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Dual use of cannabis and alcohol has increased in adolescents, but limited research has examined how it relates to impaired driving or riding with an impaired driver (IDR) compared to single substance use. This study aimed to examine the odds of alcohol- and/or cannabis-IDR among adolescents based on their use of alcohol and/or cannabis, and whether associations differed by gender and age. Cross-sectional survey data were used from a sample of 69,621 students attending 182 Canadian secondary schools in the 2021/22 school year. Multilevel logistic regression estimated the odds of exclusive alcohol-IDR, exclusive cannabis-IDR, and both alcohol and cannabis IDR (alcohol-cannabis-IDR). Substance use interactions with gender and age were tested. Overall, 14.7% of participants reported IDR; 7.5% reported exclusive alcohol-IDR, 3.2% reported exclusive cannabis-IDR, 4.0% reported alcohol-cannabis-IDR, and 7.4% were unsure if they had experienced IDR. The prevalence of IDR varied across substance use groups, 8.0% among nonuse, 21.9% among alcohol-only use, 35.9% among cannabis-only use, and 49.6% among dual use groups. Gender diverse, older, and students with lower socioeconomic status exhibited a higher likelihood of reporting alcohol-cannabis-IDR. Dual use was significantly associated with 9.5 times higher odds of alcohol-cannabis-IDR compared to alcohol-only use, and 3.0 times higher odds compared to cannabis-only use. Dual use was also associated with an increased likelihood of either alcohol- or cannabis-IDR. This study highlights that all students, regardless of substance use, are at risk of IDR, but students engaged in dual use of alcohol and cannabis face an elevated risk compared to both peers who do not use substances and those who use only a single substance. These findings emphasize the importance of targeted interventions that address the risks associated with IDR. [ABSTRACT FROM AUTHOR]

Substance use behaviours have been found to cluster in youth, and cannabis use has been previously linked to tobacco and e-cigarette use. The objective of the current study was to examine the bidirectional associations between cannabis, e-cigarette, and cigarette use among a large sample of Canadian secondary school students. A sample of students in grades 9–11 (n = 14,652) from Ontario and Alberta, Canada who participated in two waves of the COMPASS Study (Time 1 (T1): 2015–2016; Time 2 (T2): 2016–2017) was identified. Autoregressive cross-lagged models investigated the stability of product use between T1 and T2, as well as the bidirectional associations between current cannabis, e-cigarette, and cigarette use while controlling for demographic covariates. Significant autoregressive and bidirectional associations between all three substances were observed. Students who reported using cigarettes and e-cigarettes at T1 were more likely to report using cannabis at T2. Similarly, students who reported using cannabis at T1 were more likely to report using cigarettes and e-cigarettes at T2. Given the bidirectional associations identified between cannabis, e-cigarette, and cigarette use in this research, continued monitoring of evolving policies related to cannabis and e-cigarette use in Canada is needed. Additionally, school and community-based prevention efforts targeting youth should consider addressing poly-substance use. [ABSTRACT FROM AUTHOR]

Selection of appropriate study design and analytical methods is critical for producing robust research, as the design and analytical approach used can ultimately shape results and their interpretation. The objective of this research was to examine how findings from a large repeat cross-sectional data system compare to those from a sample of longitudinal data nested within the same data system, using milk and milk alternative consumption as a case study. Overall, the repeat cross-sectional and longitudinal findings were consistent, and this article highlights the strengths and limitations of both methodologies under examination. Application to social research and public health and policy are discussed. [ABSTRACT FROM AUTHOR]

