To the Editor.—
It was appropriate that two thoughtful and helpful articles about adolescent pregnancy should appear in JAMA.1,2 However, I would like to suggest a broader model for the prevention of adolescent pregnancy. In the original description of the levels of application of preventive medicine, Leavell and Clark3 defined primary prevention procedures as "measures designed to promote general optimum health by the specific protection of man against disease agents or the establishment of barriers against agents in the environment." They state that secondary prevention may be accomplished by early diagnosis and prompt treatment to prevent sequelae and limit disability. They consider tertiary prevention to be accomplished by rehabilitation.When considering adolescent pregnancy as a public health problem, it seems more appropriate to define primary prevention as all the approaches Drs McAnarney and Hendee included as well as the specific protection of providing birth control for sexually
Ganser JA. Adolescent Pregnancy Prevention: Primary, Secondary, and Tertiary. JAMA. 1990;263(6):813. doi:10.1001/jama.1990.03440060053025
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