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.

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.

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.

Traumatic brain injury and hazardous/harmful drinking: Concurrent and single associations with poor mental health and roadway aggression.

This study describes the association among lifetime traumatic brain injury (TBI) and past year hazardous/harmful drinking, as well as their unique and synergistic effects, on mental health problems and roadway aggression among Canadian adults. A cross-sectional sample of 6074 Ontario adults aged 18 years or older were surveyed between 2011 and 2013. TBI was defined as trauma to the head resulting in loss of consciousness or overnight hospitalization. Past year hazardous/harmful drinking was assessed using the Alcohol Use Disorders Identification Test. An estimated 13.1% (95%CI:12.0,14.2) adults reported a prior TBI (no hazardous/harmful drinking), 2.7% (95%CI:2.2,3.3) reported a prior TBI while concurrently screening positive for past year hazardous/harmful drinking and 9.8% (95%CI:8.9,10.9) screened positive for hazardous/harmful drinking (no TBI). Men had significantly higher odds of exhibiting all three conditions compared to women, especially for the concurrent class. Younger adults had significantly greater odds of hazardous/harmful drinking, or the concurrent class compared to adults 55 years and older. Adults in any of the three conditions had greater odds for mental health problems and roadway aggression. Concordance of both conditions corresponded to a greater than additive effect and greater odds of mild roadway aggression, than either condition alone. Results show that singly and jointly, these conditions are associated with adverse health and behavioral impediments.

Validation of a food frequency questionnaire for assessing dietary soy isoflavone intake among midlife Chinese women in Hong Kong.

Substantial evidence suggests that soy isoflavones may protect against certain chronic diseases. This study aims to assess the reproducibility and validity of a 47-item semiquantitative soy FFQ (SFFQ) designed to measure the usual intake of soy isoflavones among 145 Chinese mid-life women in Hong Kong. Reproducibility of the SFFQ was assessed by the stability of dietary intake obtained at baseline (SFFQ0) and at 13-mo follow-up (SFFQ1). Relative validity was measured by comparing data collected from SFFQ1 with those derived from 23-d, 24-h dietary recalls (DR) collected during the same 1-y validation period. Isoflavone intake was calculated using analytical values from the Chinese University of Hong Kong Soy Isoflavone Database. A total of 3,217 DR were successfully obtained. The median (interquartile range) absolute intake estimated by the SFFQ1 was 0.91 (-2.7 to 6.8) mg aglucon equivalents/d higher than the 6.3 (3.7-10.7) mg aglucon equivalents/d measured by the DR (P < 0.0057; Wilcoxon's Signed Rank test). Bland-Altman analysis further demonstrated the presence of significant proportional bias between methods among Cantonese women with above-median intake (Spearman correlation coefficient; r = 0.44; P = 0.0005). Nonetheless, the intraclass and Pearson correlation coefficients, respectively, were 0.84 and 0.72 for non-Cantonese and 0.65 and 0.50 for Cantonese, showing moderate to good levels of reproducibility and validity of the SFFQ (difference between 2 intraclass correlation coefficients, P = 0.09; difference between 2 Pearson r, P = 0.16). The unadjusted and BMI-adjusted correlations were of similar magnitude. The SFFQ is a reasonably valid instrument for assessing dietary soy isoflavone exposure in Hong Kong Chinese mid-life women.

Associations between self-reported lifetime history of traumatic brain injuries and current disability assessment in a population sample of Canadian adults.

OBJECTIVE: This study describes the association between history of lifetime traumatic brain injury (TBI) and current disabling functional restrictions among Ontario adults. SETTING AND DESIGN: A two-stage rolling cross-sectional sample of 6,048 adults aged 18 to 93 were interviewed by computer assisted telephone interviewing between 2011-2013 regarding their mental health and substance use in Ontario, Canada. TBI criteria were defined by loss of consciousness for minimum five minutes or at least one overnight hospitalization. Dimensions of functionality restrictions in the last 30 days were measured with the WHO Disability Assessment Schedule (WHODAS). RESULTS: The estimated mean for global disability in this sample of Ontario adults was 2.75 (SD = 5.4, range 0-40). The estimated means of global disability for individuals who reported a history of lifetime TBI was 4.16 (SD = 7.12) and compared with 2.46 (SD = 4.98) for individuals who never had a TBI (p < 0.001). Adults with a history of lifetime TBI had greater odds of global and item disability including restricted cognition, decreased self-care, difficulties with social relationships, fewer life activities and reduced participation in society compared to adults without a history of TBI (p < 0.001), even after adjusting for values of age, sex, marital status, household income and education. CONCLUSION: The co-occurrence of history of lifetime TBI with self-reported disability within the past 30 days provide evidence that careful consideration, planning and understanding of short and long term health needs of TBI survivors are critical.

The decline in physical activity among adolescent students: a cross-national comparison.

