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.

Correlations between weight perception and overt risk-taking among Canadian adolescents.

OBJECTIVE: Perceptions of body weight represent an important health issue for Canadian adolescents. While associations between weight perception and mental health concerns like eating disorder symptomatology are well established, there is need for more Canadian evidence about how weight perception is associated with overt risk-taking among adolescents, and further how such associations differ by biological sex. METHODS: We conducted a national analysis of grade 9-10 students participating in the 2017-2018 cycle of the Health Behaviour in School-aged Children (HBSC) study in Canada. This analysis described contemporary patterns of alternate weight perception and then examined the strength and statistical significance of such associations by biological sex, with tobacco, alcohol, and cannabis use, binge drinking, fighting, and illicit drug use as outcomes. Behaviours were considered both individually and in combination. Analyses were descriptive and analytical, with regression models accounting for the nested and clustered nature of the sampling approach. RESULTS: Responses from 2135 males and 2519 females were available for a complete case series analysis. A total of 26% and 35% of males and females, respectively, perceived themselves as "too fat" while 20% and 9% identified as "too thin". Females perceiving themselves as "too fat" reported higher likelihoods of engaging in individual and scaled indicators of overt risk-taking. Conversely, among males, alternate weight perception was associated with lower levels of such behaviours. CONCLUSION: As males and females perceive and react to weight perception differently, clinical and health promotion strategies should be developed and uniquely targeted to groups of adolescents in regards to weight perception and risk-taking.

RéSUMé: OBJECTIF: Les perceptions du poids corporel représentent une importante question de santé pour les adolescentes et les adolescents canadiens. Les associations entre la perception du poids et les risques pour la santé mentale, comme les symptômes de troubles alimentaires, sont bien établies, mais nous avons besoin de plus de données probantes canadiennes sur les associations entre la perception du poids et la prise de risques manifeste chez les adolescentes et les adolescents, et sur les différences selon le sexe biologique lorsque ces associations existent. MéTHODE: Nous avons mené une analyse nationale des élèves de 9e et de 10e année ayant participé au cycle 2017-2018 de l'Enquête sur les comportements de santé des jeunes d'âge scolaire au Canada (Enquête HBSC). Nous avons décrit les tendances contemporaines de perception erronée du poids, puis examiné la force et la signification statistique de telles associations, selon le sexe biologique, avec la consommation de tabac, d'alcool et de cannabis, l'hyperalcoolisation rapide, les combats et l'usage de drogues illicites comme résultats. Ces comportements ont été étudiés individuellement et en combinaison. Les analyses ont été descriptives et analytiques, avec des modèles de régression pour tenir compte de la méthode d'échantillonnage emboîtée et par grappes. RéSULTATS: Les réponses de 2 135 garçons et de 2 519 filles étaient disponibles pour une analyse complète de série de cas. En tout, 26 % des garçons et 35 % des filles se percevaient comme étant « en excès de poids ¼, et 20 % des garçons et 9 % des filles se percevaient comme étant « trop maigres ¼. Les filles se percevant comme étant « en excès de poids ¼ ont déclaré une probabilité plus élevée d'adopter des comportements individuels et gradués indicateurs d'une prise de risques manifeste. Réciproquement, chez les garçons, la perception erronée du poids était associée à des niveaux moins élevés de tels comportements. CONCLUSION: Comme les garçons et les filles perçoivent leur poids différemment et réagissent différemment à cette perception, il faudrait élaborer des stratégies cliniques et de promotion de la santé qui ciblent particulièrement les groupes d'adolescentes et d'adolescents et qui portent sur la perception du poids et la prise de risques.

Mental health and cannabis use among Canadian youth: Integrated findings from cross-sectional and longitudinal analyses.

