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Aim: Little is known about what youth think about restricting smoking in their homes or in cars. The present study characterises the frequency of youth being exposed to smoking in their homes and cars, and the beliefs that youth have about restricting people from smoking around youth in those locations. Methods: Data from the 2004 Youth Smoking Survey (YSS) were used to examine youth exposure to smoking and beliefs about smoking in the home and car among 29 243 Canadian youth in grades 5–9. Logistic regression models were conducted to examine if being exposed to smoking at home or in the car were associated with the beliefs youth have about either smoking around children at home or smoking around children in cars. Results: In 2004, 23.1% of youth in grades 5–9 were exposed to smoking in their home on a daily or almost daily basis, 26.3% were exposed to smoking while travelling in a car at least once in the previous week. The majority of youth reported that they do not think smoking should be allowed around children at home (90.6%) or in cars (90.2%). Males were more likely than females to report that smoking should not be allowed around children at home (OR 1.38) or in cars (OR 1.39). Youth living in a house where someone smokes inside daily were more likely to report that smoking should not be allowed around children at home (OR 1.20) or in cars (OR 1.21). Youth living in a house where the rules do not prevent people from smoking inside were also more likely to report that smoking should not be allowed around children at home (OR 2.07) or in cars (OR 1.76). Youth who have ridden in a car with someone who was smoking cigarettes in the past 7 days were more likely to report that smoking should not be allowed around children in cars (OR 1.73). Conclusions: It is common for Canadian youth to be exposed to SHS in their homes or while in cars on a frequent basis even though the vast majority of youth do not think smoking should be allowed around children in those locations. This new evidence suggests that programs and policies designed to prevent individuals from smoking around youth in these locations should be a public health priority.

Developmental studies in animals often violate the assumption of statistical independence of observations due to the hierarchical nature of the data (i.e., pups cluster by litter, correlation of individual observations over time). Mixed effect modeling (MEM) provides a robust analytical approach for addressing problems associated with hierarchical data. This article compares the application of MEM to traditional ANOVA models within the context of a developmental study of prenatal ethanol exposure in mice. The results of the MEM analyses supported the ANOVA results in showing that a large proportion of the variability in both behavioral score and brain weight could be explained by ethanol. The MEM also identified that there were significant interactions between ethanol and litter size in relation to behavioral scores and brain weight. In addition, the longitudinal modeling approach using linear MEM allowed us to model for flexible weight gain over time, as well as to provide precise estimates of these effects, which would be difficult in repeated measures ANOVA.

Cluster analysis modeling was used to identify distinct smoking taxonomies among 4,473 smokers from 29 secondary schools (2000–2001) in Ontario, Canada. Analyses revealed a two-cluster solution (4,349 [97.2%] situational smokers and 124 [2.8%] ubiquitous smokers). Different psychosocial characteristics influenced the smoking behavior of these unique groups. Our findings are substantially different from the traditional definitions for non-daily and daily smoking used in the literature, which typically impose rules about smoking frequency or volume when defining smoking status. These findings suggest that more robust taxonomies of youth smoking are required in future tobacco control research. The study's limitations are noted.

Most youth smokers intend to quit, but the majority is neither aware nor interested in most conventional cessation approaches. As such, a critical first step in understanding youth cessation is to better understand the beliefs youth have about different cessation options. This cross-sectional study used self-reported data collected from 26,379 grade 9 to 12 students in Ontario, Canada. We examined both the attitudes of youth smokers toward common smoking cessation approaches and factors associated with intentions to join a school-based cessation program. The majority of youth smokers intend to quit smoking but tend to have negative attitudes toward most formal smoking cessation approaches; Nicotine Replacement Therapy (NRT) was an exception. Among occasional smokers, self-identification as a smoker and being physically active were positively associated with intending to join a school-based cessation program. Having tried to quit smoking at least once in the past year more than doubled the likelihood of being interested in a school-based program among both occasional and daily smokers. Findings have the potential for informing the development of more effective campaigns for engaging adolescent smokers into smoking cessation treatment. Results also reinforce the need for programmatic innovation within and beyond school settings.

