Health trends in Canada 1990-2019: An analysis for the Global Burden of Disease Study.

OBJECTIVE: Monitoring trends in key population health indicators is important for informing health policies. The aim of this study was to examine population health trends in Canada over the past 30 years in relation to other countries. METHODS: We used data on disability-adjusted life years (DALYs), years of life lost (YLL), years lived with disability, life expectancy (LE), and child mortality for Canada and other countries between 1990 and 2019 provided by the Global Burden of Disease Study. RESULTS: Life expectancy, age-standardized YLL, and age-standardized DALYs all improved in Canada between 1990 and 2019, although the rate of improvement has leveled off since 2011. The top five causes of all-age DALYs in Canada in 2019 were neoplasms, cardiovascular diseases, musculoskeletal disorders, neurological disorders, and mental disorders. The greatest increases in all-age DALYs since 1990 were observed for substance use, diabetes and chronic kidney disease, and sense organ disorders. Age-standardized DALYs declined for most conditions, except for substance use, diabetes and chronic kidney disease, and musculoskeletal disorders, which increased by 94.6%, 14.6%, and 7.3% respectively since 1990. Canada's world ranking for age-standardized DALYs declined from 9th place in 1990 to 24th in 2019. CONCLUSION: Canadians are healthier today than in 1990, but progress has slowed in Canada in recent years in comparison with other high-income countries. The growing burden of substance abuse, diabetes/chronic kidney disease, and musculoskeletal diseases will require continued action to improve population health.

RéSUMé: OBJECTIF: La surveillance des tendances des indicateurs clés de la santé de la population est importante pour éclairer les politiques de santé. Dans cette étude, nous avons examiné les tendances de la santé de la population au Canada au cours des 30 dernières années par rapport à d'autres pays. MéTHODES: Nous avons utilisé des données sur les années de vie ajustées en fonction de l'incapacité (DALY), les années de vie perdues (YLL), les années vécues avec un handicap, l'espérance de vie (LE) et la mortalité infantile pour le Canada et d'autres pays entre 1990 et 2019, fournies par l'Étude mondiale sur le fardeau de la maladie. RéSULTATS: L'espérance de vie, les YLL ajustées selon l'âge et les DALY ajustées selon l'âge ont tous connu une amélioration au Canada entre 1990 et 2019, bien que le taux d'amélioration se soit stabilisé depuis 2011. Les cinq principales causes des DALY pour tous les âges au Canada en 2019 étaient les néoplasmes, les maladies cardiovasculaires, les affections musculosquelettiques, les affections neurologiques et les troubles mentaux. Les plus fortes augmentations des DALY pour tous les âges depuis 1990 ont été observées pour l'usage de substances, le diabète et les maladies rénales chroniques, ainsi que les troubles des organes sensoriels. Les DALY ajustées selon l'âge ont diminué pour la plupart des conditions, à l'exception de l'usage de substances, du diabète et des maladies rénales chroniques, ainsi que des troubles musculosquelettiques, qui ont augmenté de 94,6 %, 14,6 % et 7,3 % respectivement depuis 1990. Le classement mondial du Canada pour les DALY ajustées selon l'âge est diminué de la 9ième place en 1990 à la 24ième place en 2019. CONCLUSION: Les Canadiens sont en meilleure santé aujourd'hui qu'en 1990, mais les progrès se sont ralentis ces dernières années par rapport à d'autres pays à revenu élevé. La croissance du fardeau lié à l'abus de substances, au diabète/maladies rénales chroniques et aux affections musculosquelettiques exigera des actions continues pour améliorer la santé de la population.

Satisfaction, research productivity, and socialization in doctoral students: Do teaching assistantship, research assistantship and the advisory relationship play a role?

