Changing the Focus
(Full Paper)

Changing the Focus of Interventions: Primary Prevention at the Couple Level*

Scott P. Gardner, Ph.D.** and Linda S. Howlett, M.S.
South Dakota State University

Abstract
Traditionally, intervention programs addressing serious social issues, ranging from crime to family violence, have focused on the individual or on the community as the intervention target. Although evidence exists linking many of our significant social ills to marital distress, the marital dyad is seldom the focus of interventions. After reviewing the literature surrounding the negative effects of marital distress on children, adults, families and communities, the authors explore the need for aiming more interventions at the marital dyad. Established and new approaches to marriage education are presented along with a review of supporting studies. The authors emphasize the need for primary prevention focused at the couple level highlighting a variety of new high school marriage education curricula. Finally, recommendations for agencies, practitioners, policy makers and researchers are suggested.

Key Words: Marital distress, marriage education, primary prevention

The news recently seems replete with reports of crime, drugs, gangs, school problems, abuse, family violence, suicide and poverty. At both the national and local levels, these social symptoms have been, and continue to be problematic. Traditional thinking and interventions seem to only scratch the surface. A new approach is needed that more accurately and effectively addresses the common roots of these social ills. Current mind-sets must change in two realms. First we must consider, from an ecological perspective, what level of analysis is most appropriate to target in intervention efforts. Second, we must consider the typical versus preferred timing of interventions.

TRADITIONAL LEVELS OF INTERVENTION
Bronfenbrenner (1979) proposed an ecological model which identified various levels or contexts on which to focus in order to understand how ecology impacts a system or an individual. According to this perspective, Bronfenbrenner explained that the individual is part of several embedded systems. Beginning with the system closest to the individual, these systems include: the microsystem (roles and relations), mesosystem (relationships between two or more settings), exosystem (external settings that do not include the individual), and macrosystem (culture). Bronfenbrenner=s approach considers the environments of individuals throughout different stages of the life cycle. His approach focuses mainly on the microsystem and mesosystem, because these two have the greatest direct effects on children. For the purposes of this paper we will look at the embedded systems of the individual, the couple, the family, and the community (see Figure 1).
Historically, the majority of intervention programs have targeted the individual or the community level. There are individually focused programs for juvenile offenders which teach them skills to prevent recidivism and future offenses, but neglect the family environment. There are programs focused on the community level, as in Texas where many organizations began organizing neighborhood involvement centers to address the needs of children at risk. Although these efforts are a step in the right direction, other levels of intervention have been largely neglected (i.e. couple and family).
It would appear that our reliance for many years on psychologically- and sociologically-based theories has led us to develop interventions focused on the individual (psychology) and the community (sociology). With the advent of family science as an integration of psychology and sociology, more intervention programs are focusing on the family level. For example, the juvenile justice system has recognized the need to not only help a deviant child change, but also to help the family learn the skills necessary to change the family environment.
Many programs have adopted a beneficial multi-level approach targeting individuals, families, schools, and communities simultaneously. This inclusion of the family has been gratifying and much needed; however, there seems to be a great reluctance to take interventions one step further. What is needed is to focus interventions at the level of the couple, the foundation of the family.

EVIDENCE FOR TARGETING THE COUPLE DYAD
Consider some of the top concerns of citizens in the United States. In a random sample in three western states, the top concerns of respondents included: health care costs, substance abuse, child abuse and family violence, youth illiteracy, school dropout, inadequate schooling, elderly health care, strengthening the family, young adult health insurance, youth suicide, alcoholism and teen pregnancy (Yang, Fetsch, Jenson, & Weigel, 1997). At least 9 of the top 12 concerns have been linked to marital distress. Holmes and Rahe (1967) indicated that of the fourteen most stressful life events, eleven are related to marriage and family. Marital distress affects the individual, the family, and the community.
Effects of Marital Distress on the Individual

