A cross-sectional examination of medicinal substance abuse and use of nonmedicinal substances among Canadian youth: findings from the 2012-2013 Youth Smoking Survey.

BACKGROUND: Medicinal substance abuse is prevalent in Canada; however, little is known about patterns of abuse among young people. In this study, we sought to characterize the abuse of medicinal substances, such as prescription medications and selected over-the-counter substances, as well as that of licit and illicit nonmedicinal substances, using a nationally representative sample of young people. METHODS: Cross-sectional, nationally representative data for children in grades 7-12 were obtained from Health Canada's 2012-2013 Youth Smoking Survey (n = 38 667). Multinomial regression analyses were conducted to examine subgroup differences in medicinal substance abuse and comorbid abuse of both medicinal and nonmedicinal substances. RESULTS: About 5% of youth reported abusing medicinal substances in the previous year. Dextromethorphan, a substance found in many cough and cold syrups, was the most widely abused (2.9%), followed by pain medications (2.6%), sleeping medications (1.8%), stimulants (1.7%) and sedatives (1.0%). Abuse of nonmedicinal substances aside from tobacco and alcohol was reported by 21.3% of the population, and abuse of any substances was detected in 23.0% of the surveyed population. Girls at each grade level reported higher rates of abuse of medicinal substances than boys. Regional differences were seen with regard to the types of substances abused across Canada. INTERPRETATION: A substantial minority of Canadian youth report abusing medicinal substances, including over-the-counter medications (e.g., cough syrup) and prescriptions medications (e.g., pain medication). In contrast to nonmedicinal substances, girls were more likely than boys to report abuse of medicinal substances.

Results from Canada's 2014 Report Card on Physical Activity for Children and Youth.

BACKGROUND: The Active Healthy Kids Canada (AHKC) Report Card consolidates and translates research and assesses how Canada is being responsible in providing physical activity opportunities for children (3- to 11-years-old) and youth (12- to 17-years-old). The primary aim of this article is to summarize the results of the 2014 AHKC 10th Anniversary Report Card. METHODS: Ten physical activity indicators were graded using the AHKC Report Card development process, which includes a synthesis of the best available research, surveillance, policy and practice findings, and expert consensus. RESULTS: Grades assigned were for: 'Behaviors that Contribute to Overall Physical Activity Levels' (Overall Physical Activity Levels, D-; Organized Sport Participation, C+; Active Play, INCOMPLETE; Active Transportation, D; Sedentary Behaviors, F), 'Settings and Sources of Influence' (Family and Peers, C; School, C+; and Community and the Built Environment, B+), and 'Strategies and Investments' (Government Strategies and Investments, C; and Non-Government Strategies and Investments, A-). CONCLUSIONS: Despite good availability of policies, programs, and infrastructure, the overall physical activity levels of Canadian children and youth remain low while sedentary behavior levels remain high. As with many nations, there is room for improvement in most physical activity behaviors and some sources of influence.

Are we driving our kids to unhealthy habits? Results of the active healthy kids Canada 2013 report card on physical activity for children and youth.

This article examines the time trends in patterns of school travel mode among Canadian children and youth to inform the Active Transportation (AT) indicator of the 2013 Active Healthy Kids Canada Report Card on Physical Activity for Children and Youth. The AT grade was assigned based on a comprehensive synthesis of the 2000 and 2010 Physical Activity Monitor studies from the Canadian Fitness and Lifestyle Research Institute and the 1992, 1998, 2005, and 2010 General Social Survey from Statistics Canada. The results showed that in 2013, AT was graded a D, because less than half of Canadian children and youth used only active modes of transportation to get to and from school. The proportion of Canadian children and youth who used only inactive modes of transportation for school travel increased significantly from 51% to 62% over the last decade. Children and youth from larger communities and those with lower household income levels were significantly more likely to use AT than those living in smaller communities and those in higher income households, respectively. In conclusion, motorized transport for school travel has increased steadily over the last decade across Canada. Regional and socio-demographic disparities should be considered in efforts to increase the number of children using AT.

