Changing eating to manage weight or shape: A cross-sectional and prospective study of the prevalence and correlates in a large Canadian adolescent cohort.

OBJECTIVE: The present study examined reports of changing eating to manage weight/shape over one year among adolescents. It also tested how changing eating for weight/shape was associated with physical activity (resistance training, moderate-to-vigorous physical activity; MVPA) and mental health (depressive symptoms, flourishing), and whether weight perceptions moderated these associations. METHODS: Participants were Canadian adolescents (N = 20,614, Mage ± SD = 14.4 ± 1.3, 52.9% girls) who completed self-report surveys in the 2020-2021 and 2021-2022 waves of the COMPASS study. Separate multilevel models were tested for each outcome. RESULTS: Approximately 30% of adolescents reported changing their eating to manage weight/shape at least once a week. More days of changing eating were associated with significantly higher depressive symptoms and lower flourishing cross-sectionally (b = 0.51, b = -0.27) and over time (b = 0.35, -0.20); the flourishing association over time was weaker for adolescents who perceived themselves as overweight relative to about right. More days of changing eating were also associated with more MVPA and resistance training cross-sectionally (b = 2.81, b = 0.19) and over time (b = 1.28, b = 10). The relationship between changing eating and MVPA over time was stronger for adolescents who perceived themselves as overweight relative to about right; whereas the cross-sectional relationship between changing eating and resistance training was weaker. CONCLUSIONS: Reports of changing eating to manage weight/shape were associated with divergent health outcomes; research into how and to what extreme adolescents are changing eating to manage weight/shape, and identity factors that may contribute to these differences, is warranted.

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.

Using random forest to identify correlates of depression symptoms among adolescents.

PURPOSE: Adolescent depression is a significant public health concern, and studying its multifaceted factors using traditional methods possess challenges. This study employs random forest (RF) algorithms to determine factors predicting adolescent depression scores. METHODS: This study utilized self-reported survey data from 56,008 Canadian students (grades 7-12) attending 182 schools during the 2021/22 academic year. RF algorithms were applied to identify the correlates of (i) depression scores (CESD-R-10) and (ii) presence of clinically relevant depression (CESD-R-10 ≥ 10). RESULTS: RF achieved a 71% explained variance, accurately predicting depression scores within a 3.40 unit margin. The top 10 correlates identified by RF included other measures of mental health (anxiety symptoms, flourishing, emotional dysregulation), home life (excessive parental expectations, happy home life, ability to talk to family), school connectedness, sleep duration, and gender. In predicting clinically relevant depression, the algorithm showed 84% accuracy, 0.89 sensitivity, and 0.79 AUROC, aligning closely with the correlates identified for depression score. CONCLUSION: This study highlights RF's utility in identifying important correlates of adolescent depressive symptoms. RF's natural hierarchy offers an advantage over traditional methods. The findings underscore the importance and additional potential of sleep health promotion and school belonging initiatives in preventing adolescent depression.

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.

Factors associated with prospective changes in weight control intentions among adolescents.

INTRODUCTION: The present study examined predictors of negative changes in weight control intentions from before to during the COVID-19 pandemic among adolescents. METHODS: Participants were Canadian secondary school students enrolled in the COMPASS study and had completed self-report surveys before (T1; 2018/2019 and/or 2019/2020 school year) and during (T2; 2020/2021 and/or 2021/2022) the COVID-19 pandemic (N = 11,869, Mage ± SD = 13.79 years old ± 1.15, 52.89% girls, 45.30% boys, 1.81% gender diverse). Demographic, interpersonal, behavioral, and psychological predictors of weight control intention change from T1 (stay the same weight, not doing anything about weight) to T2 (lose weight, gain weight) were tested using multilevel logistic regressions. RESULTS: Over one-third (37.0%) of adolescents who reported wanting to stay the same weight at T1 changed their intention to lose or gain weight at T2, as did 28.5% of adolescents who reported not wanting to do anything about their weight at T1. Changing weight control intention from "not doing anything about weight" at T1 to weight gain/loss at T2 was associated with resistance training, emotion dysregulation, bullying, social media use, and gender. Changing weight control intention from "stay the same weight" at T1 to weight gain/loss at T2 was associated with gender, perceived financial comfort, social media use, and flourishing. CONCLUSIONS: Results highlight the prevalence of maladaptive weight control intention changes among adolescents, and elucidate related behavioral, interpersonal, demographic, and psychological factors. Findings can inform targeted intervention and prevention strategies to disrupt maladaptive changes in weight control intentions among high-risk subgroups.

