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

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.

Background: The comprehensive school health (CSH) framework has four components: social and physical environment; partnerships and services; teaching and learning; and policy. This study examines associations between CSH and student physical activity (PA). Methods: Using 2015/2016 COMPASS study survey data of 37,397 students (grades 9-12) from 80 secondary schools in Ontario and Alberta, Canada, associations between school-level factors within CSH and student PA outcomes (weekly moderate-to-vigorous PA [MVPA] minutes and achieving the national PA recommendations of [greater than or equal to]60 min of MVPA daily, vigorous PA [greater than or equal to]3 days/week, strengthening activities [greater than or equal to]3 days/week) were analyzed using multilevel regression models stratified by gender and grade. Results: Factors within all four CSH components were associated with student PA. Four student subgroups were more likely to achieve the recommendations if their school had youth organization partnerships (Range of AORs:1.15-1.33, p <0.05) and female students were less likely if their school had low prioritization of PA (AOR = 0.77, 95% CI: [0.65-0.92]). Grade 9 students had higher MVPA when provided non-competitive PA opportunities ([beta] = 100.4, 95%CI: [30.0-170.9]). All student subgroups had better PA outcomes when schools provided access to equipment during non-instructional time. Conclusion: There is opportunity to improve student PA through CSH-guided interventions, but different strategies may be more effective for each gender/grade.

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.

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.

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.

Background: Few youth engage in sufficient daily moderate-to-vigorous physical activity (MVPA), and the likelihood of meeting guidelines declines through secondary school. Physical education (PE) can afford youth with opportunities for MVPA. Therefore, the purpose of this study was to investigate the impact of changes in PE enrollment on MVPA and MVPA guideline adherence in Ontario and Alberta secondary students. Methods: Linked survey data was used from 1514 students who participated in year 3 (2014/2015 baseline) and year 6 (2017/2018 follow-up) of the COMPASS Study. Regression models tested whether changes in PE enrollment predicted changes in self-reported MVPA (minutes) and MVPA guideline adherence from grade 9 (baseline) to grade 12 (follow-up), controlling for sports participation and sociodemographic variables. Results: Students who remained enrolled in PE in grade 12 reported a daily average of 30 minutes more MVPA. Among students meeting MVPA guidelines and enrolled in PE in grade 9, students not taking PE in the current term in grade 12 were less likely to continue to meet guidelines than students currently enrolled in PE (adjusted odds ratio 0.53; 95% confidence interval: 0.36, 0.78; p < .0013). Conclusions: Findings from this study could inform the future implementation of a mandatory PE credit for upper year secondary students.

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.

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

Summary: 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. [ABSTRACT FROM AUTHOR]

Reducing youth cannabis use in Canada is a public health priority with schools of interest as a potential modifier of behavior and as a venue for prevention programming. This work aimed to provide a basis for future policy and programming by evaluating pre-legalization cannabis use change patterns in schools and the impact of school characteristics on these patterns. Average rates of cannabis use behavior change (initiation, escalation, reduction, cessation) were collected from 88 high schools located in Ontario and Alberta, Canada participating in the COMPASS prospective cohort study. There was little variability in cannabis use behaviors between schools with intra-class correlation coefficients lowest for cessation (0.02) and escalation (0.02) followed by initiation (0.03) and reduction (0.05). Modest differences were found based on school province, urbanicity and student-peer use. Cannabis ease of access rates had no significant effect. Fewer than half the schools reported offering school drug use prevention programs; these were not significantly associated with student cannabis use behaviors. In conclusion, current school-based cannabis prevention efforts do not appear sufficiently effective. Comprehensive implementation of universal prevention programs may reduce cannabis harms. Some factors (urbanicity, peer use rates) may indicate which schools to prioritize.

Background: The school environment has the potential to influence student body mass index (BMI) through programs and policies. Our objective was to examine the effect of modifying obesity-related school policies and programs on youths' BMI trajectories. Methods: Obesity-related school policies and programs related to physical activity and healthy eating were collected from 41 schools across Ontario at baseline (2012-2013) and year 2 (2013-2014) of the COMPASS study. Self-reported height and weight were collected from the 4951 grades 9 and 10 students who attended those schools for 3 years. Linear mixed effects regression models examined the effect of modifying obesity-related school policies and programs on youths' BMI trajectories. Results: Between Y[subscript 1] and Y[subscript 2], 26 of the 41 schools implemented distinct new obesity-related programs or policies related to physical activity or healthy eating. Five of the interventions were associated with BMI trajectories of students attending those schools compared to students attending a pooled sample of control schools, predicting a higher BMI trajectory. Conclusions: Isolated programs and policies may not successfully improve youths' BMI trajectories. Further research is required to test the implementation of policies and programs that follow a comprehensive school health (CSH) approach, targeting BMI and associated behaviors.

