Adolescent Neurological Development and its Implications for Adolescent Substance Use Prevention

Barbara Lopez; Seth J. Schwartz; Guillermo Prado; Ana E. Campo; Hilda Pantin

J Prim Prev. 2008;29(1):5-35.

Abstract & Introduction

Recent technological advancements have facilitated the study of adolescent neurological development and its implications for adolescent decision-making and behavior. This article reviews findings from the adolescent neurodevelopment and substance use prevention literatures. It also discusses how findings from these two distinct areas of adolescent development can complement each other and be used to build more developmentally appropriate interventions for preventing adolescent substance use. Specifically, a combination of child-centered and family-based strategies is advocated based on extant neurological and prevention literature. Editors' strategic implications: Researchers are encouraged to take up the authors' challenge and study the links between adolescent neurological development/decision making ability and the long term efficacy of comprehensive interventions for preventing adolescent substance use.

Despite recent reductions in the prevalence of adolescent substance use (Johnston et al. 2006a), substance use, including cigarette, alcohol, and drug use, in adolescents remains an important public health concern. Adolescents continue to display higher rates of experimental substance use than those found in adults (Chambers et al. 2003). Community based studies have found that substance initiation and use peak in late adolescence and young adulthood (Johnston et al. 2006a, b; Kandel and Yamaguchi 1999). Lifetime substance use nearly doubles between 8th grade and 12th grade (Johnston et al. 2006a), indicating that a large portion of adolescents initiate substance use in high school.

These high rates of substance use initiation in adolescence (12-18 years old) and emerging adulthood (18-25 years old: Arnett 2000) may be associated with an increased orientation toward risk taking in adolescence. For example, Gullone and Moore (2000) found that older adolescents (15-18 years old) engaged in more risk taking behavior, including substance use, than do younger adolescents (11-14 years old). Substance use in adolescence is associated with a number of problematic concomitants and sequelae, such as repeated arrests (e.g., Flory et al. 2004), substance use disorders (e.g., DeWit et al. 2000; Sung et al. 2004), comorbid psychopathology (e.g., Bucholz et al. 2000; Chung and Martin 2001; Cornelius et al. 2004; Schuckit and Hesselbrock 1994), lowered educational attainment (Ellickson et al. 2004), sexually transmitted diseases (e.g., Cook et al. 2000), teen pregnancy (e.g., Clark et al. 1997), and physical health problems in adulthood (Clark et al. 2001; Hansell and White 1991; Newcomb and Bentler 1987). Moreover, the earlier substance use begins, the more severe it and its consequences will be, and the more likely it is to be associated with negative consequences in adulthood (Grant and Dawson 1997; Hawkins et al. 1992; Flory et al. 2004). For example, Flory et al. (2004) found that youth who began to use alcohol by 12 years old evidenced more arrests and greater likelihood of substance use disorders at ages 20-22 than did youth who did not drink or who postponed drinking until after 14 years old.

In terms of consequences, adolescent substance use may influence adult outcomes by way of affecting the adolescent's functioning across several areas, including psychological (lower autonomy and perceived competence: Chassin et al. 1999) and social (e.g., relationship; King et al. 2006; Newcomb and Bentler 1988) problems. These wide-ranging impairments in adolescent functioning can, in turn, interfere with successful acquisition of adult roles such as marriage (Baumrind and Moselle 1985; Friedman et al. 2004), parenting (e.g., irresponsible parenting; King et al. 2006; Newcomb and Bentler 1988), and gainful employment (e.g., greater unemployment, job instability, lower income; Baumrind and Moselle 1985; Friedman et al. 2004).

