The Association Between Religiosity, Spirituality and Colorectal Cancer Screening: A Longitudinal Analysis of Alberta's Tomorrow Project in Canada.

We explored longitudinal associations between religion/spirituality (R/S) Salience and R/S Attendance, and colorectal cancer screening, among adults aged ≥ 50 years in Alberta, Canada. R/S Salience was not statistically significantly associated with colorectal cancer screening (adjusted odds ratio [aOR]: 1.06, 95% confidence interval [CI] 0.88-1.28). Conversely, R/S Attendance was statistically significantly associated with higher odds of colorectal cancer screening: the aOR was 1.28 (95% CI 1.02-1.59) for participants attending services at least once a month and 1.31 (95% CI 1.01-1.69) for participants attending between one and four times yearly, compared to participants who never attended. Researchers should explore the possibility of delivering colorectal cancer screening programs in R/S settings.

Learning from missing data: examining nonreporting patterns of height, weight, and BMI among Canadian youth.

BACKGROUND: Youth body mass index (BMI), derived from self-reported height and weight, is commonly prone to nonreporting. A considerable proportion of overweight and obesity (OWOB) research relies on such self-report data, however little literature to date has examined this nonreporting and the potential impact on research conclusions. The objective of this study was to examine the characteristics and predictors of missing data in youth BMI, height, and weight. METHODS: Using a sample of 74,501 Canadian secondary school students who participated in the COMPASS study in 2018/19, sex-stratified generalized linear mixed models were run to examine predictors of missing data while controlling for school-level clustering. RESULTS: In this sample, 31% of BMI data were missing. A variety of diet, exercise, mental health, and substance use variables were associated with BMI, height, and weight missingness. Perceptions of being overweight (females: 95% CI (1.42,1.62), males: 95% CI (1.71,2.00)) as well as intentions to lose weight (females: 95% CI (1.17,1.33), males: 95% CI (1.13,1.32)) were positively associated with BMI missingness. CONCLUSIONS: Findings from this study suggest that nonreporting in youth height and weight is likely somewhat related to the values themselves, and hint that social desirability may play a substantial role in nonreporting. The predictors of missingness identified in this study can be used to inform future studies on the potential bias stemming from missing data and identify auxiliary variables that may be used for multiple imputation approaches.

The impact of assistive devices on community-dwelling older adults and their informal caregivers: a systematic review.

OBJECTIVE: The purpose of this systematic review is to assess the impact of assistive devices on the life satisfaction of (Research Question 1), and informal caregiving hours received by (Research Question 2), community-dwelling older adults (≥ 65 years). METHODS: We searched CINAHL, MEDLINE, and Scopus from database inception to March 2022. For each question, two reviewers independently screened citations, extracted and narratively synthesized the data, and assessed article quality and strength of evidence. RESULTS: Of the 1391 citations screened, we found two articles pertaining to each question, for a total of four articles. In general, assistive device use was not associated with life satisfaction, while it was positively associated with informal caregiving hours. However, the risk of bias was serious across the two studies for Research Question 1, and the overall quality of evidence was "very low". The risk of bias was not serious across the two studies included in Research Question 2 and the overall quality of evidence was "low". CONCLUSION: Due to the scarcity of studies, the limitations of existing studies (i.e., risk of bias), and the evidence being low or very low quality, we could not draw firm conclusions about the associations of interest. Additional research will produce a better understanding of the two relationships and provide further evidence to inform policy decisions regarding the provision and funding of assistive devices for community-dwelling older adults. TRIAL REGISTRATION: This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database of systematic reviews (identification number: CRD42021248929 ).

Examining if changes in gender-specific and co-ed intramural programs affect youth physical activity over time: a natural experiment evaluation using school- and student-level data from the COMPASS study.

