Incorporating Quaternary Prevention: Understanding the Full Scope of Public Health Practices in Sexual Abuse Prevention

• Author: Kieran McCartan,Hazel Kemshall
• DOI: http://doi.org/10.1177/0306624X211049204
• Published date: 01 February 2023
• Date: 01 February 2023
• Subject Matter: Articles

https://doi.org/10.1177/0306624X211049204

International Journal of

Offender Therapy and

Comparative Criminology

2023, Vol. 67(2-3) 224 –246

© The Author(s) 2021

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DOI: 10.1177/0306624X211049204

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Article

Incorporating Quaternary

Prevention: Understanding

the Full Scope of Public

Health Practices in Sexual

Abuse Prevention

Kieran McCartan1 and Hazel Kemshall2

Abstract

This discussion piece argues for a refinement in our understanding of prevention in

sexual abuse, suggesting that we include quaternary prevention on the grounds that

this concept from medical literature has potential and helpful application to criminal

justice and particularly to work with those who cause sexual harm. Located within

the paradigm of Epidemiological Criminology (EpiCrim), quaternary prevention

extends the prevention spectrum to enable a stronger distinction between tertiary

level responses and long-term safe, sustainable reintegration into communities,

particularly of those who sexually abuse others. The key principles of quaternary

prevention are adapted and refined from current medical literature, and the potential

usefulness of quaternary prevention to crime and sex abuse prevention is explored.

Keywords

quaternary prevention, sexual offending, crime, EpiCrim, risk management

Introduction

Sexual abuse is a complex and multi-faceted issue, as are the reasons why people

sexually offend. There has been a growing academic and policy recognition that both

understanding and respond ing to sexual abuse requires a multi-disciplinary approach

spanning several different academic disciplines (e.g., psychology, sociology, medicine,

1University of the West of England, Bristol, UK

2De Montfort University, Leicester, UK

Corresponding Author:

Kieran McCartan, Faculty of Health and Applied Social Sciences, Department of Social Sciences,

University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK.

Email: Kieran.mccartan@uwe.ac.uk

1049204IJOXXX10.1177/0306624X211049204International Journal of Offender Therapy and Comparative CriminologyMcCartan and Kemshall

research-article2021

McCartan and Kemshall 225

criminology). This makes responding to, and preventing, sexual offending challeng-

ing, as there is no “one size fits all” approach. Rather what is needed is a dynamic,

multi-level response that addresses the individual, inter-relational, community, and

society levels (Tabachnick, 2013). Such responses arguably require a pan-disciplinary

approach through which differing disciplines can jointly focus on solving a complex

problem such as child sexual abuse.

However, current responses to sexual offending across the globe are largely

focused on the individual, and the inter-relationship of the individual to families and

networks (McCartan, Uzieblo et al., 2021). This has resulted in the person who has

committed the offence often being the sole subject of our response, rather than taking

a more holistic approach that incorporates society as well as the individual. Sexual

offences are collectively as well as individually defined and framed, and therefore,

we also need to collectively construct our responses to them including prevention

strategies (McCartan et al., 2015). The aim of this discussion article is to open up a

discussion about the contribution of Epidemiological Criminology (EpiCrim) to the

continued development and relevance of prevention; and to introduce the concept of

quaternary prevention from medicine based on the belief that quaternary prevention

could have a useful relevance to the criminal justice arena, and particularly to sexual

abuse prevention.

EpiCrim: The Intersection of Public Health and

Criminology

Criminology has been described as a “rendezvous subject,” that is a discipline

where other social science disciplines interact to focus on complex and multi-fac-

eted issues such as crime (Downes & Rock, 2011). Young (2003) famously described

it as being: “on the busy crossroads of sociology, psychology, law and philosophy”

(p. 97). By the 1980s and 90s the increased “melding” together of different disci-

plines to understand crime had begun; initially sociology, politics, and psychology,

but by the early 2000s health. By the turn of the century public health in particular

began to make an important contribution to understanding crime causation (Lainer,

2010). Notable research in this area has included crime causation, life-course analy-

ses of offending behavior, and preventative measures to reduce crime (Akers &

Lanier, 2009 ; Lainer, 2010; Lanier & Henry, 2010). This resulted in a new field of

research and practice called Epidemiological Criminology (EpiCrim) (Lainer, 2010)

(see Figure 1). EpiCrim is a recognition that the fields of criminology and health,

especially public health, come together in allowing us to understand the causes and

consequences of offending behavior better (Lainer, 2010), and this includes sexual

offending (McCartan & Prescott, 2020; Waltermaurer & Akers, 2013). In addition,

EpiCrim reinforces the life course perspective when analysing and responding to

crime. EpiCrim has been defined as:

“the explicit merging of epidemiological and criminal justice theory, methods and

practice. Consequently, it draws from both criminology and public health for its