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Objective: To compare the prevalence and trajectories of risky health behaviors in sexual minority (SM; lesbian/gay/bisexual/questioning/asexual) versus heterosexual undergraduates across their first year of post-secondary. Participants: First-year undergraduates (N = 704, M[subscript age] = 17.97 years, 24% SM) from a midsized Canadian university. Methods: Students completed monthly (September-April) online questionnaires assessing substance use (binge drinking, tobacco, cannabis, illicit drug use) and disordered eating (binge eating, fasting, purging). Results: At the outset of the academic year, SM students endorsed more frequent cannabis use, illicit drug use, fasting, and binge eating, but less frequent tobacco use, versus heterosexual students. Over the year, SM students' binge drinking frequency declined less than that of heterosexual students, but their illicit drug use decreased while that of their heterosexual peers increased, and all students reported declining disordered eating frequency. Conclusions: Campus wellness initiatives for SM students should offer prevention and harm-reduction strategies prior to or shortly after their arrival on campus.

Canadian young adults who identify as Two Spirit, lesbian, gay, bisexual, trans, queer, intersex (2SLGBTQI+) have higher smoking rates compared to their straight cisgender counterparts. One of the reasons for this trend is the perceived social acceptability of smoking and how it relates to stress, mental health and social connections. A sequential mixed-methods study was conducted with qualitative focus groups, followed by quantitative survey data collection starting in the spring of 2020, examining perceptions of both smoking and vaping. Results demonstrate higher social acceptability of vaping compared to smoking in the study sample. Qualitative results showed a strong link between the higher acceptability of smoking and vaping with coping and social connections. Quantitative results indicated that higher smoking acceptability was more common among those who currently smoke, currently vape, are younger, live in smaller cities, identify as a person of color, with variation by gender and sexual orientation; vaping was found to be more acceptable among those who currently smoke, currently vape, were younger participants, and have some post-secondary education. This research is important for the development of prevention and cessation programs in addressing both the negative and positive dimensions affecting smoking among 2SLGBTQI+young adults.

Public health campaigns have the potential to correct vaping misperceptions. However, campaigns highlighting vaping harms to youth may increase misperceptions that vaping is equally/more harmful than smoking. Vaping campaigns have been implemented in the United States and Canada since 2018 and in England since 2017 but with differing focus: youth vaping prevention (United States/Canada) and smoking cessation (England). We therefore examined country differences and trends in noticing vaping campaigns among youth and, using 2022 data only, perceived valence of campaigns and associations with harm perceptions. Seven repeated cross-sectional surveys of 16-19 year-olds in United States, Canada and England (2018-2022, n = 92 339). Over half of youth reported noticing vaping campaigns, and noticing increased from August 2018 to February 2020 (United States: 55.2% to 74.6%, AOR = 1.21, 95% CI = 1.18-1.24; Canada: 52.6% to 64.5%, AOR = 1.13, 1.11-1.16; England: 48.0% to 53.0%, AOR = 1.05, 1.02-1.08) before decreasing (Canada) or plateauing (England/United States) to August 2022. Increases were most pronounced in the United States, then Canada. Noticing was most common on websites/social media, school and television/radio. In 2022 only, most campaigns were perceived to negatively portray vaping and this was associated with accurately perceiving vaping as less harmful than smoking among youth who exclusively vaped (AOR = 1.46, 1.09-1.97). Consistent with implementation of youth vaping prevention campaigns in the United States and Canada, most youth reported noticing vaping campaigns/messages, and most were perceived to negatively portray vaping.

The current study assessed whether risk factors associated with vaping were distinct from risk factors associated with other substance use (e.g., alcohol, cannabis) during adolescence. Participants (N = 848, ages 10-16 years) completed a self-report survey to assess frequency and age of onset of substance use, risk perceptions of use, risk factors (depressive symptoms, sensation seeking, and parent-reported factors), and vape nicotine content. Groups were created to differentiate types of substance use, and frequency of substance use. Overall, adolescents who only vaped had lower depressive symptoms and indicated less nicotine vape use than adolescents who vaped and used other substances. Experimental vapers perceived other substances (but not vaping) as risky and endorsed vaping nicotine less often than regular vapers. Early initiation of vaping was not associated with polysubstance use. Taken together, our findings offer important implications for how vaping can be differentiated from other substance use during adolescence.

The current study explores the motivations underlying tobacco use among varsity athletes. A cross-sectional exploratory mixed method approach was used. Both tobacco users (TU) and non-tobacco users (NTU) completed an online survey of closed and open-ended questions. These questions focused on tobacco use, motivations for tobacco use, teammate and coaches' perceptions of athlete tobacco use, and self-perceived effects of tobacco use on health and athletic performance. Thirty-eight completed surveys were included of which 12 were TU and 26 were NTU. The majority of TU indicated that they used products during the off-season. Motivations for using tobacco products included social influences, stress-relief, and increasing energy. TU mostly indicated that there are negative effects on their health but not on their athletic performance, whereas NTU reported potential detrimental effects on their teammate's performance. Overall, varsity athletes who use tobacco products are aware of the health effects and negative opinions of their teammates.

