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.

Behavior and major barriers faced by non-injectable drug users with HBV/HCV seeking treatment for hepatitis and drug addiction in Rio de Janeiro, Brazil

Drug users (DU) are a marginalized group and at risk for viral hepatitis, who seldom access health services. A cross-sectional survey was conducted with 111 DU with chronic HBV/HCV and 15 in-depth interviews with health professionals/policymakers in Rio de Janeiro, Brazil. Most interviewees were male, non-white, with a low educational background, unemployed and/or living on less than $245 a month (minimun wage). In the last 6 months, 61.8% of interviewees snorted cocaine, 64.7% at least once a week. Half of the interviewees had a stable partner and 38.3% of those with occasional partners never/almost never using condoms. Addiction treatment seeking was found to be associated with: being white (OR:5.5), high-school degree (OR:8.7), and employment (OR:5.7). Hepatitis treatment seeking was high (80.9%), and access to low-threshold, user-friendly health services was key for treatment seeking behaviors (OR:3.6). Missed opportunities for hepatitis treatment seem to be associated with structural (uneven political/financial support to hepatitis programs) and patient-related barriers (severe addiction and non-adherence). Those most in need were less likely to access treatment, calling for renewed strategies, in order to curb hepatitis among impoverished drug users and their sexual partners.

History of Family Involvement with Child Protective Services as a Risk Factor for Bullying in Ontario Schools

BACKGROUND

  The relationship between history of family involvement with child protective services (CPS) and bullying was examined.

METHOD

  Data were obtained from 2,516 pupils aged 12-19 in the 2007 Ontario Student Drug Use and Health Survey. The association between self-reported history of family involvement with CPS and bullying was estimated using negative binomial hurdle regression models.

RESULTS

  Females who reported family CPS involvement were more likely to have bullied and been bullied compared with females without CPS involvement. Among males, family CPS involvement was only significantly associated with bully victimisation.

CONCLUSION

  A history of family CPS involvement was a risk factor for bullying victimisation and perpetration.

[Family and acquaintances of illicit drug users: community perspectives on laws and public policies in Western Rio de Janeiro, Brazil]

This article is part of the study 'Illicit Drug Use in Seven Latin American Countries and Canada: Critical Perspectives of Family and Familiars' (7LACC), which investigated four domains: protective and risk factors; preventive initiatives; treatment facilities; and laws and policies. The article presents a section of the results based on four items of the laws and policies domain--as perceived by the family and acquaintances of illicit drug users living in the community. Participants were recruited in urban primary health care units located in Western Rio de Janeiro (city), Brazil. This multi-method, cross-temporal study performed interviews with 100 adults (18 years of age or older), all cognitively healthy. Results and key conclusions included non-compliance with the fundamental principles of the Unique Health System Legislation / Law 8.080/90 and the erroneous implementation of laws and public policies on illicit drug.

[Illegal aspects of illicit drugs use in Mexico]

The objective of this cross-sectional, descriptive study was to obtain the opinions of a group of people about legal issues regarding addiction. Data collection was performed using a structured questionnaire with four themes. In order to participate, the individual could not use any drugs but should have a close relationship with a drug user. The data was processed using SPSS V. 14. There were 100 participants, 75% of whom were women, and 38% had a drug user as a friend, mainly cocaine and marijuana users. The participants had one opinion in common: laws should be more severe for people who use, sell, or transport drugs. The current laws do not improve consumers' criminal behavior. There is a need for further studies addressing people's opinion about this phenomenon in order to obtain a more realistic view of this drug issue.

[Critical perspective of relatives and acquaintances regarding protective factors and the use of illicit drugs in Guayaquil, Equador]

The objective of this study was to determine the perspectives of drug users' relatives and acquaintances about protective factors for illicit drug use at a health center in Guayaquil. This is a descriptive, cross-sectional study. Data collection was performed through interviews using a questionnaire. Interviews were performed with 100 people who knew a drug user (relative or friend). The results showed that the following personal and family factors could be protective: 97% having solid moral principles, 96% express their feelings, 98% dedicate time for the family, and 95 % have a supportive relationship with one of the parents. Regarding the community, all participants (100%) agree there is a need for a government that understands this issue, 99% refer there should be honest policemen, and 99% state the need for programs that protect people from drug use and institutions that work with prevention. Family, community and personal decisions have effects on becoming involved, hence the need to reinforce protective factors and thus reduce the number of addicted individuals.

