The impact of 12 modifiable lifestyle behaviours on depressive and anxiety symptoms in middle adolescence: prospective analyses of the Canadian longitudinal COMPASS study.

BACKGROUND: Unhealthy lifestyle behaviours are becoming increasingly common and might contribute to the growing burden of mental disorders in adolescence. We examined the associations between a comprehensive set of lifestyle behaviours and depression and anxiety in middle adolescents. METHODS: School-based survey responses were collected from 24,274 Canadian high school students at baseline and 1-year follow-up (average age 14.8 and 15.8 years, respectively). Using linear mixed-effects models, we examined prospective associations of adherence to recommendations for vegetables and fruit, grains, milk and alternatives, meat and alternatives, sugar-sweetened beverages [SSB], physical activity, screen time, sleep, and no use of tobacco, e-cigarettes, cannabis, and binge drinking at baseline with the depressive and anxiety symptoms (measured by CESD-R-10 and GAD-7 scales, respectively) at follow-up. RESULTS: Adherence to recommendations was low overall, particularly for vegetables and fruit (3.9%), grains (4.5%), and screen time (4.9%). Students adhering to individual recommendations, particularly for meat and alternatives, SSB, screen time, sleep, and no cannabis use, at baseline had lower CESD-R-10 and GAD-7 scores at follow-up. Adhering to every additional recommendation was associated with lower CESD-R-10 (ß=-0.15, 95% CI -0.18, -0.11) and GAD-7 scores (ß=-0.10, 95% CI -0.14, -0.07) at follow-up. Assuming cumulative impact, this might translate into 7.2- and 4.8-point lower CESD-R-10 and GAD-7 scores, respectively, among students adhering to 12 vs. 0 recommendations over four years of high school. CONCLUSIONS: The results highlight the preventive potential of population-based approaches promoting healthy lifestyle behaviours, particularly those with the lowest prevalence, as a strategy to improve mental health in adolescence.

Exploring educational inequalities in hypertension control, salt knowledge and awareness, and patient advice: insights from the WHO STEPS surveys of adults from nine Eastern European and Central Asian countries.

OBJECTIVE: To inform strategies aimed at improving blood pressure (BP) control and reducing salt intake, we assessed educational inequalities in high blood pressure (HBP) awareness, treatment and control; physician's advice on salt reduction; and salt knowledge, perceptions and consumption behaviours in Eastern Europe and Central Asia. DESIGN: Data were collected in cross-sectional, population-based nationally representative surveys, using a multi-stage clustered sampling design. Five HBP awareness, treatment and control categories were created from measured BP and hypertension medication use. Education and other variables were self-reported. Weighted multinomial mixed-effects regression models, adjusted for confounders, were used to assess differences across education categories. SETTINGS: Nine Eastern European and Central Asian countries (Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkey and Uzbekistan). PARTICIPANTS: Nationally representative samples of 30 455 adults aged 25-65 years. RESULTS: HBP awareness, treatment and control varied substantially by education. The coverage of physician's advice on salt was less frequent among participants with lower education, and those with untreated HBP or unaware of their HBP. The education gradient was evident in salt knowledge and perceptions of salt intake but not in salt consumption behaviours. Improved salt knowledge and perceptions were more prevalent among participants who received physician's advice on salt reduction. CONCLUSIONS: There is a strong education gradient in HBP awareness, treatment and control as well as salt knowledge and perceived intake. Enhancements in public and patient knowledge and awareness of HBP and its risk factors targeting socio-economically disadvantaged groups are urgently needed to alleviate the growing HBP burden in low- and middle-income countries.

Developing a Socioeconomic Status Index for Chronic Disease Prevention Research in Canada.

