Roadway Aggression Among Drivers and Passengers With or Without a History of Traumatic Brain Injury.

OBJECTIVE: This study examined the association between roadway aggression and traumatic brain injury (TBI) among drivers and passengers who reside in the province of Ontario, Canada. METHODS: Data were based on a 3-year cumulated cross-sectional sample of 6,048 adults aged 18 years and older who were surveyed by telephone. The outcome in this study was road rage in the form of verbal/gestural or physical aggression toward other road users and/or their vehicle. RESULTS: Driving status, history of TBI, age, gender, education, and the interaction between history of TBI and education significantly predicted roadway aggression. Odds ratios (ORs) for roadway aggression were significantly higher among drivers ( OR= 2.65) compared to passengers, between 2 and 4.5 times higher among individuals aged 18-64 years old compared to those older than 65 years, higher among adults with TBI (OR = 2.05) than without, and men (OR = 1.54) than women. Among respondents with lowest, but not highest, levels of education, roadway aggression was predicted by a history of TBI. CONCLUSION: This is the first population-based study to compare rates of roadway aggression between drivers and passengers with and without TBI. Research to understand these differences will be important for roadway aggression prevention efforts and policy.

Ever Use of Nicotine and Nonnicotine Electronic Cigarettes Among High School Students in Ontario, Canada.

INTRODUCTION: There are limited data on the use of electronic cigarettes (e-cigarettes) among youth, particularly with regard to the use of nicotine versus nonnicotine products. This study investigates ever use of nicotine and nonnicotine e-cigarettes and examines the demographic and behavioral correlates of e-cigarette use in Ontario, Canada. METHODS: Data for 2,892 high school students were derived from the 2013 Ontario Student Drug Use and Health Survey. This province-wide school-based survey is based on a 2-stage cluster design. Bivariate and multivariate analyses were used to investigate the factors associated with ever use of e-cigarettes. Ever use of e-cigarettes was derived from the question, "Have you ever smoked at least one puff from an electronic cigarette?" All analyses included appropriate adjustments for the complex study design. RESULTS: Fifteen percent of high school students reported using e-cigarettes in their lifetime. Most students who ever used e-cigarettes reported using e-cigarettes without nicotine (72%), but 28% had used e-cigarettes with nicotine. Male, White/Caucasian, and rural students, as well as those with a history of using tobacco cigarettes, were at greater odds of e-cigarette use. Seven percent of students who had never smoked a tobacco cigarette in their lifetime reported using an e-cigarette. Five percent of those who had ever used an e-cigarette had never smoked a tobacco cigarette. CONCLUSION: More students reported ever using e-cigarettes without nicotine than with nicotine in Ontario, Canada. This underscores the need for greater knowledge of the contents of both nicotine and nonnicotine e-cigarettes to better guide public health policies.

Substance Use and Related Harms Among Adolescents With and Without Traumatic Brain Injury.

OBJECTIVE: The relationship between self-reported lifetime traumatic brain injury (TBI) and drug and alcohol use and associated harms was examined using an epidemiological sample of Canadian adolescents. SETTINGS AND DESIGN: Data were derived from a 2011 population-based cross-sectional school survey, which included 6383 Ontario 9th-12th graders who self-completed anonymous self-administered questionnaires in classrooms. Traumatic brain injury was defined as loss of consciousness for at least 5 minutes or a minimum 1-night hospital stay due to symptoms. RESULTS: Relative to high schoolers without a history of TBI, those who acknowledged having a TBI in their lifetime had odds 2 times greater for binge drinking (5+ drinks per occasion in the past 4 weeks), 2.5 times greater for daily cigarette smoking, 2.9 times greater for nonmedical use of prescription drugs, and 2.7 times greater for consuming illegal drug in the past 12 months. Adolescents with a history of TBI had greater odds for experiencing hazardous/harmful drinking (adjusted odds ratio [aOR] = 2.3), cannabis problems (aOR = 2.4), and drug problems (aOR = 2.1), compared with adolescents who were never injured. CONCLUSION: There are strong and demographically stable associations between TBI and substance use. These associations may not only increase the odds of injury but impair the quality of postinjury recovery.

