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Objectives: We characterized trends in medical cannabis use; examined characteristics associated with medical cannabis use without medical authorization; and examined the association between recreational cannabis legalization and medical cannabis use in Ontario, Canada. Methods: Data were from a repeated, population-based, cross-sectional survey of adults (N = 19,543; 2014–2019). Cannabis use was categorized as either medical cannabis use, recreational cannabis use or no cannabis use. The analytical strategy included jointpoint regression, logistic regression and multinomial logistic regression. Results: Medical cannabis use increased from 4 % to 11 % (Annual Percentage Change [APC]: 25 %, 95 % Confidence Interval [CI]: 17 %–33 %) and recreational cannabis use increased from 9 % to 15 % (APC: 9 %, 95 % CI: 3 %-15 %) between 2014 and 2019. Being 18 to 29 years old compared with being 65+ years old was associated with an increased likelihood of medical cannabis use without medical authorization (Odds Ratio [OR]: 4.05, 95 % CI: 2.12–7.72), while being of fair or poor self-perceived health compared with excellent, very good or good self-perceived health (OR: 0.61, 95 % CI: 0.40–0.95) was associated with a decreased likelihood of medical cannabis use without medical authorization. Recreational cannabis legalization was associated with an increased likelihood of medical cannabis use compared with no cannabis use (OR: 1.48, 95 % CI: 1.19–1.85) and of recreational cannabis use compared with no cannabis use (OR: 1.35, 95 % CI: 1.11–1.65). Conclusions: Although medical cannabis use increased, it was largely used without medical authorization. Guidance and education that encourages medical usage under clinical supervision is recommended, and mitigation of known barriers to medical cannabis authorization.

Abstract Background Adolescence is a critical period for development, with many risk factors resulting in long-term health consequences, particularly regarding mental health. The purpose of this study was to examine the associations between problem technology use, life stress, and self-esteem in a representative sample of adolescents residing in Ontario, Canada. Methods Self-reported data were obtained from a cross-sectional sample of 4,748 students (57.9% females) in grades 9 to 12 (mean age: 15.9 ± 1.3 years) who participated in the 2019 Ontario Student Drug Use and Health Survey. Problem technology use was measured using the 6-item Short Problem Internet Use Test, life stress was assessed using an item from the British Columbia Adolescent Health Survey and self-esteem was assessed using a global measure from the Rosenberg Self-Esteem Scale. Ordinal logistic regression models were adjusted for age, sex, ethnoracial background, subjective socioeconomic status, body mass index z-score, tobacco cigarette smoking, alcohol consumption and cannabis use. Results We found that 18.3% of participants reported symptoms of moderate-to-high problem technology use, although symptoms were more common in females than males (22% vs. 14.7%, respectively). Moderate-to-high problem technology use was associated with 2.04 (95% CI: 1.77–2.35) times higher odds of reporting high life stress and 2.08 (95% CI: 1.76–2.45) times higher odds of reporting low self-esteem compared to all other response options. Conclusions Findings from this study show that problem technology use is strongly associated with higher life stress and lower self-esteem in adolescents. This study supports the importance of developing and implementing effective strategies that help to mitigate the adverse effects of problem technology use on adolescent mental health.

BackgroundDespite increasing evidence that social media use is associated with adolescents’ mental well-being, little is known about the role of various factors in modifying the effect of this association during adolescence. This study examined the association between social media use and psychological distress among adolescents and explored whether sex, age, and parental support moderate this association.MethodsData came from a representative sample of middle and high school students in Ontario, Canada. Cross-sectional analyses included 6,822 students derived from the 2019 Ontario Student Drug Use and Health Survey.ResultsOur results showed that 48% of adolescents used social media for 3 h or more per day, and 43.7% had moderate to severe psychological distress, with a higher prevalence among females (54%) than males (31%). After adjustment for relevant covariates, heavy social media use (≥3 h/day) was associated with increased odds of severe psychological distress [odds ratio (OR): 2.01; 95% confidence interval (CI):1.59–2.55]. The association of social media use with psychological distress was modified by age (p

