Do sociodemographic risk profiles for adolescents engaging in weekly e-cigarette, cigarette, and dual product use differ?

BACKGROUND: E-cigarette use represents a contemporary mode of nicotine product use that may be changing the risk profile of participating adolescents. Understanding differences in sociodemographic characteristics of adolescents engaging in contemporary e-cigarette use and traditional cigarette use is important for effectively developing and targeting public health intervention programs. The objective of this study was to identify and compare sociodemographic risk profiles for exclusive e-cigarette use and dual-product use among a large sample of Canadian youth. METHODS: A survey of 46,666 secondary school students in the 2021-22 wave of the COMPASS study measured frequency of past month e-cigarette and cigarette use as well as age, sex, gender, racial or ethnic background, spending money, relative family affluence, and having one's own bedroom. Rates of cigarette-only, e-cigarette-only, and dual product use were calculated, and separate classification trees were run using the CART algorithm to identify sociodemographic risk profiles for weekly dual-product use and weekly e-cigarette-only use. RESULTS: Over 13% of adolescents used only e-cigarettes at least weekly, 3% engaged in weekly dual e-cigarette and cigarette use, and less than 0.5% used only cigarettes. Available spending money was a common predictor of dual-product and e-cigarette-only use. Gender diverse youth and youth with lower perceived family affluence were at higher risk for dual-product use, while white and multiethnic adolescents were at greater risk of e-cigarette-only use. Two high-risk profiles were identified for e-cigarette-only use and four high-risk profiles were identified for dual product use. CONCLUSIONS: This study used a novel modelling approach (CART) to identify combinations of sociodemographic characteristics that profile high-risk groups for exclusive e-cigarette and dual-product use. Unique risk profiles were identified, suggesting that e-cigarettes are attracting new demographics of adolescents who have not previously been considered as high-risk for traditional cigarette use.

Exploring the association between the proximity to and density around schools of retailers selling IQOS products and youth use of heated tobacco products: evidence from the 2020-2021 COMPASS study. / Exploration de l'association entre la proximité et la densité des détaillants de produits IQOS autour des écoles et l'utilisation de produits de tabac chauffé chez les adolescents : données de l'étude COMPASS 2020-2021.

INTRODUCTION: Heated tobacco products (HTPs) are novel tobacco products that may appeal to youth. This study explored whether HTP retailer proximity and density to secondary schools were associated with youth use of HTPs in four Canadian provinces. METHODS: An online search between November 2020 and March 2021 identified retailers selling IQOS devices and HEETS (tobacco sticks used in IQOS) within 500 m, 1000 m and 1500 m radius circular buffer zones around high schools (N = 120) participating in the COMPASS study in 2020-2021. Retailer proximity/density data were linked to crosssectional student-level data (N = 40 636 students), and multilevel regression models examined the association between HTP retailer proximity and density and current HTP use, controlling for relevant covariates. RESULTS: While only 10.0% of schools had at least one retailer selling IQOS devices within 1000 m of the school, 65.0% of schools had at least one retailer selling HEETS. The school a student attended accounted for 23.7% of the variability in the likelihood of currently using an HTP. However, HTP retailer proximity to and density around schools were not significantly associated with the likelihood of students currently using HTPs. CONCLUSION: While the school a student attended accounted for a significant amount of variability in HTP use, these findings suggest that students may be obtaining HTPs through other, non-retail sources. Continued monitoring is warranted as HTP use among youth may change.

Evaluating the One-Year Impact of School e-Cigarette Use Interventions among Current Youth e-Cigarette Users in the COMPASS Study, 2017/18-2018/19.

