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The purpose of this study was to explore the adaptations that schools made to physical activity programs and facilities, and disparities by area urbanicity and income, during the first school year after the emergence of the COVID-19 pandemic. In a convenience sample of 132 secondary schools in Canada, school contacts responded to an annual survey in the 2020-2021 school year on changes to physical activity programs and facilities, and related staff training. Content analysis categorized open-ended text responses, and schools were compared based on area urbanicity and median income. Most schools canceled all interschool sports (88.9%) and intramurals (65.9%). New programs were added by 12.6% of schools, and about half (49%) of schools reported some continuing programs, most of which were sports programs, followed by facility and equipment access. Physical activity facilities were closed in 18.1% of schools, while 15.7% had new facilities added, and 11% temporarily converted facilities into learning spaces. Large/medium urban schools were at greater odds of having made any change to their facilities compared to schools in rural/small urban areas (odds ratio (95% confidence interval): 2.3 (1.1, 4.8)). The results demonstrate the considerable scale and nature of the restrictions in school provisions of physical activity opportunities during this period, as well as the resourcefulness of some schools in adding new programs and facilities.

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., (© 2024 The Authors. Journal of School Health published by Wiley Periodicals LLC on behalf of American School Health Association.)

Introduction: The broaden and build theory of positive emotions maintains that positive emotions serve to broaden individuals' thoughts and behaviours, resulting in the accrual of resources (e.g. resilience) that catalyze upward spirals of well-being. However, there is a relative dearth of research examining the upward spiral hypothesis in the context of adolescence., Methods: Adolescents (n = 4064) in participating Canadian high schools were surveyed annually for three years as part of the COMPASS study. Reciprocal associations between positive emotions and resilience were examined as predictors of flourishing., Results: Adolescents who experienced positive emotions more frequently than usual reported higher levels of resilience one year later. Similarly, adolescents who had higher levels of resilience than usual reported more positive emotions the following year. Higher than usual levels of resilience and positive emotions positively predicted flourishing., Conclusion: Positive emotions result in a cascade of beneficial outcomes including increased resilience and enhanced well-being, catalyzing an upward spiral towards flourishing. Opportunities to enhance positive emotions early on in adolescence may help build resources that can set students on the path towards increased well-being., Competing Interests: The authors have no financial relationships relevant to this article and no conflicts of interest to disclose.

Introduction: Canadian youth are insufficiently active, and schools may play a role in promoting student physical activity (PA). Based on the Comprehensive School Health (CSH) framework, this study examined whether school characteristics are associated with secondary school students meeting national PA recommendations over time., Methods: We used COMPASS survey data from 78 schools in Ontario and Alberta and 9870 Grade 9 and 10 students attending those schools. Students who provided two years of linked PA data (2013/14 and 2015/16) and gender were included. Multilevel analysis was conducted by gender, evaluating the relationship of school-level characteristics (guided by CSH) with students achieving all three PA recommendations after two years (≥ 60 min/day of moderate-to-vigorous PA, vigorous PA ≥ 3 days/week, strengthening activities ≥ 3 days/week)., Results: More than half (56.9%) of students achieving the PA recommendations at baseline were no longer achieving them after two years, and just a quarter (25.6%) of students not achieving the recommendations at baseline achieved them after two years. School-level factors were significantly associated with students achieving the recommendations, but these factors differed by student strata (i.e. by gender and baseline PA status). Generally, student access to equipment, public health partnerships and staff time for health were associated with increased odds of achieving the PA recommendations for certain students., Conclusion: Modifications to school characteristics within CSH may play a role in supporting students in achieving or continuing to achieve the PA recommendations after two years. Further research is needed to better understand the underlying dynamics of the observed relationships., Competing Interests: Scott Leatherdale is an Associate Scientific Editor with the HPCDP Journal, but has recused himself from the review process for this paper. The authors declare there are no other conflicts of interest.

Background: The comprehensive school health (CSH) framework has four components: social and physical environment; partnerships and services; teaching and learning; and policy. This study examines associations between CSH and student physical activity (PA)., Methods: Using 2015/2016 COMPASS study survey data of 37,397 students (grades 9-12) from 80 secondary schools in Ontario and Alberta, Canada, associations between school-level factors within CSH and student PA outcomes (weekly moderate-to-vigorous PA [MVPA] minutes and achieving the national PA recommendations of ≥60 min of MVPA daily, vigorous PA ≥3 days/week, strengthening activities ≥3 days/week) were analyzed using multilevel regression models stratified by gender and grade., Results: Factors within all four CSH components were associated with student PA. Four student subgroups were more likely to achieve the recommendations if their school had youth organization partnerships (Range of AORs:1.15-1.33, p <.05) and female students were less likely if their school had low prioritization of PA (AOR = 0.77, 95% CI: [0.65-0.92]). Grade 9 students had higher MVPA when provided non-competitive PA opportunities (β = 100.4, 95%CI: [30.0-170.9]). All student subgroups had better PA outcomes when schools provided access to equipment during non-instructional time., Conclusion: There is opportunity to improve student PA through CSH-guided interventions, but different strategies may be more effective for each gender/grade., (© 2022 American School Health Association.)

(1) The majority of Canadian youth are insufficiently active, and moderate-to-vigorous physical activity (MVPA) decreases substantially during secondary school. School factors within the comprehensive school health (CSH) framework may help attenuate this decline. This study aimed to examine how youth MVPA changes over a three-year period and evaluate the school characteristics associated with preventing the decline in MVPA over time, guided by the CSH framework. (2) This study uses COMPASS survey data from 78 secondary schools in Ontario and Alberta that participated in Year 2 (2013/14), Year 3 (2014/15), and Year 4 (2015/16), and 17,661 students attending these schools. Multilevel (linear mixed effects) models were used to determine the association between school-level factors and student MVPA (weekly minutes) over time, stratified by gender. (3) Both male and female students had a significant decline in MVPA across the 3 years, with a greater decrease observed among female students. Within the CSH framework, the school's social environment, partnerships, and policies were associated with student MVPA over time, however the specific school factors and directions of associations varied by gender. (4) School-based interventions (e.g., public health partnerships) may help avoid the decline in MVPA observed in this critical period and support student health.

Background: Despite the benefits of physical activity (PA), the majority of Canadian youth are falling short of the recommended 60 min of moderate-to-vigorous physical activity (MVPA) per day. School-based physical activity programs such as intramurals, are important opportunities for youth to be physically active. There is limited evidence available on the impact of gender-specific (e.g., female-only, male-only) and co-ed intramurals on youth PA over time, however, evidence suggests female-only intramurals may be important for female MVPA. This research aims to capitalize on a natural experiment to generate practice-based evidence on the impact of changes in gender-specific and co-ed intramurals on youth MVPA over time., Methods: This study used linked longitudinal school- and student-level data from Ontario secondary schools in year 5 (Y5:2016-2017), year 6 (Y6: 2017-2018) and year 7 (Y7: 2018-2019) of the COMPASS study. Data on intramurals from 55 schools were used to determine the changes to gender-specific and co-ed intramurals that occurred from Y5 to Y6. Baseline demographic characteristics were measured and data on PA and sport participation were collected in Y5, Y6 and Y7 on a sample of 4417 students. Hierarchical linear mixed regression models were used to estimate how changes in gender-specific and co-ed intramurals were associated with youth MVPA over time., Results: Participation in intramural, varsity and community sport were all positively and significantly associated with youth MVPA. Changes in gender-specific and co-ed intramurals were not significantly associated with youth MVPA in Y6 or Y7. However, the positive association between maintaining the addition of gender-specific intramurals on female MVPA in Y7 was on par with the significance level of α = 0.05, suggesting that adding gender-specific intramurals may be important for female MVPA., Conclusions: Adding gender-specific and co-ed intramurals may not be sufficient strategies to increase PA among youth. Further research should explore the effect of gender-specific intramurals on youth PA, as this study may have been underpowered at the school-level. Gender-specific intramurals may promote a supportive PA environment that promotes MVPA, especially among females. These intramurals may be an important component of more comprehensive strategies to increase youth MVPA., (© 2021. The Author(s).)