BACKGROUND: The decline in physical activity during adolescence is a key public health concern. This comparative study assesses whether the age-related decline in physical activity among high school students occurs similarly in the United States (U.S.) and Ontario, whether the decline in physical activity is steady throughout the age range, or whether any declines are age-specific. METHODS: Data are based on self-reports of 9th- to 12th-graders derived from the 2001 Youth Risk Behavior Survey (n=13,503) and the 2001 Ontario Student Drug Use Survey (n=1322). Physical activity is measured by the number of days of vigorous physical activity during the past 7 days. RESULTS: In both samples, there was a dominant and steady decline in physical activity between ages 14 and 18 years. The number of activity days was higher in the U.S. than in Ontario holding constant age and sex. However, a significant sample-by-age interaction showed that the decline in the percentage of U.S. students reporting 3 or more physical activity days was greater than it was in Ontario. CONCLUSIONS: While the pattern of decline was shown to be similar, the decline was stronger among US adolescents. Future research should examine additional factors influencing the decline in activity and the optimal timing of programs to reduce the decline.

Road rage and collision involvement.

OBJECTIVES: To assess the contribution of road rage victimization and perpetration to collision involvement. METHODS: The relationship between self-reported collision involvement and road rage victimization and perpetration was examined, based on telephone interviews with a representative sample of 4897 Ontario adult drivers interviewed between 2002 and 2004. RESULTS: Perpetrators and victims of both any road rage and serious road rage had a significantly higher risk of collision involvement than did those without road rage experience. CONCLUSIONS: This study provides epidemiological evidence that both victims and perpetrators of road rage experience increased collision risk. More detailed studies of the contribution of road rage to traffic crashes are needed.

Associations between a history of traumatic brain injuries and conduct disorder during youth in a population sample of Canadian adults.

This study describes the association between history of traumatic brain injury (TBI) and childhood symptoms of conduct disorder (CD). Data were based on telephone interviews with 6048 respondents derived from the 2011-2013 cycles of a representative cross-sectional survey of adults aged 18+ years in Ontario, Canada. TBI was defined as loss of consciousness for at least 5min or overnight hospitalization due to injury symptoms. Symptoms of CD before 15 years of age were assessed using five items based on the DSM-IV. Adults who reported a history of TBI reported odds 3 times higher for possible CD before 15 years of age. Odds remained significant even when age, sex, marital status, income, and education were statistically controlled. The nature of this data precludes determining if TBI occurred before or following CD symptoms. Nonetheless, the co-occurrence of a history of TBI with symptoms of CD supports the recommendation that practitioners be vigilant in assessing the history of both CD and TBI when diagnosing and treating one of these conditions. These findings do not exclude the possibility that TBI during childhood or youth may be interfering with brain development and could co-occur with conduct behaviors in both the short and long term.

The validity of the certification of manner of death by Ontario coroners.

PURPOSE: The aim of the study is to examine the validity of manner of death (MOD) certification of unnatural adult deaths by Ontario coroners. METHODS: A census of 306 active coroners practicing in Ontario was performed, with data collection occurring in 2002. Mailed self-administered questionnaires contained 14 fictitious clinicopathologic scenarios and questions regarding demographic information of the coroner. Crude and adjusted odds ratios of correct MOD certification were calculated by using responses of two deputy chief coroners as the gold standard. RESULTS: Nearly 74% of coroners responded to the survey. Deaths from hanging, drowning, and carbon monoxide had better odds of being certified correctly; whereas deaths from heroin, over-the-counter medication, and injuries from a descent had decreased odds of being certified correctly. Scenarios including a prior suicide attempt or a note had greater odds of correct MOD certification than those with only depression. Accidental deaths were underreported when injury resulted in a "natural" lethal complication and when there was a delay between injury and death. CONCLUSIONS: In detailing which deaths are likely to be misclassified and how they may be misclassified, this study will allow future research to more accurately assess suicidal and accidental deaths.

[Volume and profile of alcohol consumption among students and classmates as predictors of aggression and victimization: a multilevel analysis among Swiss adolescents]. / Volume et profil de consommation d'alcool des élèves et des camarades scolaires comme prédicteurs de l'agression et de la victimisation: une analyse multiniveaux auprès d'adolescents suisses.

OBJECTIVE: To test the effects of the volume of alcohol consumption and drinking patterns on alcohol-related aggression and victimization, both at the individual and class levels. METHODS: Representative sample drawn from the European School Survey Project on Alcohol and Other Drugs (ESPAD) of 6496 Swiss adolescents (13 to 16 years). Hierarchical multi-level models were used to simultaneously estimate individual and environmental influences. In addition to indicators of consumption of alcohol and other substances, age, sex, socioeconomic indicators and satisfaction with the relationship to parents were used as covariates. RESULTS: After controlling for confounding, both volume of alcohol consumption and the frequency of binge drinking occasions were associated independently with alcohol-related problems (aggression/victimization) on the individual level. On the aggregate level, there was colinearity between volume of drinking and frequency of heavy drinking occasions. When entered in the same model, however, only the effect of volume effect stayed in the same direction. CONCLUSIONS: Not only individual volume of drinking, but also the way alcohol is consumed influences individual problem levels. This includes individual patterns of drinking as well as environmental influences at school. These results open up important considerations for theory, research and prevention.

