There are many tools of prevention, including the following major tools:
Establishing a healthy lifestyle, which includes healthy habits such as wearing a seat belt, eating a healthy diet, getting enough physical exercise, wearing sunscreen, and not smoking
Getting vaccinated to prevent infectious diseases such as influenza, pneumococcal pneumonia, and childhood infections
Following recommendations for screenings so that disorders such as high blood pressure and cancer are detected early
If people are at high risk of developing certain disorders (such as atherosclerosis) or have such a disorder, taking medications as recommended to prevent the disorder from developing or worsening (called preventive medication therapy or chemoprevention)
Preventive medication therapy includes the following:
Cholesterol-lowering medications to prevent atherosclerosis
heart attacks and/or strokes in people at increased risk of these disorders
breast cancer in women at increased risk of breast cancer
Antihypertensive medications to reduce blood pressure and prevent strokes
Did You Know...
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Healthy Lifestyle
Lifestyle and disease are clearly linked. For example, eating an unhealthy diet (high in calories, saturated fats, and trans fatty acids and deficient in certain other nutrients), not exercising regularly, and smoking increase the risk of developing heart disease, cancer, and stroke—the three leading causes of death in the United States. Changing unhealthy lifestyle habits can help prevent particular disorders and/or improve fitness and quality of life. Talking with doctors and other health care professionals can help people make good decisions and establish healthy habits. However, establishing and maintaining a healthy lifestyle can be done only by the person. Consistently eating a healthy diet and getting enough exercise are difficult for many people, but people who do so reduce their risk of developing serious disorders and often feel better and have more energy.
Healthy eating habits can help people prevent or control disorders such as high blood pressure, heart disease, diabetes, osteoporosis, and certain cancers. Recommendations include
Eating plenty of vegetables, fruits, and whole-grain cereals and breads, partly because such a diet is high in fiber
Reducing consumption of saturated fats (such as those in butter, cheese, beef, pork, poultry with the skin, and some prepared foods) and avoiding trans fatty acids
Limiting calories to maintain recommended body weight (see table Body Mass Index (BMI))
Limiting the amount of salt consumed
Physical activity and exercise can help prevent obesity, high blood pressure, heart disease, stroke, diabetes, some types of cancer, constipation, falls, and other health problems. The best routine includes moderate physical activity for a total of 150 minutes per week, or vigorous aerobic activity for 75 minutes per week (or a combination of the two). Exercise periods should be at least 10 minutes long and ideally spread throughout the week. However, getting even a little bit of exercise is much better than none at all. For example, people who can devote only 10 minutes to physical activity a few times per week may still reap important benefits, particularly if the exercise is vigorous. Walking is one simple, effective exercise that many people enjoy. Certain types of exercise can also target specific problems. For example, stretching improves flexibility, which can help prevent falls. Aerobic exercise may decrease the risk of heart attack and angina.
Safe sex practices remain important. Key safe sex practices are avoiding risky sex partners and remaining mutually monogamous. People who have more than one sex partner can greatly reduce their risk of contracting a sexually transmitted infection by correctly using a latex condom every time they have sex. People who are allergic to latex can use other kinds of condoms.
Limiting alcohol use is important. The Centers for Disease Control and Prevention (CDC) recommends that adults of legal drinking age either not drink any alcohol or limit the amount to 2 drinks or less in a day for men or 1 drink or less in a day for women on days when alcohol is consumed. (Each drink is about one 12-ounce [341 ml] can of beer, 5 ounces [142 ml] of wine, or 1.5 ounces [43 ml] of liquor of more concentrated liquor, such as whiskey.) Whether drinking, even small amounts of alcohol, has any health benefits is unclear. Also, drinking even small amounts of alcohol may increase the risk of harmful effects.
Preventing injuries is crucial to maintaining a healthful lifestyle. People can lower their risk of injury by taking certain precautions, such as wearing appropriate protective equipment (including seat belts). For older people,the following can help reduce the risk of falling:
Removing throw rugs
Having good lighting at home
Exercising (especially to improve balance and muscle strength)
Having vision checked regularly, getting the correct glasses, and wearing them
Having a doctor, nurse, or pharmacist review all medications that can contribute to falls whenever prescriptions are added or changed
Adequate sleep is also an important part of a healthy lifestyle, particularly affecting mood and mental state. Insufficient sleep is a risk factor for injuries.