The higher rates of substance use in adolescence than in adulthood may have biological as well as social underpinnings. Accordingly, the purpose of this article is to review findings from the adolescent neurodevelopment and substance use prevention literatures and to discuss ways in which findings from these two distinct areas of adolescent development can complement each other and can be used to build more developmentally appropriate interventions for preventing adolescent substance use. Specifically, we review findings from (a) prevention studies aimed at reducing adolescent substance use and (b) neurological development studies focusing on decision-making and emotion regulation. Findings from these two areas are then used to inform research directions for adolescent substance use prevention. More specifically, findings from studies on neurological development suggest that adolescent decision making ability and emotion regulations skills are not fully developed. As a result, we argue that prevention programs that rely solely on decision-making abilities to reduce risk for substance use may not be developmentally appropriate.

In this article, we have chosen to focus on universal and selected (e.g., girls, Hispanics, African Americans) primary prevention studies (Mrazek and Haggerty 1994), which generally focus on delaying initiation of substance use. We do so for four reasons. First, the age range targeted by primary prevention (middle school and high school) represents the time when considerable changes in neurological development can be observed and when risk for substance use initiation increases sharply (Johnston et al. 2006a, b; Kandel and Yamaguchi 1999). Second, initiation of substance use in adolescence is often associated with other aspects of the problem behavior syndrome (e.g., school failure, unsafe sexual behavior, and deviant behavior; Jessor et al. 2003). Third, initiation of substance use in adolescence has also been shown to lead to neurological changes (e.g., increased risk taking; Fishbein et al. 2005; Verdejo-Garcia et al. 2006) that may result in greater susceptibility to addiction (Volkow and Li 2006). These patterns may create different pathways to substance use for initiators and non-initiators. Finally, the theory, goals, and structure of universal and selective interventions are different from those of indicated interventions, which target specific subgroups of adolescents who have already begun engaging in high risk behaviors such as conduct problems and substance use, and therefore results from indicated interventions may not generalize to universal and selective interventions (Nation et al. 2003).

A search of the PsycInfo psychological literature database was used to obtain relevant interventions aimed at preventing substance use initiation (primary prevention) that were published between January 1996 and February 2007. We focused on the past 10 years to provide a more recent review of the literature. We targeted primary prevention interventions for adolescents in general, using the search terms "prevention," or "initiation"; and "adolescent"; and "cigarette" or "tobacco" or "smoking" or "drug" or "alcohol" or "substance". We limited the preventive interventions included in the review to those that used randomized trial designs (see Carroll and Rounsaville 2003, for a complete description of stages of behavioral clinical trials). Pilot, uncontrolled, or non-randomized studies were not included in this review. This search yielded 40 prevention intervention trials. Specific information on these trials is presented in Table 1 .

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Cite this: Adolescent Neurological Development and its Implications for Adolescent Substance Use Prevention - Medscape - Jan 01, 2008.

