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Objectives: An estimated 30% of Canadian adolescents do not get the recommended 8-10hours of sleep. No prior study has examined the role of income inequality, the gap between rich and poor within a society, in adolescent sleep. The aim of this study is to examine the association between income inequality and sleep duration among Canadian adolescents, how this association differs by gender, and whether depressive symptoms, anxiety, and social cohesion mediate this relationship., Methods: Multilevel path models were conducted using cross-sectional survey data from 74,501 adolescents who participated in the Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behavior (COMPASS) study in 2018-2019. Income inequality was measured at the census division level and sleep duration, gender, depressive symptoms, anxiety, and social cohesion were measured at the individual level., Results: A 1% increase in income inequality was associated with a 3.67-minute decrease in sleep duration (95% CI=-5.64 to -1.70). The cross-level interactions between income inequality and gender were significant, suggesting that income inequality has more adverse associations with sleep among females than males. Both depressive symptoms and anxiety were significant mediators, wherein greater income inequality was associated with higher levels of depressive symptoms and anxiety, which were in turn, associated with a shorter sleep duration., Conclusion: Interventions that reduce income inequality may prevent depressive symptoms and anxiety and improve sleep in adolescents. Reducing societal income gaps may improve adolescent sleep especially in those attending school in high income inequality areas, females, and those experiencing depressive symptoms and anxiety., Competing Interests: Declaration of conflicts of interest None., (Copyright © 2024 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Declines in life expectancy in developed countries have been attributed to increases in drug-related overdose, suicide, and liver cirrhosis, collectively referred to as deaths of despair. Income inequality is proposed to be partly responsible for increases in deaths of despair rates. This study investigated the associations between income inequality, deaths of despair risk in Canada, and potential mechanisms (stress, social cohesion, and access to health services)., Methods: We obtained data from the Canadian Community Health Survey and the Canadian Vital Statistics Database from 2007 to 2017. A total of 504,825 Canadians were included in the analyses. We used multilevel survival analyses, as measured by the Gini coefficient, to examine the relationships between income inequality and mortality attributed to drug overdose, suicide, death of despair, and all-cause. We then used multilevel path analyses to investigate whether each mediator (stress, social cohesion, and access to mental health professionals), which were investigated using separate mediation models, influenced the relationship between income inequality and drug overdose, suicide, deaths of despair, and all-cause death., Results: Adjusted multilevel survival analyses demonstrated significant relationships between a one-SD increase in Gini coefficient was associated with an increased hazard for drug overdose (HR adj.  = 1.28; 95 CI = 1.05, 1.55), suicide (HR adj.  = 1.24; 95 CI = 1.06, 1.46), deaths of despair (HR adj.  = 1.26; 95 CI = 1.12, 1.40), and all-cause death (HR adj.  = 1.04; 95 CI = 1.02, 1.07). Adjusted path analyses indicated that stress, social cohesion, and access to mental health professionals significantly mediated the association between income inequality and mortality outcomes., Conclusion: Income inequality is associated with deaths of despair and this relationship is mediated by stress, social cohesion, and access to mental health professionals. Findings should be applied to develop programs to address income inequality in Canada., Competing Interests: Declaration of interest RP is a Tier 2 Canada Research Chair., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

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., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

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

Purpose: To determine if income inequality at the census division level is associated with alcohol consumption and abuse among junior high and high school students., Methods: Data on adolescents are from the Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behavior (COMPASS) study. Participant data (n = 19,759) were collected during three survey waves (2016-2017, 2017-2018, and 2018-2019) and linked to 30 census divisions within four Canadian provinces. Data on income inequality and other area-level factors were derived from the 2016 Canadian census. Multilevel logistic regression modelling was used to quantify the associations between income inequality, monthly alcohol consumption, and binge drinking., Results: After adjusting for covariates, students living in census divisions within the second and third quintiles of income inequality experienced an average 80% (OR = 1.80, 95% CI = 1.08-3.02) and 92% (OR = 1.92, 95% CI = 1.05-3.51) increased odds of engaging in monthly binge drinking, respectively, compared to those living in the first quintile. Similarly, adolescents living in census divisions within the second inequality quintile experienced an average 169% (OR = 2.69, 95% CI = 1.45, 4.99) increased odds of engaging in weekly binge drinking, compared to those living in the first quintile. There was no significant association between higher income inequality and current monthly alcohol consumption., Discussion: Moderate area-level income inequality within census divisions was adversely associated with alcohol consumption among adolescents. Future work should investigate the potential mechanisms that mediate this relationship., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: Income inequality has been linked to high and unhealthy body mass index (BMI), though there is a dearth of evidence in adolescents. Therefore, this study examines the association between income inequality and BMI in a large sample of Canadian adolescents., Methods: A pooled cross-sectional design was used. Participants were adolescents (n = 101,901) from 157 Canadian secondary schools participating in the 2016-2017, 2017-2018, or 2018-2019 waves of the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) study. BMI was calculated from self-reported height and weight and converted to World Health Organization (WHO) z-BMI scores. Gini coefficients were calculated at the census division level (n = 49) using data from the 2016 Canadian Census. Multilevel modelling was performed to account for the clustering of students nested within schools, which were nested within census divisions. Interactions were included to determine whether associations were heterogeneous for males and females., Results: Income inequality demonstrated a non-linear association with WHO z-BMI score (z-Gini: β = 0.05, 95%CI: 0.02, 0.08; z-Gini 2 : β = -0.02, 95% CI: -0.04, -0.01) among adolescents after adjusting for student-, school-, and census division-level covariates. This association was more pronounced among females., Conclusion: The association between income inequality and BMI, being overweight, or having obesity appears to be non-linear. Public health units and schools may benefit from incorporating upstream factors such as income inequality into their interventions attempting to promote healthy weights., (© 2023. The Author(s) under exclusive license to The Canadian Public Health Association.)