There is a lack of evidence for the impact of school-based e-cigarette interventions among current e-cigarette users. This natural experimental evaluation study evaluated the one-year impact of various school-based e-cigarette prevention/cessation programs among a sample of current youth e-cigarette users. The COMPASS study sample included n = 3586 current e-cigarette users from n = 90 schools with data collected between 2017 and 2019. Student e-cigarette use patterns were categorized as "escalated", "maintained", and "reduced" based on the change in past 30-day e-cigarette use between baseline and follow-up. Intervention schools added e-cigarette use "prevention", "cessation", or "protection" programs, while control schools did not make any changes. Logistic regression models identified how each category of added programs was associated with e-cigarette use patterns. About one quarter of schools added an e-cigarette use prevention/cessation program over one year. Student e-cigarette use patterns between control and intervention groups differed in proportion ranging from a decrease of 3.35% to an increase of 5.80%. Regression models did not identify any significant differences in the odds of escalating or reducing e-cigarette use in intervention relative to control schools. While many schools implemented new e-cigarette programs over one year, none of the interventions led to significant changes in e-cigarette escalation or reduction among current youth e-cigarette users. Additional studies are needed to evaluate the impact of e-cigarette interventions among current e-cigarette users.

Changes in Quantity Measures of Various Forms of Cannabis Consumption among Emerging Adults in Canada in Relation to Policy and Public Health Developments.

Limited research examines changes in quantities of various forms of smoked/vaped cannabis among regular consumers, including emerging adults (EAs; 18 to 29) in Canada. This information is particularly relevant in the current context of emerging cannabis behaviors among EAs related to political amendments (legalization of cannabis), vaping-related lung illnesses (EVALI), and unprecedented pandemics (COVID-19). This study investigated the impact of legalizing recreational cannabis use in Canada, the EVALI epidemic, and the COVID-19 pandemic on the quantity of smoked/vaped forms of cannabis in relation to gender differences. EAs retrospectively self-reported the quantity of herb, hash, concentrates, joint size, and the number of joints and vaping cartridges in relation to three consecutive developments: pre-legalization, post-legalization; pre-EVALI, post-EVALI, pre-COVID-19, and during COVID-19. The quantity of herb use significantly increased among heavy users, and vaping quantity significantly increased among light users. Overall, an increasing incremental trend was observed in the average quantity of cannabis forms used over time. Males consumed higher quantities of all cannabis forms than females. More males than females reported using concentrates (p < 0.05). These findings reveal unique aspects of the amount of various cannabis forms smoked/vaped in relation to gender and provides preliminary evidence of cannabis consumption behaviors in relation to changing social and cultural contexts.

Safety and Efficacy of Combined Resveratrol and Sirolimus in Lymphangioleiomyomatosis.

BACKGROUND: A critical need exists to develop remission-inducing therapies for lymphangioleiomyomatosis. RESEARCH QUESTION: Is the addition of resveratrol safe and more efficacious than sirolimus alone in patients with lymphangioleiomyomatosis? STUDY DESIGN AND METHODS: We conducted a phase 2, dose-escalating, open-label trial of resveratrol in patients with lymphangioleiomyomatosis receiving a stable regimen of sirolimus. Resveratrol was started at 250 mg/d and escalated every 8 weeks to maximum dose of 1,000 mg/d over 24 weeks. The primary outcome was ≥ 42% decline in serum vascular endothelial growth factor D (VEGF-D) levels on combined therapy compared with baseline VEGF-D levels on sirolimus. Secondary objectives included an assessment of the safety profile and the effect on lung function and health-related quality of life (HRQOL). Longitudinal change in outcome measures was assessed using linear mixed models. Adverse effects were tabulated using the National Cancer Institute's Common Terminology Criteria for Adverse Events version 4. RESULTS: Twenty-five patients with lymphangioleiomyomatosis with a median age of 51 years were enrolled. Pulmonary function parameters at study inclusion were: FEV1: median absolute, 1.72 L; 64% predicted; FVC: median absolute, 2.99 L; 96% predicted; and diffusing capacity of the lungs for carbon monoxide: median absolute, 14.68 mL/mm Hg/min; 37% predicted. The median serum VEGF-D value at baseline was 617 pg/mL. Patients entered the study with a median sirolimus dose of 2 mg/d with median trough level of 6.3 ng/mL. Despite some GI side effects, the addition of resveratrol was well tolerated. Although the primary outcome was not met, a statistically significant reduction in serum VEGF-D levels and improvement in HRQOL during the study was found. INTERPRETATION: The addition of resveratrol was safe and well tolerated in patients with lymphangioleiomyomatosis taking sirolimus and was associated with modest improvement in HRQOL. Larger controlled trials of this combination might be warranted to assess definitively the usefulness of resveratrol as an additive therapy in lymphangioleiomyomatosis. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT03253913; URL: www. CLINICALTRIALS: gov.