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.

BACKGROUND: We examined whether subgroups of adolescents experienced disparate changes in school connectedness—a robust predictor of multiple health outcomes—from before the COVID‐19 pandemic to the first full school year following pandemic onset. METHODS: We used 2 waves of prospective survey data from 7178 students attending 41 Canadian secondary schools that participated during the 2019‐2020 (T1; pre‐COVID‐19 onset) and 2020‐2021 (T2; ongoing pandemic) school years. Fixed effects analyses tested differences in school connectedness changes by gender, race, bullying victimization, socioeconomic position, and school learning mode. RESULTS: Relatively greater declines in school connectedness were reported by students that identified as females, were bullied, perceived their family to be less financially comfortable than their classmates, and attended schools in lower income areas. Marginally greater school connectedness declines resulted among students attending schools that were fully online at T2 than those at schools using a blended model. CONCLUSION: Results point to disparate school connectedness declines during the pandemic, which may exacerbate pre‐existing health inequities by gender and socioeconomic position, and among bullied youth. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Effective strategies to improve school climates for equity denied groups are critical for pandemic recovery and preparedness for future related events. [ABSTRACT FROM AUTHOR]

This study examined whether student tobacco, alcohol, marijuana use, and sedentary behaviour were associated with the educational outcomes of health-related absenteeism, truancy, and academic motivation in a nationally representative sample of Canadian youth. Descriptive analyses indicate a high proportion of students missed school due to health, and skipped class in the last month. Truancy increased with age, and male students are more likely to skip class and be less academically motivated. Logistic regression models showed significant associations exist between substance use and all three educational outcomes. These findings support the need for coordinated action and funding in student health promotion. (Contains 5 tables and 1 figure.)

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

Background: 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.

Consistent evidence points to the detrimental effects of income inequality on population health. Income inequality may be associated with online gambling, which is of concern since gambling is a risk factor for adverse mental health conditions, such as depression and suicide ideation. Thus, the overall objective of this study is to study the role of income inequality on the odds of participating in online gambling. Data from 74,501 students attending 136 schools participating in the 2018/2019 Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) survey were used. The Gini coefficient was calculated based on school census divisions (CD) using the Canada 2016 Census linked with student data. We used multilevel modeling to explore the association between income inequality and self-reported participation in online gambling in the last 30 days, while controlling for individual- and area-level characteristics. We examined whether mental health (depressive and anxiety symptoms, psychosocial wellbeing), school connectedness, and access to mental health programs mediate this relationship. Adjusted analysis indicated that a standardized deviation (SD) unit increase in Gini coefficient (OR = 1.17, 95% CI 1.05, 1.30) was associated with increased odds of participating in online gambling. When stratified by gender, the association was significant only among males (OR = 1.12, 95% CI 1.03, 1.22). The relationship between higher income inequality and greater odds for online gambling may be mediated by depressive and anxiety symptoms, psychosocial well-being, and school connectedness. Evidence points to further health consequences, such as online gambling participation, stemming from exposure to income inequality. [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]

Background: To assess whether changes in breakfast and water consumption during the first full school year after the emergence of the COVID-19 pandemic varied based on sex/gender, race/ethnicity, and socioeconomic status among Canadian adolescents. Methods: Prospective annual survey data collected pre- (October 2019-March 2020) and post-COVID-19 onset (November 2020-June 2021) the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) study. The sample consisted of 8,128 students; mean (SD) age = 14.2 (1.3) years from a convenience sample of 41 Canadian secondary schools. At both timepoints self-reported breakfast and water consumption were dichotomized as daily or not. Multivariable logistic generalized estimating equations with school clustering were used to estimate differences in maintenance/adoption of daily consumption post-COVID-19 based on demographic factors, while controlling for pre-COVID-19 behaviour. Results: Adjusted odds ratios (AOR) with 95% confidence intervals are reported. Females (AOR = 0.71 [0.63, 0.79]) and lower socioeconomic status individuals (AORLowest:Highest=0.41 [0.16, 1.00]) were less likely to maintain/adopt daily breakfast consumption than male and higher socioeconomic status peers in the 2020–2021 school year. Black identifying individuals were less likely than all other racial/ethnic identities to maintain/adopt plain water consumption every day of the week (AOR = 0.33 [0.15, 0.75], p < 0.001). No significant interaction effects were detected. Conclusions: Results support the hypothesis that changes in nutritional behaviours were not equal across demographic groups. Female, lower socioeconomic status, and Black adolescents reported greater declines in healthy nutritional behaviours. Public health interventions to improve adherence to daily breakfast and water consumption should target these segments of the population. Trial Registration: Not a trial. [ABSTRACT FROM AUTHOR]

