Department of Psychiatry, University of Oulu, Box 5000, FIN-90014 University of Oulu,
1 Oulu Polytechnic, Oulu and
2 Department of Public Health Science and General Practice, University of Oulu, Finland
Received 26 March 2002; in revised form 22 August 2002; accepted 4 September 2002
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ABSTRACT |
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INTRODUCTION |
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Drunk driving is one of the criteria for DSM-IV alcohol misuse (American Psychiatric Association, 1994). Numerous studies suggest that individuals with drunk driving offences have high rates of alcohol-use disorders (McCord, 1984
; Pristach et al., 1991
; Lapham et al., 2001
) as well as other substance-use disorders (Donovan, 1993
; Lapham et al., 2001
). Among high school seniors, low grade point averages increase the risk for driving after drinking (OMalley and Johnston, 1999
). However, in a study by Hasin et al.(1999)
drunk driving was not associated with a lower number of years of attained education.
The relationship between educational performance and various adolescent and adult outcomes has been investigated previously in the Northern Finland 1966 Birth Cohort. Poor school performance was associated with poor life control in adulthood (Pietilä et al., 1994), delinquency (Järvelin et al., 1995
; Rantakallio et al., 1995
), mental disorders (Isohanni et al., 1998
) and smoking (Isohanni et al., 2001a
). Educational underachievement in adulthood was linked to smoking continuing from adolescence to adulthood (Isohanni et al., 2001a
) and psychiatric morbidity (Isohanni et al., 2001b
). Drunk driving offences and criminality are currently an important focus for research in the Northern Finland 1966 Birth Cohort. Drunk driving was associated with violent criminality and mental disorders (Räsänen et al., 1999
). Single-parent family background was associated with violent recidivism (Koskinen et al., 2001
) and increased the risk for drunk driving offences (Sauvola et al., 2001
). The prevalence of criminal offences was the highest among males with alcohol-induced psychoses and male schizophrenic subjects with coexisting alcohol misuse (Tiihonen et al., 1997
).
In this paper we set out to combine these two study lines. As far as we know, there are no prospective, longitudinal studies analysing the association between school performance, drunk driving and educational achievements in adulthood. Our hypothesis was that low school performance in compulsory school would relate to later drunk driving. Furthermore, we hypothesized that drunk drivers have an elevated risk of educational failure in adulthood compared with controls. We tested this hypothesis in a large, genetically homogenous, general population birth cohort database of 11 017 individuals from Northern Finland.
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SUBJECTS AND METHODS |
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Drunk driving was treated here as an outcome variable. The relevant data for drunk driving offences was collected from the National Crime Registers, i.e. Ministry of Justice files for those between 15 and 32 years of age. By the end of 1998, 402 individuals out of 10 582 cohort members had been convicted at least once of a drunk driving offence. The mean age ± SD of the first drunk driving offence was 22.1 ± 4.3 years (range 1532 years) for males and 23.8 ± 4.2 years (range 1532 years) for females. In Finland, people aged 18 years are able to obtain a driving licence, and the legal blood alcohol limit is 50 mg/dl. Random breath testing is used routinely and extensively in roadside surveys in Finland. Any person older than 15 years of age arrested for driving under the influence is immediately registered in the National Criminal Register. The subjects were divided into two subgroups according to the number of drunk driving offences (one to two offences vs three or more, hereafter referred to as recidivists). Individuals with no drunk driving offences were used as the comparison group.
School performance
School performance was operationalized in two ways in this study. First, the categorical description of school grade level at age of 14 years was extracted from the questionnaire sent to the cohort members in 1980 (93.5% response). Data on the missing 6.5% were retrieved from their schools. The following two categories were defined: (1) not in normal grade (grade below age-appropriate level or special school), and (2) in normal grade (appropriate for age level or above). Secondly, the information on the cohort members school performance was obtained at the end of compulsory schooling (Isohanni et al., 2001b). The mean score of all school subjects at the end of the ninth grade was used as another indicator of school performance. During that year, the majority of the cohort members reached the age of 16 years. In Finland, the range of school marks is from 4 (rejected) to 10 (excellent).
