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Background: Internalized weight bias (IWB) has been identified as a correlate of higher depressive and anxiety symptoms in adolescents with higher weights. However, there has been limited investigation into how IWB relates to positive mental health and whether these associations differ across genders., Objectives: To examine the associations between IWB and mental health (depression, anxiety, flourishing) in adolescents with higher weights, and to test the potential moderating role of gender., Methods: Canadian adolescents with higher weights (N = 7538, 60% boys, 36% girls, 4% gender diverse, ages 12-19) from the COMPASS study completed a survey during the 2021-2022 school year. Data were analysed using generalized linear models., Results: Highest IWB and poorest mental health were noted within gender diverse adolescents, followed by girls then boys. Gender moderated the relationship between higher IWB and higher depression, higher anxiety and lower flourishing, with the strongest relationships noted among girls., Conclusion: IWB interventions should be tailored to gender subgroups that may be particularly vulnerable to maladaptive mental health outcomes associated with IWB. System-level changes that mitigate perpetuation of weight bias and discrimination which lead to IWB are also essential, particularly for girls., (© 2024 The Authors. Pediatric Obesity published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Introduction: Understanding the inequitable impacts of the ongoing COVID-19 pandemic on youth mental health are leading priorities. Existing research has linked income inequality in schools to adolescent depression, however, it is unclear if the onset of the pandemic exacerbated the effects of income inequality on adolescent mental health. The current study aimed to quantify the association between income inequality and adolescent mental health during COVID-19., Material and Methods: Longitudinal data were taken from three waves (2018/19 to 2020/21) of the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) school-based study. Latent Growth Curve modelling was used to assess the association between Census District (CD)-level income inequality and depressive symptoms before and after the onset of COVID-19., Results: The study sample included 29,722 students across 43 Census divisions in British Columbia, Alberta, Ontario, and Quebec. The average age of the sample at baseline was 14.9 years [standard deviation (SD) = 1.5] and ranged between 12 and 19 years of age. Most of the sample self-reported as white (76.3%) and female (54.4%). Students who completed the COMPASS survey after the onset of COVID reported 0.20-unit higher depressive scores (95% CI = 0.16, 0.24) compared to pre-COVID. The adjusted analyses indicated that the association between income inequality on anxiety scores was strengthened following the onset of COVID-19 (β = 0.02, 95% CI = 0.0004, 0.03), indicating that income inequality was associated with a greater increase in anxiety scores during COVID-19., Discussion: The adjusted results indicate that the association between income inequality and adolescent anxiety persisted and was heightened at the onset of COVID-19. Future studies should use quasi-experimental methods to strengthen this finding. The current study can inform policy and program discussions regarding the effects of the COVID-19 pandemic and pandemic recovery for young Canadians and relevant social policies for improving adolescent mental health., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Benny et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: 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., Methods: 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., Results: 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)., Discussion: 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., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: The impact of the COVID-19 pandemic and consequent public health restrictions on the mental health of adolescents is of global concern. The purpose of this study was to examine how Canadian adolescents coped during the early pandemic and whether different coping methods were associated with changes in mental health from before the pandemic to the early lockdown response., Methods: Using two-year linked survey data (2018-2020) from a prospective cohort of secondary school students (n = 3,577), linear regression models were used to examine whether changes in mental health (anxiety [Generalized Anxiety Disorder-7 scale], depression [Center for Epidemiologic Studies Depression 10-item scale Revised], emotion regulation [Difficulties in Emotion Regulation Scale], psychosocial well-being [Flourishing scale]) were related to each coping behaviour., Results: The most common reported coping behaviours included staying connected with friends online (78.8%), playing video games, watching TV/movies, and/or surfing the internet/social media (76.2%), studying or working on schoolwork (71.0%), and getting exercise (65.2%). The use of positive coping mechanisms during the early pandemic period (e.g., keeping a regular schedule, time with family, time with friends online) was associated with less adverse mental health changes from before to during the early lockdown; whereas, negative coping mechanisms (e.g., spending time alone, eating junk food) were consistently associated with more adverse mental health changes., Conclusion: This study demonstrates the importance of social support and connections with both friends and family, as well as keeping and maintaining a routine, over the pandemic. Interventions supporting positive relationships and engagement in these coping behaviours may be protective for adolescent mental health during disruptive events., (© 2023. The Author(s).)

