A scoping review of school-level risk and protective factors of youth cannabis use: An application of the socio-ecological model.

Risk and protective factors for cannabis use exist at various levels of influence, and the school environment can play a key role in preventing cannabis use and initiation as most youth. By using the socio-ecological model to hierarchically characterize school-specific risk and protective factors, a wholistic approach to school-based cannabis use prevention can be demonstrated. This study uses scoping review methodology to describe current research on school-level risk and protective factors of youth cannabis use. The socio-ecological model was used as a guiding framework to characterize the literature. PubMed, Embase, and Scopus were used to retrieve original research articles published between 2010 and 2020 that examined cannabis use as a main outcome of interest. Articles that examined school-related risk and protective factors within participants who were 18 years old or younger were included. Articles that met the pre-established criteria were extracted and categorised by theme based on levels of the socio-ecological framework. Four levels of risk and protective factors related to the school environment were identified (individual, interpersonal, community, and societal). A majority of school-based research examined individual and societal factors that influenced youth cannabis use. Our findings suggest most available research has focused on individual and societal school-level factors of cannabis use. A number of consistent themes were identified, however, findings were mixed and demonstrate the need for a more critical examination of research in order to understand which risk and protective factors are most influential among youth.

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.

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.

Use of IDegLira to Intensify, Simplify, and Increase Appropriateness of Type 2 Diabetes Therapy: A Real-Life Experience.

INTRODUCTION: Fixed ratio combination of insulin degludec and liraglutide (IDegLira) represents an option to revise inappropriate therapies in patients with poorly controlled type 2 diabetes. This study aimed to assess the pattern of use and 1-year effectiveness of IDegLira. METHODS: A retrospective chart review was performed to assess changes in glycated hemoglobin (HbA1c) (primary endpoint), fasting blood glucose (FBG), body weight, estimated glomerular filtration rate (eGFR), and lipid profile following IDegLira initiation. Previous versus concomitant diabetes treatments were also compared. RESULTS: Overall, 87 patients (mean age 73.9 ± 9.2 years, diabetes duration 18.2 ± 6.7 years, 62.1% men, HbA1c 8.3 ± 1.3%, BMI 30.4 ± 5.5 kg/m2) initiated IDegLira. Previously, 21.8% of patients were treated with oral hypoglycemic agents (OHA group), 47.1% with basal insulin ± OHA (BOT group), 5.8% with GLP-1 RA ± basal insulin (GLP1-RA group), and 25.3% with basal-bolus schemes (BB group). At the first prescription of IDegLira, secretagogues and schemes including two or more OHA were substantially reduced, leaving metformin as the most prevalent OHA (81.6%) used in combination with IDegLira. Starting dose of IDegLira ranged from 18.7 ± 3.1 U (OHA group) to 24.1 ± 4.4 U (BB group). After 1 year, HbA1c was significantly reduced by 1.25% (95% CI - 1.48; - 1.03), FBG by 52.9 mg/dl, and body weight by 2.0 kg. Also, eGFR levels and lipid profile significantly improved. No severe hypoglycemia occurred. CONCLUSION: It is possible to proactively review suboptimal or inappropriate diabetes treatment according to the most recent guidelines. Results suggest that initiation of IDegLira was associated with a reduction in drugs to be administered daily and relevant improvements in clinical outcomes.

Adolescents' Depression and Anxiety Symptoms During the COVID-19 Pandemic: Longitudinal Evidence From COMPASS.