Background: Very little research has examined how perceptions of cannabis access among underage youth in Canada have changed since cannabis was legalized and since the onset of the COVID-19 pandemic. As such, this paper examines the effect of the early and ongoing stages of the COVID-19 pandemic period on youth perceptions of cannabis access over time since the onset of the Cannabis Act in 2018 in a large sample of Canadian youth. Methods: Using data from the COMPASS study (T1:2018/19, T2:2019/20, T3:2020/21), we used both repeat cross-sectional data [T1 (n = 38,890), T2 (n = 24,109), and T3 (n = 22,795)] to examine overall trends in perceptions of cannabis access, and sequential cohort longitudinal data [n = 4,677 students linked from T1 to T3] to examine the differential changes in perceptions of cannabis access among students over time. Results: In the cross-sectional sample, the frequency of students reporting that cannabis was easy to access decreased by 26.7% from T1 (51.0%) to T3 (37.4%), although respondents who have used cannabis were more likely to report access was easy. In the longitudinal sample, perceptions of cannabis access being easy increased over time, especially among cannabis users. Perceived ease of access appears to have been slightly impeded during the initial pandemic period but rebounded during the ongoing pandemic period. Conclusions: While the prevalence of youth reporting that cannabis is easy to access has declined since legalization and throughout the early and ongoing pandemic periods, a substantial number of underage youth continue to report that cannabis is easy to access. This suggest that there is an ongoing need for continued cannabis control efforts to address this issue. [ABSTRACT FROM AUTHOR]

Objective: Little is known about self-concept in adolescents with physical-mental comorbidity. This study investigated whether physical-mental comorbidity was associated with self-concept in adolescents and examined if adolescent age or sex moderated the association between physical-mental comorbidity and self-concept. Methods: Study data were obtained from the Multimorbidity in Youth across the Life-course (MY LIFE), an ongoing Canadian study of adolescents with chronic physical illness who were recruited from outpatient clinics at a pediatric hospital. A total of 116 adolescents aged ≥ 10 years provided self-reports on key measures. Results: Adolescents with comorbidity (n = 48) had lower self-concept scores on the Self-Determination Questionnaire (SDQ; d = 0.62) and Self-Perception Profile for Children (SPPC; d = 0.53) vs. adolescents without comorbidity (n = 68). An age × comorbidity status interaction was found and age-stratified models were computed to investigate this moderating effect of age. Amongst older adolescents, comorbidity was associated with lower SDQ (B = -2.55, p <.001), but this association was not found among younger adolescents (B = -0.29, p =.680). A similar effect was found for SPPC among older (B = -0.48, p =.001) and younger adolescents (B = 0.03, p =.842). Adolescent sex was not found to be a moderator. Conclusions: Physical-mental comorbidity in adolescence was associated with lower self-concept and this association was moderated by age—differences between adolescents with vs. without comorbidity were greater for older adolescents and were clinically relevant. Opportunities to support positive self-perceptions for adolescents with comorbidity are warranted, especially when planning the transition from pediatric to adult health services. [ABSTRACT FROM AUTHOR]

Background: Despite the importance of breakfast consumption, breakfast skipping is common among Canadian youth. This study examines how changes to school-based breakfast programs are associated with breakfast-skipping behavior. Methods: Using school-level longitudinal data from Year 1 (Y[subscript 1]: 2012-2013) and Year 2 (Y[subscript 2]: 2013-2014) of the COMPASS study, quasi-experimental methods evaluated the impact over time that changes to school-based breakfast programs had on breakfast skipping or participating in school-based breakfast program. Results: Between Y[subscript 1 and Y[subscript 2], the school-level prevalence of breakfast skipping (54.5%-54.9%) and breakfast program participation (12.3%-13.6%) increased. Of the 43 participating schools, 5 implemented a new school breakfast program. Among the intervention schools, 1 school (School 4) observed a significant, and 1 school (School 3) observed a significant increase in the school-level prevalence of skipping breakfast; there was no significant change in the other 3 intervention schools. Conclusions: Despite the availability of free school breakfast programs, the majority of youth skipped breakfast at least once a school week. Owing to the variation in the types of programs implemented, additional evaluation evidence is necessary to determine which students benefited the most from these programs.

