Jane Seeley

Attention Deficit Hyperactivity Disorder Symptoms, Comorbidities, Substance Use, and Social Outcomes among Men and Women in a Canadian Sample

Background. Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that can persist in adolescence and adulthood. Aim. To examine prevalence of ADHD symptoms and correlates in a representative sample of adults 18 years and older living in Ontario, Canada. Method. We used the Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey, to examine the relationships between ADHD positive symptoms and comorbidities, substance use, medication use, social outcomes, and sociodemographics. Results. Of 4014 residents sampled in 2011-2012, 3.30% (2.75%–3.85%) screened positively for ADHD symptoms (women = 3.6%; men = 3.0%). For men, distress, antisocial symptoms, cocaine use, antianxiety medication use, antidepressant medication use, and criminal offence arrest were associated with positive ADHD screen. For women, distress, cocaine use, antianxiety medication use, antidepressant medication use, pain medication use, and motor vehicle collision in the past year were associated with positive ADHD screen. Conclusions. ADHD symptoms are associated with adverse medical and social outcomes that are in some cases gender specific.

A Tale of Two Cities: The Effect of Extended Drinking Hours in Licensed Establishments on Impaired Driving and Assault Charges

Objectives: On May 1, 1996, Ontario, Canada, amended the Liquor Licence Act to extend the hours of alcohol sales and service in licensed establishments from 1 to 2 a.m. The purpose of this study was to examine the effect of extended drinking hours on two cities in southwestern Ontario, Canada, one of which (London) would be affected by the alcohol control policy of extended drinking hours and the second city (Windsor) would be affected by two alcohol policies, extended drinking hours, and cross-border legal drinking age differences between Ontario and Michigan. Specifically, this study tested whether there were differences in impaired driving and assault charges in London and Windsor, Ontario, concomitant with the extended drinking hour amendment. Methods: A quasi-experimental design using interrupted time series was used to assess changes. The analyzed data sets were monthly police impaired driving and assault charges data for Ontario, for the 11–12 p.m., 12–1 a.m., 1–2 a.m., 2–3 a.m. and 3–4 a.m. time windows, for 4 years pre- and 3 years post-policy change. Results: Overall, London and Windsor exhibited significant overall reductions in impaired driving charges and no changes for assault charges aggregated over the 11 p.m.–4 a.m. time period after the drinking hours were extended. Within the different time windows, London showed significant decreases for the 1–2 a.m. Sunday–Wednesday and Thursday–Sunday time periods and a significant increase for the Sunday–Wednesday 3–4 a.m. time period, while Windsor demonstrated significant decreases in impaired driving charges for 1–2 a.m. Sunday–Wednesday and Thursday–Saturday time periods and significant increases for Sunday–Wednesday 2–3 and 3–4 a.m. and for Thursday–Saturday 2–3 a.m. For assault charges, no overall pre–post differences were found for the aggregated 11 p.m.–4 a.m. time period for either city. When the data were disaggregated by hour, a significant decrease was found in London for Thursday–Saturday 1–2 a.m. and significant increases for Sunday–Wednesday 2–3 a.m. and Thursday–Saturday 3–4 a.m. time periods, while no significant decreases were found in Windsor during the 1–2 a.m. time periods and one significant increase occurred during the Thursday–Saturday 2–3 a.m. time period. Conclusions: These findings, based on police data, suggest no overall effect on charges aggregated over the 11 p.m. to 4 a.m. time window, although some differences were observed for the different hours after 2 a.m., with a possible effect of the one hour extension of drinking in licensed establishments.

Attention deficit hyperactivity disorder, other mental health problems, substance use, and driving: examination of a population-based, representative canadian sample.