Abstract Background Mental health problems and substance use co-morbidities during and after the COVID-19 pandemic are a public health priority. Identifying individuals at high-risk of developing mental health problems and potential sequela can inform mitigating strategies. We aimed to identify distinct groups of individuals (i.e., latent classes) based on patterns of self-reported mental health symptoms and investigate their associations with alcohol and cannabis use. Methods We used data from six successive waves of a web-based cross-sectional survey of adults aged 18 years and older living in Canada (6,021 participants). We applied latent class analysis to three domains of self-reported mental health most likely linked to effects of the pandemic: anxiety, depression, and loneliness. Logistic regression was used to characterize latent class membership, estimate the association of class membership with alcohol and cannabis use, and perform sex-based analyses. Results We identified two distinct classes: (1) individuals with low scores on all three mental health indicators (no/low-symptoms) and (2) those reporting high scores across the three measures (high-symptoms). Between 73.9 and 77.1% of participants were in the no/low-symptoms class and 22.9–26.1% of participants were in the high-symptom class. We consistently found across all six waves that individuals at greater risk of being in the high-symptom class were more likely to report worrying about getting COVID-19 with adjusted odds ratios (aORs) between 1.72 (95%CI:1.17–2.51) and 3.51 (95%CI:2.20–5.60). Those aged 60 + were less likely to be in this group with aORs (95%CI) between 0.26 (0.15–0.44) and 0.48 (0.29–0.77) across waves. We also found some factors associated with class membership varied at different time points. Individuals in the high-symptom class were more likely to use cannabis at least once a week (aOR = 2.28, 95%CI:1.92–2.70), drink alcohol heavily (aOR = 1.71, 95%CI:1.49–1.96); and increase the use of cannabis (aOR = 3.50, 95%CI:2.80–4.37) and alcohol (aOR = 2.37, 95%CI:2.06–2.74) during the pandemic. Women in the high-symptom class had lower odds of drinking more alcohol during the pandemic than men. Conclusions We identified the determinants of experiencing high anxiety, depression, and loneliness symptoms and found a significant association with alcohol and cannabis consumption. This suggests that initiatives and supports are needed to address mental health and substance use multi-morbidities.

Abstract Background This study examined whether heavy episodic drinking (HED), cannabis use, and subjective changes in alcohol and cannabis use during the COVID-19 pandemic differ between transgender and gender-diverse (TGD) and cisgender adults. Methods Successive waves of web-based cross-sectional surveys. Setting: Canada, May 2020 to March 2021. Participants: 6,016 adults (39 TGD, 2,980 cisgender men, 2,984 cisgender women, and 13 preferred not to answer), aged ≥18 years. Measurements: Measures included self-reported HED (≥5 drinks on one or more occasions in the previous week for TGD and cisgender men and ≥4 for cisgender women) and any cannabis use in the previous week. Subjective changes in alcohol and cannabis use in the past week compared to before the pandemic were measured on a five-point Likert scale (1: much less to 5: much more). Binary and ordinal logistic regressions quantified differences between TGD and cisgender participants in alcohol and cannabis use, controlling for age, ethnoracial background, marital status, education, geographic location, and living arrangement. Results Compared to cisgender participants, TGD participants were more likely to use cannabis (adjusted odds ratio (aOR)=3.78, 95%CI: 1.89, 7.53) and to have reported subjective increases in alcohol (adjusted proportional odds ratios (aPOR)= 2.00, 95%CI: 1.01, 3.95) and cannabis use (aPOR=4.56, 95%CI: 2.13, 9.78) relative to before the pandemic. Compared to cisgender women, TGD participants were more likely to use cannabis (aOR=4.43, 95%CI: 2.21, 8.87) and increase their consumption of alcohol (aPOR=2.05, 95%CI: 1.03, 4.05) and cannabis (aPOR=4.71, 95%CI: 2.18, 10.13). Compared to cisgender men, TGD participants were more likely to use cannabis (aOR=3.20, 95%CI: 1.60, 6.41) and increase their use of cannabis (aPOR=4.40, 95%CI: 2.04, 9.49). There were no significant differences in HED between TGD and cisgender participants and in subjective change in alcohol between TGD and cisgender men; however, the odds ratios were greater than one as expected. Conclusions Increased alcohol and cannabis use among TGD populations compared to before the pandemic may lead to increased health disparities. Accordingly, programs targeting the specific needs of TGD individuals should be prioritized.