OBJECTIVE: Current and emerging public health challenges require a new approach to research training. The purpose of the CIHR-Strategic Training Program in Tobacco Research (STPTR) is to equip the next generation of scientific leaders with the knowledge, skills and experiences that will enhance their ability to conduct tobacco research that will have a positive impact on the health of the population. PARTICIPANTS: Graduate students or post-doctoral fellows from any university in Canada who are working with a STPTR Mentor in the broad area of tobacco control. Setting: Mentors at three universities: University of British Columbia, University of Toronto, and University of Waterloo. INTERVENTION: The STPTR currently has four elements: a video course linking STPTR trainees and mentors across universities; an annual meeting; stipend awards that free CIHR STPTR fellows to concentrate on research; and personal, cross-disciplinary research mentoring. OUTCOMES: Feedback solicited from current and past trainees at the three-year point of the program suggests that there are four key value-added benefits associated with being a trainee in the STPTR: transdisciplinary connectedness, community building, capacity building, and exposure. CONCLUSION: Feedback from trainees at different stages in their training experience, different academic institutions, and different academic disciplines will inform the ongoing framing of the STPTR and may inform future training programs in other disciplines of chronic disease prevention, health promotion, and the emerging science of populationlevel intervention.

Purpose: To examine lunch sources during the school week among students and the associations with fruits and vegetable (F&V) and sugar-sweetened beverage (SSB) consumption. Methods: Students (n = 23 680) from 43 Ontario, Canada, secondary schools completed a health behaviour survey in the Year 1 COMPASS study. Analysis used generalized linear mixed effects models. Results: The most frequently reported lunch source was home (2.9 days per school week), then the school cafeteria (1.1) and fast-food places or restaurants (FFRs) (0.9). Eating a home lunch was associated with having less spending money, white ethnicity, and females; whereas cafeteria lunch was associated with more spending money, lower school grade, and females. A FFR lunch was associated with males, more spending money, and higher physical activity. Greater frequency of a home lunch was associated with greater F&V consumption. Greater frequency of a FFR lunch was associated with more frequent SSB consumption. Cafeteria lunches were associated with increases in both SSB and F&V. Conclusions: Eating a lunch obtained from outside of the home is a regular behaviour among students. Sources of school-week lunches may have an important influence on dietary intake among youth. These findings reinforce the need for strategies to promote healthier lunch sources and healthier food options.

The authors characterized marijuana smoking among young adult Canadians, examined the co-morbidity of tobacco and marijuana use, and identified correlates associated with different marijuana use consumption patterns. Data were collected from 20,275 individuals as part of the 2004 Canadian Tobacco Use Monitoring Survey. Logistic regression models were conducted to examine characteristics associated with marijuana use behaviors among young adults (aged 15-24). Rates of marijuana use were highest among current smokers and lowest among never smokers. Marijuana use was more prevalent among males, young adults living in rural areas, and increased with age. Young adults who were still in school were more likely to have tried marijuana, although among those who had tried, young adults outside of school were more like to be heavy users. Males and those who first tried marijuana at an earlier age also reported more frequent marijuana use. These findings illustrate remarkably high rates of marijuana use and high co-morbidity of tobacco use among young adult Canadians. These findings suggest that future research should consider whether the increasing popularity of marijuana use among young adults represents a threat to the continuing decline in tobacco use among this population.

The purpose of this study was to examine how social models for smoking are related to smoking susceptibility among a sample of non-smoking elementary school students. The Tobacco Module of the School Health Action, Planning and Evaluation System (SHAPES) was administered to 6,431 students (grades 6 to 8) in 57 elementary schools in the province of Ontario, Canada. Multi-level logistic regression analysis was used to examine how smoking friends, parents, and the prevalence of smoking among grade 8 students at a school were related to smoking susceptibility among the 2,478 non-smoking grade 6 and 7 students. Findings indicate that non-smoking grade 6 and 7 students are more likely to be susceptible to smoking if they have (a) smoking friends, (b) a mother who smokes, or (c) two or more close friends who smoke and attend a school with a relatively high smoking rate among the grade 8 students. Sub-populations of non-smoking youth may be at increased risk for smoking because of the elementary school they attend. Future school-based smoking prevention programs might benefit from targeting prevention programming activities to the schools that are putting students at the greatest risk for smoking.