[Use of illicit drugs and critical perspectives of drug users' relatives and acquaintances in Northern Rio de Janeiro City, Brazil]

This article presents the partial results of a multicenter, qualitative study, which involved seven Latin-American countries and Canada. The results presented refer to Northern Rio de Janeiro (city), Brazil. The objective of the study was to describe the perspective of relatives/acquaintances of illicit drug users about protective and risk factors, prevention initiatives, treatment services, and legal aspects regarding illicit drugs. Interviews were performed with 99 individuals, who reported being affected by their relationship with an illicit drug user (relative or acquaintance), approaching their perspectives regarding the key-domains. Most participants were women (73.7%); relatives who used drugs were mostly men (78.2%); the most consumed drug was marijuana (77.8%). The highlighted protective factor was having recreational-sports activities in the community (88.9%), and the risk factor was curiosity for trying something new (94.4%). The main treatment services were Church Groups (51.5%), and participants stated that laws should be more punitive (82.8%). In conclusion, this information is essential to fight against drug use/abuse, showing that there is a need for actions that consider different perspectives at different levels.

[Laws and policies on illicit drugs in Brazil and the perspective of drug users' family members and acquaintances: a study in the City of Ribeirão Preto, São Paulo, Brazil]

Brazilian drugs legislation has evolved from a prohibitionist system to a less repressive one in terms of drug users. The objective of this study was to identify the perception of relatives and acquaintances of drug users living in Ribeirão Preto, São Paulo, Brazil, about the country's laws and policies on drugs. Data collection was performed using a structured questionnaire. The sample consisted of 100 drug users' relatives or acquaintances, selected at a public health service. Respondents' relationships with the drug user were as follows: 31% friend, 23% sibling, 15% child and 7% spouse. Most users (78%) were men, with an average age of 26 years. Results confirm that national laws and policies have a direct effect on individuals' attitude and behaviors. There is a lack of trust in the police and a general perception that, despite recent chances that favor user rehabilitation, the laws on drugs do not respect users' human rights.

[Risk factors related to the use of illegal drugs: the critical perspective of drug users' relatives and acquaintances at a public health center in San Pedro Sula, Honduras]

This article presents quantitative data from a multicenter, cross-sectional study, which was performed at a public health center in San Pedro Sula, Honduras, using multiple methods. The objective of the study was to describe the critical perspective of people who reported being affected by their relationship with an illicit drug user (relative or acquaintance) in terms of risk factors. Data collection was performed using 100 questionnaires. Most participants were women with low education levels. Drug users were mostly men, with an average age of 23.3 years. The most consumed drug was marijuana (78%), followed by crack/cocaine (72%), glue/inhalants (27%), hallucinogens (ecstasy/LSD) (3%), amphetamines/stimulants (1%), and heroin (1%). The identified risk factors include: previous experience with alcohol/tobacco, having friends who use drugs, lack of information, low self-esteem, age, and other personal, family and social factors. In conclusion, prevention and protection should be reinforced.

Epidemiology of firesetting in adolescents: mental health and substance use correlates

OBJECTIVE

Despite high rates of firesetting among community adolescents, little is known about its correlates. This study identifies the mental health and substance use correlates of four firesetting levels in an epidemiological sample of adolescents.

METHODS

Three thousand, nine hundred and sixty-five (3,965) students in grades 7 to 12 were surveyed. Multinomial analyses were used to compare non-firesetters; desisters (lifetime, but no past-year firesetting); low frequency firesetters (once or twice in the past 12 months); and high frequency firesetters (3 + times) on measures of mental health and substance use.

