Skip to main content

Main menu

  • Home
  • Content
    • Current
    • Archive
    • Upcoming Scientific Articles
  • Info for
    • Authors
    • Reviewers
    • Advertisers
    • Subscribers
  • About Us
    • About the North Carolina Medical Journal
    • Editorial Board
  • More
    • Alerts
    • Feedback
    • Help
    • RSS
  • Other Publications
    • North Carolina Medical Journal

User menu

  • My alerts
  • Log in

Search

  • Advanced search
North Carolina Medical Journal
  • Other Publications
    • North Carolina Medical Journal
  • My alerts
  • Log in
North Carolina Medical Journal

Advanced Search

  • Home
  • Content
    • Current
    • Archive
    • Upcoming Scientific Articles
  • Info for
    • Authors
    • Reviewers
    • Advertisers
    • Subscribers
  • About Us
    • About the North Carolina Medical Journal
    • Editorial Board
  • More
    • Alerts
    • Feedback
    • Help
    • RSS
  • Follow ncmj on Twitter
  • Visit ncmj on Facebook
Research ArticleORIGINAL RESEARCH

Examination of Behaviors and Health Indicators for Individuals with a Lifetime History of Traumatic Brain Injury with Loss of Consciousness: 2018 BRFSS North Carolina

Dana Waltzman, Kelly Sarmiento, Jill Daugherty and Scott Proescholdbell
North Carolina Medical Journal May 2022, 83 (3) 206-213; DOI: https://doi.org/10.18043/ncm.83.3.206
Dana Waltzman
Behavioral scientist, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: DWaltzman@cdc.gov
Kelly Sarmiento
Health communication specialist, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jill Daugherty
Epidemiologist, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Scott Proescholdbell
Epidemiologist, North Carolina Department of Health and Human Services, Division of Public Health, Raleigh, North Carolina.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • References
  • Info & Metrics
  • PDF
Loading

Abstract

BACKGROUND Evidence suggests that those who have sustained a traumatic brain injury (TBI) are at increased risk of adverse behaviors and health indicators, such as certain chronic physical and mental health conditions. However, little is known about the prevalence of these behaviors and health indicators among these individuals, information that could help decrease their risk of developing such conditions.

METHODS Data (N = 4733) from the 2018 North Carolina Behavioral Risk Factor Surveillance System (BRFSS) were analyzed to determine the prevalence of behaviors and health indicators among individuals who report having a lifetime history of TBI with loss of consciousness (LOC).

RESULTS North Carolinians who report a lifetime history of TBI with LOC were at increased risk of reporting a range of 3 negative health behaviors: less than always seatbelt use (adjusted odds ratio [AOR] = 1.7; 95% confidence interval [CI] = 1.2–2.4), HIV risk behaviors (AOR = 1.7; 95% CI = 1.1–2.6), and reporting less than 7 hours of sleep (AOR = 1.5; 95% CI = 1.2–1.8); more difficulty obtaining health care (not seeing a doctor due to health care cost in the past 12 months [AOR = 1.3; 95% CI = 1.0–1.8]; not getting a routine medical check-up in the past 12 months [AOR = 1.5; 95% CI = 1.2–2.0]); worse self-reported health (fair or poor general health [AOR = 1.8; 95% CI = 1.4–2.3]); and reporting fair or poor mental health (AOR = 2.1; 95% CI = 1.6–2.8) compared with individuals who did not report a history of TBI.

LIMITATIONS There are several limitations to the study, such as the sample being biased toward more severe brain injuries. Additionally, because the data in the BRFSS are retrospective and cross-sectional, it is not possible to determine temporality and causality between TBI history and the behaviors and health indicators examined.

CONCLUSION Despite these limitations, this paper is one of the first to directly examine the association between history of TBI with LOC and a range of current behaviors and health care utilization. Assessing positive and negative behaviors and health indicators can help identify and tailor evidence-based interventions for those who have a history of TBI.

Previous research demonstrates that individuals living with traumatic brain injury (TBI) are at increased risk for developing chronic health conditions such as depression [1, 2], diabetes [3], and heart disease [3], and having overall poor health [4]. Those with a moderate/severe TBI have an increased risk of dying within 5 years of the injury [5]. Sustaining a TBI has also been linked to moderate-to-severe problem gambling [6], risky sexual behavior [7], substance use disorders [8, 9], increased risk for sustaining an unintentional injury (such as a motor vehicle crash) [10], and suicidal thoughts and behaviors [2].