Purpose: The purpose of this study is to examine the relationships among self-reported screening measures of attention deficit hyperactivity disorder (ADHD), other psychiatric problems, and driving-related outcomes in a provincially representative sample of adults 18 years and older living in the province of Ontario, Canada. Methods: The study examined the results of the Centre for Addictions and Mental Health (CAMH) Ontario Monitor, an ongoing repeated cross-sectional telephone survey of Ontario adults over a 2-year period. Measures included ADHD measures (Adult ADHD Self-Report Scale-V1.1 [ASRS-V1.1], previous ADHD diagnosis, ADHD medication use); psychiatric distress measures (General Health Questionnaire [GHQ12], use of pain, anxiety, and depression medication); antisocial behavior measure (The Antisocial Personality Disorder Scale from the Mini-International Neuropsychiatric Interview [APD]); substance use and abuse measures (alcohol, cannabis, and cocaine), Alcohol Use Disorders Identification Test (AUDIT), Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), driving-related outcomes (driving after drinking, driving after cannabis use, street racing, collisions in past year), and sociodemographics (gender, age, vehicle-kilometers traveled). Results: A total of 4,014 Ontario residents were sampled, of which 3,485 reported having a valid drivers license. Overall, 3.22% screened positive for ADHD symptoms on the ASRS-V1.1 screening tool. A greater percentage of those who screened positive were younger, reported previous ADHD diagnosis and medication use, distress, antisocial behavior, anti-anxiety and antidepressant medication use, substance use, and social problems compared to those who screened negative. However, there were no statistically significant differences between those who screened positive or negative for ADHD symptoms on self-reported driving after having 2 or more drinks in the previous hour; within an hour of using cannabis, marijuana, or hash; or in a street race or collision involvement as a driver in the past year. When a sequential regression was conducted to predict self-reported collisions, younger age and higher weekly kilometers driven showed higher odds of collision involvement, and the odds ratio for cannabis use ever approached statistical significance. Discussion: This study is the first population-based study of a representative sample of adults 18 years and older living in Ontario, Canada. These results showed no relationship between the ADHD screen and collision when age, sex, and kilometers driven are controlled for. However, these analyses are based on self-report screeners and not psychiatric diagnoses and a limited sample of ADHD respondents. Thus, these results should be interpreted with caution.

Are Trade Agreements and Economic Co-Operatives Compatible with Alcohol Control Policies and Injury Prevention?

In the past 20 years, dramatic changes have occurred in the movement toward global economies and free/liberalized markets. Various trade agreements have been increasing international trade, challenging “unfair” trade practices and pushing to “harmonize” and coordinate regulations, taxation, policies and other public and private enterprises. Could these trade agreements affect alcohol and injury control policies? Furthermore, could trade agreements ultimately affect injury trends? Unfortunately research studies and data on this topic are scarce. This paper presents information on the principles underlying international trade agreements and indicates how these principles could potentially affect the sales, regulations and taxation of alcohol and impact on injuries. The call is for researchers to conduct the research needed to address these questions and potential impacts.

The impact of childhood symptoms of conduct disorder on driver aggression in adulthood

BACKGROUND Despite limited empirical investigation, existing scientific literature suggests that individuals with a history or current diagnosis of conduct disorder (CD) may be more likely to demonstrate reckless and aggressive driving. Much of the limited research in this field examines the impact of childhood CD on driver behaviour and collision risk in young adults. Few if any, studies assess the impact of this disorder on driver behaviour beyond age 21 years. The current research is a population-based study of the impact of CD symptoms during childhood on the risk of engaging in driver aggression during adulthood. METHODS Data are based on telephone interviews with 5230 respondents who reported having driven in the past year. Data are derived from the 2011-2013 cycles of the CAMH Monitor, an ongoing cross-sectional survey of adults in Ontario, Canada aged 18 years and older. A binary logistic regression analysis of self-reported driver aggression in the previous 12 months was conducted, consisting of measures of demographic characteristics, driving exposure, problem substance use, alcohol- and drug-impaired driving, symptoms of attention deficit hyperactivity disorder, and childhood (before age 15) symptoms of CD. RESULTS When entered with demographic characteristics, driving exposure, and other potential confounders, childhood symptoms of CD increased the odds of reporting driver aggression more than two-fold (adjusted OR=2.12). Exploratory analyses of the interaction between childhood symptoms of CD and age was not a significant predictor of driver aggression. CONCLUSIONS Results suggest that symptoms of CD during childhood are associated with significantly increased odds of self-reported driver aggression during adulthood. Limitations and future directions of the research are discussed.

