Adolescents’ engagement in multiple risk behaviours is associated with concussion

BACKGROUND: The objective of this study was to investigate the relationship between engagement in multiple risk behaviours (MRB) and concussion amongst youth. METHODS: This was a cross-sectional study that used survey data collected from 3059 students in grades 6–10 (approximate ages 11–15 years) from Ontario, Canada. Students reported whether or not they had a medically diagnosed concussion within the previous 12 months and the frequency that they participated in several risky behaviours including fighting, bullying, smoking, drinking alcohol, using illicit drugs, drinking caffeinated beverages, not using protective equipment, and having unsafe sex. Responses to the risky behavior items were used to create a MRB score. The association between MRB and concussion was explored using logistic regression that controlled for several confounding variables. RESULTS: Approximately 10.7% of students reported that they had a medically diagnosed concussion within the past year. A dose-response relationship was found between MRB and concussion among students in grades 9–10, while in grades 6–8 students only those in the highest MRB quartile had an increased likelihood of concussion. The relative odds for concussion in the highest versus the lowest MRB quartile were 4.67 (95% confidence interval: 2.33, 9.35) in grades 9–10 students and 2.94 (95% confidence interval, 1.90, 4.56) in grades 6–8 students. CONCLUSIONS: Engagement in MRB may be an important etiologic component of adolescent concussion. Future studies should address whether behavioural interventions designed to decrease engagement in MRB reduce the risk of concussion and other injuries.