Canadian Adolescents Research Articles

Use of Legal Appearance- and Performance-Enhancing Drugs and Substances: Findings from the Canadian Study of Adolescent Health Behaviors

Background Use of appearance- and performance-enhancing drugs and substances (APEDS) is common among adolescent and young adults. Many APEDS are legally sold “over-the-counter,” however research has documented contamination of legal APEDS and many adverse effects of use. Despite this, little research has been conducted on legal APEDS use in Canada, particularly regarding the prevalence and sociodemographic predictors of use, which was the aim of this study. Methods Data from the Canadian Study of Adolescent Health Behaviors (N = 2,731) were analyzed. Prevalence and frequency of use of 10 common APEDS in the past 12 months were estimated overall and across genders. Multiple modified Poisson regression analyses were conducted to determine the sociodemographic predictors of APEDS use. Results Overall, use of caffeine was most common among the sample (71.3%), along with protein bars (63.4%), and whey protein powders or protein shakes (63.1%). Boys and men reported greater prevalence of use of eight of the 10 APEDS, with the exception of diuretics or water pills and probiotics, compared to girls and women and transgender/gender non-confirming participants. Over three quarters (82.5%) of boys and men reported use of whey protein powders or protein shakes and 50.3% reported use of creatine monohydrate. Use of APEDS varied based on several key sociodemographic identifiers. Conclusions This study is the first to document legal APEDS use among a sample of Canadian adolescents and young adults, providing important implications for health care and policymaking professionals. Further research is needed to gain greater insight into APEDS use among Canadian young people.

The COVID-19 Pandemic and Quality of Life: Experiences Contributing to and Harming the Well-Being of Canadian Children and Adolescents.

The pandemic's restrictive measures such as lockdowns, social distancing, and the wearing of masks transformed young people's daily lives and brought up major concerns regarding children's and adolescents' well-being. This longitudinal mixed study aims to identify how different experiences contributed to children's and adolescents' well-being through different stages of the pandemic. The sample comprises 149 Canadian youth from Quebec who shared their experiences of the COVID-19 pandemic. Children and adolescents were met virtually for semi-directed interviews about their well-being at three measurement time (T1: May 2020 lockdown, T2: July 2020 progressive reopening, and T3: beginning of the second wave). At T3, they also completed a questionnaire measuring their quality of life. Our findings indicated that 22% reported a low level of well-being (N: 32), 66% a normal level of well-being (N: 90), and 18% a high level of well-being (N: 27). The comparative thematic analysis of the discourse of these three groups allows us to identify experiences that are favorable and unfavorable to the well-being of young people and to distinguish two configurations of interactions between children and their environment over the first year of the pandemic, namely that of young people who report a high level of well-being and that of those who report a worrying level of well-being. Results highlight the importance of activities, relationships, support, and representations of children and adolescents for their well-being in the pandemic context. Interventions and social measures to better support their well-being are discussed.

Gendered associations between e-cigarette use, cigarette smoking, physical activity, and sedentary behaviour in a sample of Canadian adolescents.

To examine associations between e-cigarette use, cigarette smoking, physical activity, and sedentary behaviour among a large sample of Canadian adolescents (Grades 9-12) by sex. Cross-sectional data from 55,629 students who participated in COMPASS Year 6 (2017-2018) were used. Exposures included e-cigarette use and cigarette smoking. Outcomes included meeting recommendations for moderate- to vigorous- physical activity (MVPA;≥60 min/d), muscular strengthening exercises (MSE;≥3 time/wk), and recreational screen time (ST;≤2 h/day) and participating in intramurals or competitive team sports. Logistic regressions were performed after adjusting for relevant covariates. Male adolescents showed higher prevalence of e-cigarette use (40.0% vs 31.3%) and cigarette smoking (4.4% vs 2.9%) than females. Both males and females who used e-cigarettes were more likely to meet MVPA and MSE recommendations, but less likely to meet the ST recommendation than those who did not use e-cigarettes. E-cigarette use was also consistently associated with more sport participation in males, however, among females the results were mixed. Current cigarette use was associated with meeting the MVPA recommendation and less participation in intramurals in males; however, in females, current cigarette smoking was consistently associated with less participation in any sports. Former cigarette use was associated with participation in competitive team sport within school and meeting the MSE recommendation in females only. This study found that associations between e-cigarette use and cigarette smoking with physical activity, sedentary behaviour, and sport participation are largely gendered. Identifying differential co-occurrence of risk behaviours by gender is important for future health promotion efforts targeting physical activity among adolescents.

Does pressure to gain social media attention have consequences for adolescents’ friendship closeness and mental health? A longitudinal examination of within-person cross-lagged relations

Many adolescents face pressure when it comes to securing social media attention in the form of views, comments and/or likes on their posted content. The purpose of this study was to examine how this pressure impacts adolescents’ current relationships with friends in addition to their mental health over time. Participants were Canadian adolescents (Time 1 n = 345; Mage = 17.29; 80.6% female) who reported on their felt pressure to gain social media attention, friendship closeness and internalizing symptoms in 3 surveys approximately 4 months apart (from August 2020 to June 2021). We used latent curve modeling with structured residuals (LCM-SR) to model the lagged relations between the aforementioned variables, while also controlling for time spent on social media and number of likes received. LCM-SR builds on multivariate latent curve modeling and autoregressive latent trajectory and allows for the simultaneous testing of between- and within-person stability and change over time. In line with our first hypothesis, results demonstrated that at time points when adolescents experienced more pressure to gain social media attention than usual, their friendship closeness decreased at the next time point. Social media pressure was not a significant predictor of internalizing symptoms, however. Results emphasize the importance of teasing apart within- and between-person effects when examining impacts of adolescent social media use. They also highlight the importance of targeting felt pressures to gain social media attention in order to support healthy adolescent relationships.

Adolescents’ Individual Characteristics and Intentions to Seek Help from Types of Peers and Parents

Adolescents’ relationships with friends and with parents provide them with access to potential sources of assistance when they are experiencing problems. However, we lack more nuanced information about the types of peers and parents they intend to approach and about the contributions their individual characteristics make to their plans. This study examined adolescents’ intentions to seek help for a personal/emotional problem from five types of peers and parents (female friend, male friend, romantic partner, mother, father) and evaluated the unique, common, and total contributions of youth’s individual characteristics (gender, adaptable temperament, negative affect, self-disclosure competence, and conformity to the emotional control, self-reliance, and nice in relationships gender norms) to their intentions. Participants were 358 Canadian adolescents (51% boys; Grades 9–12) who completed a survey at school. On average, adolescents reported moderate intentions to seek assistance from each type of peer and parent. Hierarchical regression and commonality analyses showed that adolescents’ gender, self-disclosure competence, and emotional control beliefs made the largest total contributions to help-seeking intentions for both types of friends; self-disclosure competence and emotional control and self-reliance beliefs were most salient for help-seeking intentions for a romantic partner; and self-reliance beliefs and negative affect were most salient for help-seeking intentions for each parent, with emotional control beliefs also contributing to help-seeking intentions for mother. These results highlight the need to include more precise terms for peers and parents in help-seeking models and in assessments of adolescents’ help-seeking intentions, and the benefit of examining the unique, common, and total contributions of adolescents’ individual characteristics to clarify their relevance to youth’s plans to seek help.

Canadian adolescents’ solitude experiences, self-perceptions, and well-being

This paper explores adolescents’ solitude activities, their reasons for choosing to be alone, and how they think and feel when they are away from others. Gender and age differences were also explored.ApproachWe looked at the links between solitary activities and emotional well-being and personal happiness. Sixty-one adolescents (68% female, Mage = 16.14 ± .50) completed self-report on-line measures assessing time alone, solitary activities, and indices of adjustment.FindingsMajority of participants reported that they were alone by choice, and that they were more often with others than alone. Age and gender differences emerged in time alone, feelings of self-worth, and emotional well-being.Research Limitations The demographics of participants was limited to English-speakers in Eastern Canada, and data collection was affected by the COVID-19 pandemic.Practical Implications School programs could be developed to better equip adolescents with the skills necessary to be productive in, and feel positive about, time spent alone.