PURPOSE: There is concern over the potentially detrimental impact of the COVID-19 pandemic on adolescents' mental health. We examined changes in depression and anxiety symptoms from before (2018-19) to the early (2019-20) and ongoing pandemic (2020-21) responses among Canadian adolescents in the context of a natural experiment. METHODS: We used linked survey data from 5,368 Canadian secondary school students who participated in three consecutive waves of the cannabis use, obesity, mental health, physical activity, alcohol use, smoking, and sedentary behaviour study during the 2018-19, 2019-20, and 2020-21 school year. Separate fixed effects models examined whether changes in depression (Center for Epidemiologic Studies Depression Scale Revised-10) and anxiety (General Anxiety Disorder-7) symptoms differed between two cohorts. The cohorts differed in the timing of their second data collection wave; one cohort participated before the pandemic and the other cohort participated in the early pandemic (spring 2020). RESULTS: Depression and anxiety symptoms increased during the early and ongoing pandemic periods in the overall sample and both cohorts. The two cohorts experienced similar elevations in their symptoms. Females and younger respondents presented greater elevations over time. The proportion of adolescents with significant depressive (29.4%) and moderate-to-severe anxiety (17.6%) symptoms at baseline increased by 1.5 times, reaching 44.8% and 29.8% in the ongoing pandemic period, respectively. DISCUSSION: Findings suggest that internalizing symptoms have consistently increased since before the onset of COVID-19, particularly in the ongoing pandemic period; however, we found no evidence of the increase being due to the pandemic in the early COVID-19 period when comparing the two cohorts. Ongoing evaluation of adolescents' mental health is necessary to capture potentially dynamic impacts over time.

A bacteriophage virus-like particle vaccine against oxycodone elicits high-titer and long-lasting antibodies that sequester drug in the blood.

Opioid use disorder (OUD) and opioid overdoses are public health emergencies. In 2021, 80,000 opioid overdose associated deaths were reported in the United States. Despite the availability of treatment strategies, including medications for opioid use disorder (MOUD) and naloxone, opioid overdoses continue to increase at an alarming rate. Opioid vaccines are a novel approach to combat the growing crisis with several candidates recently entering human clinical trials. In this study, we investigated Qß bacteriophage virus-like particles (VLPs) as a vaccine platform for immunogenic display of oxycodone. A derivative of oxycodone was conjugated to pre-formed Qß VLPs using a sulfhydryl-amine reactive heterobifunctional crosslinker with high loading of oxycodone. In mice, intramuscular immunization with Qß-oxycodone elicited high-titer, high-avidity and long-lasting antibody responses. Qß-oxycodone was also immunogenic after storage at ambient room temperature for over two weeks, demonstrating that the vaccine is highly thermostable. In mice, immunization with Qß-oxycodone elicited antibodies that sequester oxycodone in the serum, an important mechanism for preventing the adverse effects of opioid activity. Finally, Qß-oxycodone is immunogenic in nonhuman primates, eliciting serum oxycodone antibodies after intramuscular immunization of rhesus macaques. These data establish Qß-oxycodone as a promising opioid vaccine candidate.

Dementia resources for eating, activity, and meaningful inclusion (DREAM) toolkit co-development: process, output, and lessons learned.

Promoting wellbeing of persons with dementia and their families is a priority of research and practice. Engaging diverse partners, including persons with dementia and their families, to co-develop interventions promotes relevant and impactful solutions. We describe the process, output, and lessons learned from the dementia resources for eating, activity, and meaningful inclusion (DREAM) project, which co-developed tools/resources with persons with dementia, care partners, community service providers, health care professionals, and researchers with the aim of increasing supports for physical activity, healthy eating, and wellbeing of persons with dementia. Our process included: (1) Engaging and maintaining the DREAM Steering Team; (2) Setting and navigating ways of engagement; (3) Selecting the priority audience and content; (4) Drafting the toolkit; (5) Iterative co-development of tools and resources; (6) Usability testing; and (7) Implementation and evaluation. In virtual meetings, the DREAM Steering Team confirmed the toolkit audiences (primary: community service providers; secondary: persons with dementia and care partners) and identified and evolved content areas. An environmental scan identified few existing, high-quality resources aligned with content areas. The Steering Team, additional multi-perspective partners, and external contractors iteratively co-developed new tools/resources to meet gaps over a 4-month virtual process that included virtual meetings, email exchange of documents and feedback, and one-on-one calls by telephone or email. The final DREAM toolkit includes a website with seven learning modules (on the diversity of dementia, rights and inclusion of persons living with dementia, physical activity, healthy eating, dementia-inclusive practices), a learning manual, six videos, nine handouts, and four wallet cards ( www.dementiawellness.ca ). Our co-development participants rated the process highly in relation to the principles and enablers of authentic partnership even though all engagement was virtual. Through use of the co-developed DREAM toolkit, we anticipate community service providers will gain the knowledge and confidence needed to provide dementia-inclusive wellness programs and services that benefit persons with dementia and their families.