Background: In the school year immediately following cannabis legalization in Canada, this paper investigated youth perceptions of school support for the prevention and cessation of substance use. Scant research has examined student perceptions in relation to school disciplinary approaches. This study was the first to classify school discipline approach styles using school-level measures. Objective: The objective of this study was to examine whether different school cannabis use-related disciplinary approaches are associated with student cannabis use and perceptions of school supportiveness for the prevention and cessation of substance use. Results: School- and student-level survey data from Year 7 (the 2018/2019 school year) of the COMPASS study were used, including 68,037 grade 9–12 (Secondary I–V in Quebec) students attending 131 Canadian secondary schools. Schools were classified as using different cannabis use-related disciplinary styles based on school-administrator reported approaches to student first-offense violations of school cannabis policies. We identified that although none of the cannabis use-related disciplinary approach styles examined were associated with cannabis use, they were associated with student perceptions. Students attending schools classified as using a Permissive/Supportive approach had a higher likelihood of perceiving their school as supportive for substance use prevention/cessation than their peers at Authoritarian schools. Students who perceived their school as supportive for substance use prevention/cessation were less likely to report current cannabis use than their peers who perceived their school as unsupportive. Conclusions: Unlike previous studies using school classification styles that are based on student perceptions, results do not support direct associations between school cannabis use-related disciplinary styles and student cannabis use. Future prospective research should examine whether supportive disciplinary approaches (e.g., counseling referrals, educational programs) promote student perceptions of school supportiveness, and in turn, deter student substance use. [ABSTRACT FROM AUTHOR]

Background: Historically substance use literature has focused on smoking as the main mode of cannabis consumption, so there are knowledge gaps surrounding current understanding of edibles and vaping. These alternative modes of cannabis use are already common among Canadian youth; however, little is known about how these cannabis use patterns change over time. Methods: This study examined the mode (smoking, eating/drinking, vaping) and frequency of cannabis use among a large sample of Canadian youth who participated in 2017–2018 and 2018–2019 data collection waves of the COMPASS study. Using latent transition analysis, this sample consisting of 18,824 youth in grades 9–12 were categorized into cannabis use classes stratified by sex, and their transition between these classes over the one-year period was examined. Results: Three cannabis use classes were identified (occasional multimode, regular multimode, and smoking) alongside one nonuse class. Among youth who reported cannabis use at baseline, transitioning to a multimode group, and/or increasing frequency of multimode use was likely over the one-year period. Conclusions: These findings may highlight a key leverage point for harm-reduction strategies which aim to prevent cannabis related harms associated with high frequency use. [ABSTRACT FROM AUTHOR]

Background: Existing research suggests positive correlations between screen time sedentary behaviors (STSB) and substance use, including cannabis use, among youth. However, little research has examined what factors mediate these relationships. Methods: This study examined mediating pathways among STSB, internalizing symptoms (IS), and cannabis use in a linked longitudinal sample of 28 269 Canadian youth who participated in the COMPASS study over a two-year period (2017/18 to 2018/19). Structural equation modeling examined two main hypotheses cross-sectionally and over time: 1) if IS mediated associations between STSB and cannabis use frequency, and 2) if STSB mediated associations between IS and cannabis use frequency. Results: Results demonstrated significant partial mediation effects for both hypotheses. For example, indirect effects indicated that IS mediated the association between STSB and cannabis use both cross sectionally (95% CI: 0.021, 0.029) and longitudinally (95% CI: 0.006, 0.010). STSB also mediated associations between IS and cannabis use cross sectionally (95% CI: 0.015, 0.023) and longitudinally (95% CI: 0.010, 0.014). This study demonstrated that the associations between STSB, internalizing symptoms and cannabis use are complex, involving mediation in both directions. Discussion: These findings can be used to inform public health initiatives that aim to take a comprehensive approach to addressing negative health behaviors and outcomes, as it is clear that the multi-directional relationships between STSB and mental health may in-turn impact other health behaviors. Future research should continue to examine mediating factors between STSB and substance use among youth, including exploration of associations with other substances. Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1922455. [ABSTRACT FROM AUTHOR]

