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OBJECTIVES:: To estimate the prevalence of insulin resistance syndrome (IRS) in a representative sample of youth. To test for the independent contribution of insulin resistance (IR) and adiposity to clustering of metabolic risk factors. To identify the underlying components of IRS. To examine the relationship between adiposity and fasting plasma levels of free fatty acids (FFA). METHODS:: In 1999, we conducted a school-based survey of a representative sample of youth aged 9, 13 and 16?y in Quebec, Canada. Age-specific questionnaire data, standardized clinical measurements and a fasting blood sample were available for 2244 subjects. Fasting insulin and HOMA were used as surrogate measures of IR. RESULTS:: In all age-sex groups, adiposity indices, blood pressure (BP), plasma glucose and triglycerides (TG) increased significantly with increasing insulin quartiles while HDL cholesterol (HDL-C) decreased. The overall prevalence of IRS defined as hyperinsulinaemia combined with two or more risk factors including overweight, high systolic BP, impaired fasting glucose, high TG and low HDL-C, was 11.5% (95% CI: 10.2-12.9). There were no significant differences in the prevalence of IRS across ages or between sexes. The independent contribution of adiposity to clustering of risk factors was stronger than that of fasting insulin (or HOMA-IR). Factor analysis revealed three factors (BMI/insulin/lipids, BMI/insulin/glucose and diastolic/systolic BP) consistent across ages suggesting that more than one pathophysiologic process underlies IRS. Although elevation of FFA might be in the causal pathway linking obesity to IR, we did not detect any consistent association between measures of fatness and fasting plasma FFA. CONCLUSION:: IRS is highly prevalent in youth, even among children as young as age 9?y. Factor analysis identifies three physiologic domains within IRS with a unifying role for markers of IR and adiposity.International Journal of Obesity (2004) 28, 833-841. doi:10.1038/sj.ijo.0802694 Published online 1 June 2004 [ABSTRACT FROM AUTHOR]

Understanding differences in dietary patterns by smoking status is important for nutritionists and health educators involved in helping individuals to make healthy dietary and lifestyle choices. Although smokers have a poor quality diet compared with nonsmokers, no study has examined nutritional adequacy and variability in the nutrient intake of smokers. The aim of this study was to compare dietary habits of smokers with nonsmokers in terms of nutrient intake, food groups contributing to nutrient intake, nutritional adequacy and day-to-day variation in nutrient intake. Noninstitutionalized adults aged 18--65 y (n = 1543) who participated in the Food Habits of Canadians Survey (1997--1998) were studied. Subjects, selected from across Canada using a multistage, random-sampling strategy, completed an in-home 24-h dietary recall. Repeat interviews were conducted in a subsample to estimate variability in nutrient intake. Smokers had higher intakes of total and saturated fat, and lower intakes of folate, vitamin C and fiber than nonsmokers. There were no significant differences in calcium, zinc and vitamin A intakes or day-to-day variation in nutrient intake by smoking status. Smokers consumed significantly fewer fruits and vegetables than nonsmokers, leading to lower intakes of folate and vitamin C. In conclusion, smokers have a less healthy diet than nonsmokers, placing them at higher risk for chronic disease as a result of both dietary and smoking habits. Diet may act as a confounder in smoking-disease relationships. [ABSTRACT FROM AUTHOR]

PURPOSE: Risk factors (RF) for chronic disease are prevalent in youth, track to adulthood, and are associated with adult morbidity. We studied clustering (i.e. any combination) of 9 behavioral RF in 6841 children aged 9–12 in low-income multiethnic urban neighborhoods.METHODS: Subjects from 16 control schools in a prevention trial, completed questionnaires each spring from 1993-7, collecting data on smoking, unhealthy diet, obesity, sedentary behavior, and physical inactivity; height and weight were measured in a standardized protocol. Family origin (FO) was based on language(s) spoken and country of birth of subjects and parents. We examined the 5 years of data cross-sectionally, removing repeat observations of the same subject. We ranked 13 FO groupings (mean n/grouping = 449 (range 116–1403) according to mean number of RF. We then tested FO as an independent correlate of clustering controlling for age, sex, parental employment, single-parent family status, number of persons/household, and % lifetime in Canada.RESULTS: The mean age of subjects was 11.1 years; 60% of subjects and 80% of parents were born outside Canada. Clustering was high among children of Portuguese and Haitian FO, moderate among those of Canadian, Italian, Eastern European, Chinese, Cambodian, South American, Salvadorian, and other Central American FO, and low among children of Vietnamese, South Asian, and Arabic FO. Control for confounding substantiated univariate findings. When obesity was removed from the list of RF, children of Chinese, Vietnamese, and Cambodian FO were among those at highest risk (odds ratios 1.71–2.21) showing that these children, while unlikely to be overweight, had a high prevalence of other RF.CONCLUSION: Differential clustering of behavioral RF is observable by FO as early as pre-puberty. Inclusion of obesity in the list of RF masked clustering of other RF in children of Asian FO. [Copyright &y& Elsevier]

Introduction: More cigarette smokers report poor sleep quality than non-smokers, but the association between nicotine dependence (ND) and sleep quality has not been well-characterized. The objective of this study was to describe the associations among frequency and intensity of cigarette smoking, ND symptoms, and sleep quality in young adults.Methods: Data on past-year smoking frequency, number of cigarettes smoked in the past month, five ND indicators (i.e., withdrawal, craving, self-medication symptoms, mFTQ, ICD-10 criteria for tobacco dependence), and sleep quality (measured with the Pittsburgh Sleep Quality Index (PSQI)) were collected in 2011-12 in self-report questionnaires completed by 405 young adult smokers (mean age 24 (0.6) years; 45% male; 45% daily smokers) participating in a longitudinal investigation of the natural course of ND. Associations between indicators of cigarette smoking, ND symptoms, and sleep quality were examined in multivariable logistic regression analyses controlling for age, sex, mother's education, and alcohol use.Results: Thirty-six percent of participants reported poor sleep quality (PSQI>5). Higher cigarette consumption (OR(95% CI), 1.03(1.001-1.05)) but not frequency of past-year smoking, more frequent withdrawal symptoms (1.05(1.004-1.10)), more frequent cravings (1.05(1.004-1.10)), higher mFTQ scores (1.14(1.02-1.27)), and endorsing more ICD-10 criteria for tobacco dependence (1.19(1.04-1.36)) were also associated with poor sleep quality.Conclusion: Cigarette smoking and ND symptoms are associated with poor sleep quality in young adult smokers. Advice from practitioners to cut back on number of cigarettes smoked per day and treatment of ND symptoms may improve sleep quality in young adult smokers. [ABSTRACT FROM AUTHOR]