BACKGROUND: Despite the benefits of physical activity (PA), the majority of Canadian youth are falling short of the recommended 60 min of moderate-to-vigorous physical activity (MVPA) per day. School-based physical activity programs such as intramurals, are important opportunities for youth to be physically active. There is limited evidence available on the impact of gender-specific (e.g., female-only, male-only) and co-ed intramurals on youth PA over time, however, evidence suggests female-only intramurals may be important for female MVPA. This research aims to capitalize on a natural experiment to generate practice-based evidence on the impact of changes in gender-specific and co-ed intramurals on youth MVPA over time. METHODS: This study used linked longitudinal school- and student-level data from Ontario secondary schools in year 5 (Y5:2016-2017), year 6 (Y6: 2017-2018) and year 7 (Y7: 2018-2019) of the COMPASS study. Data on intramurals from 55 schools were used to determine the changes to gender-specific and co-ed intramurals that occurred from Y5 to Y6. Baseline demographic characteristics were measured and data on PA and sport participation were collected in Y5, Y6 and Y7 on a sample of 4417 students. Hierarchical linear mixed regression models were used to estimate how changes in gender-specific and co-ed intramurals were associated with youth MVPA over time. RESULTS: Participation in intramural, varsity and community sport were all positively and significantly associated with youth MVPA. Changes in gender-specific and co-ed intramurals were not significantly associated with youth MVPA in Y6 or Y7. However, the positive association between maintaining the addition of gender-specific intramurals on female MVPA in Y7 was on par with the significance level of α = 0.05, suggesting that adding gender-specific intramurals may be important for female MVPA. CONCLUSIONS: Adding gender-specific and co-ed intramurals may not be sufficient strategies to increase PA among youth. Further research should explore the effect of gender-specific intramurals on youth PA, as this study may have been underpowered at the school-level. Gender-specific intramurals may promote a supportive PA environment that promotes MVPA, especially among females. These intramurals may be an important component of more comprehensive strategies to increase youth MVPA.

Exploring gender differences in the longitudinal association between bullying and risk behaviours with Body Mass Index among COMPASS youth in Canada.

The purpose of this study was to identify gender differences in the association between bullying and Body Mass Index (BMI) longitudinally. Longitudinal data (2013-2015) from 4510 youth (Ontario, Canada) were used to model BMI with consecutive bullying status prospectively, adjusting for previously identified gender-specific health risk behaviour latent classes. To assess for gender differences, these mixed-effects models were stratified by gender. Youth who were victims of bullying (VoB) were more active, engaged in more substance use and reported higher BMI than their non-victim of bullying (NVoB) peers. The gender-specific mixed-models showed that there are gender differences in the association between bullying and BMI. Among females, repeated bullying was associated with higher odds of having overweight/obesity [by 51% (95% C.I. = 1.03, 2.23)] at follow-up. Among male youth, being a VoB at the previous wave only, was associated with higher odds of having overweight/obesity [by 60% (95% C.I. = 1.11, 2.29)] at follow-up. In contrast with previous literature that measured BMI during adulthood (i.e., years after school victimization), our study adds a unique contribution to the literature that across one year (while youth are still in secondary school), bullying is associated with higher odds of weight status and BMI among female and male youth. Since this increase occurs during secondary school, school-based programs aimed at decreasing youth bullying behaviours and addressing increases in BMI before youth leave school are of paramount importance.

A gender-stratified, multilevel latent class assessment of chronic disease risk behaviours' association with Body Mass Index among youth in the COMPASS study.

This paper sought to examine chronic disease risk behaviour latent classes and their association with Body Mass Index (BMI), assessing for gender differences. Participants were youth (n = 116,086; grades 9-12) enrolled in the COMPASS study (Ontario, Canada) during 2013, 2014, 2015. Multilevel latent class analysis was used to identify underlying, homogenous classes of youths' engagement in physical activity, smoking, binge drinking and marijuana use. Adjusted multilevel models regressed BMI on the latent classes controlling for ethnicity and grade. Three latent classes were identified: active experimenters (ACE), inactive clean youth (INC) and inactive substance users (INSU). This study found that gender differences are apparent in chronic disease risk behaviour latent classes and their association with BMI. INC males (OR = 0.85, 95% CI = 0.78, 0.93) were associated with a lower odds of overweight/obesity relative to active males who experimented with substance use. As for females, the class with the highest proportion of youth using substances were associated with higher odds (Females: OR = 1.2, 95% CI = 1.1, 1.4) of overweight/obesity relative to their active experimenting peers. As such, youth in latent classes with substance use are associated with higher BMI and weight status. Successful interventions may include school policies/programs that limit screen time use, as they were seen to have a positive effect on PA engagement and including social-influences approaches for substance use. Future research and interventions should be gender-specific as our results show that different latent classes are associated with obesity across genders.

