Social, psychological and behavioural factors in adolescence associated with early and later drunken driving.

Transcription

1 Social, psychological and behavioural factors in adolescence associated with early and later drunken driving. G unilla Karlsson and Anders Rom elsjo St Goran Clinic of Dependence Disorders, Box , S Stockholm, Sweden IN T R O D U C T IO N In several studies it is suggested that people convicted of driving while intoxicated (DWI) deviate significantly from the general population regarding both earlier alcohol consumption and various social, psychological and behavioural factors (Selzer and Barton, 1977 and Donovan, Queisser, Salzberg and Umlauf, 1985), as we found in a previous study o f drunken driving in young men during a seven-year follow-up (Karlsson and Romelsjo, 1997). With a more than 20-year follow-up we now analyse the risk of DWI associated with hazardous alcohol consumption and psychosocial factors in various periods after conscription. The question of the consistency of drinking behaviour over the life-span then arises. Fillmore (1987) reported that heavy drinking decreases over time, while Pape and Hammer (1996) found a greater consistency in drinking patterns up to the age of at least 28, especially for high consumers. We put forward the following hypotheses: 1. The importance of both alcohol abuse and psychosocial risk factors decreases as time passes. 2. The importance of both alcohol abuse and psychosocial factors increases with the number of convictions for drunken driving. 3. The social predictors are weaker for those with drunken driving but without hospital admissions for alcoholism. M ATERIAL AND M ETHODS The main source of data was the military conscription survey in (men born in ). In Sweden, all men aged are subjected to a thorough examination before compulsory military service, and in this cohort the collected data were affixed with personal identification numbers for research purposes. All 8,122 conscripts born in from the County of Stockholm, with 1.6 million inhabitants, were included. They were asked to fill in two

2 questionnaires, including questions on upbringing, social conditions, school adjustment, relations with parents and friends, smoking and use of alcohol, solvents and illicit drugs. Data on DWI and on hospitalisations with alcohol diagnoses up to 1993 were linked to the conscription survey data. The lower limit in Sweden for drunken driving was a BAC of 0.05 % up to June 1990, thereafter 0.02 %. Bivariate analyses of the relative risk were first performed, including several possible risk factors for drunken driving, followed by multivariate logistic regression analyses. Using then the likelihood-ratio test, and omitting variables with W ald-values (Hosner and Lemeshow, 1989) of less than one where we arrived at final reduced m odels, including statistically significant interaction terms. R E SU L T S Bivariate analyses for three time periods, , and showed significantly elevated relative risks (RR) for several variables, highest for contact wih the police or juvenile authorities, ran away from home, criminality, apprehended for public drunkenness and high alcohol consumption. The differences between time periods were not large, but decreased overall as time passed. Table 1 : M ultivariate analysis. D ifferent time periods for the first o ffe n c e. R elative risks, 95% confidence intervals. V A R IA B L E S (THE WHOLE PERIOD) Social class II 1.4( ) 1.8( ) Social class III 2.1( ) 3.3( ) Public drunkenness 2.7( ) 2.3( ) Sniffing of solvents 1.8( ) 1.7( ) 1.9( ) Smoking >10 cig. per day 1.7( ) OO 4 ^ t o 4 ^ 1.6( ) 2.0( ) Contact with the police or juvenile authorities 2.2( ) 3.2( ) 3.3( ) 2.1( ) Parents divorced 1.3( ) Medicine for nerves 2.0( )

3 In the multivariate analysis for , RR was elevated for father s social class, apprehension for public drunkenness, contact with the police or juvenile authorities, smoking more than 10 cigarettes a day, sniffing of solvents and having divorced parents (Table I). Smoking and contact with the police were significant risk factors in all three time periods, sniffing o f solvents in the first and in the last period and having taken medicine for nervous problems in W e also made analyses for one, two and three or more convictions (Table II). Significant risk factors for two convictions were contact with the police or juvenile authorities and smoking, which was also true for three convictions. Sniffing of solvents and having a psychiatric diagnosis were also risk factors for three convictions. T able 2 : N um bers o f convictions during R elative risks. 95% confid en ce intervals. V A R IA B L E S A N Y NUMBER OF ONE CONVICTIONS CONVICTIO N TW O CO NVICTIO NS TH REE CO N VIC TIO N S OR MORE Social classll 1.4( ) 1.4( ) Social class III 2.1( ) 2.6( ) Parents divorced 1.3( ) 1.4( ) Public drunkenness 2.7 ( ) 2.7( ) Contact with the 2.2( ) 2.( ) 3.7( ) 5.2( ) police or juvenile authorities Smoking >10 cig. per day 1.7( ) 1.5( ) 2.3( ) 2.3( ) Sniffing solvents Psychiatric diagnoses of 1.8( ) 1.7( ) 2.7( ) 2.3( ) The risk factors for both drunken driving and hospital admissions were father s social class II and III, contact with the police, public drunkenness, high alcohol consumption, sniffing and

