Students with depression and smoking LDK378 comorbidity may be more attuned to the corrections presented by the curriculum. Unlike their depressed counterparts who have never experimented with smoking, they may have the experience to know that smoking does not necessarily make one popular or cool or bring more positive attention from peers; thus, they would be able to confirm the messages presented in the curriculum and change their behavior accordingly to avoid further possible peer rejection. The most important and novel contribution to prevention literature is the mediated moderated findings. Evidence suggests that the program changed perceptions of perceived friend use prevalence as intended but only for those with a comorbidity of high depression symptoms and prior smoking.

The magnitude of the overall treatment effect on smoking behaviors depends on the presence of the CoM, and the mediating process that is responsible for that moderation lies in the social influence variable being manipulated by the program. To simplify, the program was able to change perceptions among those with CoM, and those changes were responsible for changes in smoking behavior. This finding is especially important in future curriculum development in which smoking or other socially driven behaviors are the main outcomes of interest. Gene �� Environment (social, physical, etc.) interactions need to be considered when developing future hypotheses to test and in designing interventions since those interactions may drive the success or failure of the program if the mediators and pathways are not specified well (Johnson et al.

, 2007). Depressed adolescents may be easily influenced and conform to the values and beliefs of those they identify as friends or closest peers (Katkin, Blum Sasmor, & Tan, 1966). If their referent group endorses deviant behaviors, then depressed adolescents may be more likely to engage in those behaviors for the added benefit of (perceived) acceptance (Besic & Kerr, 2009). These analyses suggest that depressed individuals can also be influenced by prevention program messages that manipulate perceptions of smoking prevalence. Studies that assess conformity and decision making under peer influence among depressed adolescents will contribute greatly to understanding the social and cognitive mechanisms involved in behavior choice.

Limitations and future directions There are several limitations to the findings of this study that warrant discussion. Despite randomized assignment at the school level, the conditions were unbalanced. Initial analyses controlled for the unbalanced conditions by using a mixed model and indicated AV-951 school intercepts as a random effect. However, models would not converge. Thus, we reverted to logistic and linear regression models and controlled school as a covariate.