Capturing socioeconomic inequalities in relation to chronic disease is challenging since socioeconomic status (SES) encompasses many aspects. We constructed a comprehensive individual-level SES index based on a broad set of social and demographic indicators (gender, education, income adequacy, occupational prestige, employment status) and examined its relationship with smoking, a leading chronic disease risk factor. Analyses were based on baseline data from 17,371 participants of Alberta's Tomorrow Project (ATP), a prospective cohort of adults aged 35−69 years with no prior personal history of cancer. To construct the SES index, we used principal component analysis (PCA) and to illustrate its utility, we examined the association with smoking intensity and smoking history using multiple regression models, adjusted for age and gender. Two components were retained from PCA, which explained 61% of the variation. The SES index was best aligned with educational attainment and occupational prestige, and to a lesser extent, with income adequacy. In the multiple regression analysis, the SES index was negatively associated with smoking intensity (p < 0.001). Study findings highlight the potential of using individual-level SES indices constructed from a broad set of social and demographic indicators in epidemiological research.

A longitudinal study of change in substance use from before to during the COVID-19 pandemic in young adults.

Introduction: We assessed change in substance use from before to during the COVID-19 pandemic in young adults and identified factors associated with initiation/increase in use. Methods: The sample comprised young adults from a longitudinal investigation of 1294 youth recruited at ages 12-13 (1999-2000) in 10 Montréal-area high schools. Pre-pandemic data on use of cannabis, alcohol, combustible cigarette, e-cigarette and binge drinking were collected at ages 20.4, 24.0 and 30.6. During COVID-19, data were collected from December 2020 to June 2021 (age 33.6). We studied the prevalence of any and weekly/daily use from age 20.4 to 33.6. Individual-level change in substance use during the pandemic was estimated as differences in the frequency of use from age 30.6 to 33.6 versus from age 24.0 to 30.6. Heterogeneity in the risk of initiated/increased substance use during COVID-19 across sociodemographic subgroups was assessed using modified Poisson regression. Results: The prevalence of cannabis use increased from 17.5% to 23.1% from before to during the pandemic; e-cigarette use increased from 3.8% to 5.4%. In individual change analyses, the proportion of participants whose substance use did not change ranged from 48.9% (alcohol) to 84.0% (e-cigarettes). The incidence of initiated/increased cannabis use (22.4%), and quit/decreased alcohol (35.2%) and binge drinking (53.5%) were higher during the pandemic than between ages 24.0 to 30.6. Low education and living alone were associated with higher risks of initiated/increased use of most substances. Discussion: Most participants reported stable patterns in substance use from before to during the COVID-19 pandemic. Funding: The NDIT study was supported by the Canadian Cancer Society (grant numbers 010271, 017435, 704031) and the Canadian Institutes of Health Research (grant number 451832).

Associations of Quantity Smoked and Socioeconomic Status With Smoke-Free Homes and Cars Among Daily Smokers.

INTRODUCTION: An association between socioeconomic status (SES) and smoke-free private spaces among smokers could be due to heavier smoking among low SES smokers. We assessed whether quantity smoked or SES are independently associated with smoke-free homes or cars in daily smokers. METHOD: Data were drawn from a cross-sectional telephone survey (2011-2012) of 750 daily smokers age ≥18 years in Quebec, Canada (45% response). Multivariable logistic regression was used to model the independent association between (a) number of cigarettes smoked per day, and (b) each of educational attainment, annual household income, or active employment status and smoke-free homes or cars. RESULTS: Participants were 41.0 years old on average, 57% were female. Median (IQR) number of cigarettes smoked per day was 14 (10, 20). Forty-eight percent of participants reported smoke-free homes; 34% reported smoke-free cars. Quantity smoked was strongly associated with both smoke-free homes and cars. Income and education (but not actively employed) were associated with smoke-free homes. None of the SES indicators were associated with smoke-free cars. CONCLUSIONS: Interventions targeting smokers to promote smoke-free homes and cars should incorporate components to help smokers reduce quantity smoked or preferably, to quit. Interventions targeting smoke-free homes will also need to address SES inequalities by education and income. Our data suggest that reduction in quantity smoked may help smokers reduce SHS exposure in cars, but that an inequality lens may not be relevant.

Towards refining World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations for red and processed meat intake: insights from Alberta's Tomorrow Project cohort.

