Anca Ialomiteanu

Anxiety and Mood Disorders and Cannabis Use

Background: Cannabis use has been linked to anxiety and mood disorders (AMD) in clinical cases, but little research on this relationship has been reported at the epidemiological level. Objectives: We examined the relationship between self-reported frequency of cannabis use and risk for AMD in the general Ontario adult population. Methods: Data were based on the CAMH Monitor survey of Ontario adults from 2001 to 2006 (n = 14,531). AMD was assessed with the 12-item version of the General Health Questionnaire (GHQ12). Frequency of cannabis use within the past year was grouped into five categories: No use (abstainer), less than once a month but at least once a year, less than once a week but at least once a month, less than daily but at least once a week, almost every day to more than once a day. Logistic regression analysis of AMD and cannabis use was implemented while controlling for demographics and alcohol problems. Results: AMD was most common among heavy cannabis users (used almost every day or more) (18.1%) and lowest for abstainers (8.7%). Compared to abstainers, the risk of AMD was significantly greater for infrequent cannabis users (OR = 1.43) and heavy cannabis users (OR = 2.04) but not for those in between. Conclusion: These data provide epidemiological evidence for a link between both light and heavy cannabis use and AMD. Scientific Significance: Recognizing the comorbidity of heavy cannabis use and AMD should facilitate improved treatment efforts. Our results also suggest the possibility that, for some individuals, AMD may occur at relatively low levels of cannabis use.

Prevalence of problem gambling in adolescents: findings from the 1999 Ontario Student Drug Use Survey.

Objectives: To describe the prevalence of gambling disorders in adolescent students in Ontario. Method Data were based on a random survey of 2371 Ontario students in grades 7 to 13 using the South Oaks Gambling Screen revised for adolescents (SOGS-RA). Results In total, 5.8% of students met the criteria for past-year problem gambling, and an additional 7.5% met the criteria for at-risk gambling. Gambling disorders were significantly higher among male students than female, but did not differ significantly by age or region. Conclusion The prevalence of gambling disorders among adolescents warrants thorough investigation and ongoing monitoring.

Alcohol and driving factors in collision risk.

In this study we examine the effect of several alcohol-related measures on self-reported collision involvement within the previous 12 months while controlling for demographic and driving exposure factors based on a large representative sample of adults in Ontario. Data are based on the 2002-2006 Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey of Ontario adults aged 18 and older (n=8542). Three logistic regressions of self-reported collision involvement in the past 12 months were implemented, each consisting of 3 steps: (1) demographic factors and driving exposure entered, (2) driving after drinking within the last 12 months entered, and (3) one of three alcohol-related measures (AUDIT subscales of alcohol consumption, dependence and problems) entered. In each step, measures from the preceding step were included in order to control for those variables. In Step 1, age (OR=0.989), region overall, Central East region (OR=0.71), West region (OR=0.67), and North region (OR=0.67), income overall and those who did not state income (OR=0.64), marital status overall and those married or living common law (OR=0.60), and number of kilometers driven in a typical week (OR=1.00) were found to be significant predictors of collision involvement. The analyses revealed that driving after drinking was a significant predictor of collision involvement in Step 2 (OR=1.51) and each of the Step 3 models (ORs=1.52, 1.37, 1.34). The AUDIT Consumption subscale was not a significant factor in collision risk. Both the AUDIT Dependence and AUDIT Problems subscales were significantly related to collision risk (ORs=1.13 and 1.10, respectively). These findings suggest that alcohol, in addition to its effects on collision risk through its acute impairment of driving skills, may also affect collision risk through processes involved when individuals develop alcohol problems or alcohol dependence.

Self-Reported Collision Risk Associated With Cannabis Use and Driving After Cannabis Use Among Ontario Adults

Objective: This study examined the effects of cannabis use and driving after cannabis use on self-reported collision involvement within the previous 12 months while controlling for demographics, driving exposure, binge drinking, and driving after drinking based on a large representative sample of adults in Ontario. Methods: Data are based on the CAMH Monitor, an ongoing cross-sectional telephone survey of Ontario adults aged 18 and older, conducted by the Centre for Addiction and Mental Health. Data on drivers who reported driving at least one kilometer per week and who responded to the collision item from 2002 to 2007 were merged into one data set (n = 8481). Logistic regression analysis of self-reported collision risk posed by cannabis use (lifetime and past 12 months), driving after cannabis use (past 12 months), and driving after drinking among drinkers (past 12 months) was implemented, controlling for the effects of gender, age, region, income, education, marital status, kilometers driven in a typical week, and consuming five or more drinks of alcohol on one occasion (past 12 months). Due to list-wise deletion of cases the logistic regression sample was reduced (n = 6907). Results: Several demographic factors were found to be significantly associated with self-reported collision involvement. The logistic regression model revealed that age, region, income, marital status, and number of kilometers driven in a typical week, were all significantly related to collision involvement, after adjusting for other factors. Respondents who reported having driven after cannabis use within the past 12 months had increased risk of collision involvement (odds ratio [OR] = 1.84) compared to those who never drove after using cannabis, a greater risk than that associated with having reported driving after drinking within the past 12 months (OR = 1.34). Conclusion: Further investigation of the impact of driving after cannabis use on collision risk and factors that may modify that relationship is warranted.