Purpose: Those born earlier within cohorts of similarly aged children tend to outperform peers in athletic and academic pursuits. Subsequent evidence suggests relatively younger children may also experience worse emotional and psychosocial health; however, evidence from middle adolescents is limited. This study assessed whether depression, anxiety, and psychosocial well-being differed by the relative birth quarter (RBQ) within a cohort of grades 9-12 in secondary schools across Canada., Methods: Data from the 2018-19 student self-report surveys of the cannabis use, obesity, mental health, physical activity, alcohol use, smoking, and sedentary behavior study were analyzed. Students having made normative progress were categorized into RBQs by the provincial enrollment cutoff date (n = 49,921). Hierarchical modeling approaches assessed whether self-reported depression, anxiety, psychosocial well-being, and positive controls differed by RBQ after controlling for covariates., Results: Despite relative age effects for positive control outcomes, no significant difference was detected for anxiety and depression scores or likelihood of meeting thresholds for having clinically relevant symptoms. However, a significant difference emerged between RBQs for psychosocial well-being scores; post hoc tests found that psychosocial well-being scores were lower in the fourth RBQ than those in all prior quarters., Discussion: Results agree with limited findings that relative age differences in emotional health are not significant in older cohorts. Nonetheless, relatively older individuals reported very small (d = .04-.05) advantages in psychosocial well-being than their youngest peers, which aligns with previous data. Longitudinal approaches to assess relative age effects on mental health during and throughout the transition into middle adolescence are warranted., (Copyright © 2021 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this research was to examine the bidirectional association between self-reported symptoms of mental disorder and physical activity among a large sample of Canadian secondary school students over time., Methods: Linked survey data were obtained from 28,567 grade 9 to 12 students across Canada participating in two waves of the COMPASS Study (2017-18; 2018-19). Autoregressive cross-lagged models were run to examine the reciprocal relationships between self-reported moderate-to-vigorous physical activity (MVPA) and symptoms of depression (CESD-10) and anxiety (GAD-7). Models were stratified by gender, and accounted for grade, ethno-racial identity, and school-level clustering., Results: Autoregressive associations show that neither symptoms of anxiety nor depression, at baseline, were predictive of mean MVPA at follow-up - consistent for the full sample and among both males and females. Higher MVPA among males at baseline was associated with lower symptoms of both anxiety (β = - 0.03, p = 0.002) and depression (β = - 0.05, p < 0.001) at follow-up. However, among females, higher MVPA at baseline was associated with greater symptoms of anxiety (β = 0.03, p < 0.001), but not symptoms of depression (β = 0.01, p = 0.073), at follow-up., Conclusion: In our large sample of Canadian secondary school students, associations between physical activity and symptoms of mental disorder were not bi-directional, and these relationships differed in males and females. This study illustrates the complex nature of the relationship between physical activity and symptoms of mental disorder among youth. While results support the benefits of promoting physical activity among males to prevent or manage internalizing symptoms, the relationship among females warrants further investigation., (© 2021. The Author(s).)

Background: Research examining the associations between movement behaviours and mental health indicators within a compositional framework are sparse and limited by their cross-sectional study design. This study has three objectives. First, to describe the change in movement behaviour composition over time. Second, to explore the association between change in movement behaviour composition and change in depressive symptoms. Third, to explore how reallocations of time between movement behaviours are associated with changes in depressive symptoms., Methods: Longitudinal data of 14,620 students in grades 9-12 (mean age: 14.9 years) attending secondary schools in Canada (Ontario, British Columbia, Alberta, Quebec) were obtained from two waves (2017/18, 2018/19) of the COMPASS study. Moderate-to-vigorous physical activity (MVPA), recreational screen time, and sleep duration were self-reported. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (Revised)-10 (CESD-R-10). Compositional data analyses using pivot coordinates and compositional isotemporal substitution for longitudinal data were used to analyse the data. Analyses accounted for school clustering, were stratified by gender and age (< or ≥ 15 years), and were adjusted for race/ethnicity, body mass index z-score, baseline movement behaviour composition, and baseline depressive symptoms., Results: There were significant differences in movement behaviour composition over time across all subgroups. For example, the relative contributions of MVPA and sleep duration to the movement behaviour composition decreased over time while screen time increased among younger boys and girls and older girls. Increasing sleep duration relative to the remaining behaviours (i.e. screen time and MVPA) was associated with lower depressive symptoms among all subgroups. Increasing screen time relative to the remaining behaviours (i.e. MVPA and sleep duration) was associated with higher depressive symptoms among all subgroups. Increasing MVPA relative to the remaining behaviours (i.e. screen time and sleep duration) was associated with lower depressive symptoms in older girls only. Isotemporal substitution estimates indicated that decreasing screen time by 60 minutes/day and replacing that time with 60 minutes of additional sleep is associated with the largest change in depressive symptoms across all subgroups., Conclusions: Findings from this prospective analysis suggest that increased sleep duration and reduced screen time are important determinants of lower depressive symptoms among adolescents., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Little is known about gender differences in associations between weight control intentions and mental health in adolescents. Our objective was to examine these associations in a large sample of adolescent girls and boys., Methods: Using data from Year 6 (2017-18) of the COMPASS study (n = 57 324), we performed a series of multivariable linear regressions to examine whether weight control intentions (gain, lose, stay the same, no intention) were associated with depression, anxiety and self-concept, while adjusting for relevant covariates including body mass index. Models were stratified by self-reported gender., Results: Compared to those with no intentions, girls who intended to lose weight reported higher symptoms of depression (B = 0.52, p < 0.001) and anxiety (B = 0.41, p < 0.001) and poorer self-concept (B = 2.06, p < 0.001). Girls who intended to gain weight also reported higher symptoms of depression (B = 0.54, p < 0.001), anxiety (B = 0.50, p < 0.001) and self-concept (B = 1.25, p < 0.001). Boys who intended to lose weight reported greater symptoms of depression (B = 0.26, p < 0.001) and anxiety (B = 0.33, p < 0.001) and poor self-concept (B = 1.10, p < 0.001). In boys, weight-gain intentions were associated with greater symptoms of anxiety (B = 0.17, p < 0.05), but not depression or self-concept., Conclusion: Intentions to gain or lose weight were associated with symptoms of mental disorder and poor self-concept in our large sample of adolescents, and these relationships differed in boys and girls. These findings have important implications for school-based programs promoting healthy weight and body image., Competing Interests: The authors declare that they have no conflicts of interest.

