When prevention science meets politics: a case study of macrosystem barriers to school-based CSEC prevention

The commercial sexual exploitation of children (CSEC) is a critical public health issue in the United States, yet rigorous evaluations of primary prevention programs remain scarce. While ecological systems theory highlights the importance of macrosystem influences (e.g., policy, political climate), these factors are rarely examined as direct barriers to prevention implementation and evaluation.

This paper describes a community-based participatory research (CBPR) case study of Project LIVE-a federally funded, school-based CSEC prevention trial in a public school district in a midsized Midwestern city-to examine how macrosystem-level forces disrupted program implementation and compromised the feasibility of rigorous evaluation.

Drawing on a multi-year (2022-2027) CDC-funded initiative, we synthesize recruitment and retention data, implementation records, and contextual documentation across an open pilot trial and a planned quasi-experimental design. Using an ecological systems framework, we analyze how federal, state, and district-level policies and events shaped study outcomes.

Despite strong community partnerships, high program relevance, and extensive recruitment efforts, enrollment and retention were insufficient to support planned analyses (e.g., <13% post-test completion in the quasi-experimental phase). Key barriers included a state-mandated shift from passive to active guardian consent, federal immigration enforcement policies that heightened fear among immigrant communities, mass federal workforce reductions affecting grant oversight, and substantial school district administrative instability. These macrosystem disruptions cascaded across micro, meso, and exosystems, ultimately leading to early termination of programming.

Findings underscore the critical yet underexamined role of macrosystem forces in shaping the feasibility and success of school-based prevention research. Even well-funded, theoretically grounded, and community-engaged interventions may fail under conditions of political instability and policy misalignment. Future prevention science should incorporate assessments of policy context, community readiness, and structural risk, and prioritize flexible, adaptive designs capable of withstanding macro-level disruptions.