Funding to doctoral students in the form of research and teaching assistantships help students become independent scholars and complete their programs. Insufficient funding, unforeseen financial obligations, and debt can discourage students from completing their programs in a timely fashion. However, supervisors may play an influential role in supporting doctoral student socialization and growth towards research autonomy. Girves and Wemmerus's (1988) doctoral student degree progress theoretical model claimed that financial assistance and students' perceptions of faculty support are key predictors of doctoral students' progress. They also proposed that students' satisfaction with their department, sense of isolation, and engagement in their programs may explain (or mediate) these associations. The aim of this study was to investigate how supervisor support and financial assistance influence doctoral students' satisfaction with their programs as well as their academic and social engagement. Using data from the Canadian Graduate and Professional Student Survey (n = 18,822 doctoral students), we evaluated a model of doctoral student productivity (i.e., publications and conference presentations) with teaching and research assistantships as key predictors and student satisfaction as mediators. We also examined how supervisor support and financial assistance relate to students' academic and social life. The results showed that teaching assistantships are negatively associated with general satisfaction and program satisfaction but positively associated with social involvement. Moreover, research assistantships were significantly and positively associated with social involvement and progress. Supervisor support was positively associated with doctoral students' general satisfaction, program satisfaction, and social involvement. The findings support Girves and Wemmerus's theory and highlight the importance of faculty support for doctoral student success. (258/300).

A cross-sectional study of mental health and well-being among youth in military-connected families. / Étude transversale sur la santé mentale et le bien-être de jeunes de familles liées au milieu militaire.

INTRODUCTION: The study objective was to compare the mental health and risk-taking behaviour of Canadian youth in military-connected families to those not in military-connected families in a contemporary sample. We hypothesized that youth in military-connected families have worse mental health, lower life satisfaction and greater engagement in risk-taking behaviours than those not in military-connected families. METHODS: This cross-sectional study used 2017/18 Health Behaviour in School-aged Children in Canada survey data, a representative sample of youth attending Grades 6 to 10. Questionnaires collected information on parental service and six indicators of mental health, life satisfaction and risk-taking behaviour. Multivariable Poisson regression models with robust error variance were implemented, applying survey weights and accounting for clustering by school. RESULTS: This sample included 16 737 students; 9.5% reported that a parent and/or guardian served in the Canadian military. After adjusting for grade, sex and family affluence, youth with a family connection to the military were 28% more likely to report low well-being (95% CI: 1.17-1.40), 32% more likely to report persistent feelings of hopelessness (1.22-1.43), 22% more likely to report emotional problems (1.13-1.32), 42% more likely to report low life satisfaction (1.27-1.59) and 37% more likely to report frequent engagement in overt risk-taking (1.21-1.55). CONCLUSION: Youth in military-connected families reported worse mental health and more risk-taking behaviours than youth not in military-connected families. The results suggest a need for additional mental health and well-being supports for youth in Canadian military-connected families and longitudinal research to understand underlying determinants that contribute to these differences.

Adolescent mental health in military families: Evidence from the Canadian Health Behaviour in School-aged Children study.

OBJECTIVES: To investigate the association between physical and mental health symptoms in adolescents and having a parent in the Canadian Armed Forces and the moderation of these associations by various sources of social support. METHODS: We used data on a nationally representative sample of 18,886 adolescents (11-15 years) in the 2017/18 Canadian Health Behaviour in School-aged Children study (HBSC). Survey assessments included multi-item scales of mental and physical health symptoms and sources of social support (peers, families, classmates, and teachers). Poisson regression was used to estimate incidence rate ratios (IRR) of weekly symptoms in military versus non-military youths. Moderation of differences between these groups were tested using interactions of variables representing support and military families. RESULTS: Military youth, compared to non-military youth, reported more mental health symptoms (IRR = 1.20; 95% CI 1.08, 1.33) but only marginally more physical symptoms (IRR = 1.15; 95% CI 1.00, 1.33) in the previous week. These associations were stronger in youths who reported lower levels of peer support (IRR = 0.99; 95% CI 0.98, 1.00 [mental health symptoms]; IRR = 0.98; 95% CI 0.97, 1.00 [physical health symptoms]). Support from families, classmates and teachers did not moderate differences in mental or physical symptoms. CONCLUSION: Canadian adolescents in military families have increased risk for experiencing poor mental health. Peer support may play a protective role, however further research is needed to guide clinical interventions for this unique population.

