title: Which forms of child/adolescent externalizing behaviors account for late adolescent risky sexual behavior and substance use?
abstract: BACKGROUND
  Health risk behaviors like substance use (alcohol, tobacco, soft/hard drugs) and risky sexual behavior become more prevalent in adolescence. Children with behavior problems are thought to be prone to engage in health risk behaviors later in life. It is, however, unclear which problems within the externalizing spectrum account for these outcomes.
  
  
  METHODS
  Three hundred and nine children were followed from age 4/5 years to 18 years (14-year follow-up). Level and course of parent-rated opposition, physical aggression, status violations and property violations were used to predict adolescent-reported substance use and risky sexual behavior at age 18 years.
  
  
  RESULTS
  Both level and change in physical aggression were unique predictors of all forms of adolescent health risk behavior. Levels of status violations predicted smoking and soft drug use only, while change in property violations predicted each of the health risk behaviors. The links between opposition and health risk behaviors were accounted for by co-occurring problem behaviors.
  
  
  CONCLUSIONS
  Of externalizing problems, physical aggression is the best predictor of adolescent substance use and risky sexual behavior from childhood onwards. Possible explanations and implications of these findings, and future research directions are discussed.
authors.affiliation: Department of Developmental Psychology, VU University, Amsterdam, The Netherlands. m.timmermans@psy.vu.nl
authors.forename: Maartje
authors.initials: M
authors.lastname: Timmermans
authors.forename: Pol A C
authors.initials: PA
authors.lastname: van Lier
authors.forename: Hans M
authors.initials: HM
authors.lastname: Koot
mesh_terms: D000293:Adolescent; D000374:Aggression / Q000523:psychology*; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000523:psychology; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007389:Internal-External Control; D007604:Juvenile Delinquency / Q000523:psychology / Q000706:statistics & numerical data; D008297:Male; D009426:Netherlands; D010552:Personality Assessment; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D013223:Statistics as Topic; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D047568:Unsafe Sex