Problem Gambling Among Ontario Students: Associations with Substance Abuse, Mental Health Problems, Suicide Attempts, and Delinquent Behaviours.

This paper describes gambling problems among Ontario students in 2009 and examines the relationship between gambling problems and substance use problems, mental health problem indicators, and delinquent behaviors. Data were derived from the Ontario Student Drug Use and Health Survey of Ontario students in grades 7-12. Gambling problems were measured as 2 or more of 6 indicators of problem gambling. In total 2.8% of the students surveyed endorsed two or more of the problem gambling items. The odds of problem gamblers reporting mental distress was 4.2 times higher than the rest of the sample and the odds of problem gamblers reporting a suicide attempt were 17.8 times greater than the rest of the sample. In addition compared to the rest of the students, delinquent behaviors were also more common among problem gamblers, including theft (OR = 14.5), selling marijuana (OR = 19.6), gang fights (OR = 11.3) and carrying a handgun (OR = 11.2). In a multivariate analysis, substance-use problems, mental health problems, and the participation in a variety of delinquent behaviors remained significantly associated with youth problem gambling behavior. Students who report problem gambling behaviors show increased substance abuse, mental health, and delinquency/criminal problems that are similar to those seen among adult problem gamblers. The association between these problems suggests that these problems could be addressed in a unified manner.

Nonmedical use of opioid analgesics among Ontario students.

OBJECTIVE: To explore the prevalence and the demographic predictors of nonmedical use of opioid analgesics in the Canadian adolescent population. DESIGN: Data are based on self-reports derived from the 2007 Ontario Student Drug Use and Health Survey, which is an anonymous, in-school, cross-sectional survey. SETTING: Schools in Ontario. PARTICIPANTS: A total of 2914 students in grades 7 to 12. MAIN OUTCOME MEASURES: Demographic predictors of nonmedical use of opioid analgesics during the past year and the sources of opioid analgesics. RESULTS: Students ranged in age from 12 to 19 years (mean 15.0, SD 1.9) and 52% were male. Of the students surveyed, 20.6% (95% confidence interval [CI] 18.9% to 22.3%) reported using opioid analgesics at least once nonmedically during the past year, with 6.2% using exclusively nonmedically and 14.4% using nonmedically and medically. Female students (16.6%, CI 14.1% to 19.6%) were more likely than male students (12.0%, CI 10.0% to 14.2%) to have used opioid analgesics both nonmedically and medically in the past year, although exclusive nonmedical use was similar between female (6.7%, CI 5.3% to 8.5%) and male (5.8%, CI 4.5% to 7.3%) students. Among students who reported using opioid analgesics nonmedically, 72% reported obtaining them from home and only 6% reported obtaining them from friends. Nonmedical opioid analgesic users had higher past-year prevalences for alcohol use, daily smoking, and other illicit drug use compared with nonusers. CONCLUSION: Nonmedical use of opioids is common among Ontario students. The motivation for using these medications without prescriptions or without medical supervision is not known. Students might have used these medications recreationally or for pain relief. Regardless of motivation, these medications are being used without medical supervision. It is important to note that the home is the main source for opioid analgesics in the absence of a prescription. Parents should be vigilant and educate themselves and their children about these medications, ensuring that prescription opioids are stored properly and avoiding casual sharing of these medications among family members.

History of Family Involvement with Child Protective Services as a Risk Factor for Bullying in Ontario Schools.

