Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT, USA.
Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA.
Prev Sci. 2019 Apr;20(3):377-384. doi: 10.1007/s11121-018-0880-y.
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 "prevescalation" 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.
当青少年迈入成年早期时，他们会遇到更多的机会去参与或加速之前被劝阻或禁止的行为。因此，如果年轻人在青少年时期尝试过吸烟，那么他们更有可能开始吸烟，更重要的是，如果他们尝试过，他们会加速吸烟。防止吸烟在年轻成年人中升级和根深蒂固对于减少烟草对长期健康的影响至关重要。然而，传统的针对青少年的干预措施侧重于预防吸烟的开始，而针对成年人的干预措施则侧重于戒烟；这两种干预措施都没有满足年轻人的需求。我们引入了“预升级”的概念，以捕捉预防通常发生在成年早期的风险行为升级的需求和机会，以吸烟为例。预升级否定了如果青少年时期发生吸烟试验，预防就已经失败的观点，而是侧重于理解和打断从尝试吸烟产品到建立主要发生在成年早期的吸烟习惯的转变。然而，由于风险行为在年轻人中经常同时发生，预升级的核心概念可能适用于其他在成年后更难改变的同时发生的行为。我们提出了一个新的框架，用于构思、制定和评估干预措施，这些措施更符合年轻人独特的行为、心理社会和社会环境特征。我们讨论了针对这一过渡阶段的必要性，我们对吸烟行为的途径和预测因素的了解，潜在的干预考虑因素以及研究挑战。