• Little is known about the development of vaping dependence. • This study found that vaping dependence develops over a longer time than smoking. • Smokers develop milestones of frequency faster than non-smokers. • However, non smokers develop other measures faster. There is considerable controversy about the development of dependence among e-cigarette users. This study describes the average amount of time using e-cigarettes before dependence milestones emerge and the differences in developing dependence between e-cigarette users who smoke cigarettes compared to those who do not. Adolescents and young adults aged 16–25 living in Canada were recruited into an online survey in 2021. Current (past-month) e-cigarette users completed 15 items assessing dependence from the Penn-State Electronic Cigarette Dependence Index and the E-cigarette Dependence Scale for a total of 12 behavioural (e.g., difficulty refraining from vaping) and 3 frequency (e.g., using e-cigarette daily, weekly, or monthly) indicators of dependence milestones. Number of years after e-cigarette onset at which the cumulative probability of attaining each milestone was 25 % was computed. Among 1205 participants, most (80.6 %) were female, 73.7 % were Caucasian, and 49.7 % resided in Ontario. Ten of the 12 e-cigarette use milestones were attained by 25 % of respondents 2 years after starting vaping except for daily cigarette use (2.5 years after onset) and waking at night to vape (5.6 years after onset). Within the entire study population, frequency milestones (weekly, monthly, daily e-cigarette use) were attained faster by ever-smokers (hazard ratio compared to attainment by never-smokers: 1.12, 1.21, and 1.28 respectively), whereas for at least monthly users, behavioural milestones were attained faster by never-smokers. Many current e-cigarette users developed symptoms of e-cigarette dependence between two and five years since onset. Never smokers may be at higher risk of becoming e-cigarette dependent since they attained e-cigarette dependence milestones faster than smokers. [ABSTRACT FROM AUTHOR]

The collective impact of major shifts in public health infrastructure and numerous new chronic disease prevention (CDP) capacity-building initiatives that have taken place in Canada over the last decade is unknown. The objective of this study was to determine if CDP capacity (i.e., skills and resources) and involvement in CDP programming improved in public health organizations in Canada from 2004 to 2010. Data for this repeated cross-sectional study were drawn from two waves of a national census of organizations mandated to carry out primary prevention of chronic disease and/or promotion of healthy eating, physical activity and tobacco control. Medians for continuous variables and frequencies for categorical variables were compared across time. Neither resources nor level of priority for CDP increased over time. There was little difference in the proportion of organizations with high levels of skills and involvement in core CDP practices (i.e., needs assessment, identification of relevant practices, planning, evaluation). Skills and involvement in CDP risk factor programming showed some gains, some steady states and some losses. Specifically, skill and involvement in tobacco control programming declined markedly while the proportion of organizations involved in healthy eating and physical activity programming increased. Skills to address and involvement in programming related to social determinants of health remained low over time as did involvement in programming addressing multiple risk factors concurrently. The lack of marked improvement in CDP capacity between 2004 and 2010 against a backdrop of initiatives favourable to strengthening the preventive health system in Canada suggests that efforts may have fallen short. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the association between the neighborhood built environment and trajectories of body mass index (BMI) in youth., Methods: Data were collected in a prospective study of 1293 adolescents in Montreal. Built environment variables were obtained from public databases for road networks, land use, and the Canadian Census. Anthropometric data were collected when participants were ages 12.5, 15 and 17 years. We undertook hierarchical cluster analysis to identify contrasting neighborhood types based on features of the built environment (e.g., vegetation, population density, walkability). Associations between neighborhood type and trajectories of BMI z-score (BMIz) were estimated using multivariable linear mixed regression analyses, stratified by sex., Results: We identified three neighborhood types: Urban, Suburban, and Village. In contrast to the Urban type, the Suburban type was characterized by more vegetation, few services and low population density. Village and Suburban types were similar, but the former had greater land use diversity, population density with more parks and a denser food environment. Among girls, living in Urban types was associated with decreasing BMIz trajectories. Living in Village types was associated with increasing BMIz trajectories. No associations were observed among boys., Conclusions: Neighborhoods characterized by greater opportunities for active living appear to be less obesogenic, particularly among girls., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: Long-term availability of health-promoting interventions (HPIs) in school settings can translate into health benefits for children. However, little is known about factors associated with HPI institutionalization in schools. In this study, we identified correlates of the institutionalization of HPIs offered in elementary schools in Quebec, Canada., Methods: In two-part, structured telephone interviews over three academic years (2016-2019), elementary school principals (or their designees) throughout Quebec identified an index HPI offered at least once in their school during the previous three years, and were asked whether it was institutionalized (i.e. explicitly written in the school's educational project, e.g. in the form of educational objectives and means of achieving them). We examined associations between institutionalization and 10 school-related and 16 HPI-related characteristics in univariable and multivariable logistic regression analyses., Results: School key informants (n = 163) reported on 147 different HPIs that had been available in their schools in the past three years, 56% of which were institutionalized. Three aspects of school culture-parent/community engagement with the school, school/teacher commitment to student health and school physical environment-were positively associated with HPI institutionalization. HPI-related characteristics positively associated with HPI institutionalization included number of competencies addressed by the HPI, number of teaching strategies employed, modifications made to the HPI prior to or during implementation and perceived success of the HPI. Inviting families or community groups to participate in the HPI was inversely associated with institutionalization., Conclusion: Better understanding of factors associated with HPI institutionalization may inform the development of school-based HPIs that have the potential for sustainability., Competing Interests: The authors have no competing interests.

Introduction: School-based health-promoting interventions (HPIs) foster adolescent health and well-being. Access to HPIs may differ by the socioeconomic advantage of students at each school (school deprivation). We assessed the importance of health issues and availability of HPIs and extracurricular activities by school deprivation in high schools in Quebec, Canada., Methods: In 2016/17, 2017/18 and 2018/19, we interviewed school principals or a designee in 48 public high schools classified as disadvantaged (33%) or advantaged (67%). Schools rated whether 13 common health-related issues were important (i.e. warranted intervention) in their student population and reported whether HPIs to address these or other health issues and/or sports or special interest extracurricular activities had been available in the past year., Results: 84% of disadvantaged schools offered one or more HPIs in the past year compared to 73% of advantaged schools. Higher proportions of disadvantaged schools perceived most of 13 health-related issues as important. HPIs for bullying/exclusion, sex education and physical activity (issues subject to government mandates) were available in most schools. Higher proportions of disadvantaged schools offered non-mandated HPIs (i.e. for healthy eating, mental health/well-being and substance use). Higher proportions of advantaged schools offered extracurricular activities in all areas other than non-competitive sports, which was offered by equal proportions of advantaged and disadvantaged schools., Conclusion: Government mandates appear to facilitate universal availability of HPIs in schools, possibly boosting equity in school-based health promotion. Further investigation of possible differences in the content, implementation and/or effects of HPIs based on school deprivation is warranted., Competing Interests: None.

Introduction: In adults, chronic exposure to air pollution is associated with elevated blood pressure, but few studies have examined this relationship in youth. We investigated the association between annual ambient concentrations of air pollutants (fine particulate matter [PM2.5] and nitrogen dioxide [NO2]) and systolic blood pressure (SBP) among adolescents in Montréal, Canada., Methods: Participants were students aged 15 to 17 years who provided SBP and residential postal code data in 2004/05 through their enrolment in the Nicotine Dependence in Teens study. Annual estimates for 2004 of residential exposure to NO2 and PM2.5 were provided by the Canadian Urban Environmental Health Research Consortium and linked to participants' residential postal code. Elevated SBP was defined as SBP ≥ 90th percentile adjusted for age, sex and height. Logistic regression was used to estimate odds ratios and 95% confidence intervals (CIs) for each pollutant with respect to elevated SBP, adjusted for relevant confounders., Results: The sample consisted of 508 adolescents (mean age: 16.9, 46% male); 4% had elevated SBP. Although estimates were not statistically significant, there were generally modest positive associations between pollutant levels and SBP. The adjusted prevalence odds ratio of elevated SBP was 1.33 (95% CI: 0.64, 3.05) for every interquartile range (IQR) increase in residential PM2.5 levels (2.1μg/m3). Similarly, the adjusted prevalence odds ratio of elevated SBP was 1.17 (95% CI: 0.47, 2.70) for every IQR increase in residential NO2 levels (10.2 ppb)., Conclusion: Findings support a possible relationship between exposure to air pollutants and increased SBP in adolescents, warranting further investigation for this important public health concern., Competing Interests: The authors declare that they have no actual or potential conflicts of interest.