Results for Interventions to Prevent Substance Use Initiation
Study	Analysis sample	Design	Intervention type	Primary prevention results
Aveyard et al. (2001)	N = 8,352 11th grade youth	Transtheoretical model vs no intervention	C	At 1 and 2 years FU, no significant intervention effects for smoking initiation
Botvin et al. (1999)	N = 2,209 8th grade girls	Life Skills Training (LST) vs drug information curriculum control	C	LST group reported less smoking initiation than control group
Brody et al. (2006)	N = 206 African American youth	Strong African American Families (SAAF) vs no intervention control	C	At 21 month FU, SAAF group reported less alcohol initiation and slower rate of increase in alcohol use than control group
Brown et al. (2002)	N = 2,643 10th grade youth	Smoking prevention vs usual care	C	Boys from smoking prevention group reported less smoking initiation than boys from usual care group
Brown et al. (2005)	N = 959 10th grade youth	Raising Healthy Children (RHC) vs control	F + C	Between 6 and 10th grade, no significant intervention effects on growth trajectories of alcohol and marijuana initiation
Byrne and Mazanov (2005)	N = 1,694 7-10th grade youth	Health-oriented vs fitness-oriented vs social skills/stress management-oriented interventions vs no intervention control	C	All three intervention groups reported less smoking reported initiation than control group. Social skills group less smoking initiation than health and fitness groups
Chou et al. (2006)	N = 2,454 8th grade Chinese youth	Chinese version of Project SMART vs no intervention control	C	No significant intervention effects on smoking initiation
Crone et al. (2003)	N = 2,562 middle school Dutch youth	Intervention vs no intervention control	C	Intervention group reported less smoking initiation than control group, at post-intervention. At 1 year FU, no significant intervention effects on smoking initiation
Curry et al. (2003)	N = 3,567 11-14 y/o	Multicomponent intervention vs usual care	M	At 20-month FU, no significant intervention effects on smoking initiation
de Vries et al. (2006)	N = 10,751 youth from Finland, Denmark, UK, Netherlands, Spain, and Portugal. Grade not reported	European Smoking Prevention Framework (ESFA) vs usual care	C	ESFA group reported less smoking initiation than usual care for Portugal only
Ellickson et al. (2003)	N = 4,276 7th and 8th grade youth	Project Alert vs no intervention control	C	Project Alert group reported less smoking and marijuana initiation than control group. No significant intervention effect on alcohol initiation
Fidler et al. (2001)	N = 2,492 11-16 y/o English youth	Psychoeducational material vs control	C	At 12-month FU, psychoeducational group reported less smoking initiation than control group
Furr-Holden et al. (2004)	N = 678 8th grader youth	Classroom centered (CC) vs family-school (FSP) vs no intervention control	C	At 7-year FU, CC group reported less initiation of partnership smoking and illicit drugs (crack, cocaine, heroine) than control group. FSP group reported less smoking initiation than control group. No significant intervention effects on alcohol initiation
Furr-Holden et al. (2004)	N = 678 8th grader youth		F
Hanewinkel and Abhauer (2004)	N = 1,625 youth from Germany, Luxembourg, Austria, and Denmark	LST vs no intervention control	C	At 15-month FU, no significant intervention effects on lifetime prevalence of smoking
Kentala et al. (1999)	N = 2,586 15 y/o Finish youth	Smoking discussion with dentist vs control	C	At 24-month FU, no significant intervention effects on smoking initiation
Lillehoj et al. (2004)	N = 456 8th grade youth	LST only or LST + Strengthening Families Program (SFP) 10-14 vs no intervention control	C	LST only and LST + SFP 10-14 groups reported delayed substance use initiation for girls only
Lillehoj et al. (2004)	N = 456 8th grade youth		F + C
Loveland-Cherry et al. (1999)	N = 428 7th grade youth and their families	In-home parent-centered intervention vs no intervention control	F	At 2-year FU, in-home group reported less alcohol use than control group for non-users at baseline only
Lynam et al. (1999)	N = 1,002 19-21 y/o	Project DARE (Drug Abuse Resistance Education) vs standard drug-education curriculum	C	At 10-year FU, no significant intervention effects on lifetime use of cigarette, alcohol, and drug
McBride et al. (2004)	N = 15 y/o Australian youth	School Health and Alcohol Harm Reduction Project (SHAHRP study) vs regular drug education classes	C	At 1-year FU, intervention group reported less alcohol initiation than control group
Palinkas (1996)	N = 296 14-19 y/o girls. 46% African American	Positive Adolescent Life Skills (PALS) + Facts of Life vs Facts of Life alone control	C	At 3-month FU, PALS + Facts of life group reported more marijuana and alcohol initiation Life alone control and less cigarette and other drug initiation than the Facts of Life alone control group
Peleg et al. (2001)	N = 760 12th grade Israeli youth	Intervention vs control	C	At 1- and 2-year FU, intervention group reported less alcohol initiation than control group
