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Throughout adolescence, both sleep and emotion regulation abilities undergo significant developmental changes. The maturational systems that govern sleep and emotion regulation are closely intertwined leading many researchers to posit a mutually reinforcing relationship. Although there is support for a bidirectional relationship among adults, empirical support for reciprocal relationships among adolescents is lacking. Given the notable developmental changes and instability that occur throughout adolescence, this is a critical period to examine whether sleep and emotion regulation abilities may be reciprocally related. Using a latent curve model with structured residuals, this study examined within-person reciprocal associations between sleep duration and emotion dysregulation among 12,711 Canadian adolescents (M[subscript age] = 14.30 years; 50% female). Participants self-reported their sleep duration and emotion dysregulation each year for 3 years beginning in Grade 9. After accounting for underlying developmental trajectories, the results did not support a bidirectional relationship between sleep duration and emotion dysregulation from one year to the next. However, there was evidence of contemporaneous associations between the residuals at each wave of assessment (r = -0.12) such that less sleep than expected was concurrently associated with higher-than-expected deviations in emotion dysregulation, or, conversely, that reporting greater emotion dysregulation than expected was associated with lower-than-expected sleep duration. In contrast to previous findings, the between-person associations were not supported. Taken together, these results indicate that the relationship between sleep duration and emotion dysregulation is primarily a within-person process rather than reflecting differences between individuals and likely operates on a more proximal timescale.

Previous research indicates that the disproportionate distribution of income within society is associated with aggression and violence. Although research has been conducted identifying the relationship between income inequality and bullying victimization and perpetration, little is known about possible mediators. We investigated the association between income inequality and bullying perpetration and victimization among adolescents participating in the Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behavior (COMPASS) study. We identified whether school connectedness and psychosocial well-being mediated the relationship between income inequality and bullying behavior. This study used pooled cross-sectional data from 147,748 adolescents aged 13 to 18 from three waves (2015-2016, 2016-2017, 2017-2018) of the COMPASS study from 157 secondary schools in British Columbia, Alberta, Ontario, and Quebec (Canada). The Gini coefficient was calculated based on the school Census Divisions (CD) using the Canada 2016 Census and linked with student data. We used multilevel modeling to investigate the relationship between income inequality and self-reported bullying victimization and perpetration, while controlling for individual-, school-, and CD-level characteristics. A standard deviation increase in Gini coefficient was associated with increased odds for bullying victimization and perpetration. Findings were observed among girls; however, inequality was only associated with perpetration among boys. We identified social cohesion and psychosocial well-being as potential mediators. To counter the adverse effects of income inequality, school-based interventions designed to increase school connectedness and student psychosocial well-being should be implemented to protect against bullying.

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.

Background: Many Canadian schools offer breakfast programs; however, students' engagement in these programs is low, while breakfast skipping is highly prevalent among youth. This study examined whether the availability of breakfast programs supports adolescents' regular breakfast eating, and identified characteristics of breakfast skippers who are not using these programs. Methods: Data from 30,771 secondary school students from Ontario and Alberta, Canada, participating in Year 3 (2014-2015) of the COMPASS study were used for descriptive and logistic regression analyses. Participants were categorized by self-reported breakfast eating and school breakfast program use. Results: Sixteen percent of participants reported using school breakfast programs. Breakfast skipping was highly prevalent among participants, regardless of their breakfast program use. Characteristics significantly associated with program use included traveling to school via public transit or a school bus, being a bullying victim, and having a high school connectedness score. A desire to lose weight and non-involvement in school sports were significantly associated with being a "breakfast skipper/nonprogram user." Conclusions: School breakfast programs do not consistently support regular breakfast eating, even among adolescents actively engaged in these programs. Future research should identify and evaluate practices to bolster participation in breakfast programs and promote regular breakfast eating among adolescents.

Background: Schools can be an efficient venue for promoting physical activity (PA) among adolescents. Physical education (PE) requires investigation because it is a variable associated with adolescent PA levels and its existence in schools represents a significant opportunity for strategies to combat declining PA levels among this population. This article examines the between-school variability in student rates of PE enrollment among a large sample of high schools in Ontario, Canada, and identifies the school- and student-level characteristics associated with PE enrollment. Methods: This cross-sectional study utilized self-reported school- and student-level data from administrators and students at 73 high schools. Students' enrollment in PE, demographic, behavioral, and psychosocial variables was linked to school environment data comprising of school demographics and administrator assessed quality of policies, facilities, and programs related to PA. Analysis involved multilevel modeling. Results: The mean rate of PE enrollment among the 73 high schools was 62.4%, with rates by school ranging from 28.9% to 81.1%. When student demographics, behavioral, and psychosocial factors were controlled for, there was still a school effect for student PE enrollment. The school effect was explained by the provision of daily PE and school median household income. Conclusions: This is the first study to examine the extent to which PE enrollment varies between schools and to identify school factors associated with school variability in rates of PE enrollment. Although most variation in PE enrollment lies between students within schools, there is sufficient between-school variation to be of interest to practitioners and policy makers. (Contains 3 tables and 1 figure.)

