Prevention includes four major tools. One tool is establishing a healthful lifestyle, which includes habits such as wearing a seat belt, eating a healthy diet, getting enough physical exercise, wearing sunscreen, and not smoking. Another tool is getting vaccinated to prevent infectious diseases such as influenza, pneumococcal pneumonia, and childhood infections. A third tool is participating in screening efforts so that diseases such as high blood pressure and cancer are detected early. The fourth tool is taking drug therapy recommended to prevent disorders from developing or worsening (preventive drug therapy, also known as chemoprevention) for people at high risk. Examples of chemoprevention include cholesterol-lowering drugs to prevent atherosclerosis, aspirinSome Trade Names
BAYER
to prevent heart attacks or strokes, tamoxifen to prevent breast cancer, and antihypertensive drugs to reduce blood pressure and prevent strokes.

Did You Know... Improving diet and exercise habits and stopping smoking help prevent all three leading causes of death in the United States (heart disease, cancer, and stroke).

Healthful Lifestyle

Lifestyle and disease are clearly linked. Particular lifestyle changes can help prevent particular disorders. Also, some lifestyle changes improve fitness and quality of life and decrease risks of many different disorders. For example, the three leading causes of death in the United States—heart disease, cancer, and stroke—are more likely to occur in people who make poor lifestyle choices, especially eating a diet high in calories, saturated fats, trans fatty acids, and cholesterol (such a diet increases the risk of having high cholesterol levels in the blood); not exercising regularly; and smoking. By having informative discussions with doctors and other health care practitioners, people can make good decisions and establish healthful habits. Establishing and maintaining a healthful lifestyle can be done only by the person. Consistently eating a healthy diet and getting enough exercise are difficult for many people. However, doing so can prove to be exciting, rewarding, and affordable. Some important parts of maintaining a healthful lifestyle follow.

Healthful eating habits can help people prevent or control diseases such as high blood pressure, heart disease, diabetes, osteoporosis, and certain cancers. A diet that includes plenty of vegetables, fruits, and whole-grain cereals and breads is recommended, in part because such a diet is high in fiber (see Overview of Nutrition: Fiber). Cutting down on harmful types of fat (saturated fats and trans fatty acids—see Overview of Nutrition: Fats) and instead eating fish, skinless poultry, and very lean meat and choosing low-fat dairy foods are recommended as well. Calories are best limited to maintain a recommended body weight. Limiting salt and getting adequate amounts of calcium and vitamin DSome Trade Names
See Ergocalciferol
are also recommended.

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 60 minutes or more on all or most days of 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 at a time to physical activity may still reap important benefits, particularly if the exercise is vigorous or if they repeat the activity throughout the day (see Exercise and Fitness: Benefits of Exercise). 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 attacks and angina.

Quitting smoking is important to a healthful lifestyle. A doctor can offer encouragement and advice on ways to successfully quit smoking, including information and recommendations on the use of nicotineSome Trade Names
NICORETTE NICOTROL
replacement products, bupropionSome Trade Names
WELLBUTRIN
and vareniclineSome Trade Names
CHANTIX
(drugs that help reduce cravings), and other tools (see Drug Use and Abuse: Treatment).

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 disease by using a latex condom properly every time they have sex (see Sexually Transmitted Diseases: How to Use a Condom). People who are allergic to latex can use other kinds of condoms.

Limiting alcohol use is important. Although small amounts of alcohol, particularly red wine, may have some health benefits, drinking more than moderate amounts (for example, 1 to 2 drinks per day, possibly less for women) is often harmful (see Drug Use and Abuse: Alcohol). Each drink is about 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of more concentrated liquor, such as whiskey.

Injury prevention plays a major role in maintaining a healthful lifestyle. For example, people can lower their risk of injury by taking certain precautions.

Adequate sleep is also an important part of a healthful lifestyle, particularly affecting mood and mental state. Insufficient sleep is a risk factor for injuries.

