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The majority of the literature focused on whether consent should be extended to the adolescent population arises from themes adapted from American tort law. In contrast to the USA, Ontario does not delineate an age of consent for medical treatment and relying on American guidelines to guide practice in Ontario is problematic. While the literature is saturated with discussions for and against seeking adolescent consent, there are currently no bioethical guidelines on adolescent consent in the province of Ontario. This paper explores adolescent refusal of care and adolescent request for care in opposition to parental wishes. The paper seeks to answer the following questions: What is the difference between an adolescent and an adult in medical decision-making? What are the barriers to seeking adolescent consent? And, can the neurobiological argument be an accurate guide for obtaining adolescent consent? [ABSTRACT FROM AUTHOR]

Background: Primary healthcare services have principal responsibility for providing child and youth wellbeing and mental health services, but have lacked appropriate measurement instruments to assess the wellbeing of Indigenous children and youth or to evaluate the effectiveness of programs and services designed to meet their needs. This review assesses the availability and characteristics of measurement instruments that have been applied in primary healthcare services in Canada, Australia, New Zealand and the United States (CANZUS countries) to assess the wellbeing of Indigenous children and youth. Methods: Fifteen databases and 12 websites were searched in December 2017 and again in October 2021. Pre-defined search terms pertained to Indigenous children and youth, CANZUS country names, and wellbeing or mental health measures. PRISMA guidelines were followed, with eligibility criteria guiding screening of titles and abstracts, and selected full-text papers. Results are presented based on the characteristics of documented measurement instruments assessed according to five desirability criteria: development for Indigenous youth populations, adherence to relational strength-based constructs, administration by child and or youth self-report, reliability and validity, and usefulness for identifying wellbeing or risk levels. Results: Twenty-one publications were found that described the development and or use by primary healthcare services of 14 measurement instruments, employed across 30 applications. Four of the 14 measurement instruments were developed specifically for Indigenous youth populations, four focused solely on strength-based wellbeing concepts but none included all Indigenous wellbeing domains. Conclusion: There is a diversity of measurement instruments available, but few fit our desirability criteria. Although it is possible that we missed relevant papers and reports, this review clearly supports the need for further research to develop, refine or adapt instruments cross-culturally to measure the wellbeing of Indigenous children and youth. [ABSTRACT FROM AUTHOR]

Copyright of Brazilian Journal of Occupational Therapy / Cadernos Brasileiros de Terapia Ocupacional is the property of Cadernos de Terapia Ocupacional da UFSCar and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Whilst adolescence is often discussed as a challenging time, it is also a stage of life with tremendous potential for building positive skills that will support current and future mental health. This paper presents results from a pilot study of a mental health and stigma reduction program called The Inquiring Mind Youth, which is based on a series of programs that have previously demonstrated effectiveness in adult and workplace samples. The program was developed in collaboration with experts and youth and piloted in nine secondary schools across Canada (Calgary area and Eastern Coast). Data from 293 adolescent participants were collected using a pre-post-follow-up design. An overall medium effect size was found for both improved resilience skills (SMD = 0.49) and decreased stigmatizing attitudes (SMD = 0.38) pre-post program. An additional multi-level modelling analysis also showed improved resilience skills and decreased stigmatizing attitudes pre-post program, with more robust shifts in one geographic region (Calgary area). Further analysis showed that resilience improvements were retained at follow-up, with smaller effects. The results of this pilot study support ongoing work and development of programming that aims to foster resilience and reduce stigmatizing attitudes in young people. Highlights: A novel mental health promotion and stigma reduction program (The Inquiring Mind Youth) was developed and piloted in Canadian schools. Participants showed increased resilience skills, decreased stigmatizing attitudes, and increased willingness to seek help after participating in the program. Males saw more improvements than females on resilience, while the opposite was found with stigmatizing attitudes, with females decreasing significantly more. Results support efforts in program development aimed at fostering resilience and reducing stigmatizing attitudes in youth. [ABSTRACT FROM AUTHOR]

This essay is an introduction to the thematic issue of Transcultural Psychiatry in honor of the work of Michael Chandler and Christopher Lalonde, developmental psychologists who made essential contributions to the study of identity and wellness among Indigenous youth in Canada and internationally. We outline their major contributions and illustrate the ways their innovative theory and methods have inspired decades of research, including the recent work presented in this issue, which addresses four broad themes: (1) the importance of a developmental perspective in mental health research; (2) the role of individual and collective continuity of identity in suicide prevention and mental health promotion; (3) Indigenous perspectives on trauma and resilience; and (4) Indigenous knowledge and values as a basis for culturally adapted and culturally grounded mental health services and interventions. [ABSTRACT FROM AUTHOR]

The global community has been significantly impacted by the COVID-19 global pandemic. LGBTQ+ (i.e., lesbian, gay, bisexual, transgender, queer, etc.) youth may face increased stressors amidst the pandemic given their significant mental and sexual health disparities, pervasive rejection — including quarantining in homes with heightened risk of abuse and victimization, and a lack of access to essential resources. Responsive supports are needed at this time for vulnerable LGBTQ+ youth, particularly tailored mental health supports. This critical reflexive paper will highlight, as qualitative social work researchers and practitioners, the swift response to the needs of vulnerable LGBTQ+ youth across Canada during this pandemic. We provide a transparent account of how we have utilized critical reflexivity, cultivated through qualitative research, to support LGBTQ+ youth. This article will elucidate the importance of critical reflexivity in effectively transitioning essential offline mental health services for LGBTQ+ youth to a technology-mediated mental health affirmative intervention. The aim of this paper is to provide qualitative researchers and practitioners practical direction through important insights gleaned by supporting marginalized LGBTQ+ youth during particularly trying times such as a global pandemic. [ABSTRACT FROM AUTHOR]

Purpose: Employment participation offers benefits including income, sense of accomplishment, social engagement, and meaningful contribution to society. Rates of competitive employment of youth with disabilities are amongst the lowest in society, despite having capacity and motivation to participate in the workplace. The marginalization of young workers with disability presents a lost opportunity for youth, potential employers, and social care systems. In order to engage young people with disabilities in employment, we present an integrated, community-based model for employment participation preparation. Materials and methods: The employment participation pathway model is based on best available evidence and 15 years of program delivery for youth with disabilities preparing to transition out of school and into employment in the Canadian context. It was conceptualized using the Knowledge to Action framework and presented for consideration in the current paper. Results: Starting early, taking a person-directed approach to planning, and considering the individual and our systems contribute to effective and comprehensive transition to employment. Conclusions: The employment participation model provides evidence and examples for service providers to consider integrating into their repertoire and begin to construct similar pathways to equip their clients and families with skills, capacities, and knowledge as they journey towards workplace participation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Ninety percent of smokers report having their first whole cigarette before the age of 19. Policies, such as youth access laws, are essential to prevent youth from becoming future smokers. In Canada, the Tobacco Act prohibits retailers from furnishing tobacco products to individuals under the age of 18. These laws can only be effective when retailers comply with them. This paper investigates the effect of retailer compliance on youth smoking behavior. METHODS: Data on individual smoking behavior in conjunction with provincial retailer compliance rates and cigarette prices for the years 1999–2005 were employed to examine the effects of retailer compliance on youth smoking participation and consumption. RESULTS: Both price and retailer compliance were significant predictors of smoking participation. A large portion of participants endorsed obtaining their cigarettes through social means. Price elasticity of demand for the overall sample was estimated to be −0.54. CONCLUSIONS: Consistent with previous literature, our results found that retailer compliance is an essential component to the successful implementation of youth access laws. Given that youth access laws and retailer compliance did not quell social access to cigarettes, there is an apparent need within schools and communities to reduce the social sale of tobacco products. [ABSTRACT FROM AUTHOR]