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Introduction: The COVID-19 pandemic intensified the impact of risk factors for adolescent mental health, including financial worry. Social support has shown to protect from negative mental health during times of stress. We examined the effect of financial worry on changes in anxiety and depression symptoms among Canadian adolescents prior to and during the pandemic, and assessed whether social support from family and friends moderated any changes. Methods: We analyzed 2-year linked data from the 2018/19 (pre-pandemic) and 2020/21 (during-pandemic) waves of the COMPASS study, with reports from 12 995 Canadian secondary school students. A series of multilevel linear regressions were conducted to examine the main hypotheses under study. Results: Students scored an average (SD) of 7.2 (5.8) on the anxiety (GAD-7) and 10.0 (6.5) on the depression (CESD-10) scales; 16.1% reported they experienced financial worry during the pandemic. Financial worry was a strong and significant predictor of increased anxiety scores (+1.7 score between those reporting "true/mostly true" versus "false/mostly false") during the pandemic, but not for depression scores. Low family and friend support were associated with anxiety, and low family support was associated with depression. No significant interactions were detected between social support and financial worry. Conclusion: Pandemic-related financial worry was significantly associated with anxiety in our large sample of Canadian adolescents. Clinical and public health initiatives should be aware of adolescents' financial worry and its associations with anxiety during times of crisis. [ABSTRACT FROM AUTHOR]

There is concern over the potentially detrimental impact of the COVID-19 pandemic on adolescents' mental health. We examined changes in depression and anxiety symptoms from before (2018-19) to the early (2019-20) and ongoing pandemic (2020-21) responses among Canadian adolescents in the context of a natural experiment. We used linked survey data from 5,368 Canadian secondary school students who participated in three consecutive waves of the cannabis use, obesity, mental health, physical activity, alcohol use, smoking, and sedentary behaviour study during the 2018-19, 2019-20, and 2020-21 school year. Separate fixed effects models examined whether changes in depression (Center for Epidemiologic Studies Depression Scale Revised-10) and anxiety (General Anxiety Disorder-7) symptoms differed between two cohorts. The cohorts differed in the timing of their second data collection wave; one cohort participated before the pandemic and the other cohort participated in the early pandemic (spring 2020). Depression and anxiety symptoms increased during the early and ongoing pandemic periods in the overall sample and both cohorts. The two cohorts experienced similar elevations in their symptoms. Females and younger respondents presented greater elevations over time. The proportion of adolescents with significant depressive (29.4%) and moderate-to-severe anxiety (17.6%) symptoms at baseline increased by 1.5 times, reaching 44.8% and 29.8% in the ongoing pandemic period, respectively. Findings suggest that internalizing symptoms have consistently increased since before the onset of COVID-19, particularly in the ongoing pandemic period; however, we found no evidence of the increase being due to the pandemic in the early COVID-19 period when comparing the two cohorts. Ongoing evaluation of adolescents' mental health is necessary to capture potentially dynamic impacts over time. [ABSTRACT FROM AUTHOR]

Depression and anxiety among adolescents are major public health concerns. Findings indicate that income inequality was associated with increased risk for depression and anxiety among adolescents; however, this has not been tested longitudinally. We aim to quantify the longitudinal association between income inequality and depression and anxiety among Canadian adolescents. We used longitudinal data on 21,141 students from three waves (2016/17–2018/19) of the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behavior (COMPASS) school-based study. Multilevel modeling was used to assess the association between census division (CD)-level income inequality and depressive and anxiety symptoms and odds for depression and anxiety over time. Across CDs, the mean Gini coefficient was 0.37 (range: 0.30, 0.46). Attending schools in CDs with higher levels of income inequality was associated with higher depressive scores (ß = 0.08; 95% confidence interval [CI] = 0.02, 0.14) and an increased odds for depression (odds ratio = 1.55, 95% CI = 1.06, 2.28) over time. Income inequality was not significantly associated with anxiety symptoms or experiencing anxiety over time. Additional analyses showed that income inequality was associated with higher depressive scores among females (ß = 0.10; 95% CI = 0.01, 0.18) and males (ß = 0.08, 95% CI = 0.01, 0.15) and for anxiety scores among females (ß = 0.13, 95% CI = 0.04, 0.22), but not among males (ß = −0.01, 95% CI = −0.09, 0.06). Findings from this study indicated that income inequality is associated with depression over time among adolescents. This study highlights key points of intervention for the prevention of mental illness in adolescents. [ABSTRACT FROM AUTHOR]