Youth Vaping During the Early Stages of the COVID-19 Pandemic Period: Adjusted Annual Changes in Vaping Between the Pre-COVID and Initial COVID-Lockdown Waves of the COMPASS Study.

BACKGROUND: Adolescence is a critical period for vaping onset. The purpose of this article was to examine the effect of the early stages of the COVID-19 pandemic period on youth vaping. METHODS: We used 3-year linked data from the COMPASS study, including 7585 Canadian (Quebec, Ontario) adolescents from which 1949 completed all three survey waves (pre-COVID-19 [2018, 2019] and online [2020] during the early pandemic period [May-July 2020]) and provided vaping data. Structural equation modeling (SEM) and difference-in-difference (DD) models were used to estimate pre-COVID-19 to initial COVID-19 pandemic period change (2019-2020) in vaping (monthly, weekly, daily) compared with 2018-2019 change to adjust for age-related effects. Models were adjusted for age of entry into the cohort and sociodemographic characteristics. RESULTS: In the SEM and DD models, the proportion of youth who were monthly and weekly vaping increased from 2018 to 2019 but decreased from 2019 to 2020; daily vaping increased across all waves. However, for all vaping outcomes modeled, the expected increases from the pre-COVID-19 wave (2019) to the initial COVID-19 period wave (2020) were lesser relative to the changes seen across the 2018 to 2019 waves. CONCLUSION: The early stages of the COVID-19 pandemic period appear to be associated with a reduction in the proportion of youth who were monthly and weekly vapers in our adjusted longitudinal models. While daily vaping increased over this same period of time, the magnitude of the increase in our adjusted longitudinal models appears attenuated by the early stages of the pandemic. IMPLICATIONS: This large prospective study of youth that included pre-pandemic data is unique in that we were able to identify that the early stages of the COVID-19 pandemic period was associated with a reduction in the proportion of youth who were monthly and weekly vapers in our adjusted longitudinal models. Conversely, the proportion of youth who were daily vaping increased over this same period of time, but the magnitude of the increase appears smaller than expected during the early stages of the pandemic in our adjusted longitudinal models. This study provides novel robust evidence that the patterns of vaping most aligned with onset and progression (i.e., monthly and weekly use) appear attenuated during the initial pandemic period.

California School Staff Reports of Seeing Students Vaping at School and Disciplinary Actions.

Youth vaping is a concern and schools may use many approaches to discipline students caught vaping at school. This study identified the prevalence of school staff seeing vaping in schools and the measures used to discipline students. A state-wide sample of 7,938 staff from 255 middle and high schools reported whether they saw any students vaping at school in the last 30 days, whether they have caught any students vaping during class in the last semester, and what happened after catching a student vaping in class. Open-text responses were coded and themes were identified related to disciplinary approaches. 31.9% of staff reported seeing students vaping at school, and 11.9% of teachers reported catching a student vaping during class. Teachers described four categories of disciplinary approaches after catching students vaping in class: no consequences, punitive approaches, restorative approaches, and mixed approaches. Additional support is necessary to help schools address student vaping.

Identifying changes in e-cigarette use among a longitudinal sample of Canadian youth e-cigarette users in the COMPASS cohort study, 2017/18-2018/19.

