According to Pransky, what question should be asked at the highest level of prevention evaluation?

The question regarding what should be asked at the highest level of prevention evaluation is focused on assessing individual-level changes that can lead to broader impacts in the community. By emphasizing whether participants' attitudes changed or if their self-esteem improved, this approach acknowledges that foundational changes in personal perspectives and self-worth are essential precursors to behavior modification.

Improvements in attitudes and self-esteem can significantly influence how individuals engage with prevention programs and apply learned skills in their daily lives. When people feel better about themselves and adopt positive attitudes, they are more likely to initiate and sustain behavioral changes that ultimately benefit not only themselves but their communities as well.

In contrast, other options may focus more on outputs or immediate indicators of participation (like attendance), or they might gauge changes in behavior at the program or community level without directly addressing personal growth. Therefore, evaluating changes in attitudes and self-esteem captures a more comprehensive view of a participant's transformation, which is essential for effective prevention outcomes.