More support needed: Evaluating the impact of school e-cigarette prevention and cessation programs on e-cigarette initiation among a sample of Canadian secondary school students.

Given the recent increase in e-cigarette use among adolescents, there is a need to further explore how school programs are associated with e-cigarette initiation. The objective of this quasi-experimental study was to evaluate the impact of multiple school-based e-cigarette prevention and cessation programs on e-cigarette initiation among Canadian adolescents. This study used data from Year 6 (2017/18) and Year 7 (2018/19) of the COMPASS study in British Columbia, Alberta, Ontario, and Quebec, Canada. Students in grades 9 to 11 who had never tried e-cigarettes at baseline were included (n = 13,269). Schools (n = 88) reported whether they added programming that addressed e-cigarette or tobacco prevention or cessation. Generalized estimating equations were used to identify how added programs were associated with e-cigarette initiation at follow-up. At one-year follow-up (2018/19), 23% of schools added programs. Our evaluation results suggest that none of the activities taken by schools to prevent or reduce vaping among students significantly prevented vaping onset. In fact, female students at schools that reported adding a theme week had higher odds of e-cigarette initiation (OR 1.68 [95% CI 1.31-2.16]) and male students at schools that reported a cessation program had higher odds of e-cigarette initiation (OR 1.20 [95% CI 1.01-1.44]). These results suggest that schools may not know how to address e-cigarette use and that there can be risks to students if programs are not carefully implemented. Results point to the need for additional support to ensure that schools are taking evidence-based approaches that support all students.

High School Intramural Participation and Substance Use: A Longitudinal Analysis of COMPASS Data.

BACKGROUND: There is an association between sports participation and substance use. However, there is some evidence that intramural sports in high school may not have the same effect. Therefore, the objective of this research was to examine the longitudinal associations between intramural participation in high school and substance use. Methods: This study used a three-year linked sample (2016-2018) of grade 9 and 10 (ages 13-17) Canadian high school students in the COMPASS (Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, Sedentary behavior) study (n = 7,845). Students reported their participation in intramurals over time (consistent, none, initiate, intermittent, and quit) and their substance use behaviors (binge drinking, cannabis use, cigarette use, and e-cigarette use). Mixed effects models were used. Results: 42% of students did not participate in intramurals. For binge drinking, male students who never participated had lower odds (0.66 [0.47-0.93]) compared to consistent intramural participators. Female (3.50 [CI: 1.34-9.16]) and male students (1.97 [1.28-3.02]) who did not participate in any intramurals were more likely to use cannabis than consistent participators. Male students who did not participate were also more likely to use cigarettes (1.81 [1.05-3.12]). No associations were found between intramural participation and e-cigarette use. Conclusion: Intramural participation may be associated with increased binge drinking among male high school students. More promisingly, consistent participation in intramurals may be protective against cannabis use among male and female students and cigarette use among male students.

Targeted nanopore sequencing for the identification of ABCB1 promoter translocations in cancer.

BACKGROUND: Resistance to chemotherapy is the most common cause of treatment failure in acute myeloid leukemia (AML) and the drug efflux pump ABCB1 is a critical mediator. Recent studies have identified promoter translocations as common drivers of high ABCB1 expression in recurrent, chemotherapy-treated high-grade serous ovarian cancer (HGSC) and breast cancer. These fusions place ABCB1 under the control of a strong promoter while leaving its open reading frame intact. The mechanisms controlling high ABCB1 expression in AML are largely unknown. We therefore established an experimental system and analysis pipeline to determine whether promoter translocations account for high ABCB1 expression in cases of relapsed human AML. METHODS: The human AML cell line THP-1 was used to create a model of chemotherapy resistance in which ABCB1 expression was driven by a promoter fusion. The THP-1 model was used to establish a targeted nanopore long-read sequencing approach that was then applied to cases of ABCB1high HGSC and AML. H3K27Ac ChIP sequencing was used to assess the activity of native promoters in cases of ABCB1high AML. RESULTS: Prolonged in vitro daunorubicin exposure induced activating ABCB1 promoter translocations in human THP-1 AML cells, similar to those recently described in recurrent high-grade serous ovarian and breast cancers. Targeted nanopore sequencing proved an efficient method for identifying ABCB1 structural variants in THP-1 AML cells and HGSC; the promoter translocations identified in HGSC were both previously described and novel. In contrast, activating ABCB1 promoter translocations were not identified in ABCB1high AML; instead H3K27Ac ChIP sequencing demonstrated active native promoters in all cases studied. CONCLUSIONS: Despite frequent high level expression of ABCB1 in relapsed primary AML we found no evidence of ABCB1 translocations and instead confirmed high-level activity of native ABCB1 promoters, consistent with endogenous regulation.

