Levels of Prevention

Sandra Owen , Clinical Faculty, Georgia State University

Introduction: The three levels of prevention provide a foundation for the

planning of alcohol and other drug prevention programming and education.
Targeting levels of prevention with specific drug risk behaviors ensures
effective intervention by promoting protective factors and reducing risk
behaviors.

Levels of Prevention

Primary Secondary Tertiary

Intervenes: Before risk behavior At initiation of At
initiation of
starts experimentation
established risk
risk behavior behavior

Purpose: Educate to prevent Educate to eliminate

Educate to reduce
risk behavior experimentation
established risk
risk behavior behavior

Strategies: Setting personal goals Understanding

Participating in
Establishing refusal consequences of
rehabilitation
skills and decision experimentation services
including
making skills. risk behavior.
counseling
Participating in Establishing positive
Establishing positive
 meaningful activities relationships with
relationships with
Accepting self trusted adults trusted
adults
responsibility for Participating in
Participating in
prevention positive peer positive
peer
drug prevention drug
prevention
education.
education.
Establishing refusal
Establishing refusal
skills and decision skills and
decision
making skills. making
skills.
Accepting self
Accepting self
responsibility for
responsibility for
prevention
rehabilitation.
Setting personal goals Setting
personal goals

Protecting Youth from High-Risk Behaviors: Search

Institute Research
External Assets
The first 20 Developmental Assets focus on positive experiences that young people
receive from the people and institutions in their lives. Four categories of external assets
are included in the framework:

• Support-Young people need to experience support, care, and love from their
families, neighbors, and many others. They need organizations and institutions
that provide positive, supportive environments.
• Empowerment-Young people need to be valued by their community and have
opportunities to contribute to others. For this to occur, they must be safe and feel
secure.
• Boundaries and expectations-Young people need to know what is expected of
them and whether activities and behaviors are "in bounds" and "out of bounds."
• Constructive use of time-Young people need constructive, enriching
opportunities for growth through creative activities, youth programs

Internal Assets
A community's responsibility for its young people does not end with the provision of
external assets. Caring adults must make a similar commitment to nurturing the internal
qualities that guide positive choices and foster a sense of confidence, passion, and
purpose. Young people need this wisdom to make responsible decisions about the present
and future. The framework includes four categories of internal assets:

• Commitment to learning-Young people need to develop a lifelong commitment

to education and learning.
• Positive values-Young people need to develop strong values that guide their
choices.
• Social competencies-Young people need skills and competencies that equip them
to make positive choices, to build relationships, and to succeed in life.
• Positive identity-Young people need a strong sense of their own power, purpose,
worth, and promise.

Assets have tremendous power to protect youth from many different harmful or
unhealthy choices. To illustrate this power, these charts show that youth with the most
assets are least likely to engage in four different patterns of high-risk behavior, based on
surveys of over 217,000 6th- to 12th-grade youth in 318 communities and 33 states
during the 1999-2000 school year.

0-10 Assets 11-20 Assets 21-30 Assets 31-40 Assets

Problem Alcohol Use 49% 27% 11% 3%

Violence 61% 38% 19% 7%
Illicit Drug Use 39% 18% 6% 1%
Sexual Activity 32% 21% 11% 3%

The same kind of impact is evident with many other problem behaviors, including
tobacco use, depression and attempted suicide, antisocial behavior, school problems,
driving and alcohol, and gambling.

Promoting Positive Attitudes and Behaviors

In addition to protecting youth from negative behaviors, having more assets increases the
chances that young people will have positive attitudes and behaviors, as these charts
show.

0-10 Assets 11-20 Assets 21-30 Assets 31-40 Assets

Exhibits Leadership 50% 65% 77% 85%

Maintains Good Health 26% 47% 69% 89%
Values Diversity 36% 57% 74% 88%
Succeeds in School 8% 17% 30% 47%
Primary Prevention

Providing specific protection against disease to prevent its occurrence is the most
desirable form of prevention. Primary preventive efforts spare the client the cost,
discomfort and the threat to the quality of life that illness poses or at least delay the
onset of illness. Preventive measures consist of counseling, education and adoption of
specific health practices or changes in lifestyle.

Examples:

a. Mandatory immunization of children belonging to the age range of 0 –

50 months old to control acute infection diseases.

b. Minimizing contamination of the work or general environment by

asbestos dust, silicone dust, smoke, chemical pollutants and
excessive noise.

Secondary Prevention

It consist of organized, direct screening efforts or education of the public to promote

early case finding of an individual with disease so that prompt intervention can be
instituted to halt pathologic processes and limit disability. Early diagnosis of a health
problem can decrease the catastrophic effects that might otherwise result for the
individual and the family from advanced illness and its many complications.

Examples:

a. Public education to promote breast self-examination, use of home kits

for detection of occult blood in stool specimens and familiarity with the
seven cancer danger signals.
 b. Screening programs for hypertension, diabetes. Uterine cancer (pap
smear), breast cancer (examination and mammography), glaucoma
and sexually transmitted disease.

Tertiary Prevention

It begins early in the period of recovery from illness and consists of such activities as
consistent and appropriate administration of medications to optimize therapeutic effects,
moving and positioning to prevent complications of immobility and passive and active
exercise to prevent disability. Continuing health supervision during rehabilitation to
restore an individual to an optimal level of functioning. Minimizing residual disability and
helping the client learn to live productively with limitations are the goals of tertiary
prevention. (Pender, 1987)