Prevalence and key covariates of non-medical prescription opioid use among the general secondary student and adult populations in Ontario, Canada.

INTRODUCTION AND AIMS To assess the prevalence and key covariates of non-medical prescription opioid use (NMPOU) in two representative surveys of adults (Centre for Addiction and Mental Health Monitor, CM) and secondary-school students (Ontario Student Drug Use and Health Survey, OSDUHS). DESIGN AND METHODS Data from the 2010 and 2011 cycles (n = 4023) of CM--a stratified, multi-stage, random-digit-dialling telephone survey of adults (18 years and older)--and the 2011 cycle of OSDUHS (n = 3266)--a self-administered written questionnaire-based survey of grade 7-12 public system students--were used. Besides NMPOU prevalence, associations were assessed by univariate and multi-step multivariate (logistic regression) analyses. NMPOU and key socioeconomic (i.e. sex, age, Aboriginal ethnicity, household location, income, subjective social status), health indicators (physical health status, psychological distress, suicidal ideation), drug use (cigarette smoking, binge drinking, cannabis use, other drug use) were measured. RESULTS NMPOU (past year) prevalence was 15.5% in students and 5.9% in adults. Various univariate associations with social, health and drug use factors were found in both populations, with differences by sex. Based on multivariate analyses, other drug use (male students) and rural residence, subjective social status, other drug use and suicidal ideation (female students); marital status and cannabis use (male adults) and binge drinking (female adults) were independently associated with NMPOU in the respective study populations. DISCUSSION AND CONCLUSIONS NMPOU was high in adults and especially students. Independent predictors of NMPOU were largely inconsistent by sex. Notably, NMPOU is widely distributed across socio-demographic and -economic strata, and thus requires broad-based interventions.

Does gender moderate the relationship between driver aggression and its risk factors

AIM The current study assessed gender as a potential moderator of the relationship between self-reported driver aggression and various demographic variables, general and driving-related risk factors. METHODS Using data from a general-population telephone survey conducted from July 2002 through June 2005, two approaches to binary logistic regression were adopted. Based on the full dataset (n=6259), the initial analysis was a hierarchical-entry regression examining self-reported driver aggression in the last 12 months. All demographic variables (i.e., gender, age, income, education, marital status), general risk factors (i.e., psychological distress, binge drinking, cannabis use), and driving-related risk factors (i.e., driving exposure, stressful driving, exposure to busy roads, driving after drinking, driving after cannabis use) were entered in the first block, and all two-way interactions with gender were entered stepwise in the second block. The subsequent analysis involved dividing the sample by gender and conducting logistic regressions with main effects only for males (n=2921) and females (n=3338) separately. RESULTS Although the prevalence of driver aggression in the current sample was slightly higher among males (38.5%) than females (32.9%), the difference was small, and gender did not enter as a significant predictor of driver aggression in the overall logistic regression. In that analysis, difficulty with social functioning and being older were associated with a reduced risk of driver aggression. Marital status and education were unrelated to aggression, and all other variables were associated with an increased risk of aggression. Gender was found to moderate the relationships between driver aggression and only three variables: income, psychological distress, and driving exposure. Separate analyses on the male and female sub-samples also found differences in the predictive value of income and driving exposure; however, the difference for psychological distress could not be detected using this separate regression approach. The secondary analysis also identified slight differences in the predictive value of four of the risk factors, where the odds ratios for both males and females were in the same direction but only one of the two was statistically significant. CONCLUSIONS The results demonstrate the importance of conducting the gender analysis using both regression approaches. With few exceptions, factors that were predictive of driver aggression were generally the same for both male and female drivers.

Assessing the prevalence of nonmedical prescription opioid use in the general Canadian population: methodological issues and questions.