Purpose: Depression and anxiety among adolescents are major public health concerns. Findings indicate that income inequality was associated with increased risk for depression and anxiety among adolescents; however, this has not been tested longitudinally. We aim to quantify the longitudinal association between income inequality and depression and anxiety among Canadian adolescents., Methods: We used longitudinal data on 21,141 students from three waves (2016/17-2018/19) of the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behavior (COMPASS) school-based study. Multilevel modeling was used to assess the association between census division (CD)-level income inequality and depressive and anxiety symptoms and odds for depression and anxiety over time., Results: Across CDs, the mean Gini coefficient was 0.37 (range: 0.30, 0.46). Attending schools in CDs with higher levels of income inequality was associated with higher depressive scores (ß = 0.08; 95% confidence interval [CI] = 0.02, 0.14) and an increased odds for depression (odds ratio = 1.55, 95% CI = 1.06, 2.28) over time. Income inequality was not significantly associated with anxiety symptoms or experiencing anxiety over time. Additional analyses showed that income inequality was associated with higher depressive scores among females (ß = 0.10; 95% CI = 0.01, 0.18) and males (ß = 0.08, 95% CI = 0.01, 0.15) and for anxiety scores among females (ß = 0.13, 95% CI = 0.04, 0.22), but not among males (ß = -0.01, 95% CI = -0.09, 0.06)., Discussion: Findings from this study indicated that income inequality is associated with depression over time among adolescents. This study highlights key points of intervention for the prevention of mental illness in adolescents., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: Cannabis, cigarette, and e-cigarette use among Canadian adolescents is a major public health concern. Income inequality has been associated with adverse mental health among youth and may contribute to the risk of frequent cannabis, cigarette, and e-cigarette use. We tested the association between income inequality and the risk of daily cannabis, cigarette, and e-cigarette use among Canadian secondary school students., Methods: We used individual-level survey data from Year 6 (2018/19) of Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary Behavior (COMPASS) and area-level data from the 2016 Canadian Census. Three-level logistic models were used to assess the relationship between income inequality and adolescent daily and current cannabis use, cigarette smoking, and e-cigarette use., Results: The analytic sample included 74,501 students aged 12-19. Students were most likely to report being male (50.4%), white (69.1%), and having weekly spending money over $100 (23.5%). We found that a standard deviation unit increase in Gini coefficient was significantly associated with increased likelihood of daily cannabis use (OR=1.25, 95% CI = 1.01-1.54) when adjusting for relevant covariates. We found no significant relationship between income inequality and daily smoking. While Gini was not significantly associated with daily e-cigarette use, we observed a significant interaction between Gini and gender (OR=0.87, 95% CI= 0.80-0.94), indicating that increased income inequality was associated with higher risk of reporting daily e-cigarette use among females only., Discussion: An association between income inequality and the likelihood of reporting daily cannabis use across all students and daily e-cigarette use in females were observed. Schools in higher income inequality areas may benefit from targeted prevention and harm reduction programs. Results emphasize the need for upstream discussion on policies that can mitigate the potential effects income inequality., Competing Interests: Declarations of Interest None declared., (Copyright © 2023. Published by Elsevier B.V.)

Purpose: According to the social determinants of health framework, income inequality is a potential risk factor for adverse mental health. However, few studies have explored the mechanisms suspected to mediate this relationship. The current study addresses this gap through a mediation analysis to determine if social support and community engagement act as mediators linking neighbourhood income inequality to maternal anxiety and depressive symptoms within a cohort of new mothers living in the City of Calgary, Canada., Methods: Data collected at three years postpartum from mothers belonging to the All Our Families (AOF) cohort were used in the current study. Maternal data were collected between 2012 and 2015 and linked to neighbourhood socioeconomic data from the 2006 Canadian Census. Income inequality was measured using Gini coefficients derived from 2006 after-tax census data. Generalized structural equation models were used to quantify the associations between income inequality and mental health symptoms, and to assess the potential direct and indirect mediating effects of maternal social support and community engagement., Results: Income inequality was not significantly associated with higher depressive symptoms (β = 0.32, 95%CI = -0.067, 0.70), anxiety symptoms (β = 0.11, 95%CI = -0.39, 0.60), or lower social support. Income inequality was not associated with community engagement. For the depression models, higher social support was significantly associated with lower depressive symptoms (β = -0.13, 95%CI = -0.15, -0.097), while community engagement was not significantly associated with depressive symptoms (β = 0.059, 95%CI = -0.15, 0.27). Similarly, for the anxiety models, lower anxiety symptoms were significantly associated with higher levels of social support (β = -0.17, 95%CI = -0.20, -0.13) but not with higher levels of community engagement (β = 0.14, 95%CI = -0.14, 0.41)., Conclusion: The current study did not find clear evidence for social support or community engagement mediating the relationship between neighbourhood income inequality and maternal mental health. Future investigations should employ a broader longitudinal approach to capture changes in income inequality, potential mediators, and mental health symptomatology over time., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

