Depression, conduct disorder, smoking and alcohol use as predictors of sexual activity in middle adolescence: a longitudinal study

Full Te ms & Condi ions o access and use can be ound a h p://www. and online.com/ac ion/jou nalIn o ma ion?jou nalCode= hpb20 Download by: [Tampe e Uni e si y] Da e: 20 Sep embe 2016, A : 00:33 Heal h Psychology and Beha io al Medicine An Open Access Jou nal ISSN: (P in ) 2164-2850 (Online) Jou nal homepage: h p://www. and online.com/loi/ hpb20 Dep ession, conduc diso de , smoking and alcohol use as p edic o s o sexual ac i i y in middle adolescence: a longi udinal s udy Rii ake u Kal iala-Heino, Sa i F öjd & Mau i Ma unen To ci e his a icle: Rii ake u Kal iala-Heino, Sa i F öjd & Mau i Ma unen (2015) Dep ession, conduc diso de , smoking and alcohol use as p edic o s o sexual ac i i y in middle adolescence: a longi udinal s udy, Heal h Psychology and Beha io al Medicine, 3:1, 25-39, DOI: 10.1080/21642850.2014.996887 To link o his a icle: h p://dx.doi.o g/10.1080/21642850.2014.996887 © 2015 The Au ho (s). Published by Taylo & F ancis Published online: 09 Jan 2015. Submi you a icle o his jou nal A icle iews: 823 View ela ed a icles View C ossma k da a Dep ession, conduc diso de , smoking and alcohol use as p edic o s o sexual ac i i y in middle adolescence: a longi udinal s udy Rii ake u Kal iala-Heino a,b *, Sa i F öjd c and Mau i Ma unen d,e a School o Medicine, Uni e si y o Tampe e, Tampe e, Finland; b Depa men o Adolescen Psychia y, Tampe e Uni e si y Hospi al, Tampe e, Finland; c School o Heal h Sciences, Uni e si y o Tampe e, Tampe e, Finland; d Facul y o Medicine, Na ional Ins i u e o Heal h and Wel a e, Uni e si y o Helsinki, Helsinki, Finland; e Depa men o Adolescen Psychia y, Helsinki Uni e si y Hospi al, Helsinki, Finland (Recei ed 5 Oc obe 2014; accep ed 7 Decembe 2014) Objec i e: To s udy associa ions be ween emo ional and beha iou al symp oms and la e engagemen in sexual beha iou s in middle adolescence. Ma e ials and me hods: All nin h g ade s in wo Finnish ci ies we e ec ui ed o espond o a ques ionnai e ocusing on men al heal h and diso de s, heal h beha iou s and isk and p o ec i e ac o s (T1), and a ollow-up su ey wo yea s la e (T2). The baseline sample (94.4% o all eligible) comp ised 1609 gi ls and 1669 boys, wi h mean age o 15.5 yea s (SD 0.39). A o al o 2070 adolescen s comple ed he su ey a bo h T1 and T2. The esponse a e o he final sample was 63.1% (2070/3278). O he esponden s, 56.6% we e gi ls. Expe ience o in e cou se and numbe o pa ne s o in e cou se we e elici ed a age 17. Dep ession was measu ed wi h he 13-i em Beck Dep ession In en o y, conduc diso de wi h he You h Sel -Repo , and smoking and alcohol consump ion wi h ques ions widely used in Finnish adolescen heal h su eys. The da a we e analysed using c oss- abula ion wi h chi squa e s a is ics o classified a iables and - es o con inuous a iables. Logis ic eg ession was used o s udy mul i a ia e associa ions. Resul s: Dep ession, conduc diso de , smoking and d inking a age 15 we e associa ed wi h ha ing expe ienced in e cou se by age 17 (odds a ios (ORs) 1.8–10.3) and wi h mul iple pa ne s o in e cou se by age 17 (ORs: 2.4–4.7) among gi ls. In boys, equen alcohol use and smoking a age 15 (ORs: 2.2 and 4.6) we e associa ed wi h expe ience o in e cou se by age 17, and hese and conduc diso de s a age 15 wi h mul iple pa ne s o in e cou se by