Current cancer prevention recommendations advise limiting red meat intake to <500 g/week and avoiding consumption of processed meat, but do not differentiate the source of processed meat. We examined the associations of processed meat derived from red v. non-red meats with cancer risk in a prospective cohort of 26 218 adults who reported dietary intake using the Canadian Diet History Questionnaire. Incidence of cancer was obtained through data linkage with Alberta Cancer Registry with median follow-up of 13·3 (interquartile range (IQR) 5·1) years. Multivariable Cox proportional hazards regression models were adjusted for covariates and stratified by age and sex. The median consumption (g/week) of red meat, processed meat from red meat and processed meat from non-red meat was 267·9 (IQR 269·9), 53·6 (IQR 83·3) and 11·9 (IQR 31·8), respectively. High intakes (4th Quartile) of processed meat from red meat were associated with increased risk of gastrointestinal cancer adjusted hazard ratio (AHR): 1·68 (95 % CI 1·09, 2·57) and colorectal cancers AHR: 1·90 (95 % CI 1·12, 3·22), respectively, in women. No statistically significant associations were observed for intakes of red meat or processed meat from non-red meat. Results suggest that the carcinogenic effect associated with processed meat intake may be limited to processed meat derived from red meats. The findings provide preliminary evidence towards refining cancer prevention recommendations for red and processed meat intake.

Social inequalities in availability of health-promoting interventions in Québec elementary schools.

Availability of health-promoting interventions (HPIs) may vary across schools serving students with different socioeconomic backgrounds. Our objectives were to describe social inequalities across elementary schools in: (i) level of importance that school principals attribute to 13 common health-related issues among students in their school; (ii) availability of HPIs within their school addressing eight health topics and (iii) (mis)alignment between perceived importance and HPI availability. Data were collected in telephone interviews with school principals in a convenience sample of 171 elementary schools (59% of 291 schools contacted). Schools were categorized as serving very advantaged, moderately advantaged or disadvantaged students. Principals reported how important 13 health issues were among students in their schools and provided data on HPI availability for 8 health issues, 4 of which required school action under government mandates. Higher proportions of principals in schools serving disadvantaged students (36% of all 171 schools) perceived most health issues as important. The mean number of HPIs in the past year was 12.0, 12.1 and 11.7 in schools serving very advantaged, moderately advantaged and disadvantaged students, respectively. Only availability of mental health HPIs differed by school deprivation (60, 43 and 30% in very, moderately and disadvantaged, respectively). Although most schools offered oral health HPIs, dental problems were not perceived as important. Smoking was perceived as not important and smoking-related HPIs were relatively rare (9%). Given rapid evolution in public health priorities, (mis)alignment between perceived importance of specific health issues and HPI availability in elementary schools warrants ongoing reflection.

Interventions that promote health may not be present in all schools. Our objectives were to describe differences across elementary schools in: (i) level of importance that school principals attribute to common health-related issues among students in their own school; (ii) the presence of interventions that address these health issues and (iii) (mis)alignment between perceived importance and presence of interventions. Telephone interviews were conducted with school principals in 171 elementary schools serving very advantaged, moderately advantaged or disadvantaged students. Principals reported how important 13 health-related issues (four of which required school action under government mandates) were among students in their schools and whether interventions were present for 8 of the 13 issues. Higher proportions of principals in schools serving disadvantaged students perceived most health issues as important. Intervention availability did not differ across schools, except that higher proportions of schools serving advantaged students reported mental health interventions. Most schools offered oral health interventions, but dental problems were not perceived as important. Smoking was also not perceived as important and interventions were relatively rare. (Mis)alignment between perceived importance of health issues and intervention availability calls for ongoing reflection.

A Pilot Trial: Fish Oil and Metformin Effects on ApoB-Remnants and Triglycerides in Women With Polycystic Ovary Syndrome.