RESULTS

Twenty-seven percent of youth reported firesetting during the past year. Of these, 13.7% reported one or two episodes, and 13.5% reported 3 or more episodes. Firesetting was more prevalent among males and among those in high school. Youth who began firesetting before age 10 were more likely to report frequent firesetting during the past year. Compared to non-firesetters, the firesetting groups had elevated risk profiles. Desisters and low frequency firesetters were more likely to report psychological distress, binge drinking, frequent cannabis use, and sensation seeking. Low frequency firesetters also reported higher rates of delinquent behavior, suicidal intent, and low parental monitoring than non-firesetters. High frequency firesetters reported elevated risk ratios for all of these risk indicators plus other illicit drug use. The cumulative number of risk indicators was positively associated with firesetting severity.

CONCLUSIONS

Firesetting is associated with psychopathology and substance use during adolescence. Findings highlight the need for programs to address the mental health and substance use problems that co-occur with firesetting.

Uso de drogas ilícitas e perspectivas críticas de familiares e pessoas próximas na cidade do Rio de Janeiro - Zona Norte, Brasil

O trabalho apresenta resultados quantitativos do Brasil, recorte centro da cidade do Rio de Janeiro (n=108), de uma pesquisa multicêntrica, multimétodos e corte temporal, envolvendo sete países latino-americanos e Canadá. A pergunta central da pesquisa foi "como familiares e pessoas próximas a usuários de drogas ilícitas descrevem fatores de proteção e de risco, iniciativas de prevenção, serviços de tratamento, leis e políticas sobre as drogas ilícitas". Os dados quantitativos foram coletados por meio de instrumento com perguntas fechadas, aplicados em 108 jovens adultos >18anos que se identificaram como pessoalmente afetados pela droga sem serem usuários. Para 104 entrevistados (96%), a dinâmica familiar que mais expõe à droga é a negligência e, para 106 (98%), a que mais protege é a relação de apoio com os pais. A política, a polícia e o sistema criminal não têm diminuído o consumo e não protegem o usuário.

El consumo de drogas y su tratamiento desde la perspectiva de familiares y amigos de consumidores: Guatemala

Actualmente Guatemala cuenta con una población de 13.344.770 personas que tiene una elevada tasa de población migrante, tanto nacional como internacional. Relacionado con el abuso de drogas, el país presenta la más alta tasa de consumo de mariguana en Centroamérica, y el consumo de cocaína se reconoce como un serio problema, que afecta mayoritariamente a los adolescentes y adultos jóvenes (15-30 años). Este estudio cualitativo y cuantitativo, describe la perspectiva de familias y familiares sobre los adictos a drogas ilícitas en Guatemala. La información recolectada proviene de personas referidas por la Línea de Crisis para drogas 1545. El estudio describe a la mariguana, seguida de cocaína y benzodiacepinas como las drogas de mayor consumo. Se detectó a la familia como el factor de protección más importante. Por otro lado, la respuesta de los servicios de salud es insuficiente; no existe en el país disponibilidad de iniciativas preventivas. Se recomienda realizar, en el futuro, otros estudios cualitativos y cuantitativos sobre este tema.

El consumo de drogas y su tratamiento desde la perspectiva de familiares y amigos de consumidores en Bogotá, Colombia

En este estudio, se presenta el análisis parcial de los resultados de un trabajo cuantitativo, relacionado con la perspectiva que tienen los familiares y amigos de consumidores frente al tratamiento para los problemas derivados del consumo de drogas ilícitas. Participaron 104 usuarios de los servicios de salud de Bogotá, El 58% considera el consumo como una enfermedad que necesita tratamiento. El 56% identifica el hospital general como la principal alternativa para el mismo y, 95% al Estado como el principal responsable de este. Las instituciones privadas son las más conocidas y dentro de estas, las comunidades terapéuticas y los grupos religiosos aparecen como los que más se comprometen con la problemática. Para el 73% los servicios existentes no son suficientes y el acceso a la utilización de los mismos es difícil. El estigma es la principal barrera para solicitar la atención, solo el 50% considera que los tratamientos son útiles. Es necesaria una mayor difusión de los recursos existentes, para aumentar su demanda y utilización.

