Components of Prevention
There are four major components of preventive medicine: (1) vaccinations to prevent infectious diseases (such as polio and measles); (2) screening programs (such as for high blood pressure, diabetes, and cancer); (3) chemoprevention (drug therapy--for example, cholesterol-lowering drugs to prevent atherosclerosis, aspirin to prevent heart attacks or strokes, antihypertensive drugs to reduce blood pressure and prevent strokes); and (4) counseling aimed at helping people make healthy lifestyle choices (such as not smoking, wearing seat belts, and eating a healthy diet).
The components of prevention are provided to achieve one of three levels of prevention: primary, secondary, or tertiary. In primary prevention, disease is stopped before it starts, often by reducing or eliminating risk factors for a health problem. Vaccinations, chemoprevention, and counseling are types of primary prevention. The type of primary preventive care given usually depends on the person's age and risk profile.
In secondary prevention, disease is detected and treated early, often before symptoms are present, thereby minimizing adverse outcomes. Secondary prevention can involve screening programs, such as mammography to detect breast cancer and prostate-specific antigen (PSA) testing to detect prostate cancer, and tracking down the sex partners of a person diagnosed with a sexually transmitted disease (contact tracing) to treat these people, if necessary, and to minimize spread of the disease.
In tertiary prevention, an existing, usually chronic disease is managed to prevent further functional loss. For example, tertiary prevention for people with diabetes focuses on tight control of blood sugar, excellent skin care, and frequent exercise to prevent heart and blood vessel disease. Tertiary prevention can involve providing supportive and rehabilitative services to maximize quality of life, such as rehabilitation from injuries, heart attack, or stroke. It also includes preventing complications among people with disabilities, such as preventing bed sores among those confined to bed.
Prevention in Children and Teenagers: Most of the medical care that children receive is preventive in nature (see Section 23, Chapter 263, Section 23, Chapter 268 and Section 23, Chapter 270). In fact, the standard "well-child" visits are geared to primary prevention. For example, most vaccinations are given during childhood. Height and weight are checked periodically to make sure a child is growing at an appropriate pace. Other screening measures, such as blood pressure measurements and vision checks, are done at specific intervals. Health care professionals counsel parents about appropriate safety measures, such as child safety seats, bicycle helmets, smoke and carbon monoxide detectors, fire extinguishers, flame-retardant sleepwear, regular cleaning and inspection of heating systems and fireplaces, window and stair guards, locked storage of unloaded firearms, removal of leaded paint in older homes, and safe storage of drugs and toxic substances. Parents are also counseled about the dietary and exercise requirements of children, about the effects of passive smoking, and about the need for children to receive regular dental checkups.
The care given to teenagers and young adults is also mostly preventive in nature. Some vaccinations, such as tetanus/diphtheria (Td) booster, measles-mumps-rubella vaccine, and hepatitis B vaccine (HBV) (if not previously vaccinated), are given to preadolescents. Screening measures almost always include measurements of height, weight, and blood pressure. Another important screening measure is checking for depression and suicidal tendencies. Other screening measures may include recommending a Pap smear for young women, checking the immunity of young women to the rubella virus, and assessing for problem drinking and other substance abuse.
Health care professionals should counsel teenagers and young adults on seat belt usage, bicycle or motorcycle helmet usage, the importance of avoiding tobacco and illicit drugs, underage drinking, the importance of avoiding alcohol when driving or swimming, and how to prevent sexually transmitted diseases and unwanted pregnancies. The importance of a balanced diet limited in fat and cholesterol and with adequate calcium (especially for girls) and the need for regular physical activity are also the focus of doctor visits. Chemoprevention (drug therapy to prevent disease) is not a mainstay for this age group, but young women who plan on becoming pregnant are usually advised to take a multivitamin containing folic acid.
Prevention in Young to Middle-aged Adults: Preventive care measures are also needed for the population of people 25 to 64 years of age. The major areas of risk for people this age are established by periodic screenings of blood pressure, height, weight, and cholesterol levels. Some experts recommend measuring blood sugar levels. A health care professional may screen for depression and stress by asking questions about mood and sleep patterns. The person may also be asked questions about the work environment to determine if there are any health hazards.