Exploring the Predictive Validity of the Susceptibility to Smoking Construct for Tobacco Cigarettes, Alternative Tobacco Products, and E-Cigarettes.

INTRODUCTION: Within tobacco prevention programming, it is useful to identify youth that are at risk for experimenting with various tobacco products and e-cigarettes. The susceptibility to smoking construct is a simple method to identify never-smoking students that are less committed to remaining smoke-free. However, the predictive validity of this construct has not been tested within the Canadian context or for the use of other tobacco products and e-cigarettes. METHODS: This study used a large, longitudinal sample of secondary school students that reported never using tobacco cigarettes and noncurrent use of alternative tobacco products or e-cigarettes at baseline in Ontario, Canada. The sensitivity, specificity, and positive and negative predictive values of the susceptibility construct for predicting tobacco cigarette, e-cigarette, cigarillo or little cigar, cigar, hookah, and smokeless tobacco use 1 and 2 years after baseline measurement were calculated. RESULTS: At baseline, 29.4% of the sample was susceptible to future tobacco product or e-cigarette use. The sensitivity of the construct ranged from 43.2% (smokeless tobacco) to 59.5% (tobacco cigarettes), the specificity ranged from 70.9% (smokeless tobacco) to 75.9% (tobacco cigarettes), and the positive predictive value ranged from 2.6% (smokeless tobacco) to 32.2% (tobacco cigarettes). Similar values were calculated for each measure of the susceptibility construct. CONCLUSIONS: A significant number of youth that did not currently use tobacco products or e-cigarettes at baseline reported using tobacco products and e-cigarettes over a 2-year follow-up period. The predictive validity of the susceptibility construct was high and the construct can be used to predict other tobacco product and e-cigarette use among youth. IMPLICATIONS: This study presents the predictive validity of the susceptibility construct for the use of tobacco cigarettes among secondary school students in Ontario, Canada. It also presents a novel use of the susceptibility construct for predicting the use of e-cigarettes, cigarillos or little cigars, cigars, hookah, and smokeless tobacco among secondary school students in Ontario, Canada.

Examining associations between school food environment characteristics and sugar-sweetened beverage consumption among Canadian secondary-school students in the COMPASS study.

OBJECTIVE: To examine associations between Canadian adolescents' sugar-sweetened beverage (SSB) consumption and several school food environment characteristics, and to investigate differences in these characteristics between schools in provinces with voluntary (Alberta) v. mandatory (Ontario) provincial school nutrition policies. DESIGN: We used a questionnaire to assess the number of weekdays participants consumed three SSB categories (soft drinks, sweetened coffees/teas, energy drinks) and various sociodemographic and behavioural characteristics. We examined the in-school water fountain accessibility, vending machines' contents and presence of various food outlets within schools' 1 km buffer. We developed hierarchical Poisson regression models to identify associations between student- and school-level characteristics and students' SSB outcomes. SETTING: Alberta and Ontario, Canada. SUBJECTS: Adolescents (n 41 829) from eighty-nine secondary schools. RESULTS: Compared with their Ontarian counterparts, Albertan participants had a significantly higher rate of SSB intake across all drink categories and SSB availability was significantly greater in Albertan schools' vending machines. Availability of sweetened coffees/teas in school vending machines and access to restaurants within the school's 1 km buffer were associated with increased SSB intake in three of the final models. Overall, the school food environment-level characteristics examined had a modest to negligible impact on student days of SSB intake. CONCLUSIONS: We identified that the school food environment characteristics examined here had little impact on adolescents' days of SSB consumption. While schools should adopt or maintain a comprehensive policy approach to discourage students' SSB intake, population-level interventions focusing on other contexts (e.g. home and community) are needed to complement existing school-based interventions.

