Angela Boak

Prevalence and Correlates of Traumatic Brain Injuries Among Adolescents

Traumatic brain injury (TBI) among adolescents has been identified as an important health priority. However, studies of TBI among adolescents in large representative samples are lacking.This information is important to the planning and evaluation of injury prevention efforts, particularly because even minor TBI may have important adverse consequences. We describe the prevalence of TBI, the mechanisms of injury, and adverse correlates in a large representative sample of adolescents living in Ontario, Canada. Language: en

Suicidality, bullying and other conduct and mental health correlates of traumatic brain injury in adolescents

Objective Our knowledge on the adverse correlates of traumatic brain injuries (TBI), including non-hospitalized cases, among adolescents is limited to case studies. We report lifetime TBI and adverse mental health and conduct behaviours associated with TBI among adolescents from a population-based sample in Ontario. Method and Findings Data were derived from 4,685 surveys administered to adolescents in grades 7 through 12 as part of the 2011 population-based cross-sectional Ontario Student Drug Use and Health Survey (OSDUHS). Lifetime TBI was defined as head injury that resulted in being unconscious for at least 5 minutes or being retained in the hospital for at least one night, and was reported by 19.5% (95%CI:17.3,21.9) of students. When holding constant sex, grade, and complex sample design, students with TBI had significantly greater odds of reporting elevated psychological distress (AOR = 1.52), attempting suicide (AOR = 3.39), seeking counselling through a crisis help-line (AOR = 2.10), and being prescribed medication for anxiety, depression, or both (AOR = 2.45). Moreover, students with TBI had higher odds of being victimized through bullying at school (AOR = 1.70), being cyber-bullied (AOR = 2.05), and being threatened with a weapon at school (AOR = 2.90), compared with students who did not report TBI. Students with TBI also had higher odds of victimizing others and engaging in numerous violent as well as nonviolent conduct behaviours. Conclusions Significant associations between TBI and adverse internalizing and externalizing behaviours were found in this large population-based study of adolescents. Those who reported lifetime TBI were at a high risk for experiencing mental and physical health harms in the past year than peers who never had a head injury. Primary physicians should be vigilant and screen for potential mental heath and behavioural harms in adolescent patients with TBI. Efforts to prevent TBI during adolescence and intervene at an early stage may reduce injuries and comorbid problems in this age group.

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.

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.

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.

Energy Drink Consumption and Associations With Demographic Characteristics, Drug Use and Injury Among Adolescents

ObjectivesTo examine energy drink consumption and its association with demographic characteristics, drug use, and injury among adolescents.MethodsData on 4,342 adolescents were derived from the 2011 Ontario Student Drug Use and Health Survey, a province-wide school-based survey of students in grades 7 through 12. The survey was based on a two-stage cluster design and analyses include appropriate adjustments for the complex sample design.ResultsOverall, 49.6% of adolescents had consumed energy drinks in the previous year. A total of 13.8% of seventh grade students had consumed energy drinks in the previous week compared to 19.1% of adolescents overall. Energy drink consumption in the previous year was highly associated with having used tobacco and cannabis in the previous year, the non-medicinal use of prescription drugs in the previous year, and binge drinking in the previous month. Consumption was also highly associated with sensation-seeking and self-reports of medical treatment for an injury (reported by 16% and 42% of adolescents, respectively). The odds of consuming energy drinks did not vary significantly for males and females, and sex was not a significant moderator of the associations examined.ConclusionThese findings support the need for greater awareness of the extent of energy drink consumption among individual adolescents and the potential that additional health and behavioural risks may be associated with consumption.RésuméObjectifsExaminer la consommation de boissons énergisantes et son association avec le profil démographique, la consommation de drogue et les traumatismes chez les adolescents.MéthodeLes données sur 4 342 adolescents provenaient du Sondage sur la consommation de drogues et la santé des élèves de l’Ontario (2011), une enquête provinciale menée en milieu scolaire auprès des élèves de la 7e à la 12e année. Le sondage était planifié selon un échantillonnage en grappe en deux étapes, et les analyses ont été adaptées à la complexité du plan d’échantillonnage.RésultatsGlobalement, 49,6% des adolescents avaient consommé des boissons énergisantes au cours de l’année précédente. En tout, 13,8% des élèves de 7e année en avaient consommé au cours de la semaine précédente, contre 19,1% des adolescents dans l’ensemble. La consommation de boissons énergisantes au cours de l’année précédente était fortement associée à la consommation de tabac et de cannabis au cours de l’année précédente, à l’utilisation de médicaments sur ordonnance à des fins non médicinales au cours de l’année précédente et aux excès occasionnels d’alcool au cours du mois précédent. La consommation était aussi fortement associée à la recherche de sensations fortes et aux déclarations autonomes de soins médicaux pour traumatisme (déclarées par 16% et 42% des adolescents, respectivement). La probabilité d’avoir consommé des boissons énergisantes ne variait pas sensiblement entre les garçons et les filles, et le sexe n’était pas une variable modératrice significative dans les associations examinées.ConclusionCes constatations confirment le besoin de mieux connaître l’ampleur de la consommation des boissons énergisantes par les adolescents et la possibilité que cette consommation soit associée à des risques supplémentaires pour la santé et le comportement.