BACKGROUND AND PURPOSE: Using data from two methodologically independent youth research studies in Canada, the Health Behaviour in School-aged Children (HBSC) study and the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) study, the objective of this study was to compare associations between youth's mental health and cannabis use across samples. Using similar indicators in both studies, our goal was to affirm the potential for nationally representative cross-sectional analyses (HBSC) to replicate findings found in a longitudinal non-representative data source (COMPASS), enhancing opportunity for causal inferences. METHODS: Data were collected from grade 9 and 10 Canadian students participating in the 2017/18 HBSC (n=8462) and 2017/18 to 2018/19 waves of COMPASS (n=32,023). Using multivariable Poisson regression models, the strength and statistical significance of the effects of mental health indicators on cannabis use outcomes were estimated within both studies and compared for consistency. Using a 2-year linked sample of students participating in COMPASS, models examining the impact of mental health indicators on cannabis use initiation and maintenance over time were similarly fit using Poisson regression to estimate relative risk. RESULTS: Similar associations between mental health problems and cannabis use were observed in both data sources. The direction, magnitude, and precision of the estimates for restless sleep, loneliness, poor wellbeing, and cannabis use were highly comparable across both studies. Worse mental health was consistently associated with current and lifetime cannabis use among youth. DISCUSSION: Cross-sectional and longitudinal findings from two large methodologically diverse studies in Canada demonstrate a replicable association between indicators of mental health and youth cannabis use. Similarities were identified and two generalizations may be concluded: 1) potentially causal etiological relationships inferred from HBSC data were supported in longitudinal findings based on COMPASS, and 2) longitudinal COMPASS data aligns with nationally representative data from HBSC.

Low risks for spiritual highs: Risk-taking behaviours and the protective benefits of spiritual health among Saskatchewan adolescents.

Objectives: Adolescent risk-taking behaviours, such as substance use and early sexual activity, can adversely impact physical health and psychosocial development. A connection to spiritual health may buffer against the negative health impacts of several risk-taking behaviours. The aim of this study was to determine if higher spiritual health was associated with lower risk-taking behaviours among school-attending adolescents in Saskatchewan, Canada. Methods: A representative sample of 4,751 adolescents in the Canadian province of Saskatchewan completed the Health Behaviour of School-aged Children (HBSC) questionnaire during the 2014 to 2015 school year. The main risk-taking behavioural outcomes were self-reported: smoking; alcohol; and cannabis use; as well as sexual intercourse. The main exposures related to spiritual health included four factors: connectedness to (1) one's self; (2) others; (3) nature; and (4) notions of the transcendent. Multivariable logistic regression analyses were used to test for associations between exposures and outcome measures. Results: The sample was balanced across gender, primarily Caucasian (71%), and primarily ages 11 to 15 years (48%). Adolescents indicated a high prevalence of spiritual health. Across all adjusted models, the results demonstrated that adolescents who value the various components of spiritual health showed a decreased likelihood of engaging in cigarette smoking, alcohol and marijuana use, and sexual intercourse. Conclusion: The findings indicate the potential for spiritual health to be considered as the basis for public- and community-health interventions, pending further evidence from experimental studies.

International trends in 'bottom-end' inequality in adolescent physical activity and nutrition: HBSC study 2002-2014.

Background: In spite of many positive trends that have emerged in the health of young people, adolescents from more affluent groups continue to experience more favourable health outcomes. There are no groups that are more vulnerable than those who report very poor ('bottom-end') indicators of health behaviour. The present study investigated the role of socio-economic factors as potential determinants of bottom-end health behaviours pertaining to physical activity and diet. Methods: Our analysis incorporated health data for some 700 000 15-year-old adolescents in 34 countries. The data source was four cycles of the Health Behaviour in School-aged Children (HBSC) study (2001/2002, 2005/2006, 2009/2010 and 2013/2014). As per UNICEF precedents, adolescents whose health behaviour scores were below the mean of the lower half of the distribution fell into the 'bottom-end' on this indicator. Results: Adolescents from less affluent families were much more likely to report being in the bottom-end of the distribution of these health indicators. Large, persistent and widespread socio-economic gradients existed for physical activity and healthy eating, while the findings were mixed for unhealthy eating. Such socio-economic inequalities were largely stable or widened for physical activity and healthy eating, while inequalities in unhealthy eating narrowed. Conclusion: Although it is important to continue monitoring average levels of adolescent health, national and international policies need to pay attention to the concentration of poor health outcomes among adolescents from less affluent families and to redress social inequalities in adolescent health behaviour.

Health and Well-Being Among Young People From Canadian Farms: Associations With a Culture of Risk-Taking.

