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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.

Declines in life expectancy in developed countries have been attributed to increases in drug-related overdose, suicide, and liver cirrhosis, collectively referred to as deaths of despair. Income inequality is proposed to be partly responsible for increases in deaths of despair rates. This study investigated the associations between income inequality, deaths of despair risk in Canada, and potential mechanisms (stress, social cohesion, and access to health services). We obtained data from the Canadian Community Health Survey and the Canadian Vital Statistics Database from 2007 to 2017. A total of 504,825 Canadians were included in the analyses. We used multilevel survival analyses, as measured by the Gini coefficient, to examine the relationships between income inequality and mortality attributed to drug overdose, suicide, death of despair, and all-cause. We then used multilevel path analyses to investigate whether each mediator (stress, social cohesion , and access to mental health professionals), which were investigated using separate mediation models, influenced the relationship between income inequality and drug overdose, suicide, deaths of despair, and all-cause death. Adjusted multilevel survival analyses demonstrated significant relationships between a one-SD increase in Gini coefficient was associated with an increased hazard for drug overdose (HR adj. = 1.28; 95 CI = 1.05, 1.55), suicide (HR adj. = 1.24; 95 CI = 1.06, 1.46), deaths of despair (HR adj. = 1.26; 95 CI = 1.12, 1.40), and all-cause death (HR adj. = 1.04; 95 CI = 1.02, 1.07). Adjusted path analyses indicated that stress, social cohesion, and access to mental health professionals significantly mediated the association between income inequality and mortality outcomes. Income inequality is associated with deaths of despair and this relationship is mediated by stress, social cohesion, and access to mental health professionals. Findings should be applied to develop programs to address income inequality in Canada. • Our study explored income inequality and deaths of despair among Canadians. • Greater income inequality predicted an increased hazard of deaths of despair. • Stress, social cohesion, and service access influenced mortality outcomes. [ABSTRACT FROM AUTHOR]

Background/aim: Given that alcohol-related victimization is highly prevalent among young adults, the current study aimed to assess the potential impacts of Minimum Legal Drinking Age (MLDA) laws on police-reported violent victimization events among young people.Design: A regression-discontinuity (RD) approach was applied to victimization data from the Canadian Uniform Crime Reporting 2 (UCR2) Incident-based survey from 2009-2013. Participants/cases: All police-reported violent victimization events (females: n = 178,566; males: n = 156,803) among youth aged 14-22 years in Canada.Measurements: Violent victimization events, primarily consisting of homicide, physical assault, sexual assault, and robbery.Results: In comparison to youth slightly younger than the drinking age, both males and females slightly older than MLDA had significant and immediate increases in police-reported violent victimization events (females: 13.5%, 95% CI: 7.5%-19.5%, p < 0.001; males: 11.6%, 95% CI: 6.6%-16.7%, p < 0.001). Victimizations occurring in the evening rose sharply immediately after the MLDA by 22.8% (95% CI: 9.9%-35.7%, p =  0.001) for females and 19.3% (95% CI: 11.5%-27.2%, p < 0.001) for males. Increases in violent victimization immediately after MLDA were most prominent in bar/restaurant/open-air settings, with victimizations rising sharply by 44.9% (95% CI: 29.5%-60.2%, p < 0.001) among females and 18.3% (95% CI: 7.7%-29.0%, p =  0.001) among males.Conclusions: Young people gaining minimum legal drinking age incur immediate increases in police-reported violent victimizations, especially those occurring in the evening and at bar/restaurant/open-air settings. Evidence suggests that increasing the MLDA may attenuate patterns of violent victimization in newly restricted age groups. [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]