Energy Drinks, Alcohol, Sports and Traumatic Brain Injuries among Adolescents

Importance The high prevalence of traumatic brain injuries (TBI) among adolescents has brought much focus to this area in recent years. Sports injuries have been identified as a main mechanism. Although energy drinks, including those mixed with alcohol, are often used by young athletes and other adolescents they have not been examined in relation to TBI. Objective We report on the prevalence of adolescent TBI and its associations with energy drinks, alcohol and energy drink mixed in with alcohol consumption. Design, Settings and Participants Data were derived from the Centre for Addiction and Mental Health’s 2013 Ontario Student Drug Use and Health Survey (OSDUHS). This population-based cross-sectional school survey included 10,272 7th to 12th graders (ages 11–20) who completed anonymous self-administered questionnaires in classrooms. Main Outcome Measures Mild to severe TBI were defined as those resulting in a loss of consciousness for at least five minutes, or being hospitalized for at least one night. Mechanism of TBI, prevalence estimates of TBI, and odds of energy drink consumption, alcohol use, and consumption of energy drinks mixed with alcohol are assessed. Results Among all students, 22.4% (95% CI: 20.7, 24.1) reported a history of TBI. Sports injuries remain the main mechanism of a recent (past year) TBI (45.5%, 95% CI: 41.0, 50.1). Multinomial logistic regression showed that relative to adolescents who never sustained a TBI, the odds of sustaining a recent TBI were greater for those consuming alcohol, energy drinks, and energy drinks mixed in with alcohol than abstainers. Odds ratios were higher for these behaviors among students who sustained a recent TBI than those who sustained a former TBI (lifetime but not past 12 months). Relative to recent TBI due to other causes of injury, adolescents who sustained a recent TBI while playing sports had higher odds of recent energy drinks consumption than abstainers. Conclusions and Relevance TBI remains a disabling and common condition among adolescents and the consumption of alcohol, energy drinks, and alcohol mixed with energy drinks further increase the odds of TBI among adolescents. These associations warrant further investigation.

The Moderating Effects of Sex and Age on the Association between Traumatic Brain Injury and Harmful Psychological Correlates among Adolescents