Purpose: The association between stressful life events and depressive symptoms is well-established, but the role of coping style in this association is less clear. We examined whether problem-focused, emotion-focused or avoidant coping style mediated and/or moderated the association in young adults., Methods: Data were drawn from a 20-year longitudinal study that included 1294 students' age 12-13 years recruited in 1999-2000 from ten high schools in Montreal, Canada. Herein we report an analysis that included 782 participants aged 24 years on average with data on covariates collected at age 20. Using VanderWeele's four-way decomposition approach, the total effect of stressful life events on depressive symptoms considering coping styles was decomposed into four components: moderation only, mediation only, mediated interaction, no mediation or moderation., Results: We observed mediation only by emotion-focused coping ([Formula: see text](95%CI) = 0.15(0.04, 0.24)) suggestive that individuals who experienced more stressful life events also reported greater use of emotion-focused coping and higher levels of depressive symptoms. We found moderation only by problem-focused coping ([Formula: see text](95%CI) = - 1.51(- 2.40, - 0.53)) and by emotion-focused coping ([Formula: see text](95%CI) = 1.16(0.57, 1.69). These results suggest that individuals reporting more problem-focused coping experienced fewer depressive symptoms after exposure to stressful life events; those reporting more emotion-focused coping experienced more depressive symptoms. Avoidant coping did not mediate or moderate the association between stressful life events and depressive symptoms., Conclusion: Interventions that aim to reduce depressive symptoms in young adults who experience stressful life events may need to reinforce problem-focused coping and minimize emotion-focused coping strategies., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Objective: Little is known about changes in alcohol and cannabis co-use over time in adolescents and young adults. We sought to describe the natural course of alcohol and cannabis co-use from age 12 to 17 and 20 to 31 and to describe frequent (i.e., ≥ once/month) binge drinking (i.e., ≥ 5 drinks/occasion) and cannabis use from age 20 to 31., Method: Data were drawn from two longitudinal studies conducted in Montréal, Canada: AdoQuest ( n = 1,852) and the Nicotine Dependence in Teens (NDIT) study ( n = 1,293). Complete data on alcohol and cannabis were available for 620 12-17-year-olds (58% female) followed from 2005 to 2011 in AdoQuest, and 673 20-31-year-olds (56% female) followed from 2007 to 2020 in NDIT. We reported proportions of co-use, exclusive drinking ("drinking"), exclusive cannabis use ("cannabis use"), frequent co-use, frequent binge drinking, and frequent cannabis use by age and sex., Results: Co-use rose from 2% at age 12-13 to 23% at age 17, was stable at 44% at age 20 and 24, and then decreased to 37% at age 31. Drinking rose from 20% to 51%, and cannabis use was consistently rare (< 2%). During young adulthood, frequent co-use declined from 21% at age 20 to 12% at age 31, and frequent binge drinking declined from 29% at age 20 to 22% at age 31. Frequent cannabis use increased from 6% at age 20 to 11% at age 31., Conclusions: Alcohol and cannabis use should be studied as time-varying behaviors. Co-use patterns should be monitored over time in this population. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objective: Robust evidence exists for the health-enhancing benefits of social support in adults. Inflammatory processes are thought to be an important mechanism linking social support and health risk. Less is known about the relation between social support and chronic inflammation during childhood and adolescence, or when the association emerges during the lifespan., Method: Data from the population-representative 1999 Quebec Child and Adolescent Health and Social (QCAHS) survey were analyzed. Youth aged 9, 13, and 16 years (N = 3613) and their parents answered questions about social support. A subsample (n = 2186) completed a fasting blood draw that was assayed for C-reactive protein (CRP)., Findings: Higher social support was significantly associated with lower hs-CRPlog, after controlling for age, sex, body mass index (BMI Z-score), medication use, puberty, ethnoracial status (French-Canadian), smoking, household income, and parental education (F = 25.88, p = < .001, Total R2adj = 10.2%). The association was largely similar for boys and girls, and strengthened with age., Conclusion: Greater social support was linked to lower chronic low-grade inflammation in a large sample of children and adolescents. Effect sizes were small and consistent with prior findings in the adult literature. Importantly, these findings provide evidence that the relation between social support and inflammation emerges early in the lifespan. Future work should consider broader, more encompassing conceptualizations of social support, the role of social media, and prospective trajectories of social support and inflammatory markers., Competing Interests: The authors have declared that no competing interests exist.

Background: There is a need for better alignment between research on sport and physical activity and the needs of those who are in a position to implement the findings. To facilitate advancement and alignment, we identified the top research priorities of sport and physical activity knowledge users from various sectors., Methods: For this priority-setting study, we used an iterative process of data collection and analysis. Sport and physical activity knowledge users from multiple sectors participated in a workshop (September 2019), which included small working group exercises followed by large-group syntheses leading to the identification of issues that required better understanding. We then sent an online questionnaire to participants for content validation and interim prioritization, to reduce the number of priorities (December 2019 to January 2020). A new questionnaire containing a shortened list of research priorities was sent to an expanded group of respondents to further streamline the list of priorities (January-March 2020)., Results: The 24 workshop participants identified 68 issues, of which 21 were retained by the 18 participants in the interim priority-setting questionnaire. The final prioritization questionnaire was completed by 33 stakeholder groups; this step produced a final list of 8 top research priorities. The final priorities identified for sport and physical activity research related to financial support, suboptimal promotion, dropout, best interventions, participation among Indigenous populations, volunteer engagement, safe and inclusive experiences, and knowledge exchange., Interpretation: The 8 priorities identified in this study provide guidance to Canadian sport and physical activity researchers. Research efforts on these priorities will reflect pressing issues as identified by representatives of all sport and physical activity sectors., Competing Interests: Competing interests: Carolyn Trono received reimbursement of travel expenses from the Centre de formation médicale du Nouveau-Brunswick to attend a workshop for the current study. No other competing interests were declared., (© 2022 CMA Impact Inc. or its licensors.)

Adolescents often report low moderate-to-vigorous physical activity (MVPA) and high screen time. We modeled sex-specific MVPA and screen time trajectories during adolescence and identified contemporaneous patterns of evolution. Data were drawn from 2 longitudinal investigations. The Nicotine Dependence in Teens (NDIT) study included 1294 adolescents recruited at age 12-13 years who completed questionnaires every 3 months for 5 years. The Monitoring Activities of Teenagers to Comprehend their Habits (MATCH) study included 937 participants recruited at age 9-12 years who completed questionnaires every 4 months for 7 years. MVPA was measured as the number of days per week of being active for at least 5 min (NDIT) or 60 min (MATCH). In both studies, screen time was measured as the number of hours spent weekly in screen activities. In each study, sex-specific group-based trajectories were modeled separately for MVPA and screen time from grade 7 to 11. Contemporaneous patterns of evolution were examined in mosaic plots. In both studies, 5 MVPA trajectories were identified in both sexes, and 4 and 5 screen time trajectories were identified in boys and girls, respectively. All combinations of MVPA and screen time trajectories were observed. However, the contemporaneous patterns of evolution were favourable in 14%-31% of participants (i.e., they were members of the stable high MVPA and the lower screen time trajectories). Novelty: MVPA and screen time trajectories during adolescence and their combinations showed wide variability in 2 Canadian studies. Up to 31% of participants showed favourable contemporaneous patterns of evolution in MVPA and screen time. Using uniform methods for trajectory modeling may increase the potential for replication across studies.

