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Traditional public health surveillance efforts are generally based on self-reported data. Although well validated, these methods may nevertheless be subjected to limitations such as biases, delays, and costs or logistical challenges. An alternative is the use of smart technologies (eg, smartphones and smartwatches) to complement self-report indicators. Having embedded sensors that provide zero-effort, passive, and continuous monitoring of health variables, these devices generate data that could be leveraged for cases in which the data are related to the same self-report metric of interest. However, some challenges must be considered when discussing the use of mobile health technologies for public health to ensure digital health equity, privacy, and best practices. This paper provides, through a review of major Canadian surveys and mobile health studies, an overview of research involving mobile data for public health, including a mapping of variables currently collected by public health surveys that could be complemented with self-report, challenges to technology adoption, and considerations on digital health equity, with a specific focus on the Canadian context. Population characteristics from major smart technology brands-Apple, Fitbit, and Samsung-and demographic barriers to the use of technology are provided. We conclude with public health implications and present our view that public health agencies and researchers should leverage mobile health data while being mindful of the current barriers and limitations to device use and access. In this manner, data ecosystems that leverage personal smart devices for public health can be put in place as appropriate, as we move toward a future in which barriers to technology adoption are decreasing., (©Pedro Elkind Velmovitsky, Merna Kirolos, Paulo Alencar, Scott Leatherdale, Donald Cowan, Plinio Pelegrini Morita. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 12.09.2024.)

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., (© 2021, American School Health Association.)

Public health is critical to a healthy, fair, and sustainable society. Realizing this vision requires imagining a public health community that can maintain its foundational core while adapting and responding to contemporary imperatives such as entrenched inequities and ecological degradation. In this commentary, we reflect on what tomorrow's public health might look like, from the point of view of our collective experiences as researchers in Canada who are part of an Applied Public Health Chairs program designed to support "innovative population health research that improves health equity for citizens in Canada and around the world." We view applied public health research as sitting at the intersection of core principles for population and public health: namely sustainability, equity, and effectiveness. We further identify three attributes of a robust applied public health research community that we argue are necessary to permit contribution to those principles: researcher autonomy, sustained intersectoral research capacity, and a critical perspective on the research-practice-policy interface. Our intention is to catalyze further discussion and debate about why and how public health matters today and tomorrow, and the role of applied public health research therein.

Objective: Current and emerging public health challenges require a new approach to research training. The purpose of the CIHR-Strategic Training Program in Tobacco Research (STPTR) is to equip the next generation of scientific leaders with the knowledge, skills and experiences that will enhance their ability to conduct tobacco research that will have a positive impact on the health of the population., Participants: Graduate students or post-doctoral fellows from any university in Canada who are working with a STPTR Mentor in the broad area of tobacco control., Setting: Mentors at three universities: University of British Columbia, University of Toronto, and University of Waterloo., Intervention: The STPTR currently has four elements: a video course linking STPTR trainees and mentors across universities; an annual meeting; stipend awards that free CIHR STPTR fellows to concentrate on research; and personal, cross-disciplinary research mentoring., Outcomes: Feedback solicited from current and past trainees at the three-year point of the program suggests that there are four key value-added benefits associated with being a trainee in the STPTR: transdisciplinary connectedness, community building, capacity building, and exposure., Conclusion: Feedback from trainees at different stages in their training experience, different academic institutions, and different academic disciplines will inform the ongoing framing of the STPTR and may inform future training programs in other disciplines of chronic disease prevention, health promotion, and the emerging science of population-level intervention.

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

Youth smoking and physical inactivity are significant public health issues, with implications for both health and education stakeholders, as school-based policies and programs have the potential to reach a broad population of youth to address these issues. Knowledge exchange tools designed around comprehensive school-level data collection systems allow for dissemination of evidence into such policies and programs. The purpose of this manuscript is to describe the process of developing knowledge exchange feedback reports for school-based health policies and programs, using the School Health Action, Planning and Evaluation System (SHAPES) data collection system. SHAPES-Ontario is a project that utilized the SHAPES research platform to collect student-level behavioural data and school-level policy and programs data on tobacco and physical activity in 81 secondary schools across Ontario, Canada. Methods used to develop the feedback reports involved categorizing and scoring survey response options based on extensive research evidence and expert feedback. Feedback report scores were aggregated into overall grades and presented in a short and long version of a feedback report for school administrators. These reports present prime examples of how to use the principles of knowledge exchange in developing a tool to bridge the gap between research and practice. (Contains 3 tables and 2 figures.)

