Villanti AC, Niaura RS, Abrams DB, Mermelstein R. (2018). Preventing smoking progression in young adults: The concept of prevescalation. Prevention Science. doi: 10.1007/s11121-018-0880-y
Noting unique features of young adult smoking behavior, the authors propose the concept of “prevescalation” to describe the need to prevent escalation in smoking behavior that may occur after experimentation with tobacco in adolescence or early young adulthood. Research has found that smoking behavior rises rapidly in some after age 18. There are several other, lower-use smoking trajectories (e.g., stable light smoking, intermittent smoking, smoking initiation after age 18) and no substantial group of “quitters” among young adult smokers. Smoking trajectories from adolescence to young adulthood often result in persistent patterns in smoking behavior being established by age 25. Additionally, young adults often do not exclusively use cigarettes for tobacco consumption. Prevescalation efforts can combine approaches from population-based prevention and personalized intervention efforts. Social media and text messaging could be leveraged to reach young adults with messages intended to interrupt or reverse escalation of smoking behavior. Such prevescalation messages could address social learning, normative information about smoking in other young adults, desires to fit in, and desires for recognition for accomplishments. Measuring impact of prevescalation efforts poses a particular challenge to prevescalation initiatives. Prevescalation does not just target smoking behavior, but changes in smoking behavior including changes in amount, frequency, and mode of smoking behavior. Thus, prevescalation efforts require frequent measurement of multifaceted smoking behavior. Ecological momentary assessments may be an ideal way to measure smoking behavior in prevescalation initiatives.