ABSTRACT. Objective. Substance abuse remains one of the major threats to adolescent health in Western cultures. The study aim was to ascertain the extent of association between pubertal development and early adolescent substance use.Methods. The design was a cross-sectional survey of 10-to 15-year-old subjects in the states of Washington, United States, and Victoria, Australia. Participants were 5769 students in grades 5, 7, and 9, drawn as a 2-stage cluster sample in each state, and the questionnaire was completed in the school classrooms. The main outcomes of the study were lifetime substance use (tobacco use, having been drunk, or cannabis use), recent substance use (tobacco, alcohol, or cannabis use in the previous month), and substance abuse (daily smoking, any binge drinking, drinking at least weekly, or cannabis use at least weekly).Results. The odds of lifetime substance use were almost twofold higher (odds ratio [OR]: 1.7; 95% confidence interval [CI]: 1.4 -2.1) in midpuberty (Tanner stage III) and were threefold higher (OR: 3.1; 95% CI: 2.4 -4.2) in late puberty (Tanner stage IV/V), after adjustment for age and school grade level. Recent substance use was moderately higher (OR: 1.4; 95% CI: 1.0 -1.9) in midpuberty and more than twofold higher (OR: 2.3; 95% CI: 1.7-3.3) in late puberty. The odds of substance abuse were twofold higher (OR: 2.0; 95% CI: 1.2-3.2) in midpuberty and more than threefold higher (OR: 3.5; 95% CI: 2.2-5.4) in late puberty. Reporting most friends as substance users was more likely in the later stages of pubertal development, a relationship that accounted in part for the association found between later pubertal stage and substance abuse.Conclusions. Pubertal stage was associated with higher rates of substance use and abuse independent of age and school grade level. Early maturers had higher levels of substance use because they entered the risk period at an earlier point than did late maturers. The study findings support prevention strategies and policies that decrease recreational substance use within the peer social group in the early teens. Pediatrics 2004; 114:e300 -e306. URL: http://www.pediatrics.org/cgi/ content/full/114/3/e300; puberty, substance abuse, smoking, alcohol consumption, cannabis, adolescence.ABBREVIATIONS. PDS, Pubertal Development Scale; OR, odds ratio; CI, confidence interval. P rofound changes in patterns of health risk occur during adolescence. The major determinants of later adult health arise in patterns of mental health, behavior, and lifestyles that develop in the early teens. 1 Early adolescent increases in depression and anxiety, 2,3 eating disorders, 4 risky sexual activity, 5 and aggressive and antisocial behavior 6 have been well documented, as have their consequences in later life.The early teens also commonly herald the onset of substance use and abuse. 7-9 Early adolescent substance abuse is relevant to health not only because it is associated with risky sexual behavior and intentional and unintentional injuries during the teens but also because...