A parallel process growth mixture model of conduct problems and substance use with risky sexual behavior
Introduction
Problem behavior is any “behavior that is socially defined as a problem, source of concern, or undesirable by the norms of conventional society” (Jessor and Jessor, 1977, p. 33). Engagement in some conduct problems and substance use are expectable manifestations of adolescent development. Yet these behaviors may presage the beginning of a serious problem behavior trajectory, including severe delinquency, substance use disorders, and increased risk for sexually transmitted diseases (STDs; Paul et al., 2000). Although it is known that conduct problems, substance use, and risky sexual behaviors co-occur, the extent of co-occurrence and developmental sequence of these behaviors are not well understood (Krueger et al., 2007). The goal of the current study was to examine relations of these problem behaviors in children from grades K to 12.
Conduct problems constitute a broad range of acting-out behaviors, including violence, physical destruction, and stealing (McMahon et al., 2006). Most children show decreasing frequencies of conduct problems as a function of age (Campbell et al., 2000), despite a relatively small group of children who show clinically elevated symptoms into adolescence (Nagin and Tremblay, 2001). Children in this latter group are thought to be at increased risk for conduct problems that are more serious and impervious to treatment (Moffitt, 1993). The societal costs associated with conduct problems, including direct harm to victims and costs of incarceration, are staggering (Cohen, 1998).
A number of studies have established a strong relation between adolescent conduct problems and substance use (e.g., Armstrong and Costello, 2002, Moffitt et al., 2008). Among adolescents who engage in both conduct problems and substance use, conduct problems typically precede initiation into substance use (Le Blanc and Loeber, 1998). The consequences of problematic substance use are far reaching and present a serious public health problem (Adams et al., 1990), including high costs in health care, educational failure, and juvenile crime (Hawkins et al., 1992). In terms of costs to society, adolescent crimes that involve substance use accounted for over $6.5 billion in medical and mental heath care expenses in 1999 alone (Miller et al., 2006).
Theorists have linked adolescent conduct problems and substance use with risky sexual behaviors (Jessor et al., 1991, Petraitis et al., 1995). Risky sexual behaviors, defined as having sex at an early age, infrequent condom use, receiving money for sexual services, and contracting STDs (Repetti et al., 2002), have been shown to be developmentally preceded by adolescent conduct problems and substance use (Biglan et al., 2004). Individuals from ages 13 to 24 accounted for 15% of reported HIV cases and the proportion of adolescents who acquire HIV as a result of substance use has increased within the last two decades (Centers for Disease Control and Prevention, 1998).
Few prospective studies have addressed temporal relations among all three problem behaviors. King et al. (2004) identified patterns of childhood conduct problems that predicted adolescent substance use but did not examine risky sexual behavior. Guo et al. (2002) found that risky sexual behavior correlated with substance use trajectories but did not incorporate conduct problems. Ramrakha et al. (2007) found that higher levels of childhood conduct problems were associated with increased odds of early sexual intercourse but did not examine substance use.
To our knowledge, only one study has examined these three problem behaviors in a single model. Schofield et al. (2008) examined these behaviors in a subset of panel data from the Fast Track Project (Conduct Problems Prevention Research Group; CPPRG, 1992) using path analyses. The authors found that conduct problems assessed from grades K to 1 predicted substance use at grade 7. In turn, greater substance use predicted higher levels of later sexual activity, defined by age of initiation and years of sexual intercourse from grades 7 to 11.
In the current study, using a sub-sample of participants in the Fast Track Project (CPPRG, 1992), we extend the research of Schofield et al. (2008) by examining longitudinal relations among conduct problems, substance use, and risky sexual behavior. Four research questions were addressed (see Fig. 1). How do conduct problems evolve during childhood? Can we identify individual variation in the comorbid development of conduct problems and substance use during adolescence? Longitudinal trajectories of tobacco, alcohol, and marijuana use were modeled separately from grades 7 to 12. How does the development of childhood conduct problems affect subsequent trajectories of adolescent conduct problems and substance use? Finally, how does the development of adolescent conduct problems and substance use affect risky sexual behavior measured during late adolescence? We extended the definition of risky sexual behavior as “sexual intercourse between grades 7 and 11” by Schofield and colleagues to include three additional indicators of risky sexual behavior: condom use frequency, receiving money for sex, and contracting STDs.
Section snippets
Participants and design
The current study used data from a community based sample of children at high risk for conduct disorder drawn from the Fast Track project, a multi-site investigation of the development and prevention of conduct problems (CPPRG, 1992). Schools within four sites (Durham, NC; Nashville, TN; rural Pennsylvania; and Seattle, WA) were identified as high-risk based on crime and poverty statistics. Within each site, schools were divided into sets matched for demographics and randomly assigned to
Results
Childhood conduct problem trajectories from grades K to 5 were estimated using a LGM. The quadratic model3
Discussion
The current study examined relations among conduct problems, substance use, and risky sexual behavior in a community sample of children at high risk for conduct disorder, using a parallel process growth mixture model. Participants in the current study started kindergarten with conduct problem scores that were one standard deviation above the normative average. The current study identified four classes of high-risk adolescents based on joint conduct problems and substance use and found that
Role of the funding source
This work was supported by National Institute of Mental Health (NIMH) grants R18 MH48043, R18 MH50951, R18 MH50952, and R18 MH50953. The Center for Substance Abuse Prevention and the National Institute on Drug Abuse also provided support for Fast Track through a memorandum of agreement with the NIMH. This work was also supported in part by Department of Education grant S184U30002, NIMH grants K05MH00797, K05MH01027, R01MN0951-15S1, and National Institute on Drug Abuse grants DA16903, DA015226,
Contributors
Wu, Witkiewitz, and McMahon developed the research hypotheses, gathered background information, and wrote the manuscript. Wu and Witkiewitz undertook statistical analyses. Dodge contributed to the theoretical framework. The Conduct Problems Prevention Research Group designed the study, wrote the protocol, and collected the data. Members of the Conduct Problems Prevention Research Group, in alphabetical order, include Karen L. Bierman, Department of Psychology, Pennsylvania State University;
Conflict of interest
There are no conflicts of interest, including any financial, personal, or other relationships with other people or organizations within 3 years of beginning the work submitted that could inappropriately influence the work.
Acknowledgements
The authors are grateful for the close collaboration of the Durham Public Schools, the Metropolitan Nashville Public Schools, the Bellefonte Area Schools, the Tyrone Area Schools, the Mifflin County Schools, the Highline Public Schools, and the Seattle Public Schools. We greatly appreciate the hard work and dedication of the many staff members who implemented the project, collected the evaluation data, and assisted with data management and analyses.
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Members of the Conduct Problems Prevention Research Group include Karen L. Bierman (Pennsylvania State University), John D. Coie (Duke University), Kenneth A. Dodge (Duke University), Mark T. Greenberg (Pennsylvania State University), John E. Lochman (University of Alabama), Robert J. McMahon (University of Washington), and Ellen E. Pinderhughes (Tufts University).