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Observational studies and clinical trials have shown that lower levels of risk factors in patients with established cardiovascular disease (CVD) can substantially reduce their risk of suffering recurrent vascular events. Efforts directed towards reducing further CV events in patients with established CVD are known as secondary prevention. This chapter reviews the epidemiological evidence for risk factor control, lifestyle changes, and medical strategies in the secondary prevention setting. Mainstays of secondary prevention include attention to blood pressure lowering, glucose control, tobacco cessation, and optimizing an individual's cholesterol using proven medical therapies, together with sound dietary and physical activity programs, and regular use of antiplatelet agents.

This chapter focuses on prevention to avert parent-child contact problems from becoming more severe. A number of prevention approaches, strategies, and programs have been developed to address different levels of severity of parent-child contact problems. These are generally separated into three different categories of prevention, each with their unique focus and target groups: primary prevention focuses on the entire population who may be at risk of parent-child contact problems after separation; secondary prevention targets children and parents who have been identified at greater risk of becoming involved in alienation; and tertiary prevention targets children and families involved in more severe levels of parental alienating behaviors.

In this chapter we address the need for metrics and methods to measure spending on prevention as a basis for understanding the current distribution of funds between prevention and treatment and to promote discussion regarding the amount that should be spent on prevention. We develop a taxonomy of prevention and produce an estimate of the portion of the National Health Expenditure Accounts (NHEA) that is devoted to prevention activities. Our estimate suggests that roughly 8.6 percent of expenditures captured by the NHEA are devoted to prevention. The difference between this estimate and earlier estimates (that suggest that as little as 1 to 2 percent of national expenditures are devoted to prevention) indicates a need for a dialog on what activities should be included in the estimate and on methods for establishing the magnitude of the associated expenditures. In addition to developing this expenditure estimate, we sketch preliminary ideas for extensions of this work that include methods to expand the estimate beyond the NHEA, and methods to explore the relationships in the cost effectiveness of alternative allocations of expenditures among prevention interventions, treatment interventions, research into new preventive measures, and research into new treatments.

Health promotion seeks to improve the level of health in a population by preventing diseases, controlling hazards, improving fitness and well being and enhancing the capacity or workers to work and to function in society. Health promotion activities are generally divided into education, health protection (protecting the worker from hazards and ensuring prompt intervention if something goes wrong) and prevention of disease. Prevention, in turn, is often divided into primary prevention (the prevention of disease in the first place, for example through clean water or immunization against infectious disease), secondary prevention (the early detection of disease at a stage when it can be treated or limited, through periodic health surveillance) and tertiary prevention (prevention of disability, for example by providing rehabilitation services after an injury). The workplace is an excellent place to promote health, to the benefit of all society. For this reason, the World Health Organization has developed many sophisticated approaches to health promotion based on education, disease prevention and enhancing fitness in the workplace, based on recognition of the determinants of health and interventions based on a model of how they work together known as the health field concept. The Ottawa Charter (1986) is a key document that brought together WHO’s approach and links it with empowerment of the worker, who is encouraged to take responsibility for his or her own health. Health promotion activities take many forms but generally target exercise and activity, diet, cancer prevention, smoking cessation, and management of chronic diseases through wellness programs.

Stroke is a leading cause of disability and mortality in the United States and other industrialized countries. This chapter discusses important issues that arise in the enumeration of stroke and how differences betweens studies can often be explained by differences in diagnostic or case definition criteria. It describes geographic variations in stroke incidence and mortality, and summarizes a vast literature on stroke risk factors. The chapter is split into two primary sections: ischemic stroke and hemorrhagic stroke and, for each stroke type, non-modifiable risk factors (i.e., genetics, age, sex, race/ethnicity) and modifiable risk factors (smoking, diet, physical activity, hypertension) are discussed. Based on the estimated prevalence of risk factors and their attributable risk for stroke in the United States, it is estimated that a significant proportion of strokes could be prevented through the control of modifiable stroke risk factors. Therefore, part of the chapter is devoted to the design of studies of primary and secondary prevention, and to studies identifying predictors of stroke recurrence.

This chapter underlines the need to broaden current discourses on the prevention of sexual offending against children beyond a narrow focus on ‘grooming’ towards the development of a wider public health approach to complement existing legal and policy frameworks. It argues that the widespread adoption of such an approach offers an effective and more realistic prospect of preventing and targeting child sexual abuse on a proactive basis by focusing on early intervention and reducing opportunities for abuse. The chapter begins with an examination of the theoretical literature on public health and preventive approaches. It then sets out a detailed programme of practical suggestions for informing future regulatory agendas on child protection and sex offender management, drawn from the primary research. This includes public education and awareness, early intervention, professional training, work with first-time offenders, and with families, and an integration of offender and victim perspectives.

A public health guide to ending the opioid crisis is needed to help frame efforts to go “upstream” and address the root causes of substance use disorder and addiction. In this introduction, the editors provide an overview of the book’s three parts (Fundamentals and Frameworks; Connecting Clinical Perspectives and Public Health Practice; Moving Upstream—Prevention, Partnership, and Public Health). While a great deal of prior work has focused on the clinical aspects of the opioid epidemic, more is needed to address the community-level aspects, including addressing the root causes of addiction, and where public health professionals can intervene at the primary, secondary, and tertiary levels of prevention. The case is made for increasing effort in the areas of primary prevention and policy change to support effective opioid stewardship at the local, state, and federal levels. The editors conclude by stating that communities will not “arrest” or “treat” their way out of this crisis. Instead, we have to redouble efforts to prevent addiction and address the clinical and community aspects of what drives an individual to become addicted in the first place.

This book begins by showing how powerful the rationale for expanding newborn screening is, with its appeal residing in secondary prevention. Rather than treating children with devastating metabolic conditions, screening advocates hope to forestall the onset of symptoms. Newborn screening identifies infants who have a condition but are still asymptomatic and offers them preventive measures that may postpone symptom development. It presents as an example the story of Scott and Renee Baio. From a public health or medical perspective their ordeal does not count for much: their daughter Bailey’s case was included in a state database of false positives and this measure represents the only official record of her screening experience. The encounter with newborn screening shaped Scott and Renee’s young marriage, their charitable work, and their relationship with their daughter.

This chapter presents the 2017 Association of State and Territorial Health Officials President’s Challenge as a paradigm for understanding the core aspects of a public health approach to preventing substance misuse and addiction. The framework describes primary, secondary, and tertiary prevention efforts and practical examples that public health professionals can use to implement them. Previously published as a journal article, this chapter includes an introduction by the author to update prior work and provide additional information and current data not included in the original piece.

Any strategy to end the opioid epidemic must include recognizing and addressing the role of widespread individual and community trauma and the need for solutions that build protective factors and agency within communities while supporting long-term treatment and recovery for those experiencing substance use disorders. In this chapter, the authors describe how a community trauma–informed approach can be applied to address and mitigate the exposures, behaviors, and high levels of hopelessness that are fueling the opioid crisis. Further, the chapter explores how primary prevention strategies can complement opioid treatment and long-term recovery interventions and address other conditions that co-occur in communities experiencing trauma.