Situation: The public health nurse of a Rural Health Unit (RHU) runs a tobacco and alcohol program for tricycle drivers and factory workers in the municipality. The nurse lists the activities of the program. Which one is an example of SECONDARY prevention?

Primary prevention reduces risk factors before disease starts (smoke-free laws, life-skills programs). Secondary prevention detects problems early through screening, such as the Alcohol Use Disorders Identification Test (AUDIT), so that early action can follow. Tertiary prevention limits disability and relapse once a disorder exists.

Secondary prevention in a community health program refers to actions that identify a health problem early, before symptoms or complications become obvious, so that timely intervention can follow. In the tobacco and alcohol program described, screening workers for risky drinking with a questionnaire fits this level because the goal is early detection of unhealthy alcohol use rather than preventing exposure or managing an established disorder.

Screening is the defining activity of secondary prevention. The Alcohol Use Disorders Identification Test (AUDIT) is a validated tool used to detect risky or harmful drinking in primary care and community settings. The Australian treatment guidelines recommend screening for unhealthy alcohol use in general practice, hospitals, emergency departments, and community health settings, and identify AUDIT as the most effective screening tool for this purpose ^[4]. When the public health nurse administers a questionnaire to tricycle drivers and factory workers, the intent is to find individuals whose drinking may already be hazardous but who have not yet been diagnosed or treated.

The supporting evidence reinforces this framework. A randomized controlled trial among university students used screening to identify participants with unhealthy alcohol use and then delivered a smartphone-based secondary prevention intervention ^[1]. The study design itself demonstrates the two-step logic of secondary prevention: first detect the problem through screening, then act early. A systematic review of emergency department interventions similarly examined brief interventions for patients identified through screening who were at risk for alcohol use disorder, emphasizing that screening is the entry point for early intervention ^[3]. An older analysis of secondary prevention programs for excessive alcohol use also described screening-based approaches as central to reducing alcohol risk and harm at the population level ^[2].

Secondary prevention does not prevent the initial exposure to alcohol; it detects unhealthy use that is already occurring so that early action can reduce progression and harm. This distinguishes it from primary prevention, which aims to stop the problem before it starts.

The other options belong to different prevention levels. Advocating a smoke-free ordinance for public places is primary prevention because it reduces environmental risk factors for the entire population before any individual disease develops. Teaching young workers skills to resist peer pressure to drink is also primary prevention, as it builds protective skills before unhealthy drinking begins. Running a relapse-prevention group for former drinkers is tertiary prevention, because it targets individuals who already have an established alcohol use disorder and aims to limit disability, recurrence, and complications.

Prevention level	Goal	Example from the program
Primary	Reduce risk factors before disease starts	Smoke-free ordinance, resistance-skills training
Secondary	Detect early disease or risky behavior through screening	Screening workers with AUDIT or similar questionnaire
Tertiary	Limit disability and relapse once a disorder exists	Relapse-prevention group for former drinkers

Key point! In licensure exams, the word “screening” almost always signals secondary prevention. Look for the action that identifies an existing but unrecognized problem rather than preventing exposure or treating an established condition.

Watch out! Do not confuse health education with secondary prevention. Teaching skills to resist peer pressure is primary prevention because it occurs before the behavior starts, while screening detects behavior that is already present ^[4].