Effects on individual socio-emotional well-being. Marital distress affects individuals both emotionally and physically. In the emotional arena, marital distress alone has been linked to manifestations of stress in children including: internalizing and externalizing behavior problems (Buehler et al., 1998; Vandewater, & Lansford, 1998); conduct disorders (Coie et al., 1991); poor academic performance and low self-esteem (Goldberg, 1993); social and emotional disturbance in school (Mattison, Morales, & Bauer, 1992); poor peer relations (Vandewater, & Lansford, 1998); youth crimes including theft, robbery, violence, gambling, and sexual crimes (Hooper, 1985); and teen suicide (McClure, 1988; Nelson, Farberow, & Litman, 1988). Marital distress has also been linked to adult manifestations of stress including: lower levels of general psychological and social well-being (Amato & Booth, 1991), lower life satisfaction in young adults (Gohm, Oishi, Darlington, & Diener, 1998); substance abuse, criminal activity, eating disorders (Goldberg, 1993); psychopathology (Bowlby, 1986; Brown, 1996); depression (Horwitz, White, & Howell-White, 1996; Klerman & Weissman, 1990); and adult suicide (McClure, 1988; Nelson, Farberow, & Litman, 1988).
Effects on individual physical well-being. Physical health is also specifically tied to marital distress. Doherty (1998) states,
A stable, happy marriage is the best protector against illness and premature death...adults who experience divorce more than double their risk of earlier mortality, and children who experience a parental divorce have their life expectancy shortened by an average of four years, according to a fifty?year longitudinal study. (p. 1)
More specifically, Levinson, Carstensen, and Gottman (1993) found that people in dissatisfied marriages report more physical problems as well as mental problems. Further, House, Landis, and Umberson (1988) found that the amount of evidence linking social relationships to physical health roughly equals the amount of evidence the Surgeon General used in 1964 to indicate that cigarette smoking is a risk factor for diseases and death. Others have also found interpersonal relationships to be an important physical health factor (Campbell, 1991a, 1991b; Doherty, 1993).

Effects of Marital Distress on the Family
Aside from the obvious impact of marital distress on families such as a correlation with marital battering/domestic violence (Bowlby, 1986; Goldberg, 1993; Markman, Floyd, Stanley, & Storaasli, 1988), there may be other less obvious reverberations. Rogers and White (1998) found that parenting satisfaction is significantly and positively related to marital quality. Davies and Cummings (1994) report that in families with severe marital distress, parents discipline is harsher and less consistent than in families with higher marital quality. After reviewing relevant research on father involvement in families, Doherty, Kouneski and Erickson (1998) concluded that marital distress is a significant barrier to quality fathering, while Aenduring marital partnerships may be the most important contribution to responsible fathering in our society@ (p. 290). In essence, satisfying and quality parenting, particularly for fathers, is inversely related to the degree of marital distress in a couple.

Effects of Marital Distress on the Community and Society
Marital distress does affect mental and physical health as well as family relationships with children, spouses and others. Marital distress not only affects the family, it also has deleterious effects on the workplace and community. The ecological model (Bronfenbrenner, 1979) suggests that the couple microsystem affects surrounding systems and even those systems not directly associated with the microsystem in question.
Effects on the workplace. Several studies show a negative effect of marital distress on the workplace. Goldberg (1993) found that marital distress lead to lower work productivity and performance. O=Leary and Smith (1991) reported that in a survey of small business operators in the Mid-West, marital problems were the number one inhibitor of productivity in the workplace. This ranked above alcohol or drug-related problems. Similarly, in a national survey of law enforcement officers, 85% indicated that the one thing that would help them the most in their job was help with their personal problems (Thomas & Caverly, 1998). Forthofer, Markman, Cox, Stanley and Kessler (1996) concluded that marital distress was positively associated with work loss. This was particularly true among men in their first 10 years of marriage. These authors estimated that marital distress results in work loss in excess of $6.8 billion per year. Gottman (1998) however, suggested that this figure is too low and estimated that up to 30% of sick time is marriage and family related.

THE MARRIAGE TABOO
Considering that so many social ills are correlated with marital distress, it is puzzling that programs and policies are not focused on the couple level. This is not to imply that other levels of intervention are not valuable. Nor does it mean that marital distress causes these problems. Research to unquestioningly state that one causes the other is not currently available. It could be that these socio-emotional, physical health and family stressors cause marital distress. Both marital distress and these personal and social problems also could be related to a third factor such as financial strain which could make it appear that marital distress causes such problems. Certainly these are possibilities, but when marital distress is correlated so strongly with so many significant social ills, it appears prudent to focus more time, money and effort in intervention efforts at the couple level. This is a missing link in endeavors to curb social problems.