Background: Adolescence coincides with the adoption of health behaviors that schools are not necessarily equipped to properly address. Collaboration between schools and external health services such as public health could fill gaps in addressing student health., Methods: The current study uses student- and school-level survey data from 59 nonprivate secondary schools in Ontario, Canada in year 6 (2017-2018) of the COMPASS study to examine barriers to improving student health, and analyze the effect of public health engagement on student health behaviors., Results: The majority of schools have received resources from their local public health unit, however, less than one third of schools were developing/implementing programs jointly, and 12% of schools reported no engagement. Students had higher odds of better overall mental health, of meeting screen time guidelines, and were less likely to bully others if public health units solved issues together with schools regarding these health behaviors., Conclusions: There is a notable lack of consistent public health engagement in schools participating in the COMPASS study despite a need for such services. Creating mechanisms to develop and strengthen effective partnerships between schools and external service providers such as public health might alleviate some barriers to implementing health interventions in Ontario secondary schools., (© 2021, American School Health Association.)

Adolescents engage in multiple health risk behaviours that put them at risk of future chronic disease. By the time students graduate from secondary school, they may be engaging in behaviours that set them on a particular health trajectory. It is important to monitor the co-occurrence of health risk behaviours of cohorts of grade 12 students over time to highlight important areas for intervention. The purpose of this study was to examine trends in health and risk behaviours over six waves among subsequent cohorts of grade twelve students from Ontario, Canada. A total of 44,740 grade 12 students participated in the COMPASS study across the six waves (2013/14 to 2018/19), and self-reported movement (physical activity, screen time, sleep), dietary (fruit and vegetables, breakfast), and substance use (smoking, vaping, binge drinking, and cannabis use) behaviours. Over 91.0% of students reported engaging in three or more health risk behaviours, with increases in the number of students reporting inadequate sleep, not eating breakfast on every school day, and vaping over time. Although modest, the wave 6 cohort reported slightly more risk behaviours compared with the wave 1 cohort, highlighting the importance of multidimensional health promotion strategies across multiple settings.

(1) School-based physical activity programs such as intramurals provide youth with inclusive opportunities to be physically active, yet we know little about how types of intramurals (e.g., team and individual sports) may contribute to youth MVPA. This research aims to evaluate how real-world changes in types of intramurals available in schools impact youth physical activity over time. (2) This study used three years of longitudinal school- and student-level data from Ontario schools participating in year 5 (2016-2017), year 6 (2017-2018) and year 7 (2018-2019) of the COMPASS study. Data on types of intramural programs from 55 schools were obtained, baseline demographic characteristics were measured and data on physical activity and sport participation were collected on a sample of 4417 students. Hierarchical linear mixed regression models were used to estimate how changes in the type of intramurals associate with youth MVPA over time. (3) Regardless of participation, adding individual and team intramurals was significantly and positively associated with female MVPA in Y6. (4) The indirect, but positive relationship between adding individual and team intramurals and female MVPA may be explained by other characteristics of the school environment that are conducive to female MVPA.

Recently, latent class analysis (LCA) and its variants have been proposed to identify subgroups of individuals who follow similar sequential patterns of latent class membership for longitudinal study. A primary assumption underlying the family of LCA is that individual observations are independent. In many applications, however, particularly in research on adolescent substance use, individuals are often dependent because of multilevel data structure, where the unit of observation (e.g., students) is nested in higher level units (e.g., schools). In this study, we propose multilevel latent class profile analysis (MLCPA), which will allow us to analyze the longitudinal data with a multilevel structure under the framework of LCA. We apply an MLCPA using data from the COMPASS study, a 9-year study funded by the Canadian Institutes of Health Research and Health Canada, in order to identify representative sequential drinking patterns of Canadian youth and investigate whether these sequential patterns vary across schools. The MLCPA identified three common student-level drinking behaviors: non-drinker , ever lifetime , and binge drinker . The sequence of drinking behaviors can be classified into one of three longitudinal sequential patterns: non-drinking stayer , light drinking advancer , and heavy drinking advancer . In addition, MLCPA uncovered two latent clusters ( low-use school and high-use school ) out of 64 schools in Ontario and Alberta based on the prevalences of sequential drinking patterns.

Priority setting in health research can assist stakeholders to identify research and policies that have the greatest potential for benefits to public health. Priority setting has been utilized by researchers to identify barriers, facilitators, and recommendations for future public health research. This commentary describes how a priority-setting approach was used as part of a workshop activity on the school nutrition environment in Ontario, Canada, to facilitate brainstorming, sorting, and rating of concepts related to the school nutrition environment. This work demonstrates an interesting and concrete case of priority setting, of interest for various planning activities (both programming and research), particularly those around school-based healthy eating programs or a related research agenda.

Objective: The objective of this research was to determine the school and community characteristics associated with milk and milk alternative (MMA) consumption by Canadian youth. Methods: We analyzed self-reported data from 50,058 Canadian students participating in the 2017-2018 wave of the COMPASS survey. We used logistic and linear regression analyses to identify school- and community-level factors associated with students meeting the MMA guidelines, and factors associated with daily number of MMA servings consumed, respectively. Results: Student-level factors were more strongly associated with MMA consumption than school- and community-level factors. Students who attended schools that provided staff with nutrition training consumed fewer daily servings of MMAs and were less likely to meet MMA guidelines. Students attending schools that received healthy eating grants were more likely to meet MMA guidelines, whereas students attending schools that sold flavored milk in their vending machines were less likely to meet MMA guidelines. Conclusion: Our findings suggest that student-level factors have a stronger association with MMA consumption than school or community factors. Additional research is needed to understand how factors associated with MMA consumption may influence behaviours over time, and how changes to Canada's food guide may impact youth eating habits.