Physical activity, proper sleep hygiene, community-based support services, routine medical check-ups, and wearing seatbelts and taking other safety precautions can contribute to good physical and mental health, including for individuals with a history of TBI [4, 11, 12]. However, less is known about whether people who have sustained a TBI engage in protective health behaviors. The goal of this paper is to examine and present the prevalence of selected positive and negative behaviors and health indicators among individuals who report having a lifetime history of TBI with self-reported loss of consciousness (LOC). It is hypothesized that those with a history of TBI with LOC were more likely to engage in risk-taking behaviors.

Methods

Study Population

The Behavioral Risk Factor Surveillance System (BRFSS) is an annual, nationally representative telephone survey of non-institutionalized US adults, aged 18 and older that collects information pertaining to health-related conditions and behaviors [13]. BRFSS collects data from all 50 states, the District of Columbia, and 3 US territories. It is the largest continuously conducted health survey system in the world and is a powerful tool for targeting and building health promotion activities (https://www.cdc.gov/brfss/about/index.htm). The BRFSS survey consists of 3 parts: the core component, optional modules, and state-added questions (https://www.cdc.gov/brfss/questionnaires/index.htm). The BRFSS employs a complex sampling design [14]; it uses a disproportionate stratified sample design for respondents who complete the survey by landline and a random sample design for those who complete the survey by cell phone. The BRFSS also uses iterative proportional fitting to weight the data. BRFSS data are deidentified and considered exempt from human subjects review by CDC’s Institutional Review Board. Analyses for this study only used data from North Carolina BRFSS respondents as North Carolina is one of the few states that incorporated a module that asked TBI-related questions. Data from the other states that included a TBI module in 2018 could not be combined due to differences in the TBI-related questions. In 2018, 4733 adults in North Carolina completed the core sections of the BRFSS using a landline or cell phone (response rate of 43.5%).

Traumatic Brain Injury Module

Similar to the Ohio BRFSS TBI state module [15], the North Carolina BRFSS TBI module is a modified version of the Ohio BRFSS TBI module and focused on questions on lifetime history of TBI with LOC only. TBI is a heterogeneous disorder with various symptoms. LOC is one such symptom with a prevalence between 5.7% and 12% [2, 16, 17]. LOC is more accurately self-reported with certainty than other symptoms and may signify a disruption of brain function [18]. After completing the core sections of the BRFSS, the TBI module was administered. For the TBI module, all respondents received the following prompt:

For these next questions, please think about injuries you have had during your entire lifetime, especially those that affected your head or neck. It might help to remember times you went to the hospital or emergency room. Think about injuries you may have received from a car or motorcycle wreck, bicycle crash, being hit by something, falling down, being hit by someone, playing sports, or an injury during military service.

This prompt was followed by the questions: “Thinking about any injuries you have had in your lifetime, were you ever knocked out or did you lose consciousness?” and “How old were you the first time you were knocked out or lost consciousness?” Responses to the first question were dichotomized as yes/no. The number of years since a respondent’s first TBI with LOC was calculated by subtracting age of first TBI from the age of the respondent at the time of the survey.

Behaviors and Health Indicators

The slate of behaviors and health indicators examined in this paper were chosen due to previous research, which demonstrated that having a past history of TBI is associated with risk-taking [2, 6–10], poor overall health status [4], and difficulty obtaining adequate health care [19]. In order to examine the association of risk-taking behaviors and TBI, we selected seatbelt usage, HIV risk behaviors, and problem/pathological gambling. To examine difficulty obtaining health care, we selected the variables that assessed not seeing a doctor due to health care cost, recent routine checkup, and health care coverage. To examine the association between TBI history and overall health status, we selected self-rated general health and mental health and sleep. The behaviors, health indicators, and dichotomized responses are displayed in Table 1.

View this table:
  • View inline
  • View popup
TABLE 1.

Behaviors and Health Indicators from the North Carolina Behavioral Risk Factor Surveillance System, 2018