age 17 (ORs: 2.8–3.2). Conclusion: Emo ional and beha iou al diso de s in middle adolescence a e associa ed wi h sexual ac i i y and isk- aking sexual beha iou s la e in he de elopmen al phase. Keywo ds: dep ession; conduc diso de ; subs ance use; sexual beha iou ; adolescence In oduc ion In adolescence, sexual de elopmen accele a es, wi h apid changes o adolescen śbodies. Young people’s expe iences o a changing body, sexuali y and de eloping gende iden i y a ec in ape - sonal, ela ional and socie al in e ac ions (Romeo & Kelley, 2009). Fi s in e cou se is o en cha ac e ized as sexual debu , and, when occu ing du ing adolescen de elopmen , is seen bo h as no ma i e de elopmen and as a o m o p oblem beha iou (Madkou , Fa ha , Halpe n, Godeau, & Gabhainn, 2010). In e cou se exposes he adolescen o he isk o unwan ed © 2015 The Au ho (s). Published by Taylo & F ancis *Co esponding au ho . Email: me ihe@u a.fi This is an Open Access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion License (h p://c ea i ecommons.o g/ Licenses/by/4.0/), which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed. Heal h Psychology and Beha io al Medicine, 2015 Vol. 3, No. 1, 25–39, h p://dx.doi.o g/10.1080/21642850.2014.996887 p egnancy and sexually ansmi ed diseases, which a e mo e likely wi h sexual ini ia ion a younge ages (Edga dh, 2000,2002; Ko chick, Sha e, & Fo ehand, 2001;O’Donnell, O’Don- nell, & S ue e, 2001). Due o he physical and emo ional imma u i y o he adolescen s, he con- sequences o hese a e also likely o be pa icula ly ha m ul. The as majo i y o adolescen s ac oss Wes e n coun ies expe ience in e cou se be o e he age o 20, bu o adolescen s aged 15, only one in en o a hi d o gi ls and one in fi e o a hi d o boys epo ha ing expe ienced in e cou se in Eu opean coun ies and he USA (Ea on e al., 2010; Hube , Bajos, & Sand o , 1998; Madkou e al., 2010). Du ing ea ly and middle adolescence, empi ical s udies ha e associa ed sexual debu and isk- aking sexual beha iou s wi h a a ie y o p oblem beha iou s, such as subs ance use, delin- quency and school- ela ed p oblems, and wi h nega i e amily ac o s such as low socio-econ- omic, no li ing wi h bo h pa en s, amily dis up ion and inadequa e pa en al con ol (Ko chick e al., 2001; Madkou e al., 2010; Wigh , Williamson, & Hende son, 2006). Adolescen s may engage in sexual beha iou s o nega i e easons such as pee p essu e o p essu e om oman ic pa ne , subs ance abuse o nega i e amily ci cums ances, o as an a emp o achie e ansi ion o adul hood. Hence, sexual debu may a he become a nega i e li e e en han ep esen a a ou - able ansi ion s ep owa ds adul hood (Dickson, Paul, He bison, & Sil a, 1998; Goodson, E ans, & Edmundson, 1997; Ko chick e al., 2001; Madkou e al., 2010; Rosen hal, Smi h, & de Visse , 1999; Wigh e al., 2006). Ea ly coi a che has been associa ed wi h childhood and adolescen conduc diso de s ha also end o in ensi y a e sexual debu . Dep ession, suicidali y and a ious isk- aking beha iou s a e mo e common among sexually ac i e middle adolescen s, no o men ion ea ly adolescen s. Sub- s ance use diso de s, an isocial beha iou and schizoph enia bu also dep ession in la e adoles- cence ha e been associa ed wi h isk- aking sexual beha iou s and ea ly sexual debu , and adolescen s wi h se e e men al diso de s ha e e ospec i ely epo ed ea ly coi a che (Hall o s e al., 2004; Heidme s e al., 2010; Ram