RéSUMé: OBJECTIFS: Étudier l'association entre les symptômes de santé physique et mentale chez les adolescents et le fait d'avoir un parent dans les forces armées canadiennes et la modération de ces associations par diverses sources de soutien social. MéTHODES: Nous avons utilisé les données d'un échantillon national représentatif d'adolescents (n = 18 886; 11 à 15 ans) dans l'étude 2017­2018 sur les comportements de santé des enfants d'âge scolaire (HBSC) au Canada. Les évaluations de l'enquête comprenaient des échelles multi-items de symptômes de santé mentale et physique et des sources de soutien social (pairs, familles, camarades de classe et enseignants). Un modèle de régression de Poisson a servi à estimer les rapports de taux d'incidence (TRI) des symptômes hebdomadaires chez les jeunes militaires par rapport aux jeunes non militaires. La modération des écarts entre ces groupes a été testée en utilisant les interactions entre le soutien militaire et les variables familiales. RéSULTATS: Les jeunes militaires, comparativement aux jeunes non militaires, ont signalé plus de symptômes de santé mentale (TRI = 1,20; IC à 95% 1,08, 1,33), mais seulement légèrement plus de symptômes physiques (TRI = 1,15; IC à 95% 1,00, 1,33) au cours de la semaine précédente. Ces associations étaient plus fortes chez les jeunes qui ont déclaré des niveaux inférieurs de soutien par les pairs (IRR = 0,99; IC à 95% 0,98, 1,00 [symptômes de santé mentale]; IRR = 0,98; IC à 95% 0,97, 1,00 [santé physique symptômes]). Le soutien des familles, des camarades de classe et des enseignants n'a pas atténué les différences de symptômes mentaux ou physiques. CONCLUSION: Les adolescents canadiens de familles militaires sont exposés à un risque accru de maladie mentale. Le soutien par les pairs peut jouer un rôle de protection, mais il faut effectuer d'autres recherches pour orienter les interventions cliniques auprès de cette population unique.

Socioeconomic Differences in the Association Between Bullying Behaviors and Mental Health in Canadian Adolescents.

BACKGROUND: Bullying and poverty are each associated with poor health in adolescents. We examined socioeconomic differences in the association of bullying and health. METHODS: The 2017/2018 Canadian Health Behaviour of School-aged Children study surveyed 21,750 youth (9-18 years). We used linear regression models to investigate interactive effects of bullying involvement (traditional and cyberbullying) and socioeconomic position (SEP) on self-reported life satisfaction, psychological symptoms, and physical symptoms. RESULTS: Involvement in either form of bullying, as a perpetrator or a target, was associated with worse health and well-being compared to uninvolved youths. Associations of victimization via conventional bullying with low life satisfaction (b = -.33 [-.61, .05]), more psychological symptoms (b = .83 [.27, 1.38]), and more somatic symptoms (b = .56 [.14, .98]) were stronger at lower SEP. CONCLUSION: Socioeconomic disadvantage intensifies the association between bullying victimization and poor health. The intersections of victimization and poverty pose a significant health risk to adolescents.

Food insecurity and its association with health and well-being in middle-aged and older adults in India.

AIM: Food insecurity is a global public health concern; however, there is limited knowledge about its health impacts in India. We examined the associations of food insecurity with socioeconomic conditions, chronic disease and various domains of health and well-being in a community sample of middle-aged and older adults (45+ years) in India. METHODS: Cross-sectional nationally representative data were collected in wave 1 (2017-2018) of the Longitudinal Ageing Study in India. Food insecurity was measured by questions of access and availability of food. We used logistic regression analyses to examine associations of food insecurity with poor self-rated health, limitations in activities of daily living (ADLs), instrumental ADLs, low life satisfaction, depression, sleep problems and low body mass. RESULTS: Food insecurity related to all seven indicators of poor health and well-being, even after controlling for material wealth and the presence of multimorbidity (which food insecurity also predicted). Associations with mental health were stronger for those for physical health. For instance, food insecurity related to a threefold increase in probable depression (OR=2.9, 95% CI=2.4 to 3.4) and low life satisfaction (OR=3.4, 95% CI=2.9 to 3.8). CONCLUSIONS: Food insecurity is a powerful social determinant of poor health among older adults in India. Policy measures to improve population health and well-being should closely follow trends in food insecurity, particularly among those living in poverty and with multiple health conditions.

Corporal punishment bans and adolescent suicide rates: An international ecological study.