Introduction: Few interventions target adolescent cigarette smokers to prevent escalation in cigarette use or promote cessation, in part because little is known about co-developing smoking and nicotine dependence (ND). Our objectives were to: (1) estimate developmental trajectories of ND/cravings, withdrawal symptoms, the modified Fagerström Tolerance Questionnaire (mFTQ) and ICD-10 tobacco dependence in incident adolescent smokers; (2) describe concordance in number and shapes of trajectories across the four ND indicators; and (3) classify participants in each ND trajectory according to cigarette smoking trajectories., Methods: Data were drawn from an ongoing longitudinal investigation of 1294 grade 7 students recruited in 1999-2000 in 10 Montreal-area high schools. Group-based joint trajectory models were used to identify distinct subgroups defined by the four ND indicators, in 307 incident smokers., Results: The optimal trajectory model included five groups for ND/craving and four groups for each of withdrawal symptoms, the mFTQ and ICD-10 tobacco dependence. The four ND indicators showed similar developmental patterns and classification into smoking trajectory groups, although some discordance was observed. Smokers in the low-level decreaser group and stable low consumers who exhibited high ND were younger than those in the cigarette-low ND trajectory groups. Moderate or rapid escalators who exhibited no/low ND were less likely to have university-educated mothers and more likely to have parents who smoke., Conclusions: Trajectories were similar across ND indicators, and generally reflected cigarette smoking trajectory shapes. Novice smokers may need education to become self-aware of developing ND symptoms, as well as to learn about alternative courses of action once ND symptoms manifest., Implications: Trajectories of cigarette smoking and ND symptoms have rarely been investigated concurrently. This study provides evidence of high concordance across four distinct ND indicators in the proportion of participants with no/low-level dependence, and with high or increasing ND. Moreover, the development of cigarette smoking is concordant with ND symptom development. Interventions to prevent escalation and promote cessation should target adolescents before first puff to increase self-awareness of developing ND symptoms, as well as to learn about alternative courses of action once ND symptoms are experienced., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: In young people, alcohol consumption and depressive symptoms are related, but the temporal ordering of the relationship is an open question. Previous studies have not disaggregated influences of interindividual and intraindividual components affecting the relationship. We investigated whether a reciprocal relationship between frequency of alcohol use and depressive symptoms exists in the general population of adolescents after removing interindividual influences., Methods: A total of 1,293 Canadian adolescents provided data on depressive symptoms and frequency of alcohol use every 3 months from grade 7 to 11 (1999-2005) for a total of 20 cycles. We used latent curve models with structured residuals, which disaggregate interindividual and intraindividual components to assess the directionality of the relationship., Results: Both drinking frequency and depressive symptoms increased linearly and quadratically over time, with significant interindividual variation around the origin and rate of change. Intercepts and slopes for drinking frequency and depressive symptoms differed by sex and age. After controlling for sex, age, maternal education, sensation seeking, impulsivity and clustering by school, a significant positive association was observed between depressive symptoms and drinking frequency 3 months later (.032 [.004, .060]; p = .024), but no association was observed between drinking frequency and subsequent depressive symptoms (.011 [-.006 to .029]; p = .193)., Conclusions: Our data provide longitudinal evidence that changes in depressive symptoms exceeding one's "normal" level predict increases in drinking frequency. This suggests that teaching youth to recognize and cope with mood changes would be worthwhile., (Copyright © 2019 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Despite limited evidence on the association between physical activity (PA) and blood pressure (BP) in youth, experts recommend that adolescents engage regularly in moderate-to-vigorous PA. We examined the relationships between PA intensity and frequency and the likelihood of having high BP in a population-based cohort of adolescents from Montréal, Canada. PA was self-reported every 3 months from grade 7 to 11, and BP was measured at ages 12.8, 15.2, and 17.0 years on average. We analyzed data from 993 participants (mean [SD] age = 16.0 [1.0], 51.6% female) with BP data at ages 15.2 and/or 17.0 years, using pooled ordinal logistic regression. BP (normal/elevated/hypertensive range) was the outcome, and past-year PA intensity and frequency were potential predictors. Eight percent of participants had elevated BP (120-129/<80), and 3.2% had BP in the hypertensive range (≥130/≥80). Participants engaged in a median (interquartile range) of 7.0 (4.5, 9.3) and 5.5 (2, 10.8) moderate and vigorous PA sessions/week, respectively. After adjusting for age, sex, mother's education, use of alcohol and cigarette consumption, engaging in PA more intense than light during the previous year was associated with a lower odds of having BP in the hypertensive range (ORs [95% CIs] = 0.93 [0.88, 0.97] to 0.97 [0.94, 0.99]). The relationships were not altered by adjusting for BMI. Our findings support recommendations that adolescents engage in at least moderate PA on a regular basis to prevent development of BP in the hypertensive range., (© 2020 Wiley Periodicals, Inc.)

Introduction: We investigated whether secondhand smoke (SHS) exposure is associated with depressive symptoms in a population-based sample of children., Methods: Never-smoking students from 29 French-language elementary schools in Greater Montréal, Canada, were followed from 5th to 11th grade (2005-2011) in five waves: 1 (5th grade), 2 (spring 6th grade), 3 (7th grade), 4 (9th grade), and 5 (11th grade). Associations between depressive symptoms and SHS exposure at home and in cars were examined in cross-sectional and longitudinal gamma generalized regression models adjusted for sex, maternal education, and neighborhood socioeconomic status., Results: The sample comprised 1553 baseline never-smokers (mean [SD] age = 10.7 [0.5] years; 44% male; 89% French-speaking). SHS exposure at home and in cars was associated with higher depressive symptom scores in cross-sectional analyses pooled across grades and adjusted for demographics (B [95% confidence interval (CI)] = 0.041 [0.017 to 0.068] for home exposure; 0.057 [0.030 to 0.084] for car exposure). In longitudinal analyses from fifth to sixth grade, B (95% CI), adjusted for demographics and baseline depressive symptoms, was 0.042 (0.003 to 0.080) for home exposure and 0.061 (0.019 to 0.103) for car exposure. From sixth to seventh grade, B (95% CI) was 0.057 (0.003 to 0.110) for home exposure and 0.074 (0.015 to 0.133) for car exposure. SHS exposure at any age did not predict depressive symptoms 2 years later., Conclusions: SHS exposure is associated with depressive symptoms in young persons, both concurrently and 1 year later. This finding adds to the evidence base supporting that children should be protected from SHS exposure., Implications: SHS exposure has deleterious effects on physical health and results of this study raise concerns that such exposure might also affect the mental health of young persons. Clearly, protecting children from SHS in all locations is a critical public health priority. Although research is needed to determine if the association between SHS exposure and depressive symptoms is causal, continued implementation of smoking bans and educational efforts to discourage smoking in vehicles when children are present are warranted., (© The Author(s) 2018. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: Sport participation promotes mental health and prevents mental illness. However, the association between specific sport profiles and mental health has not been examined. We investigate the longitudinal association between number of years with a recreational or performance sport profile and mental health during adolescence and whether these associations differ by sex., Methods: Participants (n = 318, 58.2% female) reported participation in sport every 4 months over 5 years, from ages 10-11 to 14-15 years. Each year, they were categorized as recreational or performance sport participants or as nonparticipants. Mental health was assessed at age 15-16 years. Multivariate linear regression was used to model the association between number of years (0-5) with a recreational and performance sport profile and mental health, controlling for sex, age, income, and age at puberty., Results: A recreational sport profile for ≥2 years was associated with better mental health compared with 0 years of recreational sport participation; the strongest association was observed for a recreational sport profile of 4-5 years (βˆ [95% confidence interval]: 10.29 [2.60, 17.98]). A performance sport profile for ≥1 year was associated with better mental health in late adolescence compared with 0 years of performance sport participation; the strongest association was observed for a performance sport profile of 4-5 years (βˆ [95% confidence interval]: 19.48 [9.50, 29.46]). No differences by sex were observed., Conclusion: Both recreational and performance sport profiles in childhood and early adolescence are positively associated with mental health in late adolescence. To promote mental health, strategies to encourage youth to engage and remain involved in sport are warranted., (Copyright © 2019 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: Daily cannabis use can portend problematic use or dependence. We aimed to identify early risk factors for daily cannabis use in young adults., Methods: Data were available in a longitudinal investigation of 1294 grade 7 students age 12 to 13 years at inception recruited in 10 secondary schools in Montreal, Canada, in 1999. Data on daily cannabis use were collected in mailed self-report questionnaires from 878 participants (67.9% of 1294) at age 20. The associations between each of 23 potential risk factors measured in grade 7 and daily cannabis use at age 20 were modeled using logistic regression., Results: At age 20, 44% of participants reported past-year cannabis use; 10% reported daily use. Older age; male sex; higher levels of family stress and other stress; use of alcohol, cigarettes, and other tobacco products; parent(s), sibling(s), and friend(s) smoke cigarettes; higher body mass index; higher impulsivity and novelty seeking; and lower self-esteem increased the odds of daily cannabis use., Conclusions: Children at risk of daily cannabis use as young adults can be identified early. They may benefit from early intervention to prevent problematic cannabis use.

