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Tools of Prevention

By

Magda Lenartowicz

, MD

Last full review/revision Jan 2018| Content last modified Feb 2018
Click here for the Professional Version
NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
Topic Resources

There are many tools of prevention, including the following major tools:

  • Establishing a healthy lifestyle, which includes 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 screening 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 drugs as recommended to prevent the disorder from developing or worsening (preventive drug therapy, also known as chemoprevention)

Preventive drug therapy includes cholesterol-lowering drugs to prevent atherosclerosis, aspirin to prevent heart attacks or strokes, tamoxifen to prevent breast cancer in women with increased risk, and antihypertensive drugs to reduce blood pressure and prevent strokes.

Did You Know...

  • Eating a healthy diet, exercising regularly, and stopping smoking help prevent all three leading causes of death in the United States (heart disease, cancer, and stroke).

Healthy Lifestyle

Lifestyle and disease are clearly linked. For example, eating an unhealthy diet (high in calories, saturated fats, and trans fatty acids), 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 practitioners 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

  • Limiting the amount of fat in the diet, for example, by choosing low-fat dairy foods, skinless poultry, and very lean meat

  • Reducing consumption of saturated fats and avoiding trans fatty acids and instead eating foods that contain healthier fats, such as omega-3 acids, present in certain kinds of fish

  • Limiting calories to maintain recommended body weight (see Table: Body Mass Index (BMI))

  • Limiting the amount of salt consumed

  • Getting enough calcium and vitamin D (in the diet or in supplements)

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 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 nicotine replacement products, bupropion and varenicline (drugs that help reduce cravings), and other tools.

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 correctly using a latex condom every time they have sex (see Overview of Sexually Transmitted Diseases (STDs) : Prevention). 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. 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. People can lower their risk of injury by taking certain precautions.

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

  • Learn first aid.

  • Prepare or purchase a first aid kit.

  • 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 wear 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 limit alcohol intake.

Home Safety

To prevent falls and fall-related injuries in children:

  • 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.

To prevent 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 part of the household or are visiting.

  • Follow instructions on how to safely dispose of expired drugs and drugs that are no longer necessary (see How to Dispose of Unused Medicines available at the Food and Drug Administration's web site).

To prevent 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.

To prevent 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.

To prevent exposure to radon:

  • Have the radon level in the home checked.

  • Ensure adequate ventilation, especially in the basement.

To prevent 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), and if there is any question, test paint chips.

  • Test ceramic dishes made outside the United States for lead.

  • Have children tested for lead levels if recommended by the children’s doctor.

To prevent burns:

  • 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 and do not use recreational drugs or drugs that cause drowsiness 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 $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, 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...

  • 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 these infections. 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 prevents illness in the vaccinated person and 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 allow for early detection. Early detection 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 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. 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).

Screening recommendations usually come from government or professional organizations and are based upon the best available research. However, different organizations sometimes make different recommendations. There are several reasons for this. 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, care should be individualized, and people should discuss screening with their personal physician to suit their individual situation.

Did You Know...

  • Some tests to diagnose disorders before symptoms occur (screening tests) can potentially cause more harm than good.

People might think that any test capable of diagnosing a serious disorder should be done. However, this is not true. Although screening can offer great benefits, it can also create problems. For example, screening test results are sometimes positive in people who do not have disease, and a certain number of those people then have additional follow-up tests and/or treatments that are unnecessary, often expensive, and possibly painful or dangerous.

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. Another example involves using whole-body computed tomography scans to screen everyone for cancer. Such scans are not recommended because they do 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 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 developing 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 have 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 be screened for breast cancer with magnetic resonance imaging (MRI) in addition to mammography.

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 result in severe infection and ultimately amputation.

Table
icon

Some Recommended Screening Tests* ,†

Condition

Test

For

How Often

Abdominal ultrasonography

Men aged 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)

Vision testing and eye examination

Children aged 5 or younger

Once before age 6 months and again at age 6 months–3 years and at age 3–5 years

Genetic counseling and possible genetic testing for the BRCA mutation, which indicates 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 aged 50–74

For women under age 50, consultation with their doctor about individualized screening

Every 2 years

MRI

Women at high risk (such as those with close family members who have had breast cancer)

When mammography is done

Papanicolaou (Pap) test or another similar test and sometimes a test for human papillomavirus (HPV)

All women who have ever been sexually active and have not had their cervix removed

Every 2–5 years in women aged 21–65

Cardiovascular disease (including heart attack, stroke)

Questions about risk factors, measurement of blood pressure and weight, blood tests for cholesterol (lipid profile) and blood sugar

