Young drivers vs. non-drivers: are there differences in behaviour?

BACKGROUND: Traditionally, a first step toward independence for a North American youth has been to obtain a driver's licence. Licensure can be associated with freedom and independence to provide teens opportunities to participate in conventional and health-enhancing behaviours, such as school, work, sporting events and other social activities, and/or provide opportunities to engage in unconventional, risk taking and health compromising behaviours. Yet, recent trends show that youth are delaying getting their licence. OBJECTIVE: The purpose of this study was to use the constructs of conventional and unconventional behaviours identified in Problem Behaviour Theory (PBT) under the behaviour system to examine whether driver licensure status in youth was associated with conventional, health-enhancing behaviours or unconventional, health compromising, risky behaviours. METHOD: Data were derived from the 2015 and 2017 cycles of the Ontario Student Drug Use Survey (OSDUHS). Analyses are based on a subsample of students who were at least 16 years of age. Included measures: driver's licence (at least a G1 - the first stage of a 3-stage graduated licensing system), conventional behaviours (academic performance, school connectedness, employment, physical activity, and sleep), unconventional behaviours (tobacco use, cannabis use, alcohol use, binge drinking, hazardous drinking, problematic drug use, screen time, and number of antisocial behaviours), and control factors (age, sex, region, family Socio-Economic Status (SES)). RESULTS: 67.97 % of youth 16-19 years of age obtained a driver's licence. Of the sample, 71.80 % of males, 75.05 % not living in the Greater Toronto Area (GTA), and 70.86 % of youth with an average family SES received their driver's licence. In regression analyses, older youth, males, and youth not living in the GTA had significantly higher odds of obtaining a driver's licence than younger youth, females, and youth living in the GTA. Conventional behaviours that were significantly positively associated with licensure status included youth who had high academic achievement, good social connectedness, and who were employed. Unconventional behaviours that were significantly positively associated with licensure status included alcohol use and binge drinking. DISCUSSION: In agreement with Problem Behaviour Theory, the results show that youth who obtain their licence show limited problematic lifestyle or 'proneness' (Gohari, 2019). Alcohol use and binge drinking were significantly associated with youth obtaining a driver's licence but hazardous drinking was not. This study suggests that a driver's licence for youth could both control but also instigate unconventional behaviours as identified by PBT. A driver's licence could also provide opportunities for conventional behaviours associated with education and school connectedness. However, the independence provided by a driver's licence could offer youth unsupervised social opportunities to drink and binge drink that may be health-compromising. Thus, based on PBT, licensure status is associated with both conventional behaviours, as well as problem behaviours associated with alcohol use.

Coronavirus disease 2019: What could be the effects on Road safety?

In March 2020, the World Health Organization declared COVID-19 a world-wide pandemic. Countries introduced public health measures to contain and reduce its spread. These measures included closures of educational institutions, non-essential businesses, events and activities, as well as working from and staying at home requirements. These measures have led to an economic downturn of unprecedented proportions. Generally, as economic activity declines, travel decreases and drivers are exposed to a lower risk of collisions. However, research on previous economic downturns suggests economic downturns differentially affect driver behaviours and situations. COVID-19 pandemic effects on road safety are currently unknown. However, preliminary information on factors such as the increased stress and anxiety brought about by the COVID-19 pandemic, more "free" (idle) time, increased consumption of alcohol and drugs, and greater opportunities for speeding and stunt driving, might well have the opposite effect on road safety. Using an interactionist model we identify research questions for researchers to consider on potential person and situation factors associated with COVID-19 that could affect road safety during and after the pandemic. Collaborative efforts by researchers, and public and private sectors will be needed to gather data and develop road safety strategies in relation to the new reality of COVID-19.

The relationship between motor vehicle collisions and cigarette smoking in Ontario: Analysis of CAMH survey data from 2002 to 2016.