The Nicotine Dependence in Teens (NDIT) study is a prospective cohort investigation of 1294 students recruited in 1999-2000 from all grade 7 classes in a convenience sample of 10 high schools in Montreal, Canada. Its primary objectives were to study the natural course and determinants of cigarette smoking and nicotine dependence in novice smokers. The main source of data was self-report questionnaires administered in class at school every 3 months from grade 7 to grade 11 (1999-2005), for a total of 20 survey cycles during high school education. Questionnaires were also completed after graduation from high school in 2007-08 and 2011-12 (survey cycles 21 and 22, respectively) when participants were aged 20 and 24 years on average, respectively. In addition to its primary objectives, NDIT has embedded studies on obesity, blood pressure, physical activity, team sports, sedentary behaviour, diet, genetics, alcohol use, use of illicit drugs, second-hand smoke, gambling, sleep and mental health. Results to date are described in 58 publications, 20 manuscripts in preparation, 13 MSc and PhD theses and 111 conference presentations. Access to NDIT data is open to university-appointed or affiliated investigators and to masters, doctoral and postdoctoral students, through their primary supervisor (www.nditstudy.ca)., (© The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.)

Objectives: Second-hand smoke (SHS) can attain high concentrations in cars. To protect children's health, nine Canadian provinces have enacted legislation prohibiting smoking in privately owned vehicles when children are present; Quebec is the only province with no such legislation. The objective of this study was to estimate the proportion of smokers in Quebec who smoke while travelling in a private vehicle in which children are present, and to compare the characteristics of smokers who do and do not smoke in cars., Methods: In 2011-12, 754 daily smokers who recently travelled in a car with children completed a telephone survey in which they reported how frequently they smoked in a car, if there were smoking restrictions, and perceptions about the effectiveness of legislation prohibiting smoking in cars when children are present., Results: Twenty-three percent of daily smokers smoked at least occasionally in their car when children were present. This proportion was higher among smokers who knew that there was no legislation in Quebec prohibiting smoking in cars, compared to smokers who believed that such legislation was already in effect (32% vs. 12%). Smokers with a university degree and those who reported that smoking was prohibited at home were less likely to expose children to SHS in cars. Most daily smokers (75%) believed that legislation would be effective., Discussion: The results of this study suggest that legislation prohibiting smoking in cars is necessary to protect children from SHS, that such legislation would be effective, and that it may be relatively easy to implement.

Background: Adolescent physical activity (PA) levels track into adulthood. However it is not known if type of PA participated in during adolescence is associated with PA levels later in life. We aimed to identify natural groupings of types of PA and to assess whether number of years participating in these different groupings during adolescence is related to PA level in early adulthood., Methods: 673 adolescents in Montreal, Canada, age 12-13 years at baseline (54% female), reported participation in 29 physical activities every 3 months over 5 years (1999-2005). They also reported their PA level at age 24 years (2011-12). PA groupings among the 29 physical activities were identified using factor analysis. The association between number of years participating in each grouping during adolescence and PA level at age 24 was estimated using linear regression within a general estimating equation framework., Results: Three PA groupings were identified: "sports", "fitness and dance", and "running". There was a positive linear relationship between number of years participating in sports and running in adolescence and PA level at age 24 years (β (95% confidence interval) = 0.09 (0.04-0.15); 0.08 (0.01-0.15), respectively). There was no relationship between fitness and dance in adolescence and PA level at age 24., Conclusions: The association between PA participation in adolescence and PA levels in young adulthood may be specific to certain PA types and to consistency of participation during adolescence. Results suggest that efforts to establish the habit of participation in sports and running in adolescence may promote higher PA levels in adulthood.

Identifying food patterns related to obesity can provide information for health promotion in nutrition. Food patterns and their relation with obesity among Canadian children have not been reported to date. Our aim was to identify and describe food patterns associated with obesity in children at risk of overweight. Caucasian children (n = 630) with at least 1 obese biological parent recruited into the Quebec Adiposity and Lifestyle Investigation in Youth (QUALITY) cohort were studied in cross-sectional analyses. Measures of adiposity (body mass index (BMI), waist circumference, body fat mass percentage measured by dual-energy X-ray absorptiometry), screen time, physical activity (accelerometer over 7 days), and dietary intake (three 24-h food recalls) were collected. Factor analysis was used to identify food patterns. The relationships between food patterns and overweight were investigated in logistic and multiple linear regression models. Three food patterns were retained for analysis: traditional food (red meats, main dishes-soups, high-fat dairy products, tomato products, dressings, etc.); healthy food (low-fat dairy products, whole grains, legumes-nuts-seeds, fruits, vegetables); and fast food (sugar-sweetened beverages, fried potatoes, fried chicken, hamburgers-hot dogs-pizza, salty snacks). Higher scores on the fast food pattern were associated with overweight (BMI ≥ 85th percentile), and other measures of adiposity (BMI, waist circumference, body fat mass percentage) after adjustment for age, sex, physical activity, screen time, sleep time, family income, and mother's obesity (p < 0.05). Controlling for energy intake did not change these relationships. Our results provide further evidence of a link between fast food intake and obesity in children.