Introduction: An association between socioeconomic status (SES) and smoke-free private spaces among smokers could be due to heavier smoking among low SES smokers. We assessed whether quantity smoked or SES are independently associated with smoke-free homes or cars in daily smokers. Method: Data were drawn from a cross-sectional telephone survey (2011-2012) of 750 daily smokers age [greater than or equal to]18 years in Quebec, Canada (45% response). Multivariable logistic regression was used to model the independent association between (a) number of cigarettes smoked per day, and (b) each of educational attainment, annual household income, or active employment status and smoke-free homes or cars. Results: Participants were 41.0 years old on average, 57% were female. Median (IQR) number of cigarettes smoked per day was 14 (10, 20). Forty-eight percent of participants reported smoke-free homes; 34% reported smoke-free cars. Quantity smoked was strongly associated with both smoke-free homes and cars. Income and education (but not actively employed) were associated with smoke-free homes. None of the SES indicators were associated with smoke-free cars. Conclusions: Interventions targeting smokers to promote smoke-free homes and cars should incorporate components to help smokers reduce quantity smoked or preferably, to quit. Interventions targeting smoke-free homes will also need to address SES inequalities by education and income. Our data suggest that reduction in quantity smoked may help smokers reduce SHS exposure in cars, but that an inequality lens may not be relevant.

Previous research indicates that the disproportionate distribution of income within society is associated with aggression and violence. Although research has been conducted identifying the relationship between income inequality and bullying victimization and perpetration, little is known about possible mediators. We investigated the association between income inequality and bullying perpetration and victimization among adolescents participating in the Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behavior (COMPASS) study. We identified whether school connectedness and psychosocial well-being mediated the relationship between income inequality and bullying behavior. This study used pooled cross-sectional data from 147,748 adolescents aged 13 to 18 from three waves (2015-2016, 2016-2017, 2017-2018) of the COMPASS study from 157 secondary schools in British Columbia, Alberta, Ontario, and Quebec (Canada). The Gini coefficient was calculated based on the school Census Divisions (CD) using the Canada 2016 Census and linked with student data. We used multilevel modeling to investigate the relationship between income inequality and self-reported bullying victimization and perpetration, while controlling for individual-, school-, and CD-level characteristics. A standard deviation increase in Gini coefficient was associated with increased odds for bullying victimization and perpetration. Findings were observed among girls; however, inequality was only associated with perpetration among boys. We identified social cohesion and psychosocial well-being as potential mediators. To counter the adverse effects of income inequality, school-based interventions designed to increase school connectedness and student psychosocial well-being should be implemented to protect against bullying.

Objective: This study examined the prevalence and factors associated with non-medical use of prescription stimulants to promote wakefulness. Participants: We surveyed 3,160 university students aged 18-35 between June 2016 and May 2017. Method: Participants reported whether they used prescription stimulants non-medically to stay awake and completed measures of anxiety and depressive symptoms, sleep quality, insomnia, daytime sleepiness, and attitudes toward non-medical prescription drug use. Univariate and multivariate regression models were used. Results: Prevalence of non-medical prescription stimulant use to promote wakefulness was 3.1%. The following factors remained significant in the multivariate model: alcohol, tobacco, and nicotine vapor use, attitude toward non-medical use of prescription medication, poor sleep quality, and daytime sleepiness. Conclusion: Poor sleep, substance use and more liberal attitudes to non-medical prescription drug use were associated with the misuse of stimulants to promote wakefulness. Prevention/intervention programs should promote sleep hygiene and highlight the risks of using prescription drugs non-medically.

The purpose of the study was to describe adherence to screen time (ST) and physical activity (PA) recommendations among Canadian youth. The present study was based on a representative sample of Canadian students from Grades 7 through 12 (N = 47,203). ST and PA as well as demographic (gender, ethnicity, grade, and province of residence) and individual (alcohol, tobacco and cannabis usage, school connectedness) correlates were self-reported by youth. In total, 49.2% (99% confidence interval [CI] = [46.3%, 52.2%]) of participants respected none of the recommendations, while 40.2% (99% CI [37.0%, 43.3%]) and 20.8% (99% CI [19.2%, 22.4%]) respected PA or ST recommendations, respectively. In terms of the correlates of health-related behavior, White ethnicity, alcohol use, and feeling more connected to school were positively correlated with adherence. Attending school in Quebec and smoking cannabis increased risk of poor compliance. The present findings may help the design of school-based health promotion strategies designed to increase PA and reduce ST.