Income Inequality and the Odds of Online Gambling Among a Large Sample of Adolescents in Canada.

Consistent evidence points to the detrimental effects of income inequality on population health. Income inequality may be associated with online gambling, which is of concern since gambling is a risk factor for adverse mental health conditions, such as depression and suicide ideation. Thus, the overall objective of this study is to study the role of income inequality on the odds of participating in online gambling. Data from 74,501 students attending 136 schools participating in the 2018/2019 Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) survey were used. The Gini coefficient was calculated based on school census divisions (CD) using the Canada 2016 Census linked with student data. We used multilevel modeling to explore the association between income inequality and self-reported participation in online gambling in the last 30 days, while controlling for individual- and area-level characteristics. We examined whether mental health (depressive and anxiety symptoms, psychosocial wellbeing), school connectedness, and access to mental health programs mediate this relationship. Adjusted analysis indicated that a standardized deviation (SD) unit increase in Gini coefficient (OR = 1.17, 95% CI 1.05, 1.30) was associated with increased odds of participating in online gambling. When stratified by gender, the association was significant only among males (OR = 1.12, 95% CI 1.03, 1.22). The relationship between higher income inequality and greater odds for online gambling may be mediated by depressive and anxiety symptoms, psychosocial well-being, and school connectedness. Evidence points to further health consequences, such as online gambling participation, stemming from exposure to income inequality.

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.

The intersection of internalizing symptoms and alcohol use during the COVID-19 pandemic: A prospective cohort study.

Given the well-established relationship between alcohol and internalizing symptoms, potential increases in depression and anxiety during the COVID-19 pandemic may lead to increases in alcohol consumption and binge drinking. This study examines this association from before to during two phases of the pandemic in a cohort of Canadian youth. We used linked data from a sub-sample of 1901 secondary school students who participated in three consecutive school years of the Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behaviour (COMPASS) study between 2018/19 and 2020/21. Separate multilevel logistic regression models examined the association between depression and anxiety symptoms with odds of escalation and reduction (vs. maintenance) and initiation (vs. abstinence) of alcohol consumption. Results show that depression and anxiety symptoms significantly increased over the three years, and these changes were moderated by changes in alcohol consumption and binge drinking. Students with increased depression symptoms were less likely to reduce their alcohol consumption in the early pandemic (Adjust odds ratio [AOR] 0.94, 95% CI:0.90-0.98), more likely to initiate alcohol consumption in the ongoing pandemic period (AOR 1.03, 95% CI: 1.01-1.05), and more likely to initiate binge drinking in both periods. The depression-alcohol use association was stronger among females than males. This study demonstrates a modest association between internalizing symptoms and alcohol use, particularly for depression symptoms and in females. The identified depression-alcohol use association suggests that preventing or treating depression might be beneficial for adolescent alcohol use and vice versa.

Physical activity and recreational screen time change among adolescents in Canada: Examining the impact of COVID-19 in worsening inequity.