This study examined the association between problematic technology use (PTU) and suicidal ideation and suicide attempt among adolescents and explored whether sex moderates these associations. Data used for this study were from a representative sample of middle and high school students in Ontario, Canada. Analyses included 4,390 students derived from the 2019 Ontario Student Drug Use and Health Survey. Our results showed that 19% of adolescents experienced symptoms of moderate-to-serious PTU, 16.8% had suicidal ideation, and 4.1% had suicide attempt. Females reported higher symptoms of moderate-to-serious PTU than males and reported a higher prevalence of suicidal ideation and suicide attempt. The association of PTU with suicidal ideation and suicide attempt was modified by sex. Having moderate-to-serious symptoms of PTU was associated with higher odds of suicidal ideation among males than females (OR = 3.72, 95% CI = 2.53-5.49 vs OR = 1.74, 95% CI = 1.35-2.26, respectively). Also, having moderate-to-serious symptoms of PTU was associated with higher odds of suicide attempt among males than females (OR = 6.25, 95% CI = 2.87-13.60 vs OR = 2.03, 95% CI = 1.28-3.23, respectively). In conclusion, PTU is a modifiable risk factor associated with increased odds of suicidal ideation and attempt among adolescents, with male adolescents being the most vulnerable. Further research is warranted to explore this association in more depth and to fully understand the role of sex and other potential moderators on the relationship between problem technology use and suicidality among adolescents. [ABSTRACT FROM AUTHOR]

Introduction: Research suggests that there is often a high degree of missingness in youth body mass index (BMI) data derived from self-reported measures, which may have a large effect on research findings. The first step in handling missing data is to examine the levels and patterns of missingness. However, previous studies examining youth BMI missingness used logistic regression, which is limited in its ability to discern subgroups or identify a hierarchy of importance for variables, aspects that may go a long way in helping understand missing data patterns. Methods: This study used sex-stratified classification and regression tree (CART) models to examine missingness in height, body mass and BMI data among 74 501 youth participating in the 2018/19 COMPASS study (a prospective cohort study examining health behaviours among Canadian youth), where 31% of BMI data were missing. Diet, movement, academic, mental health and substance use variables were examined for associations with missingness in height, body mass and BMI. Results: CART models indicated that the combination of being younger, having a selfperception of being overweight, being less physically active and having poorer mental health yielded female and male subgroups highly likely to be missing BMI values. Survey respondents who did not perceive themselves as overweight and who were older were unlikely to be missing BMI values. Conclusion: The subgroups identified by the CART models indicate that a sample that deletes cases with missing BMI would be biased towards physically, emotionally and mentally healthier youth. Given the ability of CART models to identify these subgroups and a hierarchy of variable importance, they are an invaluable tool for examining missing data patterns and appropriate handling of missing data. [ABSTRACT FROM AUTHOR]

To date, there are few longitudinal studies on the COVID-19 pandemic's ongoing impact on youth drinking. This study examines the changes in drinking during two phases of the pandemic in a sample of Canadian youth. We used four-year longitudinal data from the COMPASS study, including 14,085 secondary school students from Quebec and Ontario, Canada who provided linked data for any two consecutive years between 2017/18 and 2018/19 (pre-pandemic) waves, and 2019/20 and 2020/21 (during the initial and ongoing pandemic). A difference-in-difference (D-I-D) model was used to compare changes in the frequency of drinking and binge drinking between pre-COVID-19 to initial- and ongoing-pandemic period, while adjusted for age-related effects. The expected escalation in the frequency of drinking and binge drinking from the pre-pandemic wave (2018/19) to the initial pandemic (2019/20) was less than the changes seen across the 2017/18 to 2018/19 waves among sex and age groups. However, the second year of COVID was associated with an increase in the frequencies of both drinking and binge drinking. Male and younger students (aged 12–14) differentially increased their consumption. After a reduction in the initial pandemic period, the frequency of drinking and binge drinking rebounded in the second year, indicating that the pandemic's effects are not singular and have changed over time. Further examination is needed to understand the ongoing effects of the pandemic by continuing to monitor drinking in youth toward informing public health measures and harm reduction strategies. [ABSTRACT FROM AUTHOR]