Statistical Analysis

Descriptive statistics were calculated to describe the demographic characteristics (sex, age, race/ethnicity, veteran status, marital status, educational attainment, and employment status) of North Carolina adults (Table 2). These statistics were limited to those who answered “yes” or “no” to the lifetime TBI with LOC question (N = 3570). To account for the complex design of the BRFSS, frequencies and weighted percentages were estimated and compared across subgroups using χ2 tests, along with corresponding 95% confidence intervals (CI). The bivariate statistics were also limited to those who answered “yes” or “no” to the lifetime TBI with LOC question and the respective health behavior or outcome. To determine the association between TBI with behaviors and health indicators (i.e., seatbelt use, HIV risk behaviors, gambling, health care coverage, not seeing a doctor due to health care cost, recent routine check-up, general health, mental health, and sleep), separate multivariable binomial logistic regression was used to create models for each independent variable (i.e., lifetime history of TBI with LOC, number of years since first TBI with LOC), using the “no outcome” or “worse outcome” conditions as the reference group and adjusting for the demographic characteristics that were significant in the χ2 tests. Separate analyses were conducted for each of the behavior or health indicator variables. Additionally, if the primary outcome of interest (lifetime TBI with LOC) was not significant in the multivariable binomial logistic regression, then the secondary outcome of number of years since first TBI with LOC was not conducted. All analyses were performed in SAS 9.4 (SAS Institute, Cary, NC).

View this table:
  • View inline
  • View popup
TABLE 2.

Characteristics of Adult Respondents in North Carolina Behavioral Risk Factor Surveillance System, 2018a

Results

A quarter of the respondents (24.8%) in North Carolina in 2018 had a self-reported history of TBI with LOC (Table 2). Among these respondents, the median age in which it was first experienced was 16.1 years, with most respondents experiencing a mild TBI (85.2%). Among all respondents, approximately: 7.7% reported “less than always” using a seatbelt, 6.1% reported at least 1 risk behavior for HIV, 5.0% reported problem/pathological gambling, 14.6% reported not having current health care coverage, 16.3% reported not seeing a doctor due to health care cost in the past 12 months, 19.7% reported not getting a routine medical check-up in the past year, 20.6% reported fair or poor health, 12.6% reported not having good mental health, and 34.5% reported sleeping less than 7 hours a night on average.

Risk-Taking Health Behaviors

After adjustment for demographic factors that were significantly associated with each behavior or health indicator (Supplementary Table 1), lifetime history of TBI with LOC was associated with increased odds of reporting less-than-always seatbelt use (adjusted odds ratio [AOR] = 1.7; 95% confidence interval [CI] = 1.2–2.4) and HIV risk behaviors (AOR = 1.7; 95% CI = 1.1–2.6), (Table 3). The bivariate association between lifetime history of TBI with LOC and problem/pathological gambling was not significant; thus, no multivariable modeling was conducted for this variable.

View this table:
  • View inline
  • View popup
TABLE 3.

Adjusted Odds Ratio and 95% Confidence Interval for the Relationship between Traumatic Brain Injury Exposure and Health Behaviors: North Carolina Behavioral Risk Factor Surveillance System, 2018

After adjustment for significant demographic factors (Supplementary Table 1), number of years since first TBI with LOC was not associated with reported seatbelt use or HIV risk behaviors in the bivariate analyses (Table 3). Additionally, since there was no association between the primary outcome variable (lifetime history of TBI with LOC) and problem/pathological gambling, the multivariable analysis for number of years since first TBI with LOC and problem/pathological gambling was not conducted.

Difficulty Obtaining Health Care

After adjustment for significant demographic factors (Supplementary Table 1), lifetime history of TBI with LOC was associated with increased odds of reporting not seeing a doctor due to health care cost in the past 12 months (AOR = 1.3; 95% CI = 1.0–1.8) and not getting a routine medical check-up in the past 12 months (AOR = 1.5; 95% CI = 1.2–2.0) (Table 3). The bivariate association between lifetime history of TBI with LOC and health care coverage was not significant; thus, no multivariate modeling was conducted.

View this table:
  • View inline
  • View popup
SUPPLEMENTAL TABLE 1.

Select Health Behaviors by Demographic Characteristics and Lifetime History of Traumatic Brain Injury with Loss of Consciousness, North Carolina Behavioral Risk Factor Surveillance System, 2018

After adjustment for significant demographic factors (Supplementary Table 1), number of years since first TBI with LOC was not associated with not seeing a doctor due to health care cost in the past 12 months or getting a routine checkup in the past 12 months (Table 3).

Health Status

After adjustment for significant demographic factors (Supplementary Table 1), lifetime history of TBI with LOC was associated with increased odds of reporting fair or poor general health (AOR = 1.8; 95% CI = 1.4–2.3), reporting fair or poor mental health (AOR = 2.1; 95% CI = 1.6–2.8), and reporting < 7 hours of sleep (AOR = 1.5; 95% CI = 1.2–1.8) (Table 3).

The bivariate association between number of years since first TBI with LOC and general health or sleep was not significant; thus, no multivariable modeling was conducted. After adjustment for significant demographic factors (Supplementary Table 1), number of years since first TBI with LOC was not associated with mental health (Table 3).

