Exploring differences in substance use behaviours among gender minority and non-gender minority youth: a cross-sectional analysis of the COMPASS study. / Exploration des différences dans les comportements liés à la consommation de substances chez les jeunes faisant partie de minorités de genre et les jeunes ne faisant pas partie de minorités de genre : analyse transversale de l'étude COMPASS.

INTRODUCTION: Research characterizing substance use disparities between gender minority youth (GMY) and non-GMY (i.e. girls and boys) is limited. The aim of this study was to examine the differences in substance use behaviours among gender identity (GI) groups and identify associated risk and protective factors. METHODS: Cross-sectional data from Canadian secondary school students (n = 42 107) that participated in Year 8 (2019/20) or Year 9 (2020/21) of the COMPASS study were used. Hierarchal logistic regression models estimated current substance use (cigarettes, e-cigarettes, binge drinking, cannabis and nonmedical prescription opioids [NMPOs]). Predictor variables included sociodemographics, other substances, mental health outcomes, school connectedness, bullying and happy home life. Interaction terms were used to test mental health measures as moderators in the association between GI and substance use. RESULTS: Compared to non-GMY, GMY reported a higher prevalence for all substance use outcomes. In the adjusted analyses, GMY had higher odds of cigarette, cannabis and NMPO use and lower odds for e-cigarette use relative to non-GMY. The likelihood of using any given substance was higher among individuals who were involved with other substances. School connectedness and happy home life had a protective effect for all substances except binge drinking. Bullying victimization was associated with greater odds of cigarette, e-cigarette use and NMPOs. Significant interactions between GI and all mental health measures were detected. CONCLUSION: Findings highlight the importance of collecting a GI measure in youth population surveys and prioritizing GMY in substance use-related prevention, treatment and harm reduction programs. Future studies should investigate the effects of GI status on substance use onset and progression among Canadian adolescents over time.

The association between single and dual use of cannabis and alcohol and driving under the influence and riding with an impaired driver in a large sample of Canadian adolescents.

OBJECTIVE: Dual use of cannabis and alcohol has increased in adolescents, but limited research has examined how it relates to impaired driving or riding with an impaired driver (IDR) compared to single substance use. This study aimed to examine the odds of alcohol- and/or cannabis-IDR among adolescents based on their use of alcohol and/or cannabis, and whether associations differed by gender and age. METHODS: Cross-sectional survey data were used from a sample of 69,621 students attending 182 Canadian secondary schools in the 2021/22 school year. Multilevel logistic regression estimated the odds of exclusive alcohol-IDR, exclusive cannabis-IDR, and both alcohol and cannabis IDR (alcohol-cannabis-IDR). Substance use interactions with gender and age were tested. RESULTS: Overall, 14.7% of participants reported IDR; 7.5% reported exclusive alcohol-IDR, 3.2% reported exclusive cannabis-IDR, 4.0% reported alcohol-cannabis-IDR, and 7.4% were unsure if they had experienced IDR. The prevalence of IDR varied across substance use groups, 8.0% among nonuse, 21.9% among alcohol-only use, 35.9% among cannabis-only use, and 49.6% among dual use groups. Gender diverse, older, and students with lower socioeconomic status exhibited a higher likelihood of reporting alcohol-cannabis-IDR. Dual use was significantly associated with 9.5 times higher odds of alcohol-cannabis-IDR compared to alcohol-only use, and 3.0 times higher odds compared to cannabis-only use. Dual use was also associated with an increased likelihood of either alcohol- or cannabis-IDR. CONCLUSIONS: This study highlights that all students, regardless of substance use, are at risk of IDR, but students engaged in dual use of alcohol and cannabis face an elevated risk compared to both peers who do not use substances and those who use only a single substance. These findings emphasize the importance of targeted interventions that address the risks associated with IDR.

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.

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

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

Inequitable Changes in School Connectedness During the Ongoing COVID-19 Pandemic in a Cohort of Canadian Adolescents.