Objective: The primary objective of our study was to assess measurement invariance (by grade and sex) of the 7-item Generalized Anxiety Disorder (GAD-7) and 10-item Center for Epidemiologic Studies Depression Revised (CESD-R-10) scales in a sample of adolescents in Canada. If measurement invariance was demonstrated, our secondary objective was to estimate differences in scale scores across these subgroups.Methods: We used data from 59,052 adolescents in Year 7 (2018-19) of the COMPASS school-based study. Measurement invariance was tested within a multigroup confirmatory factor analysis framework. Differences in scale scores were estimated using mixed linear regression which accounted for school-level clustering and adjusted for relevant confounders.Results: Both the GAD-7 and CESD-R-10 demonstrated strict measurement invariance by sex and grade in our sample. Mean scale scores were higher among adolescents in grade 12 compared to grade 9 (βGAD-7 = 0.91, p < .001; βCESD-R-10 = 0.99, p < .001) and among female adolescents compared to males (βGAD-7 = 3.36, p < .001; βCESD-R-10 = 2.58, p < .001).Conclusions: Findings support the validity of the GAD-7 and CESD-R-10 for screening risk of generalized anxiety and depression among Canadian adolescents, and further indicate that differences observed in scale scores across subgroups reflect actual differences in risk for generalized anxiety and major depression, respectively. [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]

The impact of the COVID-19 pandemic on adolescent mental health is a global concern; however, most research is cross-sectional or started after the pandemic response began and thus unable to evaluate within-individual change. The purpose of this prospective study was to evaluate the effect of the initial COVID-19 response on adolescent mental health and ill-health as a natural experiment. We used 3-year linked data from the COMPASS study, including 7,653 Canadian (Quebec, Ontario) adolescents from which 2,099 completed surveys in all three waves (pre-COVID-19 [2018 and 2019] and online [May–July 2020], 2–3 months into the pandemic). A structural equation modeling approach to fixed effects and a difference-in-differences design were used to estimate pre-COVID-19–to–early lockdown change in mental health (psychosocial well-being [flourishing—reverse scored]) and ill-health (depression and anxiety symptoms), compared with 2018-to-2019 change. Models were adjusted for self-selection, age of entry into the cohort, and sociodemographics. Depression, anxiety, and reverse-flourishing scores increased across all waves; however, the mental health changes from the pre-COVID-19 wave (2019) to 2020 were not greater relative to the changes seen across the 2018-to-2019 waves. Our results do not support a detrimental effect of the initial stages of the COVID-19 lockdown measures on adolescent mental health. The deterioration in mental health in the early COVID-19 response was less than the decline found over a prepandemic period. Further prospective research is needed to explore the impact of the prolonged pandemic and related measures on adolescents and inequitable effects in population subgroups. [ABSTRACT FROM AUTHOR]

Introduction: The objectives of this study were to explore the extent to which adolescents adopted COVID-19 preventive measures in the first few months of the pandemic and to understand their adoption by looking at interconnected adoption-related factors and determining the strength of these factors, particularly among subgroups not expected to be early adopters. Methods: Analyses focus on data collected during Spring 2020 from 29 eastern Quebec secondary schools that participated in the COMPASS study. Participants (n = 6052) self-reported their knowledge, perception of risk and preventive practices to do with the COVID-19 pandemic. Data were analyzed using structural equation models based on gender and anxiety level. Results: The majority of respondents reported adopting the recommended COVID-19 preventive measures. The results showed three paths leading to adolescents' adoption of these measures: pandemic knowledge; perception of risk related to COVID-19; and, in particular, discussions with relatives about preventive measures and what to do in case of infection. Conclusions: While most of the adolescent participants in this study appeared to comply with COVID-19 preventive measures, factors such as discussions with relatives emerge as elements to foster in order to improve adolescents' adoption of preventive measures. [ABSTRACT FROM AUTHOR]

Abstract Background Creating school environments that support student physical activity (PA) is a key recommendation of policy-makers to increase youth PA. Given males are more active than females at all ages, it has been suggested that investigating gender differences in the features of the environment that associate with PA may help to inform gender-focused PA interventions and reduce the gender disparity in PA. The purpose of this cross-sectional study was to explore gender differences in the association between factors of the school environment and students' time spent in PA. Methods Among a sample of 10781 female and 10973 male students in grades 9 to 12 from 76 secondary schools in Ontario, Canada, student- and school-level survey PA data were collected and supplemented with GIS-derived measures of the built environment within 1-km buffers of the 76 schools. Results Findings from the present study revealed significant differences in the time male and female students spent in PA as well as in some of the school- and student-level factors associated with PA. Results of the gender-specific multilevel analyses indicate schools should consider providing an alternate room for PA, especially for providing flexibility activities directed at female students. Schools should also consider offering daily physical education programming to male students in senior grades and providing PA promotion initiatives targeting obese male students. Conclusions Although most variation in male and female students' time spent in PA lies between students within schools, there is sufficient between-school variation to be of interest to practitioners and policy-makers. More research investigating gender differentials in environment factors associated with youth PA are warranted.