Purpose: Adolescent depression is a significant public health concern, and studying its multifaceted factors using traditional methods possess challenges. This study employs random forest (RF) algorithms to determine factors predicting adolescent depression scores. Methods: This study utilized self-reported survey data from 56,008 Canadian students (grades 7–12) attending 182 schools during the 2021/22 academic year. RF algorithms were applied to identify the correlates of (i) depression scores (CESD-R-10) and (ii) presence of clinically relevant depression (CESD-R-10 ≥ 10). Results: RF achieved a 71% explained variance, accurately predicting depression scores within a 3.40 unit margin. The top 10 correlates identified by RF included other measures of mental health (anxiety symptoms, flourishing, emotional dysregulation), home life (excessive parental expectations, happy home life, ability to talk to family), school connectedness, sleep duration, and gender. In predicting clinically relevant depression, the algorithm showed 84% accuracy, 0.89 sensitivity, and 0.79 AUROC, aligning closely with the correlates identified for depression score. Conclusion: This study highlights RF's utility in identifying important correlates of adolescent depressive symptoms. RF's natural hierarchy offers an advantage over traditional methods. The findings underscore the importance and additional potential of sleep health promotion and school belonging initiatives in preventing adolescent depression. [ABSTRACT FROM AUTHOR]

Objective: Youth drinking is highly heterogenous, and subpopulations representing different alcohol use patterns may have responded differently to the COVID-19 pandemic. This study examined changing patterns of alcohol use in subpopulations of the youth population over the first two years of the pandemic. Method: We used linked survey data from 5367 Canadian secondary school students who participated in three consecutive waves of the COMPASS study between 2018/19 and 2020/21. Latent transition analysis (LTA) was used to identify patterns of alcohol use based on the frequency of drinking and frequency of binge drinking and to estimate the probability of transitioning between identified patterns. Results: LTA identified five patterns of alcohol use each representing a unique subpopulation: abstainer, occasional drinker-no binging, occasional binge drinker, monthly binge drinker, weekly binge drinker. Probability of being engaged in binge drinking for a subpopulation of occasional drinkers pre-pandemic was 61%, which reduced to 43% during the early-pandemic period. A lower proportion of occasional binge drinkers reported moving to monthly or weekly binge drinking. Female occasional drinkers were more likely to move to binge drinking patterns during the pandemic than males. Conclusions: Less frequent drinking and younger students were more likely to reduce their drinking and binge drinking than more established drinkers during the COVID-19 pandemic. Understanding of heterogenous patterns of alcohol drinking and different responses to public health crises may inform future preventive programs tailored to target subpopulations more effectively. [ABSTRACT FROM AUTHOR]