Risky cannabis use is associated with varying modes of cannabis consumption: Gender differences among Canadian high school students.

Background: Our objective was to explore associations between indicators of more risky cannabis use (i.e., solitary use, frequent use, and younger age of initiation) and different modes of cannabis use (i.e., smoking, vaping and/or edibles). Methods: Data were gathered from a large sample of Canadian youth in Alberta, British Columbia, Ontario, and Quebec who participated in Year 8 (2019-20) of the COMPASS study, and who reported using cannabis in the past year (n = 4,763). Generalized estimating equations were used to examine associations between risky cannabis use and modes of cannabis use, stratified by gender. Results: Overall, 38% of students reported using multiple modes of cannabis use. Consistent among both males and females, students who used cannabis alone (35%) and at a higher frequency (55%) were more likely to use multiple modes than smoking only. Among females, those who used cannabis alone were more likely to report using edibles only compared to smoking only (aOR=2.27, 95%CI=1.29-3.98). Earlier cannabis use initiation was associated with lower likelihood of vaping cannabis only among males (aOR=0.25; 95%CI = 0.12-0.51), and lower likelihood of using edibles only among females (aOR=0.35; 95%CI = 0.13-0.95), than by smoking only. Conclusions: Our findings suggest that multiple modes of use may be an important indicator or risky cannabis use among youth, given associations with frequency, solitary use, and age of onset.

Perceptions of and adherence to early COVID-19-related restrictions and associations with substance use among youth in Canada. / Perceptions et respect des premières restrictions liées à la COVID-19 et associations avec la consommation de substances chez les jeunes au Canada.

INTRODUCTION: As a largely social behaviour, substance use may have decreased for some youth overall in Canada during the COVID-19 pandemic; however, continued use may indicate nonadherence to pandemic-related restrictions and social distancing measures. In a sample of Canadian adolescents (aged 12-19 years), our objective was to examine how substance use (cannabis, binge drinking, cigarettes, vaping) is associated with perceptions of, and adherence to, early COVID-19-related public health measures, taking into consideration sociodemographic factors. METHODS: Cross-sectional data were retrieved from online data collected during Year 8 of the COMPASS school-based study, during the early months of the COVID-19 pandemic (May-July 2020) in British Columbia, Ontario and Quebec. We fitted two models using generalized estimating equations to examine how substance use was associated with separate measures of (1) perceptions of, and (2) adherence to early COVID-19 restrictions. RESULTS: In our sample, 10% of adolescents perceived COVID-19 restrictions as too weak and 14% perceived them as too strict. Nearly half (46%) reported taking restrictions very seriously, and 5% did not take them seriously at all. Binge drinking, cigarette use and vaping were associated with perceptions that restrictions were too strict and with nonadherence. However, adolescents who used cannabis were less likely to perceive COVID-19-related restrictions as too strict. CONCLUSION: This study highlights the association of adolescent substance use with perceptions of, and adherence to, COVID-19-related public health restrictions in Canada. Our findings emphasize a need for continual monitoring of substance use behaviours during the COVID-19 pandemic to better characterize adolescent risk and further inform targeted public health strategies accordingly.

Psychometric evaluation of the treatment entry questionnaire to assess extrinsic motivation for inpatient addiction treatment.