Canada is in the midst of an ongoing, escalating opioid crisis, with significant impacts on adolescents and young adults. Accordingly, mental health impairment was examined as a risk factor for non-medical prescription opioid use (NMPOU) among high school students. In addition, the moderating effects of the school environment, in terms of the availability of mental health services and substance use policies, were characterized. Self-reported, cross-sectional data were obtained from the COMPASS study, including 61,239 students (grades 9-12) in 121 secondary schools across Canada. Current and lifetime NMPOU were ascertained. Categorical indicators of mental health impairment and school environment were derived. The main analytical strategy encompassed hierarchal multilevel logistic regression, including the addition of interaction terms to characterize the moderation effects. Current and lifetime NMPOU were reported by 5.8% and 7.2% of the students, respectively. After adjusting for confounders, students in the highest quintile of mental health impairment had odds ratios (OR) of 2.60 (95% confidence interval [CI] 2.29-2.95) and 2.96 (95% CI 2.64-3.33) for current and lifetime NMPOU, respectively when compared to students in the lowest quintile of mental health impairment. A significant interaction between mental health impairment and school environment indicated relatively lower risks of NMPOU in students from schools that provide more mental health services and have stricter substance use policies. Mental health impairment increased the risk of NMPOU, but the associations were moderated by the school environment. These findings underscore the importance of mental health services and substance use regulations in schools.

Background: Youth who go hungry have poorer mental health than their counterparts - there are gender differences in this relationship. This study investigated the role of social support in the association between hunger and mental health among a nationally representative sample of youth in Canada in gender-specific analyses., Methods: We used a probability-based sample of 21,750 youth in grades 6-10 who participated in the 2017-2018 Canadian Health Behaviour in School-aged Children. Self-report data were gathered on hunger, mental health (measured via the World Health Organization-5 well-being index) and five sources of support - peer, family and teacher support as well as the school climate and neighborhood support. We conducted adjusted, gender-specific, multilevel regression analyses assessing the association between mental health, social support and hunger., Results: We found that youth who reported lower support were more likely to experience going to bed hungry (relative to never hungry) across all support factors. As for the social support factors, all the social support factors were associated with a higher mental health score, even after controlling for hunger. Despite these results our final set of models showed that our measures of social support did not alleviate the negative association between hunger and mental health. As for gender-specific findings, the negative association between hunger and a mental health was more pronounced among females relative to their male counterparts. We also found that certain social support factors (i.e., family, teacher and neighborhood support) were associated with a higher mental health score among females relative to males while controlling for hunger status., Conclusions: We find that five social support factors are associated with a higher mental health score among ever hungry youth; however, social support did not overpower the negative association between hunger and mental health. Food insecurity is a challenge to address holistically; however, hungry youth who have high social support have higher odds of better mental health.

Our aim was to examine measurement invariance of the Flourishing Scale (FS)-a concise measure of psychological wellbeing-across two study samples and by population characteristics among Canadian adolescents. Data were retrieved from 74,501 Canadian secondary school students in Year 7 (2018-2019) of the COMPASS Study and from the original validation of the FS ( n = 689). We assessed measurement invariance using a confirmatory factor analysis in which increasingly stringent equality constraints were specified for model parameters between the following groups: study sample (i.e., adolescents vs. adults), gender, grade, and ethno-racial identity. In all models, full measurement invariance of the FS across all sub-groups was demonstrated. Our findings support the validity of the FS for measuring psychological wellbeing among Canadian adolescents in secondary school. Observed differences in FS score among subgroups therefore represent true differences in wellbeing rather than artifacts of differential interpretation.