Safety 101
Practicing common-sense safety measures can help prevent injuries. Following simple preventive measures can greatly decrease the risk of injury in various situations. Here are some specific examples. General Safety Learn first aid Prepare or purchase a first aid kit (visit www.redcross.org) Learn cardiopulmonary resuscitation (CPR) and other methods to relieve airway obstruction, such as the Heimlich maneuver Wear a helmet when riding a bike or motorcycle and additional protective equipment as indicated for the sport, such as wrist guards for roller blading or skate boarding Store firearms safely Never swim alone If repetitive wrist motion (such as typing) is necessary, use a position unlikely to increase risk of carpal tunnel syndrome Exercise regularly and safely Eliminate or moderate alcohol intake Home Safety Childhood Falls Install safety locks on basement doors Close and lock windows when children are present Replace or cover sharp-edged furniture Do not use baby walkers Install window guards, especially above the first floor Use stair gates at the top and bottom of stairs Poisoning Never mix cleaning products Keep oven and toilet bowl cleaners, pesticides, alcohol, and antifreeze tightly sealed and out of the reach of children Keep all drugs in their original containers, and use child protective pill containers if small children are in or visiting the household Flush expired drugs and drugs that are no longer necessary down the toilet—alternatively, some pharmacies accept them for disposal Fires Install operational smoke detectors on every floor in the home, including the basement, and in every bedroom Test batteries every month and install new batteries every 6 months Plan an escape route and practice it Keep a fire extinguisher in or near the kitchen Have the electrical system inspected by a professional Do not leave lit candles unattended Do not smoke in bed Carbon Monoxide Poisoning Ensure adequate ventilation for indoor sources of combustion (such as furnaces, hot-water heaters, wood- or charcoal-burning stoves, and kerosene heaters) Clean flues and chimneys regularly and inspect them for leaks Use a carbon monoxide detector in the home Radon Have the radon level in the home checked Ensure adequate ventilation, especially in the basement Lead Poisoning Consult the local health department and ask how to detect toxic levels of lead in the home's drinking water Find out whether the paint in the house is lead-based (present in older houses); if there is any question, test paint chips Have children tested for lead levels if recommended by the children's doctor Other Set the maximum hot water heater temperature at 130° F (54.44° C) or less Food Safety Pay attention to “sell by” dates on packaging Refrigerate perishable food immediately Do not buy dented canned goods or anything with a loose or bulging lid Keep the refrigerator at 40° F (4.44° C) and the freezer at 0° F (-17.78° C) Freeze fresh meats (including fish and poultry) that will not be used in 2 days Do not let the juices from raw meats drip on other foods Wash hands before and after preparing food Cook foods thoroughly Do not use the same utensils or platters for raw and cooked meats Wash all countertops, cutting boards, and utensils in hot soapy water after use Car Safety Obey speed limits and drive defensively Make sure all passengers wear seat belts Put children in car seats or other restraints appropriate for their height and weight Do not allow a baby or child to sit on someone's lap in a moving vehicle Do not drink or use drugs before driving

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 $14 in health care costs for every $1 spent.

Many side effects have been attributed to vaccines. Actual side effects that occur depend on the vaccine, but common side effects are usually minor, such as swelling, soreness, allergic reactions at the injection site, and sometimes fever or chills. More serious side effects can occur, such as autoimmune reactions (for example, Guillain-Barré syndrome, which causes temporary weakness or paralysis). However, serious side effects are very rare if vaccines are given properly. Through systematic and extensive research, vaccines have not been linked to other serious side effects such as autism. Reports that vaccines cause side effects such as AIDS and sterility are “urban legends” that have no factual basis in developed countries. (If contaminated needles are improperly reused, however, infectious diseases can be spread, but this infection is not caused by a vaccine.) People who refuse vaccination to avoid complications place their health at much greater risk from the infection that the vaccine is designed to prevent.

Did You Know... Vaccinations can benefit people other than those receiving the vaccine.

Children and adolescents, older adults, and people whose immune system is impaired are often the most vulnerable to developing vaccine-preventable infections. They are also often the most vulnerable to developing serious symptoms from those infections. For example, whooping cough (pertussis) can develop in people of any age but may be mistaken for a cold in otherwise healthy people because the symptoms are so mild. Although it is most important to vaccinate the most vulnerable people, vaccinating other people is also important. Doing so prevents illness in the vaccinated person and also decreases 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. See Newborns and Infants: Vaccination of Infants and Children for an in-depth discussion on vaccination.

