Regular Alcohol Use Research Articles

Clustering Alcohol Use Behavior: State Socioeconomic Conditions, Alcohol Policy and Individual Regular Alcohol Use in the US

This multilevel study examined whether state-level variations existed in the prevalence of regular alcohol use in the US after controlling for individual characteristics, evaluating the contribution of both individual socio-economic status

Use of social networking sites and alcohol consumption among adolescents

ObjectivesResearch indicates that screen time (e.g. TV viewing) is associated with alcohol consumption in adolescents; however, very little is known about the link between the use of social networking sites (SNSs) and alcohol intake in this age group. The purpose of this study was to examine the association between the use of SNSs and alcohol consumption among Canadian middle and high school students, and to test whether this link varies by sex and drinking frequency or intensity. Study designSchool-based cross-sectional study. MethodsSelf-reported data on time spent on SNSs, alcohol consumption and sociodemographic characteristics were obtained from 10,072 participants within the 2013 cycle of the Ontario Student Drug Use and Health Survey, a province-wide survey of students in grades 7–12 (11–20 years old). ResultsAdolescent females who reported daily use of SNSs (≤2 hours/day or >2 hours/day) were more likely than those who use them infrequently or do not use them at all to report both occasional and regular alcohol consumption in the past 12 months, while adolescent males who reported daily use of SNSs were more likely than those who use SNSs infrequently or do not use them at all to report regular alcohol use in the past 12 months. The use of SNSs was also associated with report of binge drinking (defined as drinking five or more drinks on one occasion) in the past 4 weeks in both males and females. ConclusionsResults provide evidence that the use of SNSs is associated with alcohol consumption among adolescents. Differences between males and females in the reported associations warrant further investigations.

Tobacco Use Among Adolescents Entering Quebec Youth Protection Centers

Abstract BACKGROUND: Every year between 4,000 and 5,000 adolescents reside in Quebec Youth Protection Centers (YPCs). Many of these adolescents use tobacco products and other psychotropic substances that impact their present and future well-being. OBJECTIVES: Document the prevalence of tobacco use among youth residing in YPCs and identify associated factors. Describe the measures taken to implement policies for smoke-free environments in YPCs and promote smoking cessation counseling for youth in care. DESIGN/METHODS: Between July 2008 and May 2009, adolescents aged 14-17 living in six YPCs across Quebec were recruited on a volunteer basis to participate in a surveillance study on health risk behaviors. Data on socio-demographics, lifetime substance use and sexual risk behaviors, as well as certain health consequences related to these behaviors were obtained during structured, face-to-face interviews. An analysis of factors associated with daily tobacco use was carried out. RESULTS: Data regarding behaviors reported during the year prior to admission were collected among 499 participants (boys: 59%; median age: boys: 16; girls: 15). Lifetime tobacco use was reported by 93% of girls and 91% of boys (median age at first cigarette was 12 years). During the year prior to admission, 15% of youth reported no tobacco use, and 20% smoked occasionally. Two thirds (65%) reported daily tobacco use, with 36% of girls and 43% of boys smoking 10 or more cigarettes a day. In univariate analysis, factors significantly (p<0.05) associated with daily smoking were: school failure or dropping out; family history of problematic alcohol or drug use; precocious initiation of alcohol use before age 13; history of regular use of alcohol or cannabis; problematic drug use (measured by DEP-ADO scale); having 6 or more lifetime sexual partners. Following dissemination of these results, measures were taken to develop a smoke-free policy and implementation plan for YPCs. Health professionals were trained to do brief interventions with all youth smokers entering care. In 2015 the YPC presented a brief to the provincial parlimentary committee on the Tobacco Act to support adoption of smoke-free policies for all health establishments in Québec. CONCLUSION: Daily tobacco use is very prevalent among adolescents entering YPCs and the majority report problematic use of other psychoac-tive substances. Youth entering care merit screening for tobacco and drug use so that appropriate counseling can be initiated. Promoting policies that encourage smoke-free environments in child protection centers for both youth and the professionals working with them may greatly improve the chances for youth to live tobacco-free.

