential barriers in advance, we enhanced the rigor and feasibility of our data collection process. The study offers preliminary cost estimates to deploy RAPD infrastructure-building strategies to address emerging drug trends and sustain prevention efforts.

Public Health Significance Statement: Building prevention infrastructure is essential in preventing the onset and escalation of substance use among youth. Implementation strategies are key in building robust implementation infrastructure for prevention. Estimating costs associated with infrastructure building strategies is vital in realizing the public health impact of prevention interventions.