Program Outcomes for Youth

Reduction of Risk Behaviors in Youth: 
Adolescent Substance Abuse

Developmental Issues/Theories/Models 

Prevalence and Trends in Substance Use

Kann, L., Kinchen, S. A., Williams, B. I., Ross, J. G., Lowry, R., Grunbaum, J. A., & Kolbe, L. J. (2000). Youth Risk Behavior Surveillance-United States, 1999.

This report is based on the results of a CDC sponsored national survey of 9th through 12th grade students in public and private high schools in the United States. In 1999 approximately 16,000 students were interviewed. Data from 33 state and 16 local school-based surveys conducted in 1999 are also included. Updated information will be accessible from this web site as it becomes available.

Monitoring the Future Survey (1997).

This web site includes data from a yearly national survey. Results include historical as well as developmental trends in drug use and are broken down by type of drug as well as age of participant. Students are surveyed in 8th, 10th and 12th grades and then a sample of them are followed longitudinally. Besides the survey results, this web site also includes press releases and other information related to the survey findings.

Substance Use and Misuse, Special Issue: Symposium on Rural-Urban Continuum, 34 (4 & 5).

This special issue highlights the importance of examining issues of substance abuse in rural settings as well as in the urban settings that have traditionally been studied. The studies in this volume indicate that perhaps rural and urban drug abuse should be studied together and that similar types of interventions would be applicable to environments across the rural-urban continuum. The volume also includes implications for theory, research and policy.

Theories of Substance Abuse

Brooks, J. S., Richter, L., Whiteman, M., & Cohen, P. (1999). Consequences of adolescent marijuana use: Incompatibility with the assumption of adult roles. Genetic, Social and General Psychology Monographs, 125, 193-207.

This longitudinal study examines adolescent marijuana use and its relationship to the adoption of conventional adult roles in adulthood. Conventional adult roles are defined as employment, marriage, and parenthood following marriage. Results indicate that a history of heavy marijuana use in adolescence is related to unconventional roles in adulthood.

Negeiros, J. (1994). Theoretical orientations in drug abuse prevention research. Drugs: Education, Prevention and Policy, 1 (2) 135-142.

This article describes the most prominent theoretical developments in drug abuse prevention research. This review is organized around 3 broad theoretical models: the informative communicational model, the humanistic model and the cognitive-behavioral perspective. The article also includes details of prevention studies that have been done using each theoretical perspective and the evaluation studies that have followed.

Petraitis, J., Flay, B. R., & Miller, T. Q. (1995). Reviewing theories of adolescent substance use: Organizing pieces in the puzzle. Psychological Bulletin, 117, 67-86.

This review discusses 14 multivariate theories of experimental substance use. All the theories have received some empirical support, although there is some variation in the constructs addressed. Two theories cover cognitive causes of substance use, two cover social learning models and two deal with weakened commitment to conventional values. Four theories deal with interpersonal characteristics which may lead to substance use, and four theories integrate a variety of these constructs.

White, H. R., & Bates, M. E. (1993). Self-attributed consequences of cocaine use. International Journal of the Addictions, 28 (3), 187-209.

This study examined the reasons and consequences for cocaine use in a sample of 1270 middle- to working-class white young adults in New Jersey. The data were taken from a six-year longitudinal study. Analyses indicated that adolescents and young adults who used cocaine to help cope with stress were more likely to experience negative consequences than those individuals who used cocaine to uplift themselves, either mentally or physically.

Risk and Protective Factors

Altman, D. G., Levine, D.W., Coeytaux, R., Slade, J., & Jaffe, R. (1996). Tobacco promotion and susceptibility to tobacco use among adolescents aged 12 through 17 years in a nationally representative sample. American Journal of Public Health, 86, 1590-1593.

This article examined the relationship between adolescent susceptibility to tobacco use and exposure to marketing campaigns that are meant to increase tobacco use. Results from 1047 telephone interviews with a random sample of American youth indicated that despite tobacco companies' claims that these promotions are not intended to influence adolescents, participation in and awareness of tobacco promotions was significantly related to tobacco susceptibility and use among adolescents. This means that adolescents who were aware of or participated in these promotions were more likely to either have used tobacco products in the past or to indicate that they would use them in the future.

