Adolescent Health and High School Dropout: A Prospective Cohort Study of 9000 Norwegian Adolescents (The Young-HUNT)

Background: High school dropout is of major concern in the western world. Our aims were to estimate the risk of school dropout in adolescents following chronic somatic disease, somatic symptoms, psychological distress, concentration difficulties, insomnia or overweight and to assess to which extent the family contributes to the association between health and school dropout. Methods: A population of 8950 school-attending adolescents (13-21 years) rated their health in the Young-HUNT 1 Study (90% response rate) in 1995-1997. High school dropout or completion, was defined with the Norwegian National Education Database in the calendar year the participant turned 24 years old. Parental socioeconomic status was defined by using linkages to the National Education Database, the National Insurance Administration and the HUNT2 Survey. We used logistic regression to estimate odds ratios and risk differences of high school dropout, both in the whole population and among siblings within families differentially exposed to health problems. Results: All explored health dimensions were strongly associated with high school dropout. In models adjusted for parental socioeconomic status, the risk differences of school dropout according to health exposures varied between 3.6% (95% CI 1.7 to 5.5) for having >= 1 somatic disease versus none and 11.7% (6.3 to 17.0) for being obese versus normal weight. The results from the analyses comparing differentially exposed siblings, confirmed these results with the exception of weaker associations for somatic diseases and psychological distress. School dropout was strongly clustered within families (family level conditional intraclass correlation 0.42). Conclusions: Adolescent health problems are markers for high school dropout, independent of parental socioeconomic status. Although school dropout it strongly related to family-level factors, also siblings with poor health have reduced opportunity to complete high school compared to healthy siblings. Public health policy should focus on ensuring young people with poor health the best attainable education.