Department of Psychiatry, University of Helsinki, F1-00014, Helsinki, P.O. Box 63, Finland.
Psychiatry, Hospital District of Helsinki and Uusimaa, Helsinki, Finland.
BMC Public Health. 2024 Jan 22;24(1):255. doi: 10.1186/s12889-024-17693-w.
Heavy alcohol and cannabis use during adolescence have been previously described as risk factors not only for morbidity in adulthood, but also social problems including adversities in educational attainment. Attempts to consider overlapping risk factors and confounders for these associations are needed.
Using weighted multivariable models, we examined prospective associations between age at first drink (AFD), age at first intoxication (AFI), frequency of alcohol intoxication, as well as self-reported alcohol tolerance (i.e., number of drinks needed for the subjective experience of intoxication), and lifetime cannabis use at age 15/16 years with subsequent educational attainment obtained from comprehensive registers until age 33 in the Northern Finland Birth Cohort 1986 (6,564 individuals, 49.1% male). Confounding variables including sex, family structure (intact vs. non-intact), maternal and paternal education level, behavioural/emotional problems in school at age 7/8 years, having a history of illicit substance use in adolescence, having any psychiatric diagnosis before age 16, and parental psychiatric diagnoses, were adjusted for.
In this large birth cohort study with a 17-year follow-up, younger age at first intoxication, higher frequency of alcohol intoxication, and high self-reported alcohol tolerance at age 15/16 years were associated with poorer educational outcomes by the age of 33 years. These associations were evident regardless of potential confounders, including parental education and childhood behavioural/emotional problems. The association between adolescent cannabis use and educational attainment in adulthood was no longer statistically significant after adjusting for confounders including frequency of alcohol intoxication at age 15/16.
Assessments of age of first alcohol intoxication, high self-reported alcohol tolerance and frequency of intoxication during adolescence should be included when implementing screening strategies aimed at identifying adolescents at risk for subsequent social problems.
青春期大量饮酒和吸食大麻不仅被认为是成年后发病和社会问题（包括教育程度下降）的风险因素，还被认为是其他风险因素和混杂因素的重叠。
使用加权多变量模型，我们检验了首次饮酒年龄（AFD）、首次醉酒年龄（AFI）、醉酒频率以及自我报告的酒精耐受度（即主观醉酒体验所需的饮酒量）与 15/16 岁时终生大麻使用与 33 岁前从综合登记处获得的教育程度之间的前瞻性关联。该队列为芬兰北部出生队列 1986（6564 人，49.1%为男性）。调整了混杂变量，包括性别、家庭结构（完整与不完整）、母亲和父亲的教育水平、7/8 岁时在校行为/情绪问题、青少年时期有非法药物使用史、16 岁前有任何精神科诊断以及父母的精神科诊断。
在这项具有 17 年随访的大型出生队列研究中，首次醉酒年龄较小、醉酒频率较高、15/16 岁时自我报告的酒精耐受度较高与 33 岁时较差的教育结果相关。这些关联在调整了潜在混杂因素（包括父母教育程度和儿童行为/情绪问题）后仍然存在。调整包括 15/16 岁时的醉酒频率在内的混杂因素后，青少年大麻使用与成年后教育程度之间的关联不再具有统计学意义。
在实施旨在识别有后续社会问题风险的青少年的筛查策略时，应考虑评估青少年首次饮酒年龄、自我报告的酒精耐受度和醉酒频率。