Objectives: There are few studies describing longitudinal changes in vaping patterns among current youth e-cigarette users. The objective of this study was to identify-one-year changes in e-cigarette use patterns among a longitudinal sample of Canadian youth e-cigarette users between 2017/18 and 2018/19. Methods: The longitudinal sample included n = 4,071 current (past 30-day) e-cigarette users in grades 9-11 attending schools in four Canadian provinces. Students reported the number of days they used e-cigarettes in the past 30 days in 2017/18 and 2018/19. Based on responses, students could have escalated, reduced, stopped, or maintained their level of vaping. The prevalence of each e-cigarette use pattern was identified across demographic characteristics and regression models identified significant predictors of each use pattern. Results: Over one year, 49.2% of current youth e-cigarette users escalated, 12.8% reduced, 20.2% stopped, and 17.8% maintained their frequency of e-cigarette use. Baseline e-cigarette use frequencies varied according to use pattern. Current youth e-cigarette users with higher baseline vaping frequencies had lower odds of escalating and stopping e-cigarette use and higher odds of reducing e-cigarette use relative to maintaining the same frequency of use. Conclusions: While about half of current youth e-cigarette users increased their frequency of e-cigarette use over a 1-year period, a significant number also decreased or stopped vaping at a time when the prevalence of youth e-cigarette use increased rapidly in Canada. There is a need for longitudinal data to monitor and evaluate changes to e-cigarette use patterns that may be in response to changing public health policies.

Changes in Cannabis Consumption Among Emerging Adults in Relation to Policy and Public Health Developments.

Background: Rates of cannabis use appear to be highest among emerging adults (EA). Evidence suggests that cannabis smoking, as well as alternate methods of cannabis use (e.g., vaping, edibles) have become a prevalent mode of consumption among this population. Substance use or misuse peaks during emerging adulthood and may be influenced by extreme economic, social and community developments, such as policy changes, public health concerns, and significant global events such as pandemics. For instance, it is highly likely that cannabis consumption trends among at-risk populations were influenced by the legalization of recreational cannabis in Canada, the declaration of the "e-cigarette or vaping product use associated lung injury" or "EVALI" outbreak, and the "COVID-19" pandemic. ObjectivesWe aimed to examine self-reported changes in frequency of cannabis use among EA in Canada (N = 312): pre-legalization, post-legalization; pre-EVALI, post-EVALI; pre-COVID-19, since-COVID-19. ResultsThere was a gradual increase in average frequency of smoking and vaping cannabis across the six different time intervals from the pre-legalization period (2018) to the COVID-19 pandemic period (2020). Males reported higher frequencies of cannabis smoking and vaping compared to females. ConclusionsDespite health concerns and expectations that EVALI and COVID-19 events would lead to decreased consumption, our results suggest an average increase in smoking and vaping cannabis, although the most notable increase was after legalization. There are important sex differences in behavioral factors of cannabis use in EA, though it appears that the "gender-gap" in cannabis consumption is closing. These findings may facilitate the development of intervention programs for policy measures to address cannabis-attributable outcomes in the face of contextual factors that promote use, such as public emergencies or changes in policy landscapes.

Precision medicine in chronic obstructive pulmonary disease: how far have we come?

PURPOSE OF REVIEW: In this review, we will discuss the current status and recent developments in precision medicine in chronic obstructive pulmonary disease (COPD) through the lens of treatable traits. RECENT FINDINGS: Although the term 'treatable traits' in the treatment of COPD is relatively recent, this concept has been used for many years if one considers interventions such as long-term oxygen therapy or alpha-1 antitrypsin replacement therapy. Recent advances have included expanding the definition of COPD to include a broader population of people with lower respiratory disease but not meeting the strict criteria for obstruction, advances in imaging to aid in the diagnosis and treatment of COPD, advances in understanding symptoms and exacerbations to define severity, using biomarkers to guide therapy and better understanding and addressing polymorbidity and frailty. In addition, there is a concerted effort to use these concepts to identify COPD patients earlier in the disease process wherein disease modification may be possible. SUMMARY: Focusing on subsets of patients with COPD with certain characteristics should lead to better outcomes and fewer adverse effects from treatment. VIDEO ABSTRACT: http://links.lww.com/COPM/A30.