akha, Caspi, Dickson, Mo fi , & Paul, 2000; Tubman, Windle, & Windle, 1996). In a la ge middle adolescen sample, dep ession (Kal iala- Heino, Kosunen, & Rimpelä, 2003) and bulimia (Kal iala-Heino, Rissanen, Rimpelä, & Ran a- nen, 2001) we e he mo e common he mo e ad anced sexual expe iences he adolescen s epo ed. This held ue among bo h gi ls and boys, and when pube al iming, age, amily s uc- u e and socioeconomic s a us we e con olled o . Mo eo e , dep ession was mo e common he g ea e he numbe o pa ne s he adolescen s epo ed o in e cou se (Kosunen, Kal iala-Heino, Rimpelä, & Laippala, 2003). Ea ly ma u ing adolescen s expe ience in e cou se younge and engage in isk- aking sexual beha iou mo e equen ly han hei pee s whose ma u ing is a e age o la e (Downing & Bellis, 2009; Edga dh, 2002; E hie e al., 2006). Ea ly pube y is also associa ed wi h bo h emo ional and beha iou al diso de s among adolescen gi ls and boys (Kal iala-Heino, Koi is o, Ma unen, & F öjd, 2011; Kosunen e al., 2003). The e o e, i is impo an o con ol o pube al iming when associa ions be ween men al diso de s and sexual beha iou a e s udied among adolescen s. Hall o s, Wal e , Baue , Fo d, and Halpe n (2005) epo ed ha sexual ac i i y in adolescence was p edic i e o la e dep ession, bu no ice e sa. O he wise, ea lie s udies ha ha e associ- a ed sexual debu du ing adolescen de elopmen wi h men al diso de s ha e mainly been c oss- sec ional o ha e su eyed young adul s e ospec i ely (Hall o s e al., 2004; Heidme s e al., 2010;Ko chick e al., 2001; Madkou e al., 2010; Ram akha e al., 2000; Tubman e al., 1996; Wigh e al., 2006). In o de o be e unde s and he ole o men al diso de s in adolescen sexual beha iou s, longi udinal associa ions need o be s udied in ollow-up da a. Emo ional and beha iou al diso de s g ea ly o e lap in adolescence, bu esea ch on men al diso de s and sexual beha iou s has mainly no aken his in o accoun bu has ocused on one ype o diso de s a a ime. 26 R. Kal iala-Heino e al. The aim o his s udy was o analyse longi udinal and concu en associa ions be ween emo ional and beha iou al diso de s and sexual beha iou in middle adolescen popula ion. Gi en he exis ing findings ha mo e ad anced sexual expe iences in ea ly and middle adoles- cence a e c oss-sec ionally associa ed a he wi h poo han posi i e men al heal h, we hypo h- esized ha in e nalizing and ex e nalizing symp oms ea lie in adolescen de elopmen would p edic expe ience o in e cou se and isk- aking sexual expe iences la e du ing he de elopmen- al phase. In mo e de ail he s udy ques ions we e (1) A e dep ession, conduc diso de and subs ance use a age 15 p edic i e o ha ing expe i- enced in e cou se by age 17? (2) A e dep ession, conduc diso de and subs ance use a age 15 p edic i e o ha ing expe i- enced in e cou se wi h mul iple pa ne s by age 17? Ma e ials and me hods S udy samples and p ocedu es This s udy is pa o an ongoing p ospec i e coho s udy, he Adolescen Men al Heal h Coho (AMHC) s udy conduc ed in wo Finnish ci ies, Tampe e (200,000 inhabi an s) and Van aa (180,000 inhabi an s). Da a collec ion, p ocedu es and measu es o he s udy ha e been epo ed in de ail elsewhe e (F öjd, Ma unen, Pelkonen, on de Pahlen, & Kal iala-Heino, 2006; Ri a- kallio, Koi is o, Pelkonen, Ma unen, & Kal iala-Heino, 2008). B iefly, a school su ey com- ple ed by he nin h g ade s in all Finnish-speaking seconda y schools in he wo