BACKGROUND: The relationship between history of family involvement with child protective services (CPS) and bullying was examined. METHOD: Data were obtained from 2,516 pupils aged 12-19 in the 2007 Ontario Student Drug Use and Health Survey. The association between self-reported history of family involvement with CPS and bullying was estimated using negative binomial hurdle regression models. RESULTS: Females who reported family CPS involvement were more likely to have bullied and been bullied compared with females without CPS involvement. Among males, family CPS involvement was only significantly associated with bully victimisation. CONCLUSION: A history of family CPS involvement was a risk factor for bullying victimisation and perpetration.

Adolescent traumatic brain injuries: Onset, mechanism and links with current academic performance and physical injuries.

BACKGROUND: Traumatic brain injuries (TBIs) in adolescence are associated with adverse outcomes, but whether the timing of the onset of TBIs leads to greater deficits has not been determined. We evaluate the relationship between the first and most recent TBI, and current academic performance and medically treated physical injuries. METHODS: Data were derived from the 2015 Ontario Student Drug Use and Health Survey (OSDUHS) administered to adolescents in grades 7 to 12 (ages 12 to 18). TBI was defined as a head injury that resulted in loss of conscious for at least five minutes or at least one overnight hospitalization. RESULTS: One in five students reported having had a history of TBI in their lifetime and were more prevalent in males. Odds ratios were 2 times higher for males to have had their first (or only) and most recent TBI in grades 5 to 8, compared to females. Sports-related TBIs accounted for 41.1% of all TBIs. Hockey related TBIs were more frequent compared to soccer related TBIs. Reports of history of TBI was associated with lower academic performance and more physical injuries. First or only TBI occurring in grades 9-12 (occurring on average between 14 to 19 years of age) had higher significant odds of poorer academic performance than TBIs occurring in earlier grades (younger ages than 14 years old). Students who reported more visits for medical treatment of physical injuries in the past year had higher odds to report a history of TBIs in higher school grades. CONCLUSIONS: Adverse physical and academic outcomes among young TBI survivors are associated with the onset and frequency of history of lifetime TBI. Prevention efforts to minimize TBIs during youth is critical.

Epidemiology of firesetting in adolescents: mental health and substance use correlates.

OBJECTIVE: Despite high rates of firesetting among community adolescents, little is known about its correlates. This study identifies the mental health and substance use correlates of four firesetting levels in an epidemiological sample of adolescents. METHODS: Three thousand, nine hundred and sixty-five (3,965) students in grades 7 to 12 were surveyed. Multinomial analyses were used to compare non-firesetters; desisters (lifetime, but no past-year firesetting); low frequency firesetters (once or twice in the past 12 months); and high frequency firesetters (3 + times) on measures of mental health and substance use. RESULTS: Twenty-seven percent of youth reported firesetting during the past year. Of these, 13.7% reported one or two episodes, and 13.5% reported 3 or more episodes. Firesetting was more prevalent among males and among those in high school. Youth who began firesetting before age 10 were more likely to report frequent firesetting during the past year. Compared to non-firesetters, the firesetting groups had elevated risk profiles. Desisters and low frequency firesetters were more likely to report psychological distress, binge drinking, frequent cannabis use, and sensation seeking. Low frequency firesetters also reported higher rates of delinquent behavior, suicidal intent, and low parental monitoring than non-firesetters. High frequency firesetters reported elevated risk ratios for all of these risk indicators plus other illicit drug use. The cumulative number of risk indicators was positively associated with firesetting severity. CONCLUSIONS: Firesetting is associated with psychopathology and substance use during adolescence. Findings highlight the need for programs to address the mental health and substance use problems that co-occur with firesetting.

Perceived financial status, health, and maladjustment in adolescence.

This study examines the relationship between adolescent perception of family financial status and diverse aspects of health and maladjustment. Data were derived from the 2005 Ontario Student Drug Use Survey of 7th-12th grade students in ontario, Canada. This biennial survey monitors mental and physical health, substance use, and delinquent behavior in adolescent students. Results indicate that the significance of perceived financial status varies across adolescent outcomes. Greater emotional distress and lower self-rated health are associated with a perception of below average financial status. The associations of illicit drug use and hazardous and harmful drinking with perceived financial status vary for younger and older adolescents. Adjustments for parental education highlight differences in the influences of perceived financial status and parental education on health and behavior. Results highlight the utility of perceived family financial status in examinations of adolescent health and behavior, and the importance of examining diverse aspects of health and maladjustment.