From Fear to Avoidance: Factors Associated with the Onset of Avoidance in People who Fear Social Situations

Avoidance of social situations is a key factor in the maintenance of social anxiety disorder, with overt avoidance an important clinical indicator. This paper examines predictors of the transition from the initial experience of social fears to the development of overt avoidance behaviours. Using the 2007 Australian National Survey of Mental Health and Wellbeing, age, gender, DSM-IV diagnoses of other mental disorders and substance use were examined in discrete time survival models (n = 1,359). A majority of the sample reported overt avoidance within a year of initial social fears. Predictors of faster transitions to overt avoidance included fear of attending parties, entering a room or an older onset age. Predictors of slower transitions to overt avoidance included public performance fears and regular alcohol use. This study provides initial support for factors that may influence the transition from initial fear to overt avoidance in social anxiety disorder.

Psychosomatic problems in relation to alcohol use and physical exercise: a study between 1988 and 2011 among adolescents in Sweden

The aim was to investigate the association between psychosomatic problems and lifestyle patterns of alcohol use and physical exercise in adolescence. Cross-sectional questionnaire data from 8 years of investigations (1988–2011) were used. The sample included over 20,000 adolescents (50 % girls), aged 15–16. Adolescents were divided into three groups depending on psychosomatic problem load: 10th, 11th–89th and 90th percentiles on the psychosomatic problems scale (PSP). A composite measure of alcohol use (frequent/rarely/never) and physical exercise (regular/little/never) was created, resulting in nine combinations of health-related behaviours, and used as dependent variable. Multinomial regression analysis showed that those over the 90th percentile of the PSP had nearly 12 times higher odds of regular alcohol use combined with no exercise compared with those who had the least symptoms. The former subgroup also had higher odds of belonging to all suboptimal lifestyle categories. Those in the 11th–89th percentiles had increased, albeit smaller, odds of belonging to all lifestyle categories. Descriptive data analysis indicated gender differences and changes over time in the strength of the association between psychosomatic problems and health-related behaviours but the regression analysis did not show any statistically significant interactions. The proportion of adolescents engaging in the unhealthiest lifestyle had decreased over time while reports of psychosomatic problems had increased. Adolescents with the greatest psychosomatic symptom load were the most likely to engage in unhealthy lifestyles. This may mean multiplied risks of future psychopathology and warrants longitudinal investigations.

Intraclass correlation values for adolescent health outcomes in secondary schools in 21 European countries

BackgroundCluster randomised controlled trials (CRCTs) are increasingly used to evaluate the effectiveness of interventions for improving health. A key feature of CRCTs is that individuals in clusters are often more alike than individuals in different clusters, irrespective of treatment. This similarity within clusters needs to be taken into account when planning CRCTs to obtain adequate sample sizes, and when analysing clustered data to obtain correct estimates. MethodsNationally representative data from 15 to 16 year olds were analysed, from 21 of the 35 countries that participated in the 2007 European School Survey Project on Alcohol and Other Drugs. Within country school level intra-class correlation coefficients (ICCs) were calculated for substance use (self-reported alcohol use, regular alcohol use, binge drinking, any smoking, regular smoking, and illicit drug use) and psychosocial health (depressive mood and self-esteem). Unadjusted and adjusted ICCs are presented. ICCs are adjusted for student sex and socioeconomic status. ResultsICCs ranged from 0.01 to 0.21, with the highest (0.21) reported for regular smoking. Within country school level ICCs varied substantially across health outcomes, and among countries for the same health outcomes. Estimated ICCs were consistently higher for substance use (range 0.01–0.21), than for psychosocial health (range 0.01–0.07). Within country ICCs for health outcomes varied by changes in the measurement of particular health outcomes, for example the ICCs for regular smoking (range 0.06–0.21) were higher than those for having smoked at all in the last month (range 0.03–0.17). ConclusionsFor school level ICCs to be effectively utilised in informing sample size requirements for CRCTs and adjusting estimates from meta-analyses, the school level ICCs need to be both country and outcome specific.

Squamous cell carcinoma of the upper aerodigestive tract in exclusive smokers, chewers, and those with no habits.