ci ies was a anged o da a collec ion a T1. Du ing a school lesson and unde he supe ision o a eache subjec s comple ed a pe son-iden ifiable su ey. Ano he oppo uni y o pa icipa e was o e ed in he school o hose absen om school on he o iginal su ey day, ollowed by a pos al su ey wice i s ill no eached. Eligible pa icipan s a T2 we e s uden s who had pa ici- pa ed a T1. We o ganized school-based su eys a T1 in uppe seconda y schools and oca ional schools ollowed by pos al su ey finally by o e ing he su ey by In e ne . The subjec s o he p esen s udy we e s uden s esponding o a su ey conduc ed du ing 2002– 2003 (T1) and a wo-yea ollow-up du ing 2004–2005 (T2). The baseline sample (94.4% o all eligible) comp ised 1609 gi ls and 1669 boys. The mean age was 15.5 yea s (SD 0.39). O he esponden s, 71% we e li ing in wo-pa en amilies. The dis ibu ion o he subjec śpa en ś highes educa ion was ( a he /mo he ): 16%/13% basic compulso y educa ion only, 40%/30% basic compulso y educa ion and oca ional school, 17%/31% uppe seconda y school wi h o wi hou oca ional school, and 28%/26% academic deg ee (F öjd e al., 2006).A o al o 2070 ado- lescen s comple ed he su ey a bo h T1 and T2. The esponse a e o he final sample was 63.1% (2070/3278). O he esponden s, 56.6% we e gi ls. The mean age a T2 was 17.6 yea s (SD 0.4). Measu es Sexual beha iou Sexual expe iences we e elici ed a age 17 by asking “Ha e you e e had sexual in e cou se?” (yes/no), and u he by asking “Wi h how many pa ne s ha e you had sexual in e cou se?” (one/ wo/ h ee/ ou /fi e o mo e). In he analyses, he numbe o pa ne s was dicho omized o fi e o mo e/none o ou , wi h fi e o mo e in his age indica ing isk- aking sexual beha iou . Ea lie Finnish esea ch on adolescen sexual beha iou has simila ly used fi e o mo e pa ne s o in e cou se as indica o o isk- aking sexual ac i i y in middle adolescence (Kosunen e al., 2003). Heal h Psychology and Beha io al Medicine 27 Dep ession A Finnish modifica ion o he 13-i em Beck Dep ession In en o y (BDI) (Rai asalo, 2007)was used o assess dep ession a ages 15 and 17 (Beck & Beck, 1972; Beck, Rial, & Rickels, 1974). B ie BDI is a widely used sel - epo scale measu ing he se e i y o dep essi e symp- oms, and i s eliabili y and alidi y a e good (Benne e al., 1997). The BDI has been shown o be app op ia e o measu ing dep ession in adolescen s in popula ion s udies (Kal iala- Heino, Rimpelä, Ran anen, & Laippala, 1999; Rai asalo, 2007). Each i em is sco ed 0–3 acco d- ing o he se e i y o he symp om. Sum sco es o 13 i ems ( ange 0–39) we e dicho omized o no/ mild dep ession (sco es 0–7), and mode a e/se e e dep ession (sco es 8–39) (Beck & Beck, 1972). In his s udy, we classi y hose sco ing 8 o mo e as p esen ing wi h dep ession, o being dep essed. The cu -poin o 8 p edic s a diagnosis o dep ession by s uc u ed in e iew Schedules o Clinical Assessmen in Neu opsychia y wi h good sensi i i y (0.93) and specifici y (0.88) (Foun oulakis e al., 2003). F equen alcohol use F equency o d inking alcoholic be e ages was elici ed: “How o en do you d ink alcoholic be - e ages?”