Youth populations represent a key population for addressing mental health, yet many youths express reluctance towards help seeking. Considering the volume of time that almost all youth spend at school during the school year, it is important to assess the role of the school environment in relation to students' attitudes toward help-seeking. Data from 47,290 grade 9 to 12 students and 116 Canadian secondary schools that participated in the 2018-19 wave of the COMPASS (Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, Sedentary behaviour) study were analyzed using GEE models to assess the student and school characteristics associated with attitudes regarding seeking help for mental health concerns from an adult at school. Overall, 58% of students reported being reluctant to seek help for mental health concerns at school. Students who reported lower self-rated mental health (aOR = 1.76, 95% CI = 1.65, 1.87), emotion regulation (aOR = 1.08, 95% CI = 1.07, 1.09), family support (aOR = 2.31, 95% CI = 2.16, 2.47), peer support (aOR = 1.20, 95% CI = 1.13, 1.31), and school connectedness (aOR = 0.93, 95% CI = 0.92, 0.93) scores were more likely to be reluctant towards help-seeking at school than students with more favourable scores on these variables. Students with higher flourishing scores were less likely than students who were languishing to report reluctance to help-seeking at school (aOR = 0.96, 95% CI = 0.96, 0.97). Students attending schools in areas with lower population densities and median household incomes between $50,000-75,000 were less likely to be reluctant to help-seeking relative to students attending schools in areas with higher density (aOR = 0.85, 95% CI = 0.79, 0.93) and median household incomes (aOR = 1.20, 95% CI = 1.13, 1.31), respectively. The availability of school mental health services and specialists were not associated with student help-seeking reluctance. High levels of resistance towards help-seeking among youth remain a significant barrier, particularly among youth at highest risk (i.e., with lower support and poorer mental health). The student and school characteristics identified in the current study can help inform strategies to promote greater acceptance of help seeking among students in schools.

This study examined how schools prioritize ten key health concerns among their student populations over time and whether schools' prioritization of alcohol and other drug use (AODU) corresponds to students' substance use behaviours and cannabis legalization as a major policy change. Data were collected from a sample of secondary schools in Ontario, Canada across four years (2015/16-2018/19 [N[superscript 2015/16] = 65, N[superscript 2016/17] = 68, N[superscript 2017/18] = 61 and N2018/19 = 60]) as a part of the COMPASS study. School-level prevalence of cannabis and alcohol use between schools that did and did not prioritize student AODU as a health concern was examined. Ordinal mixed models examined whether student cannabis and alcohol use were associated with school prioritization of AODU. Chi-square tests examined changing health priorities among schools pre-post cannabis legalization. School priority ranking for AODU was mostly stable over time. While AODU was identified as an important health concern, most schools identified mental health as their first priority across the four years of the study. No significant changes to school AODU priorities were observed pre--post cannabis legalization nor was school prioritization of AODU associated with student cannabis and alcohol use behaviours. This study suggests that schools may benefit from guidance in identifying and addressing priority health concerns among their student population.

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.

Course grades, as an indicator of academic performance, are a primary academic concern at the secondary school level and have been associated with various aspects of mental health status. The purpose of this study is to simultaneously assess whether symptoms of mental illness (depression and anxiety) and mental well-being (psychosocial well-being) are associated with self-reported grades (in their primary language [English or French] and math courses) and education behaviors (school days missed due to health, truancy, and frequency of incomplete homework) in a sample of secondary school students across Canada (n = 57,394). Multivariate imputation by chained equations and multilevel proportional odds logistic regressions were used to assess associations between mental health scores, academic performance and education behaviors. Lower depression and higher psychosocial well-being scores were associated with better grade levels in both math and language courses, as well as better education behaviors. In turn, better education behaviors were associated with higher course grades. Depression scores and psychosocial well-being scores remained associated with higher grades after controlling for education behaviors, however the magnitude of association was diminished. Results indicate that the effects of mental health factors were partially attenuated by education behaviors, suggesting while reduced class attendance and poor homework adherence were associated with both academic outcomes and mental health, they do not account entirely for the association between lower grades and worse mental health.

We quantified the joint evolution of sleep duration and screen time between 2018 and 2022 in a large sample of adolescents from Quebec, Canada, to ascertain changes that occurred during the COVID-19 pandemic. A natural experiment design was used to compare variations from year to year and in association with the pandemic outbreak. Using structural equation modeling on data collected between 2018 and 2022 among adolescents attending 63 high schools, we analyzed the joint evolution of sleep duration and screen time while adjusting for previous year values, concurrent flourishing score, sex, age, and family level of material deprivation. A total of 28,307 adolescents, aged on average 14.9 years, were included in the analyses. Between 2019 and 2022, sleep duration increased by 9.6 (5.7, 13.5) minutes and screen time by 129.2 (120.5, 138.0) minutes on average. In 2022, the adolescents spent almost equal amounts of time sleeping and using screens. Lower flourishing scores were associated with shorter sleep duration and lengthier screen time. Girls' screen time became similar to boys' over time. Adolescents now spend almost equal amounts of time sleeping and using screens, a situation that calls for urgent public health actions. These findings highlight the importance of tracking changes in adolescents' behaviours over time, to design and implement interventions adapted to the changing health needs of different groups. [ABSTRACT FROM AUTHOR]