Tobacco consumption is the major risk factor for developing head and neck squamous cell cancer (SCC). The site of development of HNSCC may depend on the way the tobacco is consumed. While laryngeal cancers are more common among smokers, oral cancers are more common among tobacco chewers. Since the use of smokeless tobacco is increasing, it is important to know whether this difference is restricted only to site wise distribution or it has other clinical and pathological implications. We analyzed a prospectively collected dataset of HNSCC patients other than nasopharyngeal cancers attending our outpatient department at a single unit of the head and neck services at Tata Memorial Hospital, Mumbai, India, between January 2010 and September 2011. There were 747 eligible patients and were divided into three groups: Those with chewing as the only habit (chewers), those with smoking as the only habit (smokers), and those with no habits. Patients with regular use of alcohol were excluded from the study. The clinical and pathological parameters were analyzed. Of the 747 patients, the tobacco chewers formed 69.3% followed by smokers (19.5%) and patients with no habits (11.1%). Majority of smokers were men (98%). Site distribution revealed patients with chewing as the only habit had oral cancers (most commonly gingivobuccal complex cancers) as the most common site and those with smoking as the only habit had larynx as the most common site. In patients with no habits, oral tongue was found to be the most common site. No statistically significant pathological differences were observed in between these groups in patients who underwent surgery (n = 366) at the initial modality of treatment. There is a direct relationship between the form of tobacco use and site of appearance of HNSCC. However, there are no differences in clinical or pathological parameters between HNSCC caused by tobacco chewing or tobacco smoking.

Nonmedical Use of Prescription Medication Among Adolescents Using Drugs in Quebec.

To determine the prevalence and factors associated with nonmedical use of prescription medication (NMUPM) among adolescents who use drugs (ages 12 to 17 years) in Quebec. Secondary data analyses were carried out with data from a 6-month study, namely, the 2010-2011 Quebec Health Survey of High School Students-a large-scale survey that sought to gain a better understanding of the health and well-being of young Quebecers in high school. Bivariate and multivariate logistic regression analyses were conducted to study NMUPM among adolescents who use drugs, according to sociodemographic characteristics, peer characteristics, health indicators (anxiety, depression, or attention-deficit disorder [ADD] with or without hyperactivity), self-competency, family environment, and substance use (alcohol and drug use) factors. Among adolescents who had used drugs in the previous 12 months, 5.4% (95% CI 4.9% to 6.0%) reported NMUPM. Based on multivariate analyses, having an ADD (adjusted odds ratio [AOR] 1.47; 95% CI 1.13 to 1.91), anxiety disorder (AOR 2.14; 95% CI 1.57 to 2.92), low self-esteem (AOR 1.62; 95% CI 1.26 to 2.08), low self-control (AOR 1.95; 95% CI 1.55 to 2.45), low parental supervision (AOR 1.43; 95% CI 1.11 to 1.83), regular alcohol use (AOR 1.72; 95% CI 1.36 to 2.16), and polysubstance use (AOR 4.09; 95% CI 3.06 to 5.48) were associated with increased odds of reporting NMUPM. The observed prevalence of NMUPM was lower than expected. However, the associations noted with certain mental health disorders and regular or heavy use of other psychoactive substances are troubling. Clinical implications are discussed.

A multi-outcome analysis of the effects of treatment timing in the management of zygomatic fractures

The aim of this study was to analyze the effects of surgical treatment delay in the management of zygomatic fractures. A retrospective case series of 99 patients was undertaken. Four outcome measures were analyzed in relation to delay: facial symmetry, facial scarring, trismus, and radiographic outcome. Five additional variables were subsequently analyzed: operation, diagnosis, primary operator, regular alcohol use, and regular cigarette use. Statistically significant associations were found between delay and facial scarring, and delay and radiographic outcome. For each additional delay of a day, the odds of facial scarring being present, compared to absent, decreased by 13% (odds ratio (OR) 0.87, 95% confidence interval (CI) 0.76–0.98). For regular cigarette users, for each additional day of delay there was a 306-fold increased risk of having a radiographic outcome of major deviation from premorbid compared to equivalent to premorbid (OR 306.38, 95% CI 2.08–45,161.49). For non-regular cigarette users/non-users, for each additional day of delay there was a 1.5-fold increased risk of having a radiographic outcome of major deviation from premorbid compared to equivalent to premorbid (OR 1.50, 95% CI 1.08–2.09). These findings correlate with commonly held beliefs and anecdotal evidence. Despite the limitations, this study allows for an evidence-based approach to the timing of treatment of zygomatic fractures.