(once a week o mo e o en/app oxima ely once o wice a mon h/less o en/ne e ). In he analyses we dicho omized alcohol use equency o once a week o mo e o en s. less e- quen ly. Those who epo d inking once a week o mo e o en a e conside ed equen alcohol use s. Smoking A baseline he adolescen s we e asked “How many ciga e es, pipes o po ions o snu ha e you consumed so a ?”The esponse al e na i es we e none/1/2–50/mo e han 50. A u he ques ion was asked “Wha bes desc ibes you cu en smoking?”wi h esponse al e na i es daily/weekly/ less han weekly/has s opped smoking. Based on hese wo ques ions, he adolescen s we e dicho omized o daily smoke s (has smoked mo e han once, epo s now smoking daily) s. hose who smoke less han daily o no a all (all o he al e na i es). A ollow-up smoking was elici ed as “Wha bes desc ibes you cu en smoking?”The esponse al e na i es we e smoking daily/weekly/less han weekly/has s opped smoking/has ne e smoked, and in he ana- lyses hey we e dicho omized o smoking daily s. less o no a all. Thus, a bo h ages 15 and 17 we ocus on daily smoking. Conduc diso de Conduc diso de was measu ed by he delinquency and agg ession scales o he You h Sel - Repo (YSR) (Achenbach, 1991). The 90 h pe cen ile was used as a cu -poin o dis inguish ado- lescen s wi h significan conduc p oblems in his popula ion, sepa a ely o gi ls and boys. Al hough he YSR is a me hod based on sel - epo ed symp oms, i has been demons a ed ha high sco es on he YSR ex e nalizing scale a e p edic i e o clinical conduc diso de diagnosis wi h conside able sensi i i y and specifici y (Mo gan & Cauce, 1999). In he p esen da a, he cu - o sco e o being classified as displaying conduc diso de was 23 o gi ls and 24 o boys a age 15, and 21 o gi ls and 22 o boys a ages 17. Dep ession, equen alcohol use, daily smoking and conduc diso de a ages 15 and 17 we e s ongly in e co ela ed (da a no shown). This was aken in o accoun in he mul i a ia e analyses (see below). 28 R. Kal iala-Heino e al. Co a ia es Age and pube al iming we e included in he analyses as co a ia es. Age was calcula ed om da es o bi h and da a collec ion and was used as a con inuous a iable exp essed in yea s. Pub- e al iming was measu ed by age a mena che/oiga che by asking: How old we e you when you fi s had you pe iods/expe ienced ejacula ion? The esponse al e na i es we e 10 yea s o less/11/ 12/13/14/15 o olde /I ha e no ye . In he analyses pube al iming was classified acco ding o age a mena che/oiga che o ea ly (11 yea s o ea lie ), no ma i e (12–13 yea s) and la e (14, 15 o la e and no ye ). A i ion Al oge he 28% o he gi ls and 46% o he boys esponding o he baseline su ey d opped ou o ollow-up. No esponding a ollow-up was associa ed wi h inc eased dep ession, conduc dis- o de and subs ance abuse beha iou s in he baseline su ey (F öjd, Kal iala-Heino, & Ma unen, 2011; Kal iala-Heino e al., 2011). Responding was no associa ed wi h pube al iming in gi ls, whe eas non-no ma i e pube al iming was associa ed wi h lowe p obabili y o esponding in boys (ea ly 50%, no ma i e 59%, la e 49%; p= .001). Highe age was associa ed wi h lowe p ob- abili y o esponding (p< .001). S a is ical analyses F equency dis ibu ions o all a iables s udied a e gi en. Bi a ia e associa ions be ween sexual beha iou a age 17 (ha ing expe ienced in e cou se, ha ing had in e cou se wi h fi e o mo e pa ne s) and he men al heal h a iables s udied as well as wi h he co a ia es we e s udied using c oss- abula ion wi h chi squa e s a is ics o classified a iables and - es o con inuous a iables. We used mul i a ia e logis ic eg ession analyses o in es iga e he associa ions. Ha ing had in e cou se a age 17 and ha ing had in e cou se wi h fi e o mo e pa ne s a age 17 we