Reducing youth cannabis use in Canada is a public health priority with schools of interest as a potential modifier of behavior and as a venue for prevention programming. This work aimed to provide a basis for future policy and programming by evaluating pre-legalization cannabis use change patterns in schools and the impact of school characteristics on these patterns. Average rates of cannabis use behavior change (initiation, escalation, reduction, cessation) were collected from 88 high schools located in Ontario and Alberta, Canada participating in the COMPASS prospective cohort study. There was little variability in cannabis use behaviors between schools with intra-class correlation coefficients lowest for cessation (0.02) and escalation (0.02) followed by initiation (0.03) and reduction (0.05). Modest differences were found based on school province, urbanicity and student-peer use. Cannabis ease of access rates had no significant effect. Fewer than half the schools reported offering school drug use prevention programs; these were not significantly associated with student cannabis use behaviors. In conclusion, current school-based cannabis prevention efforts do not appear sufficiently effective. Comprehensive implementation of universal prevention programs may reduce cannabis harms. Some factors (urbanicity, peer use rates) may indicate which schools to prioritize., (© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Schools are increasingly concerned about student cannabis use with the recent legalization in Canada; however, little is known about how to effectively intervene when students violate school substance use policies. The purpose of this study is to assess the disciplinary approaches present in secondary schools prior to cannabis legalization and examine associations with youth cannabis use. This study used Year 6 (2017/2018) data from the COMPASS (Cannabis use, Obesity, Mental Health, Physical Activity, Alcohol use, Smoking, Sedentary behavior) study including 66,434 students in grades 9 through 12 and the 122 secondary schools they attend in British Columbia, Alberta, Ontario, and Quebec. Student questionnaires assessed youth cannabis use and school administrator surveys assessed potential use of 14 cannabis use policy violation disciplinary consequences through a ("check all that apply") question. Regression models tested the association between school disciplinary approaches and student cannabis use with student- (grade, sex, ethnicity, tobacco use, binge drinking) and school-level covariates (province, school area household median income). For first-offence violations of school cannabis policies, the vast majority of schools selected confiscating the product (93%), informing parents (93%), alerting police (80%), and suspending students from school (85%), among their disciplinary response options. Few schools indicated requiring students to help around the school (5%), issuing a fine (7%), or assigning additional class work (8%) as potential consequences. The mean number of total first-offence consequences selected by schools was 7.23 (SD = 2.14). Overall, 92% of schools reported always using a progressive disciplinary approach in which sanctions get stronger with subsequent violations. Students were less likely to report current cannabis use if they attended schools that indicated assigning additional class work (OR 0.57, 95% CI (0.38, 0.84)) or alerting the police (OR 0.81, 95% CI (0.67, 0.98)) among their potential first-offence consequences, or reported always using the progressive discipline approach (OR 0.77, 95% CI (0.62, 0.96)) for subsequent cannabis policy violations. In conclusion, results reveal the school disciplinary context in regard to cannabis policy violations in the year immediately preceding legalization. Various consequences for cannabis policy violations were being used by schools, yet negligible association resulted between the type of first-offence consequences included in a school's range of disciplinary approaches and student cannabis use.

Objective: To examine associations between Canadian adolescents' sugar-sweetened beverage (SSB) consumption and several school food environment characteristics, and to investigate differences in these characteristics between schools in provinces with voluntary (Alberta) v. mandatory (Ontario) provincial school nutrition policies., Design: We used a questionnaire to assess the number of weekdays participants consumed three SSB categories (soft drinks, sweetened coffees/teas, energy drinks) and various sociodemographic and behavioural characteristics. We examined the in-school water fountain accessibility, vending machines' contents and presence of various food outlets within schools' 1 km buffer. We developed hierarchical Poisson regression models to identify associations between student- and school-level characteristics and students' SSB outcomes., Setting: Alberta and Ontario, Canada., Subjects: Adolescents (n 41 829) from eighty-nine secondary schools., Results: Compared with their Ontarian counterparts, Albertan participants had a significantly higher rate of SSB intake across all drink categories and SSB availability was significantly greater in Albertan schools' vending machines. Availability of sweetened coffees/teas in school vending machines and access to restaurants within the school's 1 km buffer were associated with increased SSB intake in three of the final models. Overall, the school food environment-level characteristics examined had a modest to negligible impact on student days of SSB intake., Conclusions: We identified that the school food environment characteristics examined here had little impact on adolescents' days of SSB consumption. While schools should adopt or maintain a comprehensive policy approach to discourage students' SSB intake, population-level interventions focusing on other contexts (e.g. home and community) are needed to complement existing school-based interventions.

Background: To date, no longitudinal population-based studies of school start times have been conducted within Canada. School schedule changes provided an opportunity to examine start times in association with youth sleep, physical activity, and screen use over time., Methods: This longitudinal study included grade 9-12 students attending 49 Ontario secondary schools that participated in at least two consecutive years of the COMPASS study (2012-2017). Fixed effects models tested whether differences in within-student change in self-reported sleep duration, moderate-to-vigorous physical activity, and screen time were associated with school start time changes, adjusting for student- (grade, sex, ethnicity, spending money) and school-level covariates (median income, urbanicity, geographical area)., Results: Thirteen start time changes of 5-10 min were reported. Ten-minute advances at earlier clock times (8:30 AM-8:20 AM; 8:40 AM-8:30 AM) were associated with steeper sleep duration declines than schools with consistent start times but had no effect at later times (9:00 AM-8:50 AM). While sleep change did not differ with 5-min delays, 10-min delays (8:50 AM-9:00 AM) were associated with additional sleep (23.7 min). Apart from one school that shifted from 8:30 AM to 8:35 AM, in which screen time and physical activity decreased more steeply, no effect was found for screen time, and 5-min delays were associated with more physical activity (10.9 min) and advances with less activity (-8.0 min)., Conclusions: Results support start time delays as a valuable strategy to help ameliorate sleep debt among youth. Interference with physical activity or increased screen time appear unlikely with modest schedule changes. Potential adverse impacts on sleep require consideration with 10-min advances., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: The school environment is an ideal setting to introduce policies to prevent smoking behaviour. However, there may be variability in the strength of school board and secondary school tobacco policies, which may affect student smoking behaviours. This study assessed the strength of a sample of school board and secondary school tobacco policies and examined the association with student smoking behaviours., Methods: Tobacco policies from school boards (n = 21/26) and secondary schools (n = 43/81) that participated in the COMPASS study during 2015-2016 were obtained online. A standardized instrument was used to assess the strength of school board and secondary school tobacco policies on four domains. Using the sample of students from schools with identified policies (n = 22,696), separate multilevel regression models examined the association between school policy scores and a student's susceptibility to smoking, ever smoking, current smoking, and perceived support of the school environment., Results: The mean school board tobacco policy score was 13.7/40 and the mean secondary school tobacco policy score was 11.3/40. Students were significantly less likely to report current smoking (OR 0.95, 95% CI 0.91-0.99) and more likely to report a supportive school environment (OR 1.06, 95% CI 1.04-1.08) with each four-unit (i.e., 10%) increase in school tobacco policy score., Conclusions: The vast majority of school board and secondary school tobacco policies were missing components and therefore could not be considered comprehensive. Stronger school tobacco policies may help to reduce student current smoking behaviours.