Introduction: As a largely social behaviour, substance use may have decreased for some youth overall in Canada during the COVID-19 pandemic; however, continued use may indicate nonadherence to pandemic-related restrictions and social distancing measures. In a sample of Canadian adolescents (aged 12-19 years), our objective was to examine how substance use (cannabis, binge drinking, cigarettes, vaping) is associated with perceptions of, and adherence to, early COVID-19-related public health measures, taking into consideration sociodemographic factors. Methods: Cross-sectional data were retrieved from online data collected during Year 8 of the COMPASS school-based study, during the early months of the COVID-19 pandemic (May-July 2020) in British Columbia, Ontario and Quebec. We fitted two models using generalized estimating equations to examine how substance use was associated with separate measures of (1) perceptions of, and (2) adherence to early COVID-19 restrictions. Results: In our sample, 10% of adolescents perceived COVID-19 restrictions as too weak and 14% perceived them as too strict. Nearly half (46%) reported taking restrictions very seriously, and 5% did not take them seriously at all. Binge drinking, cigarette use and vaping were associated with perceptions that restrictions were too strict and with nonadherence. However, adolescents who used cannabis were less likely to perceive COVID-19-related restrictions as too strict. Conclusion: This study highlights the association of adolescent substance use with perceptions of, and adherence to, COVID-19-related public health restrictions in Canada. Our findings emphasize a need for continual monitoring of substance use behaviours during the COVID-19 pandemic to better characterize adolescent risk and further inform targeted public health strategies accordingly. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2005.10.003 Byline: Scott T. Leatherdale (a)(b)(c), Steve Manske (b)(d), Christina Kroeker (b) Keywords: Smoking behaviour; Youth/adolescence; Peer influences; School environment; Multi-level/hierarchical; Sex/gender differences Abstract: The purpose of this study was to examine sex differences in how the smoking behaviour of close friends and older peers at school influence smoking onset and progression among 10,843 grade 9, 10 and 11 students from 29 secondary schools in Ontario, Canada. In lower-risk student populations (i.e., students with no smoking friends or one smoking friend), males and females were both at a similar level of risk for occasional smoking as a function of the smoking rate of older students at their school. Among higher-risk student populations (i.e., students with three or more close friends who smoke), the smoking rate of older students at school did not influence the risk of occasional smoking. The odds of a female student being a regular smoker increased as the prevalence of smoking among older students at her school increased regardless of her close friends' smoking behaviour. However, among male students, the influence of older student smoking at school on the odds of regular smoking was moderated by the number of close friends who smoke. It appears that the prevalence of older student smoking at a school is more influential among younger female students, whereas the smoking behaviour of close friends appears to be more influential among younger male students. This new finding provides unique insight for tailoring and targeting future school-based smoking prevention initiatives. Author Affiliation: (a) Division of Preventive Oncology, Cancer Care Ontario, Canada (b) Department of Health Studies and Gerontology, University of Waterloo, Canada (c) Department of Public Health Sciences, University of Toronto, Canada (d) Centre for Behavioural Research and Program Evaluation for the National Cancer Institute of Canada and the Canadian Cancer Society, Canada

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]

Background: Despite the benefits of physical activity (PA), the majority of Canadian youth are falling short of the recommended 60 min of moderate-to-vigorous physical activity (MVPA) per day. School-based physical activity programs such as intramurals, are important opportunities for youth to be physically active. There is limited evidence available on the impact of gender-specific (e.g., female-only, male-only) and co-ed intramurals on youth PA over time, however, evidence suggests female-only intramurals may be important for female MVPA. This research aims to capitalize on a natural experiment to generate practice-based evidence on the impact of changes in gender-specific and co-ed intramurals on youth MVPA over time.Methods: This study used linked longitudinal school- and student-level data from Ontario secondary schools in year 5 (Y5:2016-2017), year 6 (Y6: 2017-2018) and year 7 (Y7: 2018-2019) of the COMPASS study. Data on intramurals from 55 schools were used to determine the changes to gender-specific and co-ed intramurals that occurred from Y5 to Y6. Baseline demographic characteristics were measured and data on PA and sport participation were collected in Y5, Y6 and Y7 on a sample of 4417 students. Hierarchical linear mixed regression models were used to estimate how changes in gender-specific and co-ed intramurals were associated with youth MVPA over time.Results: Participation in intramural, varsity and community sport were all positively and significantly associated with youth MVPA. Changes in gender-specific and co-ed intramurals were not significantly associated with youth MVPA in Y6 or Y7. However, the positive association between maintaining the addition of gender-specific intramurals on female MVPA in Y7 was on par with the significance level of α = 0.05, suggesting that adding gender-specific intramurals may be important for female MVPA.Conclusions: Adding gender-specific and co-ed intramurals may not be sufficient strategies to increase PA among youth. Further research should explore the effect of gender-specific intramurals on youth PA, as this study may have been underpowered at the school-level. Gender-specific intramurals may promote a supportive PA environment that promotes MVPA, especially among females. These intramurals may be an important component of more comprehensive strategies to increase youth MVPA. [ABSTRACT FROM AUTHOR]