Impact of choice of feeding tubes on long-term swallow function following chemoradiotherapy for oropharyngeal carcinoma.

Background: Prior reports have raised concerns that a prophylactic gastrostomy may be detrimental to long-term swallow function. This study evaluates patient-reported swallow function following chemoradiotherapy for oropharyngeal carcinoma in relation to the use of a prophylactic gastrostomy or nasogastric (NG) tube as required. Material and methods: The MD Anderson Dysphagia Inventory (MDADI) was posted to 204 disease-free patients at least 2 years following chemoradiotherapy for oropharyngeal carcinoma between 2010 and 2014. Results: Overall, 181/204 (89%) patients returned questionnaire at a median of 34 months post-treatment. 97/181 (54%) and 84/181 (46%) were managed with an approach of a prophylactic gastrostomy or NG tube as required, respectively. A prophylactic gastrostomy was associated with higher rates of enteral feeding (92% vs. 58%, p < .001), lower median percentage weight loss (7.0% vs. 9.4%, p < .001), increased duration of enteral feed (median 3.3 vs. 1.1 months, p < .001). There was no significant difference in patient-reported swallow function measured by MDADI summary scores and subscales for patients managed with an approach of prophylactic gastrostomy or NG as required. Duration of enteral feed correlated negatively with composite MDADI scores. A subgroup of 116/181 (64%) patients were documented as having been offered a choice of enteral feeding approach and therefore can be considered to represent clinical equipoise; there were no significant differences in MDADI scores according to route. Conclusions: Despite concern regarding the use of a prophylactic gastrostomy in prior studies, the approaches of using a prophylactic gastrostomy or an NG tube as required to support patients during/after chemoradiotherapy for oropharyngeal carcinoma were associated with similar long-term swallow outcomes.

Objectively measured active transportation to school and other destinations among 10-13 year olds.

BACKGROUND: Descriptive data on active transportation in children focuses on the trip to school and has relied on subjective reports. The purpose of this study was to use objective measures to describe total active transportation and active transportation to common destinations within children. METHODS: This was a descriptive study of 388 children aged 10-13 years from Kingston, Ontario, Canada. Participants wore a Garmin GPS watch during waking hours for seven days. Personal Activity Measurement Location System software used the GPS data to identify trips, time spent in each trip and the trip modality (walking, bicycle or vehicle). Google Maps software was used to identify trip destinations. RESULTS: A total of 8875 trips were identified. Most (69%) trips were made by vehicle; 25% were made by walking and 6% by bicycle. Mean time spent in active transportation was 10.3 min/day (95% CI: 7.4, 14.5). Time spent in active transportation was higher for boys (12.1 min/day [95% CI: 8.8, 17.0) than for girls (8.5 min/day [95% CI: 6.1, 12.0]) and increased from 7.7 min/day (95% CI: 5.5, 11.1) at age 10 to 14.3 min/day (95% CI: 10.3, 19.9) at age 13. Time spent in active transportation was lower in the winter by comparison to the other seasons. The four most common active transportation destinations were the participant's home, school, other people's homes, and parks or greenspace with 69%, 39%, 37% and 32% of participants walking or bicycling to these destinations at least once over the 7-day measurement period. CONCLUSION: Over 65% of trips made and time spent travelling occurred in a vehicle. When active transportation was used, the most common destinations were home, school, other people's homes, and parks.

A systematic review of the use and effectiveness of social media in child health.