Background: Despite the availability of several acute coronary syndrome (ACS) prognostic risk scores, there is no appropriate score for early-risk stratification at the time of the first medical contact with patients with ACS. The primary objective of this study is to develop a simple risk score that can be used for early-risk stratification of patients with ACS., Methods: We derived the risk score from the Acute Myocardial Infarction in Quebec and Canada ACS-1 registries and validated the risk score in 4 other large data sets of patients with ACS (Canada ACS-2 registry, Canada-GRACE, EFFECT-1, and the FAST-MI registries). The final risk score is named the Canada Acute Coronary Syndrome Risk Score (C-ACS) and ranged from 0 to 4, with 1 point assigned for the presence of each of these variables: age ≥75 years, Killip >1, systolic blood pressure <100 mm Hg, and heart rate >100 beats/min. The primary end points were short-term (inhospital or 30-day) and long-term (1- or 5-year) all-cause mortality., Results: The C-ACS has good predictive values for short- and long-term mortality of patients with ST-segment elevation myocardial infarction and non-ST-segment elevation ACS. The negative predictive value of a C-ACS score ≥1 is excellent at ≥98% (95% CI 0.97-0.99) for short-term mortality and ≥93% (95% CI 0.91-0.96) for long-term mortality. In other words, a C-ACS score of 0 can potentially identify correctly ≥97% short-term survivors and ≥91% long-term survivors., Conclusion: The C-ACS risk score permits rapid stratification of patients with ACS. Because this risk score is simple and easy to memorize and calculate, it can be rapidly applied by health care professionals without advanced medical training., (Copyright © 2013 Mosby, Inc. All rights reserved.)

Objective: The objective of this study is to examine depressive symptom trajectories during adolescence as predictors of physical activity (PA) in young adulthood., Methods: Adolescents residing in Montreal, Canada (n=860) reported their depressive symptoms every 3-4 months during high school in 20 data collections. Three years later, participants reported engaging in moderate and vigorous intensity PA and team sports participation. Trajectories of depressive symptoms were estimated using latent growth modeling and examined as predictors of PA outcomes., Results: Three depression symptom trajectory groups were identified during adolescence: low and declining depressive symptom scores (group 1; 37.8%); moderate and stable depressive symptom scores (group 2; 41.6%); and high increasing depressive symptom scores (group 3; 20.6%). In multivariable analyses, group 2 and group 3 participated in less moderate-intensity PA and were less likely to participate in team sports compared to group 1., Conclusions: The importance of examining intensity and type of PA as outcomes of depressive symptoms is highlighted. Targeted approaches are needed to encourage adolescents with moderate to high depression symptoms to engage in PA and team sports to improve their health and well-being., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Introduction: In addition to individual-level characteristics, the social and physical environment may influence the initiation of cigarette smoking in adolescents. The objective of this paper is to describe the association between smoking intolerance in schools, and in restaurants and corner stores located near schools, and initiation of cigarette smoking among adolescents., Methods: Data on cigarette smoking were collected in self-report questionnaires every 3 months from 1999 to 2005 in a sample of 1,293 Grade 7 students in 10 secondary schools in Montreal, Canada. Baseline never-smokers (n = 868) were retained for analysis. School administrators completed questionnaires on tobacco control policies and activities within schools. Data on access to tobacco products and smoking restrictions in restaurants and corner stores located in school neighborhoods were collected through direct observation. Schools, restaurants, and corner stores were classified as smoking tolerant or intolerant. Time to initiation of cigarette smoking was modeled as a function of smoking intolerance in schools, restaurants, and corner stores in survival analyses (Cox proportional hazards modeling)., Results: Students in smoking-intolerant schools were less likely to initiate smoking than students in smoking-tolerant schools (hazard ratio [HR; 95% CI] = 0.83 [0.68, 1.01]). Students attending schools located in neighborhoods with smoking-intolerant restaurants were less likely to initiate smoking (HR [95% CI] = 0.85 [0.68, 1.07]). There was no association between corner store smoking intolerance and initiation., Conclusions: Smoking intolerance in schools and restaurants may protect against initiation of cigarette smoking and could be useful targets for more intense tobacco control efforts.

Objective: The contribution of nutrition to health inequalities is poorly understood, particularly with regard to children. The objective of this study was to examine the influence of income and the conjoint influence of low income and food insecurity on several dietary indicators in a representative sample of Canadian youth., Methods: We used data from the Canadian Community Health Survey (CCHS) Cycle 2.2, a nationally representative population-based sample, to examine the diets of 8,938 youth aged 9-18 years. A single 24-hour recall was used to collect dietary information. Interviews were conducted in person, and anthropometric measurements were available for 71% of the sample. Estimates of variance were calculated using bootvar with weights specific to the CCHS. Generalized linear models were used to examine the associations between both low income and low-income food insecurity and anthropometric measures, food and nutrient intakes., Results: Youth from low-income households had lower height percentiles than youth from higher-income households. Low-income girls (but not low-income boys) had a higher prevalence of BMI > or = 85th percentile than their higher-income counterparts. Among low-income food-insecure households, there was a higher prevalence of BMI > or = 85th percentile in boys than among the food-secure low-income boys. Calcium and vitamin D intakes were lower among boys and girls living in low-income households. Similarly, milk consumption was lower in low-income boys. Low-income food-insecure girls had lower milk intakes and higher intake of sweetened beverages., Conclusions: We found some evidence of nutritional deprivation among Canadian youth from disadvantaged households. Longer-term indicators of nutritional status such as lower height and greater weight among disadvantaged households were consistent with these findings.

Introduction: Recent studies evidenced that adolescent never-smokers exposed to secondhand tobacco smoke (SHS) endorsed nicotine dependence symptoms. Other studies showed that SHS exposure measured with biomarkers among never-smokers independently predicted withdrawal sensations and prospective smoking initiation. The aim of the present study was to replicate and extend these findings by investigating whether social and pharmacological measures of SHS exposure predicted precursors to smoking among never-smoking adolescents., Methods: Participants included 327 never-smokers aged 11-15 years attending sixth or seventh grade in French language schools in Montréal, Canada. They completed self-report questionnaires measuring their smoking status, social smoke exposure (number of smokers in their environment and number of situations where SHS exposure occurs), and precursors to smoking initiation (smoking expectancies, perceived nicotine dependence, and smoking susceptibility). Each participant provided a saliva sample from which cotinine biomarkers were derived to measure pharmacological exposure to SHS., Results: When predictors were modeled individually, number of smokers predicted perceived nicotine dependence (p ≤ .05), smoking susceptibility (p ≤ .001), and expected benefits (p ≤ .05), whereas number of situations predicted smoking susceptibility (p ≤ .01). When predictors were modeled simultaneously, number of smokers predicted perceived nicotine dependence (p ≤ .01), smoking susceptibility (p ≤ .01), and expected benefits (p ≤ .05)., Conclusions: Social smoke exposure was a predictor for smoking precursors. Pharmacological exposure to SHS did not predict smoking precursors, which may be partly attributable to the low cotinine values observed in our sample. Suggestions for improved pharmacological measurement of SHS and implications for public health are discussed.

Background: The American Academy of Pediatrics advocates that pediatricians should be involved in tobacco counseling and has developed guidelines for counseling. We present a prognostic tool for use by health care practitioners in both clinical and non-clinical settings, to identify adolescents at risk of becoming daily smokers., Methods: Data were drawn from the Nicotine Dependence in Teens (NDIT) Study, a prospective investigation of 1293 adolescents, initially aged 12-13 years, recruited in 10 secondary schools in Montreal, Canada in 1999. Questionnaires were administered every three months for five years. The prognostic tool was developed using estimated coefficients from multivariable logistic models. Model overfitting was corrected using bootstrap cross-validation. Goodness-of-fit and predictive ability of the models were assessed by R2, the c-statistic, and the Hosmer-Lemeshow test., Results: The 1-year and 2-year probability of initiating daily smoking was a joint function of seven individual characteristics: age; ever smoked; ever felt like you needed a cigarette; parent(s) smoke; sibling(s) smoke; friend(s) smoke; and ever drank alcohol. The models were characterized by reasonably good fit and predictive ability. They were transformed into user-friendly tables such that the risk of daily smoking can be easily computed by summing points for responses to each item. The prognostic tool is also available on-line at http://episerve.chumontreal.qc.ca/calculation&#95;risk/daily-risk/daily&#95;smokingadd.php., Conclusions: The prognostic tool to identify youth at high risk of daily smoking may eventually be an important component of a comprehensive tobacco control system.