Aim: To establish whether the population-level pattern of cannabis use by quantity is similar to the distributions previously reported for alcohol, in which a small subset of drinkers accounts for a majority of total population alcohol consumption.Method: The current study pooled Waves 1-3 of the 2018 National Cannabis Survey (n = 18,900; 2584 past-three-month cannabis users), a set of stratified, population-based surveys designed to assess cannabis consumption and related behaviors in Canada. Each survey systematically measured self-reported cannabis consumption by quantity across seven of the major cannabis-product types. In order to enable the conversion of self-reported consumption of non-flower cannabis products into a standard joint equivalent (SJE: equal to 0.5 g of dried cannabis), we created conversion metrics for physical production equivalencies across cannabis products.Results: Similar to the findings in the alcohol literature, study results show that cannabis consumption is highly concentrated in a small subset of users: the upper 10% of cannabis users accounted for approximately two-thirds of all cannabis consumed in the country. Males reported consuming more cannabis by volume than females (approximately 60% versus 40%), with young males (15-34 years old) being disproportionately represented in the heaviest-using subgroups.Conclusions: Most of the cannabis used in Canada is consumed by a relatively small population of very heavy cannabis users. Future research should attempt to identify the characteristics of the heaviest-using groups, as well as how population-level cannabis consumption patterns relate to the calculus of cannabis-related harms in society. [ABSTRACT FROM AUTHOR]

Background: Alcohol-related motor vehicle collisions (MVCs) are a key concern in current international debates about the effectiveness of minimum legal drinking age (MLDA) laws, but the majority of this literature is based on natural experiments involving MLDA changes occurring 2-4 decades ago.Methods: A regression-discontinuity approach was used to estimate the relation between Canadian drinking-age laws and population-based alcohol-related MVCs (n=50,233) among drivers aged 15-23years in Canada.Results: In comparison to male drivers slightly younger than the MLDA, those just older had immediate and abrupt increases in alcohol-related MVCs of 40.6% (95% CI 25.1%-56.6%; P<0.001) in Ontario; 90.2% (95% CI 7.3%-171.2%; P=0.033) in Manitoba; 21.6% (95% CI 8.5%-35.0%; P=0.001) in British Columbia; and 27.3% (95% CI 10.9%-44.5%; P=0.001) in Alberta; but also an unexpected significant decrease in the Northwest Territories of -102.2% (95% CI -120.7%-74.9%; P<0.001). For females, release from MLDA restrictions was associated with increases in alcohol-related MVCs in Ontario [34.2% (95% CI 0.9%-68.0%; P=0.044)] and Alberta [82.2% (95% CI 41.1%-125.1%; P<0.001)]. Nationally, in comparison to male drivers slightly younger than the legislated MLDA, male drivers just older had significant increases immediately following the MLDA in alcohol-related severe MVCs [27.0% (95% CI 12.6%-41.7%, P<0.001)] and alcohol-related fatal MVCs [53.4% (95% CI 2.4%-102.9%, P=0.04)].Conclusions: Release from Canadian drinking-age restrictions appears to be associated with immediate increases in alcohol-related fatal and non-fatal MVCs, especially among male drivers. [ABSTRACT FROM AUTHOR]

Background: International debate is ongoing about the effectiveness of minimum legal drinking age (MLDA) laws. In Canada, the MLDA is 18 years of age in Alberta, Manitoba and Québec, and 19 in the rest of the country. Surprisingly few prior studies have examined the potential impacts of MLDA legislation on crime, and the current study addresses this gap.Methods: Regression-discontinuity analyses of police-reported criminal incidents from the 2009-2013 Uniform Crime Reporting (UCR) Survey, Canada's crime database.Results: Nationally, in comparison to males slightly younger than the MLDA, those just older than the MLDA had sharp increases in: all crimes, (7.6%; 95% CI=3.7%-11%, P<0.001); violent crimes, (7.4%; 95% CI=0.2%-14.6%, P=0.043); property crimes, (4.8%; 95% CI=0.02%-9.5%, P=0.049); and disorderly conduct, (29.4%; 95% CI=15.6%-43.3%, P<0.001). Among females, national criminal incidents increased sharply following the MLDA in: all crimes, (10.4%; 95% CI=3.8%-17.0%, P=0.002), violent crimes, (14.9%; 95% CI=6.4-23.2, P=0.001); and disorderly conduct, (35.3%; 95% CI=11.6-58.9, P=0.004). Among both males and females, there was no evidence of significant changes in cannabis- or narcotics-related crimes (quasi-control outcomes) vis-à-vis the MLDA (P>0.05).Conclusion: Release from drinking-age laws appears to be associated with immediate increases in population-level violent and nonviolent crimes among young people in Canada. [ABSTRACT FROM AUTHOR]