Examining changes in school vending machine beverage availability and sugar-sweetened beverage intake among Canadian adolescents participating in the COMPASS study: a longitudinal assessment of provincial school nutrition policy compliance and effectiveness.

BACKGROUND: School nutrition policies can encourage restrictions in sugar-sweetened beverage (SSB) availability in school food outlets in order to discourage students' SSB intake. The main objective was to examine how beverage availability in school vending machines changes over three school years across schools in distinct school nutrition policy contexts. Secondary objectives were to examine how students' weekday SSB intake varies with time and identify longitudinal associations between beverage availability and SSB intake. METHODS: This longitudinal study used data from the COMPASS study (2013/14-2015/16), representing 7679 students from 78 Canadian secondary schools and three provincial school nutrition policy contexts (Alberta - voluntary guidelines, Ontario public - mandatory guidelines, and Ontario private schools - no guidelines). We assessed availability of 10 beverage categories in schools' vending machines via the COMPASS School Environment Application and participants' intake of three SSB varieties (soft drinks, sweetened coffees/teas, and energy drinks) via a questionnaire. Hierarchical regression models were used to examine whether: i) progression of time and policy group were associated with beverage availability; and, ii) beverage availability was associated with students' SSB intake. RESULTS: Ontario public schools were significantly less likely than the other policy groups to serve SSBs in their vending machines, with the exception of flavoured milks. Vending machine beverage availability was consistent over time. Participants' overall SSB intake remained relatively stable; reductions in soft drink intake were partially offset by increased sweetened coffee/tea consumption. Relative to Ontario public schools, attending school in Alberta was associated with more frequent energy drink intake and overall SSB intake whereas attending an Ontario private school was associated with less frequent soft drink intake, with no differences in overall SSB intake. Few beverage availability variables were significantly associated with participants' SSB intake. CONCLUSIONS: Mandatory provincial school nutrition policies were predictive of more limited SSB availability in school vending machines. SSB intake was significantly lower in Ontario public and private schools, although we did not detect a direct association between SSB consumption and availability. The findings provide support for mandatory school nutrition policies, as well as the need for comprehensive school- and broader population-level efforts to reduce SSB intake.

Post-High School Changes in Tobacco and Cannabis Use in the United States.

BACKGROUND: The transition from high school into young adulthood is a critical developmental period with many young people going to college, moving residence, and entering the work force for the first time. The NEXT Generation Health Study (NEXT) is a nationally representative longitudinal study of adolescent health behaviors. Previous NEXT research has found that the post-high school environment is associated with changes in alcohol use. OBJECTIVES: The current study investigated the impact of school status, residential status, and work status on cannabis and cigarette use among post-high school participants. RESULTS: Living in a dorm/fraternity/sorority was associated with an increased prevalence in cannabis use while attending a 4-year college was associated with a decreased prevalence in cigarette use. CONCLUSIONS: Some aspects of the post-high school environment are related to cannabis and cigarette use. Differences in the social circumstances of cigarette and cannabis use and recent campaigns in colleges to reduce smoking may explain some of these trends.

Reconstructing a Pregnancy Cohort to Examine Potential Selection Bias in Studies on Racial Disparities in Preterm Delivery.