Discussion

Our study indicates that individuals in North Carolina who reported a lifetime history of TBI with LOC were at increased risk of reporting a range of adverse behaviors and health indicators (e.g., negative health behaviors, more difficulty obtaining health care, and worse self-reported health than individuals who do not report a history of TBI). For example, findings suggest that individuals with a lifetime history of TBI with LOC had increased odds of reporting 3 risk behaviors: less than always using a seatbelt, HIV risk behaviors, and fewer than 7 hours of sleep, though the prevalence of less than always using a seatbelt and HIV risk behaviors is still very low among respondents in North Carolina. No previous studies have specifically examined the relationship between seatbelt usage after TBI or HIV risk behaviors and TBI; however, 1 study did find a high prevalence of previous head trauma (74%) among a sample of 173 individuals living with HIV [20]. Development of interventions that address impulsivity and risk-taking behaviors following a TBI, such as those that might put an individual at risk for HIV, is an area that deserves further study [21]. The relationship between sleep and TBI, on the other hand, is well-researched [22–27]. A 2012 meta-analysis reported that sleep disturbances are present in 50% of individuals who have sustained a TBI and that these individuals were 2–4 times more likely to experience problems with sleep maintenance, early awakenings, and excessive sleepiness (e.g., falling asleep during the day or sleeping longer at night) than people who did not have a history of TBI [23]. This relationship between TBI and poor sleep outcomes is particularly striking given the critical role that good sleep plays in recovery from TBI [28]. Future research may examine the extent to which people living with TBI are provided with guidance from health care providers on sleep hygiene following a TBI, as well as whether they receive referrals to specialists when symptoms persistent.

Lifetime history of TBI with LOC was also associated with increased odds of reporting not seeing a doctor due to health care cost in the past 12 months and not getting a routine medical check-up in the past 12 months. Previous research has shown that failure to obtain care after a suspected concussion can have lasting health implications, prolong recovery, and increase the possibility that a person will sustain a second concussion before symptoms resolve from the first one [29–31]. However, our study did not allow us to determine the relationship between the timing of the TBI and health care usage soon after the injury. Generally, preventive care services (such as routine health screenings and immunizations) help to reduce death and disability [32]. Consequently, lack of access to health care and other inequalities (e.g., lower hospital admission rates based on a patient’s insurance status, race, and sex) may partially explain poor patient outcomes [19]. Future longitudinal studies may explore these factors as mediators to better understand the impacts in order to reduce some of the harmful long-term effects of sustaining a TBI. Moreover, evaluation of interventions to overcome these barriers may be beneficial.

Finally, our study also demonstrated that lifetime history of TBI with LOC was associated with increased odds of reporting fair or poor general health and reporting fair or poor mental health. In a sample of 1129 male service members with a history of blast-related mild TBI, Heltemes and colleagues reported that service members with mild TBI were 5 times more likely to report a major negative change in health compared to members with other mild injuries [33]. Additionally, there is a robust literature demonstrating the relationship between post-TBI mental illness and personality changes [34–37]. For example, secondary attention deficit hyperactivity disorder (S-ADHD), aggression, and personality changes was more common with increasing TBI severity [35, 38]. Future research may explore the effectiveness of rehabilitation services for veterans with TBI complicated by psychological sequelae [39]. Health care providers can consider screening for these adverse health outcomes in individuals with TBI and provide referrals for evidence-based services as needed.