e used in each u n as he dependen a iable. Independen a iables used we e dep ession, daily smoking, equen alcohol use and conduc diso de a ages 15 and 17. Fi s , dep ession a 15 and a 17 (and simila ly: daily smoking a 15 and 17, equen alcohol use a 15 and 17, conduc diso de a 15 and 17) we e en e ed in o he analysis con olling o age and age o mena che/ oiga che. Because dep ession, daily smoking, equen alcohol use and conduc diso de a e likely o be in e co ela ed, in he nex phase all o hese a age 15 we e en e ed simul aneously in o he logis ic eg ession analysis, con olling o age and age a mena che/oiga che. Finally, he ole o cu en dep ession, daily smoking, equen alcohol use and conduc diso de was con- olled o by adding hese in o he analyses a age 17. The esul s o he logis ic eg ession ana- lyses a e epo ed gi ing Odds a ios (ORs) wi h 95% confidence in e als (95% CI).The goodness o fi o he logis ic eg ession models was es ed wi h Hosme –Lemeshow good- ness-o -fi es . All he analyses we e ca ied ou sepa a ely o gi ls and boys. E hical conside a ions The s udy was g an ed app o al by he E hics Commi ee o Pi kanmaa Hospi al Dis ic . The subjec s ga e w i en in o med consen a e being in o med abou he s udy and he olun a iness o pa icipa ion. Thei pa en s we e in o med in ad ance by le e , bu pa en al consen was no ob ained because he Finnish legisla ion on medical esea ch allows mino s om 15 yea s o consen alone. Heal h Psychology and Beha io al Medicine 29 Resul s A g ea e p opo ion o gi ls han o boys had expe ienced in e cou se (p< .001) and epo ed fi e o mo e pa ne s o in e cou se by age 17 (p= .009). Dep ession was mo e common among gi ls bo h a age 15 (p< .001) and a age 17 (p= .001). F equen alcohol use did no di e by sex a age 15, bu a age 17 boys epo ed equen alcohol use mo e o en han gi ls (p= .001). Daily smoking was equally common in bo h sexes a bo h ime poin s (Table 1). Table 1. Dis ibu ion o sexual beha iou s, dep ession, equen alcohol use and daily smoking a ages 15 and 17, and age a mena che/oiga che as well as mean (s.d.) age a baseline among he pa icipan s o he AMHC s udy (%). Gi ls (n= 1167) Boys (n= 903) Has expe ienced in e cou se a age 17 Yes 57.6 42.0 No 39.9 51.9 Missing 2.5 6.1 Has expe ienced in e cou se wi h fi e o mo e pa ne s a age 17 Yes 14.5 11.0 No 83.0 82.9 Missing 2.5 6.1% Dep ession a age 15 Yes 11.8 6.0 No 88.0 93.5 Missing 0.5 0.6 Dep ession a age 17 Yes 10.3 6.3 No 89.5 92.8 Missing 0.2 0.9 F equen alcohol use a age 15 Yes 9.1 10.9 No 90.6 88.9 Missing 0.3 0.2 F equen alcohol use a age 17 Yes 15.9 26.0 No 83.7 73.1 Missing 0.4 0.9 Daily smoking a age 15 Yes 20.4 19.7 No 78.7 79.1 Missing 0.9 1.2 Daily smoking a age 17 Yes 25.4 25.6 No 74.1 73.5 Missing 0.4 0.9 Age a mena che/oiga che 11 o less 19.7 17.5 12–13 63.3 57.6 14 o mo e/no ye 16.7 20.7 Missing 0.3 4.2 Age a baseline (in yea s) mean (s.d.) 15.5 (0.36) 15.5 (0.36) No e: As conduc diso de was defined as he 90 h pe cen ile o he sum sco e o CBCL delinquency + agg ession scales, i s p e alence is always 10%. 