Introduction: Valid multi-faceted measurement of motivation for substance use disorder (SUD) treatment is needed to help inform treatment approaches and predict outcomes. This study examined evidence of validity for the Treatment Entry Questionnaire (TEQ-9). Methods: Data represented individuals entering inpatient SUD treatment (n = 1455). We used confirmatory factor analysis (CFA) to assess the three-factor structure of the TEQ-9 [identified (i.e., values/personally chooses treatment), introjected (i.e., internally controlled by guilt/shame) and external motivations (i.e., external pressure/demands)], and examined measurement invariance across gender, age, and ethno-racial identity. Correlation with readiness and confidence assessed convergent validity, while correlations with substance use problem severity and previous substance use treatment assessed meaningful group differences. Results: A three-factor structure was confirmed with all items loading significantly onto their respective factors (ps < 0.001). Each subscale demonstrated high internal consistency (Identified α = 0.90; Introjected α = 0.79; External α = 0.85). Each subscale demonstrated measurement invariance up to the scalar level across all sub-groups. Readiness, confidence, and substance use problem severity correlated as expected across various substances with the identified (rs = 0.098 - 0.262, ps < 0.05), and external (rs = -0.096 - -0.178, ps < 0.05) subscales. Additionally, the mean Identified subscale score was significantly higher among those who previously engaged in SUD treatment (p < 0.001). Findings for the Introjected subscale were more ambiguous. Conclusions: Findings provide evidence for factorial validity, measurement invariance, convergent validity and group differences of the TEQ-9 in a large clinically mixed inpatient SUD treatment population, providing further support of its clinical and research utility.

Physical-mental multimorbidity in children and youth: a scoping review.

OBJECTIVE: Efforts to describe the current state of research are needed to advance the field of physical-mental multimorbidity (ie, the co-occurrence of at least one physical illness and at least one mental disorder) among children and youth. Our objective was to systematically explore the breadth of physical-mental multimorbidity research in children and youth and to provide an overview of existing literature topics. DESIGN: Scoping review. METHODS: We conducted a systematic search of four key databases: PubMed, EMBASE, PsycINFO and Scopus as well as a thorough scan of relevant grey literature. We included studies of any research design, published in English, referring to physical-mental multimorbidity among children and youth aged ≤18 years. Studies were screened for eligibility and data were extracted, charted and summarised narratively by research focus. Critical appraisal was employed using the modified Quality Index (QI). RESULTS: We included 431 studies and 2 sources of grey literature. Existing research emphasises the co-occurrence of anxiety, mood and attention disorders among children with epilepsy, asthma and allergy. Evidence consists of mostly small, observational studies that use cross-sectional data. The average QI score across applicable studies was 9.1 (SD=1.8). CONCLUSIONS: There is a pressing need for more robust research within the field of child physical-mental multimorbidity.

Changes in cannabis use modes among Canadian youth across recreational cannabis legalization: Data from the COMPASS prospective cohort study.

INTRODUCTION: Canadian youth consume cannabis in multiple ways, including by smoking, vaping, and eating or drinking. Existing evidence suggests that these behaviours may change after law liberalization, though data regarding youth are scarce. We investigated changes in cannabis modes of use and associated factors across the federal legalization of recreational cannabis use for adults in Canada, among a large sample of underage youth before alternative products were made legally available. METHODS: Data were available from 2953 longitudinally linked Canadian high school students who reported on their cannabis use during the 2017/2018 and 2018/2019 school years. We explored whether students maintained a single or multiple cannabis use mode(s), contracted, or expanded the number of modes used. We then used generalized estimating equations to analyse associations of baseline characteristics with use mode trajectory. RESULTS: Expansion of cannabis use modes (42.3%) was more common than maintenance of a single mode (31.3%), maintenance of multiple modes (14.3%), or reduction (12.1%). Students who maintained multiple modes were significantly more likely to have high amounts of weekly spending money (AOR 1.68), to binge drink (AOR 2.25) or vape (AOR 1.99), to use cannabis regularly (AOR 2.67), and to endorse more symptoms of depression (AOR 1.06). School support for quitting tobacco, drug, or alcohol use appeared to have no effect. CONCLUSIONS: Multi-modal cannabis use increased among Canadian youth in our sample. Its association with other substance use and depressive symptoms may indicate clustering of additional harms. Screening for this use pattern may assist in identifying high-risk substance use and should be considered in the design of harm reduction programming.