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]

Introduction: The effectiveness of school nutrition regulations may be undermined by food environments surrounding schools. Given challenges in regulating external retail, some have recommended policies that ensure students are unable to leave school property during the day (closed campus policies; CCP). We aimed to examine whether CCP are associated with student eating behaviours. Methods: We used student and school-administrator survey data from the 60 610 Grades 9 to 12 students and 134 Canadian secondary schools that participated in Year 7 (2018/19) of the COMPASS study. Multiple ordinal regression models tested school CCP as a predictor of weekday dietary behaviours (0-5 days), controlling for student-level (grade, sex, spending money, ethnicity) and school-level (urbanicity, province, area median household income, vending machines) covariates. Results: CCP were reported by 16 schools. Students who attended CCP schools reported eating lunch purchased from fast food outlets or other restaurants and drinking sugarsweetened beverages (SSBs; soft drinks and sports drinks; sweetened coffee or tea drinks) on fewer weekdays, but consumed snacks from school vending machines on more weekdays, relative to students at open campus schools. No significant differences were observed in student reports of eating home-packed or school cafeteria lunches or snacks purchased off-campus. Conclusion: CCP may help improve adolescent diets by reducing SSB and lunchtime fast food consumption on weekdays; however, students already purchasing food may shift from off-campus to within-school options, highlighting the importance of ensuring healthy school food environments and encouraging students to bring home-prepared lunches. Future studies using experimental longitudinal designs are needed to determine the effect of CCP on various health behaviours and outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The longitudinal relationship between binge drinking and academic engagement, performance, and future aspirations and expectations was examined among a cohort of secondary school students. Methods: In separate multinomial generalized estimating equations models, linked data from Year 1 (Y1: 2012-2013), Year 2 (Y2: 2013-2014), and Year 3 (Y3: 2014-2015) of the COMPASS study (N = 27 112) were used to test the relative likelihood of responses to seven academic indices when binge drinking was initiated in varying frequencies, adjusting for gender, grade, race/ethnicity, tobacco use, and the individual mean of the predictor and all time-varying covariates. Results: Among students who had never engaged in binge drinking at baseline, those who reported regular binge drinking at follow-up were relatively less likely to complete their homework, attend class, and value and achieve high grades, with more frequent binge drinking at follow-up generally resulting in larger relative risk ratios. Interestingly, shifting from "never" to "rare/sporadic" binge drinking one to two years later resulted in an increased relative risk of wanting to pursue all levels of postsecondary education. Beginning binge drinking on a "monthly" basis also increased the likelihood of college/trade or bachelor degree ambitions, relative to high school, but not graduate/professional pathways; while degree aspirations were not associated with initiating weekly binge drinking. Conclusions: Results suggest students who initiate binge drinking have poor school performance and engagement, which may interfere with achieving their future academic goals. This study reinforces the reasons substance use prevention should be considered an academic priority, as such efforts may also prove beneficial for educational achievement. [ABSTRACT FROM AUTHOR]

Background: Negative peer experiences may lead adolescents with overweight and obesity to be less active and engage in more sitting-related behaviors. Our study is among the first to empirically test these associations and hypothesized that 1) peer victimization would mediate the negative association between body weight status and moderate-to-vigorous physical activity (MVPA), and 2) peer victimization would mediate the positive association between body weight status and screen time. Differences by gender were also explored.Methods: Participants were a part of the Year 1 data (2012-2013) from the COMPASS study, a prospective cohort study of high school students in Ontario and Alberta, Canada. The final sample consisted of 18,147 students in grades 9 to 12 from 43 Ontario secondary schools. The predictor variable was weight status (non-overweight vs. overweight/obese), the mediator was peer victimization, and the outcome variables were screen time and MVPA. Multilevel path analysis was conducted, controlling for clustering within schools and covariates. A few differences were observed between males and females; therefore, the results are stratified by gender.Results: For both males and females peer victimization partially mediated the association between weight status and screen time. Specifically, females with overweight/obesity reported 34 more minutes/day of screen time than did females who were not overweight and 2 of these minutes could be attributed to experiencing peer victimization. Similarly, males who were overweight/obese reported 13 more minutes/day of screen time than the males who were not overweight and 1 of these minutes could be attributed to experiencing more victimization. Males and females who were overweight/obese also reported less MVPA compared to those who were not overweight; however, peer victimization did not mediate these associations in the hypothesized direction.Conclusions: We found that higher rates of peer victimization experienced by adolescents with overweight and obesity partially explained why they engaged in more screen time than adolescents who were not overweight. However, the effects were small and may be of limited practical significance. Because this is one of the first studies to investigate these associations, more research is needed before bully prevention or conflict resolution training are explored as intervention strategies. [ABSTRACT FROM AUTHOR]