Distinctive Trajectory Groups of Mental Health Functioning among Assertive Community Treatment Clients: An Application of Growth Mixture Modelling Analysis

Objective: Assertive community treatment (ACT) studies that have used conventional, statistical growth modelling methods have not examined different trajectories of outcomes or covariates that could influence different trajectories, even though heterogeneity in outcomes has been established in other research on severe mental illness. The purpose of our study was to examine the general trend in mental health functioning of ACT clients over a 2-year follow-up time period, to discover groups of ACT clients with distinctive longitudinal trajectories of mental health functioning, and to examine if some of the key sociodemographic and illness-related factors influence group membership. Method: A 2-year, prospective, within-subjects study of 216 ACT clients within southern Ontario, collected functional outcome data at baseline and 12 and 24 months using the Colorado Client Assessment Record. Baseline covariates included sex, primary diagnosis, number of comorbidities, hospitalization history, and duration of illness. Growth mixture modelling (GMM) was used to examine trajectories. Results: Clinical staff assessments of ACT clients showed a statistically significant improvement in functioning and 84% achieved successful community tenure. GMM analysis identified 2 classes of ACT clients: class 1 (79.63% of clients) experienced lower and stable overall functioning, and class 2 (20.37%) showed a better baseline functioning score and improvement in the overall functioning over time. Class membership was predicted by the number of comorbidities and diagnosis. Conclusions: Our study suggests general stability in overall functioning for the sampled ACT clients over 2 years, but significant heterogeneity in trajectories of functioning.

Relationships between thrill seeking, speeding attitudes, and driving violations among a sample of motorsports spectators and drivers.

BACKGROUND Motor racing includes high speed driving and risky maneuvers and can result in negative outcomes for both spectators and drivers. Interest in motorsports is also associated with risky driving attitudes and behaviors on public roads as well as with individual difference variables, such as sensation seeking. However, whether the links between motorsports involvement and risky driving tendencies differ for spectators and drivers has remained mainly unexamined. The aim of this study was to investigate the relationships between thrill seeking, attitudes toward speeding, and self-reported driving violations among a sample of motorsports spectators and drivers. METHOD A web-based survey was conducted and sampled 408 members and visitors of car club and racing websites in Ontario, Canada. The questionnaire included measures of (i) motorsports involvement, (ii) thrill seeking (Driver Thrill Seeking Scale), (iii) attitudes (Attitudes toward Speed Limits on Roadways and Competitive Attitudes toward Driving Scale); (iv) self-reported driving violations (adapted from Driver Behaviour Questionnaire), and (v) background variables. Path analysis was performed to test the relationships among the variables. RESULTS For both spectators and drivers, thrill seeking directly predicted driving violations; competitive attitudes toward driving further mediated this relationship. Attitudes toward speed limits, however, mediated the relationship between thrill seeking and violations only for drivers. DISCUSSION We observed significant relationships among individual difference measures, motorsports involvement, speeding attitudes and violations that may inform road safety interventions, including differences in the relationships among thrill seeking, speeding attitudes, and violations for motorsports spectators and drivers.

High risk driving attitudes and everyday driving violations of car and racing enthusiasts in Ontario, Canada

Objective: Attitudes and individual difference variables of car and racing enthusiasts regarding high-risk behaviors of street racing and stunt driving have recently been investigated. Positive attitudes toward high-risk driving, personality variables such as driver thrill seeking, and other self-reported risky driving acts were associated with these behaviors. However, probable relationships among high-risk driving tendencies, everyday driving behaviors, and negative road safety outcomes have remained largely unexamined. This study aimed to investigate the associations among car and racing enthusiasts’ high-risk driving attitudes, self-reported everyday driving violations (i.e., ordinary and aggressive violations), and self-reported negative outcomes (i.e., collisions and driving offense citations). Method: A web-based survey was conducted with members and visitors of car club and racing websites in Ontario, Canada. Data were obtained from 366 participants. The questionnaire included 4 attitude measures—(1) attitudes toward new penalties for Ontarios Street Racers, Stunt and Aggressive Drivers Legislation; (2) attitudes toward new offenses of stunt driving under the same legislation; (3) general attitudes toward street racing and stunt driving; (4) comparison of street racing with other risky driving behaviors—self-reported driving violations (i.e., ordinary and aggressive violations); self-reported collisions and offense citations; and background and driving questions (e.g., age, driving frequency). Results: Results revealed that attitudes toward stunt driving offenses negatively and general attitudes toward street racing and stunt driving positively predicted ordinary violations, which, in turn, predicted offense citations. Moreover, general attitudes toward street racing and stunt driving positively predicted aggressive violations, which, in turn, predicted offense citations. Conclusion: The findings indicate that positive high-risk driving attitudes may be transferring to driving violations in everyday traffic, which mediates driving offense citations.