The purpose of this study was to assess if sub-populations of adolescents in Canada (i.e., race/ethnicity, sex/gender, and socioeconomic status [SES]) experienced a larger change in physical activity and screen time between the 2019-2020 (pre-pandemic) and the 2020-2021 (mid-pandemic) school years. Longitudinally linked data from pre-pandemic and mid-pandemic school years of a prospective cohort study of secondary school students in Canada (n = 8209) were used for these analyses. Multivariable regression modelling tested the main effects of race/ethnicity, sex/gender, and SES on changes in moderate-to-vigorous physical activity (MVPA) and screen time duration as well as adherence to Canada's 24-h Movement Guidelines. Overall between groups difference were assessed using type II analysis of deviance tests. Interactions between variables of interest were subsequently tested with a series of regression models compared to the main effects model using likelihood-ratio test. Post-hoc comparisons found Male participants' MVPA time decreased less compared to their female counterparts (M [95% CI] = -16.3 [-13.5, -19.2] min/day), but also reported greater increases in screen time compared to females (23.7 [14.7, 32.8] min/day) during the same period. MVPA in White participants decreased less than Asian participants (-10.7 [-19.5, -1.9] min/day) with a similar non-significant pattern observed in Black and Latin participants. Adolescents in higher SES categories fared better on adherence to MVPA (highest vs. lowest OR = 1.41 [0.97, 2.06]) and screen time recommendations(highest vs. lowest AOR = 3.13 [0.91, 11.11]). Results support the hypothesis that existing inequitable sociodemographic differences in MVPA participation and screen time have worsened throughout the pandemic.

Connections associated with a healthy spirituality: are these unrecognized intermediary determinants that shape health inequities in Canadian young people?

BACKGROUND: The health of adolescents is determined by structural and intermediary factors. Such factors operate through pathways that foster different opportunities to achieve health and wellbeing, contributing to inequities. Past analyses of cross-national adolescent health data show that measures of child spirituality, conceptualized as the strength of the connections in our lives, may operate as intermediary determinants in some Western countries. Inspired by this idea, the current analysis provides an in-depth exploration of such pathways among Canadian adolescents. Our objectives were to confirm the existence of relationships between economic position and seven indicators of adolescent health status, then explore whether any observed inequities could be explained by the strength of connections afforded by a healthy spirituality. METHODS: Cycle 8 of the Canadian Health Behaviour in School-aged Children (HBSC) study was conducted in 2017-18. A school-based sample (n = 18,962) of adolescents was obtained from across Canada following a standard cross-national protocol. Eligible participants completed a general survey about their health, health behaviours and their determinants. Survey data were used to model the potential effect of perceived levels of relative affluence on each of seven health indicators. Comparison of crude and adjusted relative risks estimates from weighted log-binomial regression models provided evidence of indirect mediating effects attributable to each of four domains of spirituality. RESULTS: As perceived levels of family affluence increased, the percentages of young people who reported each (7/7) of the negative health outcomes decreased. The spiritual health domain "connections to self" (i.e., the importance of meaning, purpose, joy and happiness in life) mediated the strength of relationships between relative affluence and each (7/7) of the outcomes in boys and girls. "Connections to others" (the importance of kindness, respect and forgiveness) mediated the strength of relationships between relative affluence and each (7/7) of the outcomes among girls. Inconsistent evidence of possible mediation was identified for connections to others in boys, as well as the other two domains of spirituality (connections to nature, then connections to the transcendent) in boys and girls. CONCLUSION: Specific connections afforded by a healthy spirituality could be intermediary determinants of health in Canadian adolescent populations.

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.

Measurement Invariance of the GAD-7 and CESD-R-10 Among Adolescents in Canada.

OBJECTIVE: The primary objective of our study was to assess measurement invariance (by grade and sex) of the 7-item Generalized Anxiety Disorder (GAD-7) and 10-item Center for Epidemiologic Studies Depression Revised (CESD-R-10) scales in a sample of adolescents in Canada. If measurement invariance was demonstrated, our secondary objective was to estimate differences in scale scores across these subgroups. METHODS: We used data from 59,052 adolescents in Year 7 (2018-19) of the COMPASS school-based study. Measurement invariance was tested within a multigroup confirmatory factor analysis framework. Differences in scale scores were estimated using mixed linear regression which accounted for school-level clustering and adjusted for relevant confounders. RESULTS: Both the GAD-7 and CESD-R-10 demonstrated strict measurement invariance by sex and grade in our sample. Mean scale scores were higher among adolescents in grade 12 compared to grade 9 (ßGAD-7 = 0.91, p < .001; ßCESD-R-10 = 0.99, p < .001) and among female adolescents compared to males (ßGAD-7 = 3.36, p < .001; ßCESD-R-10 = 2.58, p < .001). CONCLUSIONS: Findings support the validity of the GAD-7 and CESD-R-10 for screening risk of generalized anxiety and depression among Canadian adolescents, and further indicate that differences observed in scale scores across subgroups reflect actual differences in risk for generalized anxiety and major depression, respectively.