Purpose: Cross-sectional evidence suggests that school connectedness is an important correlate of health-related behaviors among adolescents, but prospective studies are needed to strengthen the case for a causal relationship. This study investigated the prospective relationship between school connectedness and four health-related behaviors: cigarette smoking, marijuana use, binge drinking, and physical activity., Methods: We analyzed 4 years of data from the COMPASS study. Participants included in this analysis were 33,313 students who provided information on sociodemographic, school connectedness, and the four health-related behaviors for at least two consecutive years. Generalized Estimating Equation models were used to examine whether the change in school connectedness scores predicted the change in an individual child's trajectory of health-related behaviors across 9th, 10th, 11th, and 12th grades., Results: As students moved to higher grades, school connectedness decreased, and the likelihood of being a less frequent smoker, marijuana user, and binge drinker, and meeting physical activity guidelines declined. An increase in school connectedness scores was associated with an increased likelihood of meeting physical activity recommendations (OR = 1.06, p < .01), being a less frequent smoker, marijuana user, and binge drinker (OR = 1.30, 1.17, 1.10, respectively; p's < .0001) across the 4 years., Conclusions: This study provides prospective evidence supporting the protective effects of school connectedness on substance abuse and physical activity, and highlights the importance of fostering school connectedness to support healthy adolescent development., (Copyright © 2018 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: School nutrition policies can encourage restrictions in sugar-sweetened beverage (SSB) availability in school food outlets in order to discourage students' SSB intake. The main objective was to examine how beverage availability in school vending machines changes over three school years across schools in distinct school nutrition policy contexts. Secondary objectives were to examine how students' weekday SSB intake varies with time and identify longitudinal associations between beverage availability and SSB intake., Methods: This longitudinal study used data from the COMPASS study (2013/14-2015/16), representing 7679 students from 78 Canadian secondary schools and three provincial school nutrition policy contexts (Alberta - voluntary guidelines, Ontario public - mandatory guidelines, and Ontario private schools - no guidelines). We assessed availability of 10 beverage categories in schools' vending machines via the COMPASS School Environment Application and participants' intake of three SSB varieties (soft drinks, sweetened coffees/teas, and energy drinks) via a questionnaire. Hierarchical regression models were used to examine whether: i) progression of time and policy group were associated with beverage availability; and, ii) beverage availability was associated with students' SSB intake., Results: Ontario public schools were significantly less likely than the other policy groups to serve SSBs in their vending machines, with the exception of flavoured milks. Vending machine beverage availability was consistent over time. Participants' overall SSB intake remained relatively stable; reductions in soft drink intake were partially offset by increased sweetened coffee/tea consumption. Relative to Ontario public schools, attending school in Alberta was associated with more frequent energy drink intake and overall SSB intake whereas attending an Ontario private school was associated with less frequent soft drink intake, with no differences in overall SSB intake. Few beverage availability variables were significantly associated with participants' SSB intake., Conclusions: Mandatory provincial school nutrition policies were predictive of more limited SSB availability in school vending machines. SSB intake was significantly lower in Ontario public and private schools, although we did not detect a direct association between SSB consumption and availability. The findings provide support for mandatory school nutrition policies, as well as the need for comprehensive school- and broader population-level efforts to reduce SSB intake.

Introduction: Screen time, a proxy for sedentary behaviours, has emerged as a critical health determinant among youth in contemporary societies, where most aspects of youth life involve access to screen-time devices. An understudied approach to reducing screen time among youth is bullying reduction. This study aims to understand the association between bullying perpetration, victimization, youth perception of the school environment and multiple screen-time behaviours., Methods: A total of 44,861 youth aged between 13 and 18 years in two Canadian provinces completed a validated questionnaire that collected student data on health behaviours and outcomes, including multiple screen-time behaviours, bullying perpetration and victimization, and school connectedness. The outcome variables were total screen time, time spent watching television, playing video games, internet surfing, and communication- based screen-time behaviours. Using a random intercept, the final models were built using PROC MIXED in SAS 9.4. These models were adjusted for age, ethnicity, weekly disposable income, daylight hours, and weather variables., Results: Compared to youth who reported non-involvement in bullying, youth who were bullies, victims, or both bullies and victims spent on average more minutes per day in front of screens across all screen time categories. Youth who felt happy and safe at school, and who perceived their teachers as being fair, reported lower levels of multiple screen-time behaviours., Conclusion: With non-involvement in bullying showing a strong negative association with multiple screen-time behaviours, school policies to address bullying and screen time through school connectedness could offer a novel approach in minimizing these harmful behaviours., Competing Interests: Apart from Dr. Leatherdale being the CIHR-PHAC Chair in Applied Public Health Research, and an Associate Scientific Editor with Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice, we declare that no other conflicts of interest exist.

Increasing the uptake of school health research into practice is pivotal for improving adolescent health. COMPASS, a longitudinal study of Ontario and Alberta secondary students and schools (2012-2021), used a knowledge exchange process to enhance schools' use of research findings. Schools received annual summaries of their students' health behaviors and suggestions for action and were linked with a knowledge broker to support them in making changes to improve student health. The current research explored factors that influenced COMPASS knowledge exchange activities. Semistructured interviews were conducted with researchers (n = 13), school staff (n = 13), and public health stakeholders (n = 4). Interestingly, knowledge users focused more on factors that influenced their use of COMPASS findings than factors that influenced knowledge brokering. The factors identified by participants are similar to those that influence implementation of school health interventions (e.g., importance of school champions, competing priorities, inadequate resources). While knowledge exchange offers a way to reduce the gap between research and practice, schools that need the most support may not engage in knowledge exchange; hence, we must consider how to increase engagement of these schools to ultimately improve student health.

Background: Many Canadian schools offer breakfast programs; however, students' engagement in these programs is low, while breakfast skipping is highly prevalent among youth. This study examined whether the availability of breakfast programs supports adolescents' regular breakfast eating, and identified characteristics of breakfast skippers who are not using these programs., Methods: Data from 30,771 secondary school students from Ontario and Alberta, Canada, participating in Year 3 (2014-2015) of the COMPASS study were used for descriptive and logistic regression analyses. Participants were categorized by self-reported breakfast eating and school breakfast program use., Results: Sixteen percent of participants reported using school breakfast programs. Breakfast skipping was highly prevalent among participants, regardless of their breakfast program use. Characteristics significantly associated with program use included traveling to school via public transit or a school bus, being a bullying victim, and having a high school connectedness score. A desire to lose weight and non-involvement in school sports were significantly associated with being a "breakfast skipper/nonprogram user.", Conclusions: School breakfast programs do not consistently support regular breakfast eating, even among adolescents actively engaged in these programs. Future research should identify and evaluate practices to bolster participation in breakfast programs and promote regular breakfast eating among adolescents., (© 2018, American School Health Association.)