There are several limitations to this study. First, the TBI questions are biased toward more severe brain injuries due to the requirement about needing to have experienced LOC as a result of the TBI. Second, because the data in the BRFSS are retrospective and cross-sectional, it is not possible to determine temporality and causality between TBI history and the onset of the reported health behaviors, health care usage, or self-reported health status. There may also have been recall bias for respondents to not accurately remember details of an event (especially for recall of lifetime history of TBI). However, each of the behaviors and health indicators examined were current or within the past 12 months, so it is likely that in most cases the TBI preceded the behavior or health indicator. Third, these data were collected among respondents in North Carolina only and may not be generalizable to other US states. For example, our study found a prevalence of TBI with LOC of 24.8%, but other studies report a prevalence between 5.7% and 12% [2, 16, 17]. According to the US Department of Veterans Affairs, North Carolina ranks 8th among US states with the highest population of veterans [40], a population that is more likely to report a history of TBI with LOC, and this may contribute to the higher prevalence of TBI seen in this study. It is important to collect data on the TBI experience among residents of other states to see how it varies. Fourth, there was a high percentage of missing data for the lifetime TBI with LOC question (e.g., 22% of respondents did not answer the question, n = 1094). This was due to partial completion of the survey (i.e., respondents who ended the interview before the TBI optional module) or respondents who moved to North Carolina but kept their old cell phone number and thus were only asked questions from the core BRFSS. Further, respondents who did not answer this question compared to those who did were different on all demographic characteristics, as well as health care cost and general health. For example, respondents who answered the self-reported lifetime TBI with LOC question were more likely to be female, older, less likely to have a college education or higher, had not seen a doctor in the past 12 months due to health care cost, and had worse general health compared to respondents who had missing data. Fifth, the sleep variable was defined as a binary variable (less than 7 hours of sleep and 7 hours or more of sleep). Hypersomnia and excessive sleep are often problematic in individuals who sustain a TBI [23]. However, only 3.2% of respondents in our data endorsed more than 9e hours of sleep, and due to a lack of stability of the data caused by a low N, an analysis with tertiary levels was not possible. Future studies may want to examine this relationship. Sixth, it may be the case that those at risk for TBI are more impulsive or risky in general and there may not be a direct relationship between TBI and adverse health outcomes. Seventh, this study did not analyze TBI severity or number of TBIs. Though descriptive statistics were presented for TBI severity, there was too small a sample size for further analysis. Future studies may want to examine these variables as well.

Despite these limitations, this paper is one of the first to directly examine the association between history of TBI with LOC and a range of current behaviors and health care utilization. Further, it adds to the established literature showing a strong correlation between history of TBI with LOC and self-reported poor physical and mental health. Additionally, these findings may help inform screening and referral strategies for health care providers for the care of patients with a history of TBI to promote a healthy lifestyle.

Conclusion

Taken together, the results of this analysis demonstrate that individuals who have sustained a TBI with LOC in their lifetime had increased odds of reporting certain negative health behaviors, less health care usage, and poor physical and mental self-rated health than individuals who have not sustained a TBI with LOC. Targeted TBI prevention efforts of modifiable risk and protective behaviors (such as seatbelt use), as well as the adaptation of evidence-based programs, are needed in order to reduce adverse health outcomes in patients with TBI. Additionally, health care providers can consider screening patients with a lifetime history of TBI with LOC for mental health and sleep problems and provide referrals for evidence-based services as needed.

Acknowledgments

The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Disclosure of interests: All authors report no relevant disclosures.