Research has shown that tobacco users have an increased risk of collisions compared to nonsmokers. Studies from 1967 through 2013 documented a crude relative risk of collision involvement of about 1.5 among smokers compared to nonsmokers. In January 2009, in response to concerns about the health risks associated with potentially high concentrations of secondhand smoke resulting from smoking in vehicles, the provincial government in Ontario, Canada, introduced legislation restricting smoking in vehicles where children and adolescents are present. We examined the association between reported smoking and involvement in a motor vehicle collision in a large representative sample of adult drivers in Ontario, Canada, from 2002 and 2016, with particular focus on 2002-2008 and 2010-2016, periods before and after the legislation. Data are based on the Centre for Addiction and Mental Health (CAMH) Monitor. Among licensed drivers, prevalence of self-reported collision involvement within the past year for 2002-2008 was 9.39% among those who currently smoked compared to 7.08% of nonsmokers. Following implementation of the legislation, for 2010-2016, the prevalence of collisions for smokers was 7.01% and for nonsmokers was 6.02%. The overall difference for both smokers and nonsmokers between the two time periods was statistically significant; however, the difference between the two groups for the pre-legislation period was significant even after adjusting for potential confounders, while post legislation the difference was not significant. Prior to the legislation, the prevalence of collision was higher among smokers than nonsmokers; following the introduction of the legislation the prevalence was similar for the two groups.

Young male drivers' perceptions of and experiences with YouTube videos of risky driving behaviours.

OBJECTIVE: YouTube features millions of videos of high risk driving behaviours and negative consequences of high risk driving ("fails"), such as injuries or deaths. Unfortunately, no information is available on YouTube viewership of these types of sites or on the effects of these videos on viewers. The purpose of this study was to examine young male drivers' perceptions of and experiences with YouTube videos of risky driving behaviours. METHODS: Using an exploratory qualitative descriptive approach, three 2-hour focus groups were conducted with young men 18-30 years of age to determine: (i) if they watch and share YouTube videos, including high risk driving videos; (ii) what effects high risk driving videos have on them and others and whether YouTube videos of negative consequences discourage high risk driving. RESULTS: Participants indicated three uses for YouTube; it has replaced television watching and provides entertainment and information. Motivations of both risky drivers in videos and viewers to engage in high risk driving activities included person characteristics (e.g., sensation seeking and responsivity to financial rewards for high view count videos) and socio-environmental factors (e.g., peer pressure). Most indicated that they would not try to imitate the risky behaviours exhibited in videos, although a few had tried to copy some risky driving moves from videos. CONCLUSIONS: Social, not mass media is now the common information and entertainment source for young people. YouTube videos of high risk driving are common and ubiquitous. Findings from these focus groups suggest that viewers could influence subsequent content of social media videos and reciprocally, videos could influence behaviours of some viewers, particularly young male viewers.

Attention deficit hyperactivity disorder and arrest history: Differential association of clinical characteristics by sex.

Attention deficit hyperactivity disorder (ADHD) is often cited as a risk factor for criminality. However, many studies do not take other criminogenic variables into account when reporting on this relationship. It is even less clear whether models that include ADHD as a potential risk factor for criminality consider the importance of sex differences. To answer this question, we collected data from a telephone population survey sampling adults over the age of 18 years in the province of Ontario, Canada (final sample size = 5196). Respondents were screened for ADHD using the Adult ADHD Self-Report Version 1.1 Screener (ASRS-V1.1) and four extra items. Problematic drinking was assessed using the Alcohol Use Disorders Identification Test (AUDIT), while cannabis misuse was evaluated using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The Antisocial Personality Disorder Scale from the Mini-International Neuropsychiatric Interview provided a measure of previous conduct disorder symptoms and the 12-item General Health Questionnaire screening procedure was used to gauge general distress. History of arrest was self-reported. Three separate logistic regression analyses (entire sample, male only, and female only) were applied to estimate the association of the foregoing variables with arrest history. In the combined sample, conduct disorder symptoms, problem alcohol use, and problem cannabis use all predicted history of arrest. With regard to the male sample, conduct disorder symptoms, elevated AUDIT and ASSIST scores, and general distress were associated with an arrest history. For the female subsample, only conduct disorder symptoms and problematic cannabis use showed a relationship with criminality. To summarize, ADHD did not predict history of arrest for either subsample or the combined sample. When comparing males and females, conduct disorder symptoms and cannabis misuse exerted stronger effects on history of arrest for females than males. These results suggest that the relative importance and type of clinical risk factors for arrest may differ according to sex. Such information could be useful for crime prevention policies and correctional programs that take into account differences in experience by sex.

Is there a link between motor vehicle collisions and being a cigarette smoker in Canada? Analysis of survey data from Ontario from 2002 to 2014.