E-Cigarette marketing may influence e-cigarette use among youth. This study examined reported exposure to and perceptions of e-cigarette marketing among youth between 2017 and 2019 across countries with varying e-cigarette marketing restrictions. Cross-sectional online surveys were conducted with 35 490 youth aged 16-19 from England, Canada and the United States in 2017, 2018 and 2019. Weighted logistic regression models examined trends in the adjusted prevalence of self-reported exposure to e-cigarette marketing and the perceived appeal of e-cigarette ads between 2017 and 2019, by country and by smoking/vaping status. Reports of frequent exposure to e-cigarette marketing increased between 2017 and 2019 in all countries, but less so in England, where e-cigarette marketing is more restricted. Perceiving e-cigarette marketing as appealing increased from 2017 to 2019 in Canada and the United States, but not in England. In England, exposure to e-cigarette marketing did not increase in prohibited channels between 2017 and 2019. Between 2017 and 2019, never-users' reports increased for exposure to and appeal of e-cigarette marketing. The results suggest some effectiveness of e-cigarette marketing bans in England and receptivity to e-cigarette marketing among youth never users.

Autistic individuals may be at risk of premature mortality, and physical health comorbidity increases this risk; however, most studies fail to include older autistic adults or consider lifestyle-related factors that affect health. We developed an anonymous, online physical health survey. The final sample included n = 2368 individuals (mean age = 41.42), and of these, n = 1156 were autistic individuals (mean age = 40.98). We utilized three sex-stratified statistical models to determine the prevalence of cancer, cardiovascular conditions, respiratory conditions, and diabetes. All three models indicate that autistic females are more likely to have cardiovascular conditions, respiratory conditions, asthma, low blood pressure, arrhythmias, and prediabetes than non-autistic females, and autistic males are more likely to have arrhythmias than non-autistic males; these results suggest that autistic individuals carry increased risks for these conditions when compared to the general population, even after controlling for age, ethnicity, education level, body mass index, smoking, and alcohol use. Further, these risks may differ depending on biological sex for autistic individuals. Autistic adults, and particularly autistic females, have greater and wider-ranging risks than previously thought, even after controlling for demographic and lifestyle-related factors. Although this is a large sample of autistic adults across the lifespan, future research should employ larger, population-based samples to confirm these findings.

The present paper assesses the causal effects of education on smoking and self-rated health in Canada. Education is instrumented using the changes in compulsory schooling laws. The sample is restricted to cohorts born between 1946 and 1964. The data are from the Canadian General Social Surveys of 1995 and 2016, allowing to observe the evolution of the gradient over the life course. The gradient is confirmed for smoking and self-rated health in correlational estimations, with stronger associations among males in later life. However, the IV regressions produce no evidence for a causal relationship.

Purpose: Over the years, many upstream health policies have sought to reduce smoking across populations. While smoking has been substantially reduced, the effects of these policies on education-smoking gradient remain unclear. The present paper compares the education-smoking gradient among the Generation X and the millennials, who grew up with different types of upstream policies. Design/methodology/approach: The study relies on regression analysis. The data are from the Canadian Tobacco, Alcohol and Drugs Survey of 2017, with the sample restricted to those born between 1965 and 1995. Findings: At the zero-order, the education-smoking gradient has not significantly flattened from Generation X to millennials. And, accounting for the channels of impact of education on smoking does not substantially change this pattern. Social implications: The implications for health inequalities associated with socioeconomic status, and tobacco consumption reduction policies, are discussed. Originality/value: This paper is the first study of the kind using Canadian data.

Background: Bullying has been associated with several adverse health outcomes, including substance use. However, little is known about the association between bullying and e-cigarette use. This study examined the association between bully victimization and the frequency of e-cigarette use. Methods: Data from the 2016-2017 Canadian Student Tobacco, Alcohol and Drugs Survey were used (N = 49,543). The target population consists of Canadian students enrolled in grades 7-12. Multivariable logistic regression models were used to examine the association between bullying victimization status and e-cigarette use. Results: Among the students included in the study, 14.1% were bullied less than once a week. Bullying victimization was statistically significantly associated with higher odds of any e-cigarette use in the last 30 days. Likewise, those bullied daily or almost daily were more likely to use e-cigarettes more frequently compared to students not bullied. We found a statistically significant difference in analysis stratified by sex, with female bullying victims having higher odds of all measures of e-cigarette use. Conclusions: Bullying victims were significantly more likely to use an e-cigarette, and findings appeared to vary by sex. Female bullying victims had a higher likelihood of e-cigarette use.