We do not smoke but some of us are more susceptible than others: a multilevel analysis of a sample of Canadian youth in grades 9 to 12.

BACKGROUND: Smoking susceptibility has been found to be a strong predictor of experimental smoking. This paper examined which student- and school-level factors differentiated susceptible never smokers from non-susceptible never smokers among a nationally representative sample of Canadian students in grades 9 to 12. METHODS: Student-level data from the 2008-2009 Canadian Youth Smoking Survey were linked with school-level data from the 2006 Census, and one built environment characteristic (the density of tobacco retailers surrounding schools). These data were examined using multilevel logistic regression analyses. RESULTS: The likelihood of a never smoker being susceptible to smoking significantly varied across schools (p=0.0002). Students in this study were more likely to be susceptible never smokers if they reported low self-esteem, held positive attitudes towards smoking, used alcohol or marijuana, had close friends who smoked, and came from homes without a total ban on smoking. The school location (rural versus urban), the socioeconomic status of the neighbourhood surrounding a school, and the density of tobacco retailers that were located within 1-km radius of each school were not associated with students' smoking susceptibility. CONCLUSION: These findings underscore the continued need to develop school-based tobacco use prevention policies and/or programs that enhance students' self-esteem, address tobacco use misinformation and substance use, and include strategies targeting friends who smoke, and students who come from homes without a total ban on smoking.

Using student and school factors to differentiate adolescent current smokers from experimental smokers in Canada: a multilevel analysis.

OBJECTIVE: In order to understand the factors that differentiate adolescents who have tried smoking from those who have become established smokers, this study examined which student- and school-level factors differentiated current smokers from experimental smokers among a nationally representative sample of Canadian secondary school students. METHOD: Student-level secondary data from the 2008-2009 Canadian Youth Smoking Survey was linked with school-level data from the 2006 Census and one built environment characteristic, and examined using multilevel logistic regression analyses. RESULTS: The current smoking rates varied (P<0.001) across schools. The number of tobacco retailers surrounding the schools was associated with current smoking when adjusting for student characteristics. Additionally, students were more likely to be current smokers if they were: male, in higher grades, believed that smoking can help when they are bored, reported low school connectedness, used marijuana, had a sibling or close friend who smoked, and had no smoking bans at home. CONCLUSIONS: These study findings suggest that school anti-smoking strategies need to target males, increase students' attachment to their school, address tobacco-related beliefs, and include interventions targeting smoking siblings and friends. The government should consider zoning restrictions to limit sales of tobacco products near schools.

Energy expenditure while playing active and inactive video games.

PURPOSE: To examine energy expenditure (EE) when playing active and inactive videogames (VG). METHODS: Predicted EE was measured among 51 undergraduate students while playing active and inactive VG (Ontario, Canada). RESULTS: Predicted EE was significantly higher playing the active VG compared to the inactive VG according to heart rate monitor (97.4 kcal vs 64.7 kcal) and SenseWear armband (192.4 kcal vs 42.3 kcal) estimates. CONCLUSION: Active VG may be a viable intervention tool for increasing EE among students who would otherwise be spending time in sedentary screen-based behaviors.

The imperative of strategic alignment across organizations: the experience of the Canadian Cancer Society's Centre for Behavioural Research and Program Evaluation.

The Canadian Cancer Society's Centre for Behavioural Research and Program Evaluation (CBRPE) is a national asset for building pan-Canadian capacity to support intervention studies that guide population-level policies and programs. This paper briefly describes CBRPE's experience in advancing this work in the field of prevention. The aim is to illuminate issues of central importance for advancing the goals of the Population Health Intervention Research Initiative for Canada. According to our experience, success in building the population intervention field will depend heavily on purposeful alignment across organizations to enable integration of research, evaluation, surveillance, policy and practice. CBRPE's capacity development roles include a) a catalytic role in shaping this aligned inter-organizational milieu and b) investing our resources in building tangible assets (teams, indicators, data systems) that contribute relevant capacities within this emerging milieu. Challenges in building capacity in this field are described.