Safety 101
Simple, common-sense safety measures can help prevent injuries. The following are some examples: General Safety
Home Safety To prevent falls and fall-related injuries in children:
To prevent poisoning:
To prevent fires:
To prevent carbon monoxide poisoning:
To prevent exposure to radon:
To prevent lead poisoning:
To prevent burns:
Food Safety
Car Safety
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Vaccination
Vaccines have been enormously successful. Dangerous and sometimes fatal infectious diseases such as diphtheria, pertussis, tetanus, mumps, measles, rubella, and polio have decreased by more than 99% from their peak number of cases, thanks to the availability of effective and safe vaccines and their widespread use. Furthermore, vaccinations save about $16 in health care costs for every $1 spent.
Many side effects have been attributed to vaccines (see Childhood Vaccination Concerns). Actual side effects that occur depend on the vaccine, but common side effects are usually minor and include swelling, soreness, and allergic reactions at the injection site, and sometimes fever or chills. More serious side effects can occur. They include autoimmune reactions (for example, Guillain-Barré syndrome, which causes temporary weakness or paralysis). However, serious side effects are very rare if vaccines are used appropriately.
Systematic and extensive research has found no link between vaccines and other serious side effects such as autism. Reports that vaccines cause AIDS or sterility are urban legends and have no factual basis. Refusing vaccination to avoid side effects increases the risk of getting an infection, which is a much greater threat to health than are possible side effects of vaccination.
Did You Know...
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Children and adolescents, older adults, and people whose immune system is impaired are often the most vulnerable to infections that vaccines can prevent. If these people get such infections, they are also often the most likely to have serious symptoms. For example, whooping cough (pertussis) tends to cause severe symptoms in infants but can be as mild as a cold in older, otherwise healthy people. Although it is most important to vaccinate the most vulnerable people, vaccinating other people is also important. Doing so not only prevents illness in the vaccinated person but also reduces the number of people in the community who could develop and thus transmit infection to more vulnerable people. Thus, deaths and serious complications in the community are reduced by vaccinating as many people as possible. This effect is called herd immunity.
Screening
Screening is testing of people who are at risk of a disorder but do not have any symptoms (see also Medical Testing Decisions, Screening Tests). Screening can enable doctors to detect a disorder early and to start treatment early. Early treatment sometimes keeps disorders from turning deadly. For example, abnormalities of the cervix or colon can be diagnosed and cured before they become cancerous.
Screening programs have greatly reduced the number of deaths caused by some disorders. For example, deaths due to cervical cancer, once the most common cause of cancer death among American women, have decreased 75% since 1955. However, the decrease varies from area to area, depending on availability and affordability of screening and other factors. Screening can also detect disorders that cannot be cured but that can be treated before they cause too much damage (for example, high blood pressure).
Screening recommendations usually come from government or professional organizations and are based on the best available research. However, different organizations sometimes make different recommendations. There are several reasons for different recommendations. Even the best research results are not always conclusive. Also, screening recommendations must take into account how much risk and how much expense people are willing to accept, factors that cannot be known with certainty. Thus, decisions about screening are individualized. People should discuss screening with their doctor to determine what is best for them.
Did You Know...
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People may think that any test capable of detecting a serious disorder should be done. Screening can offer great benefits. However, it can also create problems. For example, screening test results are sometimes positive in people who do not have disease. As a result, some of these people then have additional follow-up tests and/or treatments that are unnecessary, often expensive, and sometimes painful or dangerous.
Also, sometimes screening detects abnormalities that cannot or need not be treated. For example, prostate cancer often grows so slowly that in older men, the cancer is unlikely to affect their health before they die from another cause. In such cases, the treatment can be worse than the disease. Another example involves using whole-body computed tomography (CT) to screen everyone for cancer. This approach is not recommended because it does not have benefits (such as saving lives) that exceed the risks (such as developing disorders caused by the radiation exposure, including cancer). In addition, when people are told they might have a serious disorder, they can become anxious, and anxiety can affect health.