BACKGROUND: Epidemiologic studies examining preconception risk factors on perinatal outcomes are typically restricted to livebirths. By including only non-terminated pregnancies, estimates for the underlying pregnancy cohort may be subject to selection bias. We examined if potential selection bias due to induced termination by maternal race may result in different estimates of the non-Hispanic black - non-Hispanic white risk ratio (RR) for preterm delivery (PTD) among a reconstructed pregnancy cohort ('pseudo-pregnancy cohort'). METHODS: Using New York City registries of 1.6 million livebirths, spontaneous terminations, and induced terminations among non-Hispanic black and non-Hispanic white women (2000-12), we multiply imputed PTD (<37 weeks) and early PTD (<32 weeks) outcomes for induced terminations based on maternal race, age, parity, marital status, nativity, and medical care payer to construct the pseudo-pregnancy cohort. RESULTS: Among non-Hispanic black and non-Hispanic white women, 55% and 19% of pregnancies ended in induced termination and 13% and 8% resulted in PTD, respectively. Although several factors were associated with both PTD and induced termination, PTD RRs in the birth (RR 1.64, 95% confidence interval (CI) 1.62, 1.66) and pseudo-pregnancy (RR 1.63, 95% CI 1.56, 1.71) cohorts were similar. However, early PTD RR was somewhat larger in the birth (RR 2.80, 95% CI 2.71, 2.89) than pseudo-pregnancy (RR 2.47, 95% CI 2.23, 2.73) cohort. CONCLUSIONS: Using birth certificate data - thereby excluding induced terminations - to estimate the PTD racial disparity did not produce biased estimates. Our data suggest observed PTD disparities likely are not artefacts of selection bias due to induced termination.

Clustering of risk-related modifiable behaviours and their association with overweight and obesity among a large sample of youth in the COMPASS study.

BACKGROUND: Canadian youth exhibit a number of risky behaviours, some of which are associated with overweight and obesity. The purpose of this study was to examine the prevalence of 15 modifiable risk behaviours in a large sample of Canadian youth, to identify underlying subgroups based on patterns of health behaviours, and to examine the association between identified subgroups and overweight/obesity. METHODS: Data from 18,587 grades 9-12 students in Year 1 (2012-13) of the COMPASS study and latent class analysis were used to identify patterns and clustering among 15 health behaviours (e.g., physical inactivity, sedentary behaviour, unhealthy eating, substance use). A logistic regression model examined the associations between these clusters and overweight/obesity status. RESULTS: Four distinct classes were identified: traditional school athletes, inactive screenagers, health conscious, and moderately active substance users. Each behavioural cluster demonstrated a distinct pattern of behaviours, some with a greater number of risk factors than others. Traditional school athletes (odds ratio (OR) 1.15, 95% CI 1.03-1.29), inactive screenagers (OR 1.33; 1.19-1.48), and moderately active substance users (OR 1.27; 1.14-1.43) were all significantly more likely to be overweight/obese compared to the health conscious group. CONCLUSIONS: Four distinct subpopulations of youth were identified based on their patterns of health and risk behaviours. The three clusters demonstrating poorer health behaviour were all at an increased risk of being overweight/obese compared to their somewhat healthier peers. Obesity-related public health interventions and health promotion efforts might be more effective if consideration is given to population segments with certain behavioural patterns, targeting subgroups at greatest risk of overweight or obesity.

Individual, social, and environmental influences on the transitions in physical activity among emerging adults.

BACKGROUND: Youth's physical activity (PA) may change across developmental periods. Although previous studies have observed a decline in levels of PA during adolescence, few studies have explored trends in PA during the transition from adolescence to young adulthood and what factors may impact the transitional change. The purpose of this study was to examine changes and predictors of change over time in PA from 10(th) grade to post-high school. METHODS: The NEXT Generation Health Study recruited a nationally-representative cohort of US 10(th)-graders, and administered longitudinal surveys in four waves (years) to follow up the participants to their first year after high school. Using transition models, the self-reported outcomes, moderate-to-vigorous PA (MVPA) and vigorous PA (VPA) each of which was repeatedly measured by one question, were modelled in association with wave-4 environmental-status variables and time-varying covariates. RESULTS: There was a continuous decline in the proportion of respondents who met or exceeded the minimum recommended level for either MVPA (from 55.97 to 34.33 %) or VPA (from 65.96 to 54.90 %) from W1 to W4. Higher scores of peer PA, family support and VPA planning were prospectively associated with higher likelihood of meeting the MVPA/VPA recommendations. At wave 4, compared to those not working, attending 4-year colleges, or living on campus, participants working full/part time, not attending school or attending community-college level schools, and living at home or in own place were more likely to engage in MVPA. CONCLUSIONS: Peer PA, family support, self-regulatory skills, and environmental status after high school are critical factors that can promote MVPA/VPA among adolescents and emerging adults.