Introduction: This study investigates the influence of age at first use of alcohol on current alcohol use and associated behaviours in a large sample of Canadian youth. Methods: This descriptive-analytical study was conducted among Ontario Grade 12 students enrolled in the COMPASS Host Study between 2012 and 2017. We used generalized estimating equations (GEE) modelling to determine associations between age at first alcohol use and likelihood of current versus non-current alcohol use, binge drinking and mixing of alcohol with energy drinks among respondents. Results: Students reporting an age at first alcohol use between ages 13 and 14 years were more likely to report current alcohol use versus non-current use (OR = 2.80, 95% CI: 2.26-3.45) and current binge drinking versus non-current binge drinking (OR = 3.22, 95% CI: 2.45-4.25) compared to students reporting first alcohol use at age 18 years or older. Students who started drinking at 8 years of age or younger were more likely to report current versus non-current alcohol use (OR = 3.54, 95% CI: 2.83-4.43), binge drinking (OR = 3.99, 95% CI: 2.97-5.37), and mixing of alcohol with energy drinks (OR = 2.26, 95% CI: 1.23-4.14), compared to students who started drinking at 18 years or older. Conclusion: Starting to drink alcohol in the early teen years predicted current alcohol use, current binge drinking and mixing of alcohol with energy drinks when students were in Grade 12. Findings indicate a need for development of novel alcohol prevention efforts. [ABSTRACT FROM AUTHOR]

BACKGROUND: We explored priority areas of food safety education needed by high‐school students within Ontario, Canada. METHODS: We analyzed transcripts from semistructured interviews with 20 experts in food safety, food safety education in youth, and high‐school education in Ontario. Inductive thematic analysis was used to identify priority food safety education needs. RESULTS: We identified 4 priority action areas for food safety education targeting students: how to safely do the things they typically do with food; how to keep themselves and their kitchens clean and safe; how microorganisms grow and how they can result in foodborne disease; and how to keep food out of the "danger zone" 4°C to 60°C (40° F to 140° F). The results indicate that students need specific education around the use of microwaves, consumption of convenience meals, preparing and handling foods at school events, and safe transportation of food for lunches, school trips, and sporting events. CONCLUSIONS: High‐school students need food safety education specific to their usual interactions with food, including the foods, tools, and settings students regularly encounter. Delivery of food safety education should emphasize sequences of safe food‐handling behaviors for specific food interactions, such as reheating a meal in the microwave, rather than traditional food safety concepts, such as temperature abuse. [ABSTRACT FROM AUTHOR]

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

ABSTRACT BACKGROUND Although schools are considered opportune settings for youth health interventions, a gap between school health research and practice exists. COMPASS, a longitudinal study of Ontario and Alberta secondary students and schools (2012-2021), used integrated knowledge translation to enhance schools' uptake of research findings. Schools received annual summaries of their students' health behaviors and suggestions for action, and were linked with COMPASS knowledge brokers to support them in making changes to improve student health. This research examines the factors that influenced schools' participation in knowledge brokering and associated outcomes. METHODS School- and student-level data from the first 3 years of the COMPASS study (2012-2013; 2013-2014; 2014-2015) were used to examine factors that influenced knowledge brokering participation, school-level changes, and school-aggregated student health behaviors. RESULTS Both school characteristics and study-related factors influenced schools' participation in knowledge brokering. Knowledge brokering participation was significantly associated with school-level changes related to healthy eating, physical activity, and tobacco programming, but the impact of those changes was not evident at the aggregate student level. CONCLUSIONS Knowledge brokering provided a platform for collaboration between researchers and school practitioners, and led to school-level changes. These findings can inform future researcher-school practitioner partnerships to ultimately enhance student health. [ABSTRACT FROM AUTHOR]