Adult educational performance
Data on the completed level of education of cohort members were gathered from the national Educational Registry of Statistics Finland, and were available for 10 300 persons living in Finland in 1997 (Classification in Education, 1998; Isohanni et al., 2001b
). The categorization is essentially consistent with the International Standard Classification of Education. The level of education is measured by the duration of education, with education progressing in annual steps from lower to higher levels. The longer the duration of education, the higher the attained level of education. The following eight educational level categories were defined: (1) primary education (less than 9 years); (2) lower secondary education, in Finland compulsory school (9 years); (3) lower level in upper secondary education (1011 years); (4) upper level in upper secondary education (12 years); (5) lowest level in tertiary education (1314 years); (6) lower-degree level in tertiary education (15 years); (7) higher-degree level in tertiary education (16 years); and (8) doctorate or equivalent level in tertiary education.
Tertiary educational levels (levels 58) were only achieved by a few subjects [19 (5%) of male drunk drivers and 1 (3%) of female drunk drivers]. Therefore, in logistic regression modelling, the eight educational levels were combined into two categories: (1) basic education (original categories 12), i.e. 9 years or less of total education; and (2) secondary (original categories 34) and tertiary (original categories 58) education, i.e. 10 years or more education. In the basic education group the individuals have only passed the compulsory schooling, but had no upper secondary or vocational education.
Confounding variables
Low social class (Kivinen and Rinne, 1995) and psychiatric morbidity (Kessler et al., 1995
) are known to be associated with educational underachievement in adulthood. Drunk driving is also associated with these factors (Lapham et al., 2001
; Sauvola et al., 2001
). Based on this knowledge, we considered the parental social class in 1980 (III/IIIIV and V) and psychiatric morbidity of cohort members as potential confounding variables. Social classes III included those with the highest professions, classes III and IV were skilled and unskilled workers, respectively, and class V comprised farmers. The nationwide Finnish Hospital Discharge Register covers all mental and general hospitals nationwide. We identified all cohort members over the age of 16 years appearing in the Finnish Hospital Discharge Register until the end of 1997 for any psychiatric disorder. All psychiatric diagnoses were validated for DSM-III-R criteria (Isohanni et al., 1997
). The variable psychiatric morbidity was dichotomized (yes/no hospital admissions) in the logistic regression analysis. Of the drunk drivers, 84 (22.6%) males and 6 (20.0%) females had been hospitalized until the end of 1997.
Statistical analysis
We first assessed the association between school performance and drunk driving by grade level at the age of 14 years. The proportion of pupils not in normal grade was compared with the cases with normal grade in each drunk driving category and the chi-square test was used to evaluate the statistical significance of the differences. Secondly, the association between school performance and drunk driving was assessed by mean score of all school subjects at the end of compulsory schooling by cross-tabulation. The statistical significance of differences between these means (each drunk driving category vs controls) adjusted for confounding factors (social class and hospital-treated psychiatric morbidity) was evaluated using analysis of variance.
We then assessed the association between the drunk driving groups and the level of education at 31 years of age by cross-tabulation. The statistical significance of differences was evaluated using the chi-square test. In the next phase, logistic regression analysis was applied (Agresti, 1990). This provides a method to estimate the adjusted odds ratios (ORs) of the level of education by each drunk driving category. The logistic regression model for basic education vs the combination of secondary and tertiary education is reported using adjusted ORs with 95% confidence intervals (95% CI) after adjustment with parental social class and psychiatric morbidity. Analyses were performed using SAS, version 8.1 (SAS Institute, Inc., 1999
).
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RESULTS |
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The results from the cross-tabulation are presented in Table 1. Nineteen per cent of recidivists and 14% of male drunk drivers were not in the normal grade at the age of 14 years, compared with 7% of controls. The corresponding percentages were 13% and 4% for female drunk drivers and controls, respectively. The mean score (± SD) of all school subjects at the end of compulsory school among male drunk drivers was 6.6 (± 0.8), 6.3 (± 0.8) for recidivist drunk drivers and 7.3 (± 0.9) for controls. Among women, the corresponding means were 7.0 (± 0.7) and 7.8 (± 0.9) for drunk drivers and controls, respectively. A total of 64% of the male recidivists, 35% of the drunk drivers and 14% of controls had not progressed beyond the basic education level by the age of 31. Forty-seven per cent of female drunk drivers and 10% of controls remained at the basic level. Thus, a remarkable percentage of drunk drivers had not continued at school after the compulsory years.