CONTEXT: Women with polycystic ovary syndrome (PCOS) have increased incidence of atherogenic dyslipidemia and cardiovascular disease (CVD). Interventions targeting atherogenic dyslipidemia to reduce CVD risk are limited in women with PCOS. OBJECTIVE: This pilot study was conducted to determine the effect of 12 weeks of high dose fish oil (FO), metformin, and FO as an adjunct to metformin (FO-metformin) therapy on fasting and nonfasting plasma lipids and ApoB-remnants in young women with the metabolic syndrome (MetS) and PCOS. METHODS: In this open-label parallel pilot trial, women with MetS and PCOS (18-30 years of age) were randomized into 1 of 3 interventions: (1) FO; (2) metformin; and (3) FO-metformin. Plasma lipids and ApoB (48 and 100)-lipoproteins and triglycerides (TG) were measured in the fasted and postprandial state following a high-fat meal at baseline and postintervention. RESULTS: FO-metformin significantly lowered fasting plasma TG by >40% compared with FO and metformin treatments. Fasting plasma apoB48 was lowered 40% in FO-metformin and 15% in the FO groups from baseline to postintervention. ApoB48 area under the curve (ApoB48AUC), ApoB48 incremental AUC (ApoB48iAUC), ApoB100AUC, and ApoB100iAUC decreased in all groups from baseline to postintervention; however, these findings did not reach statistical significance. CONCLUSION: The findings of this pilot trial show that high dose FO and FO-metformin combination therapy tend to lower fasting and postprandial plasma TG and ApoB-lipoprotein remnants compared with metformin; however, the study is limited by small sample size. These results may be clinically significant in individuals with PCOS for management of atherogenic dyslipidemia.

Co-consumption of Vegetables and Fruit, Whole Grains, and Fiber Reduces the Cancer Risk of Red and Processed Meat in a Large Prospective Cohort of Adults from Alberta's Tomorrow Project.

We examined whether co-consumption of red and processed meat with key foods items and food constituents recommended for cancer prevention (vegetables and fruit, whole grains, and fiber) mitigates cancer incidence. In a prospective cohort of 26,218 adults aged 35-69 years at baseline, dietary intake was collected through 124-item past-year food frequency questionnaire. Incidence of all-cause and 15 cancers previously linked to red and processed meat intake was obtained through data linkage with a cancer registry (average follow-up 13.5 years). Competing risk Cox Proportional Hazard models estimated cancer risk and Accelerated Failure Time models estimated time-to-cancer occurrence for different combinations of intake levels while considering mortality from vital statistics and established confounders. Co-consumption of low vegetables and fruit intake with high processed meat was associated with higher incidence of all-cause and 15 cancers (men: HR = 1.85, 1.91; women: HR = 1.44, 1.49) and accelerated time-to-cancer occurrence (men: 6.5 and 7.1 years and women: 5.6 and 6.3 years, respectively), compared to high vegetables and fruit with low processed meat intake. Less pronounced and less consistent associations were observed for whole grains and fiber and for red meat. The findings provide initial evidence toward refining existing cancer prevention recommendations to optimize the intake and combination of foods in the general adult population.

Monitoring progress toward United Nations commitments: characteristics of Canadian legislation to promote tobacco control, physical activity and healthy eating. A descriptive study.

BACKGROUND: Legal interventions are important mechanisms for chronic disease prevention. Since Canadian laws to promote physical activity and healthy eating are growing, we compared the characteristics of legal interventions targeting physical activity and healthy eating with tobacco control laws, which have been extensively described. METHODS: We reviewed 718 federal, provincial and territorial laws promoting tobacco control, physical activity and healthy eating captured in the Prevention Policies Directory between spring 2010 and September 2017. We characterized the legislation with regard to its purpose, tools to accomplish the purpose, responsible authorities, target location, level of coerciveness and provisions for enforcement. RESULTS: Two-thirds (67.9%) of tobacco control legislation had a primary chronic disease prevention purpose (explicit in 5.3% of documents and implicit in 62.6%), and 29.5% had a secondary chronic disease prevention purpose. One-quarter (27.0%) of physical activity legislation had a primary chronic disease prevention purpose (explicit in 8.8% of documents and implicit in 18.1%), and 53.0% had a secondary chronic disease prevention purpose. In contrast, 69.3% of healthy eating legislation had no chronic disease prevention purpose. Tobacco control legislation was most coercive (restrict or eliminate choice), and physical activity and healthy eating legislation was least coercive (provide information or enable choice). Most tobacco control legislation (85.8%) included provisions for enforcement, whereas 47.4% and 24.8% of physical activity and healthy eating laws, respectively, included such provisions. Patterns in responsible authorities, target populations, settings and tools to accomplish its purpose (e.g., taxation, subsidies, advertising limits, prohibitions) also differed between legislation targeting tobacco control versus physical activity and healthy eating. INTERPRETATION: Legislative approaches to promote physical activity and healthy eating lag behind those for tobacco control. The results serve as a baseline for building consensus on the use of legislation to support approaches to chronic disease prevention to reduce the burden of chronic disease in Canadians.