Objective: The current study sought to examine Guatemalan adolescents' consumption of sugar-sweetened beverages (SSB), identify which individual-level characteristics are associated with SSB consumption and describe school characteristics that may influence students' SSB consumption.Design: Within this observational pilot study, a questionnaire was used to assess students' consumption of three varieties of SSB (soft drinks, energy drinks, sweetened coffees/teas), as well as a variety of sociodemographic and behavioural characteristics. We collected built environment data to examine aspects of the school food environment. We developed Poisson regression models for each SSB variety and used descriptive analyses to characterize the sample.Setting: Guatemala City, Guatemala.Subjects: Guatemalan adolescents (n 1042) from four (two public, two private) secondary schools.Results: Built environment data revealed that students from the two public schools lacked access to water fountains/coolers. The SSB industry had a presence in the schools through advertisements, sponsored food kiosks and products available for sale. Common correlates of SSB consumption included school type, sedentary behaviour, frequency of purchasing lunch in the cafeteria, and frequency of purchasing snacks from vending machines in school and off school property.Conclusions: Guatemalan adolescents frequently consume SSB, which may be encouraged by aspects of the school environment. Schools represent a viable setting for equitable population health interventions designed to reduce SSB consumption, including increasing access to clean drinking-water, reducing access to SSB, restricting SSB marketing and greater enforcement of existing food policies. [ABSTRACT FROM AUTHOR]

Background: With the rapid proliferation of new gambling technology and online gambling opportunities, there is a concern that online gambling could have a significant impact on public health, particularly for adolescents. The aim of this study is to examine online and land-based gambling behaviour among adolescents in 3 Canadian provinces (Ontario, Newfoundland and Labrador, Saskatchewan) prior to the implementation of legalized online gambling.Methods: Data are from 10,035 students in grades 9 to 12 who responded to the 2012-2013 Youth Gambling Survey (YGS) supplement, a questionnaire administered as part of the Canadian Youth Smoking Survey (YSS, 2012) in 3 provinces: Newfoundland and Labrador (n = 2,588), Ontario (n = 3,892), and Saskatchewan (n = 3,555).Results: Overall, 41.6% of adolescents (35.9% of females and 47.4% of males) had gambled in the past 3 months. 9.4% of adolescents had gambled online in the past 3 months alone (3.7% of females and 15.3% of males). The most popular form of online gambling was online sports betting. Adolescents also engaged in online simulated gambling including internet poker (9.1%) and simulated gambling on Facebook (9.0%). Few adolescents participated in online gambling exclusively and online gamblers were more likely than land-based gamblers to engage in multiple forms of gambling. A higher proportion of adolescent online gamblers scored "high" or "low to moderate" in problem gambling severity compared to land-based only gamblers.Conclusions: Despite restrictions on online gambling at the time of the study, adolescents were engaging in online gambling at a significantly higher rate than has been previously found. Adolescents were also using technology such as video games to gamble and free online gambling simulations. [ABSTRACT FROM AUTHOR]

Background: School-based prevention activities continue to be an important tobacco control resource, however there is little guidance for school-based tobacco control programming within Ontario. The objective of this study is to identify real-world changes in school-based tobacco control programs or policies in the COMPASS study and examine of those interventions (natural experiments) had any impact on the school-level prevalence of smoking susceptibility and current smoking over time. Methods: This paper uses longitudinal school-level smoking behaviour data from Year 1 (Y1: 2012-13) and Year 2 (Y2: 2013-14) of the COMPASS study. Changes to school-level tobacco control programs and policies were measured using the COMPASS School Programs and Policies Questionnaire and knowledge broker follow-up interviews. Quasi-experimental tests of proportion and difference-in-difference models were used to evaluate the impact of the interventions identified between Y1 and Y2 on school-level prevalence of smoking susceptibility among never smokers and current smoking. Results: Between Y1 and Y2, 17 schools reported a change in their tobacco control programming or policies. In four of the intervention schools, the increase in the within-school prevalence of susceptible never smokers between Y1 and Y2 was significantly greater than the natural change observed in the control schools. In five of the intervention schools, the decrease in the within-school prevalence of current smokers between Y1 and Y2 was significantly greater than the natural change observed in the control schools. Only two of the new interventions evaluated (both focused on policies of progressive punishment for students caught smoking on school property), were associated with significant desirable changes in both smoking susceptibility and current smoking between Y1 and Y2. Discussion: Interventions specific to effective and enforced tobacco control were the most common and consistently had the desired impact on the school-level prevalence of smoking susceptibility and current smoking. Due to the variation in the types of interventions implemented and their effectiveness, additional evaluation evidence is necessary to determine the most successful activities and contexts among individual students. The results presented here highlight which of these real-world promising interventions should be further evaluated using the longitudinal individual-level data in COMPASS over time. [ABSTRACT FROM AUTHOR]