BACKGROUND: We examined whether subgroups of adolescents experienced disparate changes in school connectedness-a robust predictor of multiple health outcomes-from before the COVID-19 pandemic to the first full school year following pandemic onset. METHODS: We used 2 waves of prospective survey data from 7178 students attending 41 Canadian secondary schools that participated during the 2019-2020 (T1; pre-COVID-19 onset) and 2020-2021 (T2; ongoing pandemic) school years. Fixed effects analyses tested differences in school connectedness changes by gender, race, bullying victimization, socioeconomic position, and school learning mode. RESULTS: Relatively greater declines in school connectedness were reported by students that identified as females, were bullied, perceived their family to be less financially comfortable than their classmates, and attended schools in lower income areas. Marginally greater school connectedness declines resulted among students attending schools that were fully online at T2 than those at schools using a blended model. CONCLUSION: Results point to disparate school connectedness declines during the pandemic, which may exacerbate pre-existing health inequities by gender and socioeconomic position, and among bullied youth. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Effective strategies to improve school climates for equity denied groups are critical for pandemic recovery and preparedness for future related events.

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.

Association Between Area-Level Income Inequality and Health-Related School Absenteeism: Evidence From the COMPASS Study.

BACKGROUND: Income inequality is theorized to impact health. However, evidence among adolescents is limited. This study examined the association between income inequality and health-related school absenteeism (HRSA) in adolescents. METHODS: Participants were adolescents (n = 74,501) attending secondary schools (n = 136) that participated in the 2018-2019 wave of the COMPASS study. Chronic (missing ≥3 days of school in the previous 4 weeks) and problematic (missing ≥11 days of school in the previous 4 weeks) HRSA was self-reported. Income inequality was assessed via the Gini coefficient at the census division (CD) level. Multilevel modeling was used. RESULTS: Greater income inequality was associated with a higher likelihood of chronic and problematic HRSA (chronic: OR = 1.17, 95% CI: 1.06, 1.30; problematic: OR = 1.29, 95% CI 1.11 to 1.50). Increased predicted probabilities for Problematic HRSA were observed at greater degrees of income inequality among students who identified as either white, black, Latinx, or mixed, while protective associations were observed among students who identified as Asian or other. No associations were modified by gender. CONCLUSION: Income inequality demonstrated unfavorable associations with HRSA, which was modified by racial identity.

School learning modes during the COVID-19 response and pre- to during pandemic mental health changes in a prospective cohort of Canadian adolescents.

PURPOSE: Considerable debate centered on the impact of school closures and shifts to virtual learning on adolescent mental health during the COVID-19 pandemic. We evaluated whether mental health changes differed by school learning modes during the pandemic response among Canadian adolescents and whether associations varied by gender and perceived home life. METHODS: We used prospective survey data from 7270 adolescents attending 41 Canadian secondary schools. Conditional change linear mixed effects models were used to examine learning mode (virtual optional, virtual mandated, in-person, and blended) as a predictor of change in mental health scores (depression [Centre for Epidemiologic Studies - Depression], anxiety [Generalized Anxiety Disorder-7], and psychosocial well-being [Flourishing scale]), adjusting for baseline mental health and covariates. Gender and home life happiness were tested as moderators. Least square means were calculated across interaction groups. RESULTS: Students learning in a blended learning mode had greater anxiety increases relative to their peers in other learning modes. Females learning fully in-person and males learning virtually when optional reported less of an increase in depression scores relative to their gender counterparts in other learning modes. Learning virtually when optional was associated with greater declines in psychosocial well-being in students without happy home lives relative to other learning modes. CONCLUSION: Findings demonstrate the importance of considering gender and home environments as determinants of mental health over the pandemic response and when considering alternative learning modes. Further research is advised before implementing virtual and blended learning modes. Potential risks and benefits must be weighed in the context of a pandemic.

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

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

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

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

An Examination of Bidirectional Associations Between Alcohol Use and Internalizing Symptoms Among Adolescents During the COVID-19 Pandemic.

PURPOSE: This study explores the bidirectional association between internalizing symptoms and alcohol use over three years of the COVID-19 pandemic to examine whether alcohol consumption is associated with higher internalizing symptoms in the next year and vice versa. METHODS: We used linked data from a sample of 2,136 secondary school students who participated in three consecutive waves (2019-2020 [T1], 2020-2021 [T2], and 2021-2022 [T3]) of the Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behaviour study during the pandemic. A random-intercept cross-lagged panel model was used to characterize reciprocal linear relations between internalizing symptoms and alcohol use. RESULTS: The findings suggest that students who reported higher levels of alcohol use at T1 experienced increased levels of depression and anxiety in the subsequent year (T2). However, this association was not observed from T2 to T3. Throughout the three-year period, depression and anxiety were not associated with later alcohol use. In males, alcohol use at T1 was a predictor of higher internalizing symptoms at T2 but not from T2 to T3. DISCUSSION: These results suggest time-sensitive impacts and notable gender differences in the relationship between internalizing symptoms and alcohol use over the pandemic. Given the complexity of impacts, ongoing evaluation of the impact of the pandemic on youth health behaviours is necessary to elucidate these unfolding relationships, especially as the pandemic continues to affect various psychosocial risk factors.