Lifestyle Behavior and Mental Health in Early Adolescence.

BACKGROUND AND OBJECTIVES: Mental illnesses affect >15% of Canadian adolescents. New preventive strategies are critically needed. We examined the associations of meeting established recommendations for diet, physical activity, sleep, and sedentary behavior in childhood with mental illness in adolescence. METHODS: Population-based prospective study (n = 3436) linking 2011 health behavior survey data of 10- to 11-year-olds with administrative health data from 2011 to 2014. Lifestyle behaviors were measured with the Harvard Food Frequency Questionnaire and self- and parental-proxy reports, expressed as meeting recommendations for vegetables and fruit, grain products, milk and alternatives, meat and alternatives, added sugar, saturated fat, sleep, screen time, and physical activity. Mental illness was defined by physician-diagnosed internalizing, externalizing, and other psychiatric conditions. Negative binomial regression was used to determine the independent and cumulative associations of meeting lifestyle recommendations with physician visits for mental illnesses. RESULTS: Of all participants, 12%, 67%, and 21% met 1 to 3, 4 to 6, and 7 to 9 recommendations, respectively, and 15% had a mental illness diagnosis during follow-up. Compared with meeting 1 to 3 recommendations, meeting 7 to 9 recommendations was associated with 56% (95% confidence interval: 38%-69%) fewer physician visits for mental illness during follow-up. Every additional recommendation met was associated with 15% fewer physician visits for mental illnesses (95% confidence interval: 9%-21%). CONCLUSIONS: Mental illness in adolescence is associated with compliance to lifestyle recommendations in childhood, with stronger associations seen when more recommendations are met. Emphasizing lifestyle recommendations in pediatric practice may reduce the future burden of mental illness.

Sex-Specific Differences in the Association Between Childhood Adversity and Cardiovascular Disease in Adulthood: Evidence From a National Cohort Study.

BACKGROUND: Childhood adversity increases the risk for cardiovascular disease (CVD) in adulthood. Previously proposed mechanisms suggest that the association is mediated by stress reactivity-known to be higher in women-and is aggravated by adult stress, but this has not yet been confirmed. Therefore, we investigated sex differences to better understand possible pathways from childhood adversity to CVD. METHODS: The National Population Health Survey, a 15-year cohort study of Canadians aged 18-49 years at baseline was used. Logistic regression with interaction terms for sex and stressful life events was used to assess the risk of CVD after childhood adversity. In secondary analyses, we assessed mediation effects of depression, smoking, alcohol, exercise, and diet using the product of coefficient approach. Mediated moderation was subsequently used to explain sex-moderated effects. RESULTS: There was a strong association between childhood adversity and CVD (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.56-2.94) for 3+ childhood adversities. The association was stronger with increasing stressful events, and female patients with 3+ stressful events exhibited the highest risk of CVD (OR, 4.40; 95% CI, 1.98-9.75). No association was found in men. Depression, smoking, and poor diet partially mediated the relationship between childhood adversity and CVD (14%, 9%, and 9%, respectively), but differences in these behaviours did not fully explain the sex-specific differences in the mediated moderation analysis. CONCLUSIONS: The effect of childhood adverse events on CVD is heightened among women, particularly women with stressful adulthoods, and this difference is not mediated by depression, smoking, or poor diet. These findings have important implications for understanding sex differences in CVD risk.

Public health strategies promoting physical activity and healthy eating in Canada: are we changing paradigms?