4 smoking (Table III). Public drunkenness was also a risk factor for drunken driving without hospital admissions (the strongest, RR=4.0 ) as well as hospital admissions without drunken driving. Contact with the police was high for those with hospital admissions without drunken driving (RR=3.7) and for truancy the relative risk was 2.6 for hospital admission. For drunken driving without hospital admission sniffing and smoking were significant risk factors. Table 3 : M ultivariate analysis. Association between psychosocial variables and hospital adm issions for alcohol diagnosis with or w ithout drunken d r iv in g. R elative risk. 95% confidence intervals. V A R IA B L E S D R U N K E N D R U N K E N ONLY H O SPITAL DRIVING AND DRIVING AND NO AD M ISSIO N S HO SPITAL HOSPITAL A D M ISSIO N S AD M ISSIO N S Social class II 1.4( ) Social class III 2.4( ) Contact with the 3.2( ) 3.7( ) police or juvenile authorities Apprehended for 1.9( ) 4.0( ) 2.1( ) public drunkenness Alcohol consumption 2.3( ) >250g/week Sniffing of solvents 2. 1( ) 4.1( ) Truancy 2.6( ) Smoking >10 cig/day 1.6( ) 2.6( ) D IS C U S S IO N One life-style factor (smoking) and contact with the police or juvenile authorities, an indicator of delinquency, had an elevated RR during all three time periods, while sniffing of solvents showed an elevated RR during the first and last periods. Other variables showed an increased RR during the first period only, which is support for our first hypothesis. Obviously, social factors, behaviour and alcohol and drug abuse are predictors of drunken driving in young men during a shorter or longer time period. Johnson and White (1989) discuss drunken driving among young people, suggesting that impaired driving may be part o f a global syndrome of

5 risk-taking behaviour and is an activity engaged in most often by those who frequently use alcohol and other drugs to cope with problems. The findings are also consistent with lesso r s (1987) problem-behaviour theory. The significant correlation between having taken medicine for nerves in adolescence and having a first drunken driving offence at the age of indicates a weak association with psychiatric illness, but other variables, i. e. psychiatric diagnoses and low emotional control, are not significant risk factors. The association of father s low social class and apprehension for public drunkenness and drunken driving disappears after the first period, possibly due to change of social class for some. That the increased risk associated with apprehension for public drunkenness disappears after the first period may be due to a change in drinking patterns. The three variables which were significant for three convictions or more, and also significant in at least one other time period, all showed the highest relative risk in the subjects with three convictions or more. This can be seen as partial support for the second hypothesis, stating that the importance of alcohol risk use and psychosocial factors increases with the number of convictions for drunken driving. On the other hand, several variables are only significant for the group with one conviction and no indicators of hazardous alcohol consumption were found in the group with the highest number of convictions. Contact with the police or juvenile authorities and smoking were risk factors for all three severity categories of convictions for drunken driving. Beerman (1988) found that drunken drivers with a higher number of arrests are more likely to have a criminal record. The fact that more variables were significant predictors in the group of subjects with both DWI convictions and hospital admissions with an alcohol diagnosis than for those who had only one of these events may be explained by the first group of subjects having more severe alcohol problems. It does not seem surprising that variables with a clear connection with alcohol problems are important risk factors for the combination of drunken driving and hospital admission with alcohol diagnoses. Noteworthy, though, is that public drunkenness is strongest (RR=4.0) in the group with no hospital admissions. On the other hand contact with the police or juvenile authorities was a significant risk factor for hospital admissions only. The third hypothesis, concerning to hospital admissions, is only partly confirmed. The risk factor pattern for those with both drunken driving and hospital admissions for alcoholism shows a broader spectrum of risk factors, including social class; for those with only drunken driving, the risk factors are fewer but stronger. In contrast to what we found when analysing drunken driving closer to conscription, life-style factors and signs of delinquency are more important when the first offence occurs at a later stage. In rehabilitation of drunken drivers, the most common approach is to try to correct their

6 drinking behaviour. As this and other studies show that delinquent behaviour and life-style are prominent risk factors, health promotion and social support early in life could also be recommended as prevention of future drunken driving! R E FERENCES Beerman, KA., Smith, MM. & Hall, RL. (1988) Predictors of recidivism in DUIs. Journal o f studies on alcohol, 49, Donovan, DM, Queisser, HR., Salzberg, PM. & Um lauf, RL. (1985) Intoxicated and bad drivers: Subgroups within the same population of high-risk men drivers. Journal o f Studies on Alcohol, 46, Fillmore, KM. (1987) Prevalence, incidence and chronicity of drinking patterns and problems among men as a function of age: a longitudinal and cohort analysis. British Journal o f Addiction, 82, Hosner, DW. & Lemeshow, S. (1989). Applied logistic regresssion. ( New York, Wiley & Sons). Jessor, R. (1987) Problem-behavior theory, psychosocial development, and adolescent problem drinking, British Journal o f Addiction, 82, Johnson, V. & White, HR. (1989). An investigation of factors related to intoxicated driving behaviors among youth. Journal o f Studies on Alcohol, 50, Karlsson, G. & Romelsjo, A. (1997) A longitudinal study o f social, psychological and behavioural factors associated with drunken driving and public drunkenness.addi'criort (In Press). Pape, H. & Hammer, T. (1996). How does young people s alcohol consumption change during the transition to early adulthood? A longitudinal study of changes at aggregate and individual level. Addiction, 91, Selzer, ML. & Barton, E. (1977) The drunken driver: A psychosocial study. Drug and. Alcohol Dependence, 2,