Marijuana is often mixed with tobacco when smoked, and there is increasing evidence that its use by non-tobacco-smoking people may be a gateway to tobacco smoking.[1][1] Using data from the 2004 Canadian Tobacco Use Monitoring Survey,[2][2] we determined whether rates of marijuana use were similar

To examine how student beliefs about tobacco industry behaviour and marketing practices were related to occasional and regular smoking among 9th to 12th graders. These findings can provide insight for developing new tobacco industry denormalization messages for youth smoking populations.Cross-sectional data were collected from 14,767 grade 9 to 12 students attending 22 secondary schools within one Public Health Region of Canada using the Tobacco Module of School Heath Action, Planning and Evaluation System (SHAPES). Logistic regression analyses were used to determine if different beliefs about tobacco companies were able to differentiate never smokers from occasional smokers, and occasional smokers from regular smokers.Occasional and regular smoking behaviour was significantly related to student beliefs about tobacco companies doing good things in the community, manipulating young people to think smoking is cool, advertising to youth, and using athletes and sports sponsorships to get young people to smoke.This study identified that beliefs about tobacco industry behaviour and marketing practices were related to youth smoking behaviour. In order to address the unique needs of smoking youth, discussions for future tobacco industry denormalization campaigns should consider messages tailored to focus on corporate social responsibility, sport and cultural event sponsorship and industry manipulation.

The purpose of this study was to examine sex differences in how the smoking behaviour of close friends and older peers at school influence smoking onset and progression among 10,843 grade 9, 10 and 11 students from 29 secondary schools in Ontario, Canada. In lower-risk student populations (i.e., students with no smoking friends or one smoking friend), males and females were both at a similar level of risk for occasional smoking as a function of the smoking rate of older students at their school. Among higher-risk student populations (i.e., students with three or more close friends who smoke), the smoking rate of older students at school did not influence the risk of occasional smoking. The odds of a female student being a regular smoker increased as the prevalence of smoking among older students at her school increased regardless of her close friends' smoking behaviour. However, among male students, the influence of older student smoking at school on the odds of regular smoking was moderated by the number of close friends who smoke. It appears that the prevalence of older student smoking at a school is more influential among younger female students, whereas the smoking behaviour of close friends appears to be more influential among younger male students. This new finding provides unique insight for tailoring and targeting future school-based smoking prevention initiatives.

Background Current research on the etiology of tobacco use has largely focused on identifying the influential psychosocial characteristics of individual students; the influences of characteristics in the school environment are generally ignored. The purpose of this study was to simultaneously examine how school and individual student characteristics were related to smoking onset. Method Multilevel logistic regression analysis was used to examine how the senior student smoking rate at a school and the psychosocial characteristics of students were able to differentiate tried-once smokers from experimental smokers in a sample of 4850 grade 9, 10, and 11 students from the School Smoking Profile (SSP) project. Results Each 1% increase in smoking rate among high school seniors increased the odds that a junior student was an experimental smoker vs. a tried-once smoker (OR 1.07, 95% CI 1.03–1.12). A significant contextual interaction was identified where the senior student smoking rate at a school moderates the negative influence of having close friends who smoke. Influential student characteristics were also identified. Conclusions The smoking prevalence of older students at a school is directly related to smoking onset among younger students at that school. Prevention programs should target schools that put students at-risk.

To examine how social models in the school environment and individual student characteristics are related to smoking susceptibility.Using data from the School Smoking Profile Project, multi-level logistic regression analysis was used to identify school and student characteristics related to smoking susceptibility among 6679 never smokers from 29 secondary schools in Ontario, Canada.If a nonsmoking student attended a school where there was student smoking on the school periphery, he or she was less likely to be susceptible to smoking (OR 0.71, 95% CI 0.57-0.89). A significant contextual interaction between the smoking on the school periphery and friends' disapproval of smoking was identified (beta = 0.68 [0.23], p.01]; students with friends who disapprove of smoking were more likely to be susceptible to smoking if they attended a school with student smoking on the school periphery.Nonsmoking students who attend a school with student smoking on the school periphery are at an increased risk for being susceptible to smoking if they have friends who disapprove of smoking. Future school-based smoking prevention programs might benefit from targeting both individual students and entire schools with programming activities.

Physical activity is a multi-faceted behaviour comprised of several components: frequency, intensity, time and type (FITT). Despite this understanding, there is currently a lack of knowledge regarding how the individual components of FITT influence chronic diseases. This is partly due to the tendency for researchers to focus on intensity via obtaining accurate measurements of energy expenditure. Although energy expenditure is an important consideration in the assessment of physical activity, it is only one component. Accordingly, future studies examining the association between physical activity and disease risk would benefit from examining all the components of FITT. Considering that all the components of FITT are modifiable, knowing their independent or combined influence on risk may provide valuable insight for future prevention interventions.