OBJECTIVES: To compare the extent to which Canadian public health organizations incorporated the Ottawa Charter for Health Promotion action areas in promoting physical activity and healthy eating in 2004 and 2010. METHODS: Data were available from repeat censuses of all regional, provincial, and national organizations with mandates to promote physical activity [n = 134 (2004); n = 118 (2010)] or healthy eating [n = 137 (2004); n = 130 (2010)]. Eleven strategies to promote these behaviors were grouped according to the five action areas. Descriptive analyses were conducted to document the level of involvement in each action area over time. RESULTS: The proportion of organizations promoting physical activity and "heavily involved" in creating supportive environments increased from 51 % (2004) to 70 % (2010). The proportion also increased for reorienting health services (29 % to 39 %). The proportion of organizations promoting healthy eating and "heavily involved" in building healthy public policy increased from 47 to 53 %. Individual skill building remained stable for physical activity but declined for healthy eating. CONCLUSIONS: While developing personal skills remains important in promoting physical activity and healthy eating in Canada, public health organizations increased involvement in structural-level strategies.

The Development and Refinement of an e-Health Screening, Brief Intervention, and Referral to Treatment for Parents to Prevent Childhood Obesity in Primary Care.

BACKGROUND: Nearly one-third of Canadian children can be categorized as overweight or obese. There is a growing interest in applying e-health approaches to prevent unhealthy weight gain in children, especially in settings that families access regularly. Our objective was to develop and refine an e-health screening, brief intervention, and referral to treatment (SBIRT) for parents to help prevent childhood obesity in primary care. MATERIALS AND METHODS: Our SBIRT, titled the Resource Information Program for Parents on Lifestyle and Education (RIPPLE), was developed by our research team and an e-health intervention development company. RIPPLE was based on existing SBIRT models and contemporary literature on children's lifestyle behaviors. Refinements to RIPPLE were guided by feedback from five focus groups (6-10 participants per group) that documented perceptions of the SBIRT by participants (healthcare professionals [n = 20], parents [n = 10], and researchers and graduate trainees [n = 8]). Focus group commentaries were transcribed in real time using a court reporter. Data were analyzed thematically. RESULTS: Participants viewed RIPPLE as a practical, well-designed, and novel tool to facilitate the prevention of childhood obesity in primary care. However, they also perceived that RIPPLE may elicit negative reactions from some parents and suggested improvements to specific elements (e.g., weight-related terms). CONCLUSIONS: RIPPLE may enhance parents' awareness of children's weight status and motivation to change their children's lifestyle behaviors but should be improved prior to implementation. Findings from this research directly informed revisions to our SBIRT, which will undergo preliminary testing in a randomized controlled trial.

Cohort Profile: The Nicotine Dependence in Teens (NDIT) Study.

The Nicotine Dependence in Teens (NDIT) study is a prospective cohort investigation of 1294 students recruited in 1999-2000 from all grade 7 classes in a convenience sample of 10 high schools in Montreal, Canada. Its primary objectives were to study the natural course and determinants of cigarette smoking and nicotine dependence in novice smokers. The main source of data was self-report questionnaires administered in class at school every 3 months from grade 7 to grade 11 (1999-2005), for a total of 20 survey cycles during high school education. Questionnaires were also completed after graduation from high school in 2007-08 and 2011-12 (survey cycles 21 and 22, respectively) when participants were aged 20 and 24 years on average, respectively. In addition to its primary objectives, NDIT has embedded studies on obesity, blood pressure, physical activity, team sports, sedentary behaviour, diet, genetics, alcohol use, use of illicit drugs, second-hand smoke, gambling, sleep and mental health. Results to date are described in 58 publications, 20 manuscripts in preparation, 13 MSc and PhD theses and 111 conference presentations. Access to NDIT data is open to university-appointed or affiliated investigators and to masters, doctoral and postdoctoral students, through their primary supervisor (www.nditstudy.ca).

Does level of tobacco control relate to smoking prevalence in Canada: a national survey of public health organizations.