Perspectiva crítica de la familia y de personas cercanas sobre factores de riesgo familiares y comunitarios en el uso de drogas ilícitas en San José, Costa Rica

En este estudio se presentan los resultados de una investigación cuantitativa, parte de un estudio multicéntrico, cuyo objetivo fue describir las perspectivas que tienen la familia y las personas cercanas a usuarios de drogas ilícitas, cuestionándose sobre cuáles serían los factores de riesgo familiar y comunitario que contribuyen a la adicción de drogas ilícitas. Se encuestó a 100 sujetos mayores de 18 años, familiares o personas cercanas a sujetos que han estado usado drogas ilícitas. Se encontró que la mayoría eran hombres, con edad promedio de 27.3 años. Los factores de riesgo provenientes de la familia identificados fueron: ser rechazado 99%, sentirse no amado 98%, falta de comunicación 95%, conflictos y violencia familiar 95%. Los factores sociales o comunitarios fueron: 99% tener amigos que usan drogas, 99% presión de los amigos, 93% vivir en un área insegura y 94% experimentar un evento estresante. Se concluyó, según su perspectiva crítica, que se debe trabajar más sobre las estrategias de prevención de factores de riesgo tanto en la familia como en la comunidad.

Cannabis use and self-reported collisions in a representative sample of adult drivers

PROBLEM

This study examines the relationships between collision involvement and several measures of cannabis use, including driving after using cannabis, among drivers, based on a population survey of Ontario adults in 2002 and 2003.

METHOD

Logistic regression analyses examined self-reported collision involvement in the last 12 months by lifetime use of cannabis, past year use of cannabis, and past year driving after using cannabis, while controlling for demographic characteristics.

RESULTS

We found that the odds of reporting collision involvement was significantly higher among cannabis users, and among those who reported driving after cannabis use. Some evidence for a dose-response relationship was seen as well.

DISCUSSION

Cannabis users and people who report driving after cannabis use are also more likely to report being involved in a collision in the past year. These observations suggest that collision prevention efforts could be aimed at these groups. Additional work to determine the causal pathways involved in the relationships observed here is needed.

IMPACT ON INDUSTRY

None.

Substance abuse and quality of life among severely mentally ill consumers: a longitudinal modelling analysis

BACKGROUND

Evidence suggests that substance abuse negatively affects both psychiatric symptom severity and quality of life (QOL) in people with severe mental illness (SMI). However, these relationships have not been examined simultaneously, nor have they been characterized over time. Thus, it is difficult to appreciate the extent to which substance abuse exerts an enduring effect on psychiatric symptoms and distress and/or QOL in this population. The purpose of this study is to test a conceptual model linking these factors together.

METHODS

Subjects were participants in a longitudinal evaluation of community mental healthcare in Ontario (n = 133). Comprehensive consumer assessments were conducted at treatment entry, and at 9 and 18 months. Subjects were receiving intensive case management or assertive community treatment throughout the 18-month study period. Structural equation modelling was used to examine the concurrent and longitudinal relationships between substance abuse, symptoms and distress, and QOL.

RESULTS

The prevalence of substance abuse was 55.0%. The SEM analysis suggested that substance abuse at baseline was associated with elevated symptomatology and distress and lower QOL, and that these effects endured after 18 months of treatment. Psychiatric symptoms and distress mediated the negative relationship between substance abuse and QOL.

CONCLUSIONS

The mediating role played by symptom and distress levels in the relationship between substance abuse and QOL suggests the importance of closely monitoring changes in these factors among SMI patients with substance problems. Tracking symptom severity and distress levels over time will allow service providers to intervene and potentially improve the QOL of individuals with SMI.