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DISCUSSION |
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Our findings are in line with the study by OMalley and Johnston (1999). In our study, the proportion of drunk drivers never progressing beyond the compulsory education level in adulthood is surprisingly high compared with the study of Hasin et al.(1999)
, in which the percentage of subjects with current DSM-IV alcohol misuse diagnosis based on drunk driving history, having less than 11 years of education, was only 8%. Shinar et al.(2001)
studied self-reports of safe driving behaviours and found no statistically significant association between drunk driving and educational level. Harrison (1998)
found that an occupational category including mainly manual or outdoor workers accounted for 42% of male drunk drivers.
For women with one to two drunk driving offences, the risk of educational underachievement in adulthood was greater than for men with the same number of offences. This result contradicts the earlier result reported by Rogers et al.(1997). In this latter study women with drunk driving offences had a higher educational level compared with men. In our opinion, our finding may be an indicator of an increasing amount of consumption and alcohol-related problems among modern women. This is well in line with the findings of Stoltenberg et al.(1999)
, whose results suggest that the prevalence of heavy drinking connected with antisocial features may be increasing for both sexes. Further studies investigating the heavy alcohol use of modern women should be undertaken.
Our results only apply to drunk driving committed before age 31 years, and readers must be aware that correlates of drunk driving might be different in those who offend for the first time after age 31 years. This study cannot estimate whether the lower school performance among drunk drivers was associated with low intelligence or rather with behavioural factors. However, 17.6% of cohort members who were at a regular school but in a lower class than appropriate for their age, and 88.8% of pupils in special schools had a measured intelligence quotient below 86 (Rantakallio and von Wendt, 1986). Given that our study design was epidemiological and register based, the causality between educational performance and drunk driving is difficult to assess. In adolescence, when our cohort members were ending their compulsory schooling, only a few individuals had started regular use of alcohol (Isohanni et al., 1994
). Thus alcohol use is not the only cause of low school performance of future drunk drivers. However, the educational failures of drunk drivers are observable already in school performance, which could speak of putative early cognitive deficits, learning difficulties, lack of motivation, poor life control or low social support. A possible aetiological pathway to explain the association between low school performance, drunk driving and later educational underachievement is a general tendency towards problem behaviour and deviance (Jessor and Jessor, 1977
). It is well known that individuals engaging in one problem behaviour are likely to be involved in other problem behaviours as well (Jessor, 1987
; Huizinga et al., 1993
). Also, common underlying aetiological traits, such as psychiatric morbidity (McMillen et al., 1992
; Lapham et al., 2001
), living in a single-parent family (Sauvola et al., 2001
) or lack of constructive hobbies and delinquent lifestyle (Miller and Plant, 1999
) may predict both educational failures and the problem use of alcohol. Our result may also be a sign of chronological progression from a childhood attention deficit hyperactivity disorder to conduct disorder and further to alcohol use and lowered educational performance (Myers et al., 1998
; Kuperman et al., 2001
).
The particular strength of this study was that the drunk driving data were based on national crime registers and we were able to confirm the association between drunk driving and lowered educational attainment at the epidemiological level. In many countries there would not be the opportunity to carry out this kind of study, because valid registers are not available, or because their use is restricted by data protection laws. This may mean that we analysed more serious alcohol-related offending than in studies that use interview-based information of ever driving after drinking. There are also cultural differences in attitudes towards drunk driving. While tendency to drunk driving can be seen only as a personality-related (Stacy et al., 1991) or cognitive and attitudinal problem (Turrisi and Jaccard, 1992
), in Finland it is highly criminalized and leads to a criminal record in those over 15 years of age. Also, previous studies from this cohort (Räsänen et al., 1999
) confirm the assumption that the individuals with drunk driving offences in Finland have more serious problems than a simple personality-related failure to estimate their drunkenness or a tendency to take extra risks. This point may help explain the strong association with low educational achievement.
In summary, we conclude that drunk driving offenders are individuals with an increased risk for stagnated education. Our finding is important because occupational life is changing rapidly, and in the modern, education-based society, educational and lifestyle demands for employees are high. Educational failures and substance use disorders are possible determinants of social disadvantage in later life. Therefore, health care professionals and teachers at all levels should pay increased attention to the needs of young people with impaired school performance and hazardous alcohol use.
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ACKNOWLEDGEMENTS |
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FOOTNOTES |
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