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]

The mental health benefits of physical activity may relate more to the context of the behavior, rather than the behavior of being active itself. The association between varsity sport (VS) participation, depression, and anxiety symptoms was explored using data from 70,449 high school students from the Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behavior study. The model adjusted for potential covariates; interactions by sex and participation in outside of school sport (OSS) were explored. Overall, 70% and 24% of respondents met or exceeded cutoff values for depression and anxiety, respectively. Students participating in VS had lower symptoms of anxiety and depression compared with nonparticipants. Results were consistent regardless of OSS participation; associations were strongest among students who participated in both VS and OSS and males. Participation in VS may prove beneficial for the prevention and/or management of depression or anxiety symptoms, particularly among males. An additive beneficial effect of OSS on depression and anxiety scores may exist. [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: In population health surveillance research, survey data are commonly analyzed using regression methods; however, these methods have limited ability to examine complex relationships. In contrast, decision tree models are ideally suited for segmenting populations and examining complex interactions among factors, and their use within health research is growing. This article provides a methodological overview of decision trees and their application to youth mental health survey data. Methods: The performance of two popular decision tree techniques, the classification and regression tree (CART) and conditional inference tree (CTREE) techniques, is compared to traditional linear and logistic regression models through an application to youth mental health outcomes in the COMPASS study. Data were collected from 74 501 students across 136 schools in Canada. Anxiety, depression and psychosocial well-being outcomes were measured along with 23 sociodemographic and health behaviour predictors. Model performance was assessed using measures of prediction accuracy, parsimony and relative variable importance. Results: Decision tree and regression models consistently identified the same sets of most important predictors for each outcome, indicating a general level of agreement between methods. Tree models had lower prediction accuracy but were more parsimonious and placed greater relative importance on key differentiating factors. Conclusion: Decision trees provide a means of identifying high-risk subgroups to whom prevention and intervention efforts can be targeted, making them a useful tool to address research questions that cannot be answered by traditional regression methods. [ABSTRACT FROM AUTHOR]

Individuals with learning disabilities (LDs) are more likely to have a mental illness, yet few studies explore this association in emerging adulthood, a developmental period with an increased risk for mental illness. The purpose of the current study was to investigate psychological distress in emerging adults (15–29 years) with and without LDs. The 2012 Canadian Community Health Survey—Mental Health was used (n = 5630), and multiple and logistic regression models with survey weights were computed. Adjusting for demographic, psychosocial, and health covariates, there was no evidence for significant differences in psychological distress among emerging adults with vs. without LDs. However, age and sex were significant effect modifiers. Among emerging adults with LDs, both males (OR = 2.39 [1.01, 5.67]) and those aged 25–29 years (OR = 3.87 [1.05, 14.30]) had an increased odds of clinically relevant psychological distress in comparison to those without LDs. These findings suggest a need for improved awareness and support for prevention of psychological distress among emerging adults with LDs, especially for males and those in later emerging adulthood. [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]

Course grades, as an indicator of academic performance, are a primary academic concern at the secondary school level and have been associated with various aspects of mental health status. The purpose of this study is to simultaneously assess whether symptoms of mental illness (depression and anxiety) and mental well-being (psychosocial well-being) are associated with self-reported grades (in their primary language [English or French] and math courses) and education behaviors (school days missed due to health, truancy, and frequency of incomplete homework) in a sample of secondary school students across Canada (n = 57,394). Multivariate imputation by chained equations and multilevel proportional odds logistic regressions were used to assess associations between mental health scores, academic performance and education behaviors. Lower depression and higher psychosocial well-being scores were associated with better grade levels in both math and language courses, as well as better education behaviors. In turn, better education behaviors were associated with higher course grades. Depression scores and psychosocial well-being scores remained associated with higher grades after controlling for education behaviors, however the magnitude of association was diminished. Results indicate that the effects of mental health factors were partially attenuated by education behaviors, suggesting while reduced class attendance and poor homework adherence were associated with both academic outcomes and mental health, they do not account entirely for the association between lower grades and worse mental health. [ABSTRACT FROM AUTHOR]