Mapping the prevalence of problem gambling and its association with treatment accessibility and proximity to gambling venues

This study examined geographic variation in the prevalence of problem gambling in Ontario and the association with various demographic factors and proximity to treatment for problem gambling and gambling venues. Drawing upon multiple sources, secondary data analysis was undertaken based on multivariate statistical methods and techniques of geographic information systems (GIS). Regional variation in prevalence of problem gambling was found in the province. P revalence of problem gambling was associated with many demographic characteristics, as well as mental disorders, co-occurring substance abuse problems, and physical health status. Geographic access to treatment was not associated with the risk of being a problem gambler. However, proximity to gambling venues was marginally important in predicting risk of problem gambling. Results are interpreted in the context of needs-based planning of treatment and prevention programs for problem gambling.

Underage gambling in Ontario casinos

This study describes self-reported attendance in an Ontario casino among Ontario students aged 18 and under in 2005 and describes changes in attendance compared to 2003 and 2001. The results showed that in 2005, 1.0% of underage students, representing some 9,400 students in Ontario, reported gambling at casinos in Ontario, a percentage that remains unchanged compared to 2003 (1.5%) and 2001 (1.4%). These data suggest that only a small percentage of underage students gamble at Ontario casinos, and there is no evidence that this percentage has changed significantly since 2001.

Factors predicting practice location and outreach consultation among University of Toronto psychiatry graduates

OBJECTIVE

To identify the determinants of practice location and of outreach consultation of recently graduated psychiatrists.

METHODS

We surveyed 153 psychiatrists who graduated from the University of Toronto Department of Psychiatry between January 1990 and June 2002 (response rate 51%), on the basis of a self-administered mail questionnaire. The survey assessed factors that influenced practice location and outreach consultation, such as demographics, links to practice communities, and outreach experiences, including rural or northern electives as a resident.

RESULTS

Professional variables were rated as the most important factors in choosing a practice location. Variables such as age or sex were not significantly associated with location. Nine percent reported working in communities of less than 100,000, and only 1% practised in Northern Ontario. Eighteen percent practised in the same location where they were born or raised. Forty-four percent had rural or northern experience as a resident but almost exclusively in the form of short, fly-in consultation electives. Twenty-four percent indicated that they provide outreach consultation. Psychiatry residents who participated in outreach electives were 10 times as likely as those who did not participate to continue outreach as a consultant.

CONCLUSION

Although early exposure to rural or northern medicine leads to significantly greater continued involvement in outreach activities after graduation, our findings suggest the need for more long-term, on-site residency training opportunities in rural and remote areas.

The impact of driver education on self-reported collisions among young drivers with a graduated license

In this study, we assess the impact of driver education on the risk of collisions in a Graduated Licensing System (GLS). Ontario's GLS requires all new drivers to successfully pass through two stages of graduated license (referred to as G1 and G2, respectively) before full licensure is granted. Surveys of driving behaviour and related factors were administered to Grades 11 and 12 students with a graduated license in seven Ontario schools in 1996 and 1998. A total of 1533 students completed the survey in 2 years. Multivariate logistic regression analysis revealed a significantly lower odds of self-reported collision involvement among G1 license holders with driver education (OR: 0.31, 95% CI: 0.12-0.83). No significant effects were observed for G2 license holders. Other significant predictors of collisions include sex of driver, months of licensure and kilometers driven for G2 license holders. These results suggest that the impact of driver education may be dependent on the stage of driver learning in which it occurs.

Prescription drug abuse in Canada and the diversion of prescription drugs into the illicit drug market

Prescription drug abuse has received considerable attention in media reports in recent years. The purpose of this article is to describe the Canadian situation and context with regards to prescription drug abuse and the diversion of psychotropic prescription drugs into the illicit drug market, with a focus on the need for more data and interventions. Canada ranks within the top 10% of countries in the use of benzodiazepines, opioid prescriptions and stimulants. There are many ways that prescription drugs are diverted into the illicit market and varied reasons for use and abuse. Prescription drug abuse is further related to a number of negative consequences, including overdose. While seniors and women have been the primary focus for research in Canada on prescription drug abuse, adolescents and young adults have received less attention. Systematic epidemiological data specifically on prescription drug abuse in the Canada context are lacking and are needed in order to more clearly understand the reasons for the phenomenon and to develop and implement appropriate interventions.