Support for mask use as a COVID-19 public health measure among a large sample of Canadian secondary school students.

BACKGROUND: Youth voice has been largely absent from deliberations regarding public health measures intended to prevent SARS-CoV-2 transmission, despite being one of the populations most impacted by school-based policies. To inform public health strategies and messages, we examined the level of student support of mask use in public spaces and school mask requirements, as well as factors associated with students' perspectives. METHODS: We used cross-sectional survey data from 42,767 adolescents attending 133 Canadian secondary schools that participated in the COMPASS study during the 2020/2021 school year. Multinomial regression models assessed support for i) wearing a mask in indoor public spaces and ii) schools requiring students to wear masks, in association with COVID-19 knowledge, concerns, and perceived risk. RESULTS: Wearing masks in indoor public spaces was supported by 81.9% of students; 8.7% were unsupportive and 9.4% were neutral/undecided. School mask requirements were supported by 67.8%, with 23.1% neutral and 9.1% unsupportive. More females supported mask wearing in public spaces (83.9% vs. 79.1%) and school mask requirements (70.8% vs. 63.5%) than males. Students had increased odds of supporting mask use in public spaces and school mask requirements if they reported concerns about their own or their family's health, had discussions regarding ways to prevent infection, perceived COVID-19 to be a risk to young people, and knew that signs are not always present in COVID-19 cases and that masks prevent SARS-CoV-2 transmission if someone coughs. CONCLUSIONS: During the year following the beginning of the pandemic, most students supported the required use of masks in schools and wearing masks in indoor public spaces. Improving knowledge around the effectiveness of masks appears likely to have the largest impact on mask support in adolescent populations among the factors studied.

Shifting school health priorities pre-post cannabis legalization in Canada: Ontario secondary school rankings of student substance use as a health-related issue.

This study examined how schools prioritize ten key health concerns among their student populations over time and whether schools' prioritization of alcohol and other drug use (AODU) corresponds to students' substance use behaviours and cannabis legalization as a major policy change. Data were collected from a sample of secondary schools in Ontario, Canada across four years (2015/16-2018/19 [N2015/16 = 65, N2016/17 = 68, N2017/18 = 61 and N2018/19 = 60]) as a part of the COMPASS study. School-level prevalence of cannabis and alcohol use between schools that did and did not prioritize student AODU as a health concern was examined. Ordinal mixed models examined whether student cannabis and alcohol use were associated with school prioritization of AODU. Chi-square tests examined changing health priorities among schools pre-post cannabis legalization. School priority ranking for AODU was mostly stable over time. While AODU was identified as an important health concern, most schools identified mental health as their first priority across the four years of the study. No significant changes to school AODU priorities were observed pre-post cannabis legalization nor was school prioritization of AODU associated with student cannabis and alcohol use behaviours. This study suggests that schools may benefit from guidance in identifying and addressing priority health concerns among their student population.

Loneliness and screen time usage over a year.

INTRODUCTION: This study investigates the stability of loneliness in adolescents over a 1-year period. Also, we examine how the use of screen time media (watching television, playing video games, surfing the Internet, and texting) predicts loneliness over a year and how loneliness predicts screen time media usage. METHODS: The study uses survey data from the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behavior Study. A large (N = 20,903; 54% female) sample of Canadian students in grades 9-11 (Time 1) and grades 10-12 (Time 2) were assessed at two-time points, 1 year apart. RESULTS: Loneliness scores were found to be stable over the 1-year period, with a slight increase. Additionally, while loneliness was associated with some screen time within the same year, the effects from loneliness or screen time variables at time one predicting the other at time two were negligible. The study also provides evidence that the various screen time media did not fit a single dimension. Finally, there were sex differences in loneliness and some of the media variables. CONCLUSIONS: Loneliness appears to increase slightly over the course of a year in high school students. Results indicated that Internet use and loneliness are related; however screen time use in one year does not have a substantial impact on loneliness a year later or vice versa. Lastly, the data suggested that researchers examine screen time behaviors individually in their investigations.

