About

Margaret Kuklinski is the Endowed Professor in Prevention and the Director of the Social Development Research Group at the University of Washington School of Social Work. Her research and intervention efforts are focused on the intersection of prevention science and health economics, aiming to promote positive developmental outcomes through community-based and family-focused interventions. She works to demonstrate the long-term impact of effective prevention programs, identify the necessary levels of investment to improve health and wellbeing, and build policy support by illustrating the benefits and costs of preventive interventions. Kuklinski supports dissemination efforts to communities, families, and agencies and has led or contributed to studies promoting healthy behaviors and positive development for over a decade. She serves as Acting Director for the Center for Communities That Care and is a co-principal investigator on longitudinal evaluations of the Communities That Care prevention system, which has shown impact on preventing drug use and antisocial behavior from adolescence into young adulthood. Additionally, she is involved in multisite trials testing prevention programs for parents of adolescents in diverse healthcare settings and co-chairs the Health Economics Working Group for projects funded under NIDA’s HEAL Prevention Initiative, focusing on preventing opioid misuse among youth. Her work includes establishing best practices for economic evaluations of interventions for children, youth, and families, and she routinely consults and lectures on health economics and prevention science.

Research topics

• Political Science
• Computer Science
• Sociology
• Medicine
• Nursing
• Environmental health
• Business
• Psychology
• Economics
• Actuarial science
• Microeconomics
• Criminology
• Gerontology
• Demography
• Developmental psychology
• Public economics

Selected publications

• Complex pragmatic trials: A model extension with simulation to account for nesting and partial cross-classification

  SSRN Electronic Journal · 2026-01-01

  preprintOpen accessSenior author
  PublisherDOI

• The Longitudinal Relationship of Loneliness With Frequency and Problematic Use of Alcohol and Cannabis Among Young Adults

  Journal of Adolescent Health · 2025-09-14 · 3 citations

  article
  PublisherDOI

• Use of alternative payment models for substance use disorder prevention in the United States: development of a conceptual framework

  Substance Abuse Treatment Prevention and Policy · 2025-01-22 · 2 citations

  articleOpen access

  BACKGROUND: Alternative payment models (APMs) are methods through which insurers reimburse health care providers and are widely used to improve the quality and value of health care. While there is a growing movement to utilize APMs for substance use disorder (SUD) treatment services, they have rarely included SUD prevention strategies. Challenges to using APMs for SUD prevention include underdeveloped program outcome measures, inadequate SUD prevention funding, and lack of clarity regarding what prevention strategies might fit within the scope of APMs. METHODS: In November 2023, the Substance Abuse and Mental Health Services Administration (SAMHSA), through a contract with Westat, convened an expert panel to refine a preliminary conceptual framework developed for utilizing APMs for SUD prevention and to identify strategies to encourage their adoption. RESULTS: The conceptual framework agreed upon by the panel provides expert consensus on how APMs could finance a variety of prevention programs across diverse populations and settings. Additional efforts are needed to accelerate the support for and adoption of APMs for SUD prevention, and the principles of health equity and community engagement should underpin these efforts. Opportunities to increase the use of APMs for SUD prevention include educating key groups, expanding and promoting the SUD prevention workforce, establishing funding for pilot studies, identifying evidence-based core components of SUD prevention, analyzing the cost effectiveness of APMs for SUD prevention, and aligning funding across federal agencies. CONCLUSION: Given that the use of APMs for SUD prevention is a new practice, additional research, education, and resources are needed. The conceptual framework and strategies generated by the expert panel offer a path for future research. SUD health care stakeholders should consider ways that SUD prevention can be effectively and equitably implemented within APMs.

  PublisherOA PDFDOI

• Author response for "Implementation Fidelity of a Virtual Adaptation of the Guiding Good Choices Program"

  2025-02-13

  peer-reviewSenior author
  PublisherDOI

• Does cannabis and electronic nicotine delivery system (ENDS) use interfere with cigarette smoking cessation in young adulthood?

  Addictive Behaviors · 2025-02-11 · 1 citations

  articleOpen access
  PublisherOA PDFDOI

• Links between young adults’ reasons for trying electronic nicotine delivery systems (ENDS), smoking history, and prospective cigarette and ENDS use

  Addictive Behaviors · 2025-07-03

  articleOpen accessSenior author
  PublisherOA PDFDOI

• Implementation Fidelity of a Virtual Adaptation of the Guiding Good Choices Program

  Journal of Community Psychology · 2025-05-30

  articleSenior author

  Offering evidence-based parenting interventions to caregivers virtually has the potential to increase the reach and public health impact of interventions. As virtual adaptations to evidence-based interventions increase, attention must be paid to implementation fidelity, as high fidelity is associated with better program outcomes. This study examined implementation fidelity of a virtual adaptation of the family-based Guiding Good Choices program delivered to 292 families in primary care in three large healthcare systems during the COVID-19 pandemic. Attendance, dosage, adherence, quality of delivery, and participant engagement were examined quantitatively and qualitatively using interventionist and observer surveys, attendance records, and focus groups with interventionists. Interventionists and observers reported high levels of dosage, adherence, quality of delivery, and participant engagement, but attendance was lower than anticipated. Results suggest that delivering parenting programs virtually in primary care with high fidelity is feasible, but retaining participants may remain challenging in this modality, particularly during a global pandemic.