More support needed: Evaluating the impact of school e-cigarette prevention and cessation programs on e-cigarette initiation among a sample of Canadian secondary school students.

Given the recent increase in e-cigarette use among adolescents, there is a need to further explore how school programs are associated with e-cigarette initiation. The objective of this quasi-experimental study was to evaluate the impact of multiple school-based e-cigarette prevention and cessation programs on e-cigarette initiation among Canadian adolescents. This study used data from Year 6 (2017/18) and Year 7 (2018/19) of the COMPASS study in British Columbia, Alberta, Ontario, and Quebec, Canada. Students in grades 9 to 11 who had never tried e-cigarettes at baseline were included (n = 13,269). Schools (n = 88) reported whether they added programming that addressed e-cigarette or tobacco prevention or cessation. Generalized estimating equations were used to identify how added programs were associated with e-cigarette initiation at follow-up. At one-year follow-up (2018/19), 23% of schools added programs. Our evaluation results suggest that none of the activities taken by schools to prevent or reduce vaping among students significantly prevented vaping onset. In fact, female students at schools that reported adding a theme week had higher odds of e-cigarette initiation (OR 1.68 [95% CI 1.31-2.16]) and male students at schools that reported a cessation program had higher odds of e-cigarette initiation (OR 1.20 [95% CI 1.01-1.44]). These results suggest that schools may not know how to address e-cigarette use and that there can be risks to students if programs are not carefully implemented. Results point to the need for additional support to ensure that schools are taking evidence-based approaches that support all students.

Investigating individual-level correlates of e-cigarette initiation among a large sample of Canadian high school students. / Étude des corrélats individuels de l'initiation à la cigarette électronique dans un vaste échantillon d'élèves canadiens du secondaire.

INTRODUCTION: Having a better understanding of individual factors associated with e-cigarette initiation can help improve prevention efforts. Therefore, this study aimed to (1) identify baseline characteristics associated with e-cigarette initiation, and (2) determine whether changes in these baseline characteristics were associated with e-cigarette initiation. METHODS: This study used data from Year 6 (2017/18, baseline) and Year 7 (2018/19, follow-up) of the COMPASS study. The final sample included 12 315 students in Grades 9 to 11 who reported never having tried e-cigarettes at baseline. Students reported demographic information, other substance use, school behaviours, physical activity, sedentary behaviour, sleep, symptoms of anxiety and depression, and emotional regulation and flourishing scores. Hierarchical GEE models, stratified by gender, examined the association between (1) baseline characteristics and e-cigarette initiation at follow-up and (2) changes in baseline characteristics and e-cigarette initiation at follow-up. RESULTS: In total, 29% of students who had not yet initiated e-cigarette use reported initiating e-cigarette use at follow-up. Students in Grades 10 and 11 were less likely to initiate e-cigarette use. Other substance use, skipping school and meeting the physical activity guidelines at baseline and one-year changes to these behaviours were associated with e-cigarette initiation among both male and female students. Additionally, some differences were noted between females and males. CONCLUSION: Given that other health behaviours were associated with e-cigarette initiation, prevention approaches should target multiple health-risk behaviours to help prevent youth e-cigarette use. Additionally, school-based approaches may benefit by being implemented at the beginning of high school or in junior high school.

Can We Reverse this Trend? Exploring Health and Risk Behaviours of Grade 12 Cohorts of Ontario Students from 2013-2019.