BACKGROUND: Social media use is highly prevalent among children, youth, and their caregivers, and its use in healthcare is being explored. The objective of this study was to conduct a systematic review to determine: 1) for what purposes social media is being used in child health and its effectiveness; and 2) the attributes of social media tools that may explain how they are or are not effective. METHODS: We searched Medline, CENTRAL, ERIC, PubMed, CINAHL, Academic Search Complete, Alt Health Watch, Health Source, Communication and Mass Media Complete, Web of Knowledge, and Proquest Dissertation and Theses Database from 2000-2013. We included primary research that evaluated the use of a social media tool, and targeted children, youth, or their families or caregivers. Quality assessment was conducted on all included analytic studies using tools specific to different quantitative designs. RESULTS: We identified 25 studies relevant to child health. The majority targeted adolescents (64%), evaluated social media for health promotion (52%), and used discussion forums (68%). Most often, social media was included as a component of a complex intervention (64%). Due to heterogeneity in conditions, tools, and outcomes, results were not pooled across studies. Attributes of social media perceived to be effective included its use as a distraction in younger children, and its ability to facilitate communication between peers among adolescents. While most authors presented positive conclusions about the social media tool being studied (80%), there is little high quality evidence of improved outcomes to support this claim. CONCLUSIONS: This comprehensive review demonstrates that social media is being used for a variety of conditions and purposes in child health. The findings provide a foundation from which clinicians and researchers can build in the future by identifying tools that have been developed, describing how they have been used, and isolating components that have been effective.

The Prehabilitation Radiotherapy Exercise, smoking Habit cessation and Balanced diet Study (PREHABS) protocol to explore the feasibility of embedding behavioural modifications into the clinical pathway for patients undergoing radical radiotherapy for lung cancer.

Patients with curable non-surgical lung cancer are often current smokers, have co-existing medical comorbidities and are treated with curative radiotherapy. To maximise the benefits of modern radiotherapy, there is an urgent need to optimise the patient's health to improve survival and quality of life. METHODS AND ANALYSIS: The Yorkshire Cancer Research-funded Prehabilitation Radiotherapy Exercise, smoking Habit cessation and Balanced diet Study (PREHABS) (L426) is a single-centre prospective feasibility study to assess embedding behavioural changes into the radical radiotherapy pathway of patients with lung cancer. Feasibility will be assessed by measuring acceptability, demand and implementation. The duration of the study is 24 months. PREHABS has two workstreams: the intervention study and the theory of change (ToC) study.Intervention study: PREHABS will commence at the R-IDEAL phase 2 trial (exploratory) based on existing evidence and includes support for smoking cessation, increasing activity and dietary well-being. Patients undergoing radical radiotherapy for lung cancer will be recruited from the oncology department at Leeds Teaching Hospitals NHS Trust (LTHT). ToC study: to maximise the acceptability and adherence to the PREHABS, we will use a ToC approach to qualitatively explore the key barriers and enablers of implementing a tailored programme of 'prehabilitation'. The PREHABS ToC study participants will be recruited from patients with lung cancer undergoing radical radiotherapy and staff from the LTHT oncology department. ANALYSIS: The primary endpoint analysis will report the number of participants and adherence to the study interventions. Secondary endpoints include continued engagement with study interventions post-treatment. The analysis will focus on descriptive statistics. Thematic analysis of the qualitative data from the ToC study will identify consensus on intervention optimisation and delivery. ETHICS AND DISSEMINATION: On 12 May 2021, the Cambridge East Ethics Committee granted ethical approval (21/EE/0048). The study is registered in the National Institute for Health and Care Research (NIHR) portfolio. The results will be disseminated through publication in peer-reviewed scientific journals and presented at conferences. TRIAL REGISTRATION NUMBER: NIHR portfolio 48420.

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.

Associations between Longitudinal Patterns of Substance Use and Anxiety and Depression Symptoms among a Sample of Canadian Secondary School Students.

