ABSTRACT
BACKGROUND: Externalising behavior problems involve a huge developmental risk potential as they can substantially interface with the parallel process of establishing and forming identity in peer groups during adolescence while simultaneously coping with expectations regarding academic achievement and behaviour. Therefore adolescents with externalising behavior constitute a potential target audience for health promotion. AIM OF THE STUDY: The purpose of this paper is to clarify in what kind of social contexts externalising behavior problems are associated with decreased subjective health in adolescence. METHOD: An analysis of secondary data from the KiGGS study (Robert Koch-Institute, 2009) was undertaken. Calculations of logistic regression models for boys and girls were performed on the basis of preceding stratifications using the indicator subjective health and including relevant social demographic factors. OUTCOME: Externalising adolescents face a higher risk of decreased subjective health than inconspicuous adolescents of the same age group, while there is a gender-specific difference (boys OR 2.76; girls OR 1.48). The gender-specific differences in subjective health appraisal found in inconspicuous adolescents cannot be verified in adolescents with externalising behaviour. Related to social demographic predictors a classic social gradient for girls is verified whereas externalising behaviour in boys is predominantly associated from high social class and decreased subjective health. In multivariate procedures a higher odds ratio for decreased subjective health becomes apparent for adolescents who ascend or descend in relation to their education level as well as for adolescents from higher social classes who had to repeat a school year. CONCLUSION: Adolescents with externalising behavior frequently rate their health situation as being bad. The fact that it is primarily boys with behavior problems and boys who are intergenerational mobile educationwise who exhibit decreased psychosocial well-being, indicates that an increased context related exclusion risk (ostracism) is an essential health risk factor. Micro-groups of adolescents facing risk of being ostracised appear to be an essential target group for prevention and health promotion which so far is not being taken into consideration on the basis of school type related recommendations.