Introduction: Having a better understanding of individual factors associated with e-cigarette initiation can help improve prevention efforts. Therefore, this study aimed to (1) identify baseline characteristics associated with e-cigarette initiation, and (2) determine whether changes in these baseline characteristics were associated with e-cigarette initiation. Methods: This study used data from Year 6 (2017/18, baseline) and Year 7 (2018/19, follow-up) of the COMPASS study. The final sample included 12 315 students in Grades 9 to 11 who reported never having tried e-cigarettes at baseline. Students reported demographic information, other substance use, school behaviours, physical activity, sedentary behaviour, sleep, symptoms of anxiety and depression, and emotional regulation and flourishing scores. Hierarchical GEE models, stratified by gender, examined the association between (1) baseline characteristics and e-cigarette initiation at follow-up and (2) changes in baseline characteristics and e-cigarette initiation at follow-up. Results: In total, 29% of students who had not yet initiated e-cigarette use reported initiating e-cigarette use at follow-up. Students in Grades 10 and 11 were less likely to initiate e-cigarette use. Other substance use, skipping school and meeting the physical activity guidelines at baseline and one-year changes to these behaviours were associated with e-cigarette initiation among both male and female students. Additionally, some differences were noted between females and males. Conclusion: Given that other health behaviours were associated with e-cigarette initiation, prevention approaches should target multiple health-risk behaviours to help prevent youth e-cigarette use. Additionally, school-based approaches may benefit by being implemented at the beginning of high school or in junior high school. [ABSTRACT FROM AUTHOR]

BACKGROUND: Adolescence coincides with the adoption of health behaviors that schools are not necessarily equipped to properly address. Collaboration between schools and external health services such as public health could fill gaps in addressing student health. METHODS: The current study uses student‐ and school‐level survey data from 59 nonprivate secondary schools in Ontario, Canada in year 6 (2017–2018) of the COMPASS study to examine barriers to improving student health, and analyze the effect of public health engagement on student health behaviors. RESULTS: The majority of schools have received resources from their local public health unit, however, less than one third of schools were developing/implementing programs jointly, and 12% of schools reported no engagement. Students had higher odds of better overall mental health, of meeting screen time guidelines, and were less likely to bully others if public health units solved issues together with schools regarding these health behaviors. CONCLUSIONS: There is a notable lack of consistent public health engagement in schools participating in the COMPASS study despite a need for such services. Creating mechanisms to develop and strengthen effective partnerships between schools and external service providers such as public health might alleviate some barriers to implementing health interventions in Ontario secondary schools. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to explore whether the way youth perceive their weight and their experiences of bullying victimization account for the increased risk of depression and anxiety symptoms, and poor psychosocial well-being, associated with overweight/obesity in a large sample of Canadian secondary school students. We also explored if associations differed by gender.Methods: We used cross-sectional survey data from year 7 (2018-19) of the COMPASS study. The sample included 57,059 students in grades 9-12 (Secondary III-V in Quebec) at 134 Canadian secondary schools (Alberta, British Columbia, Ontario, Quebec). First, multiple regression models tested associations between body mass index (BMI) classification and mental health outcomes (anxiety [GAD-7] and depression [CESD-10] symptoms, and psychosocial well-being [Diener's Flourishing Scale]). Second, weight perception and bullying victimization were added to the models. Models were stratified by gender and controlled for sociodemographic covariates and school clustering.Results: When weight perception and bullying victimization were added to the models, obesity BMI status no longer predicted internalizing symptoms and flourishing scores relative to normal-weight BMIs. Students with 'overweight' or 'underweight' perceptions, and experiences of bullying victimization in the past month, reported higher anxiety and depressive symptomatology, and lower flourishing levels, in comparison to students with 'about right' weight perceptions and without experiences of bullying victimization, respectively, controlling for BMI status. Results were largely consistent across boys and girls.Conclusions: Results suggest perceptions of weight and experiences of bullying independently contribute to differences in mental health outcomes by weight status among youth. Continued efforts targeting weight-based bullying and weight bias, and the promotion of body size acceptance and positive body image, may help reduce the risk of mental illness and poor mental health among adolescents. [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]

Introduction: Little is known about gender differences in associations between weight control intentions and mental health in adolescents. Our objective was to examine these associations in a large sample of adolescent girls and boys. Methods: Using data from Year 6 (2017-18) of the COMPASS study (n = 57 324), we performed a series of multivariable linear regressions to examine whether weight control intentions (gain, lose, stay the same, no intention) were associated with depression, anxiety and self-concept, while adjusting for relevant covariates including body mass index. Models were stratified by self-reported gender. Results: Compared to those with no intentions, girls who intended to lose weight reported higher symptoms of depression (β = 0.52, p < 0.001) and anxiety (β = 0.41, p < 0.001) and poorer self-concept (β = 2.06, p < 0.001). Girls who intended to gain weight also reported higher symptoms of depression (β = 0.54, p < 0.001), anxiety (β = 0.50, p < 0.001) and self-concept (β = 1.25, p < 0.001). Boys who intended to lose weight reported greater symptoms of depression (β = 0.26, p < 0.001) and anxiety (β = 0.33, p < 0.001) and poor self-concept (β = 1.10, p < 0.001). In boys, weightgain intentions were associated with greater symptoms of anxiety (β = 0.17, p < 0.05), but not depression or self-concept. Conclusion: Intentions to gain or lose weight were associated with symptoms of mental disorder and poor self-concept in our large sample of adolescents, and these relationships differed in boys and girls. These findings have important implications for schoolbased programs promoting healthy weight and body image. [ABSTRACT FROM AUTHOR]

