This paper reports six-year follow-up data from the first large-scale randomized trial of the social influences approach to smoking prevention. In 1979, 22 schools were randomly assigned to program or control conditions. Students in program schools received a social influences curriculum in six core and two maintenance sessions in grade 6, two booster sessions in grade 7, and one booster session in grade 8. All students were assessed at pretest (T1), immediate posttest (T2), end of grade 6 (T3), beginning and end of grade 7 (T4 and T5), end of grade 8 (T6), and grades 11 and 12 (M7

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INTRODUCTIONRecent reviewers conclude that advances in the behavioral and health sciences over the past two decades promise an effective technology for combatting diseases of lifestyle (42,53). However, the revolutionary shift from primary care emphasis to the promotion of healthy behaviors (57) has radical im plications for public health. The reality is that (a) the public health sciences need a conceptual model to guide the development and diffusion of effective health promotion programs; (b) the complex biological , behavioral , and sociocultural determinants of health behavior still are very imperfectly un derstood; (c) methods of promoting health-enhancing behaviors on a popula tion level still require much research and development; and (d) we need a conceptual framework to guide diffusion of effective programs.The aim of this chapter is to evaluate, from this perspective, research on the prevention of cigarette smoking among school children. First, we present an overall model for program development research. This model helps to organize conceptual frameworks for consideration of (a) reasons for youth smoking, (b) factors determining program impact, and (c) program diffusion . Second, we succinctly review the available empirical literatures on smoking prevention programs. Finally, we present important isues for future research: methodological considerations and priority research directions. CONCEPTUAL MODEL FOR PROGRAM DEVELOPMENT RESEARCHIn brief. program development research moves from (a) basic research to identify why people behave as they do, and how they change, to (b) a primary focus on the development of efficacious intervention methods to prevent or reduce unhealthy behavior and foster health behavior, and finally to (c) widespread diffusion, coupled with evaluation of the interventions as they are adapted to community services. Just as two decades ago clinical epidemiology started to be seen as the science of clinical medicine, so we need a research framework and methodol ogy to guide applications of behavioral science principles and knowledge to public health (7 , 10). Various models for program development and interven tion research have been described (31,41,61). These models raise a series of sequential questions, with the answer to each question setting the stage for the next phase of research: