A prospective study of financial worry, mental health changes and the moderating effect of social support among Canadian adolescents during the COVID-19 pandemic. / Étude prospective des préoccupations financières, des changements de l'état de santé mentale et de l'effet modérateur du soutien social chez les adolescents canadiens pendant la pandémie de COVID-19.

INTRODUCTION: The COVID-19 pandemic intensified the impact of risk factors for adolescent mental health, including financial worry. Social support has shown to protect from negative mental health during times of stress. We examined the effect of financial worry on changes in anxiety and depression symptoms among Canadian adolescents prior to and during the pandemic, and assessed whether social support from family and friends moderated any changes. METHODS: We analyzed 2-year linked data from the 2018/19 (pre-pandemic) and 2020/21 (during-pandemic) waves of the COMPASS study, with reports from 12 995 Canadian secondary school students. A series of multilevel linear regressions were conducted to examine the main hypotheses under study. RESULTS: Students scored an average (SD) of 7.2 (5.8) on the anxiety (GAD-7) and 10.0 (6.5) on the depression (CESD-10) scales; 16.1% reported they experienced financial worry during the pandemic. Financial worry was a strong and significant predictor of increased anxiety scores (+1.7 score between those reporting "true/mostly true" versus "false/mostly false") during the pandemic, but not for depression scores. Low family and friend support were associated with anxiety, and low family support was associated with depression. No significant interactions were detected between social support and financial worry. CONCLUSIONS: Pandemic-related financial worry was significantly associated with anxiety in our large sample of Canadian adolescents. Clinical and public health initiatives should be aware of adolescents' financial worry and its associations with anxiety during times of crisis.

Changes in breakfast and water consumption among adolescents in Canada: examining the impact of COVID-19 in worsening inequity.

BACKGROUND: To assess whether changes in breakfast and water consumption during the first full school year after the emergence of the COVID-19 pandemic varied based on sex/gender, race/ethnicity, and socioeconomic status among Canadian adolescents. METHODS: Prospective annual survey data collected pre- (October 2019-March 2020) and post-COVID-19 onset (November 2020-June 2021) the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) study. The sample consisted of 8,128 students; mean (SD) age = 14.2 (1.3) years from a convenience sample of 41 Canadian secondary schools. At both timepoints self-reported breakfast and water consumption were dichotomized as daily or not. Multivariable logistic generalized estimating equations with school clustering were used to estimate differences in maintenance/adoption of daily consumption post-COVID-19 based on demographic factors, while controlling for pre-COVID-19 behaviour. RESULTS: Adjusted odds ratios (AOR) with 95% confidence intervals are reported. Females (AOR = 0.71 [0.63, 0.79]) and lower socioeconomic status individuals (AORLowest:Highest=0.41 [0.16, 1.00]) were less likely to maintain/adopt daily breakfast consumption than male and higher socioeconomic status peers in the 2020-2021 school year. Black identifying individuals were less likely than all other racial/ethnic identities to maintain/adopt plain water consumption every day of the week (AOR = 0.33 [0.15, 0.75], p < 0.001). No significant interaction effects were detected. CONCLUSIONS: Results support the hypothesis that changes in nutritional behaviours were not equal across demographic groups. Female, lower socioeconomic status, and Black adolescents reported greater declines in healthy nutritional behaviours. Public health interventions to improve adherence to daily breakfast and water consumption should target these segments of the population. TRIAL REGISTRATION: Not a trial.

Inequities in dietary intake and eating behaviours among adolescents in Canada.

OBJECTIVE: To provide contemporary evidence of how dietary intake and eating behaviours vary by social positions among adolescents. METHODS: We used survey data collected during the 2020-2021 school year from 52,138 students attending 133 secondary schools in Alberta, British Columbia, Ontario, and Quebec, Canada. Multiple regression models tested whether self-reported indicators of dietary intake and eating behaviours differed by gender, race/ethnicity, and socioeconomic status (SES). RESULTS: Females were more likely than males to skip breakfast, restrict eating, and consume fruit, vegetables, and fast food on more days. Gender-diverse/"prefer not to say" students were more likely to restrict eating than males and the least likely to consume breakfast and drink water daily, and fruits and vegetables regularly. Black and Latin American students were more likely to restrict eating and consume purchased snacks and fast food, and less likely to drink water daily than white and Asian adolescents. Daily breakfast consumption was most likely among Latin American students. Black students were the least likely to report eating breakfast daily and fruits and vegetables regularly. Lower SES was associated with lower odds of eating breakfast and drinking water daily and regular fruit and vegetable consumption, and higher odds of restrictive eating and purchased snack consumption. Fast food consumption had a u-shaped association with SES. CONCLUSION: Results emphasize gender, racial/ethnic, and socioeconomic inequities in the diets and eating behaviours of adolescents. There is a critical need to address the structural factors contributing to inequities and prevent the consequences of dietary disparities.

RéSUMé: OBJECTIF: Montrer à l'aide de preuves contemporaines que les apports et les comportements alimentaires des adolescentes et des adolescents varient selon leur position sociale. MéTHODE: Nous avons utilisé des données d'enquête recueillies durant l'année scolaire 2020­2021 auprès de 52 138 élèves fréquentant 133 écoles secondaires en Alberta, en Colombie-Britannique, en Ontario et au Québec (Canada). Des modèles de régression multiple ont déterminé si des indicateurs autodéclarés d'apports alimentaires et de comportements alimentaires différaient selon le genre, la race/l'ethnicité et le statut socioéconomique (SSE). RéSULTATS: Les filles étaient plus susceptibles que les garçons de sauter le petit déjeuner, de restreindre leur alimentation et de consommer des fruits, des légumes et des aliments de restauration rapide sur un plus grand nombre de jours. Les élèves de diverses identités de genre/« préférant ne pas répondre ¼ à la question du genre étaient plus susceptibles de restreindre leur alimentation que les garçons; c'était aussi la population d'élèves la moins susceptible de prendre un petit déjeuner et de boire de l'eau tous les jours, et de consommer des fruits et légumes régulièrement. La population étudiante noire et latino-américaine était plus susceptible de restreindre son alimentation et de consommer des collations achetées et des aliments de restauration rapide, et moins susceptible de boire de l'eau tous les jours, que les adolescentes et les adolescents blancs et asiatiques. La consommation quotidienne du petit déjeuner était la plus probable chez les élèves latino-américains. Les élèves noirs étaient les moins susceptibles de déclarer prendre un petit déjeuner tous les jours et consommer des fruits et légumes régulièrement. Le SSE plus faible était associé à des probabilités moins élevées de prendre un petit déjeuner et de boire de l'eau tous les jours et de consommer des fruits et légumes régulièrement, et à des probabilités plus élevées de restreindre son alimentation et de consommer des collations achetées. La consommation d'aliments de restauration rapide présentait une association en U avec le SSE. CONCLUSION: Les résultats montrent qu'il existe des iniquités sur les plans du genre, de la race/l'ethnicité et du statut socioéconomique dans les régimes et les comportements alimentaires des adolescentes et des adolescents. Il existe un besoin pressant d'aborder les facteurs structurels qui contribuent à ces iniquités et de prévenir les conséquences des disparités alimentaires.

Sleep duration change among adolescents in Canada: Examining the impact of COVID-19 in worsening inequity.

Purpose: The purpose of this study was to assess if adolescent sub-populations in Canada (i.e., based on race/ethnicity, sex/gender, socioeconomic status, and urbanicity groups) experienced a larger change in sleep duration and guideline adherence between 2019 and 2020 (pre-pandemic) and the 2020-2021 (mid-pandemic) school years. Methods: Longitudinally linked data from 2019 to 2020 (pre-pandemic) and 2020-2021 (mid-pandemic) of a prospective cohort study of secondary school students (M = 14.2, SD = 1.3 years, N = 8209) in Canada were used for analyses. Regression modelling tested the main effects of race/ethnicity, sex/gender, socioeconomic status, and urbanicity on changes in sleep duration as well as adherence to Canada's 24-h Movement Guidelines for sleep (8-10 h/night). Interactions between identity variables (race/ethnicity or sex/gender) and other main effect variables were subsequently tested. Results: Females gained more sleep (4.5 [1.5, 7.5] min/day more) and increased guideline adherence (AOR = 1.16 [1.04, 1.30] than males on average. Asian race/ethnic identity was associated with less sleep gain than White identity -10.1 [-19.4, -0.8], but not guideline adherence. Individuals in large urban areas gained less sleep and adhered less to guidelines than individuals from any other level of urbanicity (-21.4 [-38.5, -4.2] to -15.5 [-30.7, -0.2] min/day). Higher individual SES scores were associated with greater sleep gain (linear trend: 11.16 [1.2-21.1]). The discrepancies in sleep gain and guideline adherence between males and females were significantly modified by race/ethnicity and urbanicity. Discussion: Increases in sleep duration may be one of the few benefits to adolescents during the COVID-19 pandemic but were not equally distributed across sub-populations. Efforts to promote better sleep adherence may need to account for sex/gender differences, especially in less urbanized areas and certain racial/ethnic groups.

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

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

Exploring Work-Time Affective States Through Ecological Momentary Assessment in an Office-Based Intervention to Reduce Occupational Sitting.

BACKGROUND: The aim of this study was to examine whether a low-cost standing desk intervention that reduced occupational sitting was associated with changes in work-time cognitive-affective states in real time using ecological momentary assessments at the start and end of the trial. METHODS: Forty-one office employees (91.7% female, mean age = 39.8 [10.1] y) were randomized to receive a low-cost standing desk or a waitlist control. Participants received 5 surveys each day for 5 workdays via smartphone application prior to randomization and at trial's end. Ecological momentary assessment assessed current work-time psychological states (valence and arousal, stress, fatigue, and perceived productivity). Multilevel models assessed whether changes in work-time outcomes over the course of the intervention were significantly different between treatment groups. RESULTS: There were no significant differences in outcomes between the groups except for fatigue, with the control group reporting a significant decrease in daily fatigue following the intervention (P < .001). The intervention group reported no significant changes in any of the work-time outcomes across the study period (P > .05). CONCLUSIONS: A low-cost standing desk intervention to reduce occupational sedentary behavior did not negatively impact work-time outcomes such as productivity and fatigue in the short term.

Changes in Body Mass, Physical Activity, and Dietary Intake during the COVID-19 Pandemic Lockdowns in Canadian University Students.

This study examined changes in body mass and body mass index (BMI), physical activity, and dietary intake in Canadian university students during the first year of the COVID-19 pandemic. Two self-reported recall surveys were conducted: after the first lockdown in September 2020 (T1) and following the second lockdown in March 2021 (T2). Eligible participants were full-time undergraduate students attending a Canadian university and residing in Canada during the first year of the pandemic. At T1, 510 students (99 male, 411 female) completed the survey, and of those, 135 (32 males, 103 females) completed the survey at T2 (73% attrition). At both T1 and T2, most participants were 18-24 years of age (93% and 90%, respectively), Caucasian (73% and 78%, respectively), and resided in the province of Ontario (79% and 80%, respectively). Body mass increased from T1 to T2 (+0.91 ± 3.89 kg t(132) = -2.7, p = 0.008). BMI also increased from T1 to T2 (+0.30 ± 1.33 kg/m2 [t(130) = -2.5, p = 0.012), with a greater number of participants within the overweight range (19.8% versus 24.4%, respectively). At T1, 38% of the participants reported a decrease in physical activity, while the number of students reporting a decrease in activity increased to 56% at T2. Dietary energy intake decreased from 1678 ± 958 kcal/day at T1 to 1565 ± 842 kcal/day at T2 [c2(1) = 7.2, p = 0.007]. Diet quality also decreased, with participants not meeting the recommended daily allowance for essential macro and micronutrients. A decrease was observed in daily servings of fruits (-27%, p < 0.001), vegetables (-72%, p < 0.001), and grains (-68%, p < 0.001). In conclusion, despite a small decrease in dietary energy intake, a modest weight gain occurred during the first year of the COVID-19 pandemic in this cohort of Canadian university students, which was potentially related to decreased physical activity and diet quality.

Stronger together: Coping behaviours and mental health changes of Canadian adolescents in early phases of the COVID-19 pandemic.

BACKGROUND: The impact of the COVID-19 pandemic and consequent public health restrictions on the mental health of adolescents is of global concern. The purpose of this study was to examine how Canadian adolescents coped during the early pandemic and whether different coping methods were associated with changes in mental health from before the pandemic to the early lockdown response. METHODS: Using two-year linked survey data (2018-2020) from a prospective cohort of secondary school students (n = 3,577), linear regression models were used to examine whether changes in mental health (anxiety [Generalized Anxiety Disorder-7 scale], depression [Center for Epidemiologic Studies Depression 10-item scale Revised], emotion regulation [Difficulties in Emotion Regulation Scale], psychosocial well-being [Flourishing scale]) were related to each coping behaviour. RESULTS: The most common reported coping behaviours included staying connected with friends online (78.8%), playing video games, watching TV/movies, and/or surfing the internet/social media (76.2%), studying or working on schoolwork (71.0%), and getting exercise (65.2%). The use of positive coping mechanisms during the early pandemic period (e.g., keeping a regular schedule, time with family, time with friends online) was associated with less adverse mental health changes from before to during the early lockdown; whereas, negative coping mechanisms (e.g., spending time alone, eating junk food) were consistently associated with more adverse mental health changes. CONCLUSION: This study demonstrates the importance of social support and connections with both friends and family, as well as keeping and maintaining a routine, over the pandemic. Interventions supporting positive relationships and engagement in these coping behaviours may be protective for adolescent mental health during disruptive events.

Physical activity and substance use among Canadian adolescents: Examining the moderating role of school connectedness.

Physical activity may play a role in promoting or preventing substance use among youth. The purpose of this study was to examine the association between different types of physical activity [i.e., non-competitive school sport, competitive school sport, outside of school sport and minutes of moderate to vigorous physical activity (MVPA) per day] and substance use (i.e., current smoking, e-cigarette, cannabis, binge drinking) among Canadian youth. Interaction effects between physical activity and school connectedness were also examined. Using data from the COMPASS study (2018-19; n = 73,672), four multi-level logistic regression models were developed to investigate whether physical activity lessened or worsened the odds of (1) smoking; (2) e-cigarette use; (3) cannabis use; and (4) binge drinking. Models were stratified by gender to reflect the inherent differences between genders. Models were adjusted for demographic factors and other covariates. Sport participation was consistently associated with substance use, whereas less evidence was found for meeting MVPA guidelines. Non-competitive school sport lessened the odds of cannabis use for males and females. However, non-competitive school sport only lessened the odds of e-cigarette use for females but increased the odds of binge drinking for males. Participation in competitive school sport lessened the odds of cigarette smoking but increased the odds of e-cigarette use and binge drinking for males and females. Outside of school sport lessened the odds of cigarette smoking and cannabis use but increased the odds of e-cigarette use and binge drinking for males and females. A significant moderation effect was found for males participating in sport outside of school and meeting MVPA guidelines who were at a lower risk of e-cigarette use in the presence of high levels of school connectedness. Our study provides evidence for further consideration and provision of extracurricular activities, specifically non-competitive sport, in protecting against substance use. Caution is required in claiming that sport participation or physical activity, in general, is negatively associated with substance use among youth.

Pharmacological interventions for prevention of weight gain in people with schizophrenia.

BACKGROUND: Antipsychotic-induced weight gain is an extremely common problem in people with schizophrenia and is associated with increased morbidity and mortality. Adjunctive pharmacological interventions may be necessary to help manage antipsychotic-induced weight gain. This review splits and updates a previous Cochrane Review that focused on both pharmacological and behavioural approaches to this problem. OBJECTIVES: To determine the effectiveness of pharmacological interventions for preventing antipsychotic-induced weight gain in people with schizophrenia. SEARCH METHODS: The Cochrane Schizophrenia Information Specialist searched Cochrane Schizophrenia's Register of Trials on 10 February 2021. There are no language, date, document type, or publication status limitations for inclusion of records in the register. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) that examined any adjunctive pharmacological intervention for preventing weight gain in people with schizophrenia or schizophrenia-like illnesses who use antipsychotic medications. DATA COLLECTION AND ANALYSIS: At least two review authors independently extracted data and assessed the quality of included studies. For continuous outcomes, we combined mean differences (MD) in endpoint and change data in the analysis. For dichotomous outcomes, we calculated risk ratios (RR). We assessed risk of bias for included studies and used GRADE to judge certainty of evidence and create summary of findings tables. The primary outcomes for this review were clinically important change in weight, clinically important change in body mass index (BMI), leaving the study early, compliance with treatment, and frequency of nausea. The included studies rarely reported these outcomes, so, post hoc, we added two new outcomes, average endpoint/change in weight and average endpoint/change in BMI. MAIN RESULTS: Seventeen RCTs, with a total of 1388 participants, met the inclusion criteria for the review. Five studies investigated metformin, three topiramate, three H2 antagonists, three monoamine modulators, and one each investigated monoamine modulators plus betahistine, melatonin and samidorphan. The comparator in all studies was placebo or no treatment (i.e. standard care alone). We synthesised all studies in a quantitative meta-analysis. Most studies inadequately reported their methods of allocation concealment and blinding of participants and personnel. The resulting risk of bias and often small sample sizes limited the overall certainty of the evidence. Only one reboxetine study reported the primary outcome, number of participants with clinically important change in weight. Fewer people in the treatment condition experienced weight gains of more than 5% and more than 7% of their bodyweight than those in the placebo group (> 5% weight gain RR 0.27, 95% confidence interval (CI) 0.11 to 0.65; 1 study, 43 participants; > 7% weight gain RR 0.24, 95% CI 0.07 to 0.83; 1 study, 43 participants; very low-certainty evidence). No studies reported the primary outcomes, 'clinically important change in BMI', or 'compliance with treatment'. However, several studies reported 'average endpoint/change in body weight' or 'average endpoint/change in BMI'. Metformin may be effective in preventing weight gain (MD -4.03 kg, 95% CI -5.78 to -2.28; 4 studies, 131 participants; low-certainty evidence); and BMI increase (MD -1.63 kg/m2, 95% CI -2.96 to -0.29; 5 studies, 227 participants; low-certainty evidence). Other agents that may be slightly effective in preventing weight gain include H2 antagonists such as nizatidine, famotidine and ranitidine (MD -1.32 kg, 95% CI -2.09 to -0.56; 3 studies, 248 participants; low-certainty evidence) and monoamine modulators such as reboxetine and fluoxetine (weight: MD -1.89 kg, 95% CI -3.31 to -0.47; 3 studies, 103 participants; low-certainty evidence; BMI: MD -0.66 kg/m2, 95% CI -1.05 to -0.26; 3 studies, 103 participants; low-certainty evidence). Topiramate did not appear effective in preventing weight gain (MD -4.82 kg, 95% CI -9.99 to 0.35; 3 studies, 168 participants; very low-certainty evidence). For all agents, there was no difference between groups in terms of individuals leaving the study or reports of nausea. However, the results of these outcomes are uncertain given the very low-certainty evidence. AUTHORS' CONCLUSIONS: There is low-certainty evidence to suggest that metformin may be effective in preventing weight gain. Interpretation of this result and those for other agents, is limited by the small number of studies, small sample size, and short study duration. In future, we need studies that are adequately powered and with longer treatment durations to further evaluate the efficacy and safety of interventions for managing weight gain.

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

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

Do You Really Want to Be Forever Young? Emotional Health and Psychosocial Well-being by Relative Birth Quarter in Canadian Adolescents.

PURPOSE: Those born earlier within cohorts of similarly aged children tend to outperform peers in athletic and academic pursuits. Subsequent evidence suggests relatively younger children may also experience worse emotional and psychosocial health; however, evidence from middle adolescents is limited. This study assessed whether depression, anxiety, and psychosocial well-being differed by the relative birth quarter (RBQ) within a cohort of grades 9-12 in secondary schools across Canada. METHODS: Data from the 2018-19 student self-report surveys of the cannabis use, obesity, mental health, physical activity, alcohol use, smoking, and sedentary behavior study were analyzed. Students having made normative progress were categorized into RBQs by the provincial enrollment cutoff date (n = 49,921). Hierarchical modeling approaches assessed whether self-reported depression, anxiety, psychosocial well-being, and positive controls differed by RBQ after controlling for covariates. RESULTS: Despite relative age effects for positive control outcomes, no significant difference was detected for anxiety and depression scores or likelihood of meeting thresholds for having clinically relevant symptoms. However, a significant difference emerged between RBQs for psychosocial well-being scores; post hoc tests found that psychosocial well-being scores were lower in the fourth RBQ than those in all prior quarters. DISCUSSION: Results agree with limited findings that relative age differences in emotional health are not significant in older cohorts. Nonetheless, relatively older individuals reported very small (d = .04-.05) advantages in psychosocial well-being than their youngest peers, which aligns with previous data. Longitudinal approaches to assess relative age effects on mental health during and throughout the transition into middle adolescence are warranted.

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

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

Are weight status and weight perception associated with academic performance among youth?

BACKGROUND: Emerging evidence suggests perceptions of being overweight account for many of the psychosocial consequences commonly associated with obesity. Previous research suggests an obesity achievement gap, yet limited research has explored weight perception in association with academic performance. Moreover, underweight perceptions have typically been excluded from research. The current study examined how BMI classification and weight perception relate to academic performance in a large cohort of youth. METHODS: We used cross-sectional survey data from 61,866 grade 9-12 students attending the 122 Canadian schools that participated in Year 6 (2017/2018) of the COMPASS study. Mixed effect regression models were used to examine associations between students' BMI classification and weight perceptions and their math and English/French course grades. All models were stratified by sex and adjusted for sociodemographic covariates and school clustering. RESULTS: For English/French grades, males and females with overweight or underweight perceptions were less likely to achieve higher grades than their peers with perceptions of being at "about the right weight", controlling for BMI and covariates. For math grades, females with overweight perceptions, and all students with underweight perceptions, were less likely to achieve higher grades than their peers with "about the right weight" perceptions. All students with BMIs in the obesity range were less likely to report grades of 60% or higher than their peers with "normal-weight" BMIs, controlling for weight perception and covariates. Overweight BMIs were predictive of lower achievement in females for English/French grades, and in males for math grades, relative to "normal-weight" BMIs. Results for students that did not respond to the weight and weight perception items resembled those for obesity BMI and overweight/underweight perceptions, respectively. CONCLUSIONS: Overall, this study demonstrates that an obesity achievement gap remains when controlling for students' perceptions of their weight, and that both underweight and overweight perceptions predict lower academic performance, regardless of BMI classification. Results suggest barriers to academic success exist among youth with larger body sizes, and those with perceptions of deviating from "about the right weight".

Revisiting the International Physical Activity Questionnaire (IPAQ): Assessing sitting time among individuals with schizophrenia.

While moderate to vigorous physical activity may be one method of addressing common physical morbidities in schizophrenia, reducing sedentary time may be a low intensity adjunct. In order to determine whether sedentary behaviour is associated with health outcomes, valid and reliable tools for assessing sedentary time are necessary. In order to characterize the validity and reliability of the International Physical Activity Questionnaire (IPAQ) for assessing sitting (sedentary) time, participants completed the IPAQ at baseline and 4 weeks later and wore accelerometers for 7 days before the final assessment. Bland-Altman analyses and intraclass correlation coefficients (ICC) were used to compare agreement between measurements. One-hundred thirteen individuals completed the study. Mean difference between the IPAQ and accelerometer was 26.8 min (95% Limits of Agreement: -458.7-512.3) and ICCA,1 was 0.23 (95% CI: 0.06-0.39). Week 1 and Week 4 administrations of the IPAQ differed by an average of 26.6 min, (95% Limits of Agreement: -510.9-564.2) and ICCA,1 was 0.41 (95% CI: 0.21-0.59). The "minutes" of sitting reported by the IPAQ do not reflect objective sedentary behaviour measurements and this current measure may be unsuitable for the population level assessment of sitting time among individuals with schizophrenia.

Walk this way: validity evidence of iphone health application step count in laboratory and free-living conditions.

Several attempts have been made to demonstrate the accuracy of the iPhone pedometer function in laboratory test conditions. However, no studies have attempted to evaluate evidence of convergent validity of the iPhone step counts as a surveillance tool in the field. This study takes a pragmatic approach to evaluating Health application derived iPhone step counts by measuring accuracy of a standardized criterion iPhone SE and a heterogeneous sample of participant owned iPhones (6 or newer) in a laboratory condition, as well as comparing personal iPhones to accelerometer derived steps in a free-living test. During lab tests, criterion and personal iPhones differed from manually counted steps by a mean bias of less than ±5% when walking at 5km/h, 7.5km/h and 10km/h on a treadmill, which is generally considered acceptable for pedometers. In the free-living condition steps differed by a mean bias of 21.5% or 1340 steps/day when averaged across observation days. Researchers should be cautioned in considering the use of iPhone models as a research grade pedometer for physical activity surveillance or evaluation, likely due to the iPhone not being continually carried by participants; if compliance can be maximized then the iPhone might be suitable.

The Utility of the Health Action Process Approach Model for Predicting Physical Activity Intentions and Behavior in Schizophrenia.