  • ©2022 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

References

  1. 1.↵
    1. Singh R,
    2. Mason S,
    3. Lecky F,
    4. Dawson J
    . Prevalence of depression after TBI in a prospective cohort: the SHEFBIT study. Brain Inj. 2018;32(1):84–90. doi: 10.1080/02699052.2017.1376756
    OpenUrlCrossRefPubMed
  2. 2.↵
    1. Anstey KJ,
    2. Butterworth P,
    3. Jorm AF,
    4. Christensen H,
    5. Rodgers B,
    6. Windsor TD
    . A population survey found an association between self-reports of traumatic brain injury and increased psychiatric symptoms. J Clin Epidemiol. 2004;57(11):1202–9. doi :10.1016/j.jclinepi.2003.11.011
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Selassie AW,
    2. Cao Y,
    3. Church EC,
    4. Saunders LL,
    5. Krause J
    . Accelerated death rate in population-based cohort of persons with traumatic brain injury. J Head Trauma Rehabil. 2014;29(3):E8–E19. doi: 10.1097/HTR.0b013e3182976ad3
    OpenUrlCrossRef
  4. 4.↵
    1. Driver S,
    2. Juengst S,
    3. Reynolds M, et al
    . Healthy lifestyle after traumatic brain injury: a brief narrative. Brain Inj. 2019;33(10):1299–1307. doi: 10.1080/02699052.2019.1641623
    OpenUrlCrossRef
  5. 5.↵
    1. Corrigan JD,
    2. Cuthbert JP,
    3. Harrison-Felix C, et al
    . US population estimates of health and social outcomes 5 years after rehabilitation for traumatic brain injury. J Head Trauma Rehabil. 2014;29(6):E1–9. doi: 10.1097/htr.0000000000000020
    OpenUrlCrossRefPubMed
  6. 6.↵
    1. Turner NE,
    2. McDonald AJ,
    3. Ialomiteanu AR, et al
    . Moderate to severe gambling problems and traumatic brain injury: A population-based study. Psychiatry Res. 2019;272:692–697. doi: 10.1016/j.psychres.2018.12.170
    OpenUrlCrossRef
  7. 7.↵
    1. Moreno JA,
    2. McKerral M
    . Relationships between risky sexual behaviour, dysexecutive problems, and mental health in the years following interdisciplinary TBI rehabilitation. Neuropsychol Rehabil. 2018;28(1):34–56. doi: 10.1080/09602011.2015.1136222
    OpenUrlCrossRef
  8. 8.↵
    1. Kennedy E,
    2. Cohen M,
    3. Munafo M
    . Childhood traumatic brain injury and the associations with risk behavior in adolescence and young adulthood: a systematic review. J Head Trauma Rehabil. 2017;32(6):425–432. doi: 10.1097/htr.0000000000000289
    OpenUrlCrossRefPubMed
  9. 9.↵
    1. Allen S,
    2. Stewart SH,
    3. Cusimano M,
    4. Asbridge M
    . Examining the relationship between traumatic brain injury and substance use outcomes in the Canadian population. Subst Use Misuse. 2016;51(12):1577–1586. doi: 10.1080/10826084.2016.1188955
    OpenUrlCrossRef
  10. 10.↵
    1. Kolakowsky-Hayner SA,
    2. Bellon K,
    3. Yang Y
    . Unintentional injuries after TBI: potential risk factors, impacts, and prevention. NeuroRehabilitation. 2016;39(3):363–370. doi: 10.3233/nre-161368
    OpenUrlCrossRef
  11. 11.↵
    1. Brown AW,
    2. Moessner AM,
    3. Mandrekar J,
    4. Diehl NN,
    5. Leibson CL,
    6. Malec JF
    . A survey of very-long-term outcomes after traumatic brain injury among members of a population-based incident cohort. J Neurotrauma. 2011;28(2):167–176. doi: 10.1089/neu.2010.1400
    OpenUrlCrossRefPubMed
  12. 12.↵
    1. National Highway Traffic Safety Administration
    . Lives Saved in 2017 by Restraint Use and Minimum-Drinking-Age Laws. Published March 2019. Accessed February 15, 2022. https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812683
  13. 13.↵
    1. North Carolina State Center for Health Statistics Department of Public Health
    . North Carolina 2018 Questionnaire: Behavioral Risk Factor Surveillance System. Published 2018. Accessed February 15, 2022. https://schs.dph.ncdhhs.gov/schs/brfss/pdf/BRFSSQ18.pdf
  14. 14.↵
    1. Centers for Disease Control and Prevention and US Department of Health and Human Services
    . The Behavioral Risk Factor Surveillance System: Comparability of Data BRFSS 2018. Revised August 2019. https://www.cdc.gov/brfss/annual_data/2018/pdf/compare-2018-508.pdf
  15. 15.↵
    1. Bogner J,
    2. Corrigan JD,
    3. Yi H, et al
    . Lifetime history of traumatic brain injury and behavioral health problems in a population-based sample. J Head Trauma Rehabil. 2020;35(1):E43–E50. doi: 10.1097/htr.0000000000000488
    OpenUrlCrossRef
  16. 16.↵
    1. Frost RB,
    2. Farrer TJ,
    3. Primosch M,
    4. Hedges DW
    . Prevalence of traumatic brain injury in the general adult population: a meta-analysis. Neuroepidemiology. 2013;40(3):154–159. doi: 10.1159/000343275
    OpenUrlCrossRefPubMed
  17. 17.↵
    1. Silver JM,
    2. Kramer R,
    3. Greenwald S,
    4. Weissman M
    . The association between head injuries and psychiatric disorders: findings from the New Haven NIMH Epidemiologic Catchment Area Study. Brain Inj. 2001;15(11):935–45. doi: 10.1080/02699050110065295
    OpenUrlCrossRefPubMed
  18. 18.↵
    1. Ruff RM,
    2. Iverson GL,
    3. Barth JT,
    4. Bush SS,
    5. Broshek DK, NAN Policy and Planning Committee
    . Recommendations for diagnosing a mild traumatic brain injury: a National Academy of Neuropsychology education paper. Arch Clin Neuropsychol. 2009;24:3–10. doi: 10.1093/arclin/acp006
    OpenUrlCrossRefPubMed
  19. 19.↵
    1. Selassie AW,
    2. Pickelsimer EE,
    3. Frazier Jr L,
    4. Ferguson PL
    . The effect of insurance status, race, and gender on ED disposition of persons with traumatic brain injury. Am J Emerg Med. 2004;22(6):465–473. doi: 10.1016/j.ajem.2004.07.024