Background: The use of alternative tobacco products (ATPs) has grown in popularity among Canadian youth. This study examined the association between a school-level characteristic (the senior student tobacco use rate) and the current use of manufactured cigarettes, little cigars or cigarillos, cigars, roll-your-own cigarettes, smokeless tobacco (SLT), and a hookah among junior students. Methods: This study used nationally representative Canadian data from 29,495 students in grades 9 to 12 as part of the 2010/2011 Youth Smoking Survey. For each ATP, we described rates of senior and junior tobacco use, calculated the variance attributed to school-level factors, and examined the association between the senior student (grades 11 and 12) tobacco use rate and the current use of each ATP among junior students (grades 9 and 10) while accounting for relevant student-level characteristics. SAS 9.3 was used for all analyses. Results: Over half of schools sampled had senior students that reported using each ATP. School-level differences accounted for between 14.1% and 29.7% of the variability in ATP current use among junior students. Each one percent increase in the number of senior students at a school that currently use manufactured cigarettes, SLT, or a hookah was significantly independently associated with an increased likelihood that a junior student at that school currently used manufactured cigarettes (OR 1.04, 95% CI 1.01 to 1.06), SLT (OR 1.14, 95% CI 1.06 to 1.24), or a hookah (OR 1.09, 95% CI 1.03 to 1.14). Conclusions: Characteristics of the school environment a junior student attends appear to play an important role in ATP use, and tobacco control programs and policies should be designed to ensure that they include strategies to curb the use of all tobacco products. Additional evidence is needed for the impact of comprehensive school-based tobacco control approaches.

Background Few researchers have the data required to adequately understand how the school environment impacts youth health behaviour development over time. Methods/Design COMPASS is a prospective cohort study designed to annually collect hierarchical longitudinal data from a sample of 90 secondary schools and the 50,000+ grade 9 to 12 students attending those schools. COMPASS uses a rigorous quasi-experimental design to evaluate how changes in school programs, policies, and/or built environment (BE) characteristics are related to changes in multiple youth health behaviours and outcomes over time. These data will allow for the quasi-experimental evaluation of natural experiments that will occur within schools over the course of COMPASS, providing a means for generating “practice based evidence” in school-based prevention programming. Discussion COMPASS is the first study with the infrastructure to robustly evaluate the impact that changes in multiple school-level programs, policies, and BE characteristics within or surrounding a school might have on multiple youth health behaviours or outcomes over time. COMPASS will provide valuable new insight for planning, tailoring and targeting of school-based prevention initiatives where they are most likely to have impact.

Background In 2006, enclosed public and workplaces in Ontario were made smoke-free by the Smoke-free Ontario Act (SFOA). Numerous area municipalities across the province have since developed local by-laws that are more restrictive than the SFOA and ban smoking in outdoor environments including parks, beaches, and patios. The current study measured reported costs associated with the implementation and enforcement of smoke-free outdoor municipal by-laws including materials and staffing costs. The study also assessed the number of warnings or tickets issued to smokers. Ontario communities with a by-law in force for at least 2 years were included in the sample (n = 42). The study was completed by 88% of area municipalities (n = 37). Municipal staff and managers completed a survey by telephone between June-September 2012. Methods No area municipality surveyed reported that they hired additional enforcement staff as a result of their community’s smoke-free by-law. Most municipalities (95%) posted signage to support awareness of their by-law; signs costs ranged from $40-$150/sign with most municipalities reporting signs were made in-house. Most communities reported actively enforcing the by-law; six communities reported they had issued tickets to people not in compliance with outdoor smoking restrictions. Conclusions The implementation, promotion, and enforcement of outdoor smoke-free by-laws have required municipal staff time and in most cases have promotional costs, but these have come from existing budgets and using existing staff. Outdoor smoke-free by-laws have not created significant burdens on municipal enforcement staff or on municipal budgets.

s / Can J Diabetes 37 (2013) S217eS289 S230 been implemented extensively in Ontario at the individual school or school board level and it is currently ‘under the radar’ with respect to its impact on the school food environment. The potential public health impact of this policy change will be presented with recommendations for future research to determine its benefits and risks.

