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.

School learning modes during the COVID-19 response and pre- to during pandemic mental health changes in a prospective cohort of Canadian adolescents.

PURPOSE: Considerable debate centered on the impact of school closures and shifts to virtual learning on adolescent mental health during the COVID-19 pandemic. We evaluated whether mental health changes differed by school learning modes during the pandemic response among Canadian adolescents and whether associations varied by gender and perceived home life. METHODS: We used prospective survey data from 7270 adolescents attending 41 Canadian secondary schools. Conditional change linear mixed effects models were used to examine learning mode (virtual optional, virtual mandated, in-person, and blended) as a predictor of change in mental health scores (depression [Centre for Epidemiologic Studies - Depression], anxiety [Generalized Anxiety Disorder-7], and psychosocial well-being [Flourishing scale]), adjusting for baseline mental health and covariates. Gender and home life happiness were tested as moderators. Least square means were calculated across interaction groups. RESULTS: Students learning in a blended learning mode had greater anxiety increases relative to their peers in other learning modes. Females learning fully in-person and males learning virtually when optional reported less of an increase in depression scores relative to their gender counterparts in other learning modes. Learning virtually when optional was associated with greater declines in psychosocial well-being in students without happy home lives relative to other learning modes. CONCLUSION: Findings demonstrate the importance of considering gender and home environments as determinants of mental health over the pandemic response and when considering alternative learning modes. Further research is advised before implementing virtual and blended learning modes. Potential risks and benefits must be weighed in the context of a pandemic.

Stronger together: Coping behaviours and mental health changes of Canadian adolescents in early phases of the COVID-19 pandemic.

BACKGROUND: The impact of the COVID-19 pandemic and consequent public health restrictions on the mental health of adolescents is of global concern. The purpose of this study was to examine how Canadian adolescents coped during the early pandemic and whether different coping methods were associated with changes in mental health from before the pandemic to the early lockdown response. METHODS: Using two-year linked survey data (2018-2020) from a prospective cohort of secondary school students (n = 3,577), linear regression models were used to examine whether changes in mental health (anxiety [Generalized Anxiety Disorder-7 scale], depression [Center for Epidemiologic Studies Depression 10-item scale Revised], emotion regulation [Difficulties in Emotion Regulation Scale], psychosocial well-being [Flourishing scale]) were related to each coping behaviour. RESULTS: The most common reported coping behaviours included staying connected with friends online (78.8%), playing video games, watching TV/movies, and/or surfing the internet/social media (76.2%), studying or working on schoolwork (71.0%), and getting exercise (65.2%). The use of positive coping mechanisms during the early pandemic period (e.g., keeping a regular schedule, time with family, time with friends online) was associated with less adverse mental health changes from before to during the early lockdown; whereas, negative coping mechanisms (e.g., spending time alone, eating junk food) were consistently associated with more adverse mental health changes. CONCLUSION: This study demonstrates the importance of social support and connections with both friends and family, as well as keeping and maintaining a routine, over the pandemic. Interventions supporting positive relationships and engagement in these coping behaviours may be protective for adolescent mental health during disruptive events.

Examining the use of decision trees in population health surveillance research: an application to youth mental health survey data in the COMPASS study. / Utilisation des arbres décisionnels dans la recherche en surveillance de la santé de la population : application aux données d'enquête sur la santé mentale des jeunes de l'étude COMPASS.

INTRODUCTION: In population health surveillance research, survey data are commonly analyzed using regression methods; however, these methods have limited ability to examine complex relationships. In contrast, decision tree models are ideally suited for segmenting populations and examining complex interactions among factors, and their use within health research is growing. This article provides a methodological overview of decision trees and their application to youth mental health survey data. METHODS: The performance of two popular decision tree techniques, the classification and regression tree (CART) and conditional inference tree (CTREE) techniques, is compared to traditional linear and logistic regression models through an application to youth mental health outcomes in the COMPASS study. Data were collected from 74 501 students across 136 schools in Canada. Anxiety, depression and psychosocial well-being outcomes were measured along with 23 sociodemographic and health behaviour predictors. Model performance was assessed using measures of prediction accuracy, parsimony and relative variable importance. RESULTS: Decision tree and regression models consistently identified the same sets of most important predictors for each outcome, indicating a general level of agreement between methods. Tree models had lower prediction accuracy but were more parsimonious and placed greater relative importance on key differentiating factors. CONCLUSION: Decision trees provide a means of identifying high-risk subgroups to whom prevention and intervention efforts can be targeted, making them a useful tool to address research questions that cannot be answered by traditional regression methods.