BACKGROUND: Exposure to corporal punishment during childhood is associated with suicidal behaviors during adolescence. To date, the protective effects of national policies governing the use of corporal punishment have rarely been studied for adolescent suicide outcomes. OBJECTIVE: To investigate contemporaneous and lagged associations between national legislation banning corporal punishment and adolescent suicide rates. PARTICIPANTS AND SETTING: We used population-level administrative and mortality data from 97 countries spanning the years 1950 to 2017. METHODS: Negative binomial models were used to investigate the relationship between the existence of official corporal punishment bans in countries and national adolescent suicide mortality rates and the potential time lag between the enactment of such bans and reductions in adolescent suicide rates. RESULTS: National policies that permitted corporal punishment in all settings (homes, schools, daycares, and alternative care) were associated with a higher relative risk (RR) for suicide in females aged 15-19 (RR = 2.07, p = .03), as were policies allowing corporal punishment in schools specifically (RR = 2.01, p = .02). Partial bans of corporal punishment and bans of school corporal punishment showed lagged effects on suicide rates which peaked after 12 years for females aged 15-19 and after 13 years for males aged 15-19. CONCLUSIONS: Study findings add to a body of evidence that suggests that official policies banning corporal punishment may promote adolescent health and well-being. The benefits of such policies in terms of reduced risk for adolescent suicide appear to peak approximately 12 to 13 years after enactment of the legislation.

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

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

Early physical maturation and subjective health complaints in adolescent girls: a pooled cross-sectional analysis.

BACKGROUND: Although adolescents are generally healthy, subjective health complaints (SHC) are common in this age group, especially in adolescent girls. We explored the association between early menarche and the frequency of psychosomatic symptoms and how this association varies between countries. METHODS: Our sample included 298 000 adolescent girls from 2002, 2006, 2010 and 2014 cycles of the Health Behaviour in School-aged Children (HBSC) study in 41 European and North American countries. School surveys measured the frequency of eight psychosomatic symptoms in the past 6 months. Early maturation was defined as self-reported age at menarche below 11 years. Using logistic regression, we estimated adjusted ORs (aORs) and 95% CIsof experiencing each psychosomatic symptom at least more than once a week and experiencing two or more symptoms at least more than once a week. RESULTS: Early menarche occurred in 4.73% of the sample and was positively related to headache, stomachache, backache, feeling low, irritability or bad temper, feeling nervous, difficulties in sleeping, feeling dizzy and two or more of these symptoms, respectively (all p values<0.001). The interactions between early menarche and survey circle were non-significant. Changing the age criterion to 12 years did not affect the results. The associations between early menarche and psychosomatic symptoms were robust across the HBSC-participating counties with two age criteria. CONCLUSIONS: Early menarche positively relates to various psychosomatic symptoms in European and North American adolescent girls. Our findings suggest that early-maturing girls may need early supportive interventions.

Identifying protective factors for gender diverse adolescents' mental health.

Few studies have disentangled differences in victimization exposures and mental health symptoms among gender diverse subgroups, nor considered the role of potential protective factors in ameliorating the impact of victimization on gender diverse youths' mental health. Here we report findings from a secondary data analysis, in which we address this gap by analyzing cross-sectional survey data (N = 11,264 in the final analytic sample) from a population-based survey of youth in participating school districts in a large Midwestern U.S. county. Relative to cisgender youth with gender conforming expression, transgender youth and cisgender youth with nonconforming gender expression are more likely to experience victimization and severe mental health concerns. Additionally, school-connectedness moderates the association between bias-based harassment and depression for cisgender youth with gender nonconforming expression, and family support/monitoring buffers the association of peer victimization with suicide attempts among transgender youth. Findings highlight the need to better understand factors which may confer protection among gender diverse adolescents, so that in turn appropriate supports across key contexts can be implemented.

Structural gender inequality and gender differences in adolescent substance use: A multilevel study from 45 countries.

-Societal gender inequality relates to gender differences in adolescent substance use.-The gender gap in adolescent substance use is larger in countries with higher levels of gender inequality.-Girls in these countries were less likely to get drunk, use alcohol or smoke cigarettes than boys.

Gender Differences in Bullying Reflect Societal Gender Inequality: A Multilevel Study With Adolescents in 46 Countries.