Weight control intentions and mental health among Canadian adolescents: a gender-based analysis of students in the COMPASS study. / Intentions en matière de contrôle du poids et santé mentale chez les adolescents canadiens : analyse comparative entre les sexes chez les élèves participant à l'étude COMPASS.

INTRODUCTION: Little is known about gender differences in associations between weight control intentions and mental health in adolescents. Our objective was to examine these associations in a large sample of adolescent girls and boys. METHODS: Using data from Year 6 (2017-18) of the COMPASS study (n = 57 324), we performed a series of multivariable linear regressions to examine whether weight control intentions (gain, lose, stay the same, no intention) were associated with depression, anxiety and self-concept, while adjusting for relevant covariates including body mass index. Models were stratified by self-reported gender. RESULTS: Compared to those with no intentions, girls who intended to lose weight reported higher symptoms of depression (B = 0.52, p < 0.001) and anxiety (B = 0.41, p < 0.001) and poorer self-concept (B = 2.06, p < 0.001). Girls who intended to gain weight also reported higher symptoms of depression (B = 0.54, p < 0.001), anxiety (B = 0.50, p < 0.001) and self-concept (B = 1.25, p < 0.001). Boys who intended to lose weight reported greater symptoms of depression (B = 0.26, p < 0.001) and anxiety (B = 0.33, p < 0.001) and poor self-concept (B = 1.10, p < 0.001). In boys, weight-gain intentions were associated with greater symptoms of anxiety (B = 0.17, p < 0.05), but not depression or self-concept. CONCLUSION: Intentions to gain or lose weight were associated with symptoms of mental disorder and poor self-concept in our large sample of adolescents, and these relationships differed in boys and girls. These findings have important implications for school-based programs promoting healthy weight and body image.

Evaluating the Associations Between Exposure to Tobacco Interventions During Inpatient Treatment and Substance Use Outcomes: Findings From a Natural Experiment.

OBJECTIVE: In this study, we took advantage of a natural experiment that occurred within a substance use disorders (SUD) treatment setting which first saw the implementation of an evidence-based practice (EBP) for tobacco cessation, followed by the implementation of a tobacco-free policy (TFP) that included a campus-wide tobacco ban. We sought to examine how implementation of the EBP and TFP was associated with substances use outcomes, in addition to tobacco use, up to 3-months posttreatment. METHODS: Data were collected from patients in a substance use disorders treatment program at baseline, discharge, 1-, and 3-months posttreatment. Using a quasi-experimental design and generalized estimating equations, we modelled how patients' (N = 480) exposure to one of 3 interventions (1: treatment as usual [TAU], 2: EBP, and 3: EBP + TFP) was associated with overall abstinence from tobacco, alcohol, and other substances over time. Measures of tobacco use frequency, amount, and quit attempts were also modelled among a sub-sample of participants who self-reported using tobacco before treatment. RESULT: Exposure to the EBP + TFP was associated with increased tobacco abstinence (odds ratio [OR] = 1.93, 95% confidence interval [CI] [1.29, 2.90]) over time, including decreases in tobacco use frequency (OR = 0.78, 95% CI [0.68, 0.89]) and amount (OR = 0.80, 95% CI [0.67, 0.96]), and increased in likelihood of making a quit attempt (OR = 1.75, 95% CI [1.10, 2.80]) compared to TAU. Exposure was not associated with alcohol and/or other substance use. CONCLUSIONS: Comprehensive tobacco interventions that include EBP + TFP can promote tobacco cessation and reduced tobacco use following inpatient SUD treatment, without adversely affecting the use of other substances.

Substance-related coping behaviours among youth during the early months of the COVID-19 pandemic.