Background The COMPASS study is designed to follow a cohort of ~30,000 grade 9 to 12 students attending ~60 secondary schools for four years to understand how changes in school characteristics (policies, programs, built environment) are associated with changes in youth health behaviours. Since the student-level questionnaire for COMPASS (Cq) is designed to facilitate multiple large-scale school-based data collections using passive consent procedures, the Cq is only comprised of self-reported measures. The present study assesses the 1-week (1wk) test-retest reliability and the concurrent validity of the Cq measures for weight status and dietary intake. Methods Validation study data were collected from 178 grade 9 students in Ontario (Canada). At time 1 (T1), participants completed the Cq and daily recoding of their dietary intake using the web-based eaTracker tool. After one week, (T2), students completed the Cq again, participants submitted their daily eaTracker logs and staff measured their height and weight. Test-retest reliability of the self-reported (SR) weight status and dietary intake measures at T1 and T2, and the concurrent validity of the objectively measured and SR weight status and dietary intake measures at T2 were examined using intraclass correlation coefficients (ICC). Results Test-retest reliability for SR height (ICC 0.96), weight (ICC 0.99), and BMI (ICC 0.95) are considered substantial. The concurrent validity for SR height (ICC 0.88), weight (ICC 0.95), and BMI (ICC 0.84) are also considered substantial. The test-retest reliability for SR dietary intake for fruits and vegetables (ICC 0.68) and milk and alternatives (ICC 0.69) are considered moderate, whereas meat and alternatives (ICC 0.41), and grain products (ICC 0.56) are considered fair. The concurrent validity for SR dietary intake identified that fruits and vegetables (ICC 0.53), milk and alternatives (ICC 0.60), and grain products (ICC 0.41) are considered fair, whereas meat and alternatives (ICC 0.34) was considered slight. Conclusions While the test-retest reliability of the measures used in this study were all high, the concurrent validity of the measures was considered acceptable. The results support the use of the self-reported COMPASS weight status and dietary intake measures for use in research where objective measures are not possible.

Background Creating school environments that support student physical activity (PA) is a key recommendation of policy-makers to increase youth PA. Given males are more active than females at all ages, it has been suggested that investigating gender differences in the features of the environment that associate with PA may help to inform gender-focused PA interventions and reduce the gender disparity in PA. The purpose of this cross-sectional study was to explore gender differences in the association between factors of the school environment and students' time spent in PA. Methods Among a sample of 10781 female and 10973 male students in grades 9 to 12 from 76 secondary schools in Ontario, Canada, student- and school-level survey PA data were collected and supplemented with GIS-derived measures of the built environment within 1-km buffers of the 76 schools. Results Findings from the present study revealed significant differences in the time male and female students spent in PA as well as in some of the school- and student-level factors associated with PA. Results of the gender-specific multilevel analyses indicate schools should consider providing an alternate room for PA, especially for providing flexibility activities directed at female students. Schools should also consider offering daily physical education programming to male students in senior grades and providing PA promotion initiatives targeting obese male students. Conclusions Although most variation in male and female students' time spent in PA lies between students within schools, there is sufficient between-school variation to be of interest to practitioners and policy-makers. More research investigating gender differentials in environment factors associated with youth PA are warranted.

AimThis study examined the factors related to whether or not school-based tobacco control efforts were associated with student smoking behaviour among two groups of students: Group 1 (15–17 years of age; grade 10 in 2000 and grade 11 in 2001) and Group 2 (16–19 years of age; grade 11 in 2000 and grade 12 in 2001).BackgroundBetween 1999 and 2001, Prince Edward Island (PEI) introduced a province-wide initiative to implement both school-based policies banning smoking on school grounds and school-based smoking prevention programming, phased in over a three-year period, in all schools.MethodsData were collected from all 10 English-speaking secondary schools in PEI (Canada) over three years (1999–2001) using the Tobacco Module of the School Health Action, Planning and Evaluation System.FindingsResults showed an increase in both occasional and regular smoking behaviour with Group 1 showing an 18% increase in occasional smoking compared to 3.9% for Group 2. The characteristic associated with an increased likelihood of regular and occasional smoking for 2000 and 2001 was students overestimating the percentage of youth their age who smoke. However, students’ knowledge and awareness of smoking policies and enforcement, students’ perceptions of schools having clear rules, and that students who break the rules get into trouble increased from 2000 to 2001. The findings from this study provide important information about how groups of students within schools experience tobacco control efforts differently. Addressing student misperceptions and policy implementation within schools may provide direction for tobacco control.

Tobacco use remains the leading cause of death and disability in Canada. Insufficient research capacity can inhibit evidence-informed decision making for tobacco control. This paper outlines a Canadian project to build research capacity, defined as a community's ability to produce research that adequately informs practice, policy, and future research in a timely, practical manner. A key component is that individuals and teams within the community must mutually engage around common, collectively negotiated goals to address specific practices, policies or programs of research. An organizing framework, a set of activities to build strategic recruitment, productivity tools, and procedures for enhancing social capital are described. Actions are intended to facilitate better alignment between research and the priorities of policy developers and service providers, enhance the external validity of the work performed, and reduce the time required to inform policy and practice.