Given the disproportionate alcohol-related consequences experienced by North American Indigenous youth, there is a critical need to identify related risk and protective factors. Self-compassion, which has been found to mitigate the effects of trauma exposure, may serve as one such protective factor given the high degree of historical trauma and contemporary discrimination identified as contributing to the alcohol-related disparities experienced by Indigenous communities. However, no research has examined how self-compassion (i.e. the ability to be kind and accepting and to extend compassion toward oneself) plays a unique role in Indigenous peoples' experiences with alcohol. First Nation adolescents between the ages of 11 and 18 living on a reserve in Eastern Canada (N = 106, Mage = 14.6, 50.0% female) completed a pencil-and-paper survey regarding their alcohol use, alcohol-related problems, and self-compassion. Self-compassion was significantly inversely associated with alcohol-related problems (b = -.51, p =.01, 95%CI [-.90, −.12], and significantly interacted with frequency of alcohol use in predicting alcohol-related problems (b = -.42, p =.04, 95%CI [-.82, −.03]). Simple slopes analyses revealed that the association between frequency of alcohol use and frequency of experiencing alcohol-related problems was significant and positive at low (b = 4.68, p <.001, 95%CI [2.62, 6.73]), but was not significant at high (b = -.29, p =.89, 95%CI [−4.35, 3.77]) levels of self-compassion. Binary logistic regression revealed that higher scores of self-compassion were associated with a lower odds of being in the high-risk group for AUD (OR = 0.90, 95%CI [0.83, 0.98], p =.02). Our results suggest self-compassion may be protective against experiencing alcohol problems in Indigenous youth and thus may be a target for behavioral interventions. [ABSTRACT FROM AUTHOR]

Developing meaningful indicators to track youth mental health (MH) is important to support the development and evaluation of responsive mental health promotion (MHP) initiatives that address the socio-economic determinants of youth MH. Development of relevant indicators is challenged, however, by the lack of knowledge regarding the relations among socio-economic factors and youth MH. Thirty diverse young people from a Canadian metropolitan area were engaged within a process of social praxis to explore their experiences of the inter-relationship between their socio-economic environments and their MH and their processes of seeking to realize their MH. Participants emphasized 'needs' as foundational to MH, whereas 'wants', driven by materialistic and wealth-oriented values and social norms, constrained their MH. Their reflections on the inter-relations among their MH and socio-economic processes highlight eight inter-related MH needs within the Canadian socio-economic context. In this paper, we present these needs and show how these needs, young people's affective states, and their access to resources within co-evolving socio-economic processes (to enable their needs) illustrate the fundamental inter-relation between young people's MH and socio-economic processes. We identify implications for measuring youth MH within MHP practice, including the importance of iterative indicator frameworks that include measures of young people's access to resources to enable their MH needs and their degree of distress. [ABSTRACT FROM AUTHOR]

Background: Children and youth who meet the physical activity, sedentary, and sleep behaviour recommendations in the Canadian 24-Hour Movement Guidelines are more likely to have desirable physical and psychosocial health outcomes. Yet, few children and youth actually meet the recommendations. The family is a key source of influence that can affect lifestyle behaviours. The purpose of this paper is to describe the process used to develop the Consensus Statement on the Role of the Family in the Physical Activity, Sedentary, and Sleep Behaviours of Children and Youth (0–17 years) and present, explain, substantiate, and discuss the final Consensus Statement. Methods: The development of the Consensus Statement included the establishment of a multidisciplinary Expert Panel, completion of six reviews (three literature, two scoping, one systematic review of reviews), custom data analyses of Statistics Canada's Canadian Health Measures Survey, integration of related research identified by Expert Panel members, a stakeholder consultation, establishment of consensus, and the development of a media, public relations, communications and launch plan. Results: Evidence from the literature reviews provided substantial support for the importance of family on children's movement behaviours and highlighted the importance of inclusion of the entire family system as a source of influence and promotion of healthy child and youth movement behaviours. The Expert Panel incorporated the collective evidence from all reviews, the custom analyses, other related research identified, and stakeholder survey feedback, to develop a conceptual model and arrive at the Consensus Statement: Families can support children and youth in achieving healthy physical activity, sedentary and sleep behaviours by encouraging, facilitating, modelling, setting expectations and engaging in healthy movement behaviours with them. Other sources of influence are important (e.g., child care, school, health care, community, governments) and can support families in this pursuit. Conclusion: Family is important for the support and promotion of healthy movement behaviours of children and youth. This Consensus Statement serves as a comprehensive, credible, and current synopsis of related evidence, recommendations, and resources for multiple stakeholders. [ABSTRACT FROM AUTHOR]

For children and their families who have experienced success in middle years mental health interventions, adolescence represents a developmental period when additional challenges can emerge and potentially threaten positive gains. For youth who have a history of disruptive behaviors, addressing risks and balancing interventions with a focus on skill development, leadership, and resiliency can serve to support these youth in reaching their potential. This paper will present the development of the Canadian SNAP-Boys Youth Leadership Services, a continuing-care component for youth who have had previous involvement in children's mental health services, designed to enhance protective factors or developmental assets. This exploratory qualitative study was conducted in 2017 and examined 12 youths' perspectives on what they have gained from participation in the program, and why they consider this program to be of value. We used thematic analysis to analyse interview transcripts. We identified themes of motivation, "second home", and personal growth. What youth value and their investment in the program can be linked to key positive youth development components of a skills focus, explicit leadership and employment opportunities, program structure, supportive relationships and a sense that they matter. Implications for practice, research, and policy are shared. [ABSTRACT FROM AUTHOR]

Several repercussions have been linked to teen dating violence, including self-silencing. Self-silencing refers to an excessive worry about the partner's needs and opinions, which can lead to neglecting one's well-being. However, the mechanisms by which dating violence, especially sexual victimization, affects self-silencing are understudied. Moreover, studies have identified sexual victimization by an intimate partner as one of the most critical factors affecting youth's self-esteem development, which may explain this relationship. The present study aimed to explore the possible mediating role of self-esteem in the relationship between sexual teen dating violence and self-silencing. Adolescents were recruited from a one-stage stratified cluster sample of 34 high schools inQuebec, Canada. Adolescents completed measures on sexual dating violence and self-esteem at Wave 1 and self-silencing in their relationship at Wave 2, 6 months later. Analyses were conducted on 2,489 adolescent girls (M = 15.48 years, SD =.95) who participated in Wave 2 and reported being in a dating relationship in the last 6 months. Results of the path analysis indicated that self-esteem acted as a mediator in the relationship between sexual teen dating violence and self-silencing. This study helps better understand the processes underlying self-silencing behaviors in adolescent victims of sexual dating violence. The results highlight a potential target for intervention to inhibit the development of self-silencing in adolescent girls experiencing sexual dating violence. [ABSTRACT FROM AUTHOR]