Summary Background Spending time outdoor has been identified as an important way to achieve the physical activity required for maintaining and improving health and to lower sedentary time among young children. However, evidence of such relationships in adolescents is particularly limited. This study investigated the relationships between frequency of outdoor physical activity after school, compliance with the physical activity, screen time, and sleep duration recommendations, and overweight/obesity among adolescents. Methods A total of 10 028 middle and high school students (mean age of 15.2 y) self‐reported the number of weekdays they spent physically active outdoors after school. Physical activity, screen time, sleep duration, height, and weight were self‐reported. Logistic regression models for the total sample and stratified by sex were adjusted for important covariates. Results Overall, there was a positive gradient between the number of weekdays spent physically active outdoor after school and compliance with the physical activity (more than or equal to 60 min/day at moderate‐to‐vigorous intensity) and screen time (less than or equal to 2 h/day) recommendations while a negative gradient with overweight/obesity was observed. Significant sex differences were observed in the associations of outdoor physical activity after school with adherence to the sleep duration and physical activity recommendations. For example, outdoor physical activity after school on all 5 days was associated with greater odds of compliance with the sleep duration recommendation among males (OR = 1.53; 95% CI, 1.01‐2.31), but not females (OR = 0.92; 95% CI, 0.65‐1.30). Conclusions Results suggest that outdoor physical activity after school could be a behavioural target to increase compliance with the physical activity and screen time recommendations and to possibly tackle excess weight among adolescents.

BackgroundAdolescence is often considered a period of heightened stress, and healthy active living behaviors may help those experiencing it to better cope with life stressors and increase their self-esteem. The 24-h movement guidelines for children and adolescents recommend ≥60 min per day of moderate-to-vigorous physical activity, ≤ 2-h per day of recreational screen time, and 9–11-h of sleep per night for school-aged children or 8–10-h per night for adolescents. The objective of this study was to examine the association of meeting the 24-h movement guidelines with life stress and self-esteem among students in Ontario, Canada.MethodsSelf-reported data on movement behaviors, life stress and self-esteem were derived from the 2019 cycle of the Ontario Student Drug Use and Health Survey, a cross-sectional and province-wide survey of students in grades 7–12 aged 11 to 20 years (N = 6,932). Multivariable ordered logistic regression analyses were adjusted for the complex sample design of the survey and for important covariates.ResultsOverall, meeting all combinations of movement behavior recommendations were associated with lower life stress and better self-esteem compared with meeting none of the recommendations, except meeting the physical activity only or screen time only recommendations that were not associated with lower life stress. Meeting all 3 recommendations was associated with lower life stress (OR: 0.40; 95 CI: 0.30–0.53) and better self-esteem (OR: 0.29; 95% CI: 0.21–0.40). There was a dose-response gradient between the number of recommendations met (3 > 2 > 1) and lower life stress (p < 0.001) and higher self-esteem (p < 0.001), with meeting all 3 recommendations being the best combination.ConclusionsThese findings suggest that meeting the recommendations of the 24-h movement guidelines is associated with lower life stress and better self-esteem among adolescents.

Introduction Household composition may be an important factor associated with anxiety during the COVID-19 pandemic as people spend more time at home due to physical distancing and lockdown restrictions. Adults living with children–especially women–may be particularly vulnerable to anxiety as they balance additional childcare responsibilities and homeschooling with work. The objective of this study was to examine the association between household composition and anxiety symptoms during the COVID-19 pandemic and explore gender as an effect modifier. Methods Data were derived from seven waves of a national online survey of Canadian adults aged 18+ years from May 2020 to March 2021, which used quota sampling by age, gender, and region proportional to the English-speaking Canadian population (n = 7,021). Multivariable logistic and modified least-squares regression models were used. Results Compared to those living alone, significantly greater odds of anxiety symptoms were observed among single parents/guardians (aOR = 2.00; 95%CI: 1.41–2.84), those living with adult(s) and child(ren) (aOR = 1.39; 95%CI: 1.10–1.76), and those living with adult(s) only (aOR = 1.22; 95%CI: 1.00–1.49). Gender was a significant effect modifier on the additive scale (p = 0.0487) such that the association between living with child(ren) and anxiety symptoms was stronger among men than women. Conclusion Additional tailored supports are needed to address anxiety among adults living with children–especially men–during the COVID-19 pandemic and future infectious disease events.