Anabolic-androgenic steroid use: Patterns of use among a national sample of Canadian adolescents and young adults

BackgroundAndrogenic-anabolic steroid (AAS) use is relatively common among international recreational and community samples and is associated with several deleterious side effects and health consequences that have not been studied recently among a large Canadian sample. Therefore, the purpose of this study was to assess and describe characteristics of AAS users compared to non-AAS users among a national sample of Canadian adolescents and young adults. MethodsData from 2,774 adolescents and young adults from the Canadian Study of Adolescent Health Behaviors were analyzed. Participants were recruited via social media advertisements and completed the survey online. Survey items measured sociodemographics, AAS use, AAS side effects, motives for AAS use, AAS administration, body satisfaction, other illicit substance use, mental health, and violence involvement. ResultsAmong the overall sample, 1.6% of participants reported lifetime AAS use, with the majority of users being White, heterosexual males. Most users strived to gain weight, with main motives for AAS use including increased muscularity and strength, and improved appearance. Most AAS users were satisfied with their body compared to non-users. Approximately one in five users had AAS dependence and experienced multiple adverse side effects. Few differences between users and non-users in self-reported mental health were found. ConclusionFindings indicate that AAS use among a community sample of Canadian adolescents and young adults is an important health issue, particularly given the relatively high occurrence of AAS dependence and adverse side effects reported by users. Findings support the need for education and intervention efforts from healthcare professionals. Further investigations among Canadian AAS users may provide more insight regarding the unique supports these individuals require.

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

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

Intermittent fasting: Describing engagement and associations with eating disorder behaviors and psychopathology among Canadian adolescents and young adults

Intermittent fasting has grown in popularity over the past several years. However, intermittent fasting has also been shown to relate to eating disorder behaviors and psychopathology, yet little research has explored this relationship in epidemiological samples. Therefore, the aims of this study were to determine prevalence and characteristics of engagement in intermittent fasting, and associations with eating disorder behaviors and psychopathology. Data from the Canadian Study of Adolescent Health Behaviors, a national study of Canadian adolescents and young adults (N = 2762) were analyzed. Multiple modified Poisson regression analyses were conducted to determine the association between intermittent fasting (past 12 months and 30 days) and eating disorder behaviors and psychopathology (measured using the Eating Disorder Examination Questionnaire). Overall, 47.7 % of women, 38.4 % of men, and 52.0 % of transgender/gender non-conforming (TGNC) participants reported engaging in intermittent fasting in the past 12 months. Intermittent fasting in the past 12 months and 30 days was significantly associated with eating disorder psychopathology among women, men, and TGNC participants. Varying patterns of association between intermittent fasting and eating disorder behaviors were found across genders, with the most consistent relationships between intermittent fasting and ED behaviors in women. Findings underscore the common nature of intermittent fasting among a large, community sample of adolescents and young adults across Canada, as well as associated eating disorder behaviors and psychopathology. Continued research is needed to further understand the effects of intermittent fasting, as clinical and public health efforts are needed to protect the health of adolescent and young adults.

Development of an adolescent advisory group to inform sexual and reproductive health research for first- and second-generation immigrant adolescents in Canada: A community-based participatory action research study.