Background: Youth mental health is a growing concern in research, practice, and policy. Practice standards, guidelines, or strategies provide an invisible infrastructure that fosters equity, quality, and safety, potentially addressing inconsistencies and more effectively attending to the mental wellness of Black youth as a particular population of concern. This scoping review aimed to address the following question: What standards exist for the delivery of mental health services to Black youth in community, primary care, and educational settings? Due to a limited initial search yield on publications about standards for the delivery of mental health services for Black youth population, our goal was then to identify and map mental health standards, recommendations, or guidelines for the delivery of mental health services using the same settings to all youth. Methods: Searches were conducted in various databases, including PubMed/MEDLINE, PsycINFO, Embase, SocINDEX, CINAHL, Gender Studies Database, Social Services Abstracts, Sociological Abstracts, Scopus, Web of Science, and Google Scholar. Screening was independently conducted by two reviewers, with disagreements resolved by a third. Information extraction was performed by two independent reviewers. Results: Out of the 2,701 screened publications, 54 were included in this scoping review. Among them, 38.9% were published between 2020 and 2023, with 40.7% originating from the United States of America, 20.4% from the United Kingdom, and 13% from Canada. Concerning the settings, 25.9% of the publications focused on primary care, 24.1% on health care services, 20.4% on educational settings, and 3.7% on the community. Additionally, 25.9% were classified as general because recommendations were applicable to various settings. Attention-deficit/hyperactivity disorder (11.1%) was the most frequently considered specific condition, followed by autism spectrum disorder (9.3%) and depression (9.3%). However, 31.5% of the included references addressed mental health in general. Only three references provided specific recommendations for the Black population. Conclusions: Recommendations, guidelines, or standards for Black youth mental health services in community, primary care, or educational settings are scarce and limited to North American countries. This scoping review emphasizes the need to consider ethnicity when developing guidelines or standards to improve racial equity and reduce disparities in access to mental health services. [ABSTRACT FROM AUTHOR]

The Child and Youth Resilience Measure (CYRM) is one of the most popular measures of resilience. In this paper, we investigate the CYRM using Rasch analysis to explore and improve its psychometric properties, leading to a more robust measure of resilience.Cross-sectional data were obtained from a questionnaire administered to n = 408 individuals in Canada aged 11-19 who were participating in the Pathways to Resilience study. Rasch analysis was applied to these data, resulting in the production of a 17-item, 2-subscale CYRM-R, consisting of intra/interpersonal and caregiver resilience subscales. The subscales demonstrated good fit to the Rasch model by satisfying requirements of unidimensionality, good fit statistics and internal reliability, and a lack of item bias and problematic local dependency. The person separation indices also indicated that the subscales had good ability to differentiate between individuals of varying levels of resilience. In sum, the CYRM-R is a 2-subscale, 17-item Rasch-validated measure of resilience with robust psychometric properties. This revised measure is recommended for researchers and practitioners who are interested in measuring resilience across diverse cultures and contexts. [ABSTRACT FROM AUTHOR]

Background Youth consumption of cigarillos (ie, little cigars) has increased markedly in recent years. In July 2010, the Canadian government banned the sale of flavoured cigarillos and required unflavoured cigarillos to be sold in packs of at least 20 units. This paper assesses changes in young persons' use of cigarillos and regular cigars, which are potential substitutes, following the policy. Methods To investigate of the change in cigar smoking following the policy, we constructed a segmented regression model that allowed the policy to change the height and the slope of the trend in the outcome variables. The model was estimated using data from the 2007-2011 Canadian Tobacco Use Monitoring Surveys. Results We obtained visual and regression-based evidence that use of cigarillos among youth declined following the policy. We also found a small, gradual increase in their use of regular cigars, possibly due to their compensatory switching from cigarillos to regular cigars. Overall, there was a net reduction in cigar use among youth after the intervention. Interpretation The policy achieved its goal of reducing youth's consumption of cigarillos, but may have an unintended consequence of increasing their use of regular cigars. Policymakers should address the possibility that youth switch to regular cigars in response to restricted access to cigarillos. Possible ways of discouraging this substituting behaviour include extending the ban to cover all flavoured cigars and mandating a minimum pack size for all cigars, or raising taxes on flavoured cigars. [ABSTRACT FROM AUTHOR]

Background: Food insecurity is a social determinant of health linked with elevated HIV exposure. Safer sex efficacy (SSE), the ability to navigate sexual decision-making and condom use, is an important marker of sexual wellbeing. Pathways from food insecurity to SSE are understudied, particularly among adolescents in Arctic regions who are at the nexus of food insecurity and sexual health disparities. We examined pathways from food insecurity to SSE among adolescents in the Northwest Territories (NWT), Canada. Methods: We implemented cross-sectional surveys with adolescents aged 13–18 recruited through venue-based sampling in 17 NWT communities. We conducted multivariable logistic regression to assess socio-demographic factors associated with food insecurity. We then conducted structural equation modeling (SEM) using maximum likelihood estimation to assess direct effects of food insecurity on SSE and indirect effects via resilience, depression, and relationship power inequity. We assessed both condom use SSE (e.g., confidence in using condoms) and situational SSE (e.g., SSE under partner pressure). Results: Most participants (n = 410) identified as Indigenous (79%) and 45% reported experiencing food insecurity. In SEM, we did not find a significant direct effect from food insecurity to SSE; however, we found indirect effects from food insecurity to condom use SSE through resilience and depression and from food insecurity to situational SSE through resilience. Conclusions: Findings call for structural interventions to address food insecurity, alongside resilience-focused strategies that address the intersection of sexual and mental health. Sexual health strategies focused on individual behavior change are insufficient to address larger contexts of poverty among Northern youth. [ABSTRACT FROM AUTHOR]

Adolescent anhedonia is a multidimensional construct defined as the loss of enjoyment or pleasure across multiple domains of life. Anhedonia is concurrently associated with substantial impairment and distress, and it prospectively predicts the onset, severity, and treatment of depression. Despite its demonstrated importance, a limited number of anhedonia measures are validated for adolescents. The current study assessed the psychometric properties of the Dimensional Anhedonia Rating Scale (DARS) in 400 English-speaking, 12- to 19-year-old adolescents. Overall, the DARS demonstrated good convergent and discriminant validity, but sub-optimal concurrent validity. The strengths and limitations of the DARS and its utility as a measure of adolescent anhedonia are discussed. Furthermore, future directions for the construction of measures of adolescent anhedonia are outlined. [ABSTRACT FROM AUTHOR]

This paper pertains to a retrospective study of immigrant students' experience of making friends and gaining social confidence in secondary school. In the study, 17 undergraduate students participated in either a one-to-one semistructured interview or focus group. Questions were asked to understand their experiences in making friends and gaining social confidence when they came to Canada between grades five to nine. Thematic analysis (Braun & Clarke, 2006) was used to analyse the data. This method was useful in looking for commonalities in meaning in participants' responses. In total, seven themes and 20 subthemes were discovered, which are discussed in detail. Implications for school professionals are discussed along with suggestions for future research. [ABSTRACT FROM AUTHOR]

