Precision prevention: time to move beyond universal interventions

Abstract

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 pressure 4 and in the inpatient clinical setting, the secondary prevention of traumatic stress.

The Role of Sleep in the Relationship Between Victimization and Externalizing Problems in Adolescents

“…Addressing the issue of victimization early in adolescence (or even earlier during childhood) is one approach that can help to reduce the likelihood of adolescents developing sleep problems, which may then help to protect them from engaging in impulsive, risk-taking behaviors due to decreased cognitive functioning. For example, a tiered intervention approach (Winston et al 2015) could employ a universal intervention to address the issues of sleep quality and quantity among adolescents, while more focused interventions could be directed towards youth that are at a particularly high risk for externalizing outcomes due to either current victimization or other environmental stressors (e.g., low SES). Alternatively, focused interventions also could address intrusive thoughts, which may be linked to poor sleep.…”

The Teen Driver

“…93 However, more intensive programs, including active parental engagement or the use of in-vehicle data recorders, reveal modest beneficial effects in the quality of risk-related communication, parental supervision in early driving, and reductions in self-reported teen risky driving. 93,94 Winston et al 95 have called for a "precision prevention" approach to teen driving safety. In this tiered approach, a robust universal prevention strategy (eg, GDL) is paired with tools and support for parents to optimize the effect of GDL on their teen driver.…”

“…Beyond universal interventions, selected interventions for subgroups of teenagers at predictably higher driving risk may be required. 95 For example, teenagers with ADHD might benefit from additional behindthe-wheel training, longer periods of restriction or supervision, and medication optimization. Most of these interventions call for increased parental involvement.…”

“…Familyfocused interventions for these young drivers seek to improve parental communication and monitoring. 97 Winston et al 95 noted that some adolescents will require individualized interventions on the basis of their personal history of risk taking or demonstrated difficulties in driving tasks. These drivers might benefit from in-vehicle technological monitoring, coupled with interventions used to strengthen parental monitoring.…”

Precisely Where Are We Going? Charting the New Terrain of Precision Prevention

“…Precision prevention risk reduction strategies, by extension, take genomic markers as their index risk factors and then try to modulate the predictive models they suggest in order to account for other above-the-skin influences, such as exposure to environmental contaminants or occupational risk factors, health behaviors related to activity or diet, or interactions between these factors (12). In this way, precision prevention combines key genetic insights with other forms of data to offer new opportunities to reduce morbidity and mortality (114). …”