The objective of this study is to examine the longitudinal associations between latent classes of substance use and anxiety and depression scores among youth who use substances. This study uses data from three waves (Wave 1: 2017/18, Wave 2: 2018/19, and Wave 3: 2019/20) of the COMPASS study. Students in grades 9 and 10 who reported substance use at baseline (n = 738) report their substance use (alcohol, cannabis, cigarettes, and e-cigarettes) and anxiety and depression symptoms at each wave. A Repeated Measures Latent Class Analysis (RMLCA) is used to determine substance use classes, and mixed models are used to examine the associations between substance use classes and anxiety and depression. We identify three classes of substance use: (1) occasional alcohol and e-cigarette use, (2) escalating poly-substance use, and (3) consistent poly-substance use. After controlling for relevant covariates, consistent poly-substance use is associated with depression (Female OR: 1.24 [95%CI: 0.46, 2.02]; Male OR 1.13 [95%CI: 0.38, 1.87]) but not anxiety. Escalating poly-substance use is associated with depression among males (OR 0.72 [95%CI: 0.10, 1.33]). These findings should be taken into consideration when creating prevention programming and treatment strategies for adolescents. Substance use programming should be comprehensive, consider multiple substances, and be cognizant of symptoms of mental illness, particularly depression.

Substance use classes and symptoms of anxiety and depression among Canadian secondary school students. / Catégories de consommation de substances et symptômes d'anxiété et de dépression chez les élèves du secondaire au Canada.

INTRODUCTION: Few studies have assessed patterns of substance use among Canadian adolescents. This cross-sectional study examined substance use classes among Canadian secondary school students and associations with anxiety and depression. METHODS: This study used data from Year 6 (2017/18) of the COMPASS study. Students (n = 51 767) reported their substance use (alcohol, cannabis, cigarette and e-cigarette use) and anxiety and depression symptoms. We employed latent class analysis to identify substance use classes and multinomial logistic regression to examine how anxiety and depression were associated with class membership. RESULTS: Overall, 40% of students indicated having anxiety and/or depression (50% in females; 29% in males) and 60% of students reported substance use (60% in females; 61% in males). We identified three substance use classes: poly-use, dual use, and non-use. Females with both anxiety and depression had the highest odds of being in the poly-use class compared to the non-use class (odds ratio [OR] = 4.09; 95% confidence interval [CI]: 3.59-4.65) followed by females with depression only (OR = 2.65; 95% CI: 2.31-3.04) and males with both anxiety and depression (OR = 2.48; 95% CI: 2.19-2.80). Symptomatology was also associated with belonging to the dual use class except among males with anxiety only (OR = 1.13; 95% CI: 0.94-1.37). CONCLUSION: Canadian secondary school students are engaging in dual and poly-substance use, and anxiety and depression were associated with such use. Females had a higher prevalence of anxiety and depression and should be a priority population for mental health programming.

An examination of how age of onset for alcohol, cannabis, and tobacco are associated with school outcomes in grade 12.

INTRODUCTION: Youth substance use prevention is a key public health priority. There is evidence that delaying substance use can improve health outcomes. While substance use is associated with negative outcomes at school, the benefits of delaying substance use on these outcomes are less well understood. METHODS: The current study examined the substance use behaviours and school outcomes of 35,221 grade 12 students in Canada. Students were asked to report when they began using alcohol, cannabis, and tobacco products as well as school outcomes including school connectedness, math and English grades, truancy, and post-secondary aspirations and expectations. Regression models were used to examine the relationship between of age of initiation of alcohol, cannabis, and tobacco use and these outcomes. RESULTS: Students who abstained from substance use throughout high school had higher school connectedness, lower truancy, and higher grades in grade 12 than students who did not. Earlier cannabis use was associated with increased truancy in grade 12. English grades were higher among students who did not use tobacco. Finally, post-secondary educational aspirations and expectations were higher among students who initiated substance use later. CONCLUSION: Grade 12 school outcomes were the best among students who abstained from substance use throughout high school. However, among students who did engage in substance use, school connectedness, truancy, English grades, and educational aspirations and expectations were more favourable among those who initiated substance use at a later age.

Diagnosing pelvic osteomyelitis in patients with pressure ulcers: a systematic review comparing bone histology with alternative diagnostic modalities.