PURPOSE: Social patterns in bullying show consistent gender differences in adolescent perpetration and victimization with large cross-national variations. Previous research shows associations between societal gender inequality and gender differences in some violent behaviors in adolescents. Therefore, there is a need to go beyond individual associations and use a more social ecological perspective when examining gender differences in bullying behaviors. The aim of the present study was twofold: (1) to explore cross-national gender differences in bullying behaviors and (2) to examine whether national-level gender inequality relates to gender differences in adolescent bullying behaviors. METHODS: Traditional bullying and cyberbullying were measured in 11-year-olds to 15-year-olds in the 2017/18 Health Behaviour in School-aged Children study (n = 200,423). We linked individual data to national gender inequality (Gender Inequality Index, 2018) in 46 countries and tested their association using mixed-effects (multilevel) logistic regression models. RESULTS: Large cross-national variations were observed in gender differences in bullying. Boys had higher odds of perpetrating both traditional and cyberbullying and victimization by traditional bullying than girls. Greater gender inequality at country level was associated with heightened gender differences in traditional bullying. In contrast, lower gender inequality was associated with larger gender differences for cyber victimization. DISCUSSION: Societal gender inequality relates to adolescents' involvement in bullying and gendered patterns in bullying. Public health policy should target societal factors that have an impact on young people's behavior.

Food and Mood: Daily Associations Between Missed Meals and Affect Among Early Adolescents.

OBJECTIVE: Youth frequently miss meals and experience hunger, yet no studies have assessed how these experiences relate to changes in daily emotional states. This daily diary study examined associations of missing breakfast, missing lunch, and hunger with daily positive and negative affect among young adolescents. METHODS: A community sample of 133 grade 5 and 6 students (50.4% boys, Mage = 10.77, 19.5% BIPOC) from two public schools completed baseline socio-demographic measures at the beginning of the study and daily measures at the end of the school day over 5 consecutive days. Measures included positive and negative affect, breakfast, lunch, and hunger. Multilevel regression models were constructed to test the associations. RESULTS: Among participating youth, 27.8% missed breakfast at least once, 15.0% missed lunch at least once, and 26.3% felt hungry at least once. Missing breakfast was associated with increased negative affect (B = 0.36, p = .030) and missing lunch was related to both increased negative affect (B = 0.52, p = .019) and decreased positive affect (B = -0.80, p = .002). Hunger was not related to daily affect. CONCLUSION: This study provides a unique view of youths' experiences of missing meals, hunger, and daily emotional states. The findings underscore the importance of youth being adequately nourished through school meal programs. Clinicians should screen for and address missing meals among their young patients.

Socioeconomic inequalities in adolescent health complaints: A multilevel latent class analysis in 45 countries.

Our study evaluated the relationship between adolescent health complaints and socioeconomic position in 45 countries. Data are from the 2017/2018 international Health Behaviour in School-aged Children survey which used proportionate sampling among adolescents aged 11 to 15 years old (n=228,979). Multilevel, multinomial regression analysis assessed the association between the multilevel latent classes with socioeconomic status (SES; at the household and country level). Three distinct latent classes were identified: No Complaints, Psychological Complaints, and a Physical and Psychological Complaints class; where, low household SES was highest for the physical and psychological complaints class. The findings suggest that health promotion policies and interventions among adolescents should consider the specific needs of adolescents living with low household SES as they report more subjective health complaints.

Socioeconomic Position Mediates the Relationship between Family Social Benefits and Adolescent Life Satisfaction in 25 countries.

The aims of this study were to assess the mediating role of household socioeconomic position (SEP) in the associations between the country-level factors: family social benefits, and public income support to single parent households (SPH), with the individual-level factor adolescent life satisfaction. Our sample consisted of adolescent (11, 13, and 15 years old) participants in the Health Behaviour in School-aged Children study (2013/2014) across Canada and 24 countries in Europe. We used World Bank data on country wealth from OECD data on social benefits for families and public income support to SPH. Multilevel linear regressions assessed mediated (indirect) associations of these country-level predictors, through SEP, with life satisfaction. Family social benefits ranged between 1.1% and 3.7% of country wealth. The direct association showed that family social benefits were associated with lower adolescent life satisfaction (ß = -0.244, 95% Confidence Intervals [C.I.] = -0.306, -0.182, p < 0.0001) among all adolescents and for adolescents in SPH (ß = -0.118, 95% C.I. = -0.161, -0.074, p < 0.0001). However, the mediated (indirect) association showed that family social benefits were associated with higher life satisfaction which is partially mediated by SEP (ß = 0.087, 95% C.I. = 0.065, 0.109, p < 0.0001) among all adolescents and for adolescents in SPH as well (ß = 0.041, 95% C.I. = 0.030, 0.052, p < 0.0001). Country policies may support the wellbeing of adolescents by reducing poverty and improving their socioeconomic position in society.

