title: Cross-sectional examination of the association of co-occurring alcohol misuse and traumatic brain injury on mental health and conduct problems in adolescents in Ontario, Canada.
abstract: 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.
  
  
  
  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 Health's Ontario Student Drug Use and Health Survey.Recent(past year) andformer(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).
  
  
  
  An estimated 11.8% of Ontario adolescents (95% CI 10.1% to 13.8%) reported a history offormerTBI and were not hazardous drinkers; 4.0% (95% CI 2.9% to 5.5%) reportedrecentTBI 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%) hadformerTBI with co-occurring hazardous drinking; and 2.2% (95% CI 1.6% to 3.0%) hadrecentTBI 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 eitherformerorrecentTBI compared to classifying as not having either of these conditions. Adolescents classified as hazardous drinkers withformerTBI had numerous and higher ORs for conduct behaviours than those withrecentTBI.
  
  
  
  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.
authors.affiliation: Department of Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.|Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Ilie
authors.affiliation: Department of Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Mann
authors.affiliation: Department of Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
authors.forename: Angela
authors.initials: A
authors.lastname: Boak
authors.affiliation: Department of Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Adlaf
authors.affiliation: Department of Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Hayley
authors.initials: H
authors.lastname: Hamilton
authors.affiliation: Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Asbridge
authors.affiliation: Department of Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rehm
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.|Division of Neurosurgery and Injury Prevention Research Office, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Cusimano
mesh_terms: D000293:Adolescent; D000070642:Brain Injuries, Traumatic / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D009864:Ontario / Q000453:epidemiology; D000066553:Problem Behavior; D057566:Self Report; D013334:Students; D000066608:Underage Drinking / Q000523:psychology* / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: MENTAL HEALTH; adolescents; alcohol; conduct behaviours; problem drinking; traumatic brain injury