European Child & Adolescent Psychiatry

, Volume 27, Issue 12, pp 1551–1561 | Cite as

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

  • Mads Uffe PedersenEmail author
  • Kristine Rømer Thomsen
  • Ove Heradstveit
  • Jens Christoffer Skogen
  • Morten Hesse
  • Sheila Jones
Original Contribution


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.


Risk factors Substance use Adolescents Externalizing behavior problems Internalizing behavior problems Culture 


Compliance with ethical standards

Ethical standards

The manuscript does not contain clinical studies or patient data. All participants gave their consent and the surveys were approved by the Danish Data Protection Agency just as all confidentiality and privacy requirements were met.

Conflict of interest

The authors declare that they have no conflict of interest. This work was funded by a block Grant from the Danish Ministry for Social Affairs and the Interior (MUP, KRT, and SJ), and the Health Ministry of Western Norway (OH). JCS did not receive any specific funding for this project. The funding sources had no role in the writing of the manuscript or the decision to submit it for publication.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Centre for Alcohol and Drug Research, School of Business and Social SciencesAarhus UniversityAarhusDenmark
  2. 2.Alcohol and Drug Research Western NorwayStavanger University HospitalStavangerNorway
  3. 3.Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research HealthBergenNorway
  4. 4.Department of Health PromotionNorwegian Institute of Public HealthBergenNorway

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