Background Although it is well established that sex is a risk factor in acquiring a traumatic brain injury (TBI) among adolescents, it has not been established whether it also moderates the influence of other TBI psychological health correlates. Methods and Findings Data were derived from a 2011 population-based cross-sectional school survey, which included 9,288 Ontario 7th–12th graders who completed anonymous self-administered questionnaires in classrooms. Response rate was 62%. Preliminary analyses found no evidence of nonresponse bias in the reporting of TBI. TBI was defined as a hit or blow to the head that resulted in a 5 minutes loss of consciousness or at least one overnight hospitalization due to symptoms associated with it. Reports of lifetime TBI were more common among males than females (23.1%, 95% CI: 20.5, 25.8 vs. 17.1%, 95% CI: 14.7, 19.8). Thirteen correlates were examined and included cigarette smoking, elevated psychological distress, suicide ideation, bully victimization (at school, as well as cyber bullying), bullying others, cannabis use, cannabis dependence and drug use problems, physical injuries, daily smoking, drinking alcohol, binge drinking, use of cannabis, and poor academic performance. Among the outcomes examined, sex moderated the relationship between lifetime TBI and cigarette smoking. In addition, sex and age jointly moderated the relationship between lifetime TBI and daily smoking, alcohol use and physical injuries. Late adolescent males who reported lifetime TBI, relative to females, displayed elevated daily smoking and injuries, whereas their females counterparts displayed elevated past year drinking. Possible bias related to self-report procedures and the preclusion of causal inferences due to the cross-sectional nature of the data are limitations of this study. Conclusions TBI differences in outcomes need to be assessed for potential moderating effects of sex and age. Results have important implications for more tailored injury prevention efforts.

Looking beyond cigarettes: Are Ontario adolescents with asthma less likely to smoke e-cigarettes, marijuana, waterpipes or tobacco cigarettes?

OBJECTIVES The purpose of this paper is to examine whether high school students in Ontario with asthma smoke cigarettes, waterpipes, marijuana or e-cigarettes more or less than those without asthma. METHODS The 2013 Ontario Student Drug Use and Health Survey provides self-report data on tobacco cigarettes, waterpipes, marijuana and e-cigarette smoking and asthma rates from 109 high schools in Ontario, Canada. Individual and social characteristics were also collected. Multiple binary logistic regression models measures the association with the various types of smoking in relation to asthma. RESULTS Adolescents with asthma have higher odds of smoking e-cigarettes or smoking any type including either cigarettes, waterpipes, marijuana or e-cigarettes. Respondents of lower socio-economic status had a higher odds of smoking marijuana or any type. Boys were more likely to smoke waterpipes, e-cigarettes or any type, while students in higher grades had a higher odds of smoking cigarettes, waterpipes, marijuana or any type. CONCLUSIONS Results from this study suggest that adolescents with asthma have a higher odds of smoking e-cigarettes than those without asthma, but no relationship was found for cigarettes, waterpipes or marijuana. Findings present some new challenges as technology changes how adolescents can smoke. Public health campaigns should target adolescents, especially those with asthma, to raise their awareness of the risks of all types of smoking including e-cigarettes.

Possession of weapon and school violence among adolescents and their association with history of traumatic brain injury, substance use and mental health issues

PURPOSE Assessment of the association between illegal possession of weapon and assault on school property among adolescents with and without a history of traumatic brain injury (TBI) while assessing risk factors for these outcomes. METHODS Data were derived from the Centre for Addiction and Mental Healths 2013 Ontario Student Drug Use and Health Survey completed by students in grades 7-12 (ages 11-20). RESULTS In this sample of 5478 adolescents, 6.1% (95% CI: 5.0, 7.4) reported carrying a weapon (e.g., gun or knife) on school property, 10.8% (95% CI: 9.5, 12.3) were engaged in a physical fight and 6.4% (95% CI: 5.4, 7.6) reported having beat up or hurt someone on purpose at school, during last year. Youth who reported carrying a weapon, who were engaged in a physical fight and those who assaulted peers on school property during last year had statistically significantly higher odds of reporting a history of TBIs, being male, in first years of high-school, scored positive for elevated psychological distress, and were current regular alcohol (weapon possession only) and cannabis users. CONCLUSION Previously it was thought that alcohol and drugs were the main contributors to school violence. Here we show that history of TBIs is yet another significant predictor of violence at school among adolescents. The results suggest that school vigilance and combined violence and TBI prevention, treatment and rehabilitation programs in this population are warranted.