Adolescents engage in multiple health risk behaviours that put them at risk of future chronic disease. By the time students graduate from secondary school, they may be engaging in behaviours that set them on a particular health trajectory. It is important to monitor the co-occurrence of health risk behaviours of cohorts of grade 12 students over time to highlight important areas for intervention. The purpose of this study was to examine trends in health and risk behaviours over six waves among subsequent cohorts of grade twelve students from Ontario, Canada. A total of 44,740 grade 12 students participated in the COMPASS study across the six waves (2013/14 to 2018/19), and self-reported movement (physical activity, screen time, sleep), dietary (fruit and vegetables, breakfast), and substance use (smoking, vaping, binge drinking, and cannabis use) behaviours. Over 91.0% of students reported engaging in three or more health risk behaviours, with increases in the number of students reporting inadequate sleep, not eating breakfast on every school day, and vaping over time. Although modest, the wave 6 cohort reported slightly more risk behaviours compared with the wave 1 cohort, highlighting the importance of multidimensional health promotion strategies across multiple settings.

Are closed campus policies associated with adolescent eating behaviours? / Les règlements interdisant aux élèves de quitter le périmètre scolaire influencent-ils les comportements alimentaires des adolescents?

INTRODUCTION: The effectiveness of school nutrition regulations may be undermined by food environments surrounding schools. Given challenges in regulating external retail, some have recommended policies that ensure students are unable to leave school property during the day (closed campus policies; CCP). We aimed to examine whether CCP are associated with student eating behaviours. METHODS: We used student and school-administrator survey data from the 60 610 Grades 9 to 12 students and 134 Canadian secondary schools that participated in Year 7 (2018/19) of the COMPASS study. Multiple ordinal regression models tested school CCP as a predictor of weekday dietary behaviours (0-5 days), controlling for student-level (grade, sex, spending money, ethnicity) and school-level (urbanicity, province, area median household income, vending machines) covariates. RESULTS: CCP were reported by 16 schools. Students who attended CCP schools reported eating lunch purchased from fast food outlets or other restaurants and drinking sugar-sweetened beverages (SSBs; soft drinks and sports drinks; sweetened coffee or tea drinks) on fewer weekdays, but consumed snacks from school vending machines on more weekdays, relative to students at open campus schools. No significant differences were observed in student reports of eating home-packed or school cafeteria lunches or snacks purchased off-campus. CONCLUSION: CCP may help improve adolescent diets by reducing SSB and lunchtime fast food consumption on weekdays; however, students already purchasing food may shift from off-campus to within-school options, highlighting the importance of ensuring healthy school food environments and encouraging students to bring home-prepared lunches. Future studies using experimental longitudinal designs are needed to determine the effect of CCP on various health behaviours and outcomes.

Trends in youth e-cigarette and cigarette use between 2013 and 2019: insights from repeat cross-sectional data from the COMPASS study.

OBJECTIVES: E-cigarettes are an increasingly popular product among youth in Canada. However, there is a lack of long-term data presenting trends in use. As such, the objective of this study was to examine trends in e-cigarette and cigarette use across various demographic characteristics between 2013 and 2019 among a large sample of secondary school youth in Canada. METHODS: Using repeat cross-sectional data from a non-probability sample of students in grades 9 to 12, this study explored trends in the prevalence of ever and current e-cigarette use and cigarette smoking between 2013-2014 and 2018-2019 in British Columbia, Alberta, Ontario, and Quebec. Trends in ever and current e-cigarette use and cigarette smoking were studied across demographic variables among students in Ontario. RESULTS: The prevalence of e-cigarette ever and current use was variable across province and increased over time, particularly between 2016-2017 and 2018-2019. In contrast, the prevalence of current cigarette smoking was relatively stable over the study period, decreasing significantly in Alberta and Ontario between 2017-2018 and 2018-2019. In Ontario, the prevalence of ever and current e-cigarette use increased among all grades, both genders, and all ethnicities. CONCLUSION: Consistent with data from the United States, the prevalence of e-cigarette use among our large sample of Canadian youth has increased substantially in a short period of time. Surveillance systems should continue to monitor the prevalence of tobacco use among youth. Additional interventions may be necessary to curb e-cigarette use among Canadian youth.