About 900 youth experiencing homelessness (YEH) reside at an emergency youth shelter (EYS) in Toronto on any given night. Several EYSs offer access to healthcare based on youths' needs, including access to primary care, and mental health and addictions support. However, youth also require healthcare from the broader health system, which is often challenging to navigate and access. Currently, little is known about healthcare coordination efforts between the EYS and health systems for YEH. Using grounded theory methodology, we interviewed 24 stakeholders and concurrently analyzed and compared data to explore pathways to healthcare coordinated for youth who reside at an EYS in Toronto. We also investigated fundamental parts (i.e., norms, resources, regulations, and operations) within the EYS and health systems that influence these pathways to healthcare using thematic analysis. A significant healthcare coordination gap was found between these two systems, typically when youth experience crises, often resulting in a recurring loop of transition and discharge between EYSs and hospitals. Several parts within each system act interdependently in hindering adequate healthcare coordination between the EYS and health systems. Incorporating training for system staff on how to effectively coordinate healthcare and work with homeless populations who have complex health needs, and rethinking information-sharing policies within circles of care are examples of how system parts can be targeted to improve healthcare coordination for YEH. Establishing multidisciplinary healthcare teams specialized to serve the complex needs of YEH may also improve healthcare coordination between systems, and access and quality of healthcare for this population. [ABSTRACT FROM AUTHOR]

Introduction: Youth media guidelines in Canada and the United States recommend that bedrooms should remain screen-free zones. This study aims to verify whether bedroom screens at age 12 years prospectively predict academic and social impairment by age 17 years. Methods: Participants were from the Quebec Longitudinal Study of Child Development birth cohort (661 girls and 686 boys). Linear regression analyses estimated associations between having a bedroom screen (television or computer) at age 12 years and selfreported overall grades, dropout risk, prosocial behaviour and likelihood of having experienced a dating relationship in the past 12 months at age 17 years, while adjusting for potential individual and family confounding factors. Results: For both girls and boys, bedroom screens at age 12 years predicted lower overall grades (B = −2.41, p ≤ 0.001 for boys; −1.61, p ≤ 0.05 for girls), higher dropout risk (B = 0.16, p ≤ 0.001 for boys; 0.17, p ≤ 0.001 for girls) and lower likelihood of having experienced a dating relationship (B = −0.13, p ≤ 0.001 for boys; −0.18, p ≤ 0.001 for girls) at age 17. Bedroom screens also predicted lower levels of prosocial behaviour (B = −0.52, p ≤ 0.001) at age 17 years for boys. Conclusion: The bedroom as an early adolescent screen-based zone does not predict long-term positive health and well-being. Pediatric recommendations to parents and youth should be more resolute about bedrooms being screen-free zones and about unlimited access in private exposures in childhood. [ABSTRACT FROM AUTHOR]

This study investigates associations between initial levels and change in the quality of the relationships youth with intellectual disabilities (ID) share with their parents and teachers, and changes in their levels of depression over time. A sample of 395 youth with mild (48.3%) and moderate (51.7%) ID, aged between 11 and 22 (M = 15.69), were recruited in Canada (n = 142) and Australia (n = 253). Youth completed self-report measures of relationship quality and depression twice over a one-year period. Initial levels of warmth (β = −.109) and conflict (β = −.302) predicted decreases in depression. Increases in warmth predicted decreases in depression (β = −.179), while increases in conflict predicted increases in depression (β =.268). Discrepancies between youth relationships with their parents and teachers predicted decreases in depression (βwarmth = −.732; βconflict = −.608). [ABSTRACT FROM AUTHOR]

This study investigates the nature of the social interaction profiles observed among youth with intellectual disabilities (ID), defined while considering their relationships with their parents, peers, and teachers, as well as the implication of these profiles for self-esteem, aggressive behaviors, and prosocial behaviors. A sample of 393 youth with mild (48.2%) to moderate (51.8%) levels of ID, aged between 11 and 22 (M = 15.70), was recruited in Canada (n = 141) and Australia (n = 253). Our results revealed four profiles, corresponding to Socially Isolated (23.24%), Socially Integrated (39.83%), Socially Rejected (28.37%) and Socially Connected (8.57%) youth with ID. The socially integrated and connected profiles both presented higher self-esteem, more prosocial behaviors, and less aggressive behaviors than the socially isolated and rejected profiles. [ABSTRACT FROM AUTHOR]

Background: Eating disorders have one of the highest mortality rates among psychiatric illnesses. Timely intervention is crucial for effective treatment, as eating disorders tend to be chronic and difficult to manage if left untreated. Clinical practice guidelines play a vital role in improving healthcare delivery, aiming to minimize variations in care and bridge the gap between research and practice. However, research indicates an active guideline implementation approach is crucial to effective uptake. Methods: Mixed methods will be used to inform and evaluate our guideline implementation approach. Semi-structured focus groups will be conducted in each of the eight provinces in Canada. Each focus group will comprise 8–10 key stakeholders, including clinicians, program administrators, and individuals with lived experience or caregivers. Qualitative data will be analyzed using conventional content analysis and the constant comparison technique and the results will be used to inform our implementation strategy. The study will then evaluate the effectiveness of our implementation approach through pre- and post-surveys, comparing changes in awareness, use, and impact of the guidelines in various stakeholder groups. Discussion: Through a multifaceted implementation strategy, involving the co-creation of educational materials, tailored training, and context-specific strategies, this study intends to enhance guideline uptake and promote adherence to evidence-based practices. Our study will also contribute valuable information on the impact of our implementation strategies. This protocol outlines a comprehensive research study aimed at evaluating an implementation approach for the uptake of the Canadian Practice Guidelines for Treating Children and Adolescents with Eating Disorders across Canada. Eating disorders (EDs) have a significant impact on mental and physical health, necessitating evidence-based and timely interventions. To address gaps in service, we propose to use focus groups to identify barriers, facilitators, and implementation strategies for guideline uptake. We will engage stakeholders, including clinicians, administrators, and individuals with lived experience, to co-create tailored educational materials which will then be disseminated. The impact of the implementation approach will be evaluated through pre- and post-implementation surveys. This study aims to enhance the availability and utilization of evidence-based treatments for children and adolescents with EDs, ensuring equitable and improved care nationwide. [ABSTRACT FROM AUTHOR]