PURPOSE: To determine whether patterns of adolescent risk behavior in rural populations, and especially farm populations, are associated with negative indicators of adolescent health and well-being, beyond an established association between risk-taking and injury. METHODS: The study base was Cycle 7 (2014) of the Canadian Health Behaviour in School-Aged Children study. Children aged 11-16 years (n = 2,565; 2,533 weighted) who reported living or working on farms were matched within schools in a 1:1 ratio with other rural children. We related a scale describing engagement in multiple risk behavior to a series of indicators of adolescent health and well-being. FINDINGS: Farm children, particularly male farm children, showed the highest levels of risk behavior. Multiple risk behavior was strongly and consistently associated with negative indicators of general health, mental health (life satisfaction, psychosomatic symptoms), and academic performance in all subpopulations. CONCLUSIONS: Adolescent risk behavior in rural populations, and especially farm populations, is common and associated with a variety of negative indicators of adolescent health and well-being. We speculate that the origins of this risk-taking lifestyle surround cultural definitions of self and identity, which have both protective and negative effects.

Gender-specific associations between involvement in team sport culture and canadian adolescents' substance-use behavior.

Canadian adolescents have some of the highest rates of substance use in the world. The etiology of this phenomenon has not been fully explored, and one possible contextual determinant is involvement in sport activities that foster risk-taking behaviors through physical and social mechanisms. Using the 2013-14 Health Behaviour in School Aged Children (HBSC) study we therefore examined this hypothesis in a contemporary national sample of Canadian adolescents. The strength and direction of the relationship between sport and substance use varied by gender and substance, with team sport participation associated with increased binge drinking (RR 1.33 [95% CI 1.13-1.56] for boys, RR 1.21 [1.06-1.38] for girls) and use of smokeless tobacco (RR 1.68 [1.34-2.10] for boys, RR 1.32 [1.01-1.72] for girls), but with lower prevalence levels of cannabis use (RR 0.73 [95% CI 0.61-0.88]) and cigarette smoking (RR 0.79 [95% CI 0.70-0.89]) in girls alone. We also compared team sport athletes with high social involvement (sports team as primary peer group) and physical involvement (higher number of days/week physically active) to those with low involvement. For boys, the combination of high physical and high social involvement was associated with the highest risk, while high social involvement alone was associated with the greatest risk for girls. While team sport participation confers only a small increased risk for substance use, the prevalence of sport participation results in a large population impact. Given this fact, interventions such as education for parents and coaches and policies encouraging engagement in a variety of extracurricular activities should be explored.

Gender Differences in the Association of Individual and Contextual Exposures with Lung Function in a Rural Canadian Population.

INTRODUCTION: To investigate the association of individual and contextual exposures with lung function by gender in rural-dwelling Canadians. METHODS: A cross-sectional mail survey obtained completed questionnaires on exposures from 8263 individuals; a sub-sample of 1609 individuals (762 men, 847 women) additionally participated in clinical lung function testing. The three dependent variables were forced expired volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio. Independent variables included smoking, waist circumference, body mass index, indoor household exposures (secondhand smoke, dampness, mold, musty odor), occupational exposures (grain dust, pesticides, livestock, farm residence), and socioeconomic status. The primary analysis was multiple linear regression, conducted separately for each outcome. The potential modifying influence of gender was tested in multivariable models using product terms between gender and each independent variable. RESULTS: High-risk waist circumference was related to reduced FVC and FEV1 for both genders, but the effect was more pronounced in men. Greater pack-years smoking was associated with lower lung function values. Exposure to household smoke was related to reduced FEV1, and exposure to livestock, with increased FEV1. Lower income adequacy was associated with reduced FVC and FEV1. CONCLUSION: High-risk waist circumference was more strongly associated with reduced lung function in men than women. Longitudinal research combined with rigorous exposure assessment is needed to clarify how sex and gender interact to impact lung function in rural populations.

Factors Related to Self-perceived Health in Rural Men and Women.

