# 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?

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> subject: Nursing Practice I — Community Health Nursing

## 문제

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?

## 보기

1. Screening workers for risky drinking with a questionnaire **✔ 정답**
2. Advocating a smoke-free ordinance for public places
3. Running a relapse-prevention group for former drinkers
4. Teaching young workers skills to resist peer pressure to drink

**정답: 1**

## 해설

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.

## 심화 해설

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].References (research sources)

- [1]Smartphone-based secondary prevention intervention for university students with unhealthy alcohol use identified by screening: study protocol of a parallel group randomized controlled trial.RCT/clinical trialBertholet N, Schmutz E, Grazioli VS, Faouzi M, McNeely J, Gmel G (2020) · DOI: 10.1186/s13063-020-4145-2

- [2]Secondary prevention of excessive alcohol use: assessing the prospects of implementation.Research articleBotelho RJ, Richmond R (1996) · DOI: 10.1093/fampra/13.2.182

- [3]Effectiveness of SBIRT for Alcohol Use Disorders in the Emergency Department: A Systematic Review.Meta-analysis/systematic reviewBarata IA, Shandro JR, Montgomery M, Polansky R, Sachs CJ, Duber HC (2017) · DOI: 10.5811/westjem.2017.7.34373

- [4]New Australian guidelines for the treatment of alcohol problems: an overview of recommendations.GuidelineHaber PS, Riordan BC, Winter DT, Barrett L, Saunders J, Hides L (2021) · DOI: 10.5694/mja2.51254

## 임상 시나리오

Screening as Secondary PreventionEarly detection in community alcohol programs
Secondary prevention focuses on early detection of unhealthy alcohol use before complications develop. Administering a screening questionnaire such as AUDIT to tricycle drivers and factory workers identifies individuals with risky drinking who have not yet been diagnosed or treated.

The core logic is a two-step process: first detect the problem through screening, then deliver early intervention. This distinguishes secondary prevention from primary prevention, which prevents exposure, and tertiary prevention, which manages established disorders.

CautionDo not confuse screening with health education or policy advocacy. Screening only identifies risk; it must be followed by a linked intervention to be effective secondary prevention.

## 핵심 개념

- **Secondary prevention** — Early detection of a health problem through screening before symptoms or complications become obvious, allowing timely intervention.
- **AUDIT** — Alcohol Use Disorders Identification Test, a validated screening tool for detecting risky or harmful drinking in community and primary care settings.
- **Primary prevention** — Actions that reduce risk factors before disease starts, such as policy advocacy or life-skills education.
- **Tertiary prevention** — Interventions that limit disability and prevent relapse once a disorder already exists.

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