Smoking and physical activity: a systematic review.

OBJECTIVES: To better understand the co-occurrence of smoking and physical inactivity. METHODS: A review of 5 databases identified 50 articles reporting empirical relationships between smoking and physical activity (PA). RESULTS: Almost 60% of the articles reported a definitely negative association, but this relationship was often attenuated or reversed among adolescents and males and for moderate (vs vigorous) exercise. Stages of change for smoking and PA were relatively unrelated. CONCLUSION: Smoking and PA are largely incongruent behaviors. Potential explanations for the observed relationships are described. These ranged from physiological (eg, lung function) to psychological (eg, depression) to socio-demographic (eg, education) factors.

Integrating public health policy, practice, evaluation, surveillance, and research: the school health action planning and evaluation system.

The Canadian Cancer Society and the National Cancer Institute of Canada have charged their Centre for Behavioral Research and Program Evaluation with contributing to the development of the country's systemic capacity to link research, policy, and practice related to population-level interventions. Local data collection and feedback systems are integral to this capacity. Canada's School Health Action Planning and Evaluation System (SHAPES) allows data to be collected from all of a school's students, and these data are used to produce computer-generated school "health profiles." SHAPES is being used for intervention planning, evaluation, surveillance, and research across Canada. Strong demand and multipartner investment suggest that SHAPES is adding value in all of these domains. Such systems can contribute substantially to evidence-informed public health practice, public engagement, participatory action research, and relevant, timely population intervention research.

Reliability and validity of a school-based physical activity questionnaire.

PURPOSE: To determine the reliability and validity of the School Health Action, Planning and Evaluation System (SHAPES) physical activity questionnaire, a machine-readable questionnaire designed to collect data from all students in a school from grades 6 to 12 and to provide feedback to the school for planning and evaluation. METHODS: Study 1 assessed test-retest reliability by administering the questionnaire twice, 1 wk apart to 2812 students in grades 9-12. Study 2 assessed criterion validity using MTI accelerometers worn consecutively for 7 d, and measured height and weight (N = 67, grades 6-12). RESULTS: The overall kappa/weighted kappa coefficient for the 1-wk test-retest reliability of the questionnaire items indicated moderate agreement (mean 0.57 +/- 0.24). Self-reported and accelerometer-measured average daily time spent performing moderate to vigorous physical activity were significantly correlated (Spearman r = 0.44, P < 0.01); however, students tended to overreport physical activity. Height and weight were not consistently over- or underreported. Self-reported and measured body mass index were significantly correlated (Spearman r = 0.90, P < 0.001). Classification of weight status by body mass index was similar using self-reported values compared with measured values. CONCLUSION: The findings of these studies suggest that the SHAPES physical activity questionnaire has acceptable reliability and validity and is suitable for use in large-scale school-based data collections for child and adolescent populations.

Outcome evaluation of a high school smoking reduction intervention based on extracurricular activities.

BACKGROUND: An outcome evaluation of a high school tobacco control intervention using extracurricular activities developed by teachers and students is reported. METHODS: Eligible subjects (n = 3,028) had participated in a randomized trial of an elementary school smoking prevention curriculum. Their high schools were matched in pairs; one school in each pair was randomly assigned to the intervention condition, the second to a "usual-care" control condition. Data were collected at the end of Grades 9 and 10. RESULTS: For Grade 8 never smokers, regular smoking rates were significantly lower for males from intervention schools (9.8 vs 16.2%, P = 0.02) at the end of Grade 10. There were no significant differences among Grade 10 smoking rates for females, or for students of either gender with previous smoking experience in Grade 8. CONCLUSIONS: The extracurricular activities approach to tobacco control is practical to implement and has promise.