Perry et al. (1996)	N = 1,176 9th grade youth	Project Northland vs no intervention control	M	Project Northland group reported less alcohol, smoking, and marijuana initiation than control group
Peterson et al. (2000)	N = 8,388 12th grade youth	Hutchinson Smoking Prevention Project (HSPP) vs no intervention control	C	At 2-year FU (12th grade) and 4-year FU (2 years after 12th grade), no intervention effects were found on smoking initiation
Schulze et al. (2006)	N = 1,852 9th grade	Smoke-Free Class Competition vs control	C	At 18-month FU, no intervention effects on smoking initiation
Simons-Morton et al. (2005b)	N = 1,320 8th grade youth	Going Places Program vs no intervention control	M	No significant intervention effect on alcohol or smoking initiation
Simons-Morton et al. (2005a)	N = 1,484 9th grade youth	Going Places Program vs no intervention control	M	No significant intervention effect on alcohol or Smoking initiation
Slater et al. (2006)	N = 4,216 8th and 9th grade youth	All Stars + Be Under Your Own Influence (BUYOI) Media Campaign vs All Stars only vs BUYOI only vs no intervention control	M	All Stars + BUYOI group reported less marijuana, cigarette, and alcohol imitation than other three groups
Slater et al. (2006)	N = 4,216 8th and 9th grade youth		C
Spoth et al. (1999a)	N = 329 7th grade youth	Prevention Drug Free Years (PDFY) vs Iowa Strengthening Families Program (ISFP) vs no intervention control	F + C	At 1-year FU (7th grader), no significant intervention effects on substance use initiation. At 2-year FU (8th grade), PDFY & ISFP group reported less substance use initiation than control group non users at 1-year FU
Spoth et al. (1999b)	N = 317 7th grader youth	ISFP vs no intervention control	F + C	At 1-year FU (7th grade) and 2-year FU (8th grade), ISFP group reported less alcohol initiation than control group
Spoth et al. (1999b)	N = 294 8th grade youth	ISFP vs no intervention control	F + C
Spoth et al. (2002)	N = 1,372 8th graders youth	LST only vs LST + SFP 10-14 vs no intervention control	C	No significant intervention effects on smoking initiation. LST + SFP 10-14 group reported the least alcohol initiation. LST only and LST + SFP 10-14 groups reported marijuana initiation than control group
Spoth et al. (2002)	N = 1,372 8th graders youth	LST only vs LST + SFP 10-14 vs no intervention control	F + C
Spoth et al. (2004)	N = 304 12th grade youth	ISFP vs PDFY vs control	F + C	At 4 year FU, ISFP had a lower rate of increase in initiation of alcohol and cigarette use than control. No intervention effects were found for PDFY compared to control
Spoth et al. (2004)	N = 304 12th grade youth	ISFP vs PDFY vs control	F
Spoth et al. (2005)	N = 1,650 9th grade youth	LST only vs LST + SFP 10-14	C	2.5 years post-baseline, LST + SFP 10-14 had a slower increase of initiation rate for substance use than LST only and control. No significant differences were found between LST only and control
Spoth et al. (2005)	N = 1,650 9th grade youth	LST only vs LST + SFP 10-14	F + C
Spoth et al. (2006)	N = 464 12th grade youth	ISFP vs PDFY vs no intervention control	F + C	At 4 year FU, ISFP group had a slower increase of initiation of alcohol and drug use than control. No intervention effect was found for PDFY and alcohol use initiation. PDFY had a higher increase of drug use initiation than control
Spoth et al. (2006)	N = 464 12th grade youth	ISFP vs PDFY vs no intervention control	F
Stevens et al. (1996)	N = 1,200 4th, 5th, and 6th grade youth	Drug prevention curriculum vs drug prevention curriculum + parent & adult community activities vs no intervention control	C	No significant intervention effect on marijuana initiation
Stevens et al. (1996)	N = 1,200 4th, 5th, and 6th grade youth		M	No significant intervention effect on marijuana initiation
Stevens et al. (2002)	N = 2,183 8th and 9th grade youth	Alcohol and tobacco prevention vs primary care safety intervention	C	At 36-month FU, no significant intervention effects on smoking initiation
Storr et al. (2002)	N = 549 7th grade youth. Over 80% African American	Classroom centered (CC) vs family-school partnership (FSP) vs no intervention control	C	At 6-year FU, CC and FSP groups reported less smoking initiation than control group
Storr et al. (2002)	N = 549 7th grade youth. Over 80% African American		F
Trudeau et al. (2003)	N = 847 8th grade youth	LST vs no intervention control	C	At 1-year FU, LST group reported less rate substance initiation than control group
Unger et al. (2004)	N = 1,430 7th grade nonsmoking youth	Project Fun Learning About Vitality Origins & Respect FLAVOR vs standard smoking prevention	C	Project Flavor group reported less smoking initiation than in standard smoking prevention group, for Hispanic boys only
Werch et al. (2000)	N = 515 8th grade Low SES youth	STARS (Start Taking Alcohol Risks Seriously) for Families Program vs no intervention control	M	At 3-month FU, STARS group reported less alcohol initiation than control group, in the magnet school only
Zavela et al. (2004)	N = 256 11th grade youth	Say Yes First (SYF) vs no treatment control	M	At 4-year FU, SYF group reported lower lifetime marijuana use than control. No significant intervention effects on lifetime alcohol use

