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Targeting ‘high-risk’ individuals
  1. Brian D Johnston
  1. Correspondence to Dr Brian D Johnston, Department of Pediatrics, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359774, Seattle, Washington, USA; ipeditor{at}bmjgroup.com

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It is not unusual for this journal to receive papers describing the epidemiology of an injury mechanism, and often endeavouring to identify risk factors associated with the outcome. In fact, we publish many such manuscripts.1–3 When discussing the motivation for a study or the implications of its results, authors will often state that risk factors they have identified could be used to ‘target’ injury control interventions towards individuals at particular injury risk. The rationale seems reasonable enough: find a demographic or behavioural marker that is associated with injury, and use this to direct limited or intensive prevention resources towards those at highest risk. But there are problems inherent in this approach that merit discussion.

Of course, at some level, every program is targeted. Clinicians don't offer smoking cessation advice to non-smokers. Nor do we typically discuss child safety restraint with non-parenting adults. …

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