Because of these issues, screening is recommended only when
The person has some real risk of developing the disorder.
The screening test is accurate.
The disorder can be more effectively treated when it is diagnosed before symptoms develop.
The health care benefits of appropriate screening make it relatively cost effective.
Some screening tests (such as tests for cervical and colon cancers) are recommended for all people of a certain age or sex. For people at increased risk because of other risk factors, tests may be recommended at an earlier age or at more frequent intervals than is recommended for people at average risk, or additional tests may be recommended. For example, a person with a family history of colorectal cancer or with a disease that increases the chances of developing colorectal cancer (such as ulcerative colitis) would be advised to have a screening colonoscopy more often than is normal for people at average risk. If a woman has close relatives who have had breast cancer (family history), screening for breast cancer with magnetic resonance imaging (MRI) in addition to mammography may be recommended.
Some screening measures are recommended for people with certain disorders. For example, people with diabetes should check their feet at least once a day for redness and ulcers, which, if ignored, may result in severe infection and ultimately amputation.
Some Recommended Screening Tests*, †
Condition | Test | For | How Often |
|---|---|---|---|
Abdominal ultrasonography | Men age 65–75 who smoke or who have previously smoked | Once | |
Questions about drinking habits | Adults | Once and periodically, as when circumstances change (for example, when under new stresses or if lifestyle changes) | |
Anxiety | Questions about symptoms, such as an upset stomach | Children age 8–18 years Adults, including women during and after pregnancy | Once |
Genetic counseling and possible genetic testing for the BRCA mutation, which indicates an increased risk of breast and ovarian cancers | Women with several close, usually first-degree relatives who have had breast cancer or ovarian cancer | Once | |
Mammography | Women age 50–74 For women under age 50, consultation with their doctor about individualized screening | Every 2 years | |
MRI (magnetic resonance imaging) | Women at high risk (such as those with close relatives who have had breast cancer) | When mammography is done | |
Papanicolaou (Pap) test or another similar test and sometimes a test for human papillomavirus (HPV) | For women age 25–65 | One of the following:
| |
Cardiovascular disease (including heart attack and stroke) | Questions about risk factors, measurement of blood pressure and weight, blood tests for cholesterol (lipid profile) and blood sugar | All adults over 20 | Annual questioning about risk factors and check of blood pressure and weight Blood sugar every 3 years Lipid profile every 5 years |
A DNA test using a urine sample or a sample taken from the vagina with a swab | Sexually active women who are 24 or younger Women who are 25 or older and have risk factors (such as several sex partners or a sexually transmitted infection) | At least yearly | |
Pregnant women who are 24 or younger Pregnant women who are 25 or older and have risk factors | During the first prenatal visit and during the 3rd trimester | ||
A DNA test using a urine sample or a sample taken from the urethra or rectum with a swab, regardless of condom use | Men who have had sex with men within the previous year | At least yearly regardless of condom use Every 3–6 months if men have an increased risk of the infection (for example, if they or their sex partners have had several sex partners) | |
Tests based on anatomy | All transgender men,and gender diverse people with a cervix. | Yearly | |
Colonoscopy, sigmoidoscopy, tests to check stool for blood (fecal occult blood tests [FOBT] or fecal immunochemical test [FIT]) or cancer DNA (FIT-DNA) | Adults age 45–75 For adults under age 45, consultation with their doctor about individual screening depending on their risk factor profile (such as family history or certain bowel disorders) | For average-risk people, one of the following: FOBT or FIT yearly FIT-DNA every 1–3 years Colonoscopy every 10 years CT colonography every 5 years Flexible sigmoidoscopy every 5 years or every 10 years with FIT every year | |
Check-up with dentist | All (regular check ups should start when the first tooth appears or before a child's first birthday) | Every 3–12 months for children and adolescents under age 18 Every 12–24 months for people aged 18 or older | |
Questions, including standardized questionnaires | Adults and children 11 or older | Once and periodically, such as during stressful circumstances (for example, divorce, job or lifestyle change, or death in the family) | |