Objectives: This study explored school start times (SST) in relation to sleep duration and adherence to guidelines among Canadian youth., Methods: Using Year 4 (2015/2016) data from the Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behaviour (COMPASS) study, the sample included 35,821 grade 9-12 students at 78 secondary schools in Ontario and Alberta, Canada. Random intercepts models tested student-reported sleep duration and whether students met sleep recommendations, as a function of SST, controlling for student- (race/ethnicity, grade, sex, travel mode to school) and school-level (school-area urbanicity and median household income) correlates., Results: For each hour delay in SST, students reported an average of almost 7 minutes longer sleep and had 1.17 (adjusted odds ratio; 95% confidence interval, 1.04-1.31) higher odds of meeting the recommendations, with other factors held constant., Conclusions: Potential impacts on student sleep require consideration when deciding on school schedules. Delayed SST warrant further exploration as an intervention to help ameliorate the widespread sleep deprivation found among Canadian youth., (Copyright © 2017 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: To examine school- and student-level correlates of physical activity., Methods: Cross-sectional Year 2 data collected from 45 298 grade 9-12 students attending 89 secondary schools in the COMPASS study were examined using multi-level modelling to predict the likelihood of students a) achieving 60 minutes of moderate to vigorous physical activity (MVPA) daily; and b) achieving the Canadian Society for Exercise Physiology (CSEP) activity guideline for youth (60 minutes/MVPA daily, vigorous physical activity at least three days in a week, and resistance training at least three days in a week)., Results: The prevalence of students achieving 60 minutes of MVPA daily and meeting the CSEP guideline was 49.3% and 31.0% respectively. Modest between-school variability was identified (1.1% for 60 minutes MVPA and 0.8% for CSEP guideline). School-level characteristics significantly associated with the outcome measures included location, school size, quality of facilities, and accessibility of facilities. Significant student-level correlates included sex, grade, weekly income, binge drinking, fruit and vegetable consumption, and body mass index., Conclusions: Most youth in this large study reported inadequate physical activity levels. Students were more likely to achieve 60 minutes of MVPA if they attended a larger school or a school in an urban location, whereas students were less likely to meet the CSEP guideline if they attended a school in a small urban location. However, student-level factors, such as binge drinking and inadequate fruit and vegetable consumption, were more strongly associated with the outcomes examined.

Objective: The current study sought to examine Guatemalan adolescents' consumption of sugar-sweetened beverages (SSB), identify which individual-level characteristics are associated with SSB consumption and describe school characteristics that may influence students' SSB consumption., Design: Within this observational pilot study, a questionnaire was used to assess students' consumption of three varieties of SSB (soft drinks, energy drinks, sweetened coffees/teas), as well as a variety of sociodemographic and behavioural characteristics. We collected built environment data to examine aspects of the school food environment. We developed Poisson regression models for each SSB variety and used descriptive analyses to characterize the sample., Setting: Guatemala City, Guatemala., Subjects: Guatemalan adolescents (n 1042) from four (two public, two private) secondary schools., Results: Built environment data revealed that students from the two public schools lacked access to water fountains/coolers. The SSB industry had a presence in the schools through advertisements, sponsored food kiosks and products available for sale. Common correlates of SSB consumption included school type, sedentary behaviour, frequency of purchasing lunch in the cafeteria, and frequency of purchasing snacks from vending machines in school and off school property., Conclusions: Guatemalan adolescents frequently consume SSB, which may be encouraged by aspects of the school environment. Schools represent a viable setting for equitable population health interventions designed to reduce SSB consumption, including increasing access to clean drinking-water, reducing access to SSB, restricting SSB marketing and greater enforcement of existing food policies.

School breakfast programs are widespread and serve varying objectives regarding youth health promotion. Evidence-based guidelines for breakfast programs may be important in maximizing their effectiveness related to student outcomes, yet it is unclear what is available in Canada. A systematic review was conducted to identify and compare Canadian guidelines related to breakfast programs. Data sources included grey literature databases, customized search engines, targeted websites, and content expert consultations. Eligible guidelines met the following criteria: government and nongovernment sources at the federal and provincial/territorial levels, current version, and intended for program coordinators. Recommendations for program delivery were extracted, categorized, and mapped onto the 4 environments outlined in the ANGELO framework, and they were classified as "common" or "inconsistent" across guidelines. Fifteen sets of guidelines were included. No guidelines were available from federal or territorial governments and 4 provincial governments. There were few references to peer-reviewed literature within the guidelines and despite many common recommendations for program delivery, conflicting recommendations were also identified. Potential barriers to program participation, including a lack of consideration of allergies and other dietary restrictions, were identified. Future research should identify how guidelines are implemented and evaluate what effect their implementation has on program delivery and student outcomes.

Objectives: We investigated the extent to which a sample of Ontario and Alberta secondary schools are being compliant with their respective provincial nutrition policies, in terms of the food and beverages sold in vending machines., Methods: This observational study used objective data on drinks and snacks from vending machines, collected over three years of the COMPASS study (2012/2013-2014/2015 school years). Drink (e.g., sugar-containing carbonated/non-carbonated soft drinks, sports drinks, etc.) and snack (e.g., chips, crackers, etc.) data were coded by number of units available, price, and location of vending machine(s) in the school. Univariate and bivariate analyses were undertaken using R version 3.2.3. In order to assess policy compliancy over time, nutritional information of products in vending machines was compared to nutrition standards set out in P/PM 150 in Ontario, and those set out in the Alberta Nutrition Guidelines for Children and Youth (2012) in Alberta., Results: Results reveal a decline over time in the proportion of schools selling sugar-containing carbonated soft drinks (9% in 2012/2013 vs. 3% in 2014/2015), crackers (26% vs. 17%) and cake products (12% vs. 5%) in vending machines, and inconsistent changes in the proportion selling chips (53%, 67% and 65% over the three school years). Conversely, results highlight increases in the proportion of vending machines selling chocolate bars (7% vs. 13%) and cookies (21% vs. 40%) between the 2012/2013 and 2014/2015 school years., Conclusion: Nutritional standard policies were not adhered to in the majority of schools with respect to vending machines. There is a need for investment in formal monitoring and evaluation of school policies, and the provision of information and tools to support nutrition policy implementation.

Background: Despite the importance of breakfast consumption, breakfast skipping is common among Canadian youth. This study examines how changes to school-based breakfast programs are associated with breakfast-skipping behavior., Methods: Using school-level longitudinal data from Year 1 (Y1 : 2012-2013) and Year 2 (Y2 : 2013-2014) of the COMPASS study, quasi-experimental methods evaluated the impact over time that changes to school-based breakfast programs had on breakfast skipping or participating in school-based breakfast program., Results: Between Y1 and Y2 , the school-level prevalence of breakfast skipping (54.5%-54.9%) and breakfast program participation (12.3%-13.6%) increased. Of the 43 participating schools, 5 implemented a new school breakfast program. Among the intervention schools, 1 school (School 4) observed a significant, and 1 school (School 3) observed a significant increase in the school-level prevalence of skipping breakfast; there was no significant change in the other 3 intervention schools., Conclusions: Despite the availability of free school breakfast programs, the majority of youth skipped breakfast at least once a school week. Owing to the variation in the types of programs implemented, additional evaluation evidence is necessary to determine which students benefited the most from these programs., (© 2016, American School Health Association.)

Background: Adolescence is characterized by low moderate- to vigorous- intensity physical activity (MVPA) levels. Targeting the school setting can increase MVPA among a large proportion of adolescents. However, school-based physical activity interventions for adolescents remain largely ineffective. Therefore, the purpose of this study was to examine how naturally-occurring changes to school physical activity policy, recreational programming, public health resources, and the physical environment, impact adolescent MVPA over a 1-year period., Methods: Quasi-experimental longitudinal data from 18,777 grade 9-12 students (mean age = 15.1 ± 0.02 years), and 86 principals from 86 schools, participating in year 2 (2013-2014) and year 3 (2014-2015) of the COMPASS study (Ontario and Alberta, Canada) was used. Total MVPA over the previous week was self-reported at both time points using the COMPASS Student Questionnaire and average daily MVPA was calculated. Changes to physical activity policies, recreational programming, public health resources, and the physical environment were self-reported by school principals. Changes to the number and condition of physical activity facilities were objectively measured during school audits using the COMPASS School Environment Application. Multi-level modeling was used to examine change in student MVPA between schools that made changes and schools that did not. Models were adjusted for several student and school level confounders., Results: Over the 1-year period, 61 of 86 schools made physical activity related changes. Of these, 9 significantly changed student MVPA. However, only 4 of 9 schools' changes increased student MVPA, including opening the fitness centre at lunch (β = 17.2, 95% CI: 2.6-31.7), starting an outdoor club (β = 17.8, 95% CI:7.4-28.1), adding a bike rack (β-14.9, 95% CI:0.7-29.1), and adding weightlifting and run/walk clubs, archery, figure skating, increased access to the sports field, and improved condition of the outdoor basketball court (β = 15.5, 95% CI: 5.2-25.7)., Conclusions: Changes such as adding or increasing access to facilities, and adding multiple recreational programs, seemed to be effective for increasing student MVPA over the 1-year period. However, given the specificity of results, a one-size fits all approach may not be effective for increasing MVPA. Instead, school principals need to consider the resources within and surrounding their school, and the interests of the students.

