Ethnic Differences in Co-Morbidity Typologies of Adolescent Substance Use, Externalizing, and Internalizing Behaviors

PRESENTATION TYPE: Individual Poster

CATEGORY/THEME: Epidemiology/Etiology

TITLE: Ethnic differences in co-morbidity typologies of adolescent substance use, externalizing, and internalizing behaviors.

Introduction: Few studies have considered ethnic differences in adolescent co-morbidity related to substance use, externalizing, and internalizing behaviors. Previous studies relying on clinical samples may underestimate co-morbidity among ethnic groups whose behavioral problems disproportionately lead to referral to the criminal justice system (African Americans). As such, co-morbidity and ethnicity studies with community samples are needed. The goal of this study was to examine: (1) typologies of problem behaviors that combine substance use, externalizing, and internalizing behaviors and (2) to consider ethnic differences in those typologies. Given past research suggesting gender differences in externalizing and internalizing, analyses were run separately for boys and girls.

Methods: 25,000 students in grades 7-12 from a single county (Wisconsin) participate in a school-based survey. 3% of the sample were Southeast Asians, 3% were other Asians, 7% were Hispanics, 13% African Americans, and 74% were European Americans.  23 items were included in a latent class analysis that indicated either substance use (alcohol, marijuana, and illicit drug use), externalizing (fighting, skipping school) and internalizing (depression, suicide ideation) behaviors.

Results: Five typologies were found among girls: (1) low risk for engagement in any risk behaviors (54%), (2) alcohol-use only (17%), (3) high risk for both externalizing and depression (12%), (4) high risk for anxiety symptoms only (9%), and (5) high risk for substance use and internalizing problems (8%). Using the low risk group and European Americans as the referent, Asians (OR = .21) and Southeast Asians (OR = .38) were less like classified as alcohol users. African Americans (OR=5.99) and Hispanics (OR = 2.76) were more likely classified into the externalizing/depression group, and Hispanics were more likely (OR = 1.83) and Southeast Asians less likely (OR = .41) classified into the substance use/internalizing typology.

Four typologies were found among boys: (1) low risk across items (61%), (2) alcohol-only (18%), (3) externalizing/depression (13%), and (4) substance use/internalizing (8%). African Americans were more likely classified in the substance use/internalizing typology (OR = 1.72), Hispanics were more likely in the externalizing/depression group (OR = 4.70) and Asian Americans were less likely in the substance use and internalizing group (OR = .17) and the alcohol-use only group (OR = .40).

Conclusions: These findings suggest that interventions targeted toward co-morbidity may be particularly effective for African Americans and Hispanics. In addition, these findings point to future research on risk/protective factors that may explain ethnic differences or typologies linked to co-morbidity.