30 R. Kal iala-Heino e al. Bi a ia e analyses O ea ly ma u ing boys, 60.0% had expe ienced in e cou se a age 17, compa ed o 46.2% o no ma i e ma u e s and 28.2% o la e ma u e s (p< .001). Ea ly ma u ing boys also mo e o en epo ed ha ing had fi e o mo e pa ne s o in e cou se a age 17 (19.6% s. 10.8% s. 4.8%, p< .001). Among gi ls, expe ience o in e cou se was mo e common he ea lie hey had expe ienced mena che (66.5% s. 61.3% s. 43.0%, p< .001), and so was ha ing had fi e o mo e pa ne s o in e cou se (25.7% s. 13.8% s. 4.6%, p< .001). Among gi ls, expe ience o in e cou se a age 17 was no associa ed wi h age a baseline. Among boys, in e - cou se by age 17 was associa ed wi h sligh ly olde age a baseline (15.53 (0.34) s. 15.46 (0.36) yea s, p= .003). Ha ing had fi e o mo e pa ne s by age 17 was no associa ed wi h age a baseline in ei he sex. Expe ience o in e cou se and epo ing fi e o mo e pa ne s o in e cou se we e mo e common among hose gi ls and boys who had p esen ed wi h conduc diso de , epo ed daily smoking o equen alcohol use a age 15. In gi ls, hese expe iences we e also mo e common among hose who had su e ed dep ession a age 15. Cu en dep ession, conduc diso de , daily smoking and equen alcohol use we e simila ly associa ed wi h expe ience o in e cou se as well as wi h epo ing fi e o mo e pa ne s o in e cou se a age 17 among gi ls, and all excep cu en dep ession also among boys (Table 2). Table 2. Expe ience o in e cou se a age 17, and epo ing fi e o mo e pa ne s o in e cou se by age 17, acco ding o dep ession, daily smoking, equen alcohol use and conduc diso de a ages 15 and 17 among Finnish gi ls and boys (%). Gi ls Boys Has expe ienced in e cou se a age 17 yea s (%) Fi e o mo e pa ne s o in e cou se li e ime (%) Has expe ienced in e cou se a age 17 yea s (%) Fi e o mo e pa ne s o in e cou se li e ime (%) pp pp Dep ession a age 15 <.001 .001 .156 .227 Yes 76.9 23.9 51.9 14.8 No 56.6 13.2 44.0 10.7 Dep ession a age 17 .03 .009 .408 .082 Yes 67.2 22.5 42.1 17.5 No 58.1 13.7 44.7 10.5 Daily smoking a 15 <.001 <.001 <.001 <.001 Yes 93.9 39.5 78.9 29.2 No 50.2 8.2 36.4 6.4 Daily smoking a 17 <.001 <.001 <.001 <.001 Yes 89.9 36.0 74.9 25.5 No 42.6 7.2 34.5 6.0 F equen alcohol use a 15 <.001 <.001 <.001 <.001 Yes 92.1 44.3 76.4 34.7 No 56.0 11.6 41.0 8.1 F equen alcohol use a 17 <.001 <.001 <.001 <.01 Yes 89.0 38.8 70.8 24.3 No 53.3 10.2 35.5 6.4 Conduc diso de a 15 <.001 <.001 <.001 <.001 Yes 86.5 12.1 63.4 32.6 No 56.1 36.1 42.7 8.5 Conduc diso de a 17 <.001 <.001 <.001 <.001 Yes 72.2 36.1 63.9 24.4 No 57.0 12.1 42.9 9.3 Heal h Psychology and Beha io al Medicine 31 Mul i a ia e analyses p edic ing expe ience o in e cou se When en e ed in o he logis ic eg ession analysis wi hou he o he symp oms/beha iou s bu a e con olling o age and age a mena che, dep ession a age 15 was associa ed wi h inc eased OR o expe iencing in e cou se by age 17 (OR 2.4, 95% CI 1.5–3.8. p< .001) among gi ls. Cu en dep ession was no s a is ically significan ly associa ed wi h in e cou se (Hosme –Leme- show goodness o fi 0.830). Conduc diso de a age 15 was associa ed wi h expe ience o in e - cou se by age 17 (OR 4.0, 95% CI 2.2–7.1, p< .001), and cu en conduc diso de was also s a is ically significan ly associa ed wi h expe ience o in e cou se (OR 1.9, 95% CI 1.2–3.1, p = .01) (HL 0.355). Bo h pas (OR 5.8, 95% CI 3.2–10.8, p< .001) and p esen (OR 4.7, 95% CI 3.0–7.6) daily smoking inc eased he OR o ha ing expe ienced in e cou se a age 17 (HL goodness o fi 0.472), as did pas (OR 5.8 (2.7–12.3), p< .001) and p esen (OR 6.8 (4.0– 11.3), p< .001) equen alcohol use (HL 0.970). When en e ed oge he , and con olling o age and age a mena che, dep ession, smoking, equen alcohol use and conduc diso de a age 15 all pe sis ed as