Background: Public health unit (PHU) engagement in schools is important for promoting wellness in students. We aimed to investigate if PHU engagement with schools may have provided protection against the risk of depression and anxiety in students during the COVID-19 pandemic., Methods: We used longitudinal data from the Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking and Sedentary behaviour survey between the 2018/19 and 2020/21 academic years. Multilevel models were used to assess the association between PHU engagement with school mental health programs prior to the COVID-19 pandemic and depressive (Center for Epidemiologic Studies Depression scale Revised) and anxiety symptoms (Generalized Anxiety Disorder scale) during the COVID-19 pandemic., Results: The sample included 23 894 students across 104 secondary schools in British Columbia, Alberta, Ontario and Quebec. In confounder-adjusted models, PHU engagement before the pandemic was not associated with student depressive symptoms (B = -0.01, 95% CI = -0.04, 0.02), but was protective against anxiety symptoms (B = -0.03, -0.06, 0.001) during the COVID-19 pandemic., Discussion: The results highlight that PHU engagement with mental health programming in schools was protective against anxiety for students during the COVID-19 pandemic. The findings support the importance of PHU engagement for improving student mental health and pandemic recovery., (© The Author(s) 2024. Published by Oxford University Press on behalf of Faculty of Public Health.)

Introduction: Individuals with low socio-economic position (SEP) experience disproportionate alcohol-attributable harm. Limited research has investigated whether these inequities are driven by alcohol-attributable conditions that are acute or chronic. The study aimed to estimate the sex-specific associations between SEP and incident wholly alcohol-attributable emergency department (ED) visits for acute and chronic harms, respectively., Methods: A cohort study was conducted using the Canadian Community Health Survey (2003-2008) linked to the National Ambulatory Care Reporting System (2002-2017) in Alberta and Ontario. SEP was measured using educational attainment. Acute and chronic ED visits were captured in the National Ambulatory Care Reporting System follow-up data. Hazard models were fit to estimate the association between SEP and acute and chronic wholly alcohol-attributable ED visits., Results: The analytical sample included 88,865 respondents. In men and women, individuals with lower SEP had increased hazard of acute ED visits (women hazard ratio [HR] 1.75, 95% confidence interval [CI] 1.07-2.87; men HR 3.47, 95% CI 2.29-5.25) and chronic ED visits (women HR 2.24, 95% CI 1.04-4.80; men HR 5.02, 95% CI 2.88-8.75). Acute and chronic wholly alcohol-attributable ED visit rates were higher in men than women., Discussion and Conclusions: The findings indicated lower SEP was associated with greater harms for both acute and chronic wholly alcohol-attributable ED visits when compared to their higher SEP counterparts. We conclude that gradients in SEP are associated with acute and chronic harms. These results highlight a need for equitable interventions that reduce the absolute burden of inequities in both acute and chronic wholly alcohol-attributable ED visits., (© 2024 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Background: Rates of drug overdoses, alcohol-related liver disease and suicide attempts represent a major public health burden in Canada. While the existing literature does highlight some evidence of association between income inequality and mental health and deaths of despair, no existing research has investigated more intermediate events. As such, the objective of the current study is to investigate the association between income inequality and hospitalisations of despair over time., Methods: Data from the 2006 Canadian Census, the 2007/2008 Canadian Community Health Survey and the 2007-2018 Discharge Abstract Database were linked. Data were analysed using Cox proportional hazards modelling accounting for robust standard errors at the area level to investigate associations between income inequality at baseline and hazards for hospitalisations of despair, hospitalisations attributable to drug overdose, alcohol-related liver disease and suicide attempts, and all-cause hospitalisations, while controlling for sociodemographics characteristics (including income) and relevant area-level variables., Results: The results highlighted statistically significant associations between income inequality and hazard of hospitalisations of despair (HR 1.38, 95% CI 1.06 to 1.80), hospitalisations related to drug overdose (HR 1.51, 95% CI 1.07 to 2.13) and all-cause hospitalisations (HR 1.17, 95% CI 1.05 to 1.30). The association between income inequality and hospitalisations related to alcohol-related liver disease and suicide attempts/self-harm were not statistically significant., Conclusion: Overall, the results showed evidence of associations between income inequality and hospitalisations of despair, drug overdose-related hospitalisations and all-cause hospitalisations. These findings are applicable to upstream policy discussion regarding reducing income inequality and identify potential points of intervention for prevention of drug overdose, alcohol-related liver disease and suicide attempts/self-harm., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

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.)