Andrews, J. A., Hops, H., & Duncan, S. (1997). Adolescent modeling of parent substance use: The moderating effect of the relationship with the parent. Journal of Family Psychology, 11, 259-270.

This study examined the role of parent-child relationships in moderating the relationship between adolescent cigarette, alcohol, and marijuana use and parent substance use. Analyses were run separately for mothers and fathers, and the authors also tested for interactions between age and gender. Results indicated that adolescents who have good relationships with their mothers would model their mothers' cigarette use and adolescents who had good relationships with their fathers modeled their fathers' marijuana use. Interactive effects between age and gender were found in all other cases. This study highlights the importance of studying age, gender and substance effects separately.

Bailey, S. L., Flewelling, R. L., & Rachal, J. V. (1992). Predicting continued use of marijuana among adolescents: The relative influence of drug-specific and social context factors. Journal of Health and Social Behaviors, 33, 51-66.

This longitudinal study examined 456 adolescents who had experimented with marijuana between one and five times. These adolescents were followed yearly for two years to determine if they continued to use marijuana or stopped after the initial experimentation. The study examined the factors that predicted continued use. Social context factors, which included family and friends' involvement in and opinions about marijuana was not a significant predictor of continued use, whereas drug-specific factors were. In particular, believing that the physical or mental consequences of marijuana use are not serious and having been stoned during one's initial experimentation with the drug did predict continued use. Background characteristics such as being white and younger also predicted continued marijuana use.

Bertrand, L. D., & Abernathy, T. J. (1993). Predicting cigarette smoking among adolescents using cross-sectional and longitudinal approaches. Journal of School Health, 63, 98-102.

An examination of factors which may predict cigarette smoking in adolescents indicated that researchers can predict with a high degree of accuracy smoking status up to three years in advance. However, concurrent prediction produced even more accurate findings. The parent/child relationship and peer smoking behavior appeared to be the most useful in discriminating between smoking status. The implications of these findings for intervention are discussed.

Durant, R. H., Rickert, V. I., Ashworth, C. S., Newman, C., & Slavens, G. (1993). Use of multiple drugs among adolescents who use anabolic steroids. New England Journal of Medicine, 328 (13), 922-926.

To better prevent steroid use, it is important to determine if steroid use is significantly different from the use of other types of drugs. A study of over 1800, ethnically diverse, mostly ninth grade adolescents, found that steroid use is highly correlated with the use of other substances, particularly cocaine and smokeless tobacco. This research further indicates the sharing of needles is a particularly serious problem for adolescents who use steroids.

Frauenglass, S., Routh, D., Pantin, H. M., & Mason, C. A. (1997). Family support decreases influence of deviant peers on Hispanic adolescents' substance use. Journal of Clinical Child Psychology, 26, 15-23.

This article examined the importance of family support on decreasing the influence of deviant peers on low SES, mostly Hispanic, 8th graders. Findings indicate that deviant peer association is associated with adolescent alcohol, tobacco and marijuana use. High family support was related to decreased levels of alcohol use for all adolescents. High family social support was also associated with lower levels of tobacco and marijuana use for those adolescents with a large number of deviant (substance using) peers.

Hawkins, J. D., Catalano, R. F., & Miller, J. Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin, 112, 64-105.

The authors argue for a risk-focused approach to substance abuse prevention programming for adolescents. They review the literature on 17 antecedents to drug abuse. By developing programs which target these specific factors, knowledge about which factors are causal will be increased. The authors recommend prevention programming beginning in early childhood and targeting multiple risk factors.

Johnson, E. O., Schutz, C. G., Anthony, J. C., & Ensminger, M. E. (1995). Inhalants to heroin: A prospective analysis from adolescence to adulthood. Drug and Alcohol Dependence, 40, 159-164.