OBJECTIVE: As impacts of the COVID-19 pandemic continue to unfold, research is needed to understand how school-aged youth are coping with COVID-19-related changes and disruptions to daily life. Among a sample of Canadian youth, our objective was to examine the mental health factors associated with using substances to cope with COVID-19-related changes, taking account of expected sex differences. METHODS: We used online data collected from 7150 students in the COMPASS study, during the early months of the COVID-19 pandemic (May-July 2020) in British Columbia, Ontario, and Quebec, Canada. We specified a sex-stratified, generalized linear mixed model to estimate the likelihood of engagement in substance-related coping behaviours, while testing for the effects of students' mental health, individual characteristics, and school neighborhood characteristics. RESULTS: Twelve percent of students (13.4% of females, 9.9% of males) in our sample reported using cannabis, alcohol, cigarettes, and/or vaping to help cope with COVID-19-related changes. Regardless of sex, students with greater depressive symptoms were more likely to engage in substance-related coping (aORFemale = 1.04, 95 %CI[1.01-1.07]; aORMale = 1.06, 95 %CI[1.013-1.11]). Among females, better psychosocial wellbeing was protective against engagement in substance related-coping (aOR = 0.96, 95 %CI[0.94-0.98]), controlling for current substance use. CONCLUSIONS: Canadian school-aged youth with generally poor mental health may be more likely to have engaged in substance use to help cope with COVID-19-related changes during the first wave of the pandemic, and female youth may be at disproportionate risk of engaging in the behaviour. Ongoing evaluation of the impacts of COVID-19 on youth health is required.

Measurement Invariance of the Flourishing Scale among a Large Sample of Canadian Adolescents.

Our aim was to examine measurement invariance of the Flourishing Scale (FS)-a concise measure of psychological wellbeing-across two study samples and by population characteristics among Canadian adolescents. Data were retrieved from 74,501 Canadian secondary school students in Year 7 (2018-2019) of the COMPASS Study and from the original validation of the FS (n = 689). We assessed measurement invariance using a confirmatory factor analysis in which increasingly stringent equality constraints were specified for model parameters between the following groups: study sample (i.e., adolescents vs. adults), gender, grade, and ethno-racial identity. In all models, full measurement invariance of the FS across all sub-groups was demonstrated. Our findings support the validity of the FS for measuring psychological wellbeing among Canadian adolescents in secondary school. Observed differences in FS score among subgroups therefore represent true differences in wellbeing rather than artifacts of differential interpretation.

Evaluating the short-term impact of a tobacco-free policy in an inpatient addiction treatment setting.

PURPOSE: Tobacco use is highly prevalent within addiction treatment settings, despite the potential benefits that cessation may provide to patients' psychosocial functioning and overall sobriety. Moreover, tobacco cessation is often insufficiently addressed in addiction treatment programs, although evidence suggests that tobacco control policies, such as access to evidence-based treatment or tobacco-free policies, may be effective. The objective of our study was to evaluate the impact of the implementation of these two tobacco control policies in an inpatient addiction treatment centre. METHODS: Using a 3-group quasi-experimental design, we examined how the implementation of the Ottawa Model for Smoking Cessation (OMSC) and a subsequent campus-wide tobacco ban influenced patients' overall smoking status, frequency, amount used per day, and quit attempts during treatment, compared to usual care. Participants (N = 397) responded to a comprehensive questionnaire upon admission and discharge from an addiction treatment program. We used generalized linear mixed modelling to measure changes over time while accounting for relevant sociodemographic covariates. RESULTS: Patients exposed to a more comprehensive tobacco control environment (i.e., the OMSC, plus complete tobacco ban) were over 80% less likely to report having used tobacco during treatment, compared to patients exposed to usual care (AOR = 0.17, 95% CI [0.05-0.63]). Receiving treatment in this setting also contributed to a 35% decrease in the average number of days patients used tobacco compared to usual care (AOR = 0.65, 95% CI [0.53-0.98]), and a 27% decrease in the average number of cigarettes used per day compared to usual care (AOR = 0.73, 95% CI [0.58-0.93]). CONCLUSION: Comprehensive tobacco control policy interventions within inpatient addiction treatment hospitals promote tobacco cessation. Such interventions should include a combination of evidence-based treatment for patients and environmental restrictions to discourage tobacco use. The results of our study suggest that, within inpatient addiction treatment settings, use of the OMSC in combination with a campus-wide tobacco ban may be more effective than usual care or the OMSC alone.