This study examines the conceptualization of risk behavior held by 26 Franco-Ontarian young adolescents (12-14 years of age) who participated in Lions Quest, a program specially designed to promote physical and mental health and to prevent drug and alcohol use. More specifically, it seeks to better understand the participating adolescents' conception of risk and protective factors in a linguistic minority context, with the eventual purpose to prevent or delay alcohol and drug use. A qualitative methodology mainly based on semi-structured interviews generated discussion around a variety of dimensions related to risky behaviors, extreme and dangerous risks, positive and negative risks, social and physical risks. The adolescents hardly mentioned drug, alcohol, and cigarette use. However, they were aware of the risks of consumption and dependence.

Our longitudinal, qualitative study with 29 pregnant adolescents who smoke used a Participatory Action Research (PAR) approach to understand experiences and the function of tobacco through pregnancy to 6 months postpartum. The young women described complex lives of overlapping oppressions interspersed with expressions of resistance; these were lived experiences on the threshold of both adulthood and an anticipated better life. Our research implicated tobacco use as a value laden action at the border of oppression and resistance. Thinking about tobacco as a component of and a flag for oppression, we combined a gender based focus with the social ecological model to create a rich understanding of the opportunities for designing equitable interventions that address a range of interconnected influences on an adolescent mother's health. Opportunities for interventions open briefly in the space between the early idealism displayed by adolescent mothers and the impinging potential reality of oppressive life trajectories.

Background: Ninety percent of smokers report having their first whole cigarette before the age of 19. Policies, such as youth access laws, are essential to prevent youth from becoming future smokers. In Canada, the Tobacco Act prohibits retailers from furnishing tobacco products to individuals under the age of 18. These laws can only be effective when retailers comply with them. This paper investigates the effect of retailer compliance on youth smoking behavior. Methods: Data on individual smoking behavior in conjunction with provincial retailer compliance rates and cigarette prices for the years 1999-2005 were employed to examine the effects of retailer compliance on youth smoking participation and consumption. Results: Both price and retailer compliance were significant predictors of smoking participation. A large portion of participants endorsed obtaining their cigarettes through social means. Price elasticity of demand for the overall sample was estimated to be -0.54. Conclusions: Consistent with previous literature, our results found that retailer compliance is an essential component to the successful implementation of youth access laws. Given that youth access laws and retailer compliance did not quell social access to cigarettes, there is an apparent need within schools and communities to reduce the social sale of tobacco products.

The aim of the study was to determine if a culturally sensitive smoking prevention program would have short-term impacts on smoking intentions among Aboriginal children. Two schools with high Aboriginal enrollment were selected for the study. A grade 4 classroom in one school was randomly assigned to receive the culturally sensitive smoking prevention program. A grade 4 classroom in the second school received a standard smoking prevention program delivered in this jurisdiction. Children in each classroom were tested pre- and post-intervention to measure attitude changes about smoking. There was a significant reduction in intentions to smoke among Aboriginal children who received the culturally sensitive smoking prevention program. The small overall sample size precluded a direct comparison of the efficacy of the culturally sensitive and standard programs. The present findings suggest a smoking prevention program that has been culturally adapted for Aboriginal children may reduce future smoking intentions among Aboriginal grade 4 students. Further research is needed to determine the extent to which school smoking prevention programs adapted to respect the long-standing use of tobacco in Aboriginal cultural traditions may be more effective than standard programs in reaching Aboriginal youth. (Contains 1 footnote and 2 tables.)

The hookah pipe is an ancient tool for smoking tobacco and is a growing public health concern at the global level. YouTube is a website that allows its members to post videos for people to watch and to share comments about the videos in an online forum. The purpose of the study was to investigate the types of videos about hookah on YouTube, their popularity, and the demographics of those who post and view the videos. YouTube was searched using the terms "hookah" and "shisha." Two independent reviewers watched each video and created categories based upon content, being Instructional, Review, Trick, Comedy, Commercial, or Health. Popularity was measured by viewer ratings and by the number of times each video was viewed in a 30-day period. Demographic information was obtained from YouTube. Findings suggested that hookah videos are viewed frequently, rated positively, most often feature and are viewed by young males in nearly every nation in the world, meaning, these videos are an international phenomenon and provides evidence of hookah's growing popularity across the globe. Health professionals should consider creating and posting videos that provide the YouTube audience with evidence-based information about the harmfulness of smoking hookah. (Contains 2 tables and 1 figure.)

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

Taxation of tobacco is a widely used strategy that promotes smoking cessation among adults and reduces cigarette consumption among continuing smokers. First Nations (FN) populations' tobacco use is estimated to be 2-3 times that of other Canadians and, in part, a reflection that tobacco products purchased on reserve by FN people are tax exempt. The purpose of this paper is to present a commentary related to the implementation and impact of a tobacco tax within an FN community.