Purpose: To examine lunch sources during the school week among students and the associations with fruits and vegetable (F&V) and sugar-sweetened beverage (SSB) consumption., Methods: Students (n = 23 680) from 43 Ontario, Canada, secondary schools completed a health behaviour survey in the Year 1 COMPASS study. Analysis used generalized linear mixed effects models., Results: The most frequently reported lunch source was home (2.9 days per school week), then the school cafeteria (1.1) and fast-food places or restaurants (FFRs) (0.9). Eating a home lunch was associated with having less spending money, white ethnicity, and females; whereas cafeteria lunch was associated with more spending money, lower school grade, and females. A FFR lunch was associated with males, more spending money, and higher physical activity. Greater frequency of a home lunch was associated with greater F&V consumption. Greater frequency of a FFR lunch was associated with more frequent SSB consumption. Cafeteria lunches were associated with increases in both SSB and F&V., Conclusions: Eating a lunch obtained from outside of the home is a regular behaviour among students. Sources of school-week lunches may have an important influence on dietary intake among youth. These findings reinforce the need for strategies to promote healthier lunch sources and healthier food options.

Background: Grey literature is an important source of information for large-scale review syntheses. However, there are many characteristics of grey literature that make it difficult to search systematically. Further, there is no 'gold standard' for rigorous systematic grey literature search methods and few resources on how to conduct this type of search. This paper describes systematic review search methods that were developed and applied to complete a case study systematic review of grey literature that examined guidelines for school-based breakfast programs in Canada., Methods: A grey literature search plan was developed to incorporate four different searching strategies: (1) grey literature databases, (2) customized Google search engines, (3) targeted websites, and (4) consultation with contact experts. These complementary strategies were used to minimize the risk of omitting relevant sources. Since abstracts are often unavailable in grey literature documents, items' abstracts, executive summaries, or table of contents (whichever was available) were screened. Screening of publications' full-text followed. Data were extracted on the organization, year published, who they were developed by, intended audience, goal/objectives of document, sources of evidence/resources cited, meals mentioned in the guidelines, and recommendations for program delivery., Results: The search strategies for identifying and screening publications for inclusion in the case study review was found to be manageable, comprehensive, and intuitive when applied in practice. The four search strategies of the grey literature search plan yielded 302 potentially relevant items for screening. Following the screening process, 15 publications that met all eligibility criteria remained and were included in the case study systematic review. The high-level findings of the case study systematic review are briefly described., Conclusions: This article demonstrated a feasible and seemingly robust method for applying systematic search strategies to identify web-based resources in the grey literature. The search strategy we developed and tested is amenable to adaptation to identify other types of grey literature from other disciplines and answering a wide range of research questions. This method should be further adapted and tested in future research syntheses.

Objectives: To explore school and student characteristics associated with the number of physical education (PE) classes that elementary students received and to determine whether these characteristics and amount of PE were associated with the physical activity (PA) levels of elementary students., Methods: Multi-level modeling with school-level (n = 30) and student-level (n = 2,447) questionnaire data from the PLAY-ON study was used to explore the school factors associated with the number of PE classes that students in grades 5 to 8 report receiving, and how these factors were associated with their PA. The Theories of Organizational Change served to operationalize the main school factors measured in this study and included assessments of: organizational climate (school practices related to PE or PA), organizational capacity (school ability to provide students with more PE or PA), and school PA/PE policies., Results: The number of PE classes reported per week was higher in schools that had two PA facilities in addition to a gymnasium (β = 1.13, p = 0.048) and in schools with greater levels of parental involvement in school-based PA decisions and programs (β = 2.06, p = 0.001). However, students in schools that provided more intramural programs reported fewer PE classes than those without (β = -1.97, p &lt; 0.001). The number of PE classes provided in the previous week was associated with greater odds of students being highly active compared to minimally active (OR = 1.14, p = 0.003)., Conclusion: Organizational and structural factors within the school environment are related to the amount of PE that students receive at school. Strategies are required to resolve the resulting inequities.

Research has identified that perceived weight status is a better predictor of weight control behavior than actual weight status. The purpose of this study was to examine whether the accuracy of weight status perception varies across schools, and to identify the student-level characteristics associated with inaccurate weight status perception among 25,060 grade 9 to 12 students attending 76 schools in Ontario, Canada. Although the majority of adolescents (60.4%) had accurate weight status perceptions, multi-level logistic regression analyses revealed significant between-school variability in the accuracy of weight status perceptions for both males and females. School location and school-level socioeconomic status were the school-level variables analyzed. We identified that males attending urban or suburban schools were more likely to overestimate their weight status compared with males attending rural schools. Important student-level characteristics included grade, weight status, sports participation and social influences. Additional research is required to better understand both the school- and student-level characteristics associated with the accuracy of weight status perceptions among adolescents.

Objectives: To examine school and student characteristics associated with physical activity in grade 1 to 4 students., Methods: Multi-level logistic regression examined factors associated with being moderately and highly active., Results: A student was more likely to be moderately or highly active if he/she attended a school that provides student access to facilities and equipment outside of school hours. Male students were more likely to be moderately or highly active and overweight or obese students were less likely to be moderately or highly active., Conclusions: Research should evaluate if implementing a school policy that provides student access to facilities and equipment outside of school hours is effective in promoting physical activity in grade 1 to 4 students.

Background: Excessive weight gain among youth is an ongoing public health concern. Despite evidence linking both policies and the built environment to adolescent and adult overweight, the association between health policies or the built environment and overweight are often overlooked in research with children. The purpose of this study was to examine if school-based physical activity policies and the built environment surrounding a school are associated with weight status among children., Methods: Objectively measured height and weight data were available for 2,331 grade 1 to 4 students (aged 6 to 9 years) attending 30 elementary schools in Ontario, Canada. Student-level data were collected using parent reports and the PLAY-On questionnaire administered to students by study nurses. School-level policy data were collected from school administrators using the Physical Activity Module of the Healthy School Planner tool, and built environment data were provided by the Enhanced Points of Interest data resource. Multi-level logistic regression models were used to examine the school- and student-level characteristics associated with the odds of a student being overweight or obese., Results: There was significant between-school random variation in the odds of a student being overweight [σ²(μ0) = 0.274(0.106), p < 0.001], but not for being obese [σ²(μ0) = 0.115(0.089)]. If a student attended a school that provided student access to a variety of facilities on and off school grounds during school hours or supported active transportation to and from school, he/she was less likely to overweight than a similar student attending a school without these policies. Characteristics of the built environment were not associated with overweight or obesity among this large cross-sectional sample of children., Conclusions: This new evidence suggests that it may be wise to target obesity prevention efforts to schools that do not provide student access to recreation facilities during school hours or schools that do not support active transportation for students. Future research should evaluate if school-based overweight and obesity prevention programming might be improved if interventions selectively targeted the school characteristics that are putting students at the greatest risk.