The Relations between Youth Cannabis Use, School Cannabis Use-Related Disciplinary Approaches and Student Perceptions of School Support.

Background: In the school year immediately following cannabis legalization in Canada, this paper investigated youth perceptions of school support for the prevention and cessation of substance use. Scant research has examined student perceptions in relation to school disciplinary approaches. This study was the first to classify school discipline approach styles using school-level measures.Objective: The objective of this study was to examine whether different school cannabis use-related disciplinary approaches are associated with student cannabis use and perceptions of school supportiveness for the prevention and cessation of substance use.Results: School- and student-level survey data from Year 7 (the 2018/2019 school year) of the COMPASS study were used, including 68,037 grade 9-12 (Secondary I-V in Quebec) students attending 131 Canadian secondary schools. Schools were classified as using different cannabis use-related disciplinary styles based on school-administrator reported approaches to student first-offense violations of school cannabis policies. We identified that although none of the cannabis use-related disciplinary approach styles examined were associated with cannabis use, they were associated with student perceptions. Students attending schools classified as using a Permissive/Supportive approach had a higher likelihood of perceiving their school as supportive for substance use prevention/cessation than their peers at Authoritarian schools. Students who perceived their school as supportive for substance use prevention/cessation were less likely to report current cannabis use than their peers who perceived their school as unsupportive.Conclusions: Unlike previous studies using school classification styles that are based on student perceptions, results do not support direct associations between school cannabis use-related disciplinary styles and student cannabis use. Future prospective research should examine whether supportive disciplinary approaches (e.g., counseling referrals, educational programs) promote student perceptions of school supportiveness, and in turn, deter student substance use.

Bi-directional relationships between physical activity and mental health among a large sample of Canadian youth: a sex-stratified analysis of students in the COMPASS study.

OBJECTIVE: The aim of this research was to examine the bidirectional association between self-reported symptoms of mental disorder and physical activity among a large sample of Canadian secondary school students over time. METHODS: Linked survey data were obtained from 28,567 grade 9 to 12 students across Canada participating in two waves of the COMPASS Study (2017-18; 2018-19). Autoregressive cross-lagged models were run to examine the reciprocal relationships between self-reported moderate-to-vigorous physical activity (MVPA) and symptoms of depression (CESD-10) and anxiety (GAD-7). Models were stratified by gender, and accounted for grade, ethno-racial identity, and school-level clustering. RESULTS: Autoregressive associations show that neither symptoms of anxiety nor depression, at baseline, were predictive of mean MVPA at follow-up - consistent for the full sample and among both males and females. Higher MVPA among males at baseline was associated with lower symptoms of both anxiety (ß = - 0.03, p = 0.002) and depression (ß = - 0.05, p < 0.001) at follow-up. However, among females, higher MVPA at baseline was associated with greater symptoms of anxiety (ß = 0.03, p < 0.001), but not symptoms of depression (ß = 0.01, p = 0.073), at follow-up. CONCLUSION: In our large sample of Canadian secondary school students, associations between physical activity and symptoms of mental disorder were not bi-directional, and these relationships differed in males and females. This study illustrates the complex nature of the relationship between physical activity and symptoms of mental disorder among youth. While results support the benefits of promoting physical activity among males to prevent or manage internalizing symptoms, the relationship among females warrants further investigation.

Do weight perception and bullying victimization account for links between weight status and mental health among adolescents?