Background: Health warning labels (HWLs) on cigarette packs in Australia, Canada, Mexico, and the United States include varying information about toxic cigarette smoke constituents and smoking-related health risks. HWL information changed more recently in Australia, Canada, and Mexico than in the United States. Aims: To investigate whether smokers' knowledge of toxic constituents and perceived smoking-related risks increased after adding this information to HWLs and how knowledge of toxic constituents is associated with perceptions of smoking-related risks. Methods: Data come from a longitudinal, online cohort of 4,621 adult smokers surveyed every 4 months from September 2012 (Wave 1) to January 2014 (Wave 5) in Australia, Canada, and Mexico, with the United States being surveyed from Waves 2 to 5. Generalized estimating equation models estimated the association between perceived smoking-related risk at follow-up and prior wave knowledge of toxic constituents, adjusting for attention to HWLs, sociodemographics, and smoking-related characteristics. Results: Between 2012 and 2014, knowledge of toxic constituents increased in Australia, Canada, and Mexico (p < 0.001), but not in the United States. Higher levels of both attention to HWLs and knowledge of toxic constituents were associated with a higher perceived risk of smoking-related conditions at follow-up across all countries except for the United States. Conclusions: Our results suggest that information about toxic constituents on prominent HWLs not only increases smoker's knowledge of toxic constituents, but that it may also reinforce the effects of HWL messages about specific, smoking-related health outcomes.

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

Assessing societal impacts of research is more difficult than assessing advances in knowledge. Methods to evaluate research impact on policy processes and outcomes are especially underdeveloped, and are needed to optimize the influence of research on policy for addressing complex issues such as chronic diseases. Contribution analysis (CA), a theory-based approach to evaluation, holds promise under these conditions of complexity. Yet applications of CA for this purpose are limited, and methods are needed to strengthen contribution claims and ensure CA is practical to implement. This article reports the experience of a public health research center in Canada that applied CA to evaluate the impacts of its research on policy changes. The main goal was to experiment with methods that were relevant to CA objectives, sufficiently rigorous for making credible claims, and feasible. Methods were "good enough" if they achieved all three attributes. Three cases on government policy in tobacco control were examined: creation of smoke-free multiunit dwellings, creation of smoke-free outdoor spaces, and regulation of flavored tobacco products. Getting to "good enough" required careful selection of nested theories of change; strategic use of social science theories, as well as quantitative and qualitative data from diverse sources; and complementary methods to assemble and analyze evidence for testing the nested theories of change. Some methods reinforced existing good practice standards for CA, and others were adaptations or extensions of them. Our experience may inform efforts to influence policy with research, evaluate research impacts on policy using CA, and apply CA more broadly.

Health warning labels (HWLs) on cigarette packs that use strong fear appeals may evoke defensive responses including acts of disparaging the warnings. Whether warning disparagement undermines HWL effectiveness remains unclear. We assessed correlates of one type of HWL disparagement and its association with subsequent cessation attempts. Longitudinal data (2012-14) on adult smokers from Australia, Canada, Mexico and the United States (US) were analyzed. HWL disparagement was assessed as the frequency of making fun of HWLs in the past month. Using Generalized Estimating Equation models we estimated correlates of HWL disparagement and whether HWL disparagement predicted subsequent cessation attempts. In each country, across all waves, 24-31% of smokers reported making fun of the warnings at least once in the past month. More frequent disparagement was found among males, younger participants, those with higher education and greater addiction, and those who recently attempted to quit. Attention to, avoidance of and talking to others about HWLs were all positively associated with HWL disparagement. In all countries, except the US, this type of HWL disparagement was an independent predictor of subsequent cessation attempts. HWL disparagement among smokers may indicate greater warning relevance and processing and does not result in counterproductive effects on cessation efforts.

Background: Frequent fruit and vegetable (FV) consumption is protective against some cancers, cardiovascular disease, and other chronic diseases. This study explores self-reported frequency of FV consumption in a nationally generalizable sample of Canadian youth in grades 6-12. Methods: Data from grades 6-12 students who participated in the 2012-2013 Youth Smoking Survey (N?=?47,203) were used to examine frequency of FV consumption. Logistic regression models were fitted to examine differences in meeting national FV intake recommendations by sociodemographic, student, and regional characteristics. Results: Approximately 10% of Canadian grade 6-12 students met FV recommendations. Students in grades 6 and 7 had significantly higher odds of meeting recommendations relative to students in grades 8-12. Students who reported achieving "mostly As" on their report cards had significantly higher odds of meeting FV recommendations relative to those receiving As and Bs, Bs and Cs, or Cs (OR?=?0.71, OR?=?0.53, and OR?=?0.46, respectively, p?