This study examined adolescent risk factors for heroin use by age 32. The sample consisted of nearly 600 individuals who completed both the adolescent and adult waves of an almost 30 year longitudinal study. Inhalant use was found to be a particularly strong predictor of heroin use, although cigarette, marijuana, and alcohol use as well as family income during childhood all predicted heroin use in adulthood.

McGarvey, E. L., Canterbury, R. J., & Waite, D. (1996). Delinquency and family problems in incarcerated adolescents with and without a history of inhalant use. Addictive Behaviors, 21, 537-542.

In a study of 619 incarcerated youth, researchers found that inhalants were more likely to be used by non-minority than minority youth. Furthermore, adolescents who had used inhalants were significantly more likely to engage in delinquency and have family problems.

Newcomb, M. D., & Bentler, P. M. (1989). Substance use and abuse among children and adolescents. American Psychologist, 44, 242-248.

This review of children and adolescents and substance abuse examines literature on various topics with a consistent focus on differentiating between substance use and abuse. They differentiate between use and abuse based upon the nature of the drug and the context that it is used, the ability of the user to deal with the drug and the consequences that result from drug use. They go on to highlight key issues associated with the patterns and extent of drug use, causes of drug use, as well as prevention, treatment and consequences.

Newcomb, M. D., Fahy, B., & Skager, R. (1990). Reasons to avoid drug use among teenagers: Associations with actual drug use and implications for prevention among diverse demographic groups. Journal of Alcohol and Drug Education, 36, 53-79.

This article focused on reasons why adolescents of various demographic groups would choose to avoid using drugs. Five reasons not to use drugs were examined: becoming an addict, getting into trouble, losing friends, disappointing parents or other adults, and disappointing oneself. Adolescents were also asked how harmful they thought alcohol and marijuana were. Overall, perceived harmfulness was most closely related to non-use of drugs, although there were interactions between reasons not to use drugs and gender, age, substance type and ethnicity. This study provides important information for targeting prevention programs to specific groups of adolescents.

Newcomb, M. D., & Felix-Ortiz, M. (1992). Multiple protective and risk factors for drug use and abuse: Cross-sectional and prospective findings. Journal of Personality and Social Psychology, 63, 280-296.

Fourteen factors which have been previously identified as relating to drug use and abuse were assigned to either risk or protective indices. Analyses examined the relation of the Risk Factor Index (RFI) and the Protective Factor Index (PFI) and their interaction to use of various drugs. Results indicated that risk factors were positively related to drug use and protective factors were negatively related to drug use, although these relationships differed as a function of the drug being examined. Results further indicated that problems associated with drug use in young adulthood were also related to protective and risk factors.

Santor, D.A., Messervey, D. & Kusumakar, V. (2000). Measuring peer pressure, popularity and conformity in adolescent boys and girls: Predicting school performance, sexual attitudes and substance abuse. Journal of Youth and Adolescence, 29, 163-182.

Peer influence has often been discussed as an important factor in adolescent substance abuse. However the various components that go into peer influence have not been adequately studied. The current study first attempts to develop validated short measures to assess 3 distinct components of peer influence; peer pressure, peer conformity and popularity. Then these constructs are examined in relation to risk behaviors, including substance abuse. Results indicate that peer pressure and peer conformity are greater risk factors for substance abuse than is the need for popularity.

Shedler, J., & Block, J. (1990). Adolescent drug use and psychological health: A longitudinal inquiry. American Psychologist, 45, 612-630.

This study investigated the relationship between personality characteristics at ages 7, 11 and 18 and drug use at age 18. Results indicated that adolescents who experimented with drugs but did not engage in heavy use were the most well-adjusted. Abstainers and frequent drug users both showed adjustment problems that were first apparent during childhood.

Swadi, H. (1999). Individual risk factors for adolescent substance abuse. Drug and Alcohol Dependence, 55, 209-224.

This article takes an international approach to the study of risk and protective factors for substance use. Research from many countries was utilized in compiling this review of recent literature. Swadi concludes that the majority of risk factors can be broken down into 3 categories; constitutional predisposition, environmental factors, and life events. These risk factors can be mediated by a number of protective factors. In addition to the specific factors this review also includes a discussion of the specific methodological issues that should be considered when reading research on risk and protective factors.