Note: y/o = years old; FU = follow-up; C = child-centered; F = family-based; M = multicomponent; F + C = family-based and child-centered

Results for Interventions to Prevent Substance Use Initiation
Study	Analysis sample	Design	Intervention type	Primary prevention results
Aveyard et al. (2001)	N = 8,352 11th grade youth	Transtheoretical model vs no intervention	C	At 1 and 2 years FU, no significant intervention effects for smoking initiation
Botvin et al. (1999)	N = 2,209 8th grade girls	Life Skills Training (LST) vs drug information curriculum control	C	LST group reported less smoking initiation than control group
Brody et al. (2006)	N = 206 African American youth	Strong African American Families (SAAF) vs no intervention control	C	At 21 month FU, SAAF group reported less alcohol initiation and slower rate of increase in alcohol use than control group
Brown et al. (2002)	N = 2,643 10th grade youth	Smoking prevention vs usual care	C	Boys from smoking prevention group reported less smoking initiation than boys from usual care group
Brown et al. (2005)	N = 959 10th grade youth	Raising Healthy Children (RHC) vs control	F + C	Between 6 and 10th grade, no significant intervention effects on growth trajectories of alcohol and marijuana initiation
Byrne and Mazanov (2005)	N = 1,694 7-10th grade youth	Health-oriented vs fitness-oriented vs social skills/stress management-oriented interventions vs no intervention control	C	All three intervention groups reported less smoking reported initiation than control group. Social skills group less smoking initiation than health and fitness groups
Chou et al. (2006)	N = 2,454 8th grade Chinese youth	Chinese version of Project SMART vs no intervention control	C	No significant intervention effects on smoking initiation
Crone et al. (2003)	N = 2,562 middle school Dutch youth	Intervention vs no intervention control	C	Intervention group reported less smoking initiation than control group, at post-intervention. At 1 year FU, no significant intervention effects on smoking initiation
Curry et al. (2003)	N = 3,567 11-14 y/o	Multicomponent intervention vs usual care	M	At 20-month FU, no significant intervention effects on smoking initiation
de Vries et al. (2006)	N = 10,751 youth from Finland, Denmark, UK, Netherlands, Spain, and Portugal. Grade not reported	European Smoking Prevention Framework (ESFA) vs usual care	C	ESFA group reported less smoking initiation than usual care for Portugal only
Ellickson et al. (2003)	N = 4,276 7th and 8th grade youth	Project Alert vs no intervention control	C	Project Alert group reported less smoking and marijuana initiation than control group. No significant intervention effect on alcohol initiation
Fidler et al. (2001)	N = 2,492 11-16 y/o English youth	Psychoeducational material vs control	C	At 12-month FU, psychoeducational group reported less smoking initiation than control group
Furr-Holden et al. (2004)	N = 678 8th grader youth	Classroom centered (CC) vs family-school (FSP) vs no intervention control	C	At 7-year FU, CC group reported less initiation of partnership smoking and illicit drugs (crack, cocaine, heroine) than control group. FSP group reported less smoking initiation than control group. No significant intervention effects on alcohol initiation
Furr-Holden et al. (2004)	N = 678 8th grader youth		F
Hanewinkel and Abhauer (2004)	N = 1,625 youth from Germany, Luxembourg, Austria, and Denmark	LST vs no intervention control	C	At 15-month FU, no significant intervention effects on lifetime prevalence of smoking