Despite the growing evidence supporting the benefit of engaging adolescents in research, the active engagement of immigrant adolescents in research is limited. Further, when exploring the sexual and reproductive health (SRH) needs of immigrant adolescents, utilization of adolescent advisory groups is finite. This study aimed to train and evaluate engagement of an adolescent advisory group (AAG) to inform SRH needs of immigrant adolescents in Canada. Using purposive sampling, 13 AAG members were recruited into this study. Members were trained in content related to SRH needs of adolescents and various research methodologies such as conducting a scoping review and qualitative interviews with adolescent participants. After 10 months of member engagement, their experiences were evaluated to identify areas of success and areas for improvement. These data were collected using the Public and Patient Engagement Evaluation Tool, which consisted of a Likert survey and open-ended questions, and analyzed in accordance to the Patient Engagement in Research (PEIR) framework. Ten members completed the evaluation survey. Likert survey responses were primarily positive. Majority of members showed positive demonstrations regarding various components of the PEIR framework, including contributions, support, research environment, and feeling valued. Findings illustrated that immigrant AAGs are constructive to informing SRH research. Not only can research teams benefit, but members are also empowered. This study provided the foundation for future immigrant adolescent engagement in research and knowledge translation, and effective means of evaluating engagement by utilizing the PEIR framework.

1 Ambulatory care visits and admissions for suicidal ideation and self-harm in Canadian adolescents during the COVID-19 pandemic: a population-based analysis

Abstract Background The COVID-19 pandemic has challenged the resiliency of Canada’s adolescent population. Understanding changes in mental healthcare utilization can shed light on the impact the pandemic has had on Canada’s youth. Objectives To assess if during the pandemic there has been an increase in the proportion of ambulatory care visits and admissions for suicidal ideation and self-harm among adolescents. Design/Methods This was a population-based, interrupted time-series analysis of adolescents 10-18 years presenting to an ambulatory care facility (including emergency department) or admitted to a healthcare facility with R458 (suicidal ideation and emotional symptoms), X60-69 (intentional self-poisoning), and X70-84 (intentional self-harm) codes based on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada (ICD-10-CA). We used the National Ambulatory Care Reporting System, Discharge Abstract Database, and Hospital Morbidity Database. The primary outcome was ambulatory care visits for a composite of suicidal ideation, intentional self-poisoning, and intentional self-harm. Results were stratified by age and sex and expressed as a rate (proportion of encounters with an outcome per 100 encounters). We compared the differences (delta) in slopes (average increase in outcomes) between April 1, 2015, to March 31, 2020, and April 1, 2020 to March 31, 2021 to determine if the expected rate (pre-pandemic) differed significantly from the observed rate (pandemic). Results From April 1, 2020, to March 31, 2021, compared to April 1, 2015, to March 31, 2020, the rate of ambulatory care visits and admissions for all conditions decreased. The average quarterly rate of ambulatory care visits for the composite among males 10-14 years, increased by 40.3%, from 0.57 to 0.8 (slope delta=0.1; 95% CI: 0.02, 0.18; p=0.012). Among females 10-14 years, the rate increased by 85.1%, from 1.81 to 3.35 (slope delta=0.7; 95% CI: 0.43, 0.97; p<0.001). Among males 15-18 years, the rate increased by 29.5%, from 1.56 to 2.02 (slope delta=0.13; 95% CI: -0.02, 0.28; p=0.078). Among females 15-18 years, the rate increased by 33.6%, from 3.18 to 4.25 (slope delta=0.26; 95% CI: -0.16, 0.68; p=0.192). The average quarterly rate of admissions was significant for females 10-14 years and increased by 27.7%, from 8.59 to 10.97 (slope delta=1.99; 95% CI: 0.57, 3.41; p=0.017). Conclusion The proportion of ambulatory care visits and admissions for emotional symptoms, suicidal ideation, and self-harm during the first year of the COVID-19 pandemic increased compared to pre-pandemic rates among adolescents 10-14 years in Canada. Our findings underscore the importance of promoting public health policies that mitigate the impact of pandemics on adolescent mental health.

