Preventing Smoking Progression in Young Adults: the Concept of Prevescalation

Abstract

As adolescents cross the threshold to young adulthood, they encounter more opportunities to engage in or accelerate previously discouraged or prohibited behaviors. Young adults, therefore, are more apt to initiate cigarette smoking and, more importantly, to accelerate their use if they tried and experimented as an adolescent. Preventing the escalation and entrenchment of smoking in the young adult years is critically important to reducing tobacco's long-term health toll. However, traditional interventions for youth have focused on preventing smoking initiation, and interventions for adults have focused on smoking cessation; both have failed to address the needs of young adults. We introduce the concept of Bprevescalation^to capture the need and opportunity to prevent the escalation of risk behaviors that typically occur during young adulthood, with a focus on the example of cigarette smoking. Prevescalation negates the notion that prevention has failed if tobacco experimentation occurs during adolescence and focuses on understanding and interrupting transitions between experimentation with tobacco products and established tobacco use that largely occur during young adulthood. However, since risk behaviors often co-occur in young people, the core concept of prevescalation may apply to other behaviors that co-occur and become harder to change in later adulthood. We present a new framework for conceptualizing, developing, and evaluating interventions that better fit the unique behavioral, psychosocial, and socio-environmental characteristics of the young adult years. We discuss the need to target this transitional phase, what we know about behavioral pathways and predictors of cigarette smoking, potential intervention considerations, and research challenges.

Electronic cigarettes, nicotine use trends and use initiation ages among US adolescents from 1999 to 2018

“…The decision to define use by cumulative life‐time exposure, as opposed to initiation, was based on two primary factors: (1) initiation is less important than cumulative life‐time use for long‐term health outcomes [29]; and (2), systematic errors in ever use of ECs have been identified in the NYTS prior to 2014 due to a change in questionnaire design [30].…”

Student Experience of School Screening, Brief Intervention, and Referral to Treatment

“…Understanding how to address these barriers and determining the most effective content to deliver during SBIRT, especially for those that have already used substances are questions that remained unanswered and could represent a logical next step for this study. For students that do report past‐year substance use, use of evidence‐based brief interventions may result in more engaging and memorable experiences …”

Opportunities and Challenges for Prevention and Intervention in Emerging Adulthood: Introduction to the Special Issue

“…In the final paper, Villanti et al (2018) introduce a novel conceptual prevention approach-prevescalation-that targets prevention of escalations in smoking behavior during emerging adulthood. This concept captures the need to address the gap between prevention of smoking initiation, typically implemented during adolescence, and adult-focused tobacco cessation interventions.…”

“…This concept captures the need to address the gap between prevention of smoking initiation, typically implemented during adolescence, and adult-focused tobacco cessation interventions. Because rapid escalation of smoking behavior is likely to occur during emerging adulthood, Villanti et al (2018) argue that prevescalation strategies, which disrupt transitions between experimentation and established use, are ideally suited for this developmental stage. The authors note that prevescalation strategies may encompass both universal prevention approaches and targeted cessation strategies, and that evaluating prevescalation interventions may require evaluations that go beyond traditional assessment of randomized control trial designs.…”