Screening

Screening is testing of people who are at risk of a disorder but do not have any symptoms. Screening can allow for early treatment, sometimes keeping disorders from turning deadly. For example, abnormalities of the cervix or colon can be diagnosed and cured before they turn cancerous. Screening programs have greatly reduced the number of deaths associated with 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. Screening can also diagnose disorders that are not curable but that can be treated before they cause too much damage (for example, high blood pressure).

Did You Know... It is often helpful to avoid tests designed to diagnose disorders before symptoms occur (screening tests).

People might think that any test capable of diagnosing a serious disorder should be performed. However, this is not true. Although screening can offer great benefits, it can also create problems. Some screening tests have a small risk of causing harm (for example, a colonoscopy can perforate or tear the colon). If such a test is performed on a large number of people who do not have any disease, then the small number of people who have the complication can outweigh the even smaller number who benefit by having the disease diagnosed. Similarly, because test results are sometimes positive in people who do not have disease, a certain number of people undergo unnecessary (and expensive and possibly painful or dangerous) tests or treatment in follow-up. Also, sometimes screening reveals 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. Whole-body computed tomography scans are not recommended because they do not have benefits (such as saving lives) that exceed the risks (such as disorders caused by the radiation exposure, including cancer). In addition, when people are told they could have a serious disorder, they can become anxious, which can affect health. Because of these issues, screening is recommended only when

• The person has some real risk of the disorder.
• The screening test is accurate.
• The disorder can be more effectively treated when 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 factors, tests may be recommended at an earlier age or at more frequent intervals 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 undergo a screening colonoscopy more often than is normally recommended for people at average risk. A woman with a strong family history of breast cancer would likely be advised to undergo screening mammography at an earlier age. Some screening measures are recommended for people with certain disorders. For example, people with diabetes should check their feet at least once daily for redness and ulcers, which, if ignored, may potentially result in severe infection and ultimately amputation.