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]

Background: Unhealthy lifestyle behaviours are becoming increasingly common and might contribute to the growing burden of mental disorders in adolescence. We examined the associations between a comprehensive set of lifestyle behaviours and depression and anxiety in middle adolescents. Methods: School-based survey responses were collected from 24,274 Canadian high school students at baseline and 1-year follow-up (average age 14.8 and 15.8 years, respectively). Using linear mixed-effects models, we examined prospective associations of adherence to recommendations for vegetables and fruit, grains, milk and alternatives, meat and alternatives, sugar-sweetened beverages [SSB], physical activity, screen time, sleep, and no use of tobacco, e-cigarettes, cannabis, and binge drinking at baseline with the depressive and anxiety symptoms (measured by CESD-R-10 and GAD-7 scales, respectively) at follow-up. Results: Adherence to recommendations was low overall, particularly for vegetables and fruit (3.9%), grains (4.5%), and screen time (4.9%). Students adhering to individual recommendations, particularly for meat and alternatives, SSB, screen time, sleep, and no cannabis use, at baseline had lower CESD-R-10 and GAD-7 scores at follow-up. Adhering to every additional recommendation was associated with lower CESD-R-10 (β=-0.15, 95% CI -0.18, -0.11) and GAD-7 scores (β=-0.10, 95% CI -0.14, -0.07) at follow-up. Assuming cumulative impact, this might translate into 7.2- and 4.8-point lower CESD-R-10 and GAD-7 scores, respectively, among students adhering to 12 vs. 0 recommendations over four years of high school. Conclusions: The results highlight the preventive potential of population-based approaches promoting healthy lifestyle behaviours, particularly those with the lowest prevalence, as a strategy to improve mental health in adolescence. [ABSTRACT FROM AUTHOR]

Data from 29,296 students in grades 9-12 as part of the 2008-2009 Youth Smoking Survey were used to examine the prevalence of cigar, cigarillo, and little cigar use and factors associated with their use. Among Canadian youth in grades 9-12, 12.9% reported current use of cigarillos or little cigars, and 8.1% reported current use of cigars. The characteristics of youth most likely to use either cigars or cigarillos and little cigars were being male, being in grade 11 or 12, being a daily or occasional cigarette smoker, having more than $20 of weekly spending money, and having ever tried flavored tobacco. Our findings suggest that cigars, cigarillos, and little cigars are used by a substantial number of Canadian youth, many of whom do not smoke cigarettes. As such, current national prevalence estimates of youth smoking may be underestimated, and existing tobacco control prevention programs and policies may be overlooking a large population of at-risk youth.

Few studies have examined how school characteristics are associated with obesity. The purpose of this study was to examine the student- and school-level characteristics associated with being overweight and obese among 12,049 students in grades 9 and 10 ("junior students") attending 76 secondary schools in Ontario, Canada. The sample was 49.2% female and the average age was 14.7 years. Overall, 15.0% of the sample was considered overweight and 6.3% of the sample was considered obese. Multi-level regression analysis revealed significant between-school random variation for the likelihood of a junior student (grade 9 or 10) being overweight or obese. For each 1% increase in the prevalence of obese senior students (grade 11 and 12) at a school, the odds of a junior student at that school being overweight or obese increased significantly. Important student-level characteristics included physical activity, screen time sedentary behaviour (e.g., watching television), participation in varsity sports and gender. Future research should evaluate if the optimal population level impact for school-based obesity prevention programming might be achieved by targeting the schools that are putting students at the greatest risk.