  PublisherDOI

• Cumulative Risk and Cumulative Protection: Relative Contributions to Predicting Substance Use, Antisocial Behaviour and Mental Health Across Development

  Criminal Behaviour and Mental Health · 2025-01-07 · 2 citations

  articleOpen accessCorresponding

  BACKGROUND: Cumulative risk scores predict negative outcomes including antisocial behaviour and mental health. Less work has examined the role of cumulative protection, despite the availability of preventive interventions focused on bolstering protection across domains. Understanding links between cumulative risk and protection measured in childhood and later outcomes can help to guide the timing of prevention programmes. AIMS: The study aimed to understand the relative contributions of early adolescent cumulative risk and cumulative protection in Grade 6 on distal outcomes six to seven years later, at ages 18-19. METHODS: Data are from the Community Youth Development Study, a community-randomised trial of the Communities That Care prevention system. The analysis sample consisted of 2002 participants from 12 control communities. Logistic regression models were estimated to quantify the main and interactive effects of Grade 6 cumulative risk and protection on alcohol, tobacco and cannabis use; antisocial behaviour, and depression at ages 18-19. RESULTS: When considered in separate models, cumulative risk and protection were each associated with later alcohol, tobacco and cannabis misuse; antisocial behaviour and depression. When considered together, coefficients for cumulative protection were attenuated, whereas coefficients for cumulative risk remained similar in magnitude. Cumulative risk was associated with larger outcome prevalence differences (average of 9%) than cumulative protection (average of 2%). Evidence for risk-protection interactions was not observed. CONCLUSIONS: Although early adolescent cumulative protection was associated with later outcomes, these associations were largely reduced when considering cumulative risk. Findings emphasise the importance of addressing cumulative risk when designing preventive interventions.

  PublisherOA PDFDOI

• Co-occurring Change in Electronic Nicotine Delivery System (ENDS) and Cigarette Harm Perceptions and Use in Young Adults

  Nicotine & Tobacco Research · 2025-01-17 · 3 citations

  articleOpen access

  INTRODUCTION: The use of electronic nicotine delivery systems (ENDS) may contribute to cigarette use and nicotine addiction by shifting perceptions and norms around tobacco, but little is known about whether or how ENDS use and norms are related to cigarette use and norms, particularly among young adults. This study tested two potential mechanisms by which END use may facilitate cigarette use: decreasing tobacco harm perceptions (desensitization) and increasing favorability of tobacco use (renormalization). AIMS AND METHOD: Analyses included data from 2187 young adults in a longitudinal panel who reported any ENDS or combustible cigarette use at ages 21, 23, or 26. The sample was 53.6% male, 19.3% Hispanic, and 68.0% White. Parallel process latent growth models were fitted to test how change in ENDS use and harm perceptions about ENDS use co-occurred with change in cigarette use and harm perceptions about cigarette use across a 6-year period from ages 21, 23, and 26 (years 2014-2019). RESULTS: When ENDS harm perceptions decreased and ENDS use increased, cigarette harm perceptions decreased and the favorability of cigarettes increased. Decreases in ENDS harm perception were differentially associated with the likelihood of transition to cigarette use (an increase) and frequency of use when it occurred (a decrease). CONCLUSIONS: Changing tobacco harm perceptions and favorability are two processes by which ENDS use may underlie transitions to cigarette use. Tobacco prevention messaging should emphasize the potential harms of ENDS use that could occur through shifting tobacco perceptions, especially among young adults who are not already frequent cigarette smokers. IMPLICATIONS: Increasing favorability of ENDS (and increased ENDS use) may generalize to combustible cigarettes. Continued use of ENDS can increase risk of cigarette use when this exposure desensitizes nonsmoking young adults from the dangers of smoking and renormalizes pro-tobacco attitudes. Findings suggest that prevention messaging around tobacco products should emphasize the potential harms of ENDS use (including the increased likelihood of cigarette use after initiating ENDS), especially among young adults who are not already frequent cigarette smokers.

  PublisherOA PDFDOI

• Changes in Young Adult Handgun Carrying in the US

  JAMA Network Open · 2025-02-06

  articleOpen access

  This cohort study evaluates changes in characteristics of young aduts who carried handguns from 2019 to 2021.

  PublisherOA PDFDOI

Recent grants

• A Pragmatic Trial of Parent-focused Prevention in Pediatric Primary Care

  NIH · $6.2M · 2018–2025

• NIH Grant F31MH010534

  NIH · $25k

Frequent coauthors

• Sabrina Oesterle

  Arizona State University

  23 shared

• Alice M. Ellyson

  Seattle University

  18 shared

• J. David Hawkins

  16 shared

• Elizabeth H. Weybright

  16 shared

• Ali Rowhani‐Rahbar

  Seattle University

  14 shared

• John S. Briney

  Seattle University

  13 shared

• Emma Gause

  Boston University

  13 shared

• Richard F. Catalano

  13 shared

Education

• PhD, Clinical and Community Psychology

  University of California, Berkeley

  1997

• MA, Psychology

  University of California, Berkeley

  1992

• AB, magna cum laude, Economics

  Harvard University

  1985

Awards & honors

• Kuklinski named to National Academies behavioral health comm…