Aims: To determine if impulsivity and socio-economic status (SES) interact to influence gambling onset in youth., Design: Longitudinal study of grade 7 students followed for 8 years., Setting: Montréal, Canada., Participants: A total of 628 adult students aged 12.6 years on average at cohort inception., Measurements: Impulsivity and SES (parent education, area deprivation) were collected during secondary school. Age of gambling onset was collected retrospectively when participants were aged 20.3 years. Cox proportional hazards regression was used to model the association between time to first report of gambling and interaction terms for each of impulsivity and parent education, and impulsivity and area deprivation accounting for sex and ethnicity., Findings: Median (interquartile range) age of gambling onset was 17.0 (4.0) years. Impulsivity independently increased the risk of gambling onset among participants with no university-educated parent [hazard ratio (HR) 1.3; 95% confidence interval 1.1-1.5] and those living in highly deprived areas (HR 1.7; 1.5-2.0). Impulsivity was not associated with gambling onset among high SES youth. Among participants with high impulsivity, risks were elevated for those with no university-educated parent relative to one or more university-educated parent (HR 1.7; 1.1-2.7), and for participants living in deprived relative to advantaged areas (HR 5.0; 2.6-9.6). SES was not associated with gambling onset among participants with low impulsivity., Conclusions: Impulsivity is a risk factor for gambling onset among low but not high SES youth, and low SES influences gambling onset primarily among impulsive youth. Gambling prevention programmes may need to consider potential interaction between impulsivity and SES., (© 2010 The Authors, Addiction © 2010 Society for the Study of Addiction.)

To understand factors influencing fruit and vegetable (F&V) consumption in children, the authors studied the association between F&V consumption in mothers and children in a sample of 1,106 boys and girls in Grades 4-6 in 24 elementary schools in low-income, multiethnic neighborhoods in Montreal, Canada. Approximately 10% of girls and 19% of boys reported not having eaten any vegetables in the week prior to questionnaire administration; 53% of girls and 63% of boys did not consume whole fruits daily. Each unit increase in F&V consumption in mothers was associated with a 10% to 20% increase in F&V consumption in children. Interventions to improve F&V consumption should aim to improve awareness among parents of the importance of fruits and vegetables and of the impact of their own behavior on their children's F&V consumption.

Cardiovascular disease (CVD) is the leading cause of mortality in women. In fact, CVD is responsible for a third of all deaths of women worldwide and half of all deaths of women over 50 years of age in developing countries. The prevalence of CVD risk factor precursors is increasing in children. Retrospective analyses suggest that there are some clinically relevant differences between women and men in terms of prevalence, presentation, management and outcomes of the disease, but little is known about why CVD affects women and men differently. For instance, women with diabetes have a significantly higher CVD mortality rate than men with diabetes. Similarly, women with atrial fibrillation are at greater risk of stroke than men with atrial fibrillation. Historically, women have been underrepresented in clinical trials. The lack of good trial evidence concerning sex-specific outcomes has led to assumptions about CVD treatment in women, which in turn may have resulted in inadequate diagnoses and suboptimal management, greatly affecting outcomes. This knowledge gap may also explain why cardiovascular health in women is not improving as fast as that of men. Over the last decades, mortality rates in men have steadily declined, while those in women remained stable. It is also becoming increasingly evident that gender differences in cultural, behavioural, psychosocial and socioeconomic status are responsible, to various degrees, for the observed differences between women and men. However, the interaction between sex-and gender-related factors and CVD outcomes in women remains largely unknown.

The purpose of this paper is to examine the utility of linking systems between public health resource and user organizations for health promotion dissemination and capacity building, and to identify factors related to the success of linking systems. The design is a parallel-case study using key informant interviews and content analysis of project reports (synthesized qualitative and quantitative data) of three provincial dissemination projects of the Canadian Heart Health Initiative-Dissemination Phase. Each provincial project used linking activities with public health user groups including meetings, skill building, resources, collaboration, networking and research feedback to facilitate capacity building for and implementation of heart health promotion activities. This paper presents empirical examples of linking system designs, activities, and qualitative and quantitative changes in the public health user groups' health promotion capacity, program delivery and sustainability. The findings indicate enhanced health promotion skills, partnerships, resources, infrastructure, and increased programming and sustainability in the targeted public health organizations of all three provincial projects. Identified barriers to the success of linking systems included lack of appropriately skilled personnel, funds, buy-in and leadership. We conclude that linking systems can be flexibly used to build capacity and disseminate health promotion innovations, and suggest conditions for success.

Growing evidence suggests an association between lipid abnormalities and fatty acid binding protein (FABP) and microsomal triglyceride transfer protein (MTP) gene variants. Our objectives were to determine whether Ala54Thr FABP2 and G-493T MTP polymorphisms are associated with increased risks of insulin resistance syndrome (IRS) in youth and/or modify the expression of accompanying dyslipidemia. Our study of 1,742 French-Canadians aged 9, 13, and 16 years did not provide evidence of a potential predisposition to IRS related to either FABP2 or MTP genotypes. However, we observed a heterogeneity of the FABP2 effect by IRS status on total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C), and apolipoprotein B (apoB) concentrations (P for interaction=0.045, 0.018, and 0.017, respectively). Among the metabolic components of IRS, only triglyceride (TG) displayed an interaction with FABP2 polymorphism: compared with Thr/Ala and Ala/Ala, the Thr/Thr genotype was associated with a steeper increase in TC, LDL-C, and apoB parallel to TG concentrations (P <0.001). IRS did not modify the associations between the MTP polymorphism and any of the biochemical parameters. Our study suggests that the effects of FABP2 allelic variations on lipid traits are context dependent, indicating that this variant may play an important role in cardiovascular pathogenesis in the presence of IRS or hypertriglyceridemia.

Cardiovascular diseases are now the world's leading cause of death. To reduce high rates of such preventable premature deaths, evidence-based approaches to heart health promotion must be disseminated across public health systems. To succeed, we must build capacity to disseminate strategies that are practical and effective. However, we know little about such dissemination, and we lack both conceptual frameworks to guide our thinking and appropriate scientific methodologies. This article presents conceptual and analytic frameworks that integrate several approaches to understanding and studying dissemination processes within public health systems. This work is based on the Canadian Heart Health Dissemination Project, a research program examining a national heart health dissemination initiative. The primary focus is the development of a systematic protocol for measuring levels of capacity and dissemination, and determining successful conditions for, and barriers to, capacity and dissemination, as well as the nature of the relationship between these key concepts.