Purpose Understanding risk factors that initiate or accelerate chronic diseases is essential for developing high impact prevention and detection strategies. The dynamic processes of disease and disability can only be appropriately examined through longitudinal research that captures the changing individual within a changing social context, and incorporates multiple levels of inquiry – at the level of the genome, the individual, and the society. We need well-designed, large-scale population-based prospective studies involving the best science from multiple disciplines. We describe the developmental phase of the Ontario Cohort Consortium, a platform for innovative, multidisciplinary cohort research in chronic disease prevention. Methods A description of the goals and objectives, governance and leadership structure, design options, methods of recruitment, data collection and storage, partnerships and policies to produce a detailed protocol for a chronic disease cohort research platform. Results We summarize the lessons learned in developing a distributed, multi-disciplinary cohort research initiative and plans for the long-term program. We will also provide a progress update on the activities of working groups identifying recruitment options (including aboriginal populations), biospecimen collection, processing, and storage options for genetic and biomarker studies for exposure, susceptibility and effect, options for interventions (community and individual), lifestyle and environmental exposures collection and measurement, and ethics and quality assurance. Conclusion Developing a prospective, multidisciplinary cohort research platform to understand chronic disease etiology, identify biomarkers for early detection, and evaluate interventions in disease prevention, require a well-coordinated and sustainable research program that emphasizes excellence in science and leadership, harmonization of data collection and measurement, effective communications, and partnerships with other cohort projects regionally, nationally and internationally.

Purpose Weight misperceptions appear common among youth, potentially influencing their motivation to engage in health-related behaviours; however, the direction of impact remains unclear. The current study examined how weight perception influences physical activity (PA) and diet among youth. Methods This study used 2-year linked data of 19,322 grade 9–12 students from Year 2 (Y2:2013-2014) and 3 (Y3:2014-2015) of the COMPASS study. Generalized Estimating Equation models tested the effect of Y3 weight perception on the various Y3 PA and dietary behaviour measures, adjusting for Y3 covariates (grade, race/ethnicity, weekly spending money), school cluster, school area median household income, and the Y2 outcome. Models were stratified by gender and body mass index (BMI) classification. Results Regardless of BMI status, overweight perceptions among boys and girls were associated with lower likelihoods of playing school sports, physical education class enrollment, meeting resistance exercise recommendations, eating breakfast regularly, and less vigorous-intensity PA, and among boys only, lower odds of meeting PA guidelines, compared to their peers who perceived their weight as “about right”. In boys with normal-weight BMIs, underweight perceptions predicted less vigorous-intensity PA, and lower odds of physical education class enrollment, and of meeting PA and resistance exercise recommendations, than “about right” perceptions. Among girls, underweight perceptions predicted lower likelihoods of engaging in adequate resistance exercise and playing intramurals, and greater odds of eating fast food on weekends, purchasing snacks, and drinking energy drinks and sugar-sweetened beverages. Girls with overweight/obese BMIs who perceived their weight as such were less likely to consume adequate fruits and vegetables relative to their counterparts with “about right” weight perceptions. Conclusions Overall, weight perceptions of “about right” appear more favourable for health behaviours among youth across the weight range. Results suggest obesity prevention strategies aiming to increase awareness of weight status may have unintended effects., Highlights • Study on how weight perceptions influence PA and dietary behaviours. • Several models tested using linked data from a large cohort of youth. • Weight perceptions of “about right” appear most favourable for health behaviours. • Both overweight and underweight perceptions were detrimental for PA and diet. • Results were consistent regardless of BMI status or gender.