Objectives: The current study team sought to understand smokeless tobacco (SLT) usage trends among youth, using nationally representative data collected as part of the Canadian Youth Smoking Survey (YSS) between 2004 and 2008., Methods: Descriptive analyses of SLT ever use among respondents in grades 6 to 9 were examined according to year of data collection (2008, n = 31,249; 2006, n = 34,050; and 2004, n = 23,362). Using the 2008 data from respondents in grades 6 to 12 (n = 51,922), logistic regression models were used to examine characteristics associated with SLT ever use and current use., Results: Between 2004 and 2008, the prevalence of youth in grades 6 to 9 reporting they have ever tried SLT significantly decreased by 30.8%. In 2008, male students were more likely than females to have tried SLT (OR 4.87, 95% CI 4.34-5.45) or to currently use SLT (OR 4.96, 95% CI 4.12-5.96). There are regional differences in prevalence of SLT use across Canada, with the highest rates in western provinces and the lowest in Quebec. Current smokers were also more likely to use SLT (OR 11.86, 95% CI 10.22-13.76) compared to non-smokers. Older students are more likely to report ever use or current use of SLT., Conclusion: The findings from this study demonstrate that in Canada, adolescent SLT use is primarily an issue with males and there are significant regional differences. Ongoing monitoring of SLT is encouraged considering the tobacco industry's recent investments and product development and increased use in countries like the United States.

Few studies have examined how school characteristics are associated with obesity. The purpose of this study was to examine the student- and school-level characteristics associated with being overweight and obese among 12,049 students in grades 9 and 10 (junior students) attending 76 secondary schools in Ontario, Canada. The sample was 49.2% female and the average age was 14.7 years. Overall, 15.0% of the sample was considered overweight and 6.3% of the sample was considered obese. Multi-level regression analysis revealed significant between-school random variation for the likelihood of a junior student (grade 9 or 10) being overweight or obese. For each 1% increase in the prevalence of obese senior students (grade 11 and 12) at a school, the odds of a junior student at that school being overweight or obese increased significantly. Important student-level characteristics included physical activity, screen time sedentary behaviour (e.g., watching television), participation in varsity sports and gender. Future research should evaluate if the optimal population level impact for school-based obesity prevention programming might be achieved by targeting the schools that are putting students at the greatest risk.

The objective is to examine school-level program and policy characteristics and student-level behavioural characteristics associated with being overweight. Multilevel logistic regression analysis were used to examine the school- and student-level characteristics associated with the odds of a student being overweight among 1264 Grade 5-8 students attending 30 elementary schools in Ontario, Canada. Data were derived from the Physical Activity of Youth in Ontario Schools host study. Significant between-school random variation in overweight was identified [σ²(μ0)=0:187 (0:084), P < 0.001]; school-level differences accounted for 5.4% of the variability in the odds of a student being overweight versus a normal weight. A student attending a school that was in the action phase for the school-level construct 'Availability and use of interschool programs' was significantly less likely to be overweight than a similar student attending a school that was in the initiation phase for this construct. Important student-level characteristics included physical activity (PA) and gender. Developing a better understanding of the school- and student-level characteristics associated with overweight among youth is critical for informing school-based prevention policies. Future research should evaluate if implementing and promoting interschool PA programming, and which types of interschool activities, are effective in preventing or reducing overweight.

Objectives: Schools represent an important environment for physical activity (PA) promotion among youth. Schools can promote PA through policies and programs but our understanding of how these school characteristics associate with student PA levels is largely unknown. Developing this understanding is critical for implementing new prevention interventions. The aim of this study was to identify the school- and student-related characteristics associated with moderate and high levels of PA in a sample of Ontario elementary schools., Methods: Using multi-level logistic regression analyses, we explored the school- and student-level characteristics associated with being moderately and highly active using data collected from administrators and from students in grades 5 to 8 at 30 elementary schools in Ontario. Students' PA levels, sex, grade, and the number of physical education classes per week were linked to school environment data--specifically, a school's chosen implementation model for daily physical activity and whether it offers intramural and interschool PA programming., Results: Findings indicate that there was significant between-school variation for being moderately and highly active. Students were less likely to be moderately or highly active if they attended a school offering interschool PA programming. An important student characteristic positively associated with student PA levels included participating in at least two physical education classes per week., Conclusion: The residual differences in PA by school suggest that school-level characteristics facilitate higher levels of student PA beyond individual-level factors. Although most variation in student PA lies between students within schools, there is sufficient between-school variation to be of interest to practitioners and policy-makers.

Introduction: We examined school and student characteristics associated with screen-time sedentary behavior., Methods: We analyzed data collected from 2,449 students in grades 5 through 8 who attended 30 elementary schools in Ontario, Canada. We used multilevel logistic regression to examine the student- and school-level factors associated with moderate and high screen-time sedentary behavior., Results: Moderate screen time did not vary significantly across schools. Student characteristics significantly associated with moderate screen time were sex, number of friends who are active, and parental encouragement of physical activity. High screen time did vary significantly across schools; school-level differences accounted for 12% of the variability in the odds of a student reporting high screen time. Students who attended a school in the more advanced phase of emphasizing participation in physical activity through school programs were less likely to report high screen time compared with students who attended schools in the earlier phase for this school-level indicator. Student characteristics significantly associated with high screen time were sex, parental encouragement of physical activity, parental support of physical activity, and race/ethnicity., Conclusion: High levels of screen-time sedentary behavior are associated with both student characteristics and the characteristics of the school a student attends. Developing a better understanding of the school characteristics associated with sedentary behavior will be valuable for guiding the development of interventions to reduce sedentary behavior among youth populations.

Background: Schools can be an efficient venue for promoting physical activity (PA) among adolescents. Physical education (PE) requires investigation because it is a variable associated with adolescent PA levels and its existence in schools represents a significant opportunity for strategies to combat declining PA levels among this population. This article examines the between-school variability in student rates of PE enrollment among a large sample of high schools in Ontario, Canada, and identifies the school- and student-level characteristics associated with PE enrollment., Methods: This cross-sectional study utilized self-reported school- and student-level data from administrators and students at 73 high schools. Students' enrollment in PE, demographic, behavioral, and psychosocial variables was linked to school environment data comprising of school demographics and administrator assessed quality of policies, facilities, and programs related to PA. Analysis involved multilevel modeling., Results: The mean rate of PE enrollment among the 73 high schools was 62.4%, with rates by school ranging from 28.9% to 81.1%. When student demographics, behavioral, and psychosocial factors were controlled for, there was still a school effect for student PE enrollment. The school effect was explained by the provision of daily PE and school median household income., Conclusions: This is the first study to examine the extent to which PE enrollment varies between schools and to identify school factors associated with school variability in rates of PE enrollment. Although most variation in PE enrollment lies between students within schools, there is sufficient between-school variation to be of interest to practitioners and policy makers.