Why then have we as a society been hesitant to target the couple level? Two reasons emerge: the private nature of marriage and the current sociopolitical attitudes. The marriage relationship is seen as personal, private, and sacred. Marriage therapists encourage new couples to maintain a firm boundary around the new marriage to keep others out of the middle of the relationship. Couples are reticent to share marital concerns outside of the marriage and put up a front that all is well. Indeed when a couple does share information about their marital problems, others are uncomfortable with the information. In domestic violence situations we even hear of neighbors closing their windows and doors while saying, Awe don=t want to become involved in their business.@ Unfortunately, these views have kept people from seeking help for significant marital problems including conflict, violence and abuse. Marriage is also seen as sacred and between a couple and their Deity. This notion places an additional boundary around the marital relationship which adds to its impermeability. On the other hand, marriage is a contract between the couple and the state, and when marital problems affect children, schools, the workplace, communities, and the nation, we can no longer afford to treat marriage as a taboo and off-limits fortress.

Related to this, our sociopolitical climate also plays a role in our reluctance to target the couple level. Some family scholars have begun to address the AM-word@ attitude, treating the word Amarriage@ as politically incorrect. It seems that in an effort to be inclusive and sensitive to all family forms, we have thrown the marriage baby out with the bath water. This has led not only to avoiding the M-word, but has also led to avoiding the couple as a viable intervention target for any family form. We see examples of this at both the national and state levels. In his State of the Union address, President Clinton (1997) talked about our many family-related problems and suggested some important solutions. In all this talk about family-related societal problems however, he never once mentioned the word, Amarriage.@ Similarly, the Office of the Attorney General of the State of Texas produced a comprehensive report on gangs and gang violence which included a variety of interventions (Buhmann, 1993). While the report acknowledged that the largest percent of the state=s serious juvenile offenders came from divorced families, none of the recommended solutions mentioned marriage or family. Whitehead (1996) also pointed out that even the American Association for Marriage and Family Therapy annual conferences present few sessions on marriage each year. The word Amarriage@ Ashowed up twice in 1992 and not at all in 1993" (p. 190). Likely these omissions were largely unintentional; however, the trend of avoiding the M-word is a clear and problematic hurdle to the implementation of interventions targeted at the couple level.

IMPORTANCE OF INTERVENTION TIMING
After changing intervention efforts to be more inclusive of the couple level, timing of efforts must be addressed. In attempting to avoid the mental and physical health problems associated with marital distress, it seems clear that prevention is preferable to crisis intervention. Heller and Monahan (1977) indicate that prevention occurs at three time periods or levels: primary prevention, focused on those who do not currently have a problem; secondary prevention, focused on those who are at risk for developing problems; and tertiary prevention, focused on those who already have a problem so future relapses can be prevented.

Considering the interventions that are typically used to address the many social symptoms of our society, it is fair to say that the vast majority of today=s interventions are tertiary prevention efforts at best. In essence, most of our social programs and funding are mopping up the overflowing bath water rather than turning off the faucet. The ideal approach is primary prevention, focusing prevention efforts on everyone before a problem emerges. In a meta-analysis comparing primary prevention programs in general (for children and adolescents) to other interventions, Durlak and Wells (1997) found that the average participant in a primary prevention group out performs 59-82% of those in control groups.

Prevention at the Couple Level
Effective couple-focused programs. Marriage educators have been aware of the need for prevention at the couple level for a number of years and have developed well supported programs. Perhaps the best evidence for the effectiveness of premarital preparation programs lies in a number of meta-analyses that have looked at the outcome research on these types of programs over the years. In summarizing 29 marital and premarital programs, Gurman and Kniskern (1977) found that these programs were effective in decreasing the likelihood of marital problems. Hof and Miller (1981) looked at 40 studies of such programs and suggested that these programs appear to be effective. Wampler (1982) reviewed 19 studies on the Minnesota Couples Communication Program and found that these programs have an immediate and positive effect on communication behavior and relationship satisfaction. Research on marital satisfaction also suggests that programs targeting premarital couples have more of an impact than those programs targeting couples already married (Giblin, Sprenkle, & Sheehan, 1985).