Objective. Increasing our understanding of the differences between obesity and overweight status across various geographical areas may have important public health implications. We aimed to explore prevalence and factors (i.e., demographic and lifestyle) associated with overweight and obesity among youth across urban, suburban and rural settings. Methods. A cross-sectional study used self-reported data collected from students (grades 9–12) attending 76 high schools in Ontario, Canada, as part of the SHAPES-Ontario study (2005–2006). Of the 34 578 eligible students selected to complete the Physical Activity Module in the 76 participating schools, 73.5% (n=25 416; 50.8% males, 49.2% females) completed the survey. Univariate and multivariate analyses were conducted using body mass index for weight measurement and self-reported data on lifestyle factors, and self-perception of body weight. Results. The overall prevalence of overweight and obesity was 14.3% and 6.3%, respectively. The prevalence of overweight in urban, suburban and rural areas was 14.6%, 13.8% and 15.1%, respectively, while the prevalence of obesity was 6.3%, 6.0% and 6.7%, respectively, and the difference was significant (χ2= 16.53, p<0.05). In the multivariate logistic regression analysis, age, TV watching, level of urbanization and perception of body weight were important predictors of overweight and obesity. Conclusion. Our understanding of how overweight and obesity rates vary depending on the level of urbanization may help health professionals to either tailor programs to the needs of the individuals living in these different areas or to target existing programs to the contexts where they are most likely to have an impact. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: It has been suggested that health benefits from physical activity may be accrued through active commuting to school. Considering that active commuting is modifiable via policy and that there is limited research examining active commuting among high school students, this is a domain that warrants further investigation. The purpose of this study is to explore the relationships between demographic, behavioral, social/psychological, and environmental correlates of active commuting to school among a sample of high school students. Methods: Students (N = 21,345) from 76 Ontario high schools (grades 9–12) completed the School Health Action, Planning and Evaluation System Physical Activity Module between 2005–2006. Demographic (gender, grade, body mass index), behavioral (smoking status, physical activity, sedentary time), social/psychological (perceived athletic ability, weight status, parental encouragement), and environmental (school location, type, weather) predictors of active commuting (daily or mixed mode) were assessed. Results: Only 42.5% of high school students reported actively commuting to school. Students were less likely to actively commute to school if they were girls, in grade 12, smoked daily, were low–moderate in physical activity, or attended a rural school. Conclusions: Patterns of active commuting to school are influenced by multiple factors, some of which are modifiable through intervention. This has important implications for future school-based programming designed to enhance health and physical activity of adolescents through using active modes of transportation to school. [Copyright &y& Elsevier]

The article cites studies on the reliability and validity of the School Health Action, Planning and Evaluation System (SHAPES) physical activity questionnaire. SHAPES is a machine-readable questionnaire designed to collect data from grade six to 12 students and to provide feedback to schools for planning and evaluation. Results showed an overall kappa/weighted kappa coefficient for the 1-week test-retest reliability of the questionnaire items indicated moderate agreement. Researchers concluded that SHAPES was reliable and valid and was suitable for use in a large-scale school-based data collections for child and adolescent populations.

Introduction: This study investigates the stability of loneliness in adolescents over a 1-year period. Also, we examine how the use of screen time media (watching television, playing video games, surfing the Internet, and texting) predicts loneliness over a year and how loneliness predicts screen time media usage.Methods: The study uses survey data from the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behavior Study. A large (N = 20,903; 54% female) sample of Canadian students in grades 9-11 (Time 1) and grades 10-12 (Time 2) were assessed at two-time points, 1 year apart.Results: Loneliness scores were found to be stable over the 1-year period, with a slight increase. Additionally, while loneliness was associated with some screen time within the same year, the effects from loneliness or screen time variables at time one predicting the other at time two were negligible. The study also provides evidence that the various screen time media did not fit a single dimension. Finally, there were sex differences in loneliness and some of the media variables.Conclusions: Loneliness appears to increase slightly over the course of a year in high school students. Results indicated that Internet use and loneliness are related; however screen time use in one year does not have a substantial impact on loneliness a year later or vice versa. Lastly, the data suggested that researchers examine screen time behaviors individually in their investigations. [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]