Objective: To assess the prevalence of nonmedical prescription opioid use (NMPOU) in the Canadian general adult population in the context of rising overall prescription opioid (PO) consumption and related problems in North America. Method: The prevalence of NMPOU was assessed as a multiitem construct in the Canadian Alcohol and Drug Use Monitoring Survey (CADUMS; n = 16 672), an ongoing cross-sectional monthly random digit dialing telephone survey representative of the general Canadian population, aged 15 years and older. CADUMS data were collected between April and December of 2008 with a response rate of 43.5%. Results: About 22% of CADUMS respondents reported PO use in the last year, while 0.5% reported NMPOU during the same time frame. PO use was significantly higher among women than among men, and highest in the group aged 25 to 54 years. NMPOU was similar among men and women, and highest in the group aged 15 to 24 years. Conclusions: CADUMS data indicate an extremely low rate of NMPOU, especially given the levels of overall PO use, other PO-use related problems, and NMPOU levels estimated in the general US population where NMPOU has been assessed to be 10 times higher than in Canada. NMPOU survey item construction and response rates appear to strongly influence and potentially compromise NMPOU survey data. Existing NMPOU data and survey methods need to be validated for this important indicator in Canada, where increasing PO use and problem levels have been recognized as a significant and rising public health problem.

Alcohol marketing and retailing: Public opinion and recent policy developments in Canada

Recent developments in alcohol policy in Canada, particularly those pertaining to alcohol marketing and retailing, provide the context for this study of public opinion on alcohol policy topics. Three national surveys were conducted in 1989, 1994 and 2004. Respondents to the telephone interviews were sampled by province to be representative of the population aged 15 and older; numbers ranged from 4658 (2004) to 12,155 (1994). The key variables were gender, age group, province, education, drinking pattern and frequency of heavy drinking. Ten questions about alcohol policy were included in the analysis, but not all questions were asked in all 3 years. The logistic regression models contained a year effect, independent variable effect, and a year‐by‐independent variable effect. There was considerable variation in support across policy topics, the rank order being similar from year to year. There was somewhat less support for those items, e.g. higher taxes or fewer outlets, considered to be effective by evaluation studies. A major finding was a decline in support over time. Women, older respondents, and lighter drinkers and abstainers were more likely to be supportive of alcohol control policies. The analyses also revealed interaction between provinces and rate of change in declining support. The authors hypothesize that intensive marketing and retailing of alcohol may be important factors in declining public support. Declining support for alcohol policy is expected to have implications for controlling damage and costs related to increasing alcohol consumption.

Associations between a History of Traumatic Brain Injuries and Current Cigarette Smoking, Substance Use, and Elevated Psychological Distress in a Population Sample of Canadian Adults.

This study describes the prevalence of reported history of traumatic brain injury (TBI) and its association with reports of current substance use, cigarette smoking, and psychological distress among Canadian adults in a population sample. A cross-sectional sample of 1999 Ontario adults 18-93 years of age were surveyed by telephone in 2011 as part of the Center for Addiction and Mental Healths ongoing representative survey of adult mental health and substance use in Ontario, Canada. Loss of consciousness for at least 5 min or at least one overnight hospitalization resulting from symptoms associated with the TBI injury represented minimum criteria for TBI. An estimated 16.8% (95% confidence interval, 14.8, 19.0) of adults reported a TBI in their lifetime. Men had higher prevalence of TBI than women. Adults who reported a history of TBI had higher odds of reported past-year daily smoking (adjusted odds ratio [AOR] = 2.15), using cannabis (AOR = 2.80) and nonmedical opioids (AOR = 2.90), as well as screened significantly for recent elevated psychological distress (AOR = 1.97) in the past few weeks, compared to adults without a history of TBI. Co-occurrence of a history of TBI with current elevated psychological distress and substance use warrants vigilance among medical practitioners to assess the possibility of a history of TBI during reviews of the history leading to the occurrence of these conditions.

Checkered Expectations: Predictors of Approval of Opening a Casino in the Niagara Community

This paper reports on the findings of a survey prior to the opening of a casino in Niagara Falls, Ontario (N= 1002 adults) on approval of the casino, expectations regarding the impact of the casino, attitudes toward gambling, gambling behaviour, and demographic information. The respondents generally had a positive attitude towards gambling. The expectations of community impact clustered into 3 factors: negative social consequences (crimes, addiction), negative environmental consequences (litter, noise, traffic), and positive economic consequences (jobs, stores, income). The majority of respondents expected economic benefits from the casino as well as a decrease in the environmental quality of the city. Expectations regarding social problems were mixed with a majority expecting an increase in serious crimes, but only a minority expecting an increase in people on welfare. Covariance structure modelling revealed that a positive attitude towards gambling and expecting economic benefits were positively related to approval of the casino, and expecting social problems was negatively related to approval. Given that more than seven in ten respondents supported the opening of the casino, the expected economic benefits coupled with a generally positive attitude towards gambling, apparently outweighed concerns about problems associated with gambling.