Background: Considerable public health efforts are ongoing Canada-wide to reduce the prevalence of smoking in the general population. From 1985 to 2005, smoking rates among adults decreased from 35% to 19%, however, since that time, the prevalence has plateaued at around 18-19%. To continue to reduce the number of smokers at the population level, one option has been to translate interventions that have demonstrated clinical efficacy into population level initiatives. Nicotine Replacement Therapy (NRT) has a considerable clinical research base demonstrating its efficacy and safety and thus public health initiatives in Canada and other countries are distributing NRT widely through the mail. However, one important question remains unanswered - do smoking cessation programs that involve mailed distribution of free NRT work? To answer this question, a randomized controlled trial is required. Methods/Design: A single blinded, panel survey design with random assignment to an experimental and a control condition will be used in this study. A two-stage recruitment process will be employed, in the context of a general population survey with two follow-ups (8 weeks and 6 months). Random digit dialing of Canadian home telephone numbers will identify households with adult smokers (aged 18+ years) who are willing to take part in a smoking study that involves three interviews, with saliva collection for 3-HC/cotinine ratio measurement at baseline and saliva cotinine verification at 8-week and 6-month follow-ups (N = 3,000). Eligible subjects interested in free NRT will be determined at baseline (N = 1,000) and subsequently randomized into experimental and control conditions to receive versus not receive nicotine patches. The primary hypothesis is that subjects who receive nicotine patches will display significantly higher quit rates (as assessed by 30 day point prevalence of abstinence from tobacco) at 6-month follow-up as compared to subjects who do not receive nicotine patches at baseline. Discussion: The findings from the proposed trial are timely and highly relevant as mailed distribution of NRT require considerable resources and there are limited public health dollars available to combat this substantial health concern. In addition, findings from this randomized controlled trial will inform the development of models to engage smokers to quit, incorporating proactive recruitment and the offer of evidence based treatment. Trial Registration: ClinicalTrials.gov: NCT01429129 Background Smoking is a leading cause of preventable death worldwide and the leading cause of preventable cancer death. Tobacco use is responsible for approximately 33% of potential years of life lost (PYLL) due to all cancers in

Background Substance use and weight gain among youth increase the risk for future disease. As such, the purpose of this study is to examine how many Canadian youth are currently failing to meet substance use and weight gain related public health guidelines. Methods Data from the 2010–11 Youth Smoking Survey were used to examine grade 9 to 12 students meeting seven different guidelines by sex and by grade. Results Among Canadian youth, 8.8% were current smokers, 18.8% were current marijuana users, 25.5% were current binge drinkers, 22.5% were considered overweight or obese, 31.2% did not meet physical activity guidelines, 89.4% exceeded sedentary behaviour guidelines, and 93.6% reported inadequate fruit and vegetable intake. The mean number of risk factors per student was 2.9 (±1.2); only 0.5% of youth reported having none of the risk factors. Conclusion Students rarely met all seven public health guideline examined, and the vast majority of actually reported having two or more modifiable risk factors for disease.

Background Grey literature is an important source of information for large-scale review syntheses. However, there are many characteristics of grey literature that make it difficult to search systematically. Further, there is no ‘gold standard’ for rigorous systematic grey literature search methods and few resources on how to conduct this type of search. This paper describes systematic review search methods that were developed and applied to complete a case study systematic review of grey literature that examined guidelines for school-based breakfast programs in Canada. Methods A grey literature search plan was developed to incorporate four different searching strategies: (1) grey literature databases, (2) customized Google search engines, (3) targeted websites, and (4) consultation with contact experts. These complementary strategies were used to minimize the risk of omitting relevant sources. Since abstracts are often unavailable in grey literature documents, items’ abstracts, executive summaries, or table of contents (whichever was available) were screened. Screening of publications’ full-text followed. Data were extracted on the organization, year published, who they were developed by, intended audience, goal/objectives of document, sources of evidence/resources cited, meals mentioned in the guidelines, and recommendations for program delivery. Results The search strategies for identifying and screening publications for inclusion in the case study review was found to be manageable, comprehensive, and intuitive when applied in practice. The four search strategies of the grey literature search plan yielded 302 potentially relevant items for screening. Following the screening process, 15 publications that met all eligibility criteria remained and were included in the case study systematic review. The high-level findings of the case study systematic review are briefly described. Conclusions This article demonstrated a feasible and seemingly robust method for applying systematic search strategies to identify web-based resources in the grey literature. The search strategy we developed and tested is amenable to adaptation to identify other types of grey literature from other disciplines and answering a wide range of research questions. This method should be further adapted and tested in future research syntheses. Electronic supplementary material The online version of this article (doi:10.1186/s13643-015-0125-0) contains supplementary material, which is available to authorized users.