    OpenUrlCrossRefPubMed
  20. 20.↵
    1. Jaffe MP,
    2. O’Neill J,
    3. Vandergoot D,
    4. Gordon WA,
    5. Small B
    . The unveiling of traumatic brain injury in an HIV/AIDS population. Brain injury. 2000;14(1):35–44. doi: 10.1080/026990500120916
    OpenUrlCrossRefPubMed
  21. 21.↵
    1. James LM,
    2. Strom TQ,
    3. Leskela J
    . Risk-taking behaviors and impulsivity among veterans with and without PTSD and mild TBI. Mil Med. 2014;179(4):357–363. doi: 10.7205/milmed-d-13-00241
    OpenUrlCrossRefPubMed
  22. 22.↵
    1. Viola-Saltzman M,
    2. Watson NF
    . Traumatic brain injury and sleep disorders. Neurol Clin. 2012;30(4):1299–1312. doi: 10.1016/j.ncl.2012.08.008
    OpenUrlCrossRefPubMed
  23. 23.↵
    1. Mathias J,
    2. Alvaro P
    . Prevalence of sleep disturbances, disorders, and problems following traumatic brain injury: a meta-analysis. Sleep Med. 2012;13(7):898–905. doi: 10.1016/j.sleep.2012.04.006
    OpenUrlCrossRefPubMed
  24. 24.
    1. Kempf J,
    2. Werth E,
    3. Kaiser PR,
    4. Bassetti CL,
    5. Baumann CR
    . Sleep–wake disturbances 3 years after traumatic brain injury. J Neurol Neurosurg Psychiatry. 2010;81(12):1402–1405. doi: 10.1136/jnnp.2009.201913
    OpenUrlAbstract/FREE Full Text
  25. 25.
    1. Ouellet M-C,
    2. Beaulieu-Bonneau S,
    3. Morin CM
    . Sleep-wake disturbances after traumatic brain injury. Lancet Neurol. 2015;14(7):746–757. doi: 10.1016/S1474-4422(15)00068-X
    OpenUrlCrossRefPubMed
  26. 26.
    1. Castriotta RJ,
    2. Murthy JN
    . Sleep disorders in patients with traumatic brain injury. CNS drugs. 2011;25(3):175–185. doi: 10.2165/11584870-000000000-00000
    OpenUrlCrossRefPubMed
  27. 27.↵
    1. Viola-Saltzman M,
    2. Musleh C
    . Traumatic brain injury-induced sleep disorders. Neuropsychiatr Dis Treat. 2016;12: 339–348. doi: 10.2147/NDT.S69105
    OpenUrlCrossRef
  28. 28.↵
    1. Theadom A,
    2. Cropley M,
    3. Parmar P, et al
    . Sleep difficulties one year following mild traumatic brain injury in a population-based study. Sleep Med. 2015;16(8):926–932. doi: 10.1016/j.sleep.2015.04.013
    OpenUrlCrossRefPubMed
  29. 29.↵
    1. O’Connor K,
    2. Allred D,
    3. Cameron K, et al
    . History of diagnosed and undiagnosed concussions at baseline had differential impact on neurocognitive performance and symptom scores. J Neurol Sci. 2017;381:758. doi: 10.1016/j.jns.2017.08.2139
    OpenUrlCrossRef
  30. 30.
    1. Meehan III WP,
    2. Zhang J,
    3. Mannix R,
    4. Whalen MJ
    . Increasing recovery time between injuries improves cognitive outcome after repetitive mild concussive brain injuries in mice. Neurosurgery. 2012;71(4):885–892. doi: 10.1227/NEU.0b013e318265a439
    OpenUrlCrossRefPubMed
  31. 31.↵
    1. Byard RW,
    2. Vink R
    . The second impact syndrome. Forensic Sci Med Pathol. 2009;5(1):36–38. doi: 10.1007/s12024-008-9063-7
    OpenUrlCrossRefPubMed
  32. 32.↵
    1. US Department of Health and Human Services
    . Clinical Preventive Services. USDHHS website. Accessed December 17, 2019. https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Clinical-Preventive-Services
  33. 33.↵
    1. Heltemes KJ,
    2. Holbrook TL,
    3. MacGregor AJ,
    4. Galarneau MR
    . Blast-related mild traumatic brain injury is associated with a decline in self-rated health amongst US military personnel. Injury. 2012;43(12):1990–1995. doi: 10.1016/j.injury.2011.07.021
    OpenUrlCrossRef
  34. 34.↵
    1. Ilie G,
    2. Mann RE,
    3. Boak A, et al
    . Suicidality, bullying and other conduct and mental health correlates of traumatic brain injury in adolescents. PloS one. 2014;9(4):e94936. doi: 10.1371/journal.pone.0094936
    OpenUrlCrossRefPubMed
  35. 35.↵
    1. Schachar RJ,
    2. Park LS,
    3. Dennis M
    . Mental health implications of traumatic brain injury (TBI) in children and youth. J Can Acad Child Adolesc Psychiatry. 2015;24(2):100–108. PMID: 26379721
    OpenUrl
  36. 36.
    1. Andelic N,
    2. Sigurdardottir S,
    3. Schanke AK,
    4. Sandvik L,
    5. Sveen U,
    6. Roe C
    . Disability, physical health and mental health 1 year after traumatic brain injury. Disabil Rehabil. 2010;32(13):1122–1131. doi:10.3109/09638280903410722. 20113311
    OpenUrlCrossRefPubMed
  37. 37.↵
    1. Seal KH,
    2. Bertenthal D,
    3. Kumar S
    . Association between mild traumatic brain injury and mental health problems and self-reported cognitive dysfunction in Iraq and Afghanistan Veterans. J Rehabil Res Dev. 2016;53(2):185–198. doi: 10.1682/JRRD.2014.12.0301
    OpenUrlCrossRef
  38. 38.↵
    1. Max JE,
    2. Koele SL,
    3. Castillo CC, et al
    . Personality change disorder in children and adolescents following traumatic brain injury. J Int Neuropsychol Soc. Mar 2000;6(3):279–289. doi:10.1017/s1355617700633039
    OpenUrlCrossRef
  39. 39.↵
    1. Centers for Disease Control and Prevention, National Institute of Health, Department of Defense
    . Report to Congress on Traumatic Brain Injury in the United States: Understanding the Public Health Problem among Current and Former Military Personnel. Published June 2013. Accessed February 15, 2022. https://www.cdc.gov/traumaticbraininjury/pdf/Report_to_Congress_on_Traumatic_Brain_Injury_2013-a.pdf
  40. 40.↵
    1. US Department of Veterans Affairs
    . National Center for Veterans Analysis and Statistics. VA website. Accessed September 24, 2020. https://www.va.gov/vetdata/Veteran_Population.asp
PreviousNext
Back to top