Research is needed to develop evidence-based behavioral interventions for preventing and treating obesity that are specific to the schizophrenia population. This study is the precursor to such intervention research where we examined the utility of the social cognitions outlined within the Health Action Process Approach (HAPA) model for predicting moderate to vigorous physical activity (MVPA) intentions and behavior among individuals with schizophrenia or schizoaffective disorder. A prospective cohort design [baseline (T1), week 2 (T2), and week 4 (T3)] was used to examine the HAPA constructs and MVPA across a sample of 101 adults (Mage = 41.5 ± 11.7 years; MBMI = 31.2 ± 7.8 kg/m2; 59% male). Two hierarchical regression analyses were conducted controlling for age, gender, BMI, and previous self-reported MVPA. In the first regression, intentions at T1 were regressed onto the T1 motivational HAPA constructs (risk perception, affective attitudes, task self-efficacy) and social support; MVPA status (meeting vs. not meeting the MVPA guidelines) assessed via accelerometry at T3 was regressed onto T1 social support and intentions followed by T2 action and coping planning, and maintenance self-efficacy in the second analysis. Overall, the motivational and social support variables accounted for 28% of the variance in intentions, with affective attitudes (ß = 0.33, p < 0.01) and task self-efficacy (ß = 0.25, p < 0.05) exhibiting significant, positive relationships. For MVPA status, the model as a whole explained 39% of the variance, with the volitional HAPA constructs explaining a non-significant 3% of this total variance. These findings suggest a need for interventions targeting self-efficacy and affective attitudes within this clinical population.

Revisiting the International Physical Activity Questionnaire (IPAQ): Assessing physical activity among individuals with schizophrenia.

BACKGROUND: Individuals with schizophrenia tend to have low levels of physical activity (PA) which contributes to high rates of physical comorbidities. Valid and reliable methods of assessing PA are essential for advancing health research. Ten years after initial validation of the Short-Form International Physical Activity Questionnaire (IPAQ), this study expands on the initial validation study by examining retest reliability over a 4-week period, assessing validity with a larger sample, and comparing validity of the IPAQ to a 24-hour recall alternative. METHODS: Participants completed the IPAQ at baseline and 4weeks later, along with a 24-hour PA recall at week 4. At week 3 participants wore waist accelerometers for 7days. Spearman's correlation coefficients and Bland-Altman plots were calculated based on weekly minutes of moderate to vigorous PA (MVPA). RESULTS: Test-retest reliability for the self-administered IPAQ was ρ=0.47, p<0.001 for MVPA. Correlation between IPAQ assessment and accelerometer-determined MVPA was ρ=0.30, p=0.003. The 24-hour recall correlated significantly with MVPA on the previous day ρ=0.27, p=0.012. A Bland-Altman plot indicated the IPAQ-SF underreported by -119.2min (-72%) on average compared to accelerometry (95% limits of agreement -1017.1 to 778.7min, -292% to 147%). CONCLUSION: Compared to previous IPAQ validation work in this population, criterion validity was similar, but reliability was lower over a 4-week period. MVPA criterion validity of the 24-hour recall was comparable to the 7-day self-report IPAQ. Findings further support that the IPAQ is a suitable assessment tool for epidemiological studies. Objective measures of physical activity are recommended for intervention assessment.

Characterizing the affective responses to an acute bout of moderate-intensity exercise among outpatients with schizophrenia.

In addition to offering many physical health benefits, exercise may help improve mental health among individuals with schizophrenia through regulating affect. Therefore, the purpose of this study is to characterize affective responses experienced before, during and after a 10-min bout of exercise versus passive sitting among individuals with schizophrenia. A randomized crossover design compared affect related to feelings of pleasure and arousal at baseline, 6-min into the task, immediately post-task, and 10min post-task to sitting. Thirty participants enroled in the study; 28 participants completed the study. Separate mixed model analyses of variance were conducted for pleasure and arousal, with test order as the between-subject factor, and time and task as within-subject factors. For pleasure, a significant main effect for time and a time x task interaction effect emerged. Post-hoc Bonferroni corrected t-tests (α=.0125) revealed significant differences between pleasure at baseline and both immediately post-task and 10min post-task. No other main effects or interactions emerged. Individuals with schizophrenia derive acute feelings of pleasure from exercise. Thus, exercise may provide a method of regulating affect to improve mental health. Future studies should examine the links between affective responses to health behaviours such as long-term adherence to exercise within this population.