Purpose: High-frequency cannabis use in adolescents has been associated with adult mental illness. In contrast, physical activity has been demonstrated to benefit mental health status. The purpose of this study was to examine whether, within a 1-year prospective study design, changes in cannabis use frequency are associated with changes in mental health, and whether meeting physical activity guidelines moderates these associations. Methods: COMPASS (2012–2021) is a hierarchical longitudinal health data survey from a rolling cohort of secondary school students across Canada; student-level mental health data linked from Years 5 (2016/17) and 6 (2017/18) were analysed (n = 3173, 12 schools). Multilevel conditional change regression models were used to assess associations between mental health scores change, cannabis use change and physical activity guideline adherence change after adjusting for covariates. Results: Adopting at least weekly cannabis use was associated with increases in depressive and anxiety symptoms and decreases in psychosocial well-being. Maintaining physical activity guidelines across both years improved psychosocial well-being regardless of cannabis use frequency, and offset increases in depressive symptoms among individuals who adopted high frequency cannabis use. Physical activity adherence had no apparent relationship with anxiety symptoms. Conclusion: Regardless of the sequence of events, adopting high frequency cannabis use may be a useful behavioural marker of current or future emotional distress, and the need for interventions to address mental health. Physical activity adherence may be one approach to minimizing potential changes in mental health associated with increasing cannabis use. [ABSTRACT FROM AUTHOR]

Background: Active video games (AVGs) have gained interest as a way to increase physical activity in children and youth. The effect of AVGs on acute energy expenditure (EE) has previously been reported; however, the influence of AVGs on other health-related lifestyle indicators remains unclear. Objective: This systematic review aimed to explain the relationship between AVGs and nine health and behavioural indicators in the pediatric population (aged 0–17 years). Data sources: Online databases (MEDLINE, EMBASE, psycINFO, SPORTDiscus and Cochrane Central Database) and personal libraries were searched and content experts were consulted for additional material. Data selection: Included articles were required to have a measure of AVG and at least one relevant health or behaviour indicator: EE (both habitual and acute), adherence and appeal (i.e., participation and enjoyment), opportunity cost (both time and financial considerations, and adverse events), adiposity, cardiometabolic health, energy intake, adaptation (effects of continued play), learning and rehabilitation, and video game evolution (i.e., sustainability of AVG technology). Results: 51 unique studies, represented in 52 articles were included in the review. Data were available from 1992 participants, aged 3–17 years, from 8 countries, and published from 2006–2012. Overall, AVGs are associated with acute increases in EE, but effects on habitual physical activity are not clear. Further, AVGs show promise when used for learning and rehabilitation within special populations. Evidence related to other indicators was limited and inconclusive. Conclusions: Controlled studies show that AVGs acutely increase light- to moderate-intensity physical activity; however, the findings about if or how AVG lead to increases in habitual physical activity or decreases in sedentary behaviour are less clear. Although AVGs may elicit some health benefits in special populations, there is not sufficient evidence to recommend AVGs as a means of increasing daily physical activity. [ABSTRACT FROM AUTHOR]

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]

Aims: The objective of the study was to examine if depression or anxiety was associated with youth cannabis use; and investigate whether flourishing, an indicator of overall wellbeing, moderates these associations.Methods: Students (N=6550) were recruited from 10 secondary schools (grade 9-12) in Ontario and British Columbia, Canada. Self-report questionnaires were used to assess symptoms of depression [CESD-R-10], anxiety [GAD-7], flourishing [Deiner's Flourishing Scale], and cannabis use. Logistic regression and product-term interactions were used to examine the associations between mental health and youth cannabis use, and the potential moderating effect(s) of flourishing.Results: In our sample, 32% of participants had ever used cannabis, and 42% and 32% reported elevated depressive and anxiety symptoms, respectively. Associations between depression, anxiety, and cannabis use were no longer significant when flourishing was added to the models. In addition, there was no evidence suggesting a moderating effect of flourishing (all interactions were not statistically significant). Instead, robust associations were found between flourishing and cannabis use (ever use and frequency).Conclusions: Indicators of mental wellbeing, such as flourishing, appear to be associated with a lower likelihood of cannabis use, even after controlling for depression and anxiety. Results suggest prevention strategies for youth cannabis use should aim to foster mental wellbeing among all youth, rather than exclusively targeting those experiencing mental health problems. Future longitudinal studies should test the sequential relationship between cannabis use and changes in both positive and negative mental health. [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]