The objective is to examine school-level program and policy characteristics and student-level behavioural characteristics associated with being overweight. Multilevel logistic regression analysis were used to examine the school- and student-level characteristics associated with the odds of a student being overweight among 1264 Grade 5-8 students attending 30 elementary schools in Ontario, Canada. Data were derived from the Physical Activity of Youth in Ontario Schools host study. Significant between-school random variation in overweight was identified [[sigma][subscript [mu]O][squared]=0:187 (0:084), P less than 0.001]; school-level differences accounted for 5.4% of the variability in the odds of a student being overweight versus a normal weight. A student attending a school that was in the action phase for the school-level construct "Availability and use of interschool programs" was significantly less likely to be overweight than a similar student attending a school that was in the initiation phase for this construct. Important student-level characteristics included physical activity (PA) and gender. Developing a better understanding of the school- and student-level characteristics associated with overweight among youth is critical for informing school-based prevention policies. Future research should evaluate if implementing and promoting interschool PA programming, and which types of interschool activities, are effective in preventing or reducing overweight.

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

Data from the Canadian Youth Smoking Survey (n = 27,030 in 2006; n = 16,705 in 2004; n = 11,757 in 2002) were used to examine changes in the prevalence and comorbid use of alcohol, tobacco, and marijuana over time and examine if demographic factors and binge drinking are associated with comorbid substance use among youth. Alcohol was the most prevalent substance used, and it was rare to find youth who had used tobacco or marijuana without also having tried alcohol. Youth who reported binge drinking were substantially more likely to also have tried tobacco and/or marijuana. These data suggest that multi-substance prevention programs are required for youth populations.

The objective of this study was to examine the pattern of relations between missing weight and height (BMI) data and a range of demographic, physical activity, sedentary behavior, and academic measures in a young sample of elementary school children. A secondary analysis of a large cross-sectional study, PLAY-On, was conducted using self-reported data from a convenience sample of fifth- to eighth-grade students (9-14 years) attending 30 elementary schools in Ontario, Canada. Items assessed related to demographics (age, gender, and ethnicity), physical activity (energy expenditure, location, and sport participation), sedentary behavior (communication and screen-time), and academics. Of the 2,111 children who were included in the analyses, 960 (45.5%) were missing BMI data. Children without BMI data were more likely to be younger, female, of non-white ethnicity, have lower daily energy expenditure values, not participate in school sports, and have lower-rated academic standing than those children with BMI data. Overall, this study demonstrates characteristics of children who fail to self-report their height or weight. The trend for younger children to be more likely to fail to report BMI suggests that some children may be unmotivated non-responders. Meanwhile, the trend for girls to be more likely to fail to report weight than boys indicates that some girls may be motivated non-responders. Self-report BMI might include too much missing data to be effective for determining children's progress toward previously established targets for intervention and surveillance efforts. (Contains 3 tables.)

In the domain of school-based tobacco control, there is a large gap between the research being performed and the type of research needed to inform school-based prevention activities. The tobacco module of the school health action planning and evaluation system is a data collection and feedback system designed to support school-based tobacco control planning and evaluation. Despite numerous opportunities to evaluate interventions and natural experiments that have been occurring within schools, school boards, provinces, and even nationally within the last few years, a lack of systematic data collection means that the impact of these initiatives has not been robustly evaluated. (Contains 2 figures.)

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.)

Objectives: To examine how older smoking peers at school and the smoking behavior of friends and family members are related to youth smoking. Methods: The School Smoking Profile was used to collect data on tobacco use and determinants of tobacco use from 22,091 students from 29 secondary schools in Ontario, Canada. Correlates of occasional and regular smoking were examined using multilevel logistic regression analyses. Results: Students are at increased risk for smoking if they (a) have smoking friends, (b) have smoking family members, and (c) attend a school with a relatively high senior-student smoking rate. Conclusion: These findings suggest that prevention programs should target both at-risk schools and at-risk students.

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]

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 2015/16 = 65, N 2016/17 = 68, N 2017/18 = 61 and N 2018/19 = 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. [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]

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]

