Primary prevention approaches can be subdivided

If the aim is to reduce the incidence of a condition, two broad approaches may be taken ( Fig., 2). A whole population may receive an intervention at an early age: a universal approach. Alternatively, a subpopulation thought to be at particular risk for a condition may be targeted. This can be further subdivided into selective (when groups are the target of a prevention activity) or indicated (when a preventive measure is addressed to individuals). An example of a selective intervention is a programme of parent management training for lone teenage parents in socially disadvantaged areas, whereas genetic counselling for parents who have a single child with autism is an indicated intervention.

Targeting can be related to individual vulnerabilities, situational factors, or events. Risk may be because of individual genetic factors, the presence of constitutional factors (low intelligence, specific developmental problems, adverse temperament, coexisting physical illness, or disability), because of exposure to chronic stressors (intrafamilial discord, social disadvantage, parental psychiatric disorder, substandard schooling), or because of discrete individual experiences (abuse, life-threatening catastrophe, parental divorce, closed head injury). When more than one is present, they have often been shown to interact, each magnifies the effect of the other, so that removing one will considerably reduce the impact of the others. However, interaction does not always occur and sometimes there is simple summation/8)

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