Symptom dimensions in youth on the pathway to drop-out

School dropout is a complex process that co-occurs with other problem behaviours (Bradshaw, 2008). Factors at multiple levels of the ecology (individual, family, school, neighbourhood) can influence a youth’s progression toward school success or failure (Bronfenbrenner & Morris, 1998). General deviance theory suggests that students who are involved in drug & alcohol abuse, or other deviant behaviour are more likely to drop out (Battin-Pearson, 2000). Similarly, deviant affiliation theory posits that peers’ beliefs about school and academic achievement influence their friends’ behaviour and attitudes (Gilmore, 1992). Furthermore, peer influences differ for boys and girls (Kahn, 2009). Social learning theory explains how reward and punishment as well as modelling and imitation play an important role in how individuals learn gender (‘how to be a boy or a girl’) (Bussey & Bandura, 1999). Boys drop out of school more often than girls and boys are more likely to engage in deviant behaviours (eg. use of violence). Such behaviours provide means to earn respect, prove masculinity, and meet peer expectations which make them ‘too cool for school’: peer status has a negative effect on school dropout, but peer status among violent friends increases dropout for lower SES boys (Staff & Kreager, 2008). The transactional model of development (Patterson, 1989) suggests that children with early behaviour problems are at risk for developing academic problems and experiencing rejection from their prosocial peers. Their lack of prosocial connections can lead them to form connections with deviant peers and in turn engage in other delinquent acts. The family and home environment have also been the focus of theoretical approaches to understanding dropout. Gender theories state that masculinity beliefs also play a role in boys’ early psychological detachment from their parents - before they are ready to do so - because they stress independence and autonomy for men, also called the ‘boy code’ (Kahn, 2009). Family socialization theory posits that students’ academic achievement in the classroom is affected by their home environment (Battin-Pearson, 2000). Stressful events such as parental divorce, family conflict, and loss of a loved one can influence how a student behaves in and outside the classroom (Sewell, 2008). In addition, parents’ education level and the importance parents place on academic success can affect a student’s sense of purpose and agency in the school environment. Finally, cumulative risk theory posits an inverse association between the number of risk factors and positive adjustment and acknowledges the significance of risk factors across ecological levels (Bronfenbrenner & Morris, 1998; Rutter, 1989).Taken together, the theoretical work on early school leaving and school dropout indicates that these issues are complex, that gender plays a role, that there are multiple pathways to dropout, and that a variety of factors at different ecological levels influence these processes (Bradshaw, 2008; Ensminger & Slusarcick, 1992; Jimerson, 2000). Good education is a strong predictor of good health. It is even suggested that investments to improve educa¬tional achievement can save more lives than can medical advances (Woolf, 2007). Much of the research on reducing school dropout rates focuses on the psychological traits of students and the orga¬nizational characteristics of teachers, schools, and school systems. Only few researchers have examined the impact of health and gender differences therein. Therefore, it is strongly recommended to reframe the school dropout rate as a public health issue and to improve school completion rates (Freudenberg & Ruglis, 2007). To improve school completion rates, public health researchers need to develop new conceptual and ana¬lytic approaches to study the reciprocal relationships between health and education and consider education as an arena for intervention as well as a marker or moderator for social position (Thrane, 2006; Freudenberg & Ruglis, 2007). One of the aims of our study is to gain insight in symptom dimensions from earlier life that are involved in the developmental pathways towards later school dropout and optimise the effectiveness of interventions aimed at preventing school dropout. In the current proposal, we set out to examine early life health-related precursors and determinants of future school dropout. This will provide insight into a. early signals of school dropout – that can be used by Youth Health Care physicians, and b. the extent to which direct selection contributes to socioeconomic health inequalities. In general, our proposal aims at finding out about early medical, socioeconomic and personality-related influences, including gendered experiences and gender differences, and thus will provide further insight into how to develop more effective interventions aimed at reducing school dropout and socioeconomic inequalities in health.