School matters: drinking dimensions and their effects on alcohol-related problems among Ontario secondary school students

AIMS

To test the hypotheses that average volume of alcohol consumption and patterns of drinking, each influence alcohol-related problems and that both act at individual and aggregate levels.

METHODS

The 2003 cycle of the Ontario Student Drug Use Survey obtained self-administered questionnaires from a representative classroom-based survey of 2455 Ontario secondary school students (grades 9-12) from 74 schools, with a student completion rate of 72%. Average volume of alcohol consumption was assessed using a quantity-frequency measure. Heavy drinking occasions were operationalized by four dummy variables indicating less than monthly, monthly, weekly and daily consumption of five or more drinks per occasion, with never having a heavy drinking occasion serving as the reference group. Alcohol-related problems were measured by using seven items of the Alcohol Use Disorders Identification Test.

RESULTS

As hypothesized, both the average volume of alcohol consumption and patterns of drinking influenced alcohol-related problems at the student level, independently of each other. At the school level, both determinants significantly influenced the problems, but not when simultaneously entered into the equation.

CONCLUSIONS

Future prevention of alcohol-related problems in adolescents should consider both the average volume and patterns of drinking. Both prevention and research should also try to include environmental determination of alcohol-related problems.

Predictors of completion status in a remedial program for male convicted drinking drivers

OBJECTIVE

Rates of attrition in alcohol and drug treatment programs are often greater than 50%, and completion of treatment has been shown to be a potent predictor of posttreatment outcome. The current study examined both rates and predictors of completion among male participants in a remedial measures program for convicted drinking drivers.

METHOD

Male individuals (n = 5,409) convicted of a drinking driving offense in Ontario between October 2000 and December 2002 who did and did not complete a mandatory rehabilitation program were described in terms of demographic, drug use and legal variables collected at time of assessment.

RESULTS

The program completion rate was extremely high (97.3%). In multivariate analyses, noncompleters-relative to completers-were younger; drank more frequently; were less likely to own a home; and were more likely to live in urban centers, have two or more lifetime impaired driving convictions and have experienced more than one adverse consequence of substance use.

CONCLUSIONS

Ontario's remedial measures program for convicted drinking drivers, in which the return of a suspended license after the period of mandatory suspension is contingent on the completion of the program, demonstrates a very low level of client attrition. Individuals who do not complete the program bear many similarities to those at high risk for persistent drink-drive behavior and its associated negative health consequences.

Road rage experience and behavior: vehicle, exposure, and driver factors

Road rage has generated increasing public concern. Research has shown that victimization and perpetration of road rage is more common among males and younger drivers. We aimed to extend the understanding of determinants of road rage to driving exposure and vehicle factors, based on a 20022003 population survey of 1,631 regular drivers in Ontario, Canada. Regression analyses revealed that number of times drivers reported experiencing road rage in the previous 12 months was significantly greater for males, younger respondents, and those residing in Toronto. Also, victimization was significantly greater for drivers who did all their driving on busy roads and increased with number of kilometers driven on a typical week; however, type of vehicle driven was not significant. Number of times road rage perpetration was reported in the past 12 months was significantly greater for males, younger respondents, and those residing in Toronto, and lower for those in the Eastern and Northern region. Road rage perpetration increased significantly with number of weekly kilometers driven and was significantly greater for drivers who are always on busy roads and lower for those who never drive on busy roads, and higher for high-performance vehicle drivers. Even after controlling for driving exposure, road rage victimization and perpetration were highest for drivers in Toronto, where the pace of life may be more demanding. As expected, high-performance vehicle drivers reported more road rage perpetration. These individuals may experience more frustration when they are prevented from using the full performance capacities of their vehicles by crowded urban roadways.