Objective: Little is known about self-concept in adolescents with physical-mental comorbidity. This study investigated whether physical-mental comorbidity was associated with self-concept in adolescents and examined if adolescent age or sex moderated the association between physical-mental comorbidity and self-concept. Methods: Study data were obtained from the Multimorbidity in Youth across the Life-course (MY LIFE), an ongoing Canadian study of adolescents with chronic physical illness who were recruited from outpatient clinics at a pediatric hospital. A total of 116 adolescents aged ≥ 10 years provided self-reports on key measures. Results: Adolescents with comorbidity (n = 48) had lower self-concept scores on the Self-Determination Questionnaire (SDQ; d = 0.62) and Self-Perception Profile for Children (SPPC; d = 0.53) vs. adolescents without comorbidity (n = 68). An age × comorbidity status interaction was found and age-stratified models were computed to investigate this moderating effect of age. Amongst older adolescents, comorbidity was associated with lower SDQ (B = -2.55, p <.001), but this association was not found among younger adolescents (B = -0.29, p =.680). A similar effect was found for SPPC among older (B = -0.48, p =.001) and younger adolescents (B = 0.03, p =.842). Adolescent sex was not found to be a moderator. Conclusions: Physical-mental comorbidity in adolescence was associated with lower self-concept and this association was moderated by age—differences between adolescents with vs. without comorbidity were greater for older adolescents and were clinically relevant. Opportunities to support positive self-perceptions for adolescents with comorbidity are warranted, especially when planning the transition from pediatric to adult health services. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The System of Observing Play and Leisure Activity in Youth (SOPLAY) has assisted in providing valid and reliable data of youth physical activity and characteristics specific to environmental contexts. The review aimed to examine empirical research that employed the SOPLAY instrument to measure physical activity in leisure‐based activity environments in North American countries. Methods: The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. A systematic search was conducted with an exhaustive process using 10 electronic databases to locate peer‐reviewed studies implementing SOPLAY that were published between 2000 and 2021. Results: A total of 60 studies were included in the review. Most studies (n = 35) reported physical activity findings related to contextual characteristics measured using SOPLAY. Interestingly, a few of the studies (n = 8) found the provision of equipment and supervision, particularly adult supervision, significantly increased child physical activity observed. Conclusions: This review provides information relative to the group‐level physical activity observed across multiple contexts (ie, playgrounds, parks, recreation centers) using a validated direct observation instrument. [ABSTRACT FROM AUTHOR]

Background: Racism is a social determinant of health that links to the health and well‐being of racial/ethnic marginalized populations. However, perceived racism among African Canadian adolescents has not been adequately addressed, especially the link between racism and psychosocial stressors in school settings. Aim: The aim of the current study was to assess racism and the link to school‐related psychosocial stressors in a population‐based sample of African Canadian adolescents. Design: Secondary analysis of the population‐based 2018 British Columbia Adolescent Health Survey dataset. Methods: Logistic regression and generalized linear models tested the link between racism and psychosocial stressors among African Canadian adolescents (n = 942), adjusting for sociodemographic factors. Results/Findings: More than 38% of the adolescents reported racism in the year preceding the survey. Regardless of gender and birthplace, and controlling for covariates, those who experienced racism were significantly more likely to report peer victimization, which includes teasing, social exclusion, cyberbullying and sexual harassment, and they felt less safe and connected to their schools compared to those who did not experience racism. With gender and birthplace differences, those who reported racism had higher odds of having been physically assaulted, stayed away from school, reported negative emotional responses and used avoidant behaviours to evade racism. Conclusion: African Canadian adolescents are a visible racialized ethnic group in British Columbia, who are at heightened risk of racism and the associated psychosocial stressors. Impact: These findings demonstrate the influences of racism on psychosocial stressors and related emotional responses among African Canadian adolescents. Nurses and other healthcare providers should be cognizant of racism and the psychological impacts when providing care to "at‐risk" populations. Promoting positive and inclusive school climates and addressing racism at all levels of the society will foster better social integration, as well as improve the health and academic achievement of African Canadian adolescents. Patient or Public Contribution: We presented the research and preliminary results of the data analysis to the African community (parents and adolescents who self‐identify as African). The African community who attended the gathering corroborated the link between racism and health and reiterated that addressing these psychosocial stressors can promote adolescent health and well‐being. The attendees accepted all the variables that we included in the analysis. However, they emphasized the need for more African representation among school staff and teachers to foster trust, feelings of safety and connectedness, and to promote African students' academic achievement and well‐being. They stressed the need to train and build the capacities of the school staff and teachers so that they can assist students regardless of race. They emphasized the need to promote cultural awareness and cultural sensitivity among all healthcare providers. We included the recommendations in the appropriate sections of the manuscript. [ABSTRACT FROM AUTHOR]

Art therapy is one rehabilitation treatment which enables youth in secure care to express unresolved conflicts, increase self-esteem, and gain insight to personal experiences in a creative and supportive therapeutic space. This study investigated hope and resilience outcomes following art therapy for youth residing in a secure care centre located in Canada. In this pre–post experimental design study, thirteen (N = 13) youth, ages 12–19, received 12 weekly individual art therapy sessions. Hope, resilience, and goals were measured using the Children's Hope Scale (CHS), the Resilience Scale (RS-25), and the Bridge Drawing with Path (BDP) art-based assessment. Results indicated that the 12 weekly individual art therapy sessions enhanced hope and resilience in youth residing in secure care by 29% and 16%, respectively. Secure care environments may benefit from incorporating art therapy as a rehabilitation treatment to improve youths' levels of hope, resilience, self-determination, and future pathways. Future studies should utilise a group design with a control group to evaluate the effects of art therapy on youth residing in secure care environments. Art therapy is one rehabilitation treatment which enables youth in secure care to express unsettled conflicts, increase self-esteem, and gain understanding of personal experiences in a creative and supportive therapeutic space. This study investigated the effectiveness of art therapy on the levels of hope and resilience in youth residing in a secure care centre located in Canada. In this pre–post experimental design, thirteen youth, ages 12–19, received 12 weekly individual art therapy sessions. Hope, resilience, and goals were measured using the Children's Hope Scale (CHS), the Resilience Scale (RS-25), and the Bridge Drawing with Path (BDP) art-based assessment. Results showed that the 12 weekly art therapy sessions enhanced hope and resilience in youth residing in secure care by 29% and 16%, respectively. Secure care environments may benefit from including art therapy as a rehabilitation treatment to improve youths' levels of hope, resilience, self-determination, and future pathways. Future studies should use a group design with a control group to measure the effects of art therapy on youth residing in secure care environments. [ABSTRACT FROM AUTHOR]

Introduction: The need for child/adolescent mental health care in Canada is growing. Primary care can play a key role in filling this gap, yet most providers feel they do not have adequate training. This paper reviews the Canadian literature on capacity building programs in child and adolescent psychiatry for primary care providers, to examine how these programs are being implemented and evaluated to contribute to evidence-based initiatives. Methods: A systematic literature review of peer-reviewed published articles of capacity building initiatives in child/adolescent mental health care for primary care practitioners that have been implemented in Canada. Results: Sixteen articles were identified that met inclusion criteria. Analysis revealed that capacity building initiatives in Canada are varied but rigorous evaluation methodology is lacking. Primary care providers welcome efforts to increase mental health care capacity and were satisfied with the implementation of most programs. Discussion: Objective conclusions regarding the effectiveness of these programs to increase mental health care capacity is challenging given the evaluation methodology of these studies. Conclusion: Rigorous evaluation methods are needed to make evidence-based decisions on ways forward to be able to build child/adolescent mental health care capacity in primary care. Outcome measures need to move beyond self-report to more objective measures, and should expand the measurement of patient outcomes to ensure that these initiative are indeed leading to improved care for families. [ABSTRACT FROM AUTHOR]

This study analyzes the previous literature on the online safety of children and youth under "the 4Cs risk framework" concerning contact, content, conduct, and contract risks. It then conducts a comparative study of Australia, Canada, and the UK, comparing their institutions, governance, and government-led programs. Relevant research in Childhood Education Studies is insufficient both in quantity and quality. To minimize the four major online risks for children and youth in cyberspace, it is necessary to maintain a regulatory approach to the online exposure of children under the age of 13. Moreover, the global society should respond together to these online risks with "multi-level" policymaking under a "multi-stakeholder approach". At the international level, multilateral discussion within the OECD and under UN subsidiaries should continue to lead international cooperation. At the domestic level, a special agency in charge of online safety for children and youth should be established in each country, encompassing all relevant stakeholders, including educators and digital firms. At the school and family levels, both parents and teachers need to work together in facilitating digital literacy education, providing proper guidelines for the online activities of children and youth, and helping them to become more satisfied and productive users in the digital era. [ABSTRACT FROM AUTHOR]