Adolescent risk behaviours and psychological distress across immigrant generations.

OBJECTIVE: To examine disparities in hazardous and harmful drinking, illicit drug use, delinquency, and psychological distress among three immigrant generations of youth. METHODS: Data on 4,069 students were derived from the 2005 cycle of the Ontario Student Drug Use Survey, a province-wide school-based survey of 7th to 12th graders. The survey employed a two-stage cluster design (school, class). Analyses include adjustments for the complex survey design, specifically stratification, clusters, and weights. RESULTS: Both drug use and hazardous and harmful drinking increase across immigrant generations. First-generation youth report significantly less use than second-generation youth, who in turn report less use than third and later generations. Generational differences in the levels of hazardous and harmful drinking increase with age. Delinquency is significantly less among first-generation youth relative to youth of other immigrant generations. Symptoms of psychological distress are highest among first-generation youth compared to youth of other immigrant generations. CONCLUSION: The nature of differences between foreign- and native-born adolescents varies across behaviours. As such, it is important to gain knowledge about the adjustment levels of these two groups with regard to specific components of well-being. Such knowledge is necessary for developing policies and programs to promote emotional and behavioural health.

[Use of illicit drugs and critical perspectives of drug users' relatives and acquaintances in Northern Rio de Janeiro City, Brazil]. / Uso de drogas ilícitas e perspectivas críticas de familiares e pessoas próximas, na cidade do Rio de Janeiro, Zona Norte, Brasil.

This article presents the partial results of a multicenter, qualitative study, which involved seven Latin-American countries and Canada. The results presented refer to Northern Rio de Janeiro (city), Brazil. The objective of the study was to describe the perspective of relatives/acquaintances of illicit drug users about protective and risk factors, prevention initiatives, treatment services, and legal aspects regarding illicit drugs. Interviews were performed with 99 individuals, who reported being affected by their relationship with an illicit drug user (relative or acquaintance), approaching their perspectives regarding the key-domains. Most participants were women (73.7%); relatives who used drugs were mostly men (78.2%); the most consumed drug was marijuana (77.8%). The highlighted protective factor was having recreational-sports activities in the community (88.9%), and the risk factor was curiosity for trying something new (94.4%). The main treatment services were Church Groups (51.5%), and participants stated that laws should be more punitive (82.8%). In conclusion, this information is essential to fight against drug use/abuse, showing that there is a need for actions that consider different perspectives at different levels.

[Family and acquaintances of illicit drug users: community perspectives on laws and public policies in Western Rio de Janeiro, Brazil]. / Familiares e pessoas conhecidas de usuários de drogas ilícitas: recorte de opiniões sobre leis e políticas públicas de uma comunidade da Zona Oeste do Rio de Janeiro, Brasil.

This article is part of the study 'Illicit Drug Use in Seven Latin American Countries and Canada: Critical Perspectives of Family and Familiars' (7LACC), which investigated four domains: protective and risk factors; preventive initiatives; treatment facilities; and laws and policies. The article presents a section of the results based on four items of the laws and policies domain--as perceived by the family and acquaintances of illicit drug users living in the community. Participants were recruited in urban primary health care units located in Western Rio de Janeiro (city), Brazil. This multi-method, cross-temporal study performed interviews with 100 adults (18 years of age or older), all cognitively healthy. Results and key conclusions included non-compliance with the fundamental principles of the Unique Health System Legislation / Law 8.080/90 and the erroneous implementation of laws and public policies on illicit drug.

[Illegal aspects of illicit drugs use in Mexico]. / Aspectos legales del uso de drogas ilícitas en México.