Botvin G. J., Dusenbury L., Baker, E., James-Ortiz, S., Botvin, E. M., & Kerner, J. (1992). Smoking prevention among urban minority youth: Assessing effects on outcome and mediating variables. Health Psychology, 11, 290-299.

This article describes the results of an evaluation of a social resistance/competence enhancement approach to preventing smoking. The program was implemented with over 3000 urban, mostly minority, 7th graders. The curriculum addressed the major cognitive, attitudinal, psychological and social factors which are correlated to smoking. The intervention was shown to be effective, lowering smoking prevalence by almost 30%. The program was also shown to impact mediators which were closely related to behavior, but there was no effect on more distal components.

Brown, J. H., D'Emidio-Castion, M., & Pollard, J. A. (1997). Students and substances: Social power in drug education. Educational Evaluation and Policy Analysis, 19, 65-82.

This study used both qualitative and quantitative methods to determine the influence of various program delivery methods on drug use in a statewide evaluation in California. Efforts were made to include a wide range of demographic groups. The majority of students indicated that they were not influenced by the program and had either neutral or negative affect toward the educators in charge of the program. These findings were stronger for older students (7-12 grades). The authors advocate a conceptual shift in drug abuse education to utilize more experiential teaching and allowing students more decision-making power.

Dielman, D. E. (1994). School-based research on the prevention of adolescent alcohol use and misuse: Methodological issues and advances. Journal of Research on Adolescence, 4, 271-293.

This article reviews much of the research on alcohol use and misuse prevention programs based in the schools. Following the review Dielman discusses those previously published findings regarding the Alcohol Misuse Prevention Study (AMPS). Specifically addressed is the effectiveness of a refusal skills/social skills approach, the endurance of the effect, the increased effectiveness with teens who had already experimented with alcohol, and the importance of peer and parent influences.

Ellickson, P. L., Bell, R. M., & McGuigan, K. (1993). Preventing adolescent drug use: Long-term results of a junior high program. American Journal of Public Health, 83, 856-861.

An 11-lesson drug resistance curriculum for 7th and 8th graders in highly diverse schools, indicated significant changes in drug use behavior for the students. Long-term follow-ups showed that these effects ceased to exist upon completion of the program, although cognitive risk factors, including perceived norms, risks and expectations, were significantly reduced for those adolescents who received peer-led interventions. Despite these cognitive changes, there was no significant behavior change once the intervention ended.

Goldberg, L., Elliot, D., Clarke, G. N., MacKinnon, D. P., Moe, E., Zoref, L., Green, C., Wolf, S. L., Greffrath, E., Miller, D. J., & Lapin, A. (1996). Effects of a multidimensional anabolic steroid prevention intervention: The adolescents training and learning to avoid steroid (ATLAS) program. JAMA, 276 (19), 1555-1562.

This study describes a steroid use prevention program targeting high school football players from over 30 Oregon high schools. The high schools were matched and randomly assigned to treatment and control conditions. The intervention consisted of three parts: 1) a seven-session classroom component conducted by coaches and trained teen leaders discussing effects of steroid use, sports nutrition, and strength training alternatives to steroids, 2) seven weight room training classes, and 3) an informational discussion session for parents of football players. Results indicated that adolescents who received the intervention altered their attitudes and behaviors in healthy ways. Many risk factors associated with steroid use were reduced, and follow-up studies indicated that many of these results were still significant one year later.

Gorman, D. M. (1995). Are school-based resistance skills training programs effective in preventing alcohol misuse? Journal of Alcohol and Drug Education, 41, 74-98.

In response to previous research indicating that knowledge-based and affective programming are ineffective in preventing substance abuse, resistance skills training has become one of the most widely used types of programming to prevent substance abuse. This review of resistance skills training programs indicates that these programs may also be ineffective with the majority of the population. The author then critiques the methodology of those programs that do show some effect. Suggestions for how to improve programs are also included.