In this issue

North Carolina Medical Journal: 83 (3)
North Carolina Medical Journal
Vol. 83, Issue 3
May/June 2022
  • Table of Contents
  • Index by author
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on North Carolina Medical Journal.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Examination of Behaviors and Health Indicators for Individuals with a Lifetime History of Traumatic Brain Injury with Loss of Consciousness: 2018 BRFSS North Carolina
(Your Name) has sent you a message from North Carolina Medical Journal
(Your Name) thought you would like to see the North Carolina Medical Journal web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
1 + 0 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Examination of Behaviors and Health Indicators for Individuals with a Lifetime History of Traumatic Brain Injury with Loss of Consciousness: 2018 BRFSS North Carolina
Dana Waltzman, Kelly Sarmiento, Jill Daugherty, Scott Proescholdbell
North Carolina Medical Journal May 2022, 83 (3) 206-213; DOI: 10.18043/ncm.83.3.206

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Examination of Behaviors and Health Indicators for Individuals with a Lifetime History of Traumatic Brain Injury with Loss of Consciousness: 2018 BRFSS North Carolina
Dana Waltzman, Kelly Sarmiento, Jill Daugherty, Scott Proescholdbell
North Carolina Medical Journal May 2022, 83 (3) 206-213; DOI: 10.18043/ncm.83.3.206
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Methods
    • Results
    • Discussion
    • Conclusion
    • Acknowledgments
    • References
  • Figures & Data
  • Info & Metrics
  • References
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • The Societal Cost of Excessive Drinking in North Carolina, 2017
  • Assessing Breast Cancer Risks to Improve Care for an Increased-Risk Population within Eastern North Carolina
Show more ORIGINAL RESEARCH

Similar Articles

About & Contact

  • About the NCMJ
  • Editorial Board
  • Feedback

Info for

  • Advertisers
  • Authors
  • Reviewers
  • Subscribers

Articles & Alerts

  • Archive
  • Current Issue
  • Get Alerts
  • Upcoming Articles

Additional Content

  • Current NCIOM Task Forces
  • NC Health Data & Resources
  • NCIOM Blog
North Carolina Medical Journal

ISSN: 0029-2559

© 2022 North Carolina Medical Journal

Powered by HighWire