There is an association between sports participation and substance use. However, there is some evidence that intramural sports in high school may not have the same effect. Therefore, the objective of this research was to examine the longitudinal associations between intramural participation in high school and substance use. Methods: This study used a three-year linked sample (2016-2018) of grade 9 and 10 (ages 13-17) Canadian high school students in the COMPASS (Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, Sedentary behavior) study (n = 7,845). Students reported their participation in intramurals over time (consistent, none, initiate, intermittent, and quit) and their substance use behaviors (binge drinking, cannabis use, cigarette use, and e-cigarette use). Mixed effects models were used. Results: 42% of students did not participate in intramurals. For binge drinking, male students who never participated had lower odds (0.66 [0.47-0.93]) compared to consistent intramural participators. Female (3.50 [CI: 1.34-9.16]) and male students (1.97 [1.28-3.02]) who did not participate in any intramurals were more likely to use cannabis than consistent participators. Male students who did not participate were also more likely to use cigarettes (1.81 [1.05-3.12]). No associations were found between intramural participation and e-cigarette use. Conclusion: Intramural participation may be associated with increased binge drinking among male high school students. More promisingly, consistent participation in intramurals may be protective against cannabis use among male and female students and cigarette use among male students. [ABSTRACT FROM AUTHOR]

Research has indicated that cannabis consumption through alternative modes of use such as eating/drinking or vaping may be increasing in areas where cannabis has been legalized. However, there is little research that examines these different modes of cannabis use in a Canadian youth context. The purpose of this study was to identify pre-legalization modes of cannabis use (smoking, eating/drinking, vaping) among a sample of 45,677 secondary school students who participated in year 6 (2017/18) of the COMPASS study. Within our sample, 24.9% reported cannabis use within the last 12 months; among those, 38.7% reported occasional use, and 61.3% reported current use. Multi-mode patterns of use were common; more than half of those reporting current cannabis use indicated a use pattern other than exclusively smoking, and over 20% reported use via all three modes. Findings from a latent class analysis identified three distinct groups and suggested that eating/drinking cannabis and vaping cannabis may more often be an addition to smoking rather than a replacement. Continued monitoring of these patterns is important for public health and necessary to evaluate any changes resulting from cannabis legalization. [ABSTRACT FROM AUTHOR]

Latent class analysis was performed to identify clusters of items on the Longitudinal Study of Adolescent Health – School Connectedness Scale among students. Cluster membership was explored by student-reported ethnicity. The sample included students attending Canadian secondary schools in two waves of the COMPASS study: Years 4 (Y4:2015/16) (N=40,436) and 7 (Y7:2018/19) (N=60,610). Results were comparable across waves. Four clusters resulted: strongly connected (Y4 66.6%; Y7 67.9%), socially disconnected (14.1%; 15.2%; perceptions of equitable treatment but lacking feelings of belonging), social belonging (11.9%; 10.3%; feelings of being part of their school and close to others, but less likely to perceive equitable treatment), and weakly connected (7.4%; 6.6%). White and Asian students were more likely to be 'strongly connected', while Black and 'other' or mixed ethnicity students were overrepresented in the 'weakly connected' and 'social belonging' clusters. Cluster variations merit attention to improve how racialized and ethnic minority youth experience school environments. [ABSTRACT FROM AUTHOR]

Objective: To investigate demographic and behavioral risk factors for non-medical use of prescription opioids. Methods: Canadian high school students taking part in the COMPASS study reported non-medical use of prescription opioids in three categories (oxycodone, fentanyl, other prescription pain relievers) in 2017/2018. Factors of interest were collected at two baselines (2016/2017; 2015/2016) and included validated demographic (age, gender, race/ethnicity, spending money), substance use (alcohol, tobacco, cannabis), and school-related (connectedness, homework completion, truancy) measures. Results: In total, 18,826 and 7,967 students were linked between 2017/2018 and 2016/2017 or 2015/2016 respectively. Use of fentanyl was least prevalent (0.7% and 1.0% respectively), with the use of oxycodone (1.7% and 1.9%) more and use of other prescription pain relievers (4.9% and 5.1%) most common. Male gender, substance use, and lack of homework completion were associated with the use of oxycodone and other prescription pain relievers. School connectedness was identified as a potential protective factor. Conclusions: Two-thirds of significant associations found were present only in one of the two models, highlighting the complexity of non-medical use of prescription opioids among youth. School connectedness may lower the risk of non-medical use of prescription opioids, indicating that a school-based focus is justified. [ABSTRACT FROM AUTHOR]