The drugs-violence nexus among American and Canadian youth

This paper examines the relationship between drug use and violence among representative samples of students in the United States and Ontario, Canada. Canada has significantly lower levels of violent crime than the United States, but students report similar rates of drug use. Using logistic regression analysis, we find a similar relationship between drug use and violence among adolescents in the two countries. All the drugs considered--cannabis, cocaine, and alcohol binge drinking--are significantly related to violent behavior; whether the perpetrator or the victim. The most noteworthy difference may be that in Ontario, drug use appears to be even more highly correlated with violence than in the United States.

Substance use disorders in young adults with and without LD: predictive and concurrent relationships

This article reports on young people with and without learning disabilities (LD) and substance use disorders (SUD). Participants were assessed for LD at ages 12 and 19 and for SUD and psychiatric disorders at age 19. Participants with LD at ages 12 and 19 were more likely to develop an SUD or a psychiatric disorder compared to participants without consistent LD. Participants with LD at age 19 were more likely to have a concurrent SUD or psychiatric disorder compared to those without LD at age 19, while participants with LD at age 12 showed only a trend toward increased rates of SUD at age 19 when compared to participants without LD at age 12. Participants with and without LD did not differ in substance use, consumption levels, or onset history. In a multivariate model, adolescent LD was associated with a three-fold increased risk for SUD after behavioral problems and family structure had entered the model. Although these results provide some support for the notion that adolescents with LD are at increased risk for SUD, LD also appears to confer a general risk for adverse outcomes.

Nonresponse in a follow-up to a representative telephone survey of adult drinkers

OBJECTIVE

Examined predictors of nonresponse among respondents who agreed to receive a follow-up questionnaire on alcohol use after participating in a representative telephone survey, and among respondents who did and did not return the follow-up questionnaire.

METHOD

A total of 2,072 (52.2% female) respondents to a representative monthly telephone survey were assessed on sociodemographic variables and alcohol use. Respondents were asked whether they would be willing to fill out an additional mailed questionnaire on alcohol use and attitudes toward drinking. Almost half (n = 956; 46%) of respondents agreed to participate in the follow-up survey; 430 (45%) of those individuals completed and returned the questionnaire.

RESULTS

Agreement to receive the follow-up questionnaire was unrelated to alcohol use. Regarding gender, men were 1.42 times more likely than women to exhibit nonresponse in returning the follow-up questionnaire (95% CI: 1.08-1.42). After adjusting for the impact of demographic factors, respondents who consumed alcohol at least once per week were 1.43 times more likely than respondents who drank less frequently to exhibit nonresponse in returning the questionnaire (95% CI: 1.05-1.93). Respondents who consumed five or more standard drinks at least once per week were 1.83 times more likely to exhibit nonresponse in returning the questionnaire, compared with respondents who engaged in heavy drinking less frequently (95% CI: 1.15-2.92).

CONCLUSIONS

Mailout questionnaires following a representative telephone survey may bias samples toward obtaining fewer men, fewer weekly drinkers and fewer heavier drinkers. Although the magnitude of these biases were relatively small, epidemiological studies on alcohol use may wish to oversample men and heavier drinkers in follow-up studies recruiting from population surveys.

Fourteen-year follow-up of speech/language-impaired and control children: psychiatric outcome

OBJECTIVE

To examine the association between early childhood speech and language disorders and young adult psychiatric disorders.

METHOD

In a longitudinal community study conducted in the Ottawa-Carleton region of Ontario, Canada, interviewers administered structured psychiatric interviews to age 19 participants who were originally identified as speech-impaired only, language-impaired, or nonimpaired at age 5. The first stage of the study took place in 1982 when participants were 5 years old, and the latest stage of the study took place between 1995 and 1997 when participants had a mean age of 19 years. This report examines the association between early childhood speech/language status and young adult psychiatric outcome.

RESULTS

Children with early language impairment had significantly higher rates of anxiety disorder in young adulthood compared with nonimpaired children. The majority of participants with anxiety disorders had a diagnosis of social phobia. Trends were found toward associations between language impairment and overall and antisocial personality disorder rates. Males from the language-impaired group had significantly higher rates of antisocial personality disorder compared with males from the control group. Age of onset and comorbidity did not differ by speech/language status. The majority of participants with a disorder had more than one.