Partial F-tests with multiply imputed data in the linear regression framework via coefficient of determination.

Tests for regression coefficients such as global, local, and partial F-tests are common in applied research. In the framework of multiple imputation, there are several papers addressing tests for regression coefficients. However, for simultaneous hypothesis testing, the existing methods are computationally intensive because they involve calculation with vectors and (inversion of) matrices. In this paper, we propose a simple method based on the scalar entity, coefficient of determination, to perform (global, local, and partial) F-tests with multiply imputed data. The proposed method is evaluated using simulated data and applied to suicide prevention data.

Trajectories of eating behaviors in a nationally representative cohort of U.S. adolescents during the transition to young adulthood.

BACKGROUND: Diets of U.S. adolescents and adults do not meet recommendations, increasing risk of chronic disease. This study examined trajectories and predictors of eating behaviors in U.S. youth from age 16-20 years, and evaluated longitudinal associations of eating behaviors with weight outcomes. METHODS: Data come from the first four waves (years) of the NEXT Generation Health Study, a nationally representative cohort of U.S. students in 10(th) grade during the 2009-2010 school year (n = 2785). Annual surveys queried frequency of food group intake (times/day of fruit and vegetables, whole grains, sugar-sweetened soda, sweet and salty snacks), and meal practices (days/week of breakfast, family meals, fast food, and television during meals). Body mass index (BMI, kg/m(2)) was calculated from self-reported height and weight. Adjusted generalized estimating equations and linear mixed models with multiple imputation for missing data estimated eating behavior trajectories overall and by baseline weight status (normal weight = 5 ≤ BMI%ile < 85, overweight = 85 ≤ BMI%ile < 95, obese = BMI%ile ≥ 95), accounting for the complex sampling design. Separate GEE models estimated longitudinal associations of food group frequencies with meal practices and of BMI with eating behaviors. RESULTS: Eating behaviors tracked strongly from wave 1-4 (residual intraclass correlation = 41% - 51%). Across all baseline weight categories, frequency of food group intake and meal practices decreased over time, except for fast food, which remained stable. Fruit/vegetable intake frequency was associated positively with family meals (ß ± SE = 0.33 ± 0.05) and breakfast (0.18 ± 0.03), and inversely with fast food (-0.31 ± 0.04), while whole grain intake frequency was associated positively with family meals (0.07 ± 0.02), television meals (0.02 ± 0.009) and breakfast (0.04 ± 0.01). Soda and snacks were positively associated with television meals (0.08 ± 0.008 and 0.07 ± 0.009, respectively) and fast food (0.24 ± 0.02 and 0.20 ± 0.03, respectively), while soda was inversely associated with breakfast frequency (-0.05 ± 0.01). Time-varying BMI was unrelated to eating behaviors other than an inverse association with time-varying snacks (-0.33 ± 0.12). CONCLUSIONS: Strong tracking over time supports the importance of early establishment of health-promoting eating behaviors in U.S. adolescents. Findings suggest meal practices may be important intervention targets. Lack of evidence for hypothesized associations of BMI and eating behaviors indicates the need for research confirming these findings using more precise measures of dietary intake.

Exploring the association between religious participation and memory in middle- and older-aged adults in the Canadian Longitudinal Study on Aging.

To investigate the association between religious participation and memory in persons aged 45-85 years. Using the Canadian Longitudinal Study on Aging, frequency of religious participation was measured from "daily" to "never"; immediate and delayed recall memory were assessed with the Rey Auditory Verbal Learning Test. We regressed memory onto religious participation for persons aged < 65 years and persons aged ≥ 65 years. We found some evidence of effect modification: among persons < 65 years, monthly to yearly participation versus never attending was positively associated with immediate and delayed recall memory; among persons aged ≥ 65 years, weekly or more participation versus never attending was negatively associated with immediate and delayed recall memory. However, regression coefficients were small (-0.09 ≤ B ≤ 0.06) and most were not statistically significant (p < 0.05). Insufficient evidence existed to conclude that religious participation was associated with memory in our sample.