This study examines the effects of different cigarette package warnings in Australia, Canada and the United Kingdom up to 5 years post-implementation. The data came from the International Tobacco Control Surveys. Measures included salience of warnings, cognitive responses, forgoing cigarettes and avoiding warnings. Although salience of the UK warnings was higher than the Australian and Canadian pictorial warnings, this did not lead to greater levels of cognitive reactions, forgoing or avoiding. There was no difference in ratings between the Australian and UK warnings for cognitive responses and forgoing, but the Canadian warnings were responded to more strongly. Avoidance of the Australian warnings was greater than to UK ones, but less than to the Canadian warnings. The impact of warnings declined over time in all three countries. Declines were comparable between Australia and the United Kingdom on all measures except avoiding, where Australia had a greater rate of decline; and for salience where the decline was slower in Canada. Having two rotating sets of warnings does not appear to reduce wear-out over a single set of warnings. Warning size may be more important than warning type in preventing wear-out, although both probably contribute interactively.

The aim of the present study was to assess smokers' level of agreement with smoking-related risks and toxic tobacco constituents relative to inclusion of these topics on health warning labels (HWLs). 1000 adult smokers were interviewed between 2012 and 2013 from online consumer panels of adult smokers from each of the three countries: Australia (AU), Canada (CA) and Mexico (MX). Generalized estimating equation models were estimated to compare agreement with smoking-related risks and toxic tobacco constituents. For disease outcomes described on HWLs across all three countries, there were few statistical differences in agreement with health outcomes (e.g. emphysema and heart attack). By contrast, increases in agreement where the HWLs were revised or introduced on HWLs for the first time (e.g. blindness in AU and CA, bladder cancer in CA). Similarly, samples from countries that have specific health content or toxic constituents on HWLs showed higher agreement for that particular disease or toxin than countries without (e.g. higher agreement for gangrene and blindness in AU, higher agreement for bladder cancer and all toxic constituents except nitrosamines and radioactive polonium in CA). Pictorial HWL content is associated with greater awareness of smoking-related risks and toxic tobacco constituents.

Background: As youth struggle with anxiety and depression, promoting positive mental fitness is a primary concern. Canadian school-based mental health programs that focus on positive psychology and positive mental health initiatives emphasize safe and supportive environments, student engagement, resilience, and self-determination. This study examined predictors of mental fitness and its 3 components (autonomy, competence, and relatedness). Methods: School Health Action Planning and Evaluation System-Prince Edward Island (SHAPES-PEI) and the New Brunswick Student Wellness Survey (NB SWS) are data collection and feedback systems that survey youth about 4 health behaviors. Grade 7-12 students in Prince Edward Island (N?=?3318) and New Brunswick (N?=?7314) completed a mental fitness questionnaire in 2008-2009 (PEI) and 2006-2007 (NB). Four linear regression models were conducted to examine student characteristics associated with mental fitness, autonomy, competence, and relatedness. Results: Positive associations were found between school connectedness (p?

Background: This study explores the patterns of use and co-use of tobacco and cannabis among Ontario adolescents over 3 decades and if characteristics of co-users and single substance users have changed. Methods: Co-use trends for 1981-2011 were analyzed using the Centre for Addiction and Mental Health Ontario Student Drug Use and Health Survey, which includes 38,331 students in grades 7, 9, and 11. A co-user was defined as someone reporting daily tobacco and/or cannabis use in the past month. Trends over time (by gender and academic performance) were analyzed with logistic regression. Results: The prevalence of tobacco-only use, cannabis-only use, and co-use fluctuated considerably. During 1981-1993, there were more tobacco-only users than co-users and cannabis-only users; since 1993 the prevalence of tobacco use has decreased dramatically. Co-use prevalence peaked at 12% (95% confidence interval: 9, 15) in 1999, when prevalence of overall use of both substances was highest. In 2011, 92% of tobacco users also used cannabis, up from 16% in 1991. Conclusions: In 2011 nearly all students who smoke tobacco daily also use cannabis. Non-regular use of either substance is highest now compared with the past 3 decades. Contemporary tobacco and cannabis co-users are significantly different than past users. Youth prevention programs should understand the changing context of cannabis and tobacco among youth.

Objective: To examine gender differences in the association between beliefs in heart disease preventability and 10-year incidence of coronary heart disease (CHD) in a population-based sample. Methods: A total of 2,688 Noninstitutionalized Nova Scotians without prior CHD enrolled in the Nova Scotia Health Study (NSHS95) and were followed for 10 years. Risk factors, health behaviors, and incident CHD were assessed. Participants responded "yes" or "no" to a question about heart disease preventability. Survival models, adjusted for age, income, total and high-density lipoprotein cholesterol, and systolic blood pressure, were used to estimate the relation between health belief and incident CHD. Gender differences in the relation between health beliefs and health behaviors were assessed. Results: Gender was a significant moderator of the relation between belief and CHD incidence; specifically, women who believed heart disease could be prevented were less likely to have incident CHD events compared with women who believed heart disease could not be prevented (hazard ratio [HR] = 0.36, 95% confidence interval [CI] = 0.24-0.55, probability less than 0.001). This relation was not found for men. Belief was also related to smoking behavior for women (Beta = -0.70, odds ratio [OR] = 0.50, 95% CI = 0.33-0.74, probability = 0.001) but not for men. Smoking significantly mediated the relation between health beliefs and incident CHD for women (z = -1.96, probability = 0.05), but not for men. Conclusion: Health belief in prevention and subsequent smoking was an important independent predictor of incident CHD in women but not in men. (Contains 2 tables and 3 figures.)

