Externalizing behavior problems are related to substance use in adolescents across six samples from Nordic countries

The aim of this study is to investigate associations between use of cigarettes, cannabis, and alcohol (CCA) and psychosocial problems among adolescents with different cultural backgrounds living in Nordic countries. Data from six questionnaire-based surveys conducted in Denmark, Norway, and Greenland, with participants from different cultural and religious backgrounds, were compared. A total of 2212 adolescents between 15 and 18 years of age participated in the study. The surveys were carried out nationally and in school settings. All adolescents answered a 12-item questionnaire (YouthMap12) with six questions identifying externalizing behavior problems and six questions identifying internalizing behavior problems, as well as four questions regarding childhood neglect and physical or sexual abuse, and questions about last month use of CCA. Externalizing behavior problems were strongly associated with all types of CCA use, while childhood history of abuse and neglect was associated with cigarette and cannabis use. The associations did not differ by sample. Despite differences between samples in use of CCA, national, cultural, and socioeconomic background, very similar associations were found between psychosocial problems and use of CCA. Our findings highlight the need to pay special attention to adolescents with externalizing behavior problems and experiences of neglect and assault in CCA prevention programs, across different ethnic and socioeconomic backgrounds.