This study examined self-perceived health status among men and women who live on farms, as well as variations in factors related to negative health status observed by gender. Data were collected in the province of Saskatchewan, Canada, in 2013 through the use of a cross-sectional survey. A multistage sample was developed consisting of farms nested within rural municipalities and then agricultural soil zones. The response rate was 48.8% at the farm level, with a final sample of 2,353 (1,416 men, 937 women) from 1,119 farms. Variables under study included self-reports of health status, as well as demographic, behavioral, and farm operational factors that could influence perceived health status. The analysis was initially descriptive followed by multilevel logistic regression analyses. Self-reports of diagnosed comorbidities were strongly associated with negative health status among both men and women. Daytime sleepiness was more modestly associated with negative health status in both genders. Among men, additional risk factors tended to be functional, and included older age, part-time work status, and binge drinking. Among women, additional risk factors included cigarette smoking, overweight or obesity, and lower levels of education. The study demonstrated that there were both similarities and differences between men and women on farms in the factors related to negative self-perceived health status. These findings should inform the content and targeting of health promotion programs aimed at rural populations.

Access to Specialist Care in Rural Saskatchewan: The Saskatchewan Rural Health Study.

The role of place has emerged as an important factor in determining people's health experiences. Rural populations experience an excess in mortality and morbidity compared to those in urban settings. One of the factors thought to contribute to this rural-urban health disparity is access to healthcare. The objective of this analysis was to examine access to specialized medical care services and several possible determinants of access to services in a distinctly rural population in Canada. In winter 2010, we conducted a baseline mail survey of 11,982 households located in rural Saskatchewan, Canada. We obtained 4620 completed household surveys. A key informant for each household responded to questions about access to medical specialists and the exact distance traveled to these services. Correlates of interest included the location of the residence within the province and within each household, socioeconomic status, household smoking status, median age of household residents, number of non-respiratory chronic conditions and number of current respiratory conditions. Analyses were conducted using log binomial regression for the outcome of interest. The overall response rate was 52%. Of households who required a visit to a medical specialist in the past 12 months, 23% reported having difficulty accessing specialist care. The magnitude of risk for encountering difficulty accessing medical specialist care services increased with the greatest distance categories. Accessing specialist care professionals by rural residents was particularly difficult for persons with current respiratory conditions.

Neighbourhood crime and adolescent cannabis use in Canadian adolescents.

BACKGROUND: Although neighbourhood factors have been proposed as determinants of adolescent behaviour, few studies document their relative etiological importance. We investigated the relationship between neighbourhood crime and cannabis use in a nationally representative sample of Canadian adolescents. METHODS: Data from the 2009/10 Canadian Health Behaviour in School-aged Children (HBSC) survey (n=9134 14- and 15-year-olds) were combined with area-level data on crime and socioeconomic status of the neighbourhood surrounding the schools (n=218). RESULTS: Multilevel logistic regression analyses showed that after individual and contextual differences were held constant, neighbourhood crime related to cannabis use (OR 1.29, CI 1.12-1.47 per 1.0 SD increase in crime). This association was not moderated by parental support nor having cannabis-using friends. The amount of explained variance at the neighbourhood level was 19%. CONCLUSIONS: Neighbourhood crime is an important factor to consider when designing interventions aimed at reducing adolescent cannabis use. Interventional research should examine the effectiveness of community-based interventions that target adolescents through parents and peers.

Cross-national evidence for the clustering and psychosocial correlates of adolescent risk behaviours in 27 countries.

BACKGROUND: According to Jessor's Problem Behaviour Theory (PBT) and Moffitt's theory of adolescence-limited antisocial behaviour, adolescent risk behaviours cluster and can be predicted by various psychosocial factors including parent, peer and school attachment. This study tested the potential influence of the sociocultural, or macro-level, environment on the clustering and correlates of adolescent risk behaviour across 27 European and North American countries. METHODS: Analyses were based on data from the 2009-10 Health Behaviour in School-aged Children (HBSC) study. Participants compromised 56,090 adolescents (M(age) = 15.5 years) who self-reported on substance use (tobacco, alcohol, cannabis) and early sexual activity as well as on psychosocial factors (parent, peer and school attachment). RESULTS: Multiple group confirmatory factor analyses (with country as grouping variable) showed that substance use and early sexual activity loaded on a single underlying factor across countries. In addition, multiple group path analyses (with country as grouping variable) showed that associations between this factor and parent, peer and school attachment were identical across countries. CONCLUSION: Cross-national consistencies exist in the clustering and psychosocial correlates of substance use and early sexual activity across western countries. While Jessor's PBT stresses the problematic aspects of adolescent risk behaviours, Moffitt emphasizes their normative character. Although the problematic nature of risk behaviours overall receives more attention in the literature, it is important to consider both perspectives to fully understand why they cluster and correlate with psychosocial factors. This is essential for the development and implementation of prevention programmes aimed at reducing adolescent risk behaviours across Europe and North America.