Prevalence of Traumatic brain injury among female offenders in France. Results of the Fleury TBI study

Traumatic Brain injury (TBI) is a serious public health concern. The vast majority of studies about TBI and criminality have included male offenders and little is known about females. That could be explained by the fact that females represent a very small proportion of prisoners. In the general population most reports on TBI also refer to males because they represent 3/4 to 2/3 of subjects who sustained a TBI. This study examines the prevalence of TBI among a population of female offenders. To establish the prevalence of self-reported TBI in a female prison population, to compare the prevalence of TBI among this population and the general population, and to discuss the possible links between TBI and criminality. All female offenders consecutively admitted in Fleury-Mérogis prison, during a 3-month period were included in the study. During the routine admission procedure they were interviewed by health care staff. Information and consent were given orally. The questionnaires were completely anonymised. 100 questionnaires were analysed with a population of 88 adult females and 12 juveniles. The prevalence of a self-reported history of TBI was 21%. The first cause of TBI among females was violence related (35%) and the large majority had sustained repeated TBIs. Prevalence of self-reported epilepsy was 6.8% for adult females. Psychiatric care was reported by 11.4% of females. Nearly a fourth of females received anxiolytic treatment (23.9%) whereas 13.6% were on antidepressant treatment. Adult females used more alcohol than cannabis (21.6% versus 12.5%). Daily or regular use of alcohol and cannabis was found in 9.1% and 4.6% respectively. To our knowledge, this is the first study to report the prevalence of self-reported TBI among prisoners in France and in particular among female offenders. As described in the literature, women are at higher risk of TBI from domestic violence. Research in this area should focus on prevention measures.

The effectiveness of sleep education programs in improving sleep hygiene knowledge, sleep behavior practices and/or sleep quality of college students: a systematic review protocol

The effectiveness of sleep education programs in improving sleep hygiene knowledge, sleep behavior practices and/or sleep quality of college students: a systematic review protocol

The effectiveness of sleep education programs in improving sleep hygiene knowledge, sleep behavior practices and/or sleep quality of college students: a systematic review protocol.

REVIEW QUESTION / OBJECTIVE What is the effectiveness of sleep education programs in improving sleep hygiene knowledge, sleep behavior practices and/or sleep quality of college students? The review objective is to identify, appraise and synthesize the best available evidence on the effectiveness of sleep education programs in improving sleep hygiene knowledge, sleep behavior practices, and/or sleep quality versus traditional strategies. INCLUSION CRITERIA Types of participants This review will consider studies that include all undergraduate or graduate college students, male or female, and of all ages, cultures and ethnicities. All undergraduate and graduate college students will be considered for inclusion due to pre-existing behaviors and circumstances that occur when a student enters into the college environment, for example, late night sleep patterns due to studies and socializing as previously discussed in Background. Pre-existing knowledge on sleep hygiene practices, diagnoses and treatments are not considered in this systematic review as confounding variables as the entire population is exposed to the contexts and risks for poor sleep health. Types of intervention(s) This review will consider studies that evaluate formal sleep education programs that include a curriculum on sleep hygiene practices that is designed to facilitate sleep health including but not limited to: maintaining regular sleep wake times, limited alcohol, caffeine and nicotine use prior to bed time, regular sleep wake schedules, and sleep environments conducive to sleep. Formal educational delivery will include, for example: college courses/seminars that are delivered face-to-face, web-based computer programs, and/or a combination of these delivery methods. The formal sleep TRUNCATED AT 250 WORDS

Alcohol and Drug Use Among Postoperative Bariatric Patients: A Systematic Review of the Emerging Research and Its Implications.

Emerging research suggests that some bariatric surgery patients are at a heightened risk for developing substance use problems, especially alcohol use problems. An exhaustive literature review was conducted in January 2015 to investigate all articles published that included data on postoperative alcohol use, alcohol use disorders, and illicit drug use among bariatric surgery patients. Twenty-three studies reported on alcohol and/or substance use among bariatric patients. Six studies longitudinally assessed alcohol use behaviors; 3 of these studies found an increase in alcohol use following surgery. Six studies were cross-sectional, and 2 studies assessed medical records. Five studies investigated the prevalence of admissions to substance abuse treatment, and 3 studies combined alcohol and drug use data in a single index. Six studies reported on illicit drug use and reported low-postoperative use. The studies' samples were primarily non-Hispanic white females in their upper 40s, and only 11 of the 23 studies utilized validated assessment instruments. Studies employing longitudinal designs and large sample sizes indicate that bariatric patients who had the gastric bypass procedure are at an elevated risk for alcohol use problems postoperatively. Research also indicates that bariatric surgery patients might be overrepresented in substance abuse treatment facilities. Risk factors for problematic postoperative alcohol use include regular or problematic alcohol use presurgery, male gender, younger age, tobacco use, and symptoms of attention deficient and hyperactivity disorder. As a whole, however, studies indicate bariatric surgery patients demonstrate a low prevalence of problematic alcohol use, and studies about gastric bypass patients are not entirely conclusive. Prospective, longitudinal studies are needed, utilizing standardized and validated alcohol assessment instruments that follow postoperative bariatric patients well beyond 2 years, and account for types of bariatric procedure. Finally, study samples with greater racial/ethnic diversity and wider age ranges are needed.