Research on specific premarital education programs reports that programs improve global relationship adjustment; improve commitment to the couple relationship (Buckner & Salts 1985); increase self-disclosure, increase acceptance of partner and use of positive solutions, improve problem-solving skills, decrease disagreements and negative emotions, and thus promote marital quality and stability (Markman, & Hahlweg, 1993; see also Markman, Renick, Floyd, Stanley, & Clements, 1993; and Renick, Blumberg, & Markman, 1992). Additionally, such programs cut the divorce rate by half (Markman et al., 1988; Olsen 1983) and lead to happier, better functioning children (Markman, et al. 1988). It is also important to note that as with any skills, these skills affect all relationships including those outside the couple relationship (e.g. parent-child, employer-employee, etc.).
Although many couples programs are successful, those which focus on giving the couples specific skills appear to enjoy the most research support. Sollee (1999) suggests that skills are more important than knowledge about marital relationships. The research other too have found that skills have more of an impact than does knowledge of various marital concepts (Gardner, 1999).

New couple-focused efforts. Others besides marriage educators are beginning to realize the need for prevention at the couple level. For example, some state lawmakers have begun to change marriage licensing laws to reemphasize the commitment of marriage. Although a number of states have pursued such options, only a few are mentioned here to illustrate. Louisiana has implemented two types of marriage licenses, the traditional and the Acovenant@ marriage license. The covenant marriage license limits the grounds for divorce and extends formal separation periods in hopes that couples will be less likely to divorce. In January 1999 a Florida marriage law went into effect which in part offers a reduction in marriage license fees for those who take a marriage preparation course or counseling (Marriage Preparation and Preservation Act, 1998). At the community level, over 100 locales across the nation have instituted community marriage policies in which clergy across denominations who perform marriages agree not to marry anyone who does not first attend some form of premarital preparation. Judge Jim Sheridan of Adrian County, Michigan organized a similar policy. In this case all marrying civil servants (judges, magistrates, justices of the peace) agreed not to marry anyone who does not first attend some form of premarital preparation. This policy then garnered the support of clergy in the county. In the greater Grand Rapids, Michigan area, this marriage policy has expanded so that schools, businesses and others are also encouraging marriage education.
These are admirable movements toward prevention targeted at the couple level. One criticism of such interventions is that they generally target people who are already engaged, and this may be too late. Wedding plans often tend to cloud the picture. Additionally, those who pursue premarital preparation are perhaps not those who need it the most. Intervention needs to take place long before engagement, and it must be true primary prevention in which everyone obtains the intervention, not just those who are most interested in it.

PRIMARY PREVENTION IN THE SCHOOLS
Knoff and Batsche (1990) argue that the school is the best place for all children to be drawn into mental health services. It is also an ideal place for primary prevention targeted at the couple level. An additional section of the recent Florida Marriage Preparation and Preservation Act (1998) uses this strategy to accomplish true primary prevention. This legislation provides for marriage education skills courses for all 9th- and 10th-grade high school students starting January 1, 1999. In this way, nearly everyone is targeted, the intervention is early enough to catch people before they become engaged, and the intervention is focused at the couple level. A number of these high school and middle school curricula currently exist. There are six major programs that will be discussed here.

The Art of Loving Well
The Art of Loving Well is a literature-based relationships curriculum for middle school and high school students (Coalition for Marriage, Family and Couples Education [CMFCE], 1998). Based on a textbook consisting of 41 ethnically diverse classic works and contemporary adolescent literary selections, The Art of Loving Well has been used with students in grades 7-12 in 47 states within schools, community groups, church groups, and homes. The textbook contains three sections that include exercises emphasizing social and emotional skills, effective communication, critical thinking, decision making skills, conflict resolution, and sexual abstinence. The sections are titled Early Loves and Losses, Romance, and Commitment and Marriage. The values of social responsibility, responsible sex, committed faithful love, and friendship are promoted throughout the curriculum (CMFCE). Developed at Boston University, the curriculum was initially tested on 10,000 students in 8th- and 9th-grade English and health classes. The evaluations assessing the impact of the curriculum specifically on sexual risk-taking in relationships have been positive. The results suggested that of the 8th-grade students who identified themselves as virgins at the beginning of the school year, only 8% of those taking this curriculum reported that they had sex during that year compared to 28% of the control group (Kreitzer, 1992).

Building Relationships: Skills for a Lifetime
Building Relationships is a program developed for teens ages 13 to 18 (CMFCE, 1998). This curriculum is based on the PREPARE and ENRICH research of Olson, Fournier, and Druckman (1989), and is rooted in family systems and communication as well as conflict theory. The purpose of Building Relationships is to build awareness of dating and other relationships in school and church settings by using a textbook that includes 13 chapters focusing on dating, communication problems, affection and sexuality, family of origin issues, financial issues, and values and beliefs. The curriculum seeks to teach skills of assertiveness and active listening, constructive conflict resolution, verbal and nonverbal communication of expression, budgeting and managing finances, goal setting, and the importance of having a mentor. The length of the curriculum varies from 5 to 20 sessions (CMFCE).