Background: Alarming secular declines in physical activity (PA) have been observed among youth over the last decade. A better understanding of the predictors of these declines is crucial to identifying those children most at risk and to developing interventions that target youth before the onset of decline. This report identifies 1- and 2-year predictors of decline in PA among fourth- and fifth-grade students from inner-city neighborhoods in Montreal, Canada., Methods: Data for this study were collected in classroom questionnaires each May/June from 1993 to 1997. Analyses for this paper were completed in 2001. The cohort included active (at least one PA per day) children with baseline and 1-year (n =1873) or 2-year (n =509) follow-up data., Results: In boys, 1-year predictors of decline to an inactive status identified in generalized estimating equations analysis included moderate (vs high) baseline PA (odds ratio [OR]=1.66, 95% confidence interval [CI]=0.91-3.05); low PA self-efficacy (OR=1.67, 95% CI=1.03-2.71); born outside Canada (OR=2.13; 95% CI=1.31-3.46); Asian origin (OR=1.81; 95% CI=1.03-3.16) and no participation in school teams (OR=1.81, 95% CI=0.93-3.55). In girls, these 1-year predictors included moderate PA (OR=1.91, 95% CI=1.10-3.32); low PA self-efficacy (OR=1.70, 95% CI=1.15-2.49); watching four or more TV programs per day (OR=1.40, 95% CI=0.97-2.02); mother unemployed (OR=1.54, 95% CI=1.07-2.23); and grade five (vs grade four) (OR=1.35, 95% CI=0.94-1.93). Two-year predictors in boys included moderate baseline PA (OR=2.52, 95% CI=0.84-7.50), and born outside Canada (OR=1.96, 95% CI=0.91-4.20). In girls, these 2-year predictors included moderate baseline PA (OR=2.75, 95% CI=1.01-7.49); no participation in school teams (OR=2.14, 95% CI=0.92-5.00); watching four or more TV programs per day (OR=1.93, 95% CI=0.99-3.74); and born outside Canada (OR=1.85, 95% CI=0.96-3.55)., Conclusions: Reduced TV viewing among girls and increased participation in school sports teams in boys and girls may prevent declines in PA among pre-adolescents from inner-city neighborhoods.

Non-communicable diseases are the major cause of preventable death in industrialized countries and a growing concern elsewhere (Singapore Declaration, 1998). Modifiable risk factors for these diseases are prevalent [e.g., in Canada, 75% of adults have at least one modifiable risk factor for cardiovascular disease (CVD)] (Heart and Stroke Foundation of Canada, 1997).

Objective: To identify one-year predictors of smoking initiation among never-smokers, and of continued smoking among ever-smokers., Design: Two sequential cohorts of grade 4 and 5 children. Data were collected as part of Coeur en sante St Louis du Parc, a non-randomised controlled trial to evaluate the impact of a school-based heart health promotion programme., Setting: 24 inner-city elementary schools located in multiethnic, low-income neighbourhoods in Montreal., Subject: 1824 schoolchildren aged 9-12 years with baseline and one-year follow-up data., Main Outcome Measures: Changes in smoking behaviour over a year; the ability of baseline data to predict smoking initiation and continued smoking a year later was investigated in logistic regression analyses., Results: The prevalence of ever-smoking was 21.1% at baseline and 30.2% at one-year follow up. One in six never-smokers initiated smoking; one in three ever-smokers continued smoking. Predictors of initiation included age (odds ratio (OR) = 1.6, 95% confidence interval (CI) = 1.3 to 2.0), male gender (OR = 1.5 (95% CI = 1.1 to 2.0)), friends who smoke (OR = 2.3 (95% CI = 1.7 to 3.3)), sibling(s) who smoke (OR = 1.9 (95% CI = 1.2 to 3.1)), father/mother who smokes (OR = 2.2 (95% CI = 1.6 to 3.0)), and frequent high fat/"junk food" consumption (OR = 1.6 (95% CI = 1.1 to 2.1)). Age and friends who smoke were also independent predictors of continued smoking in both genders. In addition, in boys, current smokers at baseline were 2.6 times (95% CI = 1.4 to 5.0) more likely to continue smoking than past smokers. In girls, being overweight was associated with continued smoking (OR = 3.5 (95% CI = 1.6 to 7.6))., Conclusions: Smoking prevention programmes should address parental and sibling influences on smoking, in addition to refusal skills training. Among girls, weight-related issues may also be important.

Objectives: This study investigated factors related to the perceived sustainability of 189 heart health promotion interventions initiated by a public health department or research initiative and implemented in a variety of organizations across Canada., Methods: Data were collected in a telephone survey of key informants from schools, restaurants, grocery stores, health care facilities, and sports facilities that had implemented a heart health promotion intervention (risk factor screening, courses for smoking cessation, healthy eating or physical activity, support groups to promote healthy lifestyles, environmental modification, dissemination of information) in the past 8 years., Results: Overall, 43.6% of 189 interventions were perceived to be very permanent, 34.8% were somewhat permanent, and 21.5% were not permanent. Independent correlates of perceived sustainability included intervention used no paid staff (odds ratio (OR) 95% confidence interval (95% Cl) = 3.7 (1.8, 7.5)), intervention was modified during implementation (OR (95% Cl) = 2.7 (1.4, 5.0)), there was a good fit between the local provider and the intervention (OR (95% Cl) = 2.4 (1.2, 5.0)), and there was the presence of a program champion (OR (95% Cl) = 2.3 (1.2, 4.4))., Conclusion: Consideration of these factors by health promotion program planners could increase the potential for sustainability of health promotion interventions implemented in the community., (Copyright 1998 American Health Foundation and Academic Press.)

Objective: To validate an adaptation of a short questionnaire measuring behaviour related to selecting low fat diets. The questionnaire was adapted for telephone use in a low income, low education population., Design: The factorial structure of the 38 item adaptation was studied in a population based random sample of 1432 adults. Seven day test-retest reliability was measured in a convenience sample of 93 adults, and criterion related validity in measuring fat was assessed against a dietitian administered diet history in another convenience sample of 81 adults., Setting: Adults aged 18-65 years living in low income, inner city neighbourhoods in Montreal, Canada., Results: Principal components analysis identified five food factors: avoid fat, junk food, high fat traditional foods, low fat substitutes for high fat foods, and modification of meat to reduce fat. Two factors were similar to those of the original version. Internal consistency of the subscales ranged from 0.49-0.72. Test-retest reliability ranged from 0.72-0.90. Validation of the subscales against usual dietary intake indicated that the "junk food" factor, arising from questions added to the original questionnaire to reflect local dietary habits, was most closely related to fat intake (r = 0.48; p < 0.001)., Conclusion: This telephone adaptation provides an inexpensive and valid method of measuring fat intake. However, these results suggest that adaptations of existing dietary instruments should be validated in the populations for which they are intended before they are used.

Epidemiologic and clinical features of Kawasaki disease in 106 patients seen between 1980 and 1986 at The New York Hospital in midtown Manhattan were compared with those in large series from the United States, Canada, and Japan. Dissimilarities in our Kawasaki disease experience included ethnic heterogeneity of our patients (50% white, 18% black, 16% Hispanic, and 16% Oriental) and, in comparison with the Japanese experience, an older mean age (3 1/2 vs 1 1/2 years) with fewer children less than 2 years of age (32% vs 50% to 60%). In comparison with the general population of the geographic urban and suburban referral area for our hospital and in comparison with our general pediatric population, Oriental children with Kawasaki disease were overrepresented (16% vs 2%). More families of children with Kawasaki disease were members of the upper and middle class (73%) than were the population seen in general pediatrics (31.7%) at our hospital. Personal interviews with 63 families of children with Kawasaki disease and 63 control families with children paired for ethnic group, sex, and age revealed no epidemiologic differences except for use of rug shampoo within 1 month of onset in 16 episodes in 15 children with Kawasaki disease in 14 families (22% of families) compared with two families of control children (3%) (P less than .001).