Background In 2006, enclosed public and workplaces in Ontario were made smoke-free by the Smokefree Ontario Act (SFOA). Numerous area municipalities across the province have since developed local by-laws that are more restrictive than the SFOA and ban smoking in outdoor environments including parks, beaches, and patios. The current study measured reported costs associated with the implementation and enforcement of smoke-free outdoor municipal bylaws including materials and staffing costs. The study also assessed the number of warnings or tickets issued to smokers. Ontario communities with a by-law in force for at least 2 years were included in the sample (n = 42). The study was completed by 88% of area municipalities (n = 37). Municipal staff and managers completed a survey by telephone between June-September 2012. Findings No area municipality surveyed reported that they hired additional enforcement staff as a result of their community's smoke-free by-law. Most municipalities (95%) posted signage to support awareness of their by-law; signs costs ranged from $40-$150/sign with most municipalities reporting signs were made in-house. Most communities reported actively enforcing the by-law; six communities reported they had issued tickets to people not in compliance with outdoor smoking restrictions. Conclusions The implementation, promotion, and enforcement of outdoor smoke-free by-laws have required municipal staff time and in most cases have promotional costs, but these have come from existing budgets and using existing staff. Outdoor smoke-free by-laws have not created significant burdens on municipal enforcement staff or on municipal budgets. [ABSTRACT FROM AUTHOR]

Background Excessive weight gain among youth is an ongoing public health concern. Despite evidence linking both policies and the built environment to adolescent and adult overweight, the association between health policies or the built environment and overweight are often overlooked in research with children. The purpose of this study was to examine if school-based physical activity policies and the built environment surrounding a school are associated with weight status among children. Methods Objectively measured height and weight data were available for 2,331 grade 1 to 4 students (aged 6 to 9 years) attending 30 elementary schools in Ontario, Canada. Student-level data were collected using parent reports and the PLAY-On questionnaire administered to students by study nurses. School-level policy data were collected from school administrators using the Physical Activity Module of the Healthy School Planner tool, and built environment data were provided by the Enhanced Points of Interest data resource. Multi-level logistic regression models were used to examine the school- and student-level characteristics associated with the odds of a student being overweight or obese. Results There was significant between-school random variation in the odds of a student being overweight [σ² µ0 = 0.274(0.106), p < 0.001], but not for being obese [σ² µ0 = 0.115(0.089)]. If a student attended a school that provided student access to a variety of facilities on and off school grounds during school hours or supported active transportation to and from school, he/she was less likely to overweight than a similar student attending a school without these policies. Characteristics of the built environment were not associated with overweight or obesity among this large cross-sectional sample of children. Conclusions This new evidence suggests that it may be wise to target obesity prevention efforts to schools that do not provide student access to recreation facilities during school hours or schools that do not support active transportation for students. Future research should evaluate if school-based overweight and obesity prevention programming might be improved if interventions selectively targeted the school characteristics that are putting students at the greatest risk. [ABSTRACT FROM AUTHOR]