In particular research domains, the randomized control trial (RCT) is considered to be the only means for obtaining reliable estimates of the true impact of an intervention. However, an RCT design would often not be considered ethical, politically feasible, or appropriate for evaluating the impact of many policy, programme, or structural changes common in public health research. As such, researchers must use alternative yet robust research methods for determining the impact of such interventions. The evaluation of natural experiments (i.e. an intervention not controlled or manipulated by researchers), using various experimental and non-experimental design options can provide an alternative to the RCT. The following review highlights (a) the importance of evaluating natural experiments; (b) design considerations associated with evaluating natural experiments; (c) methods for reducing bias in natural experimental studies; and (d) the potential benefits of targeted systems to enable natural experiments in emerging priority domains moving forward. [ABSTRACT FROM AUTHOR]

Objectives: Métis, with a population of close to 390,000 people, are a culturally distinct and constitutionally recognized Aboriginal group in Canada that suffers from poorer overall health than non-Aboriginal Canadians. One important predictor of good health is physical activity. Guided by frameworks based on social and Aboriginal-specific determinants, we investigated the correlates of leisure-time physical activity (LTPA) and active transportation (walking) among adult Métis, with a particular focus on how culturally specific variables were associated with these two types of activity. We also examined how demographic, geographic, socioeconomic and health-related factors were associated with physical activity. Design: We used data from Statistics Canada’s 2006 Aboriginal Peoples Survey and Métis Supplement to analyze the correlates of physical activity among Métis aged 20-64, using a series of logistic regression models. Results: Having attended a Métis cultural event in the past year was positively associated with LTPA, as was a high level of spirituality. Similarly, those who had attended a cultural event in the last year were more likely to report a high level of active transportation. Speaking an Aboriginal language and being a member of a Métis organization were not independently associated with the two types of physical activity. Self-perceived health, being male and household income were other correlates positively associated with LTPA, whereas age, body mass index and smoking were negatively associated with this type of activity. Active transportation was positively associated with self-perceived health and being female, while negatively associated with age and body mass index. Conclusions: The results of this study suggest that interventions aimed at increasing physical activity among adult Métis might be more successful if they are connected to cultural activities and spirituality. This research also suggests that demographic, socioeconomic and health-related factors are important considerations when designing initiatives to increase physical activity among adult Métis. [ABSTRACT FROM AUTHOR]

Background:With the development of new gambling technology, and increased internet accessibility, online gambling has rapidly emerged as a new gambling market. Governments in numerous jurisdictions have moved to legalize online gambling, yet little is known about the impact of online gambling availability particularly for adolescents. To date, few studies have identified the characteristics of adolescent online gamblers and even fewer have looked at whether these characteristics differ from land-based adolescent gamblers. This study examined socio-demographic and factors associated with online gambling for adolescents and compared this to land-based gamblers to examine whether the profile of online gamblers are unique. Method:Data for the current study comes from the 2012–2013 Youth Gambling Survey (YGS) (n = 10 035) and consists of students in Grades 9 to 12 from three Canadian provinces: Newfoundland and Labrador, Ontario, and Saskatchewan. Results:Compared to adolescents who did not have a gambling problem, those who had low to moderate (OR = 2.21,p < .001) or high problem gambling severity (OR = 13.60,p < .001) were significantly more likely to gamble online. Adolescents who played free games were also significantly more likely to gamble online (OR = 2.75,p < .001). Females were significantly less likely to gamble online compared to males (OR = 0.31,p < .001). Other than gender, problem gambling severity and playing free games, when compared to land-based adolescent gamblers, the profile of online gamblers are not that different. Conclusions:Current prevention efforts for adolescents should focus on gambling across modalities. [ABSTRACT FROM PUBLISHER]