Is there a link between motor vehicle collisions and being a cigarette smoker in Canada? Analysis of survey data from Ontario from 2002 to 2014

ABSTRACT Objective: Although most research on drugs and driving has focused on the use of alcohol and cannabis, research that has been conducted on cigarette smoking and collisions has found that smokers have an increased collision involvement. Studies dating from 1967 through 2013 have shown a crude relative risk of about 1.5 among smokers compared to nonsmokers. In Canada, the association between smoking and collisions has not been recently investigated. Studies that have examined the association between smoking and collisions often did not control for all confounding factors, such as alcohol use and driving exposure, which have been associated with increased collision rates. Additionally, a number of these studies were examined in countries and at times when prevalence of smoking was much higher than is currently the case in Canada. The purpose of this research is to examine the association between self-reported current smoking and past-year collision involvement, controlling for confounding factors, in a large representative sample of adult drivers in Ontario, Canada, from 2002 and 2014. Method: Data are based on the Centre for Addiction and Mental Health (CAMH) Monitor, an ongoing, rolling telephone survey of Ontario adults that provides epidemiological surveillance of indicators related to alcohol, tobacco, and other drug use, as well as physical and mental health. The survey uses random-digit-dialing methods via Computer-Assisted Telephone Interview, with response rates over 50%. Results: Prevalence of self-reported collision involvement within the past year for 2002–2014 was 8.6% among those who currently smoke compared to 6.5% of nonsmokers. Logistic regression analysis, controlling for the potential confounding effects of sociodemographics, driving exposure measures, drinking frequency, and hazardous alcohol use, found that the overall odds for collision involvement in the preceding year among current smokers for 2002–2014 was 1.27 (95% confidence interval [CI], 1.06–1.53) times that of nonsmokers. Conclusions: These findings indicate that despite a substantial reduction in overall prevalence of smoking in Canada, smokers still have a significantly increased odds of collision involvement, even when controlling for alcohol and exposure. Additionally, the results are consistent with the increased odds/risks of motor vehicle collisions found in other countries.

Attention deficit hyperactivity disorder and arrest history: Differential association of clinical characteristics by sex

Attention deficit hyperactivity disorder (ADHD) is often cited as a risk factor for criminality. However, many studies do not take other criminogenic variables into account when reporting on this relationship. It is even less clear whether models that include ADHD as a potential risk factor for criminality consider the importance of sex differences. To answer this question, we collected data from a telephone population survey sampling adults over the age of 18 years in the province of Ontario, Canada (final sample size = 5196). Respondents were screened for ADHD using the Adult ADHD Self-Report Version 1.1 Screener (ASRS-V1.1) and four extra items. Problematic drinking was assessed using the Alcohol Use Disorders Identification Test (AUDIT), while cannabis misuse was evaluated using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The Antisocial Personality Disorder Scale from the Mini-International Neuropsychiatric Interview provided a measure of previous conduct disorder symptoms and the 12-item General Health Questionnaire screening procedure was used to gauge general distress. History of arrest was self-reported. Three separate logistic regression analyses (entire sample, male only, and female only) were applied to estimate the association of the foregoing variables with arrest history. In the combined sample, conduct disorder symptoms, problem alcohol use, and problem cannabis use all predicted history of arrest. With regard to the male sample, conduct disorder symptoms, elevated AUDIT and ASSIST scores, and general distress were associated with an arrest history. For the female subsample, only conduct disorder symptoms and problematic cannabis use showed a relationship with criminality. To summarize, ADHD did not predict history of arrest for either subsample or the combined sample. When comparing males and females, conduct disorder symptoms and cannabis misuse exerted stronger effects on history of arrest for females than males. These results suggest that the relative importance and type of clinical risk factors for arrest may differ according to sex. Such information could be useful for crime prevention policies and correctional programs that take into account differences in experience by sex.