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Selected Screening Schedule for Adults*,† Condition Test For How Often Abdominal aortic aneurysm Abdominal ultrasonography Men age 65 to 75 who smoke or have previously smoked Once Alcohol misuse Questioning Adults Once and periodically, such as if circumstances change (for example, when under new stresses or if lifestyle changes) Amblyopia and strabismus Vision testing and eye examination Children age 5 or younger Once Breast and ovarian cancers Genetic counseling and possible genetic testing for BRCA mutation, which indicates increased risk for breast and ovarian cancers Women with a strong family history of breast cancer (see Breast Disorders: Risk Factors for Breast Cancer) or ovarian cancer (see Cancers of the Female Reproductive System: Ovarian Cancer) Once Breast cancer Mammography and clinical breast examination Women 40 and older Every 1 to 2 years Cervical cancer Papanicolaou (Pap) test or liquid cervical cytology test All women who have ever been sexually active and have not had their cervix removed Every 1 to 3 years Most women can stop having Pap tests after age 65 Chlamydial infection Culture or DNA test Sexually active women age 25 or younger or who have risk factors (such as multiple sex partners or a sexually transmitted diseases) Once and periodically, such as when circumstances change (for example, new sex partners or after becoming pregnant) Colorectal cancer Colonoscopy or other testing (such as virtual colonoscopy or computed tomography scan) Adults age 50 or older Every 5 to 10 years Dental problems Check-up with dentist All Every 3 to 12 months for those under age 18 Every 3 to 24 months for age 18 and older Depression Questioning Adults Once and periodically, such as during stressful circumstances (for example, divorce, job or lifestyle change, or death in the family) Diabetes Blood tests to measure blood sugar level Adults who are overweight or with high blood pressure or high levels of lipids in their blood At least once Glaucoma Eye examination and eye pressure test Adults age 40 and older Every 2 to 4 years for adults age 40 to 64 Every 1 to 2 years for those age 65 and older Gonorrhea Culture or tests such as DNA testing Pregnant women and young women who are sexually active Once and periodically, such as when circumstances change (such as with new sex partners or after becoming pregnant) Hearing loss Hearing tests Adults age 65 or older Yearly Hemolytic disease of the newborn RhO(D) incompatibility screening Pregnant women First prenatal visit; for most RhO(D)-negative women, test again at 24 to 28 weeks of pregnancy Hepatitis B Blood test for infection with the virus Pregnant women At first prenatal visit High blood pressure (hypertension) Blood pressure measurement Adults Every office visit or annually High levels of lipids (fats) and cholesterol in the blood Blood tests to measure lipid (including cholesterol) levels Men age 35 and older and women age 45 and older Every 5 years; more often if levels are abnormal Human immunodeficiency virus (HIV) infection, including AIDS Blood test for infection with the virus Adolescents and adults at risk of HIV infection and all pregnant women Once and if new high-risk activity occurs (for example, those with multiple sex partners or injection drug use and in men having sex with men) Osteoporosis Dual x-ray absorptiometry (DEXA scan) to measure bone density Women age 60 and older who are at risk for osteoporotic fractures and all women age 65 and older (see Osteoporosis: Diagnosis) At least once Overweight in adults and children; growth disturbance in children Measurement of height and weight All Weight: Every scheduled office visit or annually Height: Every scheduled office visit in children and adolescents Refractive errors (poor vision) Vision testing (screening exams do not require an optometrist or ophthalmologist) All Once for age 0 to 6 months Once at age 3 Every 2 years for age 6 to 17 Every 2 to 3 years for age 18 to 40 Every 2 years for age 41 to 60 Every year for age 61 and older Syphilis Blood test Adults with risk factors (such as multiple sex partners or a previous sexually transmitted disease), all pregnant women, and those who have other diagnosed sexually transmitted diseases Once and periodically, such as when circumstances change (such as with new sex partners or after becoming pregnant) Tobacco use Questioning Adolescents and adults Every office visit *Based on recommendations by most major authorities in the United States. However, differences do exist among their recommendations. †Screening measures that can be done at home include regularly measuring weight and, once yearly, checking skin for signs of change and for bleeding skin lesions, perhaps having another person (such as a spouse) look at locations that are difficult to see, such as the back or behind the ears. Selected Screening Schedule for Adults*,† Condition Test For How Often Abdominal aortic aneurysm Abdominal ultrasonography Men age 65 to 75 who smoke or have previously smoked Once Alcohol misuse Questioning Adults Once and periodically, such as if circumstances change (for example, when under new stresses or if lifestyle changes) Amblyopia and strabismus Vision testing and eye examination Children age 5 or younger Once Breast and ovarian cancers Genetic counseling and possible genetic testing for BRCA mutation, which indicates increased risk for breast and ovarian cancers Women with a strong family history of breast cancer (see Breast Disorders: Risk Factors for Breast Cancer) or ovarian cancer (see Cancers of the Female Reproductive System: Ovarian Cancer) Once Breast cancer Mammography and clinical breast examination Women 40 and older Every 1 to 2 years Cervical cancer Papanicolaou (Pap) test or liquid cervical cytology test All women who have ever been sexually active and have not had their cervix removed Every 1 to 3 years Most women can stop having Pap tests after age 65 Chlamydial infection Culture or DNA test Sexually active women age 25 or younger or who have risk factors (such as multiple sex partners or a sexually transmitted diseases) Once and periodically, such as when circumstances change (for example, new sex partners or after becoming pregnant) Colorectal cancer Colonoscopy or other testing (such as virtual colonoscopy or computed tomography scan) Adults age 50 or older Every 5 to 10 years Dental problems Check-up with dentist All Every 3 to 12 months for those under age 18 Every 3 to 24 months for age 18 and older Depression Questioning Adults Once and periodically, such as during stressful circumstances (for example, divorce, job or lifestyle change, or death in the family) Diabetes Blood tests to measure blood sugar level Adults who are overweight or with high blood pressure or high levels of lipids in their blood At least once Glaucoma Eye examination and eye pressure test Adults age 40 and older Every 2 to 4 years for adults age 40 to 64 Every 1 to 2 years for those age 65 and older Gonorrhea Culture or tests such as DNA testing Pregnant women and young women who are sexually active Once and periodically, such as when circumstances change (such as with new sex partners or after becoming pregnant) Hearing loss Hearing tests Adults age 65 or older Yearly Hemolytic disease of the newborn RhO(D) incompatibility screening Pregnant women First prenatal visit; for most RhO(D)-negative women, test again at 24 to 28 weeks of pregnancy Hepatitis B Blood test for infection with the virus Pregnant women At first prenatal visit High blood pressure (hypertension) Blood pressure measurement Adults Every office visit or annually High levels of lipids (fats) and cholesterol in the blood Blood tests to measure lipid (including cholesterol) levels Men age 35 and older and women age 45 and older Every 5 years; more often if levels are abnormal Human immunodeficiency virus (HIV) infection, including AIDS Blood test for infection with the virus Adolescents and adults at risk of HIV infection and all pregnant women Once and if new high-risk activity occurs (for example, those with multiple sex partners or injection drug use and in men having sex with men) Osteoporosis Dual x-ray absorptiometry (DEXA scan) to measure bone density Women age 60 and older who are at risk for osteoporotic fractures and all women age 65 and older (see Osteoporosis: Diagnosis) At least once Overweight in adults and children; growth disturbance in children Measurement of height and weight All Weight: Every scheduled office visit or annually Height: Every scheduled office visit in children and adolescents Refractive errors (poor vision) Vision testing (screening exams do not require an optometrist or ophthalmologist) All Once for age 0 to 6 months Once at age 3 Every 2 years for age 6 to 17 Every 2 to 3 years for age 18 to 40 Every 2 years for age 41 to 60 Every year for age 61 and older Syphilis Blood test Adults with risk factors (such as multiple sex partners or a previous sexually transmitted disease), all pregnant women, and those who have other diagnosed sexually transmitted diseases Once and periodically, such as when circumstances change (such as with new sex partners or after becoming pregnant) Tobacco use Questioning Adolescents and adults Every office visit *Based on recommendations by most major authorities in the United States. However, differences do exist among their recommendations. †Screening measures that can be done at home include regularly measuring weight and, once yearly, checking skin for signs of change and for bleeding skin lesions, perhaps having another person (such as a spouse) look at locations that are difficult to see, such as the back or behind the ears.