Combined Whole Methylome and Genomewide Association Study Implicates CNTN4 in Alcohol Use.

Methylome-wide association (MWAS) studies present a new way to advance the search for biological correlates for alcohol use. A challenge with methylation studies of alcohol involves the causal direction of significant methylation-alcohol associations. One way to address this issue is to combine MWAS data with genomewide association study (GWAS) data. Here, we combined MWAS and GWAS results for alcohol use from 619 individuals. Our MWAS data were generated by next-generation sequencing of the methylated genomic DNA fraction, producing over 60million reads per subject to interrogate methylation levels at ~27million autosomal CpG sites in the human genome. Our GWAS included 5,571,786 single nucleotide polymorphisms (SNPs) imputed with 1000 Genomes. When combining the MWAS and GWAS data, our top finding was a region in an intron of CNTN4 (p=2.55×10(-8) ), located between chr3: 2,555,403 and 2,555,524, encompassing SNPs rs1382874 and rs1382875. This finding was then replicated in an independent sample of 730 individuals. We used bisulfite pyrosequencing to measure methylation and found significant association with regular alcohol use in the same direction as the MWAS (p=0.021). Rs1382874 and rs1382875 were genotyped and found to be associated in the same direction as the GWAS (p=0.008 and p=0.009). After integrating the MWAS and GWAS findings from the replication sample, we replicated our combined analysis finding (p=0.0017) in CNTN4. Through combining methylation and SNP data, we have identified CNTN4 as a risk factor for regular alcohol use.

Lifestyle-factors in adolescence as predictors of number of musculoskeletal pain sites in adulthood: a 17-year follow-up study of a birth cohort.

Musculoskeletal (MS) pain, especially in multiple body sites, may develop into a disabling problem. Still, the long-term risk factors of MS pain are insufficiently known. We examined whether adverse health behaviors in adolescence are associated with the number of pain sites in adulthood. The study population was a subgroup (n = 5,737) of the 1966 Northern Finland Birth Cohort, which had answered a postal questionnaire on health behaviors at the age of 14 and a pain questionnaire at approximately 31 years. Adverse health behaviors in adolescence, such as occasional smoking (odds ratio (OR) 1.6; 95% confidence interval (CI) 1.0-2.6) and overweight/obesity (1.7; 1.0-2.8) among males, and daily smoking (1.9; 1.0-3.5) and regular use of alcohol (2.2; 1.0-4.8) among females predicted pain in three or more body regions at the age of 31. Physical inactivity (1.6; 1.1-2.5) and moderate physical activity (1.7; 1.1-2.6) were risk factors for two pain sites among females. In addition, the ORs for pain in three or more body regions were high, but the CIs were broad for daily smoking among males and overweight/obesity among females (1.7; 0.8-3.5 and 1.4; 0.8-2.2, respectively). As adverse health behaviors in adolescence were moderately associated with multisite MS pains in adulthood, the effectiveness of intervening in adverse health behaviors in adolescence as regards later MS pain should be analyzed.

