Preventing adolescent smoking: what have we learned about treatment construct validity?

In recent years, numerous programs introduced to prevent adolescent smoking have demonstrated some success. This paper reviews the treatment construct validity of such programs; that is, we seek to determine how and why programs reduce adolescent smoking. The review leads to the conclusion that little is presently known about the construct validity of successful programs, a problem that results primarily from the neglect of process assessment and analyses. The advantages and disadvantages of several future research approaches are discussed, including: (a) utilization of process measures within large scale treatment/no-treatment designs, (b) small-scale studies to test the effects of prevention components on process measures (e.g., attitudes, intentions to smoke), and (c) combinations of these two approaches.