Kentala et al. (1999)	N = 2,586 15 y/o Finish youth	Smoking discussion with dentist vs control	C	At 24-month FU, no significant intervention effects on smoking initiation
Lillehoj et al. (2004)	N = 456 8th grade youth	LST only or LST + Strengthening Families Program (SFP) 10-14 vs no intervention control	C	LST only and LST + SFP 10-14 groups reported delayed substance use initiation for girls only
Lillehoj et al. (2004)	N = 456 8th grade youth		F + C
Loveland-Cherry et al. (1999)	N = 428 7th grade youth and their families	In-home parent-centered intervention vs no intervention control	F	At 2-year FU, in-home group reported less alcohol use than control group for non-users at baseline only
Lynam et al. (1999)	N = 1,002 19-21 y/o	Project DARE (Drug Abuse Resistance Education) vs standard drug-education curriculum	C	At 10-year FU, no significant intervention effects on lifetime use of cigarette, alcohol, and drug
McBride et al. (2004)	N = 15 y/o Australian youth	School Health and Alcohol Harm Reduction Project (SHAHRP study) vs regular drug education classes	C	At 1-year FU, intervention group reported less alcohol initiation than control group
Palinkas (1996)	N = 296 14-19 y/o girls. 46% African American	Positive Adolescent Life Skills (PALS) + Facts of Life vs Facts of Life alone control	C	At 3-month FU, PALS + Facts of life group reported more marijuana and alcohol initiation Life alone control and less cigarette and other drug initiation than the Facts of Life alone control group
Peleg et al. (2001)	N = 760 12th grade Israeli youth	Intervention vs control	C	At 1- and 2-year FU, intervention group reported less alcohol initiation than control group
Perry et al. (1996)	N = 1,176 9th grade youth	Project Northland vs no intervention control	M	Project Northland group reported less alcohol, smoking, and marijuana initiation than control group
Peterson et al. (2000)	N = 8,388 12th grade youth	Hutchinson Smoking Prevention Project (HSPP) vs no intervention control	C	At 2-year FU (12th grade) and 4-year FU (2 years after 12th grade), no intervention effects were found on smoking initiation
Schulze et al. (2006)	N = 1,852 9th grade	Smoke-Free Class Competition vs control	C	At 18-month FU, no intervention effects on smoking initiation
Simons-Morton et al. (2005b)	N = 1,320 8th grade youth	Going Places Program vs no intervention control	M	No significant intervention effect on alcohol or smoking initiation
Simons-Morton et al. (2005a)	N = 1,484 9th grade youth	Going Places Program vs no intervention control	M	No significant intervention effect on alcohol or Smoking initiation
Slater et al. (2006)	N = 4,216 8th and 9th grade youth	All Stars + Be Under Your Own Influence (BUYOI) Media Campaign vs All Stars only vs BUYOI only vs no intervention control	M	All Stars + BUYOI group reported less marijuana, cigarette, and alcohol imitation than other three groups
Slater et al. (2006)	N = 4,216 8th and 9th grade youth		C
Spoth et al. (1999a)	N = 329 7th grade youth	Prevention Drug Free Years (PDFY) vs Iowa Strengthening Families Program (ISFP) vs no intervention control	F + C	At 1-year FU (7th grader), no significant intervention effects on substance use initiation. At 2-year FU (8th grade), PDFY & ISFP group reported less substance use initiation than control group non users at 1-year FU
Spoth et al. (1999b)	N = 317 7th grader youth	ISFP vs no intervention control	F + C	At 1-year FU (7th grade) and 2-year FU (8th grade), ISFP group reported less alcohol initiation than control group
Spoth et al. (1999b)	N = 294 8th grade youth	ISFP vs no intervention control	F + C