RéSUMé: OBJECTIFS: Les cigarettes électroniques sont de plus en plus populaires auprès des jeunes au Canada. Il manque cependant de données à long terme sur les tendances de leur usage. C'est pourquoi nous avons cherché à examiner les tendances de l'usage des cigarettes électroniques et des cigarettes selon diverses caractéristiques démographiques entre 2013 et 2019 dans un vaste échantillon de jeunes fréquentant l'école secondaire au Canada. MéTHODE: À l'aide de données transversales répétées d'un échantillon non probabiliste d'élèves de la 9e à la 12e année, l'étude a exploré les tendances de la prévalence de l'usage antérieur et actuel des cigarettes électroniques et des cigarettes entre 2013-2014 et 2018-2019 en Colombie-Britannique, en Alberta, en Ontario et au Québec. Les tendances de l'usage antérieur et actuel des cigarettes électroniques et des cigarettes ont été étudiées pour diverses variables démographiques chez les élèves de l'Ontario. RéSULTATS: La prévalence de l'usage antérieur et actuel des cigarettes électroniques varie selon la province et a augmenté avec le temps, particulièrement entre 2016-2017 et 2018-2019. Par contre, la prévalence de l'usage actuel des cigarettes a été relativement stable sur la période de l'étude et a sensiblement diminué en Alberta et en Ontario entre 2017-2018 et 2018-2019. En Ontario, la prévalence de l'usage antérieur et actuel des cigarettes électroniques a augmenté chez les élèves de toutes les années, des deux sexes et de toutes les origines ethniques. CONCLUSION: Comme pour les données des États-Unis, la prévalence de l'usage des cigarettes électroniques dans notre vaste échantillon de jeunes Canadiens a considérablement augmenté sur une courte période. Les systèmes de surveillance devraient continuer à surveiller la prévalence du tabagisme chez les jeunes. Des interventions supplémentaires pourraient être nécessaires pour freiner l'usage des cigarettes électroniques chez les jeunes Canadiens.

Are School Substance Use Policy Violation Disciplinary Consequences Associated with Student Engagement in Cannabis?

Schools are increasingly concerned about student cannabis use with the recent legalization in Canada; however, little is known about how to effectively intervene when students violate school substance use policies. The purpose of this study is to assess the disciplinary approaches present in secondary schools prior to cannabis legalization and examine associations with youth cannabis use. This study used Year 6 (2017/2018) data from the COMPASS (Cannabis use, Obesity, Mental Health, Physical Activity, Alcohol use, Smoking, Sedentary behavior) study including 66,434 students in grades 9 through 12 and the 122 secondary schools they attend in British Columbia, Alberta, Ontario, and Quebec. Student questionnaires assessed youth cannabis use and school administrator surveys assessed potential use of 14 cannabis use policy violation disciplinary consequences through a ("check all that apply") question. Regression models tested the association between school disciplinary approaches and student cannabis use with student- (grade, sex, ethnicity, tobacco use, binge drinking) and school-level covariates (province, school area household median income). For first-offence violations of school cannabis policies, the vast majority of schools selected confiscating the product (93%), informing parents (93%), alerting police (80%), and suspending students from school (85%), among their disciplinary response options. Few schools indicated requiring students to help around the school (5%), issuing a fine (7%), or assigning additional class work (8%) as potential consequences. The mean number of total first-offence consequences selected by schools was 7.23 (SD = 2.14). Overall, 92% of schools reported always using a progressive disciplinary approach in which sanctions get stronger with subsequent violations. Students were less likely to report current cannabis use if they attended schools that indicated assigning additional class work (OR 0.57, 95% CI (0.38, 0.84)) or alerting the police (OR 0.81, 95% CI (0.67, 0.98)) among their potential first-offence consequences, or reported always using the progressive discipline approach (OR 0.77, 95% CI (0.62, 0.96)) for subsequent cannabis policy violations. In conclusion, results reveal the school disciplinary context in regard to cannabis policy violations in the year immediately preceding legalization. Various consequences for cannabis policy violations were being used by schools, yet negligible association resulted between the type of first-offence consequences included in a school's range of disciplinary approaches and student cannabis use.