OBJECTIVES: To describe levels of tobacco control "effort" in public health organizations across provinces, and to test the hypothesis that "effort" is associated with the prevalence of daily smoking. METHODS: Data were drawn from a national survey (Oct 2004-Apr 2005) of all public health organizations engaged in chronic disease prevention in Canada in 2004. We investigated the association between "effort" and decline in smoking prevalence (CTUMS, 1999-2009) across provinces in an ecologic study design. "Effort" was assessed using two indicators: percent of public health organizations engaged in tobacco control, and mean level of involvement in engaged organizations. RESULTS: Of 216 organizations, 88% had undertaken tobacco control activities in the three years prior to data collection and were categorized as "engaged". Level of involvement in tobacco control was highest in community-at-large settings; and it was generally higher for population- than for individual-level strategies. Nova Scotia reported higher levels of involvement than other provinces. There was substantial variability in "effort" across provinces. High-"effort" provinces (BC, NS, ON, QC) experienced, on average, improvement in the "change in smoking prevalence" score (1999 to 2009). CONCLUSION: The findings provide evidence that provincial tobacco control "effort" relates to declines in smoking prevalence. Given that smoking remains a critical public health issue, the kinds of data reported herein are needed to inform the debate on how best to invest in tobacco control infrastructure to combat the most important public health threat of our times.

The importance of Active Transportation to and from school for daily physical activity among children.

OBJECTIVE: To investigate if students who use of Active Transportation (AT) to and from school among urban and rural Canadian children are more likely to meet physical activity recommendations. METHODS: The Raising healthy Eating and Active Living in Alberta (REAL Kids Alberta) study is a population-based health survey among Grade 5 students. In 2009, physical activity levels were measured using time-stamped pedometers (number of steps/hour) among 688 children. Parents reported mode of transportation to and from school (AT/non-AT). Multilevel multiple linear regression analyses with corresponding ß coefficients were conducted to quantify the relationship between mode of transportation to and from school with (1) overall step count, and (2) the likelihood of achieving at least 13,500 steps per day recommended for optimal growth and development. RESULTS: Among urban children, those who used AT to and from school accumulated more steps [ß=1124(95% CI=170,2077)] and although not significant, were more likely to achieve the recommended 13,500 steps/day compared to those not using AT to and from school [OR=1.61(95% CI=0.93,2.81)]. CONCLUSION: Using AT to and from school appears to be beneficial to children by supplementing their physical activity, particularly those living in urban regions. Strategies to promote physical activity are needed, particular for children residing in rural regions and smaller towns.

Does the "healthy immigrant effect" extend to smoking in immigrant children?

The "healthy immigrant effect" may apply to lifestyle-related behaviors in immigrant children. In a cross-sectional study of 1,959 children aged 9-12 years, the number of years lived in Canada was related to an increased risk of smoking among immigrant children. Interventions may be needed for immigrant children to prevent the adoption of unhealthy behaviors prevalent in their new host environments.

Participation in organised sports does not slow declines in physical activity during adolescence.

BACKGROUND: Among youth, participation in extracurricular physical activities at school and organised physical activities in the community is associated with higher physical activity levels. The objective was to determine if participation in organised physical activities during early adolescence protects against declines in physical activity levels during adolescence. METHODS: Every 3 months for 5 years, students initially in grade 7 (aged 12-13 years) completed a 7-day physical activity recall and provided data on the number and type of (extracurricular) physical activities organised at school and in the community in which they took part. To study rates of decline in physical activity, only adolescents who reported an average of >/=5 moderate-vigorous physical activity sessions per week in grade 7 (n = 1028) were retained for analyses. They were categorised as to whether or not they were involved in organised physical activities in grade 7. We used generalized estimating equation Poisson regression to compare the rate of decline in number of moderate-vigorous physical activity sessions per week during adolescence between initially physically active students who participated in organised physical activity in grade 7 and those who did not. RESULTS: In grade 7, about 87% of physically active adolescents reported taking part in at least one organised physical activity. Compared to active adolescents not involved in organised physical activities, baseline involvement in physical activity was 42% (95% CI 26-59%) higher among those involved in organised physical activity (mean number of moderate-vigorous physical activity sessions per week = 14.6 +/- 13.1 vs 10.4 +/- 9.0). Physical activity declined by 8% per year in both groups. Results were similar in analyses that examined the effect of school or community-based physical activities separately. CONCLUSION: Although participation in organised physical activities during early adolescence is associated with more physical activity throughout secondary school, participation in such activities does not protect against declines in physical activity over time.