Spoth et al. (2002)	N = 1,372 8th graders youth	LST only vs LST + SFP 10-14 vs no intervention control	C	No significant intervention effects on smoking initiation. LST + SFP 10-14 group reported the least alcohol initiation. LST only and LST + SFP 10-14 groups reported marijuana initiation than control group
Spoth et al. (2002)	N = 1,372 8th graders youth	LST only vs LST + SFP 10-14 vs no intervention control	F + C
Spoth et al. (2004)	N = 304 12th grade youth	ISFP vs PDFY vs control	F + C	At 4 year FU, ISFP had a lower rate of increase in initiation of alcohol and cigarette use than control. No intervention effects were found for PDFY compared to control
Spoth et al. (2004)	N = 304 12th grade youth	ISFP vs PDFY vs control	F
Spoth et al. (2005)	N = 1,650 9th grade youth	LST only vs LST + SFP 10-14	C	2.5 years post-baseline, LST + SFP 10-14 had a slower increase of initiation rate for substance use than LST only and control. No significant differences were found between LST only and control
Spoth et al. (2005)	N = 1,650 9th grade youth	LST only vs LST + SFP 10-14	F + C
Spoth et al. (2006)	N = 464 12th grade youth	ISFP vs PDFY vs no intervention control	F + C	At 4 year FU, ISFP group had a slower increase of initiation of alcohol and drug use than control. No intervention effect was found for PDFY and alcohol use initiation. PDFY had a higher increase of drug use initiation than control
Spoth et al. (2006)	N = 464 12th grade youth	ISFP vs PDFY vs no intervention control	F
Stevens et al. (1996)	N = 1,200 4th, 5th, and 6th grade youth	Drug prevention curriculum vs drug prevention curriculum + parent & adult community activities vs no intervention control	C	No significant intervention effect on marijuana initiation
Stevens et al. (1996)	N = 1,200 4th, 5th, and 6th grade youth		M	No significant intervention effect on marijuana initiation
Stevens et al. (2002)	N = 2,183 8th and 9th grade youth	Alcohol and tobacco prevention vs primary care safety intervention	C	At 36-month FU, no significant intervention effects on smoking initiation
Storr et al. (2002)	N = 549 7th grade youth. Over 80% African American	Classroom centered (CC) vs family-school partnership (FSP) vs no intervention control	C	At 6-year FU, CC and FSP groups reported less smoking initiation than control group
Storr et al. (2002)	N = 549 7th grade youth. Over 80% African American		F
Trudeau et al. (2003)	N = 847 8th grade youth	LST vs no intervention control	C	At 1-year FU, LST group reported less rate substance initiation than control group
Unger et al. (2004)	N = 1,430 7th grade nonsmoking youth	Project Fun Learning About Vitality Origins & Respect FLAVOR vs standard smoking prevention	C	Project Flavor group reported less smoking initiation than in standard smoking prevention group, for Hispanic boys only
Werch et al. (2000)	N = 515 8th grade Low SES youth	STARS (Start Taking Alcohol Risks Seriously) for Families Program vs no intervention control	M	At 3-month FU, STARS group reported less alcohol initiation than control group, in the magnet school only
Zavela et al. (2004)	N = 256 11th grade youth	Say Yes First (SYF) vs no treatment control	M	At 4-year FU, SYF group reported lower lifetime marijuana use than control. No significant intervention effects on lifetime alcohol use

Note: y/o = years old; FU = follow-up; C = child-centered; F = family-based; M = multicomponent; F + C = family-based and child-centered

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Adolescent Neurological Development and its Implications for Adolescent Substance Use Prevention

Abstract & Introduction

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