Purpose: To examine how school-based smoking policies and prevention programs are associated with occasional and regular smoking among a cohort of grade 12 students in Prince Edward Island, Canada, between 1999 and 2001., Methods: Data from the Tobacco Module of the School Health Action, Planning and Evaluation System (SHAPES) collected from 3,965 grade 12 students in 10 high schools were examined using multi-level regression analysis., Results: Attending a school with smoking prevention programming was associated with a decreased risk of being an occasional smoker (OR 0.42, 95% CI: 0.18, 0.97). School-based policies banning smoking on school property were associated with a small increased risk of occasional smoking (OR 1.06, 95% CI: 0.67, 1.68) among some students. The combination of both policies and programs was not associated with either occasional or regular smoking., Conclusion: This preliminary evidence suggests that tailored school-based prevention programming may be effective at reducing smoking uptake; however, school smoking policies and the combination of programs and policies were relatively ineffective. These findings suggest that a new approach to school-based tobacco use prevention may be required.

Background: Current tobacco access restrictions are ineffective because youth can find noncompliant retailers or social sources from which to get cigarettes., Purpose: The purpose of this study is to examine characteristics related to the cigarettes access behaviors of underage smoking youth., Methods: Data were collected from 20,297 students (Grades 9-12) attending 29 secondary schools in Ontario, Canada in 2001. Multilevel logistic regression analyses were used to examine how tobacco retailers surrounding schools, school smoking rates, and student characteristics were related to smokers buying their own cigarettes, getting someone else to buy their cigarettes, or getting their cigarettes from friends., Results: Among underage smokers, 34.3% usually buy their own cigarettes, and 42.1% report that they are never asked for their age when trying to buy cigarettes. The more tobacco retailers there were surrounding a school, the more likely smokers were to buy their own cigarettes and the less likely they were to get someone else to buy their cigarettes. Students' smoking habits were also related to their cigarette access behaviors., Conclusions: Tobacco retailer density surrounding schools is related to student cigarette access behaviors. Selective enforcement of youth access laws in retail outlets in close proximity to schools might help to prevent underage youth from smoking.

The purpose of this study was to examine how social models for smoking are related to smoking susceptibility among a sample of non-smoking elementary school students. The Tobacco Module of the School Health Action, Planning and Evaluation System (SHAPES) was administered to 6,431 students (grades 6 to 8) in 57 elementary schools in the province of Ontario, Canada. Multi-level logistic regression analysis was used to examine how smoking friends, parents, and the prevalence of smoking among grade 8 students at a school were related to smoking susceptibility among the 2,478 non-smoking grade 6 and 7 students. Findings indicate that non-smoking grade 6 and 7 students are more likely to be susceptible to smoking if they have (a) smoking friends, (b) a mother who smokes, or (c) two or more close friends who smoke and attend a school with a relatively high smoking rate among the grade 8 students. Sub-populations of non-smoking youth may be at increased risk for smoking because of the elementary school they attend. Future school-based smoking prevention programs might benefit from targeting prevention programming activities to the schools that are putting students at the greatest risk for smoking.

Introduction: Canadian youth are insufficiently active, and schools may play a role in promoting student physical activity (PA). Based on the Comprehensive School Health (CSH) framework, this study examined whether school characteristics are associated with secondary school students meeting national PA recommendations over time. Methods: We used COMPASS survey data from 78 schools in Ontario and Alberta and 9870 Grade 9 and 10 students attending those schools. Students who provided two years of linked PA data (2013/14 and 2015/16) and gender were included. Multilevel analysis was conducted by gender, evaluating the relationship of school-level characteristics (guided by CSH) with students achieving all three PA recommendations after two years (≥ 60 min/day of moderate-to-vigorous PA, vigorous PA ≥ 3 days/week, strengthening activities ≥ 3 days/week). Results: More than half (56.9%) of students achieving the PA recommendations at baseline were no longer achieving them after two years, and just a quarter (25.6%) of students not achieving the recommendations at baseline achieved them after two years. School-level factors were significantly associated with students achieving the recommendations, but these factors differed by student strata (i.e. by gender and baseline PA status). Generally, student access to equipment, public health partnerships and staff time for health were associated with increased odds of achieving the PA recommendations for certain students. Conclusion: Modifications to school characteristics within CSH may play a role in supporting students in achieving or continuing to achieve the PA recommendations after two years. Further research is needed to better understand the underlying dynamics of the observed relationships. [ABSTRACT FROM AUTHOR]

Background: In the school year immediately following cannabis legalization in Canada, this paper investigated youth perceptions of school support for the prevention and cessation of substance use. Scant research has examined student perceptions in relation to school disciplinary approaches. This study was the first to classify school discipline approach styles using school-level measures. Objective: The objective of this study was to examine whether different school cannabis use-related disciplinary approaches are associated with student cannabis use and perceptions of school supportiveness for the prevention and cessation of substance use. Results: School- and student-level survey data from Year 7 (the 2018/2019 school year) of the COMPASS study were used, including 68,037 grade 9–12 (Secondary I–V in Quebec) students attending 131 Canadian secondary schools. Schools were classified as using different cannabis use-related disciplinary styles based on school-administrator reported approaches to student first-offense violations of school cannabis policies. We identified that although none of the cannabis use-related disciplinary approach styles examined were associated with cannabis use, they were associated with student perceptions. Students attending schools classified as using a Permissive/Supportive approach had a higher likelihood of perceiving their school as supportive for substance use prevention/cessation than their peers at Authoritarian schools. Students who perceived their school as supportive for substance use prevention/cessation were less likely to report current cannabis use than their peers who perceived their school as unsupportive. Conclusions: Unlike previous studies using school classification styles that are based on student perceptions, results do not support direct associations between school cannabis use-related disciplinary styles and student cannabis use. Future prospective research should examine whether supportive disciplinary approaches (e.g., counseling referrals, educational programs) promote student perceptions of school supportiveness, and in turn, deter student substance use. [ABSTRACT FROM AUTHOR]

BACKGROUND: The school environment has the potential to influence student body mass index (BMI) through programs and policies. Our objective was to examine the effect of modifying obesity‐related school policies and programs on youths' BMI trajectories. METHODS: Obesity‐related school policies and programs related to physical activity and healthy eating were collected from 41 schools across Ontario at baseline (2012‐2013) and year 2 (2013‐2014) of the COMPASS study. Self‐reported height and weight were collected from the 4951 grades 9 and 10 students who attended those schools for 3 years. Linear mixed effects regression models examined the effect of modifying obesity‐related school policies and programs on youths' BMI trajectories. RESULTS: Between Y1 and Y2, 26 of the 41 schools implemented distinct new obesity‐related programs or policies related to physical activity or healthy eating. Five of the interventions were associated with BMI trajectories of students attending those schools compared to students attending a pooled sample of control schools, predicting a higher BMI trajectory. CONCLUSIONS: Isolated programs and policies may not successfully improve youths' BMI trajectories. Further research is required to test the implementation of policies and programs that follow a comprehensive school health (CSH) approach, targeting BMI and associated behaviors. [ABSTRACT FROM AUTHOR]