associa ed wi h ha ing had expe ience o in e cou se a age 17 (Table 3). Adding he cu en symp oms/beha iou s le elled ou he p edic i e associa ion o equen alcohol consump ion a age 15, bu also esul ed in essen ially poo e goodness o fi o he model (Hosme –Lemeshow goodness o fi 0.02). Among boys, dep ession a age 15 and a age 17 did no inc ease he OR o ha ing expe i- enced in e cou se a age 17, when en e ed in o a logis ic eg ession model and con olling o age and age a oiga che. Daily smoking a bo h age 15 (OR 2.9, 95% CI1.7–4.8, p< .001) and a age 17 (OR 3.1, 95% CI2.0–4.9, p< .001) was associa ed wi h ha ing had in e cou se by age 17 (HL 0.206), as was equen alcohol use a age 15 (OR 2.5, 95% CI 1.4–4.5, p= .001) and a 17 (OR 3.4, 95% CI2.4–5.0, p< .001) (HL0.430). Conduc diso de a age 15 p o ed associa ed wi h in e cou se by age 17 (OR 2.0, 95% CI1.2–3.4), bu cu en conduc diso de was no associa ed wi h ha ing expe ienced in e cou se a age 17 among boys (HL 0.221). When independen a iables we e en e ed simul aneously, daily smoking a age 15 and e- quen alcohol use a age 15 we e associa ed wi h in e cou se by age 17, bu dep ession and conduc diso de a age 15 we e no (Table 3). The longi udinal associa ions be ween daily smoking and equen alcohol use a age 15 and in e cou se by age 17 pe sis ed when symp oms a age 17 we e added o he model (HL o model wi h all he a iables was 0.829). Mul i a ia e analyses p edic ing mul iple pa ne s o in e cou se Among gi ls, p e ious dep ession and cu en dep ession we e no associa ed wi h ha ing expe i- enced in e cou se wi h fi e o mo e pa ne s a age 17, when en e ed in a logis ic eg ession model a e con olling o age and age a mena che. Pas (OR 3.3, 95% CI 2.1–5.2) and p esen (OR 2.7, 95% CI 1.7–4.4) conduc diso de was associa ed wi h epo ing fi e o mo e pa ne s o in e - cou se (Hosme –Lemeshow goodness o fi 0.639), as we e pas (OR 2.9, 95% CI 1.8–4.5) and p esen (OR 3.8, 95% CI 2.4–6.0) smoking (HL 0.252) and pas (OR 3.6, 95% CI 2.2–5.7) and p esen (OR 4.2, 95% CI 2.8–6.2) equen alcohol use (HL 0.686). When all he symp oms and beha iou s s udied a age 15 we e en e ed in o he model simul- aneously, and a e con olling o age and age a mena che, in e cou se wi h fi e o mo e pa ne s by age 17 was among gi ls p edic ed by conduc diso de , daily smoking and equen alcohol use a age 15 (Table 3). These associa ions also pe sis ed when cu en symp oms and beha iou s we e added in o he model (Hosme –Lemeshow goodness o fi o he model including bo h pas and p esen symp oms: 0.613). Among boys, pas (OR 4.0, 95% CI 2.3–7.1) and p esen (OR 2.0, 95% CI 1.1–3.6) conduc diso de (HL 0.393), pas (OR 2.7, 95% CI 1.5–4.9) and p esen (OR 2.8, 95% CI 1.6–5.1) 32 R. Kal iala-Heino e al. Rosen hal, D. A., Smi h, A., & de Visse , R. (1999). Pe sonal and social ac o s influencing age a fi s sexual in e cou se. A chi es o Sexual Beha io ,28, 319–333. Tanne , J. M. (1962). G ow h a adolescence. Ox o d: Blackwell. Tubman, J. G., Windle, M., & Windle, R. C. (1996). The onse and c oss- empo al pa e ning o sexual in e - cou se in middle adolescence: P ospec i e ela ionships wi h beha io al and emo ional p oblems. Child De elopmen ,67, 327–343. Wigh , D., Williamson, L., & Hende son, M. (2006). Pa en al influences on young people’s sexual beha io : A longi udinal analysis. Jou nal o Adolescence,29, 473–494. Heal h Psychology and Beha io al Medicine 39