General action to promote health is the other category of primary prevention measures. Health promotion includes the basic activities of a healthy lifestyle: good nutrition and hygiene, adequate exercise and rest, and avoidance of environmental and health risks. Limiting exposure to sunlight, using sunscreen, and wearing protective clothing are examples of primary prevention measures to reduce the risk of developing skin cancer.
Health promotion also includes education about the other interdependent dimensions of health known as wellness. Examples of health education programs aimed at wellness include stress management, parenting classes, preparation for retirement from the workforce, and cooking classes.
Historically, public health programs in developed countries have emphasized the primary prevention of infectious diseases (illnesses caused by microorganisms) by making environmental changes, such as improving the safety and purity of food and water supplies and providing immunizations. Table 2.1 shows the 2006 recommended schedule of childhood and adolescent immunizations—a key primary prevention measure in the United States and other developed countries.
TABLE 2.1 Recommended childhood and adolescent immunization schedule, by vaccine and age, 2006
Today, the most pressing health problems in developed countries are chronic diseases, such as heart disease, cancer, and diabetes, and obesity. Primary prevention of chronic diseases is more challenging than primary prevention of infectious diseases because it requires changing health behaviors. Efforts to change deeply rooted and often culturally influenced patterns of behaviors, such as diet, alcohol and tobacco use, and physical inactivity, generally have been less successful than environmental health and immunization programs.
Primary prevention programs are developed in response to actual and potential threats to community public health. Recent primary prevention programs have examined ways to prevent youth violence and acts of bioterrorism (use of biological or chemical weapons).
Primary Prevention of Youth Violence
Violence on high school campuses across the United States has focused media attention on the problem of violence during childhood, adolescence, and young adulthood. In the 2003 Youth Risk Behavior Survey conducted by the CDC, more than 6% of students interviewed said they had carried a firearm at least once during the past month, and 17.1% had carried a weapon such as a gun, knife, or club.
According to the CDC's National Center for Injury Prevention and Control (NCIPC), 81% of homicide victims ages fifteen to twenty-four were killed with firearms in 1999. In fact, firearm-related homicides were the second-leading cause of injury death among teens ages fifteen to nineteen years and the third-leading cause of injury death among teens ages ten to fourteen. In 2002 homicide persisted as the second-leading cause of death among young people ages fifteen to twenty-four. (See Table 1.12 in Chapter 1.)
To develop programs to prevent violence and violent deaths among children and teens, the CDC followed a systematic public health approach to identify and describe the problem, design and evaluate measures to prevent the problem, and put those measures in place in the community. The approach that public health professionals use to develop all prevention programs consists of the following steps, some of which may be conducted simultaneously:
- Surveillance—The first step is to collect and analyze data to determine the size and scope of the problem. To understand youth violence, researchers looked at how many people were injured or killed as a result of youth violence. They looked at the ages, attitudes, school performance, family histories, and other characteristics of the children and teens that committed violent acts. They also noted when (day, night, weekends, summer, winter, spring, or fall) and where (school, home, public parks) violence occurred.
TABLE 2.2
Potential participant groups for interventions to prevent youth violence
All children and adolescents in a community
All children in a specific age group, school, grade
Children and adolescents with risk factors such as—
use of alcohol or other drugs
history of early aggression
social or learning problems
exposure to violence at home, in their neighborhood, or in the media
parental drug or alcohol use
friends who engage in problem behavior
academic failure or poor commitment to school
poverty
recent divorce, relocation, or other family disruption
access to firearms
Children and adolescents with high-risk behaviors such as—
criminal activity
fighting or victimization
drug or alcohol abuse
selling drugs
carrying a weapon
membership in a gang
dropping out of school
unemployment
homelessness
recent immigration
Parents and other family members
Influential adults such as—
teachers
coaches
child care providers
General population of a community
SOURCE: "Table 2. Potential Participant Groups for Interventions to Prevent Youth Violence," in Best Practices of Youth Violence Prevention: A Sourcebook for Community Action, Centers for Disease Control and Prevention, June 2002, http://www.cdc.gov/ncipc/dvp/bestpractices/chapter1.pdf (accessed December 13, 2005)
- Determining the Cause—By analyzing the data collected in the surveillance process, researchers can identify the underlying causes of the problem. Once public health professionals know who is at risk for a particular problem and why a certain group is at risk they are better able to design actions to prevent it. Table 2.2, a list of potential participants for anti-youth-violence interventions, notes risk factors and high-risk behaviors likely to lead to violence among children and adolescents.
- Develop and Test Preventive Measures—Using the results of the data analysis, public health professionals develop prevention programs called interventions. These interventions target specific populations and may be conducted at specific locations. (See Table 2.3.) Before recommending widespread use of interventions, health professionals test the programs to find out if they work as effectively as hoped. Every intervention is evaluated to find out if it achieves its objectives. Table 2.4 is an example of a goal—reducing expulsions resulting from fights in middle schools—of an intervention and its measurable objectives.