All

Annual questioning about risk factors and check of BP 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 and women who are over 24 and have risk factors (such as several sex partners or a sexually transmitted disease)

All pregnant women during first prenatal visit

Men who have had sex with men within the previous year

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 aged 50 (45 in blacks)–75

For adults under age 50, consultation with their physician about individual screening depending on their risk factor profile (such as family history or certain bowel disorders)

For average-risk people— FOBT or FIT yearly; FIT-DNA every 1-3 years; colonoscopy every 10 years; CT colonography every 5 years; or flexible sigmoidoscopy every 5 years or every 10 years along with FIT every year

Check-up with dentist

All (regular check ups should start when 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 older than 45 or 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

Children younger than 18 who are overweight and have 2 or more specific risk factors (family history, member of certain ethnic groups, history of maternal diabetes)

Every 3 years, depending on risk factors and the results of previous tests

A DNA test using a urine sample or a sample taken from the vagina with a swab

Women 24 or younger who are sexually active and women over 24 who have risk factors (such as several sex partners or a sexually transmitted disease)

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 aged 65 or older

Yearly

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, IV 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

People born between 1945 and 1965 and people who have risk factors (such as those who use intravenous drugs)

Once

High blood pressure (hypertension)

Blood pressure measurement

Adults and children 3 or older

Every office visit or annually

Blood or saliva test for infection with the virus

Everyone aged 15–65 years, those over 65 with risk factors for HIV infection, and all pregnant women

At least once and 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 scan

People aged 55 to 80 with a 30 pack-year smoking history who 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 and women under 65 if they are at risk of fractures due to osteoporosis

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 annually

Refractive errors (poor vision)

Vision testing (screening examinations do not require an optometrist or ophthalmologist)

All

Children: At least once and at well-child visits thereafter at age 3–5 years

Adults: Every 2-4 years for people aged 18–64

Every 1-2 years for those aged 65 and older

Blood test for the infection

Adults with risk factors (such as having several sex partners, having had a previous sexually transmitted disease, men's having sex with men) and all pregnant women

Once and periodically, such as when circumstances change (such as with new sex partners or after becoming pregnant)

Questions

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.

FIT = fecal immunochemical test; FOBT = fecal occult blood test; MRI = magnetic resonance imaging.

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, aspirin 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 and dual x-ray absorptiometry (DXA) to detect osteoporosis. It can also involve tracking down the sex partners of a person diagnosed with a sexually transmitted disease (contact tracing) and treating these people, if necessary, 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 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 aspirin 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.

Tertiary prevention also includes preventing complications among people with disabilities, such as preventing bed sores in those confined to bed.

Table
icon

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).

Consider taking drugs recommended to prevent cancer (such as tamoxifen for women at high risk of breast cancer).

Get recommended screening tests.

Do not smoke.

Avoid exposure to toxic substances (especially in industrial settings).

Diabetes (type 2)

Exercise regularly.

Eat a balanced diet.

Maintain recommended body weight.

Maintain normal lipid levels through diet and, if necessary, drugs.

Maintain normal blood pressure through diet, exercise, stress reduction, and, if necessary, drugs.

Do not smoke.

Maintain normal cholesterol and other fat (lipid) 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, 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).

Take aspirin and lipid-lowering drugs if recommended (for most adults at high risk of coronary artery disease).

Do not use cocaine.

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 drugs (if necessary).

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.

Consume adequate amounts of calcium and vitamin D (in the diet or in supplements).

Do weight-bearing exercises (for example, walking, jogging, tennis, and dancing) every day for at least 30 minutes.

Take bone-strengthening drugs if prescribed by a doctor.

Limit consumption of caffeine and alcohol (to one drink a day).

Do not smoke.

There are two vaccines for pneumonia:

Get the pneumococcal conjugate vaccine (PCV 13) for all babies and children younger than 2 years old, all adults 65 years or older, and people 2 through 64 years old with certain medical conditions.

Get the pneumococcal polysaccharide (PPSV 23) vaccine for all adults 65 years or older, people 2 through 64 years old who are at increased risk for disease due to certain medical conditions, and adults 19 through 64 years old who smoke cigarettes.

Practice abstinence or limit the number of sex partners.

Use condoms and follow safe sex practices.

Depending on your sexual activity, discuss with your doctor whether you should take preventive medicine for HIV infection.

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 can of beer, one 5-ounce glass of wine, or 1.5 ounces of liquor (such as whiskey).

Drugs Mentioned In This Article

Generic Name Select Brand Names
CHANTIX
WELLBUTRIN, ZYBAN
NOLVADEX
COMMIT, NICORETTE, NICOTROL
No US brand name
NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
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