Adults with cystic fibrosis: spiritual coping with lifelong disease.

Cystic fibrosis (CF) is a chronic life-shortening disease requiring significant coping. Spiritual belief relates to treatment behaviors. Little is known about spirituality's role in adults diagnosed as children, nor how it compares with adults diagnosed as adults. Adults over 18 years, diagnosed as children completed a questionnaire; some were randomized to also participate in an interview or daily phone diary to measure adherence. Qualitative analyses of 25 adults are presented. Participants reframed their disease as part of a Divine Plan, in which Divine assistance was conditional upon adherence. Linear regression models of spiritual constructs on airway clearance, nebulized medication, and exercise are presented. Adults diagnosed as children related spirituality to CF in ways both consistent and different from adults diagnosed as adults. Spiritual beliefs were related to adherence determinants and intentions. Increased understanding of the relationship between spirituality and health behaviors is important to providing person-centered care.

Exploring the Bi-Directional Association between Tobacco and E-Cigarette Use among Youth in Canada.

Research has demonstrated associations between e-cigarette use and tobacco use among youth. However, few studies have examined whether reciprocal relationships exist between e-cigarette and tobacco use. The objective of this study was to examine whether bi-directional associations exist between e-cigarette and tobacco use in a large longitudinal sample of Canadian youth. A longitudinal sample of secondary students (n = 6729) attending 87 schools in Ontario and Alberta, Canada, who completed the COMPASS student questionnaire across three waves (from 2014-2015 to 2016-2017) was identified. Using cross-lagged models, we explored bi-directional associations between current tobacco and e-cigarette use, adjusting for relevant covariates. Our findings showed that current e-cigarette use predicted subsequent tobacco use between Wave 1 (W1) and Wave 2 (W2) of the study (W1-2: OR = 1.54, 95% CI = 1.37-1.74). Similarly, current tobacco use predicted e-cigarette use during earlier waves of the study (W1-2: OR = 1.43, 95% CI = 1.30-1.58). However, these relationships dissipated in later waves, when tobacco use no longer predicted e-cigarette use (W2-3: OR = 1.07, 95 % CI = 0.99-1.16). This study extends prior work that focused mainly on the association between e-cigarette and subsequent tobacco use. Specifically, our findings portray a more complex relationship, where e-cigarette use may influence and be influenced by tobacco use.

Exploring the association between E-cigarette retailer proximity and density to schools and youth E-cigarette use.

Limited evidence exists examining the association between e-cigarette retailer density and e-cigarette use among youth. This study explored whether e-cigarette retailer proximity and density to schools were associated with youth use of e-cigarettes in 4 Canadian provinces. Between October and December 2017, an online search identified e-cigarette retailers within 500 m, 1000 m, and 1500 m circular buffer zones around high schools (N = 122) that participated in the COMPASS study in 2017-18. Retailer proximity/density data were linked to student-level data (N = 63,400 students). Multilevel regression models examined the association between e-cigarette retailer proximity and density and ever and current e-cigarette use, controlling for relevant covariates. Results indicated the average school had <1 e-cigarette retailer within 500 m, 1000 m, and 1500 m. Significant between-school variability in the likelihood of ever [σ2 µ0 = 0.215 (0.030), p < .0001] and current [σ2 µ0 = 0.258 (0.036), p < .0001] e-cigarette use was found among students. However, after controlling for relevant covariates, e-cigarette retailer proximity and density surrounding a school were not significantly associated with the likelihood of ever or currently using e-cigarettes. These findings suggest that students are accessing e-cigarettes through other sources.