Preventive Drug Therapy

Preventive drug therapy (also known as chemoprevention) is the use of drugs 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 drug being considered. Preventive drug therapy is clearly helpful in, for example, prevention of infection in people with certain disorders (such as AIDS), prevention of headache in people with migraines, and many other specific situations. Although preventive drug therapy is effective only in specific situations, some of those situations are common, so the therapy is useful for many people. For example, for adults at risk of coronary artery disease or stroke, aspirinSome Trade Names
BAYER
is usually recommended. Newborns routinely receive eye drops to prevent gonococcal infection of the eyes. Women who are at high risk of breast cancer may benefit from preventive drug therapy (for example, with the drug tamoxifen).

Three Levels of Prevention
The three levels of prevention are primary, secondary, and tertiary. In primary prevention, a disorder is actually prevented from developing. Vaccinations, counseling to change high-risk behaviors, and sometimes chemoprevention are types of primary prevention. In secondary prevention, disease is detected and treated early, often before symptoms are present, thereby minimizing serious consequences. Secondary prevention can involve screening programs, such as mammography to detect breast cancer;dual x-ray absorptiometry (DEXA) scanning to detect osteoporosis; 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 complications or further damage. For example, tertiary prevention for people with diabetes focuses on tight control of blood sugar, excellent skin care, frequent examination of the feet, and frequent exercise to prevent heart and blood vessel disease. Tertiary prevention for a person who has had a stroke may involve taking aspirinSome Trade Names BAYER to prevent a second stroke from occurring. Tertiary prevention can involve providing supportive and rehabilitative services to prevent deterioration and 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 in those confined to bed.