BACKGROUND: The purpose of this study was to explore whether the way youth perceive their weight and their experiences of bullying victimization account for the increased risk of depression and anxiety symptoms, and poor psychosocial well-being, associated with overweight/obesity in a large sample of Canadian secondary school students. We also explored if associations differed by gender. METHODS: We used cross-sectional survey data from year 7 (2018-19) of the COMPASS study. The sample included 57,059 students in grades 9-12 (Secondary III-V in Quebec) at 134 Canadian secondary schools (Alberta, British Columbia, Ontario, Quebec). First, multiple regression models tested associations between body mass index (BMI) classification and mental health outcomes (anxiety [GAD-7] and depression [CESD-10] symptoms, and psychosocial well-being [Diener's Flourishing Scale]). Second, weight perception and bullying victimization were added to the models. Models were stratified by gender and controlled for sociodemographic covariates and school clustering. RESULTS: When weight perception and bullying victimization were added to the models, obesity BMI status no longer predicted internalizing symptoms and flourishing scores relative to normal-weight BMIs. Students with 'overweight' or 'underweight' perceptions, and experiences of bullying victimization in the past month, reported higher anxiety and depressive symptomatology, and lower flourishing levels, in comparison to students with 'about right' weight perceptions and without experiences of bullying victimization, respectively, controlling for BMI status. Results were largely consistent across boys and girls. CONCLUSIONS: Results suggest perceptions of weight and experiences of bullying independently contribute to differences in mental health outcomes by weight status among youth. Continued efforts targeting weight-based bullying and weight bias, and the promotion of body size acceptance and positive body image, may help reduce the risk of mental illness and poor mental health among adolescents.

Examining the impact of the early stages of the COVID-19 pandemic period on youth cannabis use: adjusted annual changes between the pre-COVID and initial COVID-lockdown waves of the COMPASS study.

BACKGROUND: Given the high rates of cannabis use among Canadian youth and that adolescence is a critical period for cannabis use trajectories, the purpose of this paper was to examine the effect of the early stages of the COVID-19 pandemic period on youth cannabis use in the context of a natural experiment. We used 3-year linked data from the COMPASS study, including 7653 Canadian (Quebec, Ontario) adolescents from which 1937 completed all 3 survey waves (pre-COVID-19 [2018, 2019] and online [2020] during the early pandemic period [May-July 2020]). Structural equation modeling (SEM) and double difference (DD) models were used to estimate pre-COVID-19 to initial COVID-19 pandemic period change (2019-2020) in cannabis use (monthly, weekly, daily) compared to 2018 to 2019 change to adjust for age-related effects. Models were adjusted for age of entry into the cohort and sociodemographic characteristics. RESULTS: In the SEM and DD models, monthly, weekly, and daily cannabis use increased across all waves; however, the expected increases from the pre-COVID-19 wave (2019) to the initial COVID-19 period wave (2020) were lesser relative to the changes seen across the 2018 to 2019 waves. The cross-sectional data from May to July 2020 identified that the majority of youth who use cannabis did not report increased cannabis use due to COVID-19 or using cannabis to cope with COVID-19. CONCLUSION: During the early stages of the COVID-19 pandemic period, there does not appear to be a detrimental effect on youth cannabis use, when adjusted for age-related changes. Further prospective research is needed to explore the impact of the ongoing pandemic response on youth cannabis use onset and progression.

Hit the chronic physical activity: are cannabis associated mental health changes in adolescents attenuated by remaining active?

PURPOSE: High-frequency cannabis use in adolescents has been associated with adult mental illness. In contrast, physical activity has been demonstrated to benefit mental health status. The purpose of this study was to examine whether, within a 1-year prospective study design, changes in cannabis use frequency are associated with changes in mental health, and whether meeting physical activity guidelines moderates these associations. METHODS: COMPASS (2012-2021) is a hierarchical longitudinal health data survey from a rolling cohort of secondary school students across Canada; student-level mental health data linked from Years 5 (2016/17) and 6 (2017/18) were analysed (n = 3173, 12 schools). Multilevel conditional change regression models were used to assess associations between mental health scores change, cannabis use change and physical activity guideline adherence change after adjusting for covariates. RESULTS: Adopting at least weekly cannabis use was associated with increases in depressive and anxiety symptoms and decreases in psychosocial well-being. Maintaining physical activity guidelines across both years improved psychosocial well-being regardless of cannabis use frequency, and offset increases in depressive symptoms among individuals who adopted high frequency cannabis use. Physical activity adherence had no apparent relationship with anxiety symptoms. CONCLUSION: Regardless of the sequence of events, adopting high frequency cannabis use may be a useful behavioural marker of current or future emotional distress, and the need for interventions to address mental health. Physical activity adherence may be one approach to minimizing potential changes in mental health associated with increasing cannabis use.