OBJECTIVE: Although most research on drugs and driving has focused on the use of alcohol and cannabis, research that has been conducted on cigarette smoking and collisions has found that smokers have an increased collision involvement. Studies dating from 1967 through 2013 have shown a crude relative risk of about 1.5 among smokers compared to nonsmokers. In Canada, the association between smoking and collisions has not been recently investigated. Studies that have examined the association between smoking and collisions often did not control for all confounding factors, such as alcohol use and driving exposure, which have been associated with increased collision rates. Additionally, a number of these studies were examined in countries and at times when prevalence of smoking was much higher than is currently the case in Canada. The purpose of this research is to examine the association between self-reported current smoking and past-year collision involvement, controlling for confounding factors, in a large representative sample of adult drivers in Ontario, Canada, from 2002 and 2014. METHOD: Data are based on the Centre for Addiction and Mental Health (CAMH) Monitor, an ongoing, rolling telephone survey of Ontario adults that provides epidemiological surveillance of indicators related to alcohol, tobacco, and other drug use, as well as physical and mental health. The survey uses random-digit-dialing methods via Computer-Assisted Telephone Interview, with response rates over 50%. RESULTS: Prevalence of self-reported collision involvement within the past year for 2002-2014 was 8.6% among those who currently smoke compared to 6.5% of nonsmokers. Logistic regression analysis, controlling for the potential confounding effects of sociodemographics, driving exposure measures, drinking frequency, and hazardous alcohol use, found that the overall odds for collision involvement in the preceding year among current smokers for 2002-2014 was 1.27 (95% confidence interval [CI], 1.06-1.53) times that of nonsmokers. CONCLUSIONS: These findings indicate that despite a substantial reduction in overall prevalence of smoking in Canada, smokers still have a significantly increased odds of collision involvement, even when controlling for alcohol and exposure. Additionally, the results are consistent with the increased odds/risks of motor vehicle collisions found in other countries.

Literature review on risky driving videos on YouTube: Unknown effects and areas for concern?

OBJECTIVE: Entry of terms reflective of extreme risky driving behaviors into the YouTube website yields millions of videos. The majority of the top 20 highly subscribed automotive YouTube websites are focused on high-performance vehicles, high speed, and often risky driving. Moreover, young men are the heaviest users of online video sharing sites, overall streaming more videos, and watching them longer than any other group. The purpose of this article is to review the literature on YouTube videos and risky driving. METHODS: A systematic search was performed using the following specialized database sources-Scopus, PubMed, Web of Science, ERIC, and Google Scholar-for the years 2005-2015 for articles in the English language. Search words included "YouTube AND driving," "YouTube AND speeding," "YouTube AND racing." RESULTS: No published research was found on the content of risky driving videos or on the effects of these videos on viewers. This literature review presents the current state of our published knowledge on the topic, which includes a review of the effects of mass media on risky driving cognitions; attitudes and behavior; similarities and differences between mass and social media; information on the YouTube platform; psychological theories that could support YouTube's potential effects on driving behavior; and 2 examples of risky driving behaviors ("sidewalk skiing" and "ghost riding the whip") suggestive of varying levels of modeling behavior in subsequent YouTube videos. CONCLUSIONS: Every month about 1 billion individuals are reported to view YouTube videos (ebizMBA Guide 2015 ) and young men are the heaviest users, overall streaming more YouTube videos and watching them longer than women and other age groups (Nielsen 2011 ). This group is also the most dangerous group in traffic, engaging in more per capita violations and experiencing more per capita injuries and fatalities (e.g., Parker et al. 1995 ; Reason et al. 1990 ; Transport Canada 2015 ; World Health Organization 2015 ). YouTube also contains many channels depicting risky driving videos. The time has come for the traffic safety community to begin exploring these relationships.

Adult attention deficit hyperactivity disorder symptom profiles and concurrent problems with alcohol and cannabis: sex differences in a representative, population survey.