Connections: Relationships and Marriage
Connections is a curriculum that was written for use by teachers, counselors, and others who work with youth in grades 11-12 (CMFCE, 1998). It was developed by Charlene Kamper, a family life teacher in Redlands, California, and is published by The Dibble Fund. The curriculum contains 15 one-hour lessons that comprise four units: personality, relationships, communication and conflict resolution, and marriage. The content aims to fulfill the needs of today=s youth for self-understanding and self-esteem, healthy dating relationships and values, effective communication and conflict resolution skills, and the awareness of skills needed to build a successful marriage. While Connections is currently being used in 20 states, there has been little formal research done on the impact of the curriculum. However, independent evaluations have found that the curriculum has a positive impact on the attitudes of adolescents (Kamper, 1998). Studies evaluating the Connections curriculum are currently underway in California and South Dakota (Clark, 1998; Gardner, 1998).

Social-Emotional Intelligence
Another program, Social-Emotional Intelligence (EQ) has been developed to teach relationship skills to children in elementary and middle school (CMFCE, 1998). EQ can be used in schools, churches, clubs, and homes. It consists of 24 thirty-minute lessons on intrapersonal and interpersonal skills. Lessons are taught by using exercises, skits, homework, and handouts. The program has three age-appropriate versions: grades K-1, grades 2-4, and grades 5-8. The program is unique in the fact that volunteer teachers assist in the teaching of the program. These volunteers are often high school students, college students, and parents who are solicited to assist with the program (CMFCE).

Pairs for Peers
Pairs for Peers is a program for teens ages 13-18 that consists of 26 lessons for high schoolers and 20 lessons for middle schoolers that are each 50 minutes in length (CMFCE, 1998). This curriculum is based on the Pairs marriage enrichment program established by Gordon (1993). The program teaches the following skills: (a) communication enhancement, (b) conflict resolution, (c) respect for differences, (d) empathy development, (e) values of healthy relationships, (f) self-worth development, (g) avoidance of misunderstandings, (h) appreciation of others, (I) taking responsibility, and (j) viewing the family of origin. These skills are taught through lectures, role plays, interactive exercises, and peer coaching.

Partners
The Partners program is a 10-week program used with 11th- and 12th-graders (CMFCE, 1998). This program is also based largely on the Pairs program of Gordon (1993). In this case, the curriculum is sponsored by the American Bar Association B Family Law Section, and is taught alternately by the classroom teacher and a local lawyer. There are ten 50-minute sessions that teach students communication and negotiation skills, relationship stress management, and how to recognize the qualities they would like in a mate. A video is used to structure the program which illustrates a young couple with a child. The couple experiences a common difficulty, and ultimately one partner consults with an attorney about divorce and thus realizes the consequences of marital breakup. The students then work to identify the real source of conflict for the couple and identify how their communication patterns fuel the conflict. The students then learn and role play alternative approaches to the conflict. Throughout the 10 weeks, students learn about how family law issues impact their lives (CMFCE).

CHALLENGES
Clulow (1996) suggests that one of the problems with education-based interventions is the assumption of rationality, or that with proper information, people will make rational choices. A second problem with education is that people must look at and explore their own situations for the education to be most effective and some Amay not wish to explore their experience other than in ways that will help them manage what preoccupies them most at the time@ (p. 349). High school students seem particularly susceptible to both of these issues.
Another challenge to implementation of such primary prevention efforts in the schools lies in the fears of some that such curricula will be overly value-laden. As Clulow (1996) suggests, some feel that Apublic solutions to private problems could result in unwarranted and unwelcome intrusions into the inner sanctum of the family....The specter of social control was raised as a threat to individual freedoms and rights@ (p. 343). Others fear that mandating such courses will take away from the basics of reading, writing and arithmetic. Interestingly, however, parents are seeing the need to teach interpersonal skills. A survey of 12 industrialized nations by the National Center for Education Statistics and the Pelavin Research Institute (Galper, 1998) found that for the U.S. and much of Europe, teaching socialization skills in schools was more important to the public than all academic subjects except mathematics.