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Selected Strategies for Preventing Some Major Health Problems* Health Problem Preventive Measures Heart disease Maintain normal lipid and cholesterol levels through diet and drugs (if necessary) Maintain normal blood pressure through diet, exercise, stress reduction, and drugs (if necessary) Consume a balanced diet high in fiber and limited in fat, cholesterol, and calories Avoid smoking Undergo sufficient regular exercise Take aspirinSome Trade Names BAYER if recommended (most adults at high risk of coronary artery disease) Cancer Avoid smoking (lung cancer) Eat a balanced diet high in fiber and limited in fat, cholesterol, and calories (breast cancer, colorectal cancer) Avoid too much sun exposure and use sunscreens with a high sun-protection factor (skin cancer) Take recommended chemoprevention such as tamoxifen (women at high risk of breast cancer and who choose to do this) Get recommended screening tests Stroke Avoid smoking Maintain normal blood pressure through diet, exercise, stress reduction, and drugs (if necessary) Maintain normal cholesterol through diet, exercise, and drugs (if necessary) Avoid cocaine Chronic obstructive pulmonary disease Avoid smoking Avoid exposure to toxic substances (especially in industrial settings) Diabetes Exercise regularly Eat a balanced diet Maintain recommended body weight Osteoporosis Consume adequate amounts of calcium and vitamin DSome Trade Names See Ergocalciferol Do weight-bearing exercises (for example, walking, jogging, tennis, dancing) every day for at least 30 minutes Take bone-strengthening drugs if prescribed by a doctor Pneumonia Receive pneumonia (pneumococcal) vaccine once, repeated once after 5 years for those at high risk, including those over age 65 Influenza Receive influenza vaccine every year (particularly infants, older adults, and people who have heart, lung, or immune system disorders) Tooth loss Brush teeth and use dental floss regularly Avoid frequent sweets Visit a dentist regularly Take supplemental fluoride (preschool children older than 6 months whose water source is fluoride-deficient) Sexually transmitted diseases Practice abstinence or limit the number of sex partners Use condoms and follow safe sex practices Liver disease Drink alcohol in moderation if at all Receive vaccination against hepatitis A and B (all children and high-risk adults) *In addition to these preventive measures, people should undergo recommended screening tests (see Prevention: Selected Screening Schedule for Adults*,†). Selected Strategies for Preventing Some Major Health Problems* Health Problem Preventive Measures Heart disease Maintain normal lipid and cholesterol levels through diet and drugs (if necessary) Maintain normal blood pressure through diet, exercise, stress reduction, and drugs (if necessary) Consume a balanced diet high in fiber and limited in fat, cholesterol, and calories Avoid smoking Undergo sufficient regular exercise Take aspirinSome Trade Names BAYER if recommended (most adults at high risk of coronary artery disease) Cancer Avoid smoking (lung cancer) Eat a balanced diet high in fiber and limited in fat, cholesterol, and calories (breast cancer, colorectal cancer) Avoid too much sun exposure and use sunscreens with a high sun-protection factor (skin cancer) Take recommended chemoprevention such as tamoxifen (women at high risk of breast cancer and who choose to do this) Get recommended screening tests Stroke Avoid smoking Maintain normal blood pressure through diet, exercise, stress reduction, and drugs (if necessary) Maintain normal cholesterol through diet, exercise, and drugs (if necessary) Avoid cocaine Chronic obstructive pulmonary disease Avoid smoking Avoid exposure to toxic substances (especially in industrial settings) Diabetes Exercise regularly Eat a balanced diet Maintain recommended body weight Osteoporosis Consume adequate amounts of calcium and vitamin DSome Trade Names See Ergocalciferol Do weight-bearing exercises (for example, walking, jogging, tennis, dancing) every day for at least 30 minutes Take bone-strengthening drugs if prescribed by a doctor Pneumonia Receive pneumonia (pneumococcal) vaccine once, repeated once after 5 years for those at high risk, including those over age 65 Influenza Receive influenza vaccine every year (particularly infants, older adults, and people who have heart, lung, or immune system disorders) Tooth loss Brush teeth and use dental floss regularly Avoid frequent sweets Visit a dentist regularly Take supplemental fluoride (preschool children older than 6 months whose water source is fluoride-deficient) Sexually transmitted diseases Practice abstinence or limit the number of sex partners Use condoms and follow safe sex practices Liver disease Drink alcohol in moderation if at all Receive vaccination against hepatitis A and B (all children and high-risk adults) *In addition to these preventive measures, people should undergo recommended screening tests (see Prevention: Selected Screening Schedule for Adults*,†).

Last full review/revision September 2007 by James T. Pacala, MD, MS