BACKGROUND: Adult attention deficit hyperactivity disorder (ADHD) shows a robust association with alcohol and cannabis misuse, and these relationships are expressed differently in males and females. Manifestation of specific ADHD symptom profiles, even in the absence of the full disorder, may also be related to problems with alcohol and cannabis, although these relationships have not been investigated in epidemiological studies. To address this question, we studied the sex-specific associations of ADHD symptomatology with problematic alcohol and cannabis use in a representative sample of adults aged 18 years and older residing in Ontario, Canada. METHODS: Data were obtained from the Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey, between January 2011 and December 2013. Respondents (n = 5080) reported on current ADHD symptomatology, measured using the Adult ADHD Self-Report Version 1.1 Screener (ASRS-V1.1) and four additional items, and alcohol and cannabis use, which were measured using the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), respectively. Logistic regression analyses were conducted in men and women to test the association of each ADHD symptom cluster (hyperactivity, inattentiveness, impulsivity) with problematic alcohol and cannabis use. RESULTS: After controlling for age, education, and comorbid internalizing and externalizing psychopathology, hyperactive symptoms were associated with problematic alcohol use in both men and women and with problematic cannabis use in men. Impulsive symptoms were independently associated with problematic cannabis use in men. By contrast, inattentive symptomatology predicted problems with alcohol and cannabis only in women. In all models, age was negatively associated with substance misuse and externalizing behavior was positively correlated and the strongest predictor of hazardous alcohol and cannabis use. CONCLUSIONS: ADHD symptom expression in adulthood is related to concurrent hazardous use of alcohol and cannabis. Distinctive ADHD symptom profiles may confer increased risk for substance misuse in a sex-specific manner.

Relationships between thrill seeking, speeding attitudes, and driving violations among a sample of motorsports spectators and drivers.

BACKGROUND: Motor racing includes high speed driving and risky maneuvers and can result in negative outcomes for both spectators and drivers. Interest in motorsports is also associated with risky driving attitudes and behaviors on public roads as well as with individual difference variables, such as sensation seeking. However, whether the links between motorsports involvement and risky driving tendencies differ for spectators and drivers has remained mainly unexamined. The aim of this study was to investigate the relationships between thrill seeking, attitudes toward speeding, and self-reported driving violations among a sample of motorsports spectators and drivers. METHOD: A web-based survey was conducted and sampled 408 members and visitors of car club and racing websites in Ontario, Canada. The questionnaire included measures of (i) motorsports involvement, (ii) thrill seeking (Driver Thrill Seeking Scale), (iii) attitudes (Attitudes toward Speed Limits on Roadways and Competitive Attitudes toward Driving Scale); (iv) self-reported driving violations (adapted from Driver Behaviour Questionnaire), and (v) background variables. Path analysis was performed to test the relationships among the variables. RESULTS: For both spectators and drivers, thrill seeking directly predicted driving violations; competitive attitudes toward driving further mediated this relationship. Attitudes toward speed limits, however, mediated the relationship between thrill seeking and violations only for drivers. DISCUSSION: We observed significant relationships among individual difference measures, motorsports involvement, speeding attitudes and violations that may inform road safety interventions, including differences in the relationships among thrill seeking, speeding attitudes, and violations for motorsports spectators and drivers.

Attention Deficit Hyperactivity Disorder Symptoms, Comorbidities, Substance Use, and Social Outcomes among Men and Women in a Canadian Sample.

Background. Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that can persist in adolescence and adulthood. Aim. To examine prevalence of ADHD symptoms and correlates in a representative sample of adults 18 years and older living in Ontario, Canada. Method. We used the Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey, to examine the relationships between ADHD positive symptoms and comorbidities, substance use, medication use, social outcomes, and sociodemographics. Results. Of 4014 residents sampled in 2011-2012, 3.30% (2.75%-3.85%) screened positively for ADHD symptoms (women = 3.6%; men = 3.0%). For men, distress, antisocial symptoms, cocaine use, antianxiety medication use, antidepressant medication use, and criminal offence arrest were associated with positive ADHD screen. For women, distress, cocaine use, antianxiety medication use, antidepressant medication use, pain medication use, and motor vehicle collision in the past year were associated with positive ADHD screen. Conclusions. ADHD symptoms are associated with adverse medical and social outcomes that are in some cases gender specific.

Using factor analytic models to examine the association between attention-deficit/hyperactivity disorder symptoms and health-related outcomes in a representative population survey.