Background Excessive weight gain among youth is an ongoing public health concern. Despite evidence linking both policies and the built environment to adolescent and adult overweight, the association between health policies or the built environment and overweight are often overlooked in research with children. The purpose of this study was to examine if school-based physical activity policies and the built environment surrounding a school are associated with weight status among children. Methods Objectively measured height and weight data were available for 2,331 grade 1 to 4 students (aged 6 to 9 years) attending 30 elementary schools in Ontario, Canada. Student-level data were collected using parent reports and the PLAY-On questionnaire administered to students by study nurses. School-level policy data were collected from school administrators using the Physical Activity Module of the Healthy School Planner tool, and built environment data were provided by the Enhanced Points of Interest data resource. Multi-level logistic regression models were used to examine the school- and student-level characteristics associated with the odds of a student being overweight or obese. Results There was significant between-school random variation in the odds of a student being overweight [σ2μ0 = 0.274(0.106), p

Background Adolescence is characterized by low moderate- to vigorous- intensity physical activity (MVPA) levels. Targeting the school setting can increase MVPA among a large proportion of adolescents. However, school-based physical activity interventions for adolescents remain largely ineffective. Therefore, the purpose of this study was to examine how naturally-occurring changes to school physical activity policy, recreational programming, public health resources, and the physical environment, impact adolescent MVPA over a 1-year period. Methods Quasi-experimental longitudinal data from 18,777 grade 9–12 students (mean age = 15.1 ± 0.02 years), and 86 principals from 86 schools, participating in year 2 (2013–2014) and year 3 (2014–2015) of the COMPASS study (Ontario and Alberta, Canada) was used. Total MVPA over the previous week was self-reported at both time points using the COMPASS Student Questionnaire and average daily MVPA was calculated. Changes to physical activity policies, recreational programming, public health resources, and the physical environment were self-reported by school principals. Changes to the number and condition of physical activity facilities were objectively measured during school audits using the COMPASS School Environment Application. Multi-level modeling was used to examine change in student MVPA between schools that made changes and schools that did not. Models were adjusted for several student and school level confounders. Results Over the 1-year period, 61 of 86 schools made physical activity related changes. Of these, 9 significantly changed student MVPA. However, only 4 of 9 schools’ changes increased student MVPA, including opening the fitness centre at lunch (β = 17.2, 95 % CI: 2.6–31.7), starting an outdoor club (β = 17.8, 95 % CI:7.4–28.1), adding a bike rack (β–14.9, 95 % CI:0.7–29.1), and adding weightlifting and run/walk clubs, archery, figure skating, increased access to the sports field, and improved condition of the outdoor basketball court (β = 15.5, 95 % CI: 5.2–25.7). Conclusions Changes such as adding or increasing access to facilities, and adding multiple recreational programs, seemed to be effective for increasing student MVPA over the 1-year period. However, given the specificity of results, a one-size fits all approach may not be effective for increasing MVPA. Instead, school principals need to consider the resources within and surrounding their school, and the interests of the students.

Objectives To examine the association between time of smoking initiation and both the independent and joint effects of active and passive tobacco smoke exposure and the risk of breast cancer in a sample of Ontario women. Methods Data from two large population-based case-control studies conducted among Ontario women aged 25–75 years were combined for analysis (n = 12,768). Results Women who had ever smoked and were exposed to passive smoke had a significant increased risk of breast cancer (OR 1.13, 95%CI 1.01–1.25). A significant increased risk was also observed among women who initiated smoking: at age 26 or older (OR 1.26, 95%CI 1.03–1.55); more than five years from menarche (OR 1.26, 95%CI 1.12–1.42); and, after their first live birth (OR 1.25, 95%CI 1.02–1.52). Conclusions The results suggest that women who initiate smoking at an older age are at an increased risk of breast cancer.

Background Given the decline in physical activity (PA) levels among youth populations it is vital to understand the factors that are associated with PA in order to inform the development of new prevention programs. Many studies have examined individual characteristics associated with PA among youth yet few have studied the relationship between the school environment and PA despite knowing that there is variability in student PA levels across schools. Methods Using multi-level logistic regression analyses we explored the school- and student-level characteristics associated with PA using data from 2,379 grade 5 to 8 students attending 30 elementary schools in Ontario, Canada as part of the PLAY-Ontario study. Results Findings indicate that there was significant between-school random variation for being moderately and highly active; school-level differences accounted for 4.8% of the variability in the odds of being moderately active and 7.3% of the variability in the odds of being highly active. Students were more likely to be moderately active if they attended a school that used PA as a reward and not as discipline, and students were more likely to be highly active if they attended a school with established community partnerships. Important student characteristics included screen time sedentary behaviour, participating in team sports, and having active friends. Conclusion Future research should evaluate if the optimal population level impact for school-based PA promotion programming might be achieved most economically if intervention selectively targeted the schools that are putting students at the greatest risk for inactivity.