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

BACKGROUND: The comprehensive school health (CSH) framework has four components: social and physical environment; partnerships and services; teaching and learning; and policy. This study examines associations between CSH and student physical activity (PA). METHODS: Using 2015/2016 COMPASS study survey data of 37,397 students (grades 9‐12) from 80 secondary schools in Ontario and Alberta, Canada, associations between school‐level factors within CSH and student PA outcomes (weekly moderate‐to‐vigorous PA [MVPA] minutes and achieving the national PA recommendations of ≥60 min of MVPA daily, vigorous PA ≥3 days/week, strengthening activities ≥3 days/week) were analyzed using multilevel regression models stratified by gender and grade. RESULTS: Factors within all four CSH components were associated with student PA. Four student subgroups were more likely to achieve the recommendations if their school had youth organization partnerships (Range of AORs:1.15‐1.33, p <.05) and female students were less likely if their school had low prioritization of PA (AOR = 0.77, 95% CI: [0.65‐0.92]). Grade 9 students had higher MVPA when provided non‐competitive PA opportunities (β = 100.4, 95%CI: [30.0‐170.9]). All student subgroups had better PA outcomes when schools provided access to equipment during non‐instructional time. CONCLUSION: There is opportunity to improve student PA through CSH‐guided interventions, but different strategies may be more effective for each gender/grade. [ABSTRACT FROM AUTHOR]

Introduction: This study examined longitudinal associations between e-cigarette use, cigarette smoking, physical activity, and recreational screen time (ST) in a cohort of Canadian adolescents (ages 14-17 years; grades 9-12).Aims and Methods: Data from 5951 adolescents who participated in COMPASS Year 4 (2015-2016; baseline) and Year 6 (2017-2018; follow-up) were used. Exposures included e-cigarette use and cigarette smoking. Outcomes included cutpoints for moderate- to vigorous-physical activity (MVPA; ≥60 min/d), muscular strengthening exercises (MSE; ≥3 time/wk), participation in sport (SP; intramural or competitive), and recreational screen time (ST; ≤430 min/day). Generalized linear mixed models were performed.Results: e-Cigarette use (16.6% vs. 39.2%), cigarette smoking (0.9% vs. 4.7%), and dual use (0.8% vs. 4.1%) increased from baseline to follow-up. SP (70.8% vs. 61.3%) and the prevalence of meeting MVPA (49.8% vs. 42.1%) and MSE cutpoints (54.0% vs. 45.3%) decreased from baseline to follow-up. Recreational ST remained similar from baseline to follow-up. New e-cigarette use at follow-up was associated with maintenance of SP and meeting MVPA and MSE cutpoints, but also with increased ST. New cigarette smoking at follow-up was associated with maintaining high ST and low SP. Cigarette smoking at baseline and follow-up was associated with maintaining high ST, low MSE, and low SP. Cigarette smoking cessation at follow-up was associated with increasing MVPA and MSE, decreasing ST, and maintaining low SP.Conclusion: Given the clustering and co-occurring unhealthy behavioral patterns, intervention strategies to promote healthy lifestyles should take a holistic approach, by targeting multiple behavioral changes simultaneously.Implications: This investigation highlighted that, unhealthy behaviors, particularly e-cigarette use, cigarette smoking, and excessive use of screens, tend to co-occur among Canadian adolescents. Therefore, intervention strategies to promote healthy lifestyles should take a holistic approach, by targeting multiple behavioral changes simultaneously particularly in school and community settings. As an exception, new and stable e-cigarette use appears to co-occur with achieving sufficient levels of physical activity. Increasing awareness about the risk of e-cigarette use may target population groups that are physically and socially active (eg, athletes, sport teams). [ABSTRACT FROM AUTHOR]

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

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

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

BACKGROUND Few youth engage in sufficient daily moderate‐to‐vigorous physical activity (MVPA), and the likelihood of meeting guidelines declines through secondary school. Physical education (PE) can afford youth with opportunities for MVPA. Therefore, the purpose of this study was to investigate the impact of changes in PE enrollment on MVPA and MVPA guideline adherence in Ontario and Alberta secondary students. METHODS: Linked survey data was used from 1514 students who participated in year 3 (2014/2015 baseline) and year 6 (2017/2018 follow‐up) of the COMPASS Study. Regression models tested whether changes in PE enrollment predicted changes in self‐reported MVPA (minutes) and MVPA guideline adherence from grade 9 (baseline) to grade 12 (follow‐up), controlling for sports participation and sociodemographic variables. RESULTS: Students who remained enrolled in PE in grade 12 reported a daily average of 30 minutes more MVPA. Among students meeting MVPA guidelines and enrolled in PE in grade 9, students not taking PE in the current term in grade 12 were less likely to continue to meet guidelines than students currently enrolled in PE (adjusted odds ratio 0.53; 95% confidence interval: 0.36, 0.78; p <.0013). CONCLUSIONS: Findings from this study could inform the future implementation of a mandatory PE credit for upper year secondary students. [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]

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]

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. [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]