Asthma incidence and risk factors in a national longitudinal sample of adolescent Canadians: a prospective cohort study.

BACKGROUND: Estimates of asthma incidence and its possible determinants in adolescent populations have rarely been obtained using prospective designs. We sought to identify socio-demographic and other patterns in the incidence of asthma among Canadian adolescents and to examine possible behavioural and environmental determinants of asthma incidence using longitudinal analyses. METHODS: We used data from the National Population Health Survey (NPHS), a nationally representative longitudinal survey of Canadians. All persons aged 12-18 years without asthma at baseline were followed up to a maximum of 12 years. The outcome was a reported diagnosis of asthma during the follow-up period. Analyses were weighted to the population and bootstrapping procedures were used to estimate variances. RESULTS: Participants (n = 956) represented 2,038,890 adolescents of whom 293,450 (14.4%) developed asthma over the 21,274,890 person-years of follow-up. Overall, the incidence of asthma was 10.2 per 1000 person-years. In adjusted Cox regression analysis, being female (HR = 2.13, 95% CI = 1.26-3.62, p = 0.005) and being exposed to passive smoking (HR = 2.06, 95% CI = 1.27-3.34, p = 0.003) were associated with the development of asthma while no statistically significant associations were identified for rural residence, being overweight, and other health behaviours. There was also an apparent cohort effect among girls where girls who were older at baseline reported being diagnosed with asthma more over the follow-up than their younger counterparts. This was not observed among males. CONCLUSIONS: Asthma prevention initiatives for adolescents should target girls and focus on smoking exposures. The role that differential diagnostic patterns play in these observations should be investigated to more accurately assess the incidence of asthma.

Do societal wealth, family affluence and gender account for trends in adolescent cannabis use? A 30 country cross-national study.

AIMS: To examine cross-national changes in frequent adolescent cannabis use (40+ times consumed over life-time at age 15) over time and relate these trends to societal wealth, family affluence and gender. DESIGN: Data from three cycles (2002, 2006, 2010) of the Health Behaviour in School-aged Children (HBSC) Study were used for cross-sectional and trend analyses of adolescent cannabis use. SETTING: Representative surveys in 30 European and North American countries. PARTICIPANTS: A total of 160 606 15-year-old students. MEASUREMENTS: Respondents' life-time cannabis use, demographics, family affluence (FAS) and frequency of peer contacts were measured individually. Indicators of wealth (gross domestic product per capita, GDP) and perceived availability of cannabis were obtained from national public data bases. FINDINGS: The frequency of life-time cannabis use decreased over time among adolescents in Europe and North America, particularly in western European countries and the United States (relative risk (RR) = 0.86: confidence interval (CI) 0.79-0.93). This trend was not observed consistently in rapidly developing countries in eastern, central and southern Europe. Over time (2002-10), cannabis use became: (i) less characteristic of high GDP countries in contrast to lower GDP countries (RR = 0.74: CI 0.57-0.95); (ii) less characteristic of youth from high FAS families in contrast to youth from low FAS families (RR = 0.83: CI 0.72-0.96); and (iii) characterized by an increasing gender gap, i.e. consumption was higher among males (RR 1.26: CI 1.04-1.53). Perceived availability of cannabis and peer contacts remained strong predictors of frequent cannabis use. CONCLUSIONS: Among 30 European and North American countries, cannabis use appears to have 'trickled down' over time, with developing countries taking on the former (heavier) use pattern of richer countries, and less affluent youth taking on the former (heavier) use pattern of more affluent youth. Cannabis use continues to be more common among adolescent males than females.

Prevalence of chronic bronchitis in farm and nonfarm rural residents in Saskatchewan.

OBJECTIVE: To determine the prevalence of chronic bronchitis (CB) and associated risk factors in farm and nonfarm rural residents in Saskatchewan, Canada. METHODS: The questionnaire collected information about health, contextual, and individual factors from 8261 farm and nonfarm adult residents (18 years and older). RESULTS: The prevalence of CB was 5.3% among farm residents and 6.4% among nonfarm residents. We found a greater prevalence of CB associated with household income adequacy, increasing age, allergies, history of lung disease in a parent, exposure to stubble smoke, obesity, prenatal exposure to smoking, and female sex. Smoking interacted with occupational exposure to wood dust and solvents, and allergic reaction to molds. CONCLUSION: The results suggest that increasing household income and reducing smoking could be primary, modifiable determinants of CB prevalence.