Using classification and regression trees to model missingness in youth BMI, height and body mass data. / Utilisation des arbres de classification et de régression pour modéliser les données manquantes sur l'IMC, la taille et la masse corporelle chez les jeunes.

INTRODUCTION: Research suggests that there is often a high degree of missingness in youth body mass index (BMI) data derived from self-reported measures, which may have a large effect on research findings. The first step in handling missing data is to examine the levels and patterns of missingness. However, previous studies examining youth BMI missingness used logistic regression, which is limited in its ability to discern subgroups or identify a hierarchy of importance for variables, aspects that may go a long way in helping understand missing data patterns. METHODS: This study used sex-stratified classification and regression tree (CART) models to examine missingness in height, body mass and BMI data among 74 501 youth participating in the 2018/19 COMPASS study (a prospective cohort study examining health behaviours among Canadian youth), where 31% of BMI data were missing. Diet, movement, academic, mental health and substance use variables were examined for associations with missingness in height, body mass and BMI. RESULTS: CART models indicated that the combination of being younger, having a selfperception of being overweight, being less physically active and having poorer mental health yielded female and male subgroups highly likely to be missing BMI values. Survey respondents who did not perceive themselves as overweight and who were older were unlikely to be missing BMI values. CONCLUSION: The subgroups identified by the CART models indicate that a sample that deletes cases with missing BMI would be biased towards physically, emotionally and mentally healthier youth. Given the ability of CART models to identify these subgroups and a hierarchy of variable importance, they are an invaluable tool for examining missing data patterns and appropriate handling of missing data.

The association between religiosity, spirituality, and breast cancer screening: A cross-sectional analysis of Alberta's Tomorrow Project.

Breast cancer is the leading cause of cancer-related mortality among women. Screening permits the early detection and treatment of malignancies, thereby reducing mortality. A woman's religiosity and spirituality (R/S) may facilitate screening through encouragement of healthy behaviors. Population-level data from Alberta's Tomorrow Project (ATP) were used to explore the cross-sectional association between R/S and breast cancer screening among women aged 50 to 69 years who did not have a history of breast cancer. Two variables were used to measure R/S: (1) R/S Salience was defined as the importance of religion and spirituality in one's life; (2) R/S Attendance was defined as the frequency of attendance at religious or spiritual services. We regressed breast cancer screening (mammogram: yes/no) on each R/S variable in separate multivariable logistic regression models. At baseline (n = 2569), 94% of women reported receiving a mammogram. Greater R/S Salience was not associated with receipt of mammogram: the adjusted odds ratio (aOR) was 1.04 (95% confidence interval [CI]: 0.71-1.51. R/S Attendance also showed no association with mammogram: attending at least once monthly versus never attending (aOR: 1.10; 95% CI: 0.71-1.69); attending one to four times yearly versus never attending (aOR: 0.95, 95% CI: 0.57-1.58). Further research could examine specific subgroups of the population, e.g., whether use of R/S to promote breast cancer screening may be more effective among females with strong pre-existing connections to faith.

Biological Embedding of Psychosocial Stressors Within a Sample of Canadian Firefighters: An Exploratory Analysis.

OBJECTIVE: We wanted to determine whether the biological embedding of perceived psychosocial stress could be observed within a sample of Canadian firefighters. METHODS: We collected sociodemographic and general health-related information from 58 firefighters. In addition, measures of work-related and general life psychosocial stress, perceived social support, and physiological parameters thought to reflect the embedding of stress were gathered and analyzed using analysis of variance and linear regression models. RESULTS: Despite observing a positive relationship between psychosocial stress and allostatic load, the association was not significant; however, age did significantly predict allostatic load ( B = 0.09, P = 0.04). Notably, our participants reported abundant social support that was inversely associated with perceived stress. CONCLUSIONS: Although perceived stress did not significantly affect allostatic load in our sample, high levels of social support may have provided an important countervailing force.