Youth perception of difficulty accessing cannabis following cannabis legalization and during the early and ongoing stages of the COVID-19 pandemic: repeat cross-sectional and longitudinal data from the COMPASS study.

BACKGROUND: Very little research has examined how perceptions of cannabis access among underage youth in Canada have changed since cannabis was legalized and since the onset of the COVID-19 pandemic. As such, this paper examines the effect of the early and ongoing stages of the COVID-19 pandemic period on youth perceptions of cannabis access over time since the onset of the Cannabis Act in 2018 in a large sample of Canadian youth. METHODS: Using data from the COMPASS study (T1:2018/19, T2:2019/20, T3:2020/21), we used both repeat cross-sectional data [T1 (n = 38,890), T2 (n = 24,109), and T3 (n = 22,795)] to examine overall trends in perceptions of cannabis access, and sequential cohort longitudinal data [n = 4,677 students linked from T1 to T3] to examine the differential changes in perceptions of cannabis access among students over time. RESULTS: In the cross-sectional sample, the frequency of students reporting that cannabis was easy to access decreased by 26.7% from T1 (51.0%) to T3 (37.4%), although respondents who have used cannabis were more likely to report access was easy. In the longitudinal sample, perceptions of cannabis access being easy increased over time, especially among cannabis users. Perceived ease of access appears to have been slightly impeded during the initial pandemic period but rebounded during the ongoing pandemic period. CONCLUSIONS: While the prevalence of youth reporting that cannabis is easy to access has declined since legalization and throughout the early and ongoing pandemic periods, a substantial number of underage youth continue to report that cannabis is easy to access. This suggest that there is an ongoing need for continued cannabis control efforts to address this issue.

Self-concept in Adolescents with Physical-Mental Comorbidity.

Objective: Little is known about self-concept in adolescents with physical-mental comorbidity. This study investigated whether physical-mental comorbidity was associated with self-concept in adolescents and examined if adolescent age or sex moderated the association between physical-mental comorbidity and self-concept. Methods: Study data were obtained from the Multimorbidity in Youth across the Life-course (MY LIFE), an ongoing Canadian study of adolescents with chronic physical illness who were recruited from outpatient clinics at a pediatric hospital. A total of 116 adolescents aged ≥ 10 years provided self-reports on key measures. Results: Adolescents with comorbidity (n = 48) had lower self-concept scores on the Self-Determination Questionnaire (SDQ; d = 0.62) and Self-Perception Profile for Children (SPPC; d = 0.53) vs. adolescents without comorbidity (n = 68). An age × comorbidity status interaction was found and age-stratified models were computed to investigate this moderating effect of age. Amongst older adolescents, comorbidity was associated with lower SDQ (B = -2.55, p < .001), but this association was not found among younger adolescents (B = -0.29, p = .680). A similar effect was found for SPPC among older (B = -0.48, p = .001) and younger adolescents (B = 0.03, p = .842). Adolescent sex was not found to be a moderator. Conclusions: Physical-mental comorbidity in adolescence was associated with lower self-concept and this association was moderated by age-differences between adolescents with vs. without comorbidity were greater for older adolescents and were clinically relevant. Opportunities to support positive self-perceptions for adolescents with comorbidity are warranted, especially when planning the transition from pediatric to adult health services.

Income inequality and mental health in adolescents during COVID-19, results from COMPASS 2018-2021.