Pap smears (for cervical cancer) and mammograms (depending on the woman's age or family history of breast cancer) are recommended for women, and breast self-examination is encouraged. After the age of 50 (or younger if there is a family history suggesting increased risk), some experts recommend that men receive an annual rectal examination to screen for prostate cancer. A blood test for prostate-specific antigen (PSA) is sometimes recommended instead of or in addition to the rectal examination. Self-examination of the testicles is discussed as a means to help detect testicular cancer, especially among males from adolescence through age 40. An annual test of the stool for hidden (occult) blood and periodic sigmoidoscopy or another colon cancer screening method are recommended for men and women over the age of 50.
Depending on the person's risk profile, the health care professional may offer counseling on stopping smoking, avoiding alcohol or certain drugs (illicit drugs and drugs that cause sedation) while driving, wearing seat belts, using motorcycle or bicycle helmets, having working smoke and carbon monoxide detectors in the home, having heating systems and fireplaces cleaned and inspected periodically, and making sure all firearms are safely stored. People who spend a lot of time outdoors in areas where Lyme disease is common are advised to take precautions (see Section 17, Chapter 190).
The health care professional will also likely emphasize the importance of a balanced diet (including whole grains, fresh fruits and vegetables, and adequate calcium) limited in fat and cholesterol and the need for regular exercise. Sexual behavior is discussed; again, depending on the person's risk profile, the focus of the discussion may be on preventing sexually transmitted diseases and unintended pregnancies. Women who are planning on becoming pregnant are advised to take a multivitamin with folic acid, to stop smoking, and to limit alcohol intake.
Vaccinations are not central to this age group, although tetanus/diphtheria (Td) boosters are recommended every 10 years, and people at high risk of complications of the flu or pneumonia would benefit from the influenza vaccine every year and pneumonia (pneumococcal) vaccine. The pneumonia vaccine should be repeated once, at least 5 years after the first immunization with the vaccine. Hepatitis B vaccine (HBV) is recommended for health care workers, people at high risk of exposure to blood and blood products, and people at increased risk of exposure due to risky sexual practices. All young adults previously not vaccinated should receive the hepatitis B vaccine.
Women who are experiencing certain symptoms of menopause are counseled about the possibility of receiving short-term hormone replacement therapy (see Section 22, Chapter 243). Other possibilities for chemoprevention include aspirin for people at risk of heart attacks, cholesterol-lowering drugs for people with high cholesterol levels that have not responded to diet and exercise, and drugs that improve or preserve bone density for people with or at risk of osteoporosis (see Section 5, Chapter 60).
Prevention in Older Adults: Preventive care also plays a big role in the health of people over age 65. Many screening measures (blood pressure, height, weight, blood sugar level, cholesterol level, vision and hearing tests, stool tests for hidden blood, colon cancer screening, mammograms, Pap smears, and bone density tests for women, prostate-specific antigen tests for men) may be undertaken.
Counseling measures may include smoking cessation, alcohol curtailment, injury prevention (such as removing throw rugs and installing bathtub rails and grab bars to prevent falls, installing devices such as large-numbered telephones, and setting the hot water heater at not more than 130 degrees to prevent burns), ways to prevent sexually transmitted diseases, and the need for regular dental visits.
A balanced diet limited in fat and cholesterol is emphasized, as is adequate calcium, vitamin D, and vitamin K, especially for women for prevention of osteoporosis. Regular exercise is still beneficial at this age to help prevent heart disease, diabetes, stroke, osteoporosis, and cancer, among other health problems.
Three vaccinations are recommended for people of this age group. The pneumonia (pneumococcal) vaccine is recommended for every person once after reaching 65 years of age, to prevent the most common community-acquired pneumonia, unless the person had the same vaccine before age 65 and less than 5 years previously. The influenza vaccine is recommended every year, and a tetanus/diphtheria (Td) booster is recommended every 10 years.
Possibilities for chemoprevention are cholesterol-lowering drugs to prevent atherosclerosis, antihypertensive drugs to control blood pressure and prevent stroke, and drugs that improve or preserve bone density to prevent osteoporosis or the broken bones (fractures) that may result if a person already has osteoporosis.
 See the table Selected Screening Schedule for Adults.
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