The objective of the study was to examine the factor structure of attention-deficit/hyperactivity disorder (ADHD) symptoms in a representative population survey of adults and the association of these factors with health outcomes. Hierarchical and correlated factor analysis models were compared, and regression analyses with these models were used to determine the associations with psychological distress and substance use problems. A total of 1449 adults 18-65 years of age participated in a cross-sectional survey over the phone. ADHD symptom data came from an ADHD screener (10 items), and health outcomes were assessed using a questionnaire measuring psychological distress and two measures of substance use problems. The hierarchical general factor models with specific factors best represented the structure of ADHD in this representative population survey. The general factor and residual inattention factor were significantly associated with psychological distress, and the general factor was associated with substance use problems. From the correlated factor models, the inattention factor was associated with psychological distress and the hyperactivity factor was related to substance use problems. The hierarchical and correlated factor models explained similar levels of variance in outcomes. The results replicate previous studies indicating that a model of ADHD symptoms with a unitary dimension and separable dimensions of residual inattention and hyperactivity/impulsivity demonstrates a better fit than correlated factor models. The ADHD general factor was consistently significantly related to outcomes.

The impact of childhood symptoms of conduct disorder on driver aggression in adulthood.

BACKGROUND: Despite limited empirical investigation, existing scientific literature suggests that individuals with a history or current diagnosis of conduct disorder (CD) may be more likely to demonstrate reckless and aggressive driving. Much of the limited research in this field examines the impact of childhood CD on driver behaviour and collision risk in young adults. Few if any, studies assess the impact of this disorder on driver behaviour beyond age 21 years. The current research is a population-based study of the impact of CD symptoms during childhood on the risk of engaging in driver aggression during adulthood. METHODS: Data are based on telephone interviews with 5230 respondents who reported having driven in the past year. Data are derived from the 2011-2013 cycles of the CAMH Monitor, an ongoing cross-sectional survey of adults in Ontario, Canada aged 18 years and older. A binary logistic regression analysis of self-reported driver aggression in the previous 12 months was conducted, consisting of measures of demographic characteristics, driving exposure, problem substance use, alcohol- and drug-impaired driving, symptoms of attention deficit hyperactivity disorder, and childhood (before age 15) symptoms of CD. RESULTS: When entered with demographic characteristics, driving exposure, and other potential confounders, childhood symptoms of CD increased the odds of reporting driver aggression more than two-fold (adjusted OR=2.12). Exploratory analyses of the interaction between childhood symptoms of CD and age was not a significant predictor of driver aggression. CONCLUSIONS: Results suggest that symptoms of CD during childhood are associated with significantly increased odds of self-reported driver aggression during adulthood. Limitations and future directions of the research are discussed.

High-risk driving attitudes and everyday driving violations of car and racing enthusiasts in Ontario, Canada.

OBJECTIVE: Attitudes and individual difference variables of car and racing enthusiasts regarding high-risk behaviors of street racing and stunt driving have recently been investigated. Positive attitudes toward high-risk driving, personality variables such as driver thrill seeking, and other self-reported risky driving acts were associated with these behaviors. However, probable relationships among high-risk driving tendencies, everyday driving behaviors, and negative road safety outcomes have remained largely unexamined. This study aimed to investigate the associations among car and racing enthusiasts' high-risk driving attitudes, self-reported everyday driving violations (i.e., ordinary and aggressive violations), and self-reported negative outcomes (i.e., collisions and driving offense citations). METHOD: A web-based survey was conducted with members and visitors of car club and racing websites in Ontario, Canada. Data were obtained from 366 participants. The questionnaire included 4 attitude measures-(1) attitudes toward new penalties for Ontario's Street Racers, Stunt and Aggressive Drivers Legislation; (2) attitudes toward new offenses of stunt driving under the same legislation; (3) general attitudes toward street racing and stunt driving; (4) comparison of street racing with other risky driving behaviors-self-reported driving violations (i.e., ordinary and aggressive violations); self-reported collisions and offense citations; and background and driving questions (e.g., age, driving frequency). RESULTS: Results revealed that attitudes toward stunt driving offenses negatively and general attitudes toward street racing and stunt driving positively predicted ordinary violations, which, in turn, predicted offense citations. Moreover, general attitudes toward street racing and stunt driving positively predicted aggressive violations, which, in turn, predicted offense citations. CONCLUSION: The findings indicate that positive high-risk driving attitudes may be transferring to driving violations in everyday traffic, which mediates driving offense citations.

