title: Cumulative contextual risk at birth in relation to adolescent substance use, conduct problems, and risky sex: General and specific predictive associations in a Finnish birth cohort.
abstract: BACKGROUND
  Research indicates that risk factors cluster in the most vulnerable youth, increasing their susceptibility for adverse developmental outcomes. However, most studies of cumulative risk are cross-sectional or short-term longitudinal, and have been based on data from the United States or the United Kingdom. Using data from the Northern Finland Birth Cohort 1986 Study (NFBC1986), we examined cumulative contextual risk (CCR) at birth as a predictor of adolescent substance use and co-occurring conduct problems and risky sex to determine the degree to which CCR predicts specific outcomes over-and-above its effect on general problem behavior, while testing for moderation of associations by gender.
  
  
  METHODS
  Analyses of survey data from 6963 participants of the NFBC1986 followed from the prenatal/birth period into adolescence were conducted using structural equation modeling.
  
  
  RESULTS
  CCR had long-term positive associations with first-order substance use, conduct problems, and risky sex factors, and, in a separate analysis, with a second-order general problem behavior factor. Further analyses showed that there was a positive specific effect of CCR on risky sex, over-and-above general problem behavior, for girls only.
  
  
  CONCLUSIONS
  This study, conducted within the Finnish context, showed that CCR at birth had long-term general and specific predictive associations with substance use and co-occurring problem behaviors in adolescence; effects on risky sex were stronger for girls. Results are consistent with the hypothesis that early exposure to CCR can have lasting adverse consequences, suggesting the need for early identification and intervention efforts for vulnerable children.
authors.affiliation: Boys Town National Research Institute for Child and Family Studies, 14100 Crawford Street, Boys Town, NE 68010, USA. Electronic address: walter.mason@boystown.org.
authors.forename: W Alex
authors.initials: WA
authors.lastname: Mason
authors.affiliation: Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, 204 Barkley Memorial Center, Lincoln, NE 68583, USA. Electronic address: sjanuary2@unl.edu.
authors.forename: Stacy-Ann A
authors.initials: SA
authors.lastname: January
authors.affiliation: Boys Town National Research Institute for Child and Family Studies, 14100 Crawford Street, Boys Town, NE 68010, USA. Electronic address: mary.chmelka@boystown.org.
authors.forename: Mary B
authors.initials: MB
authors.lastname: Chmelka
authors.affiliation: University of Nebraska-Lincoln, Department of Child, Youth and Family Studies, 135 Mabel Lee Hall, Lincoln, NE 68588, USA. Electronic address: gparra2@unl.edu.
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Parra
authors.affiliation: Institute for Social Research, ICPSR, University of Michigan, P.O. Box 1248, Ann Arbor, MI 48106, USA. Electronic address: jsavolai@umich.edu.
authors.forename: Jukka
authors.initials: J
authors.lastname: Savolainen
authors.affiliation: Center for Life Course Health Research, Faculty of Medicine, University of Oulu, P.O. Box 5000, Fin-90014, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland; Department of Psychiatry, Unit for Clinical Neuroscience, University of Oulu, Oulu, Finland. Electronic address: jouko.miettunen@oulu.fi.
authors.forename: Jouko
authors.initials: J
authors.lastname: Miettunen
authors.affiliation: Center for Life Course Health Research, Faculty of Medicine, University of Oulu, P.O. Box 5000, Fin-90014, Oulu, Finland; Department of Epidemiology and Biostatistics, MRC PHE Centre for Environment and Health, School of Public Health, Imperial College, One Kemble Street, London WC2B 4AN, UK; Biocenter Oulu, University of Oulu, Oulu, Finland; Unit of Primary Care, Oulu University Hospital, Oulu, Finland. Electronic address: m.jarvelin@imperial.ac.uk.
authors.forename: Marjo-Riitta
authors.initials: MR
authors.lastname: Järvelin
authors.affiliation: Center for Life Course Health Research, Faculty of Medicine, University of Oulu, P.O. Box 5000, Fin-90014, Oulu, Finland; Unit of Primary Care, Oulu University Hospital, Oulu, Finland. Electronic address: anja.taanila@oulu.fi.
authors.forename: Anja
authors.initials: A
authors.lastname: Taanila
authors.affiliation: Oulu University Hospital, Oulu, Finland; PEDEGO Research Center, University of Oulu, P.O. Box 20, Fin-90029 OYS Oulu, Finland. Electronic address: irma.moilanen@oulu.fi.
authors.forename: Irma
authors.initials: I
authors.lastname: Moilanen
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000428:Alcohol Drinking / Q000453:epidemiology; D015331:Cohort Studies; D019955:Conduct Disorder / Q000453:epidemiology*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007230:Infant, Low Birth Weight; D008137:Longitudinal Studies; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011253:Pregnancy in Adolescence / Q000706:statistics & numerical data; D000066553:Problem Behavior; D012306:Risk; D012307:Risk Factors; D012309:Risk-Taking; D020954:Single-Parent Family / Q000706:statistics & numerical data; D012907:Smoking / Q000453:epidemiology; D012923:Social Class; D019966:Substance-Related Disorders / Q000453:epidemiology*; D047568:Unsafe Sex / Q000706:statistics & numerical data*
keywords: Adolescence; Conduct problems; Cumulative contextual risk; Risky sex; Substance use