Background: School nutrition policies can encourage restrictions in sugar-sweetened beverage (SSB) availability in school food outlets in order to discourage students' SSB intake. The main objective was to examine how beverage availability in school vending machines changes over three school years across schools in distinct school nutrition policy contexts. Secondary objectives were to examine how students' weekday SSB intake varies with time and identify longitudinal associations between beverage availability and SSB intake. Methods: This longitudinal study used data from the COMPASS study (2013/14–2015/16), representing 7679 students from 78 Canadian secondary schools and three provincial school nutrition policy contexts (Alberta – voluntary guidelines, Ontario public – mandatory guidelines, and Ontario private schools – no guidelines). We assessed availability of 10 beverage categories in schools' vending machines via the COMPASS School Environment Application and participants' intake of three SSB varieties (soft drinks, sweetened coffees/teas, and energy drinks) via a questionnaire. Hierarchical regression models were used to examine whether: i) progression of time and policy group were associated with beverage availability; and, ii) beverage availability was associated with students' SSB intake. Results: Ontario public schools were significantly less likely than the other policy groups to serve SSBs in their vending machines, with the exception of flavoured milks. Vending machine beverage availability was consistent over time. Participants' overall SSB intake remained relatively stable; reductions in soft drink intake were partially offset by increased sweetened coffee/tea consumption. Relative to Ontario public schools, attending school in Alberta was associated with more frequent energy drink intake and overall SSB intake whereas attending an Ontario private school was associated with less frequent soft drink intake, with no differences in overall SSB intake. Few beverage availability variables were significantly associated with participants' SSB intake. Conclusions: Mandatory provincial school nutrition policies were predictive of more limited SSB availability in school vending machines. SSB intake was significantly lower in Ontario public and private schools, although we did not detect a direct association between SSB consumption and availability. The findings provide support for mandatory school nutrition policies, as well as the need for comprehensive school- and broader population-level efforts to reduce SSB intake. [ABSTRACT FROM AUTHOR]

The purpose of the current study was to simultaneously examine commonly proposed risk and protective factors for sleep deprivation over time among a large cohort of Ontario and Alberta secondary school students. Using 4-year linked longitudinal data from youth in years 1 through 4 (Y1[2012/2013], Y2[2013/2014], Y3[2014/2015], Y4[2015/2016]) of the COMPASS study (n=26,205), the likelihood of students meeting contemporary sleep recommendations was tested based on their self-reported substance use, bullying victimization, physical activity, and homework and screen time. Models controlled for the effect of student-reported gender, race/ethnicity, grade, school clustering, and all other predictor variables. Relative to baseline, students became less likely to meet the sleep recommendations if at follow-up they had initiated binge drinking, experienced cyber bullying victimization, or were spending more time doing homework, with other factors held constant. The likelihood of reporting sufficient sleep increased if students had begun engaging in resistance training at least three times a week. No longitudinal effect was observed when students increased their caffeine consumption (energy drinks, coffee/tea), initiated cannabis or tobacco use, experienced other forms of bullying victimization (physical, verbal, or belongings), engaged in more moderate-vigorous physical activity, or increased their screen use of any type. Few of the commonly purported modifiable risk and protective factors for youth sleep deprivation held in multinomial longitudinal analyses. Causal conclusions appear premature, with further research required to confirm the targets likely to be most effective in assisting more youth in meeting the sleep recommendations. [ABSTRACT FROM AUTHOR]

Abstract: Background: Smoking susceptibility has been found to be a strong predictor of experimental smoking. This paper examined which student- and school-level factors differentiated susceptible never smokers from non-susceptible never smokers among a nationally representative sample of Canadian students in grades 9 to 12. Methods: Student-level data from the 2008–2009 Canadian Youth Smoking Survey were linked with school-level data from the 2006 Census, and one built environment characteristic (the density of tobacco retailers surrounding schools). These data were examined using multilevel logistic regression analyses. Results: The likelihood of a never smoker being susceptible to smoking significantly varied across schools (p= 0.0002). Students in this study were more likely to be susceptible never smokers if they reported low self-esteem, held positive attitudes towards smoking, used alcohol or marijuana, had close friends who smoked, and came from homes without a total ban on smoking. The school location (rural versus urban), the socioeconomic status of the neighbourhood surrounding a school, and the density of tobacco retailers that were located within 1-km radius of each school were not associated with students' smoking susceptibility. Conclusion: These findings underscore the continued need to develop school-based tobacco use prevention policies and/or programs that enhance students' self-esteem, address tobacco use misinformation and substance use, and include strategies targeting friends who smoke, and students who come from homes without a total ban on smoking. [Copyright &y& Elsevier]