5 Clinical and demographic characteristics of a cohort of children and adolescents followed at a multidisciplinary gender diversity clinic for French-speaking youth

Abstract Background According to recent population-based surveys, approximately 2% of Canadian children and adolescents identify as transgender or non-binary (TNB). Since its inception in 2016, the multidisciplinary paediatric gender diversity clinic at Sainte-Justine University Hospital Center has seen a rapid increase in the number of new referrals, which mirrors increases seen in paediatric gender diversity clinics across the country. Our clinic is the first Canadian multi-disciplinary paediatric gender diversity clinic for French-speaking youth and currently provides comprehensive affirmative medical care for approximately 350 TNB children and adolescents. TNB youths present significantly higher rates of mental health disorders and suicidal behaviours than their cis-gender peers. However, the specific needs and characteristics of French-speaking TNB youth have not yet been studied. Objectives The aim of the study is to describe the demographic and clinical characteristics of a cohort of children and adolescents who received care at the Sainte-Justine University Hospital Centre gender diversity clinic. Design/Methods De-identified data was collected retrospectively from the medical records of all 279 patients who received care at the clinic between its inception and May 31st, 2021. A research questionnaire was developed under the supervision of an adolescent medicine physician and a paediatric endocrinologist to collect data on patient socio-demographic, behavioural, psychosocial, mental health and medical characteristics. Follow-up visits were included until October 15th, 2021. All data was entered into a password-protected database. The project was approved by the CHU Sainte-Justine Research Ethics Board. Results At the time of their initial consultation, patients were on average 14.4 years old (4.1 to 18.3 years old) and 70.6% were assigned female at birth. Most of the youth had disclosed their gender identity to their families (94.3%) and nearly three-quarters (73.5%) had initiated a social transition. More than half of the patients presented with at least one mental health comorbidity (55.2%) on their first clinic visit. One in two youths reported past or current suicidal ideation at the initial consultation and 12.2% had attempted suicide. During the follow-up period, 49.5% of patients received a prescription for pubertal blockers and 40.9% received a prescription for gender-affirming hormonotherapy (testosterone or estrogen). Conclusion Children and adolescents followed at the Sainte-Justine University Hospital Center gender diversity clinic present with high rates of mental health comorbidities, including suicidal ideation and attempts, highlighting the importance of providing supportive services for these youths and their families. Future research building on these findings will help identify the specific needs, care trajectories, and impacts of gender affirming treatment on the health and well-being of French-speaking TNB youth.

Trends and Disparities in Suicidality Among Heterosexual and Sexual Minority/Two-Spirit Indigenous Adolescents in Canada

PurposeTo explore trends in sexual orientation group differences in suicidality among Indigenous adolescents and evaluate whether gaps between heterosexual and sexual minority/Two-Spirit adolescents have changed over time. MethodsLeveraging pooled school-based population data from five waves of the British Columbia Adolescent Health Survey (1998–2018), we used age-adjusted logistic regression models, separately for boys and girls, to examine 20-year trends and disparities in past year suicidal ideation and suicide attempts among heterosexual and sexual minority/Two-Spirit Indigenous adolescents (N = 13,788). ResultsSuicidal ideation increased among all sexual orientation groups in 2018 compared to previous survey waves. Suicide attempts spiked for heterosexual girls in 2003, remained stable for heterosexual boys, and decreased for sexual minority/Two-Spirit boys and girls over time. Compared to their heterosexual peers, sexual minority/Two-Spirit boys had higher odds of suicidal ideation since 1998, whereas sexual minority/Two-Spirit girls had higher odds of suicidal ideation since 2003. Sexual minority/Two-Spirit (vs. heterosexual) boys were approximately 4–7 times more likely to attempt suicide since 2008, whereas sexual-minority/Two-Spirit (vs. heterosexual) girls were approximately 3–4 times more likely to attempt suicide since 2003. These gaps in suicidality were persistent across time. DiscussionSexual minority/Two-Spirit Indigenous adolescents are at an elevated risk for suicidality compared to their heterosexual Indigenous peers. While trends of suicidal ideation worsened for all Indigenous adolescents, suicide attempts either lessened or remained stable over time. Greater efforts are needed to help reduce suicidality among Indigenous adolescents in Canada, especially among sexual minority/Two-Spirit young people.