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.)

Objective: To examine associations between utilitarian walking, utilitarian cycling, leisure time physical activity and body mass index (BMI)., Methods: Participants from the National Population Health Survey (NPHS) of Statistics Canada were interviewed by telephone every two years from 1994 to 2010. Analysis includes data from 6894 living participants aged 18-64years. Fixed effects and random intercepts models examined the association between BMI, utilitarian walking, and utilitarian cycling, controlling for behavioral and sociodemographic factors., Results: The final adjusted fixed effects models showed no significant relationship between utilitarian walking and BMI. In the unbalanced sample utilitarian cycling for 1 to 5h per week (b=-0.15, 95% CI: -0.28 to -0.02), and more than 5h per week (b=-0.22, 95% CI: -0.44 to 0.00) was significantly associated with BMI over time. In the fully balanced sample utilitarian cycling for 1 to 5h per week (b=-0.12, 95% CI: -0.27 to 0.03), more than 5h per week (b=-0.16, 95% CI: -0.45 to 0.13) was not significantly associated with BMI over time., Conclusion: The results suggest that utilitarian walking is not related to BMI. The relationship between utilitarian cycling and BMI is less clear., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objectives: Non-fatal overdose remains a significant source of morbidity among people who inject drugs (IDU). Although depression and social support are important in shaping the health of IDU, little is known about the relationship between these factors and overdose. Therefore, we sought to determine whether depressive symptoms and social support predicted non-fatal overdose among IDU in a Canadian setting., Methods: Data were derived from three prospective cohorts of people who use drugs: the Vancouver Injection Drug Users Study (VIDUS), the ACCESS Cohort, and the At-Risk Youth Study (ARYS). Multilevel modeling was used to determine if depression and social support were significant predictors of non-fatal overdose across time. Analyses were stratified by sex., Results: There were 1931 participants included in this analysis, including 653 (33.8%) females and 69 (3.6%) youth 20 years old or younger. Depressed men (adjusted odds ratio [AOR]=1.53, 95% confidence intervals [CI]=1.25, 1.87) and women (adjusted odds ratio [AOR]=2.23, 95% confidence intervals [CI]=1.65, 3.00) were more likely to experience a non-fatal overdose. Further, among women, those who reported having 3 or more persons they could rely upon for social support were less likely to experience a non-fatal overdose (AOR=0.54, 95% CI 0.31, 0.93)., Conclusion: Although depression was a significant predictor of non-fatal drug overdose, social support was a significant predictor among women only. Possible strategies to prevent non-fatal overdose may include identifying IDU experiencing severe depressive symptoms and providing targeted mental health treatments and mobilizing interpersonal social support among IDU, especially among women., (Copyright © 2013 Elsevier Ireland Ltd. 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.

Background: Concern has been raised regarding the increased prevalence of physical inactivity among children. Active transportation, such as walking and cycling to school, is an opportunity for children to be physically active., Objective: To identify the sociodemographic predictors of active transportation to schools across time among school-aged children participating in the Canadian National Longitudinal Survey of Children and Youth (NLSCY)., Methods: The sample included 7690 school-aged children attending public schools who were drawn from cycle 2 (1996 and 1997) of the Canadian NLSCY. Data were collected through interviews with the person most knowledgeable about the child. Parents were asked how their child usually gets to school. Responses were dichotomized into active (walking or bicycling) or inactive (school bus, public transit, is driven, or multiple) modes. Using 3 waves of data from the Canadian NLSCY (1996-2001), we estimated the effect of sociodemographic factors on the likelihood of active transportation to school across time using random-effects models., Results: Longitudinal analyses indicated that as children aged, the likelihood of using active transportation to school increased, peaked at the age of 10 years, and then decreased. Urban settings (odds ratio [OR]: 3.66 [95% confidence interval (CI): 3.23-4.15]), households with inadequate income (OR: 1.21 [95% CI: 1.06-1.38]), living with 1 parent (OR: 1.46 [95% CI: 1.29-1.65]), and having an older sibling living at home (OR: 1.14 [95% CI: 1.04-1.25]) were significant predictors of active transportation to school at baseline and carried through across time., Conclusions: Understanding the factors that influence active transportation may support its adoption by children, which in turn may contribute to meeting physical activity guidelines.