The objective of this cross-sectional, descriptive study was to obtain the opinions of a group of people about legal issues regarding addiction. Data collection was performed using a structured questionnaire with four themes. In order to participate, the individual could not use any drugs but should have a close relationship with a drug user. The data was processed using SPSS V. 14. There were 100 participants, 75% of whom were women, and 38% had a drug user as a friend, mainly cocaine and marijuana users. The participants had one opinion in common: laws should be more severe for people who use, sell, or transport drugs. The current laws do not improve consumers' criminal behavior. There is a need for further studies addressing people's opinion about this phenomenon in order to obtain a more realistic view of this drug issue.

[Critical perspective of the family and acquaintances on family and community risk factors in illicit drug use in São Jose, Costa Rica]. / Perspectiva crítica de la familia y de personas cercanas sobre factores de riesgo familiares y comunitarios en el uso de drogas ilícitas en San José, Costa Rica.

This article presents the results of a quantitative study. The purpose was to describe the perspective of family members and acquaintances of illicit drug users about family and community risk factors that can contribute to addiction to illicit drugs. A questionnaire was used for data collection. The population consisted of 100 individuals, 18 years of age or older, who reported being affected by their relationship with an illicit drug user (relative or acquaintance). Most users (82%) were men, with an average age of 27.3 years. Family risk factors included: family rejection (99%), not feeling loved (98%), lack of communication (95%), family conflicts and violence (95%). Social or community factors included: 99% having friends who use drugs, 99% peer pressure, 93% living in an unsafe area, and 99% experienced a stressful event. The critical perspective proposes to use more prevention strategies to avoid risk factors in the family and community.

[Risk factors related to the use of illegal drugs: the critical perspective of drug users' relatives and acquaintances at a public health center in San Pedro Sula, Honduras]. / Factores de riesgo relacionados al uso de drogas ilegales: perspectiva crítica de familiares y personas cercanas en un centro de salud público en San Pedro Sula, Honduras.

This article presents quantitative data from a multicenter, cross-sectional study, which was performed at a public health center in San Pedro Sula, Honduras, using multiple methods. The objective of the study was to describe the critical perspective of people who reported being affected by their relationship with an illicit drug user (relative or acquaintance) in terms of risk factors. Data collection was performed using 100 questionnaires. Most participants were women with low education levels. Drug users were mostly men, with an average age of 23.3 years. The most consumed drug was marijuana (78%), followed by crack/cocaine (72%), glue/inhalants (27%), hallucinogens (ecstasy/LSD) (3%), amphetamines/stimulants (1%), and heroin (1%). The identified risk factors include: previous experience with alcohol/tobacco, having friends who use drugs, lack of information, low self-esteem, age, and other personal, family and social factors. In conclusion, prevention and protection should be reinforced.

[Drug consumption and treatment from a family and friends perspectives: Guatemala]. / El consumo de drogas y su tratamiento desde la perspectiva de familiares y amigos de consumidores: Guatemala.

This quantitative and qualitative research describes the perspective of families and relatives of drug abusers in seven Latin American countries. In Guatemala, most of the people affected by the drug problem is multidrug abusers. Marijuana, followed by cocaine and benzodiazepines are the most used drugs. Of the respondents, 46% think drug use is a personal choice. They also recognize family as the most important protective factor, friends who use drugs and peer pressure are the major risk factors. The study reveals that the population believes that the response of the health services is insufficient, and that the preventive initiatives are not available or not properly addressed. The results show the need of more studies to update the knowledge of the drug problem in Guatemala. Future qualitative and quantitative research is needed to address the theme.

[Drug use and treatment from the perspective of the users' family and friends in Bogota, Colombia]. / El consumo de drogas y su tratamiento desde la perspectiva de familiares y amigos de consumidores en Bogotá, Colombia.

