Energy Drinks, Alcohol, Sports and Traumatic Brain Injuries among Adolescents

RESEARCH ARTICLE Energy Drinks, Alcohol, Sports and Traumatic Brain Injuries among Adolescents Gabriela Ilie1,2*, Angela Boak3, Robert E. Mann3,4, Edward M. Adlaf3,4, Hayley Hamilton3,4, Mark Asbridge5, Jürgen Rehm3,4, Michael D. Cusimano4,6 1 Injury Prevention Research Office, St. Michael’s Hospital, Toronto, Canada, 2 Department of Psychology, University of Toronto, Toronto, Canada, 3 Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Canada, 4 Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, 5 Dalhousie University, Halifax, Canada, 6 Division of Neurosurgery, University of Toronto, Toronto, Canada a11111 * Abstract OPEN ACCESS Citation: Ilie G, Boak A, Mann RE, Adlaf EM, Hamilton H, Asbridge M, et al. (2015) Energy Drinks, Alcohol, Sports and Traumatic Brain Injuries among Adolescents. PLoS ONE 10(9): e0135860. doi:10.1371/journal.pone.0135860 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. Editor: Fernando de Castro, Hospital Nacional de Parapléjicos - SESCAM, SPAIN Objective Received: March 18, 2015 We report on the prevalence of adolescent TBI and its associations with energy drinks, alcohol and energy drink mixed in with alcohol consumption. Accepted: July 27, 2015 Published: September 16, 2015 Design, Settings and Participants Copyright: © 2015 Ilie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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 selfadministered questionnaires in classrooms. Data Availability Statement: Due to the Centre for Addiction and Mental Health’s and The Ontario Public and Catholic School Board’s institutional Research Ethics Board agreements our data cannot be made available in the manuscript, the supplemental files or a public repository. Readers, however, may contact to request the public data file underlying the findings of this study from the Centre for Addiction and Mental Health from Angela Boak ( ) and/or Dr. Robert Mann ( ). Full reports of the public data files and the surveys administered can be accessed online: http://www. camh.ca/en/research/news_and_publications/ontario- 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, PLOS ONE | DOI:10.1371/journal.pone.0135860 September 16, 2015 1 / 13 Energy Drinks, Alcohol, Sport Concussions among Adolescents student-drug-use-and-health-survey/Pages/default. aspx. Funding: This work was financially supported by a Team Grant (TIR103946) from Canadian Institutes of Health Research and by funds from the Ontario Neurotrauma Foundation, AUTO21, a member of the Networks of Centres of Excellence (NCE) program that is administered and funded by the Natural Sciences and Engineering Research Council (NSERC), the Canadian Institutes of Health Research (CIHR), and the Social Sciences and Humanities Research Council (SSHRC), in partnership with Industry Canada. Drs. RM, HH and JR also acknowledge ongoing funding support from the Ontario Ministry of Health and Long-Term Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. 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. Introduction In recent years, traumatic brain injuries (TBI) among children and adolescents have been identified as a major health concern in the United States and Canada, with increases of 57% in sports-related TBI in the US between 2001 and 2009 [1–5]. Recently, we reported that 5.6% of students in grades 7–12 in Ontario, Canada reported a TBI in the previous 12 months, most of which were identified as having occurred during team sports play [5]. Sports offer youth many health benefits, and a recent report notes that only 4% of 12- to 17-year-olds in Canada meet the recommended guidelines of 60 minutes of moderate to vigorous activity daily, while North-American youth 12 to 17-years-old spend an average of 9.3 hours daily being sedentary [6]. Nevertheless, rates of sports-related TBI among adolescents have been described as an epidemic [7]. Many of these injuries are unreported and are not considered serious by youth, their parents, coaches and often medical practitioners [8]. Positive attitudes towards violence in team sports (e.g., hockey, American football) embedded in North American culture may also play a role in this problem [9]. The Centre for Disease Control and Prevention and the Institute of Medicine have recommended several actions to address this problem, including research on the risks and consequences of TBI, and knowledge translation to the public and the vulnerable populations (e.g., young and old athletes) [1–5]. One in five adolescents in a 2011 Canadian sample reported sustaining a traumatic brain injury in their lifetime [5]. Adolescent TBI raises concerns given the acute and chronic cognitive, emotional and psychosocial consequences such injured adolescent may endure during a period in their development (when social sk (...truncated)