Determinants of early-stage hearing loss among a cohort of young workers with 16-year follow-up.

OBJECTIVES: The authors had a unique opportunity to study the early impacts of occupational and recreational exposures on the development of noise-induced hearing loss (NIHL) in a cohort of 392 young workers. The objectives of this study were to estimate strength of associations between occupational and recreational exposures and occurrence of early-stage NIHL and to determine the extent to which relationships between specific noise exposures and early-stage NIHL were mitigated through the use of hearing protection. METHODS: Participants were young adults who agreed to participate in a follow-up of a randomised controlled trial. While the follow-up study was designed to observe long-term effects (up to 16 years) of a hearing conservation intervention for high school students, it also provided opportunity to study the potential aetiology of NIHL in this worker cohort. Study data were collected via exposure history questionnaires and clinical audiometric examinations. RESULTS: Over the 16-year study period, the authors documented changes to hearing acuity that exceeded 15 dB at high frequencies in 42.8% of men and 27.7% of women. Analyses of risk factors for NIHL were limited to men, who comprised 68% of the cohort, and showed that risks increased in association with higher levels of the most common recreational and occupational noise sources, as well as chemical exposures with ototoxic potential. Use of hearing protection and other safety measures, although not universal and sometimes modest, appeared to offer some protection. CONCLUSIONS: Early-stage NIHL can be detected in young workers by measuring high-frequency changes in hearing acuity. Hearing conservation programmes should focus on a broader range of exposures, whether in occupational or non-occupational settings. Priority exposures include gunshots, chainsaws, power tools, smoking and potentially some chemical exposures.

Urban-rural differences in asthma prevalence among young people in Canada: the roles of health behaviors and obesity.

BACKGROUND: Asthma prevalence has been reported to be lower in rural regions, but the reasons for this are not known. OBJECTIVE: To confirm the existence of an urban-rural geographic gradient in asthma prevalence among Canadian youths and to evaluate whether this gradient was mediated by health behaviors. METHODS: Cross-sectional data from 4,726 Canadian youth (grades 6-10) were collected during the 2001-02 Health Behaviour in School-Aged Children survey. Geographic region was categorized as metro (urbanized), non-metro but adjacent to metro, and rural. Asthma was defined via self-report of doctors' diagnoses and at least 1 of: (1) asthma symptoms or (2) a health care visit for asthma in the past year. Health behaviors (diet and physical activity) as well as obesity were also assessed. RESULTS: Asthma prevalence was lowest in rural regions (metro = 17.7%, non-metro-adjacent = 15.6%, rural = 14.8%). A lower risk of asthma was associated with rural region (adjusted odds ratio [OR] = 0.76, 95% CI = 0.61-0.95) and living in non-metro-adjacent regions (adjusted OR = 0.81, 95% CI = 0.65-1.01). Health behaviors and obesity status did not mediate the association between geographic region and asthma. Being overweight or obese, having a high physical activity level, and exposure to passive smoking independently elevated the risk of asthma, whereas increased consumption of whole milk or vegetables were each protective. CONCLUSIONS: Although asthma prevalence among youth was lower in rural areas, this association was not mediated by health behaviors or obesity. Other exposures, likely environmental, are the logical mechanisms through which rural geographic status is related to lower asthma prevalence.

Screen time and risk behaviors in 10- to 16-year-old Canadian youth.

OBJECTIVE: To examine television, computer, and video game use as possible determinants of multiple risk behaviors (MRB) among Canadian youth. METHODS: Results are based on the Canadian 2005/06 Health Behaviour in School-Aged Children Survey. This survey included a representative cross-sectional sample of 8215 youth in grades 6-10, and a 1-year longitudinal sample of 1424 youth in grades 9-10. Total hours per week of television, video games, and computer use were calculated and participants were grouped into quartiles. Six risk behavior variables (smoking, drunkenness, non-use of seatbelts, cannabis use, illicit drug use, non-use of condoms) were combined to form a MRB score. Ordinal and repeated measure logistic regression models were used to examine associations between screen time and MRB variables. RESULTS: High computer use (top quartile) was associated with approximately a 50% increased engagement of MRB in both samples. High television use was also associated with modestly increased engagement in MRB in the cross-sectional sample. CONCLUSIONS: High computer use was the screen time behavior that was mostly strongly and consistently associated with engagement in MRB. Future research is needed to understand the relationship between specific screen time behaviors and adolescent health to help strengthen current screen time guidelines for youth.