Blood tests to measure hemoglobin A1C or the blood sugar level | Adults who are between ages 35 and 70 and those who are overweight, who have high blood pressure or high levels of cholesterol and/or other fats (lipids) in the blood, or who have had high blood sugar levels in the past All children and adolescents who do not have symptoms, are age 10 or older (or after puberty begins), and are overweight or obese or who have other risk factors, such as a mother who had diabetes during pregnancy (gestational diabetes) | Every 3 years, depending on risk factors and the results of previous tests During pregnancy: At 24 weeks of pregnancy or later | |
A DNA test using a urine sample or a sample taken from the vagina with a swab | Women who are 24 or younger and are sexually active Women who are 25 or older and have risk factors (such as several sex partners or a sexually transmitted infection) All pregnant women during first prenatal visit Men who have had sex with men within the previous year | Once and periodically, as when circumstances change (such as with new sex partners or after becoming pregnant) | |
Hearing examination | Adults age 50 or older | Different recommendations by national organizations such as
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Rh(D) incompatibility screening Sometimes other tests, depending on test results | Pregnant women | At the first prenatal visit | |
Blood test for infection with the hepatitis B virus | Pregnant women, household contacts, intravenous drugs users, men who have sex with men. and numerous other risk factors | At the first prenatal visit | |
Blood test for infection with the hepatitis C virus | Adults age 18–79 People who have risk factors (such as using intravenous drugs) | Once | |
High blood pressure (hypertension) | Blood pressure measurement | Adults and children 3 or older | Every office visit or once a year |
Human immunodeficiency virus (HIV) infection, including AIDS | Blood or saliva test for infection with HIV | Everyone aged 15–65 years, those over 65 with risk factors for HIV infection, and all pregnant women | At least once and again if new high-risk activity occurs (for example, having more than one sex partner, using injection drugs, and, in men, having sex with men) |
Low-dose CT | People who are age 50–80 and smoke 20 or more packs a year and currently smoke or have quit only within the past 15 years | Every year | |
Dual x-ray absorptiometry (DXA) to measure bone density | All women aged 65 or older Women under 65 if they are at risk of fractures due to osteoporosis or have risk factors for osteoporosis (such as close relative who have osteoporosis or a low body weight, who smoke, or take corticosteroids or other medications that can cause bone loss) | At least once | |
Overweight in adults and children | Measurement of height and weight Calculation of body mass index (BMI) | All adults and children 6 or older | Every scheduled office visit or once a year |
Reduced vision | Age-appropriate eye examination and vision testing for amblyopia/strabismus, refractive error, and any other problems that can cause reduced vision | All | Different recommendations by national organizations such as Children: By age 6 months (for eye health, vision development, and alignment of the eyes) At least once in all children age 3 to 5 years to detect amblyopia or its risk factors Adults age 65 or older: Every 1–2 years |
Blood test for the infection | Adults with risk factors such as
| Once and periodically, as when circumstances change (such as having new sex partners or becoming pregnant) | |
Questions about using tobacco | All adolescents and adults | Every office visit | |
* Based on recommendations from various major authorities in the United States. However, differences do exist among their recommendations. Also, people with increased risk of a disease are usually screened more often. Not all recommendations are included in this table. | |||
† Screening measures that can be done at home include regularly measuring weight and, once yearly, checking the skin for changes and for sores that bleed. People can ask another person (such as a spouse) to check their skin in areas that are difficult to see, such as the back or behind the ears. Some physicians suggest that men check for lumps in their testes, although evidence of the effectiveness of doing so is unclear. | |||
‡ High-risk HPV testing involves testing for the types of HPV that are most likely to cause cervical cancer. This test can identify pieces of the DNA of these cancers in cervical cells. | |||
Preventive Medication Therapy
Preventive medication therapy (also known as chemoprevention) is the use of medications to prevent disease. For such therapy to be recommended, the person must be at risk of the disorder being prevented and be at low risk of side effects caused by the medication being considered.