Attention deficit hyperactivity disorder, other mental health problems, substance use, and driving: examination of a population-based, representative canadian sample.

PURPOSE: The purpose of this study is to examine the relationships among self-reported screening measures of attention deficit hyperactivity disorder (ADHD), other psychiatric problems, and driving-related outcomes in a provincially representative sample of adults 18 years and older living in the province of Ontario, Canada. METHODS: The study examined the results of the Centre for Addictions and Mental Health (CAMH) Ontario Monitor, an ongoing repeated cross-sectional telephone survey of Ontario adults over a 2-year period. Measures included ADHD measures (Adult ADHD Self-Report Scale-V1.1 [ASRS-V1.1], previous ADHD diagnosis, ADHD medication use); psychiatric distress measures (General Health Questionnaire [GHQ12], use of pain, anxiety, and depression medication); antisocial behavior measure (The Antisocial Personality Disorder Scale from the Mini-International Neuropsychiatric Interview [APD]); substance use and abuse measures (alcohol, cannabis, and cocaine), Alcohol Use Disorders Identification Test (AUDIT), Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), driving-related outcomes (driving after drinking, driving after cannabis use, street racing, collisions in past year), and sociodemographics (gender, age, vehicle-kilometers traveled). RESULTS: A total of 4,014 Ontario residents were sampled, of which 3,485 reported having a valid driver's license. Overall, 3.22% screened positive for ADHD symptoms on the ASRS-V1.1 screening tool. A greater percentage of those who screened positive were younger, reported previous ADHD diagnosis and medication use, distress, antisocial behavior, anti-anxiety and antidepressant medication use, substance use, and social problems compared to those who screened negative. However, there were no statistically significant differences between those who screened positive or negative for ADHD symptoms on self-reported driving after having 2 or more drinks in the previous hour; within an hour of using cannabis, marijuana, or hash; or in a street race or collision involvement as a driver in the past year. When a sequential regression was conducted to predict self-reported collisions, younger age and higher weekly kilometers driven showed higher odds of collision involvement, and the odds ratio for cannabis use ever approached statistical significance. DISCUSSION: This study is the first population-based study of a representative sample of adults 18 years and older living in Ontario, Canada. These results showed no relationship between the ADHD screen and collision when age, sex, and kilometers driven are controlled for. However, these analyses are based on self-report screeners and not psychiatric diagnoses and a limited sample of ADHD respondents. Thus, these results should be interpreted with caution.

Distinctive trajectory groups of mental health functioning among assertive community treatment clients: an application of growth mixture modelling analysis.

OBJECTIVE: Assertive community treatment (ACT) studies that have used conventional, statistical growth modelling methods have not examined different trajectories of outcomes or covariates that could influence different trajectories, even though heterogeneity in outcomes has been established in other research on severe mental illness. The purpose of our study was to examine the general trend in mental health functioning of ACT clients over a 2-year follow-up time period, to discover groups of ACT clients with distinctive longitudinal trajectories of mental health functioning, and to examine if some of the key sociodemographic and illness-related factors influence group membership. METHOD: A 2-year, prospective, within-subjects study of 216 ACT clients within southern Ontario, collected functional outcome data at baseline and 12 and 24 months using the Colorado Client Assessment Record. Baseline covariates included sex, primary diagnosis, number of comorbidities, hospitalization history, and duration of illness. Growth mixture modelling (GMM) was used to examine trajectories. RESULTS: Clinical staff assessments of ACT clients showed a statistically significant improvement in functioning and 84% achieved successful community tenure. GMM analysis identified 2 classes of ACT clients: class 1 (79.63% of clients) experienced lower and stable overall functioning, and class 2 (20.37%) showed a better baseline functioning score and improvement in the overall functioning over time. Class membership was predicted by the number of comorbidities and diagnosis. CONCLUSIONS: Our study suggests general stability in overall functioning for the sampled ACT clients over 2 years, but significant heterogeneity in trajectories of functioning.