“Every day I grew stronger and stronger being there”.: empowerment through land-and art-based Peer Leader retreats with Indigenous and Northern young people

ABSTRACT Indigenous adolescents in Canada are among those shouldering the impacts of colonialism and racism. Peer approaches and art-and-land-based programming have demonstrated promise to support empowerment and well-being, yet little is known about their efficacy with Northern and Indigenous adolescents in Canada or of how this group conceptualises empowerment. Fostering Open eXpression among Youth (FOXY) and Strength, Masculinities, and Sexual Health (SMASH) conduct land-and-arts-based Peer Leader Retreats with adolescents from the Northwest Territories, Nunavut and the Yukon Territories. Retreats (2017–2019) included 286 participants (n=196 women [trans-inclusive], n=84 men [trans-inclusive], n=5 non-binary), aged 12–19, the majority of whom (n=235) were Indigenous. Participants completed surveys immediately before and following retreats and 6 months after. Focus group discussions (FGDs) (n=24) were conducted with participants (peer leaders and apprentices) (n=232) following the retreat, and youth staff members (peer facilitators) (aged 14–21, n=7 FGDs). Applying thematic analysis, we explored retreat experiences (FGDs), and Wilcoxon signed-rank tests to examine pre/post retreat changes in leadership, empowerment, and self-confidence (surveys). Quantitatively, there were statistically significant increases in leadership and empowerment in post-retreat scores compared to pre-retreat. Qualitatively, findings demonstrate how Peer Leader Retreats premised on land-and-art-based approaches can support empowerment, confidence, leadership, and social-connectedness.

2.6 Clinical Interventions for Adolescent Vaping of Nicotine and Cannabis

The use of vapes or electronic cigarettes to consume nicotine and cannabis continues to be a major health concern in the pediatric age group. Recent studies show that 1 in 5 high school students in the United States have vaped nicotine in the past month and that vaping of cannabis has doubled among US and Canadian adolescents between 2013 and 2020. The limited evidence for the use of medications to treat nicotine and cannabis is a barrier to effective treatment. This lecture will discuss clinical interventions for cessation of nicotine and cannabis use via vapes and will provide practical considerations from experience in ambulatory and inpatient clinic settings.

Cyberbullying and Gambling Disorder: Associations with Emotion Regulation and Coping Strategies

The presence of unsuitable coping and emotion regulation strategies in young populations with gambling disorder (GD) and in those who have experienced cyberbullying victimization has been suggested. However, this association has not been explored in depth. In this study, our aim was to analyze individual differences in emotion regulation, coping strategies, and substance abuse in a clinical sample of adolescents and young adult patients with GD (n = 31) and in a community sample (n = 250). Furthermore, we aimed to examine the association between cyberbullying and GD. Participants were evaluated using the Cyberbullying Questionnaire-Victimization, the Canadian Adolescent Gambling Inventory, the Coping Strategies Inventory, the Difficulties in Emotion Regulation Scale, the Alcohol Use Disorders Identification Test and the Drug Use Disorders Identification Test. Structural Equation Modeling was used to explore associations between these factors in a community sample and in a clinical group. In both groups, exposure to cyberbullying behaviors was positively associated with higher emotion dysregulation and the use of maladaptative coping styles. Our findings uphold that adolescents and young adults who were victims of cyberbullying show difficulties in emotion regulation and maladaptive coping strategies when trying to solve problems. The specific contribution of sex, age, gambling severity, emotion regulation, and coping strategies on cyberbullying severity is also discussed. Populations at vulnerable ages could potentially benefit from public prevention policies that target these risk factors.

Advertising expenditures across media on food and beverage products heavily advertised on youth-appealing television stations in Canada.