Quality of life and risk of psychiatric disorders among regular users of alcohol, nicotine, and cannabis: An analysis of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC)

Research is limited on the effects of regular substance use on mental health-related outcomes. We used a large nationally representative survey to examine current and future quality of life and risk of psychiatric disorders among past-year regular (weekly) users of alcohol, nicotine, and cannabis. Data on psychiatric disorders and quality of life from two waves (Wave 1 N = 43,093, Wave 2 N = 34,653) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) were used to test study aims. In cross-sectional analyses, regular nicotine and cannabis use were associated with higher rates of psychiatric disorder, though regular alcohol use was associated with lower rates of disorders. Prospective analyses found that regular nicotine use predicted onset of anxiety, depressive, and bipolar disorders. Regular alcohol use predicted lower risk of these disorders. Regular cannabis use uniquely predicted the development of bipolar disorder, panic disorder with agoraphobia, and social phobia. Lastly, regular alcohol use predicted improvements in physical and mental health-related quality of life, whereas nicotine predicted deterioration in these outcomes. Regular cannabis use predicted declines in mental, but not physical health. These data add to the literature on the relations between substance use and mental and physical health and suggest increased risk of mental health problems among regular nicotine and cannabis users and better mental and physical health among regular alcohol users. Examination of mechanisms underlying these relationships is needed.

Concurrent Alcohol and Marijuana Use as a Determinant of Condom Beliefs and Utility Among African American Male Inmates

The objective of this study is to determine the extent to which regular use of marijuana and alcohol may influence African American inmate’s beliefs, views, and practices regarding condoms. In this article, we report and discuss the implications of our findings for the planning of HIV prevention interventions for African American male inmate populations. Relationships between individual condom use and belief variables were examined using linear regression models. All models specified regularity of marijuana or alcohol use with respect to detailed condom use or belief outcomes as predictor variables. Analysis from 126 male inmates recruited from three medium security prisons and one Area Transition Center in Georgia are presented herein. Results note that frequency of marijuana use predicted and was associated with inmate’s reporting how often they use a condom during sex (Beta = −0.261, P < 0.009), suggesting that the more respondents reported smoking marijuana, the less likely they were to indicating using condoms during sex. Regularity of alcohol consumption was almost predictive of inmates indicating that they could always talk to any potential sex partner to make him/her understand why they should use condoms (p < 0.082) and stating that they could always say no to sexual intercourse with someone they had just met even if they were very attracted to that person (p < 0.063).

Study of the health status of geriatric age group in Chitwan district of Nepal

Retirement, change in housing, illness or death of spouse greatly affect the physical and mental well-being of the geriatric person. This study aims to find out the health status of geriatric age group in chitwan district of Nepal. A cross sectional study was carried out among 300 geriatric people where 15.7% of the geriatric were living alone, 50.3 % and 39.7% of geriatrics gave history of regular use of tobacco and alcohol respectively. Co-morbidities were found in 63% of geriatrics who suffered from 2 or more diseases. In Total 44% were found to have Ophthalmic problems, 23% were found to have ENT problems, 5.33% were found to mental disorders, 33% were found to have CVS problems, 43% were found to have GI problems, 15.67 % were found to have Metabolic disorder. The study highlighted a high prevalence of morbidity and health related problems in geriatric age groups.DOI: http://dx.doi.org/10.3126/jcmc.v5i1.12560

Prevention of Premature Death of Somatic Causes in Patients with Mental Illness and Comorbid Substance Use Disorder

Introduction Physical comorbidities are common in patients with mental illness and substance use disorder. Both regular use of alcohol and cannabis have been associated with adverse health effects. However, their physical comorbidities can also be explained by other unhealthy lifestyle choices, i.e. lack of physical activity, poor nutrition and smoking. Aim The aim of this study is to analyse baseline and follow up data after one and a half year of a 3-year interventional programme of improvement of physical health in patients with mental illness and comorbid substance use disorder. Methods All patients with mental illness and substance use disorder referred to Department M at Aarhus University Hospital Risskov, Denmark from 1 July 2013 and onwards are included in the programme. The study takes an active awareness and motivational interviewing approach to increase knowledge and understanding of physical health problems. The intervention includes health promotion activities, and physical health parameters are monitored. Further guidance on healthy food intake, smoking cessation and a physically active life is provided. Results 50 patients are expected to be participating in the programme after one and a half year. Preliminary results after one-year show that 89,7 % smoke cigarettes, their level of physical activity is low, which is seen in the extent of their sedentary behaviour. Further there are problems with insufficient food intake among patients. Conclusions This study indicates, that patients with mental illness and comorbid substance use disorder need guidance on a healthier lifestyle. They show an interest in this interventional programme.

Waterpipe use among high school students in Ontario: Demographic and substance use correlates.

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. 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. 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. 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.