Relationships between income inequality and health: a study on rural and urban regions of Canada.

INTRODUCTION: Many studies have demonstrated that health is a function of relative and not absolute income within populations. Canadian studies are not conclusive; most indicate that there is no relationship between income inequality and health within Canada. There is a need for further investigation into the validity of the 'relative income' hypothesis in the Canadian population. The primary objective of this research was to test the 'relative income' hypothesis across Canadian health regions. The second objective was to extend the hypothesis to consider rural versus urban populations. METHODS: This research involved ecological analyses. The source of the data was the Canadian Community Health Survey, Cycle 3.1. The units of analysis were Canadian health regions. Health of a region was estimated as the percentage of people who rated their health as good or excellent. The primary exposure variable was the ratio of people whose personal income was less than $15,000 relative to those reporting more than $80,000 in the year preceding the survey. This ratio provided a measure of the distribution of income. The main covariates were ecological measures of socio-demographic variables, social capital, substance use behaviours (smoking and alcohol consumption), rural/urban status of the region, and absolute income in the region. Correlation analyses and multiple linear regressions were performed to ascertain the relationship between income inequality and population health, adjusting for important covariates. RESULTS: The measure of income inequality alone appeared to explain 18% of the variability in the measure of population health. However, after adding the measure of absolute income to the model, although 29% of the variability was explained, the independent contribution of the inequality measure became non-significant. Linear regression models suggested that the absolute income variable alone could explain 30% of the variance in the health status of populations. Other variables with a statistically significant contribution to the final model were education and alcohol consumption. The effect of rural/urban geographic status on the relationship of interest was similar to other covariates. This variable did not change the individual relationship between income inequality or absolute income and the measure of population health status. In both rural and urban regions, absolute income and education had positive effects on population health. In urban regions alcohol consumption was a significant negative contributor to population health status; whereas, in rural regions, smoking status had a significant negative effect on population health status. CONCLUSION: Across Canadian health regions, health status in populations was a function of absolute income but not relative income. Regions with higher levels of education had better levels of self-rated health. A larger percentage of heavy drinkers was also correlated with lower population health status. Findings were consistently observed in rural and urban populations. The study findings have implications for public health, economic, and social policies.

Cross-national comparison of adolescent drinking and cannabis use in the United States, Canada, and the Netherlands.

BACKGROUND: This research examined the prevalence of drinking and cannabis use among adolescents in the United States, Canada, and the Netherlands, countries with substantially different laws and policies relating to these substances. METHODS: Laws regarding drinking and cannabis use were rated for each country. Substance use prevalence data among 10th graders from the Health Behaviour in School-Aged Children Survey conducted in each country in 2005-2006 were examined. RESULTS: Laws regarding alcohol and cannabis were found to be strictest in the United States, somewhat less strict in Canada, and least strict in the Netherlands. On most measures of drinking, rates were lower in the United States than in Canada or the Netherlands. With United States as the referent, relative risks (RR) for monthly drinking were 1.30 (1.11-1.53) for Canadian boys and 1.55 (1.31-1.83) for girls, and 2.0 (1.73-2.31) for Dutch boys and 1.92 (1.62-2.27) for Dutch girls. Drunkenness was also higher among Canadian boys and girls and Dutch boys. However, rates of cannabis use did not differ between the countries, except that Dutch girls were less likely to use cannabis in the past year (RR=.67; .46-.96). CONCLUSIONS: The lower prevalence of adolescent drinking and drunkenness (except among Dutch girls) in the United States is consistent with the contention that strict drinking policies may limit drinking among 10th graders. However, the finding that cannabis use rates did not differ across countries is not consistent with the contention that prohibition-oriented policies deter use or that liberal cannabis policies are associated with elevated adolescent use. Based on these findings, the case for strict laws and policies is considerably weaker for cannabis than for alcohol.