Smoking bans offer practical protection against environmental tobacco smoke and highlight the decreasing normative status of smoking. At Canadian universities, indoor smoking is now completely prohibited, but regulations vary with respect to outdoor smoking. The purpose of this research was to conceptualize the interactions of smoking bans on campus with changing social norms around smoking. Interviews were conducted with 36 key informants, exploring the development and normative significance of smoking bans at three case study institutions. Five key themes were identified in the transcripts. First, universities were understood as community leaders and role models. Second, they were viewed as institutions with a mandate to promote health. Third, students were generally perceived to view smoke-free environments and lifestyles as normative. Fourth, respondents also acknowledged that students remain vulnerable to social and behavioural influences that can encourage smoking. Finally, they articulated bans' normative effects: restricting where smoking occurs on campus may discourage initiation and support cessation. Our findings suggest that health-promoting policies, such as smoking bans, can be motivated by changes in social norms and that their implementation reinforces this norm shift. Moreover, the contextual and compositional characteristics of universities mean they are uniquely placed to adopt such initiatives.

The purpose of this study was to examine both the family antecedents and the outcomes of early puberty, with a particular focus on factors related to family socioeconomic status (SES). The study employed a comprehensive measurement of pubertal development and longitudinal data from the Canadian National Longitudinal Survey of Children and Youth. The sample (N = 8,440; 49% girls) included four cohorts of children who were followed biennially for 10 years, starting from age 4-11 to 14-21 years. Data were drawn at different years of age from these cohorts of children. Girls whose fathers were unemployed were more likely to experience early puberty than those whose fathers were employed. For boys, those living with fathers who had not finished secondary school were more likely to experience early puberty. Early maturing girls tended to engage in smoking and drinking at an earlier age compared with their peers. These findings provide support for psychosocial acceleration theory and suggest that different aspects of low family SES may act as a psychosocial stress for early pubertal maturation in boys versus girls, which may lead to engagement in drinking and smoking at a younger age, at least for girls.

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

There is a strong empirical connection between individual and peer substance use during adolescence. The determination of whether this level of covariation reflects influence or selection is obscured by both the design and measurement strategies used. This present study utilizes a short-term longitudinal design with bi-monthly assessments to address the following two hypotheses: a) Adolescents select friends on the basis of their substance use, and b) New friend substance use predicts changes in future use. French Canadian adolescents (n = 143) were interviewed on their friendship networks and substance use behaviors (e.g., tobacco, alcohol and marijuana) four times during a school year. Cross-lag panel models revealed that adolescents who use substances tend to select new friends who use. Moreover, once in the network, these new friends also contribute to changes in the adolescents' substance use. These findings are relevant to understanding the multiple functions of adolescent substance use. (Contains 1 table and 1 figure.)

Background: Young adults remain the earliest legal target for the tobacco industry. Against this, the existence of smoking policies would appear to offer some protection to students on campus. However, little research has been conducted into the outcomes of such policies from a student perspective. Methods: The authors conducted 8 focus groups at 4 selected Canadian undergraduate campuses to investigate student perceptions and behaviors resulting from campus smoking policies. Results: Results indicated that student smoking behaviors are minimally impacted by campus smoking policies due to seriously compromised implementation and enforcement. Conclusions: These findings imply that the presence of campus smoking policies and claims of "smoke-free" campuses should not be misinterpreted as achievement and without renewed focus and adequate tobacco control infrastructure, it will remain possible for young adults to initiate and maintain tobacco smoking on campus. (Contains 1 table.)

Propensity score methods allow investigators to estimate causal treatment effects using observational or nonrandomized data. In this article we provide a practical illustration of the appropriate steps in conducting propensity score analyses. For illustrative purposes, we use a sample of current smokers who were discharged alive after being hospitalized with a diagnosis of acute myocardial infarction. The exposure of interest was receipt of smoking cessation counseling prior to hospital discharge and the outcome was mortality with 3 years of hospital discharge. We illustrate the following concepts: first, how to specify the propensity score model; second, how to match treated and untreated participants on the propensity score; third, how to compare the similarity of baseline characteristics between treated and untreated participants after stratifying on the propensity score, in a sample matched on the propensity score, or in a sample weighted by the inverse probability of treatment; fourth, how to estimate the effect of treatment on outcomes when using propensity score matching, stratification on the propensity score, inverse probability of treatment weighting using the propensity score, or covariate adjustment using the propensity score. Finally, we compare the results of the propensity score analyses with those obtained using conventional regression adjustment. (Contains 4 tables and 5 figures.)

