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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.

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.

OBJECTIVES: To examine co-occurring mental health problems among a population-based sample of high school students in Ontario, Canada, to understand their prevalence, associated risk factors, and relationship with mental health service access and utilization. METHODS: The data were derived from the 2013 Ontario Student Drug Use and Health Survey, a biennial survey of students attending publicly funded Ontario schools, from a subsample of students who completed both the internalizing and substance use portions of the survey (n = 2945). Rates of co-occurring problems were calculated for the previous 12 months. Service use for students with co-occurring problems was also calculated for the past 12 months. Odds ratios were estimated using binary logistic regression models correcting for the survey design. RESULTS: In an adjusted model, youth with internalizing symptoms were 2.40 times more likely and youth with substance use problems were 2.24 times more likely to have accessed mental health services during the past 12 months than youth without these problems. Youth with co-occurring internalizing and substance use problems were 6.74 times more likely (95% CI 4.66–9.76, p

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.

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 Health9s 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.

OBJECTIVE: To examine energy drink consumption and its association with demographic characteristics, drug use, and injury among adolescents. METHODS: Data 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. RESULTS: Overall, 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. CONCLUSION: These 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.

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.

This study examines whether access to alcohol and tobacco around the school relates to higher or lower odds of cigarette smoking and binge-drinking among Ontario high school students. The 2013 Ontario Student Drug Use and Health Survey provides data on self-reported smoking and drinking, individual covariates and subjective socio-economic status for 6142 students (grades 9–12) in Ontario, Canada. Locations of schools were geocoded and 1.6 km network buffers defined the school neighbourhoods. Multi-level logistic regression examines individual and school neighbourhood factors with smoking and binge drinking as the dependent variable. Higher density of retail outlets increased the odds of smoking, but not the odds of binge-drinking. Older age, lower SES and being male increased the odds of smoking; while older age and being male also increased the odds of binge-drinking. Lower SES and higher population density decreased the odds of binge-drinking. Proximity to tobacco and alcohol outlets was not significant. Findings showed that a greater number of outlets in the school neighbourhood is significantly associated with higher odds of smoking, but not binge-drinking. School neighbourhood access to tobacco outlets should be considered when formulating policy interventions to reduce smoking for adolescents.

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 Health’s 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.

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.

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. Language: en

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. Language: en

OBJECTIVE: To examine waterpipe use and its association with demographic factors, tobacco cigarette smoking, ever use of electronic cigarettes (e-cigarettes) and alcohol use among high school students. METHODS: Data were derived from the 2013 Ontario Student Drug Use and Health Survey, a school-based survey of 7th to 12th grade students. This province-wide survey was based on a stratified two-stage cluster design. Analyses were based on a subsample of 2,873 high school students and included adjustments for the complex sample design. RESULTS: Overall, 12.5% of high school students (grades 9-12) had used a waterpipe in the previous year. Awareness of waterpipes was high – 68.4% of students reported that they were aware of waterpipes but had not used one in the past year; 19.1% had never heard of waterpipes or hookah. The percentage of high school students reporting waterpipe use in the past year was similar to reports of tobacco cigarette use (12.5% and 11% respectively). Waterpipe use was highly associated with past-year tobacco cigarette and regular alcohol use as well as ever use of e-cigarettes. In multivariate analyses, males and females had similar odds of waterpipe use, and non-White students and those in higher grades had greater odds of use after controlling for other substance use. CONCLUSION: These findings suggest that waterpipe use among high school students should be of some concern and suggest the need for policy measures to address potential risks associated with use.

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.

BackgroundAlthough 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 findingsData 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.ConclusionsTBI 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.

Direct questions on child maltreatment in population-based surveys are often limited by ethical and methodological issues. This restricts the ability of researchers to examine an important aspect of early adversity and its relationship to health and behavior. An alternative to excluding issues of maltreatment entirely in population-based surveys is to include questions on child and family involvement with child protective services (CPS). A school-based adolescent survey that included a question on child and family involvement with CPS yielded results that were generally consistent with other studies relating child maltreatment to health and behavioral outcomes such as psychological distress symptoms, delinquency, aspects of bullying, and health service utilization. Such findings suggest that questions on involvement with CPS may be a reasonable proxy for child maltreatment. Despite the lack of information on the reason for involvement or specific categories of maltreatment, CPS involvement questions highlight the shared familial experience that surrounds CPS involvement and serves as a general reflection of an adverse experience that can be utilized by researchers interested in early experiences.

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. Language: en

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