Three Levels of Prevention
The three levels of prevention are primary, secondary, and tertiary. In primary prevention, a disorder is actually prevented from developing. Types of primary prevention include the following:
In secondary prevention, disease is detected and treated early, often before symptoms are present, thus minimizing serious consequences. Types of secondary prevention include the following:
In tertiary prevention, an existing, usually chronic disease is managed to prevent complications or further damage. Types of tertiary prevention include the following:
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Some Strategies for Preventing Major Health Problems*
Health Problem | Preventive Measures |
|---|---|
Do not smoke (to prevent lung cancer and many other cancers). Eat a balanced diet high in fiber, fruits, and vegetables and limited in fat (particularly saturated fat and trans fatty acids) and calories (to prevent breast cancer and colorectal cancer). Reduce consumption of salt- or smoke-cured food (to prevent stomach cancer). Avoid too much sun exposure, and use sunscreens with a high sun-protection factor (to prevent skin cancer). Make sure children get the HPV (human papillomavirus) vaccine (to prevent cervical cancer and throat cancer). Get recommended screening tests. | |
Do not smoke. Avoid exposure to toxic substances (especially in industrial settings). | |
Wash hands frequently. Improving ventilation and moving activities outdoors Stay home if symptoms of COVID develop (or any signs of a cold or flu to prevent passing it on to others) Get the COVID-19 vaccine and stay up to date on vaccinations Check CDC recommendations for COVID-19 prevention because recommendations may change, depending on where a person lives | |
Diabetes (type 2) | Exercise regularly. Eat a balanced diet. Maintain recommended body weight. Maintain normal lipid levels through diet and, if necessary, medications. Maintain normal blood pressure through diet, exercise, stress reduction, and, if necessary, medications. Do not smoke. |
Heart disease and stroke | Maintain normal cholesterol and other fat (lipid) levels through diet and, if necessary, medications. Maintain normal blood pressure through diet, exercise, stress reduction, and, if necessary, medications. Consume a balanced diet high in fiber, fruits, and vegetables and limited in fat (particularly saturated fat and trans fatty acids) and calories. Maintain recommended body weight. Do not smoke. Exercise regularly and include aerobic exercise (such as brisk walking, bicycling, and jogging) and muscle-strengthening exercise (such as training with free weights or weight machines). |
High blood pressure (hypertension) | Consume a balanced diet high in fiber, fruits, and vegetables and limited in salt, fat (particularly saturated fat and trans fatty acids), and calories. Exercise regularly and include aerobic exercise and muscle-strengthening exercise. Maintain normal cholesterol through diet, exercise, and, if necessary, medications. Maintain recommended body weight (through diet and exercise). Do not smoke. |
Get the influenza vaccine every year (particularly infants, older adults, and people who have a heart, lung, or immune system disorder). | |
Drink alcohol in moderation if at all. Get the vaccine for hepatitis A and B (for all children and for adults with risk factors for the disease). | |
Do muscle-strengthening and stretching exercises. Remain physically active. –Maintain recommended body weight. | |
Do weight-bearing exercises (for example, walking, jogging, tennis, and dancing) every day for at least 30 minutes. Take bone-strengthening medications if prescribed by a doctor. Do not smoke. | |
Get a pneumococcal vaccine (there are two vaccines to help protect against pneumonia, with varying recommendations for who should receive them) | |
Practice abstinence or limit the number of sex partners. Use condoms and follow safe sex practices. For children age 11–12 (or as young as 9) and everyone who is age 26 or under and not already vaccinated, get an HPV vaccine. If between age 27 and 45, talk to a doctor about benefits. Depending on sexual activity, discuss with a doctor whether preventive medications for HIV infection are needed. | |
Brush teeth and use dental floss regularly. Limit how often sweets are consumed. Visit a dentist regularly. Take supplemental fluoride if needed (for example, if the water source for preschool children older than 6 months is fluoride-deficient). | |
* In addition to these preventive measures, people should have recommended screening tests (see table Some Recommended Screening Tests). | |
† 1 drink = one 12-ounce [341 ml] can of beer, 5 ounces [142 ml] of wine, or 1.5 ounces [43 ml] of liquor (such as whiskey). | |
CDC = Centers for Disease Prevention and Control; HPV = human papillomavirus. | |