This article presents an analysis of the partial results from a quantitative study that addresses the perspective of drug users' family and friends regarding the treatment of problems resulting from the use of illicit drugs. Participants were 104 health service users in Bogotá. Of the participants, 58% consider that drug use is a disease that needs treatment; 56% stated the general hospital as the main alternative for treatment; 95% reported that the state accounted for this situation. Participants were more acquainted with private institutions, with therapeutic communities and religious groups being reported as the ones with the strongest commitment to the problem. For 73% of participants, the existing services are inappropriate and of difficult use and access. Stigma is the main barrier for a person to seek health care, and only 50% believe there is any use in treatments. There is a need for broader dissemination of the existing resources so as to increase their implementation and use.

[Critical perspective of relatives and acquaintances regarding protective factors and the use of illicit drugs in Guayaquil, Equador]. / Factores de protección relacionado al uso de drogas ilícitas: perspectiva crítica de familiares y personas cercanas a los usuarios de drogas, en la Ciudad de Guayaquil, Ecuador.

The objective of this study was to determine the perspectives of drug users' relatives and acquaintances about protective factors for illicit drug use at a health center in Guayaquil. This is a descriptive, cross-sectional study. Data collection was performed through interviews using a questionnaire. Interviews were performed with 100 people who knew a drug user (relative or friend). The results showed that the following personal and family factors could be protective: 97% having solid moral principles, 96% express their feelings, 98% dedicate time for the family, and 95 % have a supportive relationship with one of the parents. Regarding the community, all participants (100%) agree there is a need for a government that understands this issue, 99% refer there should be honest policemen, and 99% state the need for programs that protect people from drug use and institutions that work with prevention. Family, community and personal decisions have effects on becoming involved, hence the need to reinforce protective factors and thus reduce the number of addicted individuals.

[Laws and policies on illicit drugs in Brazil and the perspective of drug users' family members and acquaintances: a study in the City of Ribeirão Preto, São Paulo, Brazil]. / Políticas e leis sobre drogas ilícitas no Brasil e a perspectiva de familiares e pessoas próximas a usuários de drogas: estudo na Cidade de Ribeirão Preto, São Paulo, Brasil.

Brazilian drugs legislation has evolved from a prohibitionist system to a less repressive one in terms of drug users. The objective of this study was to identify the perception of relatives and acquaintances of drug users living in Ribeirão Preto, São Paulo, Brazil, about the country's laws and policies on drugs. Data collection was performed using a structured questionnaire. The sample consisted of 100 drug users' relatives or acquaintances, selected at a public health service. Respondents' relationships with the drug user were as follows: 31% friend, 23% sibling, 15% child and 7% spouse. Most users (78%) were men, with an average age of 26 years. Results confirm that national laws and policies have a direct effect on individuals' attitude and behaviors. There is a lack of trust in the police and a general perception that, despite recent chances that favor user rehabilitation, the laws on drugs do not respect users' human rights.

[Illicit drug use and the critical perspectives of drug users' relatives and acquaintances in Northern Rio de Janeiro City, Brazil]. / Uso de drogas ilícitas e perspectivas críticas de familiares e pessoas próximas na cidade do Rio de Janeiro-Zona Norte, Brasil.

This article presents the partial results of a multicenter, cross-temporal study, which was performed using multiple methods, and involved seven Latin-American countries and Canada. The results presented refer to the city center of Rio de Janeiro (n=108). The central question of the study was: 'How do illicit drug users' relatives and acquaintances describe protective and risk factors, prevention initiatives, treatment services, laws and policies regarding illicit drugs?' The quantitative data was collected using an instrument containing closed questions. In total, 108 young adults (18 years of age or older) were interviewed, who stated being affected by the drug although they were not users. For 104 interviewees (96%), negligence is the family dynamics that causes the greatest exposure to drugs, and 106 (98%) consider that parent support is what offers the greatest protection. Policies, the police and the criminal system have neither reduced drug use nor do they protect users.