Objectif : Les études sur le traitement communautaire dynamique (TCD) qui ont utilisé des méthodes de modèle de croissance statistiques traditionnelles n'ont pas examiné les différentes trajectoires des résultats ou covariantes qui pourraient influencer les différentes trajectoires, même si l'hétérogénéité des résultats a été établie dans d'autres recherches sur la maladie mentale grave. Le but de notre étude était d'examiner la tendance générale du fonctionnement de la santé mentale chez des clients de TCD sur une période de suivi de 2 ans, afin de découvrir des groupes de clients de TCD ayant des trajectoires longitudinales distinctes du fonctionnement de la santé mentale et d'examiner si certains des facteurs sociodémographiques clés et liés à la maladie influencent l'adhésion au groupe. Méthode : Une étude prospective sur 2 ans intra-sujets de 216 clients de TCD du sud de l'Ontario a recueilli des données de résultat fonctionnel au départ et à 12 et 24 mois, à l'aide du registre d'évaluation des clients du Colorado. Les covariantes de départ incluaient le sexe, le diagnostic primaire, le nombre de comorbidités, les antécédents d'hospitalisation, et la durée de la maladie. Le modèle de croissance à mélange de distributions (MCMD) a servi à examiner les trajectoires. Résultats : Les évaluations cliniques du personnel des clients de TCD ont indiqué une amélioration statistiquement significative du fonctionnement et 84 % ont atteint un statut d'occupation réussie dans la communauté. L'analyse du MCMD a identifié 2 classes de clients de TCD : la classe 1 (79,63 % des clients) a connu un fonctionnement général plus faible et stable, et la classe 2 (20,37 %) a obtenu un meilleur score de fonctionnement au départ et une amélioration du fonctionnement général avec le temps. L'adhésion à la classe était prédite par le nombre de comorbidités et le diagnostic. Conclusions : Notre étude suggère une stabilité générale du fonctionnement global pour les clients de TCD échantillonnés sur 2 ans, mais une hétérogénéité significative des trajectoires du fonctionnement.

Street racing video games and risk-taking driving: An Internet survey of automobile enthusiasts.

PURPOSE: The purpose of this study was to examine the relationships among risky driving attitudes, self-perceptions as a risky driver, playing of "drive'em up" (which rewarded players for frequent traffic and other violations) and "circuit" racing video games as well as self-reported risky driving through a web-based survey of car and racing club members in relation to a socio-cognitive model of the effects of racing video game playing. METHOD: An Internet questionnaire was developed and included: (1) self-perceptions as a risky driver scales (Driver Thrill Seeking and Competitive Attitude Toward Driving); (2) attitudes regarding street racing; (3) street racing video game playing, and (4) self-reported risky driving (Risk-Taking Driving Scale). A sequential logistic regression was performed entering age and driving exposure as control variables in the first block, self-perceptions as a risky driver in the second block, attitudes in the third block and playing "drive'em up" and "circuit" racing games in the last block to examine their effects on self-reported risk-taking driving. RESULTS: A total of 503 survey respondents were included in the analyses and only 20% reported any risk-taking driving. Higher score on the Competitive Attitude Toward Driving Scale, more positive attitudes toward street racing, and more frequent reported playing of "drive'em up" video games were associated with higher odds on the self-reported Risk-Taking Driving Scale. However, the Driver Thrill Seeking Scale and "circuit" video game playing failed to predict self-reported risk-taking driving. CONCLUSIONS: Self-perceptions as a risky driver, positive attitudes toward risky driving and "drive'em up" street-racing games, but not "circuit" racing games, are associated with increased risk-taking driving. These findings are congruent with experimental studies in which games that reward driving violations increased risk taking, suggesting that risk taking may be a function of type of street racing game played by affecting self-perceptions as a risky driver.

A tale of two cities: the effect of extended drinking hours in licensed establishments on impaired driving and assault charges.