Background: Substance use and weight gain among youth increase the risk for future disease. As such, the purpose of this study is to examine how many Canadian youth are currently failing to meet substance use and weight gain related public health guidelines. Methods: Data from the 2010–11 Youth Smoking Survey were used to examine grade 9 to 12 students meeting seven different guidelines by sex and by grade. Results: Among Canadian youth, 8.8% were current smokers, 18.8% were current marijuana users, 25.5% were current binge drinkers, 22.5% were considered overweight or obese, 31.2% did not meet physical activity guidelines, 89.4% exceeded sedentary behaviour guidelines, and 93.6% reported inadequate fruit and vegetable intake. The mean number of risk factors per student was 2.9 (±1.2); only 0.5% of youth reported having none of the risk factors. Conclusion: Students rarely met all seven public health guideline examined, and the vast majority of actually reported having two or more modifiable risk factors for disease. [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]

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. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To examine the prevalence and associated factors of bidi and hookah use among Canadian youth. Methods: Data from 41,886 grade 7 to 12 youth were used to examine factors associated with bidi and hookah use. Results: Youth who are current or former cigarette smokers, have tried marijuana or alcohol, were more likely to use bidi or hookah. Conclusions: Results suggest bidi and hookah use may be an emerging issue in tobacco control among youth. Findings also support an integrated approach where future prevention efforts should address multiple risk behaviors. [Copyright &y& Elsevier]

Background: With the proliferation of social casino games (SCGs) online, which offer the opportunity to gamble without monetary gains and losses, comes a growing concern regarding the effects of these unregulated games on public health, particularly among adolescents. However, given the limited research pertaining to SCG use, little is currently known about the manner in which adolescents engage with this new gambling medium. The present study aims to identify the factors that characterize adolescent social casino gamers, and to determine whether these factors differ by SCG type. Moreover, the study examines the extent to which social casino gaming is associated with monetary gambling and problem gambling in this cohort.Method: Data were obtained from students in Grades 9 to 12 (n = 10,035) residing in the Canadian provinces of Ontario, Saskatchewan, and Newfoundland and Labrador. Participants completed the Youth Gambling Survey (YGS), which is a supplementary instrument administered alongside the Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS). Logistic regression was used to assess the factors associated with SCG play.Results: Overall, 12.4% of respondents reported having participated in SCGs in the past three months. Compared to adolescents who did not report playing SCGs, SCG players were typically more likely to participate in monetary gambling activities, and were more prevalently classified as problem gamblers of low-to-moderate severity or high severity. Although profiles of SCG players differed across SCG game types, factors significantly associated with the playing of SCGs were gender, weekly spending money, having friends and parents who gamble, and screen time. It was also shown that current smokers were significantly more likely to participate in simulated slots online relative to adolescents who did not play SCGs.Conclusion: Significant associations exist between SCG play, monetary gambling, and problem gambling among adolescents. Gambling intervention efforts directed at this population should aim to identify personal and environmental factors associated with social casino gaming, and should be tailored to different types of SCGs. [ABSTRACT FROM AUTHOR]

Background: Despite the potential population-level impact of a health-promoting schools approach, schools face challenges in implementation, indicating a gap between school health research and practice. Knowledge exchange provides an opportunity to reduce this gap; however, there has been limited evaluation of these initiatives. This research explored researchers' and knowledge users' perceptions of outcomes associated with a knowledge exchange initiative within COMPASS, a longitudinal study of Canadian secondary students and schools. Schools received annual tailored summaries of their students' health behaviours and suggestions for action and were linked with knowledge brokers to support them in taking action to improve student health.Methods: Qualitative semi-structured interviews were conducted with COMPASS researchers (n = 13), school staff (n = 13), and public health stakeholders (n = 4) to explore their experiences with COMPASS knowledge exchange. Key issues included how knowledge users used school-specific findings, perceived outcomes of knowledge exchange, and suggestions for change.Results: Outcomes for both knowledge users and researchers were identified; interestingly, knowledge users attributed more outcomes to using school-specific findings than knowledge brokering. School and public health participants indicated school-specific findings informed their programming and planning. Importantly, knowledge exchange provided a platform for partnerships between researchers, schools, and public health units. Knowledge brokering allowed researchers to gain feedback from knowledge users to enhance the study and a better understanding of the school environment. Interestingly, COMPASS knowledge exchange outcomes aligned with Samdal and Rowling's eight theory-driven implementation components for health-promoting schools. Hence, knowledge exchange may provide a mechanism to help schools implement a health-promoting schools approach.Conclusions: This research contributes to the limited literature regarding outcomes of knowledge brokering in public health and knowledge exchange in school health research. However, since not all schools engaged in knowledge brokering, and not all schools that engaged discussed these outcomes, further research is needed to determine the amount of engagement required for change and examine the process of COMPASS knowledge brokering to consider how to increase school engagement. [ABSTRACT FROM AUTHOR]