CONCLUSIONS

Results support the association between early childhood speech and language functioning and young adult psychiatric disorder over a 14-year period. This association underscores the importance of effective and early interventions.

Heterogeneity among smokers and non-smokers in attitudes and behaviour regarding smoking and smoking restrictions

OBJECTIVE

To determine if smokers and non-smokers cluster into meaningful, discrete subgroups with distinguishable attitudes and behaviours regarding smoking and smoking restrictions.

DESIGN

Qualitative research with 45 smokers guided development of questionnaire items applied in a population based telephone survey of 432 current smokers and 1332 non-smokers in Ontario, Canada.

METHODS

Cluster analysis of questionnaire items used to categorise adult smokers and non-smokers; comparison of clusters on sociodemographic characteristics and composite knowledge and attitude scores.

RESULTS

Smokers clustered in three groups. "Reluctant" smokers (16%) show more concern about other people discovering that they smoke, but parallel "easygoing" smokers (42%) in supporting restrictions on smoking and not smoking around others. "Adamant" smokers (42%) feel restrictions have gone too far, and are less likely to accommodate non-smokers. Significant gradients across categories in the expected direction were observed with respect to smoking status, stage of change, knowledge, and attitude scores, and predicted compliance with restrictions, validating the proposed typology. Non-smokers also clustered into three groups, of which the "adamant" non-smokers (45%) are the least favourably disposed to smoking. "Unempowered" non-smokers (34%) also oppose smoking, but tend not to act on it. "Laissez-faire" non-smokers (21%) are less opposed to smoking in both attitude and behaviour. A significant gradient across categories in the expected direction was observed with respect to composite scores regarding knowledge of the health effects of active and passive smoking and a composite score on support for restrictions on smoking in public places.

CONCLUSION

Recognition and consideration of the types of smokers and non-smokers in the population and their distinguishing characteristics could inform the development of tobacco control policies and programmes and suggest strategies to assist implementation.

What factors predict student self-rated physical health?

Data from a randomly selected sample of 840 Ontario students were used to examine factors that affect self-rated physical health. Analyses focused on demographics, family structure, family financial situation, child-parent relationship, school achievement, self-esteem, alcohol, tobacco and cannabis use as factors which directly and indirectly influence self-rated health. Specifically, higher income, good child-parent relationship, higher interest and achievement in school, high self-esteem, not smoking, and being male were all positively and directly associated with higher self-ratings of health. Family structure was mediated by income, and school achievement and child-parent relationship were mediated by tobacco use and self-esteem. Our analyses suggest that student perceptions of physical health are affected by demographic, economic, social, psychological and competency factors.

Toward comprehensive school drug policy in Ontario

The study reported here examines the development and implementation of School Drug Policy in Ontario Boards of Education, the components of these policies, and the composition of policy development committees. Data from 125 Boards of Education were obtained from responses to a questionnaire administered in the Fall of 1991. Findings from the study indicate that school drug policies are increasingly comprehensive-including not only disciplinary measures, but also a preventive curriculum and early intervention component. The composition of policy development working groups normally consisted of such groups as board personnel, teachers, and practitioners from other fields. Students were not often included in the process of policy development. Thus, the development and implementation of school drug policy in Ontario indicates a "top down" rather than "bottom up" approach.

Student cannabis use and enforcement activity in Canada: 1977-1987

This paper explores the relationship between cannabis use among Ontario students and enforcement activity between the years 1977 and 1987. Although the results clearly showed a significant decline in the use of cannabis during this time period, none of the enforcement activity factors were significantly related to prevalence of use. The only significant association showed that quantity of cannabis-related seizures, was correlated with students perceived availability of cannabis. Data with longer time trends and more intervals are needed to establish the existence of any relationship between prevalence of drug use and enforcement activity.