Background: Alcohol consumption and distress have increased among Canadians since the start of the COVID-19 pandemic.Methods: We examined whether sociodemographic and COVID-19-related worries are associated with various combinations of alcohol consumption and comorbid psychological distress variables among a Canadian sample of adults. Data were derived from a sample of Canadian adults (N = 1,005, 49.6% female) who participated in an online survey in May 2020. Four multivariate ordinal logistic regression models were used to estimate the odds of binge drinking, increased alcohol consumption during the pandemic, and psychological distress. Predictor variables used in the analyses included self-reported sociodemographic characteristics, financial worries, COVID-19 impact on work, and worrying about getting ill.Results: Women were found to have higher odds of increased drinking and anxiety. Also being divorced, separated, or widowed was associated with higher odds of binge drinking and anxiety, and binge drinking and depression. Furthermore, being 60 or older was associated with lower odds of binge drinking and depression and increased drinking and depression, as well as lower odds of increased drinking and depression and increased drinking and anxiety. High income groups were associated with higher odds of binge drinking, increased drinking, and mental distress. Compared to those less worried, being very worried about finances were associated with higher odds of binge drinking and anxiety, increased drinking and anxiety, and increased drinking and depression. Also, being very worried about getting ill with COVID was associated with higher odds of binge drinking and anxiety and increased drinking and anxiety.Conclusion: Our findings identify several demographic and COVID-related worries for increased odds of alcohol intake and co-morbid psychological distress during the COVID-19 pandemic, including identifying as a woman, high income groups, being divorced, separated or widowed, and experiencing financial worries and COVID illness worries. These characteristics should be considered when developing prevention and treatment programs for adults with problematic alcohol use and comorbid anxiety and depression.

BackgroundUnderstanding the factors contributing to mental well-being in youth is a public health priority. Self-reported enthusiasm for the future may be a useful indicator of well-being and has been shown to forecast social and educational success. Typically, cross-domain measures of ecological and health-related factors with relevance to public policy and programming are analyzed either in isolation or in targeted models assessing bivariate interactions. Here, we capitalize on a large provincial data set and machine learning to identify the sociodemographic, experiential, behavioral, and other health-related factors most strongly associated with levels of subjective enthusiasm for the future in a large sample of elementary and secondary school students. ObjectiveThe aim of this study was to identify the sociodemographic, experiential, behavioral, and other health-related factors associated with enthusiasm for the future in elementary and secondary school students using machine learning. MethodsWe analyzed data from 13,661 participants in the 2019 Ontario Student Drug Use and Health Survey (OSDUHS) (grades 7-12) with complete data for our primary outcome: self-reported levels of enthusiasm for the future. We used 50 variables as model predictors, including demographics, perception of school experience (i.e., school connectedness and academic performance), physical activity and quantity of sleep, substance use, and physical and mental health indicators. Models were built using a nonlinear decision tree–based machine learning algorithm called extreme gradient boosting to classify students as indicating either high or low levels of enthusiasm. Shapley additive explanations (SHAP) values were used to interpret the generated models, providing a ranking of feature importance and revealing any nonlinear or interactive effects of the input variables. ResultsThe top 3 contributors to higher self-rated enthusiasm for the future were higher self-rated physical health (SHAP value=0.62), feeling that one is able to discuss problems or feelings with their parents (SHAP value=0.49), and school belonging (SHAP value=0.32). Additionally, subjective social status at school was a top feature and showed nonlinear effects, with benefits to predicted enthusiasm present in the mid-to-high range of values. ConclusionsUsing machine learning, we identified key factors related to self-reported enthusiasm for the future in a large sample of young students: perceived physical health, subjective school social status and connectedness, and quality of relationship with parents. A focus on perceptions of physical health and school connectedness should be considered central to improving the well-being of youth at the population level.