RECOMMENDATIONS
Agencies, Practitioners, and Schools
Agencies and practitioners can assess their typical levels and timing of intervention programs. There is a great need to change our focus to primary prevention at the couple level, whatever the intervention. Programs that have added a family component can take that family component one step further by considering the needs of the marital dyad and the necessity of teaching children the skills necessary to have successful and happy marriages.

Those wishing to implement marriage education curricula in the schools can begin by ascertaining what courses are already being taught. Many schools have health and/or family life courses where the subject matter includes marriage and relationship skills; however, teachers often lack a coherent curriculum. Most teachers have been very pleased to find that ready-to-teach curricula are available. Next, many individual school districts have the authority to require all their students to take a family life course. Encourage administrators to consider such a requirement. The information in these classes is beneficial for all students and will impact every area of their life including their potential for success in the workplace. Often, these courses are offered but are not required.
Funding

Funding for the purchase of these marriage education curricula can be secured through a number of avenues. First, schools may already have budgeted funds for new curricula. Second, some businesses in the community will often be willing to fund such endeavors. For example, the Partners curriculum is often purchased by a law firm in the community whose attorneys then help to teach the course to the students. At a state level, the Oklahoma Bar Association also purchased both the Connections and Partners curricula for all the high schools in the state. Third, your state vocational education division or department of education may have funds available for innovative programs. Some states such as Massachusetts have been successful in purchasing these curricula with pregnancy prevention and abstinence education dollars. South Dakota was able to purchase the Connections curriculum for many of its high schools through vocational education funds. When seeking funding for such programs, the proposal should emphasize the social costs of marital distress on society and how the program in question can reduce these costs.
Policy Makers

Alarmed by the societal costs of marital distress and divorce, policy makers in many states (Alabama, Alaska, Georgia, Florida, Illinois, Indiana, Louisiana, Michigan, Texas, Utah, and Wisconsin) and countries (Australia, England, Norway, and the United States) have recently presented legislation geared toward decreasing the divorce rate and its many negative outcomes. Policy makers are encouraged to focus efforts at the primary prevention level as opposed to focusing solely on creating barriers to divorce. Policy makers can also learn from the successes and failures of other states. According to D. Sollee (personal communication, December 17, 1998), founder of the Coalition for Marriage, Family and Couple=s Education, as of the end of 1998, only Florida and Louisiana=s bills had progressed out of committee partly because they did not restrict divorce laws and made premarital counseling optional as opposed to mandatory. Alaska=s recently failed marriage legislation (November, 1998) also points out one of the pitfalls to avoid. According to K. Pearson (personal communication, October 19, 1998), director of the State Department of Health and Human Services, citizens were concerned about the possibility of negative values being taught to their children. Efforts must be taken to ensure that parents are aware that these curricula are not overly value-laden, but simply focus on teaching skills within a child=s current value system. Lastly, others have suggested that it is important to emphasize that these programs are primarily educational as opposed to therapeutic (Roberts & Morris, 1998). In this way parents can be assured that they are not sending their child to a group counseling session.

IMPLICATIONS FOR RESEARCH
Senediak (1990) points out that a number of problems exist with premarital education programs including: the theoretical nature of most programs, lack of specific goals in program format, and poor evaluation procedures. This led Senediak to conclude that the current value of these programs is limited. Although the programs are now more theoretically based, have clearer objectives and are better evaluated, new limitations have emerged. Marriage preparation programs in general have been researched and shown to be effective in reducing marital distress; however, the available school marriage education curricula have not been well evaluated due to their newness. Information is needed in a number of areas. First, there is a need to assess students= current baseline knowledge and skills for a successful marriage. Next, there is a need to know if these curricula increase short-term knowledge and self-esteem; improve relationship skills; decrease abusive relationships, risky sexual behavior, and teen pregnancy; and otherwise have an immediate impact on the lives of young people. Lastly, there is a need to assess the long-term impact, if any, on students= future marriages and relationships including the impact on marital distress, divorce, and other stressors associated with marital distress (Laner & Russell, 1995).

Many other areas will need to be addressed along the way including ideal course content, the effectiveness of the programs for rural versus urban students, and the effectiveness of programs for various ethnic and minority groups. Such research will allow these curricula to be refined, focused and efficient so as to best help students in all their future relationships.

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Figure Caption
Figure 1. Embedded levels of analysis for possible intervention focus.