Objective: To study actual and perceived substance use in Canadian university students and to compare these rates with US peers. Participants: Students (N = 1,203) from a large Canadian university. Methods: Participants were surveyed using items from the National College Health (NCHA) Assessment of the American College Health Association questionnaire. Results: Alcohol was the most common substance used (65.8%), followed by marijuana (13.5%) and cigarettes (13.5%). Substance use and norms were significantly less than the NCHA US data. Overall, respondents generally perceived the typical Canadian student to have used all 3 substances. Perceived norms significantly predicted use, with students more likely to use alcohol, cigarettes, or marijuana if they perceived the typical student to use these substances. Conclusions: Similar to their US peers, Canadian university students have inaccurate perceptions of peer substance use. These misperceptions may have potentially negative influences on actual substance use and could be a target for intervention. Further research examining the cross-cultural differences for substance abuse is warranted. (Contains 3 tables and 1 figure.)

The influence of using substances with friends on future individual use was examined in the context of parental monitoring rules and the ecology of peer activities. A 1-year longitudinal study design included a combined sample of North Italian and French Canadian adolescents (N = 285, 53% girls, M = 14.25 years). Data analyses were conducted using structural equation modeling and multiple regression analyses. As expected, the covariation between parental monitoring and adolescent substance use was mediated by "co-use" with friends. Moreover, the relation between substance use with friends and individual substance use was moderated by parental monitoring rules and the peer activity context. Specifically, the relation between substance co-use with friends and individual substance use was stronger when the level of parental monitoring rules was low and when friends spent their time together primarily in unstructured contexts such as on the street or in park settings. These findings underline the importance of adults' use of rules to monitor adolescents prone to substance use, and the role of context in facilitating or reducing peer influence. (Contains 2 figures and 5 tables.)

Although cultural and subcultural differences during the transition to adulthood have been examined, important factors like rural/urban upbringing and gender differences among Canadian emerging adults have been neglected. The present study explored developmentally significant tasks including criteria for adulthood, beliefs about religiosity, and risk-taking behaviors among 287 male and female Canadian emerging adults from rural and urban backgrounds. Results revealed that compared to their urban counterparts, rural emerging adults were more likely to place importance on role and biological transitions as criteria for achieving adulthood, and engaged in more risk-taking behaviors (excluding smoking). Female emerging adults were more likely to believe in the importance of role transition, norm compliance, and family capacities compared to males, and were more likely to smoke. In contrast, males were more likely than females to espouse the importance of biological transitions and engage in non-smoking risk behaviors. These findings were interpreted in light of sociocultural and gender socialization differences among emerging adults from rural and urban upbringings. (Contains 1 table.)

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

The objective of this study was determine if the inclusion of Canadian-style graphic images would improve the degree to which adolescents attend to, and subsequently are able to recall, novel warning messages in tobacco magazine advertising. Specifically, our goal was to determine if the inclusion of graphic images would 1) increase visual attention, as measured by eye movement patterns and fixation density, and 2) improve memory for tobacco advertisements among a group of 12 to 14 year olds in the western United States. Data were collected from 32 middle school students using a head-mounted eye-tracking device that recorded viewing time, scan path patterns, fixation locations, and dwell time. Participants viewed a series of 20 magazine advertisements that included five U.S. tobacco ads with traditional Surgeon General warning messages and five U.S. tobacco ads that had been modified to include non-traditional messages and Canadian-style graphic images. Following eye tracking, participants completed unaided- and aided-recall exercises. Overall, the participants spent equal amounts of time viewing the advertisements regardless of the type of warning message. However, the warning messages that included the graphic images generated higher levels of visual attention directed specifically toward the message, based on average dwell time and fixation frequency, and were more likely to be accurately recalled than the traditional warning messages. (Contains 2 tables, 2 figures and 1 footnote.)

The college years occur during the stage of life when many people develop permanent smoking habits, and approximately one-third go on to become addicted smokers. The 18-24 year demographic that makes up the majority of undergraduate attendees represents the earliest years that the tobacco industry now can legally attempt to lure new customers into smoking. This research investigated the ways in which university tobacco control policies are developed, introduced to students, faculty and staff and how they are implemented and enforced. Findings show that tobacco control initiatives at Canadian undergraduate universities face a wide range of challenges including a lack of dedicated and consistent tobacco control personnel, ownership issues, funding, enforcement and monitoring dilemmas. Participants also reported that the layout and geographic location of the campus can result in difficulties in implementation. Consequently, it appears that there may be a growing, although inadvertent, tolerance for smoking on Canadian campuses.