Abstract: Purpose : To examine how school-based smoking policies and prevention programs are associated with occasional and regular smoking among a cohort of grade 12 students in Prince Edward Island, Canada, between 1999 and 2001. Methods : Data from the Tobacco Module of the School Health Action, Planning and Evaluation System (SHAPES) collected from 3,965 grade 12 students in 10 high schools were examined using multi-level regression analysis. Results : Attending a school with smoking prevention programming was associated with a decreased risk of being an occasional smoker (OR 0.42, 95% CI: 0.18, 0.97). School-based policies banning smoking on school property were associated with a small increased risk of occasional smoking (OR 1.06, 95% CI: 0.67, 1.68) among some students. The combination of both policies and programs was not associated with either occasional or regular smoking. Conclusion : This preliminary evidence suggests that tailored school-based prevention programming may be effective at reducing smoking uptake; however, school smoking policies and the combination of programs and policies were relatively ineffective. These findings suggest that a new approach to school-based tobacco use prevention may be required. [Copyright &y& Elsevier]

Background: To date, no longitudinal population-based studies of school start times have been conducted within Canada. School schedule changes provided an opportunity to examine start times in association with youth sleep, physical activity, and screen use over time.Methods: This longitudinal study included grade 9-12 students attending 49 Ontario secondary schools that participated in at least two consecutive years of the COMPASS study (2012-2017). Fixed effects models tested whether differences in within-student change in self-reported sleep duration, moderate-to-vigorous physical activity, and screen time were associated with school start time changes, adjusting for student- (grade, sex, ethnicity, spending money) and school-level covariates (median income, urbanicity, geographical area).Results: Thirteen start time changes of 5-10 min were reported. Ten-minute advances at earlier clock times (8:30 AM-8:20 AM; 8:40 AM-8:30 AM) were associated with steeper sleep duration declines than schools with consistent start times but had no effect at later times (9:00 AM-8:50 AM). While sleep change did not differ with 5-min delays, 10-min delays (8:50 AM-9:00 AM) were associated with additional sleep (23.7 min). Apart from one school that shifted from 8:30 AM to 8:35 AM, in which screen time and physical activity decreased more steeply, no effect was found for screen time, and 5-min delays were associated with more physical activity (10.9 min) and advances with less activity (-8.0 min).Conclusions: Results support start time delays as a valuable strategy to help ameliorate sleep debt among youth. Interference with physical activity or increased screen time appear unlikely with modest schedule changes. Potential adverse impacts on sleep require consideration with 10-min advances. [ABSTRACT FROM AUTHOR]

• Investigated income inequality and daily substance use among adolescents. • Increased Gini coefficient was associated with daily cannabis use. • We found no significant relationship between income inequality and daily smoking. • Increased Gini coefficient was associated with daily e-cigarette use only in girls. Cannabis, cigarette, and e-cigarette use among Canadian adolescents is a major public health concern. Income inequality has been associated with adverse mental health among youth and may contribute to the risk of frequent cannabis, cigarette, and e-cigarette use. We tested the association between income inequality and the risk of daily cannabis, cigarette, and e-cigarette use among Canadian secondary school students. We used individual-level survey data from Year 6 (2018/19) of Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary Behavior (COMPASS) and area-level data from the 2016 Canadian Census. Three-level logistic models were used to assess the relationship between income inequality and adolescent daily and current cannabis use, cigarette smoking, and e-cigarette use. The analytic sample included 74,501 students aged 12–19. Students were most likely to report being male (50.4%), white (69.1%), and having weekly spending money over $100 (23.5%). We found that a standard deviation unit increase in Gini coefficient was significantly associated with increased likelihood of daily cannabis use (OR=1.25, 95% CI = 1.01–1.54) when adjusting for relevant covariates. We found no significant relationship between income inequality and daily smoking. While Gini was not significantly associated with daily e-cigarette use, we observed a significant interaction between Gini and gender (OR=0.87, 95% CI= 0.80–0.94), indicating that increased income inequality was associated with higher risk of reporting daily e-cigarette use among females only. An association between income inequality and the likelihood of reporting daily cannabis use across all students and daily e-cigarette use in females were observed. Schools in higher income inequality areas may benefit from targeted prevention and harm reduction programs. Results emphasize the need for upstream discussion on policies that can mitigate the potential effects income inequality. [ABSTRACT FROM AUTHOR]