Leventhal, H., & Keeshan, P. (1993). Promoting healthy alternatives to substance abuse. In S. Millstein, A. Peterson, & E. Nightingale (Eds.), Promoting the Health of Adolescents: New directions in the 21st century (pp. 260-284). New York: Oxford University Press.

Provides an overview of current substance abuse prevention strategies and their successes and failures. Much of the work on substance abuse prevention has focused on the construction of barriers. The authors of this chapter advocate the development of a transactional framework conceptualizing the adolescent as an active participant. This approach is based on the premise of healthy alternative choices for adolescents. The authors end the chapter by making recommendations for ways in which positive alternatives could be applied to future prevention efforts.

Lynam, D. R., Milich, R., Zimmerman, R., Novak, R., Logan, T. K., Martin, C., Leukefeld C., & Clayton, R. (1999). Project DARE: No effects at 10-year follow-up. Journal of Consulting and Clinical Psychology, 67, 590-593.

This evaluation of DARE, one of the most widely administered drug abuse prevention programs in the United States, indicated that there were not significant benefits associated with this program as opposed to regular school drug abuse education. This evaluation performed 10 years after the initial program period indicated no differences in drug attitudes, drug use or self-esteem. Also included in the article is a discussion regarding the continued popularity of this program despite the lack of positive impact.

National Assembly. (1994). Building Resiliency: What Works! A Community Guide to Preventing Alcohol & Other Drug Abuse Through Positive Youth Development. Washington, DC: National Assembly.

This guide provides information on bridging the gap between research and youth development. The guide seeks to explain the concepts of prevention and youth development as well as clarify what strategies are effective and which are ineffective in developing resiliency in adolescents. Furthermore, this guide reviews community programs that are used to reduce drug and alcohol abuse while promoting positive youth development.

National Institute on Drug Abuse. (1997). Preventing Drug Use among Children and Adolescents: A research-based guide. (DHHS Publication No. 97-4212). Washington, DC: National Institute on Drug Abuse.

This booklet details some basic prevention principles which can be used with either community-, school-, or family-based programming. Very basic ideas of what questions should be answered through evaluation are also included. This source also contains information on some widely used research-based drug abuse prevention programs. The booklet also has numerous references and resources including contact names and addresses to obtain more information about the specific programs described within.

NIAAA/CSAP (1995). The challenge of participatory research: Preventing alcohol-related problems in ethnic communities. (DHHS Publication No. SMA 95-3042). Washington, DC: CSAP.

This book discusses the need for culturally sensitive research and programming and provides some guidelines for this to occur. Conceptual and methodological issues are addressed, and case studies are presented from the academic, community researcher and ethnic community strategist points of view. Case studies presented are African American, Native American, Asian American, and Hispanic populations. Office of Substance Abuse Prevention (1991). Preventing Adolescent Drug Use: From theory to practice. (DHHS Publication No. ADM. 91-1725). Rockville, MD:

Office of Substance Abuse Prevention. This book includes many of the essential topics regarding substance abuse prevention. It includes sections on risk and protective factors, guidelines for prevention programming, methods of targeting high-risk adolescents and some programs which are currently in use. Special attention is paid to being sensitive to the needs of the target population.

Pentz, M. A. (1999). Prevention in the community. In R.T. Ammerman, P. J.Ott & R. E. Tarter (Eds.), Prevention and societal impact of drug and alcohol abuse (pp. 327-344). Mahwah, NJ: Lawrence Erlbaum. This chapter addresses the importance of considering community-based alcohol and drug abuse prevention programming. This type of programming allows for the collaboration between multiple community groups for a common goal. Advantages and disadvantages of these types of programs are addressed as well as future directions for research. Much of the information in this chapter deals with some of the more well-known community programs currently in effect.

Shope, J. T., Copeland, L. A., Marcoux, B. C., & Kamp, M. E. (1996). Effectiveness of a school-based substance abuse prevention program. Journal of Drug Education, 26, 323-337.