Accurate diagnosis of osteomyelitis underlying pressure ulcers is essential, as overdiagnosis exposes patients to unnecessary and prolonged antibiotic therapy, while failure to diagnose prevents successful treatment. Histopathological examination of bone biopsy specimens is the diagnostic gold standard. Bone biopsy can be an invasive procedure, and, for this reason, other diagnostic modalities are commonly used. However, their accuracy is questioned in literature. This systematic review aims to assess accuracy of various modalities (clinical, microbiological and radiological) for the diagnosis of pelvic osteomyelitis in patients with pressure ulcers as compared to the gold standard. A systematic literature search was conducted in July 2019 using the MEDLINE (Medical Literature Analysis and Retrieval System - MEDLARS - Online) and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases. The search terms were "decubitus ulcer", "pressure ulcer", "pressure sore", "bedsore" and "osteomyelitis". The inclusion criteria were original full-text articles in English comparing the results of bone histology with those of other diagnostic modalities in adult patients with pelvic pressure ulcers. Six articles were included in the systematic review. Clinical diagnosis was found to be neither specific nor sensitive. Microbiological examination, and in particular cultures of bone biopsy specimens, displayed high sensitivity but low specificity, likely reflecting contamination. Radiological imaging in the form of X-ray and CT (computed tomography) scans displayed high specificity but low sensitivity. MRI (magnetic resonance imaging), bone scanning and indium-labelled scintigraphy displayed high sensitivity but low specificity. Our systematic review did not find any diagnostic method (clinical, microbiological or radiological) to be reliable in the diagnosis of pelvic osteomyelitis associated with pressure ulcers as compared to bone histology.

OPEN ARCH: integrated care at the primary-secondary interface for the community-dwelling older person with complex needs.

Optimal care of community-dwelling older Australians with complex needs is a national imperative. Suboptimal care that is reactive, episodic and fragmented, is costly to the health system, can be life threatening to the older person and produces unsustainable carer demands. Health outcomes would be improved if services (health and social) are aligned towards community-based, comprehensive and preventative care. Integrated care is person-focussed in outlook and defies a condition-centric approach to healthcare delivery. Integration is a means to support primary care, with the volume and complexity of patient needs arising from an ageing population. Older Persons Enablement and Rehabilitation for Complex Health Conditions (OPEN ARCH) is a targeted model of care that improves access to specialist assessment and comprehensive care for older persons at risk of functional decline, hospitalisation or institutionalised care. OPEN ARCH was developed with primary care as the central integrating function and is built on four values of quality care: preventative health care provided closer to home; alignment of specialist and generalist care; care coordination and enablement; and primary care capacity building. Through vertical integration at the primary-secondary interface, OPEN ARCH cannot only improve the quality of care for clients, but improves the capacity of primary care to meet the needs of this population.

Longitudinal associations between bullying and alcohol use and binge drinking among grade 9 and 10 students in the COMPASS study.

OBJECTIVES: Adolescents involved in bullying are at increased risk for alcohol use; however, much of this research has been cross-sectional. The aim of this work was to therefore examine the longitudinal associations between bullying and future alcohol use. METHODS: Data were drawn from the COMPASS study. The current study used a 2-year linked sample of grade 9 and 10 students from 2015 to 2017 (n = 6005). Students were asked to report their involvement with bullying as well as alcohol use and binge drinking behaviours. Generalized estimating equations regression analyses were used to examine the relationship between bullying involvement at baseline and alcohol use and binge drinking at follow-up. RESULTS: Overall, 20% of students in grades 9 and 10 reported involvement in bullying. There was evidence of a modest longitudinal association between bullying and binge drinking. Being a bully or bully-victim at baseline was associated with increased odds of initiating future binge drinking. CONCLUSIONS: Being a bully or bully-victim in grade 9 or 10 was associated with initiating binge drinking within the following 2 years. Targeted alcohol use prevention programming may benefit these groups.