Using Decision Trees to Examine Environmental and Behavioural Factors Associated with Youth Anxiety, Depression, and Flourishing.

Modifiable environmental and behavioural factors influence youth mental health; however, past studies have primarily used regression models that quantify population average effects. Decision trees are an analytic technique that examine complex relationships between factors and identify high-risk subgroups to whom intervention measures can be targeted. This study used decision trees to examine associations of various risk factors with youth anxiety, depression, and flourishing. Data were collected from 74,501 students across Canadian high schools participating in the 2018-2019 COMPASS Study. Students completed a questionnaire including validated mental health scales and 23 covariates. Decision trees were grown to identify key factors and subgroups for anxiety, depression, and flourishing outcomes. Females lacking both happy home life and sense of connection to school were at greatest risk for higher anxiety and depression levels. In contrast with previous literature, behavioural factors such as diet, movement and substance use did not emerge as differentiators. This study highlights the influence of home and school environments on youth mental health using a novel decision tree analysis. While having a happy home life is most important in protecting against youth anxiety and depression, a sense of connection to school may mitigate the negative influence of a poor home environment.

Trends in youth cannabis use across cannabis legalization: Data from the COMPASS prospective cohort study.

Canada legalized recreational cannabis use for adults on October 17, 2018 with decision-makers emphasising the need to reduce cannabis use among youth. We sought to characterise trends of youth cannabis use before and after cannabis legalization by relying on a quasi-experimental design evaluating cannabis use among high school students in Alberta, British Columbia, Ontario, and Québec who participated in the COMPASS prospective cohort study. Overall trends in use were examined using a large repeat cross-sectional sample (n = 102,685) at two time points before legalization (16/17 and 17/18 school years) and one after (18/19 school year). Further differential changes in use among students affected by legalization were examined using three sequential four-year longitudinal cohorts (n = 5,400) of students as they progressed through high school. Youth cannabis use remains common with ever-use increasing from 30.5% in 2016/17 to 32.4% in 2018/19. In the repeat cross-sectional sample, the odds of ever use in the year following legalization were 1.05 times those of the preceding year (p = 0.0090). In the longitudinal sample, no significant differences in trends of cannabis use over time were found between cohorts for any of the three use frequency metrics. Therefore, it appears that cannabis legalization has not yet been followed by pronounced changes on youth cannabis use. High prevalence of youth cannabis use in this sample remains a concern. These data suggest that the Cannabis Act has not yet led to the reduction in youth cannabis use envisioned in its public health approach.

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.

Prevalence and correlates of youth poly-substance use in the COMPASS study.

BACKGROUND AND AIMS: Youth poly-substance use, associated with long-term negative health and social outcomes, is of increasing concern following the rise of e-cigarette vaping and cannabis legalization in Canada. This work aimed to investigate current evidence on correlates of this behaviour to inform effective prevention and harm reduction programming. DESIGN: Cross-sectional sample taking part in a cohort study. SETTING: Canadian high schools (AB, BC, ON, QC) PARTICIPANTS: 74,501 Canadian high school students who completed the COMPASS student questionnaire in 2018/2019. MEASUREMENTS: Self-report data on use of five substances (alcohol, cigarettes, e-cigarettes, cannabis, and opioids) alongside demographic factors, social and school support, and mental health-related measures. RESULTS: Of the 39% of youth who reported current substance use, 53% reported using two or more. E-cigarette vaping was most prevalent (28%) and most often combined with other substances. Feeling supported by friends and having no problem with seeking help at school were associated with higher levels of poly-substance use. Family support, school connectedness, and school support to resist drugs decreased the risk of substance co-use. CONCLUSIONS: The evidence presented here suggests that interventions for youth poly-substance use should rely on joint efforts between parents, schools, and communities to focus on structural factors rather than problematizing the individual.

Age at first alcohol use predicts current alcohol use, binge drinking and mixing of alcohol with energy drinks among Ontario Grade 12 students in the COMPASS study. / Utiliser l'âge de la première consommation d'alcool pour prédire la consommation d'alcool, la consommation excessive d'alcool et le mélange d'alcool et de boissons énergisantes chez les élèves de 12e année en Ontario dans le cadre du projet COMPASS.