OBJECTIVES: On May 1, 1996, Ontario, Canada, amended the Liquor Licence Act to extend the hours of alcohol sales and service in licensed establishments from 1 to 2 a.m. The purpose of this study was to examine the effect of extended drinking hours on two cities in southwestern Ontario, Canada, one of which (London) would be affected by the alcohol control policy of extended drinking hours and the second city (Windsor) would be affected by two alcohol policies, extended drinking hours, and cross-border legal drinking age differences between Ontario and Michigan. Specifically, this study tested whether there were differences in impaired driving and assault charges in London and Windsor, Ontario, concomitant with the extended drinking hour amendment. METHODS: A quasi-experimental design using interrupted time series was used to assess changes. The analyzed data sets were monthly police impaired driving and assault charges data for Ontario, for the 11-12 p.m., 12-1 a.m., 1-2 a.m., 2-3 a.m. and 3-4 a.m. time windows, for 4 years pre- and 3 years post-policy change. RESULTS: Overall, London and Windsor exhibited significant overall reductions in impaired driving charges and no changes for assault charges aggregated over the 11 p.m.-4 a.m. time period after the drinking hours were extended. Within the different time windows, London showed significant decreases for the 1-2 a.m. Sunday-Wednesday and Thursday-Sunday time periods and a significant increase for the Sunday-Wednesday 3-4 a.m. time period, while Windsor demonstrated significant decreases in impaired driving charges for 1-2 a.m. Sunday-Wednesday and Thursday-Saturday time periods and significant increases for Sunday-Wednesday 2-3 and 3-4 a.m. and for Thursday-Saturday 2-3 a.m. For assault charges, no overall pre-post differences were found for the aggregated 11 p.m.-4 a.m. time period for either city. When the data were disaggregated by hour, a significant decrease was found in London for Thursday-Saturday 1-2 a.m. and significant increases for Sunday-Wednesday 2-3 a.m. and Thursday-Saturday 3-4 a.m. time periods, while no significant decreases were found in Windsor during the 1-2 a.m. time periods and one significant increase occurred during the Thursday-Saturday 2-3 a.m. time period. CONCLUSIONS: These findings, based on police data, suggest no overall effect on charges aggregated over the 11 p.m. to 4 a.m. time window, although some differences were observed for the different hours after 2 a.m., with a possible effect of the one hour extension of drinking in licensed establishments.

A comparison of self-reported motor vehicle collision injuries compared with official collision data: an analysis of age and sex trends using the Canadian National Population Health Survey and Transport Canada data.

OBJECTIVE: The purpose of this study was to compare the age and sex trends of motor vehicle collision injuries between a nationally representative self-report survey and official police motor vehicle collision report data. To do this, population-based estimates of motor vehicle collision injuries were established using data from the National Population Health Survey (NPHS), a prospective, population-based, longitudinal survey that was compared to Transport Canada's official motor vehicle collision report statistics. METHODS: Aggregated mean data (1994-1996) were compared for seven age groups (15-19, 20-24, 25-34, 35-44, 45-54, 55-64, and 65+) from both data sets. RESULTS: No significant differences were found between males' and females' MVC injuries for any age category in the NPHS. A comparison of the NPHS and Transport Canada data found two small (significant) within-sex differences between the data sets, but overall, the analysis largely revealed similar trends for self-reported injury for all age categories and sex. CONCLUSIONS: The results indicate that the incidence of injuries based on self-report data in a nationally representative sample is similar to official sources of reporting and are thus a valid indicator or motor vehicle collision injury incidence. The results also confirm that injury trends differ from fatality trends.

Impact of extended drinking hours in Ontario on motor-vehicle collision and non-motor-vehicle collision injuries.

OBJECTIVE: On May 1, 1996, Ontario, Canada, amended the Liquor Licence Act to extend the hours of alcohol sales and service in licensed establishments from 1 am to 2 am. The purpose of this study was to evaluate the impact of extended drinking hours in Ontario on motor-vehicle collision (MVC) and other injuries admitted to regional trauma units based on Ontario Trauma Registry data. METHOD: A quasi-experimental design using interrupted time series was used to assess changes in admissions to Ontario trauma units. The analyzed data sets were monthly data on number of admissions from MVC and other causes of injury during the 11 pm-12 am, 12-1 am, 1-2 am, and 2-3 am time windows for 4 years before and 3 years after the policy change (May 1992-April 1999). RESULTS: For MVC injuries, no significant pre-post increases were found for the 2-3 am period commensurate with the introduction of the extended drinking hours, but decreases were found for the 11 pm-12 am and 1-2 am periods. For non-MVC injuries, a significant increase was found for the 2-3 am period. CONCLUSIONS: The data sets suggest that increased availability of alcohol as a result of extension of closing hours had an impact on non-MVC injuries presenting to Ontario trauma units, but road safety initiatives may have mediated the effects of the extension on MVC injuries. These observations are consistent with those of other studies of small changes in alcohol availability.