The search for healthy schools: A multilevel latent class analysis of schools and their students.

The objective of this study was to establish and investigate a taxonomy of school health among high school students in Ontario, Canada. Data analyzed were based on 3358 9th-12th graders attending 103 high schools who participated in the 2011 Ontario Student Drug Use and Health Survey. Based on 10 health-related indicators, multilevel latent class analysis was used to extract 4 student-level latent classes and 3 school-level latent classes. Unhealthy schools (19% of schools) had the lowest proportion of healthy students (39%) and the highest proportion of substance-using (31%) and unhealthy (18%) students. Healthy schools (66%) contained the highest proportion of healthy students (56%) and smaller proportions of substance-using (22%) and unhealthy students (8%). Distressed schools (15%) were similar to healthy schools in terms of the proportions of healthy and unhealthy students. Distressed schools, however, were characterized by having the largest proportion of distressed students (35%) and the lowest proportion of substance-using students (4%). Meaningful categories of schools with respect to healthy environments can be identified and these categories could be used for focusing interventions and evaluating school health programs.

Cross-sectional examination of the association of co-occurring alcohol misuse and traumatic brain injury on mental health and conduct problems in adolescents in Ontario, Canada.

OBJECTIVE: This study describes the impact of traumatic brain injury (TBI) and hazardous drinking on mental health and behavioural issues among Ontario adolescents. In particular, we assessed the incremental co-occurrence of hazardous drinking with a history of TBI, in comparison to experiencing just one of these conditions. METHODS: A cross-sectional subsample of 3130 Ontario adolescents attending grades 9-12, and aged 10-21 were surveyed in 2013 as a part of the Centre for Addiction and Mental Health's Ontario Student Drug Use and Health Survey. Recent (past year) and former (lifetime and excluding the last year) TBI were defined as trauma to the head that resulted in loss of consciousness for at least 5 min or overnight hospitalisation. Current hazardous drinking was derived using the Alcohol Use Disorders Identification Test (AUDIT). RESULTS: An estimated 11.8% of Ontario adolescents (95% CI 10.1% to 13.8%) reported a history of former TBI and were not hazardous drinkers; 4.0% (95% CI 2.9% to 5.5%) reported recent TBI and were not hazardous drinkers; 13.7% (95% CI 12.3% to 15.3%) were hazardous drinkers who never had a TBI; 4.1% (95% CI 2.9% to 5.8%) had former TBI with co-occurring hazardous drinking; and 2.2% (95% CI 1.6% to 3.0%) had recent TBI with co-occurring hazardous drinking. Most odds increased significantly and were two to three times higher for reporting compromised mental health, violent and non-violent conduct behaviours, and reported victimisation for classifying as a hazardous drinker at the time of testing with co-occurring either former or recent TBI compared to classifying as not having either of these conditions. Adolescents classified as hazardous drinkers with former TBI had numerous and higher ORs for conduct behaviours than those with recent TBI. CONCLUSIONS: Results emphasise the strong interplay between TBI and hazardous drinking and point to the need for integrating prevention efforts to reduce these conditions and their co-occurrence among adolescents.

Ten-year trends in overweight/obesity among Ontario middle and high school students and their use in establishing baseline measures for government reduction targets.

OBJECTIVES: Public health concern about increasing levels of child/youth overweight and obesity has resulted in initiatives to address this issue. In 2012, the Ontario Ministry of Health and Long-Term Care (MOHLTC) established a target to reduce childhood obesity by 20% within five years. In this paper, we examine trends and establish baseline levels of overweight/obesity to assess the impacts of population-level interventions. METHODS: We analyzed 10 years (2003-2013) of data accumulated from six cycles of the Ontario Student Drug Use and Health Survey using logistic regression to assess trends in the prevalence of overweight/obesity among middle and high school students. The 2013 data are used to begin monitoring progress toward achieving the MOHLTC target. RESULTS: From 2003 through 2013, the prevalence of overweight/obesity among middle school students in the province remained stable overall and among all subgroups except 7th-grade females, who showed a significant linear decline. Among high school students, the prevalence of overweight/obesity showed a significant linear increase and an increase among 11th graders, females, and 10th- and 11th-grade females specifically. The prevalence remained stable but elevated among 9th- and 12th-grade females as well as among males in all grades. In 2013 (baseline for the MOHLTC target), 25.1% of students in grades 7-12 were overweight or obese, implying a presumed 2018 target of 20.1%. CONCLUSION: Ten-year trends in overweight/obesity indicate stability among males and significant linear increases in some female subgroups. Also, baseline data (2013) will facilitate the monitoring of future interventions aimed at achieving the 2018 MOHLTC target.