Introduction: While the benefits of complying with health recommendations is well documented, a considerable proportion of Canadians engage in multiple modifiable risk behaviors. The purpose of this multi-wave longitudinal study was to identify the individual period prevalence and co-occurrence of multiple modifiable risk behaviors, particularly excessive alcohol consumption, physical inactivity, and tobacco use, within a nationally representative sample of Canadians.Methods: Secondary data analysis was conducted on the first seven cycles of the National Population Health Survey. This longitudinal sample included 15,167 Canadians aged 12years of age or older. Gender-specific criteria were employed to define excessive alcohol consumption. Individuals expending <3.0kcal/kg/day during their leisure-time and smoking cigarettes (daily or occasionally) met the criteria for physical inactivity and tobacco use, respectively.Results: The period prevalence of the Canadian general population that participated in multiple risk behaviors was 21.5% in cycle 7. The most common pairwise combination of co-occurring risk behaviors was physical inactivity and smoking. The proportion of Canadians reporting the co-occurrence of all three risk behaviors in cycle 7 was 2.6%.Conclusions: Understanding patterns of modifiable risk behaviors is an initial step in developing and implementing public health interventions. The co-occurrence of these three risk behaviors is a viable concern for one in five Canadians. For these individuals, the likelihood of encountering premature morbidity and mortality is escalated. As the majority of Canadians reported being physically inactive, allocating limited resources towards enhancing leisure-time physical activity levels could have significant population-level implications for improving the health of Canadians. [ABSTRACT FROM AUTHOR]

Background Evaluating the interrelationship of health behaviors could assist in the development of effective public health interventions. Furthermore, the ability to identify cognitive mediators that may influence multiple behavioral changes requires evaluation. Purpose To evaluate covariation among health behaviors, specifically alcohol consumption, leisure-time physical activity, and smoking, and examine whether mastery acts as a mediating social-cognitive mechanism that facilitates multiple health behavior change in a longitudinal analysis. Methods In 2010, secondary data analysis was conducted on the first seven cycles of the Canadian National Population Health Survey. Data collection began in 1994-1995 and has continued biennially. At the time of this analysis, only seven cycles of data (2006-2007) were available. Parallel process growth curve models were used to analyze covariation between health behaviors and the potential mediating effects of perceived mastery. Results Increases in leisure-time physical activity were associated with reductions in tobacco use, whereas declines in alcohol consumption were associated with decreases in tobacco use. Covariation between alcohol consumption and leisure-time physical activity did not reach statistical significance. For the most part, mastery was unsuccessful in mediating the interrelationship of multiple behavioral changes. Conclusions Health behaviors are not independent but rather interrelated. In order to optimize limited prevention resources, these results suggest that population-level intervention efforts targeting multiple modifiable behavioral risk factors may not need to occur simultaneously. [ABSTRACT FROM AUTHOR]

This paper examines the influence of an initial face-to face meeting in an e-mail delivered physical activity intervention. RMANCOVA was conducted to examine differences between e-mail and face-to-face arms in mean weekly steps adjusted for baseline steps, sex, and body mass index (BMI). Overall, 68 participants were analyzed (face-to-face: (n=35); e-mail: (n=33). Participants in the face-to-face arm walked a greater number of steps each week; however, differences between arms pre- and post-intervention were not statistically significant (F (1, 60) = 0.31, p = .5796). These findings suggest that a physical activity intervention where initial instructions are delivered via e-mail is not statistically significantly different from a face-to-face approach. [ABSTRACT FROM AUTHOR]