RéSUMé: OBJECTIFS: Les adolescents impliqués dans l'intimidation courent un risque accru de consommation d'alcool. Cependant, une grande partie de cette recherche a été transversale. Cette étude vise à examiner les associations longitudinales entre l'intimidation et la consommation future d'alcool. MéTHODES: Les données provenaient de l'étude COMPASS. La présente étude utilise un échantillon d'élèves de 9e et 10e années qui ont été suivi de 2015 à 2017 (n = 6 005). Les élèves ont été invités à signaler leur implication dans l'intimidation, la consommation d'alcool et la consommation excessive d'alcool. Des modèles d'équations d'estimation généralisées ont servi à examiner la relation entre la participation à l'intimidation au départ, et la consommation d'alcool et la consommation excessive d'alcool occasionnelle dans les deux années suivantes. RéSULTATS: 20 % des élèves de 9e et 10e années ont déclaré avoir été victimes d'intimidation. Il y avait des preuves d'une modeste association longitudinale entre l'intimidation et la consommation excessive d'alcool. Être un intimidateur ou une victime d'intimidation au départ était associé à une probabilité accrue de consommation excessive d'alcool occasionnelle par la suite. CONCLUSION: Être un intimidateur ou victime d'intimidation était associé à une consommation excessive d'alcool occasionnelle deux ans plus tard chez les élèves de la 9e et la 10e année. Des programmes ciblés de prévention de la consommation d'alcool pourraient bénéficier à ces groupes.

A cross-sectional examination of the association between co-ed and gender-specific school intramural programs and intramural participation among a sample of Canadian secondary school students.

Intramurals are an important part of the physical activity offerings in secondary schools; however, it is not well understood how co-ed and gender-specific intramural programs impact intramural participation among male and female students. Therefore, the objective of this research was to examine if the number of co-ed, male-only, and female-only intramurals offered at a school was associated with student participation in intramurals. A large sample of Canadian secondary school students (N = 59,370) completed the COMPASS survey in 2017-2018. School staff reported the number of co-ed, male-only, and female-only intramurals offered at each school. Students reported whether they participated in school intramurals. Hierarchical models were used to assess associations. Intramural participation was marginally higher among male students (36%) than female students (32%; p < 0.0001). Female students attending schools that offered female-only intramurals were 17% (OR 1.17 [95% CI: 1.05-1.30]) more likely to participate. The number of co-ed and male-only intramurals offered were not significantly associated with student participation. We found a positive association between offering female-only intramurals and female intramural participation, highlighting the importance of these programs for female students. Offering female-only intramurals may be a way for schools to improve participation and physical activity levels of female students. More research is needed on the impact of specific sports or activities on male and female student participation.

High school sport participation and substance use: A cross-sectional analysis of students from the COMPASS study.

INTRODUCTION: The objective of this study was to examine the association between participation in school sports and substance use behaviors in both male and female high school students. METHODS: The current study used cross-sectional data from 60,601 students from Year 6 (2017-2018) of the COMPASS study. Students reported their school physical activity participation (none, intramurals only, varsity only, both) and past 30-day substance use (binge drinking, cannabis use, cigarette use, e-cigarette use). Hierarchical logistic regression models predicted the odds of substance use, by sex. RESULTS: 55% of students did not participate in any school sports and 32% reported substance use. Intramurals were negatively associated with cannabis use and cigarette use among all students and e-cigarette use among females. Varsity sports were associated with lower odds of cigarette use among all students and cannabis use among males. In contrast, participating in varsity sports was associated with increased odds of binge drinking and e-cigarette use among all students. Participating in both intramurals and varsity sports was associated with increased odds of binge drinking and e-cigarette use but with decreased odds of cannabis use and cigarette use. CONCLUSIONS: Intramurals were found to be protective against cannabis use and cigarette use among all students and e-cigarette use among females. Although varsity sports were protective against cannabis and cigarette use, they were found to be a risk factor for binge drinking and e-cigarette use. Substance use prevention efforts should be a focus among school varsity sports teams, especially for binge drinking and e-cigarette use.

Prevalence and correlates of youth poly-substance use in the COMPASS study.