Trends in material and non-material inequalities in adolescent health and health behaviours: A 12-year study in 23 European countries.

Information on trends in adolescent health inequalities is scarce but the available evidence suggests that inequalities are increasing. Prior studies describe associations between material resources of socioeconomic status (SES) and health, while information on non-material SES resources and inequalities in health behaviours is lacking. To improve current understandings of evolutions in adolescent health inequalities, we examined how material and non-material SES resources were associated with changes in selected health outcomes (life satisfaction, physical and psychological symptoms) and health behaviours (physical activity, screen time, breakfast, fruit, vegetables, sweets and soft drinks consumption and alcohol and tobacco use) over a 12-year period. Repeated cross-sectional data came from the 2002, 2006, 2010 and 2014 waves of the Health Behaviour in School-aged Children (HBSC) survey from 23 European countries (n = 480,386). Measures of family affluence and occupational social class were used as indicators of material and non-material SES resources respectively. Regression-based slope indices of inequality indicated that absolute material and non-material inequalities remained stable from 2002 to 2014 in all health outcomes, except for life satisfaction for which a decrease in material inequalities was found between the highest and lowest affluence group (0.81 to 0.68 difference; p < 0.001). In terms of health behaviours, material inequalities decreased in screen time between highest and lowest affluence groups (0.53 to 0.34 h/day difference; p < 0.001), fruit (odds ratio [OR] 1.89 to 1.72 lower odds; p = 0.0088) and soft drinks consumption (OR 1.36 to 1.13 lower odds; p < 0.001) and remained stable in all others. Non-material inequalities increased in all health behaviours (except for sweets consumption) between highest and lowest occupational social class groups: physical activity (0.16 to 0.24 h/day difference; p = 0.0071), screen time (-0.41 to -0.58 h/day difference; p < 0.001), breakfast (0.21 to 0.51 day/week difference; p < 0.001), fruit (OR 1.23 to 1.48 higher odds; p < 0.001), vegetables (OR 1.39 to 1.74 higher odds; p < 0.001) and soft drinks consumption (OR 0.59 to 0.43 lower odds; p < 0.001) and alcohol (OR 0.99 to 0.85 lower odds; p = 0.0420) and tobacco use (OR 0.71 to 0.59 lower odds; p = 0.0183). In summary, non-material inequalities in most health behaviours increased, whereas material inequalities in adolescent health and health behaviours remain stable or decreased. Policies and interventions may consider non-material SES components as these can help in reducing future health inequalities.

Commentary on "Different roles of interpersonal trust and institutional trust in COVID-19 pandemic control".

An increasing number of epidemiologic studies have identified trust as a social determinant of COVID-19 mortality. Trust influences public compliance with policies aimed at containing the pandemic through physical distancing, wearing masks, and vaccine uptake. However, whilst some forms of trust are public assets (e.g., trust in government), others might be liabilities (e.g., trust in close friends and family members). Contributing to this body of work, Lou et al. (2022) examined associations of trust with COVID-19 fatality rates and willingness to get tested for COVID-19. Using correlation analyses, behavioral experiments, and agent-based modeling, they found institutional trust predicted lower COVID-19 fatality rates and greater willingness to get tested. In contrast, interpersonal trust predicted the speed with which COVID-19 was controlled in the early stages of the pandemic and people's willingness to obey norms preventing the spread of the virus (e.g., decreased nonessential outdoor activity). Investigations such as this offer useful knowledge to public health officials on ways to mitigate a pandemic. This commentary examines the pivotal role of social science in pandemic control, which up to now has been underfunded and overshadowed by the race to develop vaccines. We also highlight the importance of theory, particularly in research on trust, to producing evidence that is replicable and meaningful for policy application.