INTRODUCTION: This study investigates the influence of age at first use of alcohol on current alcohol use and associated behaviours in a large sample of Canadian youth. METHODS: This descriptive-analytical study was conducted among Ontario Grade 12 students enrolled in the COMPASS Host Study between 2012 and 2017. We used generalized estimating equations (GEE) modelling to determine associations between age at first alcohol use and likelihood of current versus non-current alcohol use, binge drinking and mixing of alcohol with energy drinks among respondents. RESULTS: Students reporting an age at first alcohol use between ages 13 and 14 years were more likely to report current alcohol use versus non-current use (OR = 2.80, 95% CI: 2.26-3.45) and current binge drinking versus non-current binge drinking (OR = 3.22, 95% CI: 2.45-4.25) compared to students reporting first alcohol use at age 18 years or older. Students who started drinking at 8 years of age or younger were more likely to report current versus non-current alcohol use (OR = 3.54, 95% CI: 2.83-4.43), binge drinking (OR = 3.99, 95% CI: 2.97-5.37), and mixing of alcohol with energy drinks (OR = 2.26, 95% CI: 1.23-4.14), compared to students who started drinking at 18 years or older. CONCLUSION: Starting to drink alcohol in the early teen years predicted current alcohol use, current binge drinking and mixing of alcohol with energy drinks when students were in Grade 12. Findings indicate a need for development of novel alcohol prevention efforts.

Trends of poly-substance use among Canadian youth.

INTRODUCTION: Poly-substance use, increasingly understood as a behaviour with uniquely adverse consequences, is on the rise among Canadian youth. High levels of e-cigarette vaping and the recent legalization of recreational cannabis use may result in an acceleration of this trend. The aim of this work was to characterise changes in youth poly-substance use over time, generate baseline data for future investigations, and highlight areas of interest for policy action. METHODS: Descriptive statistics and regression models explored patterns and trends in concurrent use of multiple substances (alcohol, cigarettes, cannabis, and e-cigarettes) among Canadian high school students taking part in the COMPASS prospective cohort study during Y2 (2013/2014; n = 45,298), Y3 (2014/2015, n = 42,355), Y4 (2015/2016; n = 40,436), Y5 (2016/2017; n = 37,060), and Y6 (2017/2018; n = 34,879). RESULTS: Poly-substance use increased significantly over time, with over 50% of students who used substance reporting past-year use of multiple substances by 2017/2018. Male and Indigenous students were significantly more likely to report poly-substance use than female and white students respectively. E-cigarette vaping doubled from Y5 to Y6 and was included in all increasingly prevalent substance use combinations. CONCLUSIONS: Youth poly-substance use, rising since 2012/2013, saw a particularly steep increase after 2016/2017. Differential effects were observed for distinct demographic subpopulations, indicating tailored interventions may be required. E-cigarette vaping surged in parallel with the observed increase, suggesting a key role for this behaviour in shaping youth poly-substance use.

Prelegalisation patterns and trends of cannabis use among Canadian youth: results from the COMPASS prospective cohort study.

OBJECTIVE: Canada federally legalised recreational cannabis use among adults in October 2018. The impact this will have on Canadian youth is cause for concern. The current study examined changes in youth cannabis use over the time prior to legalisation to explore the impact of the beginning federal discourse around legalisation during the 2016/2017 school year. DESIGN: COMPASS, a prospective cohort study based on annual self-administered questionnaires. SETTING: Ontario and Alberta during the first 6 years of the COMPASS study (2012/2013 to 2017/2018). PARTICIPANTS: Canadian grade 9-12 students attending secondary schools participating in COMPASS. In total, 2 30 404 questionnaires were included in the analysis (Y1: 2012/2013, n=24 173; Y2: 2013/2014, n=45 298; Y3: 2014/2015, n=42 355, Y4: 2015/2016, n=40 436; Y5: 2016/2017, n=37 060; Y6: 2017/2018, n=34 897). PRIMARY AND SECONDARY OUTCOME MEASURES: Lifetime cannabis use, past-year cannabis use, weekly cannabis use, ease of access to cannabis and age at first cannabis use. RESULTS: Cannabis never-use decreased between Y5 and Y6. Changes in age at first cannabis use mirrored this trend, with male students consistently starting younger. Cannabis access rates increased from Y4, mainly led by female students. Lifetime and past-year use rates were lowest in Y4 then increased in Y5 and Y6 due to a rise in the occasional use more common among female students, who reported use increases first. Non-white students were more likely use cannabis, with black and Aboriginal students the only two groups consistently reporting more weekly than occasional use, though with opposing trajectories. Overall, Aboriginal students had the highest odds of reporting lifetime, past-year and weekly use among the demographic groups examined. CONCLUSION: After a steady decrease in patterns of cannabis among youth over several years, it appears that there has been a gradual increase in cannabis use among youth following the start of discourse around cannabis legalisation, with some populations of youth being at greater risk.