Psychological correlates and binge drinking behaviours among Canadian youth: a cross-sectional analysis of the mental health pilot data from the COMPASS study.

OBJECTIVE: The objective of this study was to examine associations between depression, anxiety and binge drinking among a large sample of Canadian youth, while testing the moderating effect of flourishing. This research uses data from the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, Sedentary Behaviour (COMPASS) study (2012-2021) with a large sample size collecting data on youth health behaviours within Canadian secondary schools. DESIGN: Cross-sectional SETTING: 14 secondary schools across Ontario and British Columbia, Canada. PARTICIPANTS: A sample of grade 9-12 students (n=6570) who participated in the Mental Health pilot of the COMPASS study PRIMARY AND SECONDARY OUTCOME MEASURES: Self-reported questionnaires assessed student binge drinking behaviours (5≥drinks), symptoms of depression (Center for Epidemiologic Studies Depression Scale (Revised)-10 scores≥10) and anxiety (Generalised Anxiety Disorder 7-item Scale scores≥10), and flourishing (Diener's Flourishing Scale: 8-40). RESULTS: In our sample of 6570 students, 37.0% of students reported binge drinking in the last year, and 41.4% and 31.7% of students report clinically-relevant symptoms of depression and anxiety, respectively. Anxiety (adjusted OR (AOR): 0.57, (99% CI 0.15 to 2.22)) and depression (AOR: 1.98, (99% CI 0.76 to 5.13)) symptoms were not found to be associated with binge drinking and we did not detect any moderating role of flourishing. Rather, factors that were associated with increased odds of binge drinking included sports team participation (AOR: 1.67, (99% CI 1.37 to 2.03)) and use of other substances (tobacco (AOR: 3.00, (99% CI 2.12 to 4.25)) and cannabis (AOR: 7.76, (99% CI 6.36 to 9.46))). Similar associations were found for frequency of binge drinking. CONCLUSIONS: Consistent with existing literature, binge drinking behaviours were problematic, as well as clinically-relevant symptoms of depression and anxiety. However, mental health problems and well-being may not be responsible for explaining patterns of binge drinking in youth. Targeted intervention efforts towards student athletes and concurrent substance users are necessary for addressing binge drinking in youth populations.

Multimorbidity in children and youth: a scoping review protocol.

INTRODUCTION: Multimorbidity (co-occurring physical and mental illness) is an important issue for clinicians and researchers with combined efforts aimed at promoting the health and well-being of individuals across the life course. In children and youth, experience of any chronic physical illness leads to a substantial increase in risk for mental illness. As a growing field of interest, research is needed to map the current state of the literature in child and youth multimorbidity in order to identify existing gaps and inform the direction of future investigations. METHODS AND ANALYSIS: We are proposing the conduct of a scoping review to explore the depth and breadth of existing evidence in the field of child and youth multimorbidity. The scoping review will follow the methodological framework developed by Arksey and O'Malley, and will incorporate additional scoping review recommendations made by Levac et al . A systematic search of the following four key databases will be conducted: (1) PubMed; (2) EMBASE; (3) PsycINFO; and (4) Scopus, using combinations of Medical Subject Headings (MeSH) and Emtree terms. We will also consult grey literature sources and hand-search reference lists of included studies to identify additional studies of relevance. For eligible studies that meet all identified inclusion and exclusion criteria, a data extraction tool will be used to collect and store key study characteristics that will be relevant for collating, summarising and reporting the results of the scoping review. This scoping review also presents a novel use of quality index scoring, which we anticipate will contribute to strengthening the rigour of the scoping review methodology. ETHICS AND DISSEMINATION: The proposed scoping review does not require ethical approval. Final study results will be disseminated via conference presentations, publication in a peer-reviewed journal and knowledge translation activities with relevant stakeholders.