- Implementation—During this phase the preventive measures found to be effective are communicated so they may be put into action. To communicate methods
TABLE 2.3 Possible settings for interventions to prevent youth violence
"Table 3. Possible Settings for Interventions to Prevent Youth Violence," in Best Practices of Youth Violence Prevention: A Sourcebook for Community Action, Centers for Disease Control and Prevention, June 2002, http://www.cdc.gov/ncipc/dvp/bestpractices/chapter1.pdf (accessed December 13, 2005) TABLE 2.3 Possible settings for interventions to prevent youth violence SOURCE: "Table 3. Possible Settings for Interventions to Prevent Youth Violence," in Best Practices of Youth Violence Prevention: A Sourcebook for Community Action, Centers for Disease Control and Prevention, June 2002, http://www.cdc.gov/ncipc/dvp/bestpractices/chapter1.pdf (accessed December 13, 2005) General population of young people
schools
churches
playgrounds
youth activity centers
homes
shopping centers and malls
movie theaters
High-risk youth
alternative schools
juvenile justice facilities
social service facilities
mental health and medical care facilities
hospital emergency departments
recreation centersYoung children
child care centers
homes
schools
Parents
homes
workplaces
churches
community centersTABLE 2.4
Example of a goal and its objectives to prevent youth violence
Goal: Reduce expulsions resulting from fights in middle schools.
Objectives:
- By 2000, offer a 25-lesson program in 6th-grade classes to help students develop social skills and learn nonaggressive responses appropriate for dealing with conflict.
Who: Prevention specialists
What: 1-hour sessions offered twice a week for one school year on topics such as self-understanding, conflict resolution, anger control, and prosocial actions
How much: All 6th-grade classes
When: By 2000
Where: Columbia County schools
- By 2001, implement a school-wide program to mediate behavior problems and disputes between adolescents.
Who: Teachers and peer mediators
What: Weekly mediation clinics
How much: All 6th-, 7th-, and 8th-grade students
When: By 2001
Where: Columbia County schools
- By 2002, reduce the number of fights among 8th-grade students from five per month to two per month.
Who: Middle school students
What: Incidents of physical aggression
How much: Reduce by 60 percent
When: By 2002
Where: Columbia County schools
- By 2004, reduce by half the number of middle school students (grades 6 through 8) expelled because of fights or other disruptive incidents in the schools.
Who: Middle school students
What: Expulsions related to fights in schools
How much: Reduce from an average of two per month to one per month
When: By 2004
Where: Columbia County schools
SOURCE: "Table 4. Example of a Goal and Its Objectives," in Best Practices of Youth Violence Prevention: A Sourcebook for Community Action, Centers for Disease Control and Prevention, June 2002, http://www.cdc.gov/ncipc/dvp/bestpractices/chapter1.pdf (accessed December 13, 2005)
to prevent violence among children and teens, the CDC conducted training programs, published articles in journals for public health workers and health care
TABLE 2.5 Mentoring activities"Table 7. Mentoring Activities," in Best Practices of Youth Violence Prevention: A Sourcebook for Community Action, Centers for Disease Control and Prevention, June 2002, http://www.cdc.gov/ncipc/dvp/bestpractices/chapter2b.pdf (accessed December 13, 2005)
practitioners, and produced a book of recommended programs entitled Best Practices of Youth Violence Prevention: A Sourcebook for Community Action.TABLE 2.5 Mentoring activities SOURCE: "Table 7. Mentoring Activities," in Best Practices of Youth Violence Prevention: A Sourcebook for Community Action, Centers for Disease Control and Prevention, June 2002, http://www.cdc.gov/ncipc/dvp/bestpractices/chapter2b.pdf (accessed December 13, 2005) Social Event-related (field trips) talking about life experiences camping or hiking having lunch together attending a concert or an art exhibit visiting the mentor's home attending a sporting event Recreational Life skills-related playing games or sports developing a fitness or nutrition plan doing arts and crafts attending a cooking class walking in the park discussing proper etiquette going to the mall participating in a public-speaking class Academic Job- or career-related working on homework visiting the mentor's workplace visiting the library developing a resume reading together talking about career options working on the computer practicing interview skills Civic helping in a community clean-up effort working at a soup kitchen - By 2000, offer a 25-lesson program in 6th-grade classes to help students develop social skills and learn nonaggressive responses appropriate for dealing with conflict.
- Evaluation—After preventive measures or interventions have been implemented, they are evaluated to see if they have effectively prevented the problem.
The CDC's Best Practices of Youth Violence Prevention: A Sourcebook for Community Action includes programs aimed at families, parents with infants and small children, and youth considered to be at risk. The book recommends providing social services to strengthen families, improving communication skills, and mentoring. Mentoring pairs young people with adult role models who, by example, teach and support social skills. Table 2.5 shows some mentoring activities recommended in the sourcebook.
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