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Precision prevention: time to move beyond universal interventions
  1. Flaura K Winston1,2,3,
  2. Kristina Puzino4,
  3. Daniel Romer5
  1. 1Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  2. 2Department of Pediatrics, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  3. 3Leonard Davis Institute for Health Economics, Philadelphia, Pennsylvania, USA
  4. 4Lehigh University, Bethlehem, Pennsylvania, USA
  5. 5Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Flaura K Winston, The Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, 3535 Market Street, Suite 1150, Philadelphia, PA 19104, USA; flaura{at}

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Nearly two decades ago, the Institute of Medicine (IOM) in the USA recognised that many adverse health outcomes result from behavioural tendencies that place individuals at risk. Programmes designed to change these behaviours could have long-term salutary effects. They further noted the heterogeneity within and across populations and over time in the nature and severity of unhealthy behaviours. To address the disparate needs of individuals in a population, the IOM proposed a multi-tiered framework for prevention that provides differential and increasingly more intense preventive intervention as a function of level of risk and response to prior intervention.1 This framework has been adopted for a wide range of educational and behavioural health issues; for example, in the school setting, the prevention and early intervention for preschool children at risk for learning or behaviour problems;2 ,3 in the community setting, the management of blood pressure4 and in the inpatient clinical setting, the secondary prevention of traumatic stress.5 However, unintentional injury prevention still relies largely on ‘one-size-fits-all’ or universal strategies (eg, laws and their enforcement and education campaigns). While such ‘universal’ injury prevention strategies can reach the widest audience, complementary targeted risk approaches are necessary to meet the needs of minority, higher risk populations, and to increase the value of prevention strategies.

Injury prevention recognises the concept of ‘tailored interventions’ that deliver culturally sensitive or other adapted measures depending upon the characteristics of the target audience. These include altering the language in which an intervention is delivered6 to a population or varying the implementation of an intervention to accommodate important individual differences, for example, through kiosk-delivered tailored messaging7 ,8 or safety technology tailored to the characteristics of the vehicle occupant. When air bags were first introduced, they were largely one-size-fits-all and children and short-statured women …

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