Assisted dying legislation is available to support adult deaths in multiple international jurisdictions. In Canada, a parliamentary committee has recommended extending Medical Assistance in Dying (MAID) legislation to include 'competent mature minors'. Even though such a policy change would affect young people, to date formal discussions about MAID for minors have excluded them. No empirical studies have elicited youth perspectives on including them in future legislation. This qualitative descriptive study uses focus groups to explore young people's perspectives on MAID and its potential extension to include minors using methodological and theoretical commitments to participatory research and children's agency. Our participants explored philosophical and medical dimensions of MAID, including pain and suffering, the choice to die, and how MAID enables a peaceful, controlled death. They unpacked the concept of maturity vis‐à‐vis age and a child/adult binary, using these reflections to posit safeguards for ensuring minors' MAID requests would be fairly evaluated. Finally, they explored relational dimensions of dying, paying particular attention to the impact of MAID on grievers. Our results illustrate that young people are capable and keen to contribute toward discussions and decisions about MAID. Our study supports the participation of young people in any extension of MAID, as well as in other high‐stakes matters that may affect them, challenging dominant assumptions that underestimate their capacities to do so. [ABSTRACT FROM AUTHOR]

In this article, we take a strength-based approach to understand how applied theatre as a vehicle provides opportunities for embodied voices to have a positive influence on the well-being, and attitudes to health, of young people who have been ‘pushed’ to the margins. We begin by explaining the concepts of well-being, embodiment and embodied voices, and applied theatre. Following this we explore an example of a theatre project developed in Canada with Indigenous youth to illustrate how the well-being of those who might be termed ‘marginalised’ in this context, is enhanced through a process of embodied reflexivity using applied theatre approaches. Finally, we discuss challenges with this approach to working with ‘marginalised’ youth, and also present some recommendations for professionals using applied theatre for co-creation with ‘marginalised’ youth for their well-being.We share how our research led us to conclude that a commitment to the arts as a fundamental and core process for developing wellness and wellbeing is necessary. This would mean professionals associated with any programmes or projects generated to explore embodied work with young people need see the arts as a philosophical underpinning, rather than as just an additional activity that can be inserted into any programme. [ABSTRACT FROM PUBLISHER]

This study examined pathways from prosocial behaviour in the beginning of the school year to emotional health and academic achievement in the end of the year, taking into account the mediating role of peer acceptance. Participants were 734 grade 4 to 7 students in public elementary schools (51% female) in Western Canada. As expected, pathway analyses taking into account the clustered structure of the data indicated that self-reported prosocial behaviour in the beginning of the school year was significantly related higher levels of self-reported optimism, lower levels of depressive symptoms, and better grades in the end of the year; the association was mediated by peer-reported peer acceptance in the classroom. Findings support the role of peer acceptance as an underlying mechanism involved in the association between prosocial behaviour and positive developmental health outcomes in early adolescence. Findings are also practically relevant as they inform school-based social-emotional competence promotion through interventions. [ABSTRACT FROM AUTHOR]

Background: Unhealthy lifestyle behaviours are becoming increasingly common and might contribute to the growing burden of mental disorders in adolescence. We examined the associations between a comprehensive set of lifestyle behaviours and depression and anxiety in middle adolescents. Methods: School-based survey responses were collected from 24,274 Canadian high school students at baseline and 1-year follow-up (average age 14.8 and 15.8 years, respectively). Using linear mixed-effects models, we examined prospective associations of adherence to recommendations for vegetables and fruit, grains, milk and alternatives, meat and alternatives, sugar-sweetened beverages [SSB], physical activity, screen time, sleep, and no use of tobacco, e-cigarettes, cannabis, and binge drinking at baseline with the depressive and anxiety symptoms (measured by CESD-R-10 and GAD-7 scales, respectively) at follow-up. Results: Adherence to recommendations was low overall, particularly for vegetables and fruit (3.9%), grains (4.5%), and screen time (4.9%). Students adhering to individual recommendations, particularly for meat and alternatives, SSB, screen time, sleep, and no cannabis use, at baseline had lower CESD-R-10 and GAD-7 scores at follow-up. Adhering to every additional recommendation was associated with lower CESD-R-10 (β=-0.15, 95% CI -0.18, -0.11) and GAD-7 scores (β=-0.10, 95% CI -0.14, -0.07) at follow-up. Assuming cumulative impact, this might translate into 7.2- and 4.8-point lower CESD-R-10 and GAD-7 scores, respectively, among students adhering to 12 vs. 0 recommendations over four years of high school. Conclusions: The results highlight the preventive potential of population-based approaches promoting healthy lifestyle behaviours, particularly those with the lowest prevalence, as a strategy to improve mental health in adolescence. [ABSTRACT FROM AUTHOR]

Purpose: Young people with disabilities are persistently under-employed and experience concerning rates of discrimination and ableism in looking for work and within the workplace. Focusing on youth is salient because rates of ableism are often higher among younger ages compared to older. The objective of this systematic review was to explore the experiences and impact of workplace discrimination and ableism among youth and young adults with disabilities. Methods: Systematic searches of seven databases from 2000 to 2021 were conducted. Four reviewers independently applied the inclusion criteria, extracted the data and rated the study quality. Results: Of the 39 studies meeting our inclusion criteria, they represented 516,281 participants across eight countries over a 20-year period. The findings highlight the rates of workplace ableism, factors affecting workplace ableism (i.e., type of disability, gender, education level, lack of employers' knowledge about disability), ableism in job searching and anticipated ableism. The review also noted the impact of workplace ableism, which included pay discrimination, lack of job supports and social exclusion, job turnover and unemployment, and discrimination allegations and charges. Conclusions: Our findings reveal the stark prevalence of workplace ableism among youth and young adults with disabilities. There is an urgent need for further in-depth research to understand youth's lived experiences of ableism and the development of solutions to address it so they can be included in a meaningful and respectful way in the workplace. [ABSTRACT FROM AUTHOR]

Acquired Brain Injury (ABI) is the leading cause of death and disability in children, yet educators report a lack of knowledge about ABI and supporting students with ABI. With no formal learning about ABI, education professionals may turn to the internet for information. To find online resources about supporting students with ABI, in any format, available freely and publicly, aimed toward elementary educators and that could be applied in a Canadian context. We performed an environmental scan using keyword Google searches, key websites, and expert recommendations. The search was performed twice: 2018 and 2021. 96 resources were included after screening. The resources were published by organizations in the United States (n = 57), Canada (n = 19), United Kingdom (n = 16), Australia (n = 3) and New Zealand (n = 1). Traumatic brain injury and concussion were the most commonly addressed type of ABI, and Short Fact/Information sheets were the most common resource format. Between 2018 and 2021, 13 previously included resource links were no longer accessible. This scan suggests that there are many online resources available to educators in a variety of formats, and that information online can be transient. Future studies should evaluate the accuracy and quality of the resources available. [ABSTRACT FROM AUTHOR]