• Few epidemiology studies have replicated findings from multiple research systems. • Canadian youth mental health and cannabis use is compared across two data sources. • Associations between mental health and cannabis use were highly similar. • Potential etiology of repeat cross-sectional data was supported by longitudinal data. • Data from large convenience sample aligns with nationally representative data. Using data from two methodologically independent youth research studies in Canada, the Health Behaviour in School-aged Children (HBSC) study and the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) study, the objective of this study was to compare associations between youth's mental health and cannabis use across samples. Using similar indicators in both studies, our goal was to affirm the potential for nationally representative cross-sectional analyses (HBSC) to replicate findings found in a longitudinal non-representative data source (COMPASS), enhancing opportunity for causal inferences. Data were collected from grade 9 and 10 Canadian students participating in the 2017/18 HBSC (n =8462) and 2017/18 to 2018/19 waves of COMPASS (n =32,023). Using multivariable Poisson regression models, the strength and statistical significance of the effects of mental health indicators on cannabis use outcomes were estimated within both studies and compared for consistency. Using a 2-year linked sample of students participating in COMPASS, models examining the impact of mental health indicators on cannabis use initiation and maintenance over time were similarly fit using Poisson regression to estimate relative risk. Similar associations between mental health problems and cannabis use were observed in both data sources. The direction, magnitude, and precision of the estimates for restless sleep, loneliness, poor wellbeing, and cannabis use were highly comparable across both studies. Worse mental health was consistently associated with current and lifetime cannabis use among youth. Cross-sectional and longitudinal findings from two large methodologically diverse studies in Canada demonstrate a replicable association between indicators of mental health and youth cannabis use. Similarities were identified and two generalizations may be concluded: 1) potentially causal etiological relationships inferred from HBSC data were supported in longitudinal findings based on COMPASS, and 2) longitudinal COMPASS data aligns with nationally representative data from HBSC. [ABSTRACT FROM AUTHOR]

Given the well-established relationship between alcohol and internalizing symptoms, potential increases in depression and anxiety during the COVID-19 pandemic may lead to increases in alcohol consumption and binge drinking. This study examines this association from before to during two phases of the pandemic in a cohort of Canadian youth. We used linked data from a sub-sample of 1901 secondary school students who participated in three consecutive school years of the Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behaviour (COMPASS) study between 2018/19 and 2020/21. Separate multilevel logistic regression models examined the association between depression and anxiety symptoms with odds of escalation and reduction (vs. maintenance) and initiation (vs. abstinence) of alcohol consumption. Results show that depression and anxiety symptoms significantly increased over the three years, and these changes were moderated by changes in alcohol consumption and binge drinking. Students with increased depression symptoms were less likely to reduce their alcohol consumption in the early pandemic (Adjust odds ratio [AOR] 0.94, 95% CI:0.90–0.98), more likely to initiate alcohol consumption in the ongoing pandemic period (AOR 1.03, 95% CI: 1.01–1.05), and more likely to initiate binge drinking in both periods. The depression-alcohol use association was stronger among females than males. This study demonstrates a modest association between internalizing symptoms and alcohol use, particularly for depression symptoms and in females. The identified depression-alcohol use association suggests that preventing or treating depression might be beneficial for adolescent alcohol use and vice versa. • Depression and anxiety increased in 2021/2022 compared to April–June 2020. • Females were more likely to maintain/increase alcohol use during the pandemic. • Youth's depression was associated with changes in alcohol use during the pandemic. • Increased depression was associated with increased risk of binge drinking onset. • Females with increased depression were less likely to reduce alcohol use. [ABSTRACT FROM AUTHOR]

Movement behaviours (e.g., physical inactivity, short sleep duration, high screen time) are associated with mental illness but less is known about the relationship between health behaviours and positive mental health constructs such as flourishing. This study examines if changes in adherence to the Canadian 24-Hour Movement Behaviour Guidelines for Children and Youth (moderate-to-vigorous physical activity (MVPA), total screen time (ST), sleep) are associated with changes in youth flourishing over one year. Students (N = 2292) were recruited from 12 secondary schools in Canada participating in the COMPASS study. Conditional change models were used to analyze two waves of longitudinal questionnaire data from 2016-17 to 2017-18. One-year change in adherence to the MVPA, ST, and sleep duration guidelines were modeled as predictors of flourishing adjusting for covariates. Models were stratified by sex. For males only, meeting MVPA guidelines both years was associated with higher flourishing compared to males not meeting guidelines (Est:0.87, SE:0.36, p = .01). Reducing ST was associated with higher flourishing for males only relative to other males who continued to exceed the ST guidelines (Est:2.23, SE:1.04, p < .03). Longer sleep duration had the most consistent association with greater flourishing among females (Est:1.02, SE:0.3, p < .001) and males (Est:0.93, SE:0.34, p < .006), highlighting sleep as a public health priority in the context of 24-hour movement behaviours. These findings contribute to increasing calls for research examining positive mental health constructs independent of mental illness. [ABSTRACT FROM AUTHOR]