Profiles of Contextual Risk at Birth and Adolescent Substance Use in a Finnish Birth Cohort

         Introduction: It is well-documented that contextual risk factors (e.g., economic disadvantage, parent substance misuse) tend to co-occur. Less clear, however, is how contextual risk factors cluster together. Improving our understanding of configurations among risk factors is important because it can inform the development of tailored interventions that better address the specific needs of youth and their families. This study used person-centered methodology to examine whether there are subgroups of families with distinct profiles of contextual risk observed around the time of birth, and whether subgroup membership was differentially related to adolescent substance use (16 years later).

         Method: Data from the Northern Finland Birth Cohort 1986 (NFBC1986) were used. Several aspects of the education and health care systems in Finland make the NFBC1986 well-suited to examine prenatal/birth risk factors and later psychosocial outcomes. For example, Finland has an extensive network of local maternity health care centers governed by municipal districts. They are free of charge and most expecting mothers attend them monthly during pregnancy as well as following pregnancy for at least the first six months. Thus, most pregnancies and infants are carefully monitored, which facilitates early detection and treatment of any complications or risks. Mothers also get additional support in the form of a "maternity package" with abundant clothing and other materials for taking care of newborns. The NFBC1986 includes 9,432 individuals followed from prenatal development into adolescence. Eleven measures of contextual risk from the prenatal/birth period were examined. Measures of alcohol, cigarette, and illegal drug use were assessed when participants were 16 years old.

         Results and Conclusions: Findings from a latent class analysis indicated that a five-class model provided the most meaningful solution: Parent Substance Misuse (11.20%), Large Family Size (7.72%), Maternal Deviance (4.66%), Low Risk (69.69%), and Socioeconomic Disadvantage (6.72%). The Large Family Size and Low Risk groups had the lowest levels of alcohol, cigarette, and illegal drug use. Similarly high levels of use on each of the three substance-related outcomes were found for the Parent Substance Misuse, Maternal Deviance, and Socioeconomic Disadvantage groups. Results indicated that parent substance-related problems were key prenatal risk factors that tended to cluster together and co-occur with other prenatal risk factors differently for different subgroups of youth. Our results suggest that interventions for adolescent substance use could start during the prenatal/birth period and should target distinct profiles of contextual risk with an emphasis on both maternal and paternal substance use.