BACKGROUND AND AIMS: Youth poly-substance use, associated with long-term negative health and social outcomes, is of increasing concern following the rise of e-cigarette vaping and cannabis legalization in Canada. This work aimed to investigate current evidence on correlates of this behaviour to inform effective prevention and harm reduction programming. DESIGN: Cross-sectional sample taking part in a cohort study. SETTING: Canadian high schools (AB, BC, ON, QC) PARTICIPANTS: 74,501 Canadian high school students who completed the COMPASS student questionnaire in 2018/2019. MEASUREMENTS: Self-report data on use of five substances (alcohol, cigarettes, e-cigarettes, cannabis, and opioids) alongside demographic factors, social and school support, and mental health-related measures. RESULTS: Of the 39% of youth who reported current substance use, 53% reported using two or more. E-cigarette vaping was most prevalent (28%) and most often combined with other substances. Feeling supported by friends and having no problem with seeking help at school were associated with higher levels of poly-substance use. Family support, school connectedness, and school support to resist drugs decreased the risk of substance co-use. CONCLUSIONS: The evidence presented here suggests that interventions for youth poly-substance use should rely on joint efforts between parents, schools, and communities to focus on structural factors rather than problematizing the individual.

An examination of how age of onset for alcohol, cannabis, and tobacco are associated with physical activity, screen time and BMI as students are preparing to graduate from high school.

INTRODUCTION: In this study we examined the co-occurrence of alcohol, cannabis, and tobacco among a large cohort of grade 12 students in Canada, and then explored if the age of initiation of these substances was associated with moderate-to-vigorous physical activity (MVPA), screen time, and BMI. METHODS: This cross-sectional study used student-level data from grade 12 students in years 1 to 5 (2012-2016) of the COMPASS study. Random intercept linear regression models were used to examine the impact of age of initiation of alcohol, cannabis, and tobacco use on student average daily physical activity, daily screen time and BMI. RESULTS: Twenty-eight percent of students had only tried one substance with alcohol being the most reported single substance used (25%). The most common co-occurrence was students reporting having tried all three substances (27%). Nineteen percent of students reported no substance use by grade 12.Younger age of first use of alcohol was associated with increased MVPA in grade 12. Earlier initiation of cannabis and tobacco were associated with increased screen time in grade 12. Age of first use of alcohol, cannabis and tobacco were not associated with BMI in grade 12. CONCLUSION: While no specific cut-off age was identified this study indicates that for every year tobacco and cannabis use are delayed among children, there are subsequent reductions to screen time in grade 12. Early initiation of alcohol was associated with increased MVPA in grade 12. Early initiation of alcohol, cannabis and tobacco were not associated with BMI in grade 12.

Patients' experience of enteral feeding following (chemo) radiotherapy for head and neck cancer: A qualitative study.

BACKGROUND & AIMS: Enteral feeding is commonly required during radiotherapy treatment for head and neck cancer. Only limited qualitative research into head and neck cancer patients' experiences of enteral tube feeding has been undertaken. The aim of this qualitative study was to evaluate patients' experiences of EF and the surrounding decision making process. METHODS: Semi-structured, face-to face interviews were conducted with ten patients who had completed (chemo)radiotherapy/radiotherapy for head and neck cancer at a cancer centre in the North of England. Interviews were recorded, transcribed verbatim and analysed qualitatively using Thematic Analysis. RESULTS: Participants described the restrictions on daily living caused by enteral feeding tubes and enteral feeding. Despite these restrictions, participants recognised the value of the enteral feeding tube including its role in their survival and the importance of their involvement in decision making. Participants described coping mechanisms used to deal with the difficulties associated with enteral feeding. CONCLUSIONS: The results of this study provide a unique qualitative insight into the lived experiences of H&N cancer patients managed with enteral feeding and the impact of the decision making process. The results have relevance for professionals supporting this patient group with enteral feeding.

Objectively measured crime and active transportation among 10-13 year olds.

This study examined the temporal relationship between objective measures of neighborhood crime and active transportation among children. A sample of 387 children aged 10-13 years from Kingston, Canada were studied between January 2015 and December 2016. Active transportation was measured over 7 days using Geographic Information System loggers. The number of crimes per capita were measured within a 1 km distance of participants' homes for the 24-month period prior to when their active transportation was measured. Surprisingly, children living in neighborhoods in the highest neighborhood crime rate quartile engaged in significantly more active transportation than children living in neighborhoods in the lowest neighborhood crime rate quartile (16.4 versus 10.2 min/day, p < 0.05). This relationship persisted after adjustment for several individual, family, and environmental covariates.