Background: Appropriate and timely consideration of ethical, legal, organizational, and social issues in universal preventive programs for eating disorders (UPPED) are relevant for the approval, funding and implementation of health‐policy decision making. Objective: To identify and analyse the ethical, legal, organizational, and social aspects involved in interventions aimed at the universal prevention of eating disorders (ED) in children, pre‐adolescents and adolescents in the school settings. Method: A scoping review of the literature was carried out. MEDLINE, EMBASE, CENTRAL, PsycINFO, and Social Science Citation Index were searched for studies published in English or Spanish. The quality of the studies was assessed using specific scales for each study design. Results: Fourteen studies were included: one scoping review; four narrative reviews, six observational studies, two qualitative studies, and one mixed methods study. Results were narratively synthesised according to: (1) equity; (2) gender perspective; (3) potential harm; (4) participants and facilitators profile; (5) feasibility; and (6) acceptability. Conclusions: Interactive programs with relevant contents for participants have greater acceptability. Programs focussed on developing competencies can reduce the risk of potential harm. Incorporating a gender perspective contributes to improving equity. Teachers with prior training in ED are well suited as facilitators of these programs. Key points: EDs can lead to health problems such as increased mental morbidity, heart and kidney disease, and increased mortality. In addition, the economic impact of EDs is highUniversal preventive programs for ED are of particular interest, since they constitute an efficient approach for early preventionThe consideration of ethical, legal, organisational and social issues in universal preventive programmes for eating disorders are relevant to the approval, funding and implementation of health policy decisionsTeachers with prior training in ED are well suited as facilitators of these programsA research need arising from the study is to assess whether population‐focussed or universal programmes work better and whether there is any ethical, legal, organisational and social impact [ABSTRACT FROM AUTHOR]

Our study examined how increased dairy consumption versus habitually low dairy consumption, against a background of healthy eating (and exercise), influenced diet quality, nutrient intake, and snacking in Canadian female adolescents (14.8 ± 2.2 years) with overweight/obesity (OW/OB). We also explored dairy consumption patterns in the group consuming dairy products. Participants were randomized into two groups: higher/recommended dairy (RDa; 4 svg/d; n = 24) or low dairy (LDa; 0–2 svg/d; n = 23). Both groups participated in a 12-week, eucaloric, lifestyle modification intervention consisting of exercise training and nutritional counseling. The intervention increased the total Canadian Healthy Eating Index score (p < 0.001) with no differences between groups. The "other food" sub-score improved more in RDa than LDa (p = 0.02), and the "saturated fat" sub-score increased more in LDa than RDa (p = 0.02). The intervention significantly increased the consumption of dairy-related nutrients more in RDa than LDa (p < 0.05). The intervention also decreased snack size in both groups (p = 0.01) and improved percentage of healthy snack energy intake more in RDa than LDa (p = 0.04). More servings of dairy products were consumed as snacks than at breakfast, lunch, or dinner (p < 0.05). Thus, our study improved diet quality, and dairy product consumption improved intakes of key related nutrients and snack consumption in adolescents with OW/OB. [ABSTRACT FROM AUTHOR]

This single‐arm, repeated measures study investigated the impact caregiver trauma history may have on treatment response following an intensive, 2‐day Emotion Focused Family Therapy (EFFT) caregiver workshop. Caregivers (n = 243) completed questionnaires regarding their child's emotion regulation and clinical symptoms, as well as their own childhood trauma history (i.e., exposure to various forms of child maltreatment), caregiver self‐efficacy and caregiver blocks (e.g., fears) to support their child's treatment and recovery. Questionnaires were administered prior to and immediately following the workshop and again 4, 8 and 12 months later. At baseline, caregivers who reported experiences of childhood maltreatment demonstrated more blocks compared with caregivers who did not (B = 6.35, SE = 2.62, p < 0.05). Results indicated that caregivers with and without maltreatment histories reported similar, significant gains in their child's total difficulties (B = 0.64, SE = 0.41, p = 0.12) and emotional negativity and lability (B = 0.51, SE = 0.48, p = 0.29) at 12‐month post‐workshop. Caregivers with maltreatment histories reported greater improvements in caregiver blocks (B = 5.15, SE = 1.34, p < 0.001) and child emotion regulation (B = 0.90, SE = 0.18, p < 0.001) than caregivers without maltreatment histories. They also report less, but still significant, improvement in parental self‐efficacy (B = −0.68, SE = 0.26, p < 0.01) when compared with caregivers without maltreatment histories. Findings suggest that EFFT workshops may be an acceptable and effective trans‐diagnostic intervention for families presenting with complex histories, including caregiver exposure to childhood maltreatment. [ABSTRACT FROM AUTHOR]

There are currently no universal evidence-based nutrition guidelines that address the gluten-free (GF) diet for children/youth (4–18 years). A GF food guide was created to help children/youth with coeliac disease (CD) and their families navigate the complexities of following a GF diet. Guide formation was based on pre-guide stakeholder consultations and an evaluation of nutrient intake and dietary patterns. The study objective was to conduct an evaluation on guide content, layout, feasibility and dissemination strategies from end-stakeholder users (children/youth with CD, parents/caregivers and health care professionals). This is a cross-sectional study using a multi-method approach of virtual focus groups and an online survey to conduct stakeholder evaluations. Stakeholders included children/youth (4–18 years), their parents/caregivers in the coeliac community (n 273) and health care professionals (n 80) with both paediatric and CD experience from across Canada. Thematic analysis was performed on focus group responses and open-ended survey questions until thematic saturation was achieved. χ2 and Fisher's exact statistical analyses were performed on demographic and close-ended survey questions. Stakeholders positively perceived the guide for content, layout, feasibility, ethnicity and usability. Stakeholders found the material visually appealing and engaging with belief that it could effectively be used in multi-ethnic community and clinical-based settings. Guide revisions were made in response to stakeholder consultations to improve food selection (e.g. child-friendly foods), language (e.g. clarity) and layout (e.g. organisation). The evaluation by end-stakeholders provided practical and patient-focused feedback on the guide to enable successful uptake in community and clinical-based settings. [ABSTRACT FROM AUTHOR]

Background: E-cigarette use is increasing among Canadian youth, with experimentation especially prevalent among never-smoking youth. Among this group, there is concern e-cigarette use contributes to future initiation of smoking through a gateway effect. However, e-cigarette use and smoking share many common risk factors; a postulated mechanism to explain the apparent causal pathway from e-cigarette use to smoking initiation in previously smoking-naïve youth. A better understanding of the relationships between smoking susceptibility and e-cigarette use among never-smoking youth is needed. Purpose/objectives: The primary aim of this study was to gain a deeper understanding of the risk factors associated with smoking susceptibility in youth who have recently used e-cigarettes. Methods: This study used data (n = 40,363) from the 2018/2019 Canadian Student Tobacco Alcohol and Drug Use Survey (CSTADS) to compare the risk factor profiles of susceptible and non-susceptible never-smoking e-cigarette users, as well as susceptible and non-susceptible never-smoking youth who have never used an e-cigarette. Results: E-cigarette use, independent of susceptibility status, was associated with a sociodemographic and behavioral risk factor profile likely to confer a higher risk of initiating smoking. Among e-cigarette users, smoking susceptibility was associated with more smoking risk factors. Conclusions/importance: Study findings support a common risk-factor model, rather than e-cigarette use itself, to explain differences in the likelihood of smoking initiation among e-cigarette users. E-cigarette use and smoking initiation may be interchangeable outcomes amongst those with smoking risk factors. The risks of e-cigarette use, and their regulatory status, need to be balanced with their potential as harm reduction tools. [ABSTRACT FROM AUTHOR]