A school-based social pressures resistance training approach to substance abuse prevention was utilized in 6 school districts of various ethnic composition. Fifth through eighth graders were administered this program for two consecutive years and then compared to a control group. The first year consisted of 6 sessions, while the second year consisted of 8 sessions. The sample was only large enough to test the effectiveness of the program on the 6th/7th grade cohort. While drug use increased for all groups from 6th grade to 7th grade, it increased significantly less among students who received the program than among those students who did not receive the intervention.

Swisher, J. D. (1993). Early adolescent belief systems and substance abuse. In R.M. Lerner (Ed.), Early adolescence (pp. 369-382). Hillsdale, NJ: Lawrence Erlbaum.

This chapter emphasizes the need to examine adolescent beliefs when developing programs to prevent substance abuse. Intrapersonal, interpersonal, and extrapersonal beliefs as well as interventions designed to alter them were included in the discussion. Intrapersonal beliefs included expectations regarding future success and the perceived risk associated with drug use. Interpersonal beliefs have been the focus of most research and encompass the attitudes and behavior of friends and family. Extrapersonal beliefs refer to how adolescents view the social systems around them, including attitudes toward drug and alcohol laws.

Tobler, N. S. (1986). Meta-analysis of 143 adolescent drug prevention programs: Quantitative outcome results of program participants compared to a control or comparison group. Journal of Drug Issues, 16, 537-367.

Results of a meta-analysis of 143 drug prevention programs in the secondary schools are reported. Programs were divided into five types: knowledge only, affective, peer, knowledge plus affective, and alternative programs. Peer programs which aim to use peer influence to decrease drug use were found to be most effective with average populations. Alternative programs which make no mention of drug use but provide adolescents with alternatives through one-on-one relationships and skill building were effective for at-risk populations. None of the other program types were as effective in reducing drug use.

Weinstein, S. (1999). The educator's guide to substance abuse prevention. Mahwah, NJ: Lawrence Erlbaum.

This book is an excellent resource for any individual who deals with youth. The book includes chapters that address issues of substance abuse theory, but primarily focuses on actual prevention and situations that arise for those individuals who are involved in substance abuse prevention. In addition, attention is given to the cultural structures within our society that impact the way children and adolescents view substance abuse prevention.

Zavela, K. J., Battistich, V., Dean, B. J., Flores, R., Barton, R., & Delaney, R. J. (1997). Say yes first: A longitudinal, school-based alcohol and drug prevention project for rural youth and families. Journal of Early Adolescence, 17, 67-96.

This study describes the evaluation of a multicomponent school-based primary and secondary drug and alcohol prevention program for rural youth. Very few programs specifically target rural teens. The Say Yes First program provided training for staff, as well as drug prevention through a comprehensive health education program academic programming, parent education, alternative activities, and case management. Results indicate that greater involvement in the Say Yes First program led to lowered drug use over time and improved academic achievement.

Measurement Issues

Gruenewald, P. J., Treno, A. J., Taff, G., & Klitzner, M. (1997). Measuring community indicators: A systems approach to drug and alcohol problems. Thousand Oaks, CA: Sage Publications.

This book includes information on how community indicators can be used in program evaluation. Indicators that relate to the drug and alcohol abuse problem are used specifically to illustrate this type of methodology. A systems perspective is used throughout the book.

National Institute on Drug Abuse. (1981). Assessing marijuana consequences: Selected questionnaire items. (DHHS Publication No. ADM 81-1150). Washington, DC: Superintendent of Documents, U.S. Government Printing Office.

This volume includes items developed by a group of prominent researchers. The group never condensed the items into a single concise instrument. Evaluations of the items by these and other researchers are a part of this volume. The evaluations are used in development of long- and short- form instruments to assess the consequences of marijuana use and other constructs.

Rounsaville, B. J., Tims, F. M., Horton, A. M. Jr., & Sowder, B. J. (Eds.). (1993). Diagnostic source book on drug abuse research and treatment. Washington, DC: National Institute of Health Publication.

This volume includes a chapter which discusses the importance of using similar measures to assess drug use and abuse. Subsequent chapters include descriptions of various measures which assess different areas related to drug use.

| Risk Behaviors |
| Program Outcomes for Youth |
| NOWG Home |