Health Promotion, Prevention, and Harm Reduction
What to know
Prevention levels: universal, selective, indicated (Institute of Medicine classification). Risk and protective factors across individual, family, school, and community domains. Harm reduction principles: meet people where they are, reduce negative consequences, non-judgmental, pragmatic. Key interventions: naloxone distribution, syringe services programs (reduce HIV/HCV), fentanyl test strips, supervised consumption sites (where legal), nicotine replacement, and safe driving/medication disposal education. Understand SBIRT and screening in primary care. Know policy approaches (taxation, minimum legal drinking age, advertising restrictions) and environmental strategies. Recognize stigma reduction as a prevention tool.
Traps
Questions equate harm reduction with "enabling" - evidence shows SSPs and naloxone reduce harms without increasing use. Watch for items suggesting abstinence is required before harm-reduction services (it is not). Distinguish universal (whole population) from indicated (high-risk individuals) prevention. Note that naloxone does not reverse alcohol or stimulant overdose.
Rule of thumb
Match prevention to risk level: universal for everyone, selective for at-risk groups, indicated for individuals showing early signs. Harm reduction is a bridge, not a barrier, to treatment.
Worked example
A community with rising opioid overdoses implements naloxone distribution and a syringe services program. These are evidence-based harm-reduction strategies that reduce overdose deaths and infectious disease without increasing substance use.