In children, the mechanisms implicated in deterioration of glucose homeostasis versus reversion to normal glucose tolerance (NGT) remain uncertain. We aimed to describe the natural history of dysglycemia from childhood to late adolescence and to identify its early determinants. We used baseline (8–10 years, n = 630), 1st follow‐up (10–12 years, n = 564) and 2nd follow‐up (15–17 years, n = 377) data from the QUALITY cohort of White Canadian children with parental obesity. Children underwent a 2‐h oral glucose tolerance test at each cycle with plasma glucose and insulin measured at 0/30/60/90/120 min. American Diabetes Association criteria defined dysglycemia (impaired fasting glucose, impaired glucose tolerance or type 2 diabetes). Longitudinal patterns of insulin sensitivity and beta‐cell function were estimated using generalized additive mixed models. Model averaging identified biological, sociodemographic and lifestyle‐related determinants of dysglycemia. Of the children NGT at baseline, 66 (21%) developed dysglycemia without reverting to NGT. Among children with dysglycemia at baseline, 24 (73%) reverted to NGT. In children with dysglycemia at 1st follow‐up, 18 (53%) later reverted to NGT. Among biological, sociodemographic and lifestyle determinants at 8–10 years, only fasting and 2‐h glucose were associated with developing dysglycemia (odds ratio [95% CI] per 1 mmol/L increase: 4.50 [1.06; 19.02] and 1.74 [1.11; 2.73], respectively). Beta‐cell function decreased by 40% in children with overweight or obesity. In conclusion, up to 75% of children with dysglycemia reverted to NGT during puberty. Children with higher fasting and 2‐h glucose were at higher risk for progression to dysglycemia, while no demographic/lifestyle determinants were identified. [ABSTRACT FROM AUTHOR]

Purpose: The Risk of Pediatric and Adolescent Cancer Associated with Medical Imaging (RIC) Study is quantifying the association between cumulative radiation exposure from fetal and/or childhood medical imaging and subsequent cancer risk. This manuscript describes the study cohorts and research methods. Methods: The RIC Study is a longitudinal study of children in two retrospective cohorts from 6 U.S. healthcare systems and from Ontario, Canada over the period 1995–2017. The fetal-exposure cohort includes children whose mothers were enrolled in the healthcare system during their entire pregnancy and followed to age 20. The childhood-exposure cohort includes children born into the system and followed while continuously enrolled. Imaging utilization was determined using administrative data. Computed tomography (CT) parameters were collected to estimate individualized patient organ dosimetry. Organ dose libraries for average exposures were constructed for radiography, fluoroscopy, and angiography, while diagnostic radiopharmaceutical biokinetic models were applied to estimate organ doses received in nuclear medicine procedures. Cancers were ascertained from local and state/provincial cancer registry linkages. Results: The fetal-exposure cohort includes 3,474,000 children among whom 6,606 cancers (2394 leukemias) were diagnosed over 37,659,582 person-years; 0.5% had in utero exposure to CT, 4.0% radiography, 0.5% fluoroscopy, 0.04% angiography, 0.2% nuclear medicine. The childhood-exposure cohort includes 3,724,632 children in whom 6,358 cancers (2,372 leukemias) were diagnosed over 36,190,027 person-years; 5.9% were exposed to CT, 61.1% radiography, 6.0% fluoroscopy, 0.4% angiography, 1.5% nuclear medicine. Conclusion: The RIC Study is poised to be the largest study addressing risk of childhood and adolescent cancer associated with ionizing radiation from medical imaging, estimated with individualized patient organ dosimetry. [ABSTRACT FROM AUTHOR]

High survival rates in adolescent cancer patients have shifted the medical focus to the long-term outcomes of cancer treatments. Surgery, chemotherapy, and radiation increase the risk of infertility and infertility-related distress in adolescent cancer patients and survivors. The aims of this narrative review were to (1) describe the psychosocial impacts of cancer-related infertility in adolescents, (2) identify multilevel barriers to fertility preservation (FP) conversations and referrals, and (3) conclude with evidence-based clinical solutions for improving the oncofertility support available to Canadian adolescents. The results of this review revealed that FP decisions occur within the patient, parent, and health care provider (HCP) triad, and are influenced by factors such as parent attitudes, patient maturity, and HCP knowledge. Decision tools and HCP education can promote the occurrence of developmentally appropriate fertility discussions. At the systems level, cost and resource barriers prevent patients from receiving sufficient fertility information and referrals. Clinical models of care (MOCs) can define interdisciplinary roles and referral pathways to improve the integration of oncofertility services into adolescent cancer care. The continued integration of oncofertility care will ensure that all Canadian adolescents receive the exemplary medical and psychological support necessary to make empowered decisions about their own fertility. [ABSTRACT FROM AUTHOR]

Although schools are one of the largest providers of behavioral health services for youth, many barriers exist to the implementation of evidence-based interventions in schools. This study used the Stages of Implementation Completion (SIC) to examine school-based implementation outcomes for a computer-assisted cognitive behavioral therapy intervention for anxious youth. Organizational factors and predictors of program startup also were examined. Results indicated that the SIC detected implementation variability in schools and suggested that spending more time completing pre-implementation activities may better prepare schools for active implementation of program delivery. Furthermore, proficiency emerged as a potentially important organizational factor to examine in future school-based implementation research. [ABSTRACT FROM AUTHOR]

Aims: Canada's 2018 Cannabis Act allows youth (age 12–17 years) to possess up to 5 g of dried cannabis (or equivalent) for personal consumption/sharing. This study assessed whether the Cannabis Act was associated with changes in police‐reported cannabis offences among youth in Canada. Design Time series model using national daily criminal incident data from January 1, 2015–December 31, 2018 from the Canadian Uniform Crime Reporting Survey (UCR‐2). Seasonal autoregressive integrated moving average time series models, stratified by sex, assessed the relations between legalization and youth cannabis‐related offences. Setting: Canada, 2015–2018. Cases Police‐reported cannabis‐related offenses among youth age 12–17 years (male, n = 32 178; female, n = 9001). Measurements Outcomes: police‐reported cannabis‐related crimes, property crimes, and violent crimes. Covariate: calendar‐month. Findings For females, legalization was associated with a step‐effect decrease of 4.56 (95% confidence interval [CI] = 3.32, 5.81; P < 0.001) police‐reported cannabis‐related criminal offences per day, an effect equivalent to a 64.6% (standard error [SE] = 33.5%) reduction. For males, legalization was associated with a drop of 12.73 (95% CI = 8.82, 16.64; P < 0.001) cannabis‐related offences per day, equaling a decrease of 57.7% (SE = 22.6%). Results were inconclusive as to whether there were associations between cannabis legalization and patterns of property crimes or violent crimes. Conclusions: Implementation of the Cannabis Act in Canada in 2018 appears to have been associated with decreases of 55%–65% in cannabis‐related crimes among male and female youth. [ABSTRACT FROM AUTHOR]