INTRODUCTION: Understanding the inequitable impacts of the ongoing COVID-19 pandemic on youth mental health are leading priorities. Existing research has linked income inequality in schools to adolescent depression, however, it is unclear if the onset of the pandemic exacerbated the effects of income inequality on adolescent mental health. The current study aimed to quantify the association between income inequality and adolescent mental health during COVID-19. MATERIAL AND METHODS: Longitudinal data were taken from three waves (2018/19 to 2020/21) of the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) school-based study. Latent Growth Curve modelling was used to assess the association between Census District (CD)-level income inequality and depressive symptoms before and after the onset of COVID-19. RESULTS: The study sample included 29,722 students across 43 Census divisions in British Columbia, Alberta, Ontario, and Quebec. The average age of the sample at baseline was 14.9 years [standard deviation (SD) = 1.5] and ranged between 12 and 19 years of age. Most of the sample self-reported as white (76.3%) and female (54.4%). Students who completed the COMPASS survey after the onset of COVID reported 0.20-unit higher depressive scores (95% CI = 0.16, 0.24) compared to pre-COVID. The adjusted analyses indicated that the association between income inequality on anxiety scores was strengthened following the onset of COVID-19 (ß = 0.02, 95% CI = 0.0004, 0.03), indicating that income inequality was associated with a greater increase in anxiety scores during COVID-19. DISCUSSION: The adjusted results indicate that the association between income inequality and adolescent anxiety persisted and was heightened at the onset of COVID-19. Future studies should use quasi-experimental methods to strengthen this finding. The current study can inform policy and program discussions regarding the effects of the COVID-19 pandemic and pandemic recovery for young Canadians and relevant social policies for improving adolescent mental health.

Exploring the longitudinal associations between census division income inequality and BMI trajectories among Canadian adolescent: Is gender an effect modifier?

Background: Income inequality is a structural determinant of health linked to increased risk of overweight and obesity, although its links to the health of adolescent populations are not well understood. This study investigated the longitudinal associations between census-division-level (CD) income inequality and BMI trajectories among Canadian adolescents, and determine if these associations vary by gender. Methods: Study data are from the Cannabis use, Obesity, Mental health, Physical Activity, Alcohol use, Smoking, and Sedentary behaviour (COMPASS) cohort of adolescents attending secondary schools in Canada. Our sample included 14,675 adolescents who were followed up across three waves of the COMPASS study (2016-2017, 2017-2018, and 2018-2019) and linked to 30 CDs. Measures of income inequality and other area-level covariates were derived and linked to COMPASS participants using data from the 2016 Canadian Census. We utilized multilevel mixed-effects linear regression modelling to quantify the associations between income inequality and BMI and test for effect modification by gender. Sensitivity analyses were run excluding those with BMI scores in the range considered overweight or obesity at baseline. Results: Higher CD income inequality was significantly associated with higher z-transformed BMI scores (ß = 0.11, 95% CI = 0.034 to 0.19). The interaction term between income inequality and time was not statistically significant, indicating that this association remained constant over time. Once stratified by gender, the association between inequality and BMI became stronger for males (ß = 0.14, 95% CI = 0.060 to 0.022) and attenuated for females (ß = 0.063, 95% CI = -0.047 to 0.17). Conclusion: Attending schools in CDs with higher income inequality was associated with higher BMI scores among male but not female adolescents. Further work is needed to investigate this discrepancy and identify the structural mechanisms that mediate the relationship between inequality and adolescent health.

Inequality's on Tap: A Longitudinal Study of Area-Level Income Inequality and Alcohol Consumption Among Canadian Adolescents.

PURPOSE: To determine if income inequality at the census division level is associated with alcohol consumption and abuse among junior high and high school students. METHODS: Data on adolescents are from the Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behavior (COMPASS) study. Participant data (n = 19,759) were collected during three survey waves (2016-2017, 2017-2018, and 2018-2019) and linked to 30 census divisions within four Canadian provinces. Data on income inequality and other area-level factors were derived from the 2016 Canadian census. Multilevel logistic regression modelling was used to quantify the associations between income inequality, monthly alcohol consumption, and binge drinking. RESULTS: After adjusting for covariates, students living in census divisions within the second and third quintiles of income inequality experienced an average 80% (OR = 1.80, 95% CI = 1.08-3.02) and 92% (OR = 1.92, 95% CI = 1.05-3.51) increased odds of engaging in monthly binge drinking, respectively, compared to those living in the first quintile. Similarly, adolescents living in census divisions within the second inequality quintile experienced an average 169% (OR = 2.69, 95% CI = 1.45, 4.99) increased odds of engaging in weekly binge drinking, compared to those living in the first quintile. There was no significant association between higher income inequality and current monthly alcohol consumption. DISCUSSION: Moderate area-level income inequality within census divisions was adversely associated with alcohol consumption among adolescents. Future work should investigate the potential mechanisms that mediate this relationship.

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.