Table 1.

Translational research stages—definitions, sources of complexity, and examples of complexity in tobacco prevention

Type	Type 0 translation (T0)	Type 1 translation (T1)	Type 2 translation (T2)
Definition	The fundamental process of translating findings and discoveries from social and biomedical sciences into research with human subjects.	Moving from bench to bedside. Translation of applied theory to methods and program development.	Moving from bedside to practice and involves translation of program development to efficacious trials.
General challenge driven by complexity	In this translational stage, it can be challenging to integrate different scientific research discoveries relevant to a complex behavioral problem that occur across relevant disciplines (e.g., psychology, neurobiology, social epidemiology, behavioral economics) that have implications at multiple ecological levels (e.g., intra- and inter-personal, family, community, etc.).	As interventions, programs, and policies are developed, they must be based on a holistic understanding of the mechanisms determining risky behaviors. With increasing complexity of underlying mechanisms, it is more difficult to design impactful interventions because unaddressed factors may undermine effects.	Maximizing intervention efficacy requires understanding how interventions are best delivered. Based on insights from T0 and T1 work, it is important to make critical decisions about how an intervention should be implemented. In the context of complex behavior change, this can require careful study, planning, and experimentation.
Challenge specific to tobacco prevention	How do neurobiological processes, epigenetics, and socio-cultural forces interconnect and affect tobacco use, non-use, quitting, and relapse in individuals and populations over time? (Fig. 1)	Based on the holistic, mechanistic understanding of tobacco use resulting from T0 stage work, what are the most appropriate and actionable targets for decreasing tobacco use? What unanticipated consequences might result from each option? Can actions be re-designed to make them more synergistic and impactful? (Fig. 2)	Before implementing a school-based prevention intervention, what must be considered to support intervention fidelity? What is the appropriate dosage of intervention components? For an accompanying social marketing campaign, what can be done to ensure that critical audiences are reached to maximize intervention synergy? (Fig. 3)
Type	Type 3 translation (T3)	Type 4 translation (T4)	Type 5 translation (T5)
Definition	Determining whether efficacy can be replicated under real world settings.	Wide-scale implementation, adoption and institutionalization of new guidelines, practices, and policies.	Translation to global communities. Involves fundamental, universal change in attitudes, policies, and social systems.
General challenge driven by complexity	As more complex behaviors are targeted by intervention, all of the factors that matter in stages T0-T2 are likely to vary in the real world – across individuals, community, and over the life-course. At this point, it is important to identify and evaluate which complexities across real-world settings are most likely to compromise or bolster real-world effectiveness.	In this translational stage, it is important to study threats to broad use of the intervention. The greater the quantity and diversity of stakeholders affected by the intervention, the greater is the likelihood that some group (or groups) might resist it. At this point, it is important to understand what aspects of the intervention might be resisted, by whom, and why.	As the complexity of targeted behaviors increases, and the number of stakeholders affecting or affected by intervention grows, a more complex web of attitudes, incentives, relationships, rules of engagement, and sphere of influence surrounds intervention. Understanding which changes will best support prevention can be daunting and requires careful planning.
Challenge specific to tobacco prevention	How will the multi-pronged tobacco prevention intervention (school-based intervention with an accompanying social marketing campaign) work in communities with different levels of resources and motivation to implement? What else might threaten the intervention’s effectiveness in certain communities? How might a community adapt it to address problems that arise in implementation, to make the intervention more consistent with local context and culture? (Fig. 4)	Who is most likely to react negatively to the tobacco prevention intervention, and why? What shape is resistance likely to take, and will it undermine the intervention’s effectiveness? What can be done to position the intervention for minimal resistance and optimal wide-scale diffusion? (For example, can tobacco company response be anticipated and addressed at the outset?) (Fig. 5)	What can be done within communities, and at state, national, and global levels to best support meaningful tobacco prevention? (Fig. 6)