Background: Some evidence suggests early initiation of alcohol use is associated with academic underachievement; however, substance use onset is an ambiguous concept, resulting in mixed findings across studies. Moreover, the quantity of early use is likely an important determinant. Binge drinking is a common pattern among younger cohorts, and is shown to magnify the risk of related problems. Objectives: The current study explored how students who initiated binge drinking early (grade 10 or earlier) or later in high school (grade 11 or 12) differed in relation to a variety of academic indices. Methods: The sample consisted of 19,764 grade 9 to 12 students with at least 2 years of linked-longitudinal data from Year 1(Y1: 2012-2013), Year 2(Y2: 2013-2014), and Year 3(Y3: 2014-2015) of the COMPASS study. Separate multinomial GEE models tested the likelihood of different responses to outcome measures of academic goals, engagement, preparedness, and performance based on the timing of binge drinking onset. Models adjusted for binge drinking initiation in varying frequencies, gender, grade, race/ethnicity, and smoking. Results: Compared to students with earlier onsets of binge drinking, youth with later onsets were more likely to regularly attend class, complete their homework, value good grades, achieve high English or Math marks, have graduate/professional degree ambitions, and expect to obtain a college/trade school diploma after high school, yet they were less likely to expect to achieve a bachelor's degree. Conclusion: Results highlight the importance of substance use prevention programs targeting early adolescents. Both delaying and preventing binge drinking have the potential to improve scholastic outcomes. [ABSTRACT FROM AUTHOR]

Using nationally representative data from the Canadian Community Health Survey, we explored if the Vancouver 2010 Winter Olympics were associated with leisure-time physical activity rates among youth in Canada. No statistically significant changes were observed in the rate of moderately active/active youth in Canada or the province of British Columbia (BC) over the two-year time periods under investigation. At the regional level however, a significant increase in the rate of moderately active/active females from 2007–2008 (pre-event) to 2009–2010 (the year prior to the event and the year the event was staged) was observed in the Richmond, BC, health region (z = 2.05,p = .04). Previous conclusions that trickle-down effects do not occur are not supported by our data. Instead, we conclude that trickle-down effects may in fact occur, but may tend to be localised within certain communities (i.e. close to where Olympic events are staged) and among particular segments of a population. [ABSTRACT FROM AUTHOR]

Cluster analysis modeling was used to identify distinct smoking taxonomies among 4,473 smokers from 29 secondary schools (2000-2001) in Ontario, Canada. Analyses revealed a two-cluster solution (4,349 [97.2%] situational smokers and 124 [2.8%] ubiquitous smokers). Different psychosocial characteristics influenced the smoking behavior of these unique groups. Our findings are substantially different from the traditional definitions for non-daily and daily smoking used in the literature, which typically impose rules about smoking frequency or volume when defining smoking status. These findings suggest that more robust taxonomies of youth smoking are required in future tobacco control research. The study's limitations are noted. [ABSTRACT FROM AUTHOR]

Youth overweight and obesity (OWOB) surveillance often uses body mass index (BMI) derived from self-reported height and weight, but these measures can suffer from high proportions of missing data. Complete case analysis (CCA) is the most common approach to handle missing data, but this approach can introduce bias if missing data are not missing completely at random. Using BMI and related covariate data from 36,546 female and 37,126 male youth aged 12–19 years who participated in the COMPASS study in 2018/19, where approximately 30% of BMI data were missing, results and inference were compared between CCA and multiple imputation (MI) approaches to examine associations with youth BMI. Results of regression joint models showed contrasting findings between MI and CCA, highlighting that appropriate methodological choices in the handling of missing data are essential in youth OWOB research and that choices can impact research inference and thereby associated policy and programming recommendations. [ABSTRACT FROM AUTHOR]