BackgroundThe COVID-19 global pandemic has increased the burden of mental illness on Canadian adults. However, the complex combination of demographic, economic, and lifestyle factors and perceived health risks contributing to patterns of anxiety and depression has not been explored. ObjectiveThe aim of this study is to harness flexible machine learning methods to identify constellations of factors related to symptoms of mental illness and to understand their changes over time during the COVID-19 pandemic. MethodsCross-sectional samples of Canadian adults (aged ≥18 years) completed web-based surveys in 6 waves from May to December 2020 (N=6021), and quota sampling strategies were used to match the English-speaking Canadian population in age, gender, and region. The surveys measured anxiety and depression symptoms, sociodemographic characteristics, substance use, and perceived COVID-19 risks and worries. First, principal component analysis was used to condense highly comorbid anxiety and depression symptoms into a single data-driven measure of emotional distress. Second, eXtreme Gradient Boosting (XGBoost), a machine learning algorithm that can model nonlinear and interactive relationships, was used to regress this measure on all included explanatory variables. Variable importance and effects across time were explored using SHapley Additive exPlanations (SHAP). ResultsPrincipal component analysis of responses to 9 anxiety and depression questions on an ordinal scale revealed a primary latent factor, termed “emotional distress,” that explained 76% of the variation in all 9 measures. Our XGBoost model explained a substantial proportion of variance in emotional distress (r2=0.39). The 3 most important items predicting elevated emotional distress were increased worries about finances (SHAP=0.17), worries about getting COVID-19 (SHAP=0.17), and younger age (SHAP=0.13). Hopefulness was associated with emotional distress and moderated the impacts of several other factors. Predicted emotional distress exhibited a nonlinear pattern over time, with the highest predicted symptoms in May and November and the lowest in June. ConclusionsOur results highlight factors that may exacerbate emotional distress during the current pandemic and possible future pandemics, including a role of hopefulness in moderating distressing effects of other factors. The pandemic disproportionately affected emotional distress among younger adults and those economically impacted.

BackgroundLGBTQ2S youth are overrepresented among youth experiencing homelessness and experience significantly higher rates of mental health issues compared to heterosexual and cisgender youth. COVID-19 related challenges for LGBTQ2S youth experiencing homelessness remain unknown. To address this gap, this study aimed to understand the impacts of the COVID-19 pandemic on LGBTQ2S youth at risk of, and experiencing, homelessness in the Greater Toronto Area, Ontario, Canada and surrounding areas.MethodsUtilizing a mixed-methods convergent parallel design, LGBTQ2S youth experiencing homelessness were recruited to participate in virtual surveys and in-depth one-on-one interviews. Surveys included standardized measures and were administered to measure mental health outcomes and collect information on demographic characteristics, and health service use. Survey data were analyzed with descriptive statistics and statistical tests for difference of proportions. Interviews were analyzed using an iterative thematic content approach.ResultsSixty-one youth completed surveys and 20 youth participated in one-on-one interviews. Quantitative and qualitative data showed that youth have been significantly impacted by the COVID-19 pandemic in various ways, including experiencing poor mental health, such as suicidality, depression, anxiety, and increased substance use, and lack of access to health and social support services.ConclusionOur study highlights the need for LGBTQ2S inclusive and affirming health care and support services for precariously housed adolescents to address the pre-existing social and health issues that have been exacerbated by the pandemic.

En Jamaica existen altas tasas de abuso de drogas, lo que remarca la necesidad de comprender los motivadores para el abuso de sustancias. El experimentar maltrato psicológico (abuso emocional y negligencia) durante la infancia ha sido sugerido como un factor de riesgo para el abuso de sustancias. Este estudio investiga la relación entre maltrato psicológico infantil y el abuso de sustancias en la adultez entre estudiantes universitarios jamaiquinos. Trescientos ochenta y dos (382) estudiantes universitarios fueron seleccionados usando una técnica de muestreo sistemático. Ellos completaron el Cuestionario Escala de Distrés Psicológico de Kessler, así como ítems seleccionado de los cuestionarios de Experiencias Adversas en la Infancia y de Uso de Drogas de CICAD. El 66.7% había experimentado maltrato psicológico. El análisis de Chi-cuadrados identificó una relación significativa entre experimentar maltrato psicológico y abuso de sustancias (p