This research estimated and characterized advertising expenditures on food products heavily advertised on youth-appealing television stations in Canada in 2019 overall, by media, by food category, and compared expenditures in two policy environments (Quebec and the rest of Canada, excluding the territories) and on "healthier" versus "less healthy" products. Advertising expenditure estimates for 57 selected food categories promoted on television, radio, out-of-home media, print media, and popular websites were licensed from Numerator. Sixty-one products or brands were identified as heavily advertised on youth-appealing stations and classified as "healthier" or "less healthy" based on a nutrient profile model proposed by Health Canada. Total expenditures and expenditures per adolescent capita were calculated. Approximately, $110.9 million was spent advertising food products heavily advertised to adolescents in Canada in 2019, with television accounting for 77% of total expenditures and fast food restaurants accounting for 51%. Most expenditures (77%; $80.6 million) were devoted to advertising "less healthy" products. In Quebec, advertising expenditures on examined products were 23% lower per capita ($45.15/capita) compared to the rest of Canada ($58.44/capita). Advertising expenditures in Quebec were lower for energy drinks (-47%; -$0.80/capita) and candy and chocolate (-41%; -$1.00/capita) and higher for yogurt (+85%; +$1.22/capita) and portable snacks (+25%; +$0.15/capita). Quebec's restriction of commercial advertising directed to children under 13 may explain lower per capita advertising expenditures on some "less healthy" foods heavily advertised to adolescents in Quebec. Nevertheless, this spending remains high in Quebec and nationally. Continued monitoring of these expenditures is warranted.

Associations between physical activity, affect regulation difficulties, and mental health among Canadian adolescents at two different points of the COVID-19 pandemic

Objective. Although physical activity declined with social distancing measures and stay-at-home orders during the COVID-19 pandemic, youth who engaged in more physical activity experienced fewer mental health problems. If and how physical activity maintained its protective role throughout the ongoing pandemic remains unclear. This study models associations between three types of physical activity (indoor, outdoor, with parents), affect regulation, and anxious and depressive symptoms in two independent adolescent samples (T1: Summer 2020; T2: Winter 2020/21). Methods and Measures. Six hundred sixty-two Canadian adolescents (T1: M age = 15.69, SD = 1.36; 52% girls; 5% trans+) and 675 Canadian adolescents (T2: M age = 15.80, SD = 1.46; 50% girls; 6% trans+) participated in an online survey. Data included frequency of physical activity indoors, outdoors, and with parents, affect regulation difficulties, and measures of anxious and depressive symptoms. Results. Multiple-group path analysis showed indoor physical activity had an indirect effect on anxiety and depressive symptoms through affect dysregulation, but only at T1. Physical activity with parents was protective for adolescent anxiety and depressive symptoms at both T1 and T2 and had an indirect effect through affect dysregulation and suppression. Conclusion. Findings contribute to our understanding of how physical activity protects adolescent mental health, and point to strengthening family supports and recreation opportunities.

Differential effects of maternal- and paternal-adolescent attachments on friendship security and intimacy.

The present study examined the differential contributions of adolescent-reported maternal and paternal attachment anxiety and avoidance on friendship security and intimacy. Participants were 776 Canadian adolescents between the ages of 13 and 19 years (M=15.18, SD=1.58) who provided ratings of their perceived attachment avoidance and anxiety towards their mothers and fathers and responded to measures of friendship security and intimacy. Findings showed that maternal and paternal attachment avoidance and not anxiety negatively predicted friendship security. Moreover, maternal attachment avoidance was negatively associated with friendship intimacy. Multigroup analyses showed that security was negatively predicted by maternal anxious attachment for junior high school boys and girls. Additionally, paternal avoidant attachment was negatively associated with friendship intimacy for junior high school boys and girls. These findings highlight the unique effects associated with maternal and paternal attachment on specific friendship features and underscore the importance of the role of fathers in adolescence.

Links Between Adolescents' Moral Mindsets and Narratives of their Inconsistent and Consistent Moral Value Experiences.

Past work on moral mindsets has largely overlooked the adolescent developmental period, a time when adolescents are navigating the complexities of moral life and experiencing tensions between important moral principles and their own actions. This study investigated how moral incrementalism and essentialism are linked to how adolescents construct meanings about their moral experiences. The sample included 96 Canadian adolescents (12-15-years of age; M = 13.5 years). Adolescents generated written narratives of times when they acted inconsistently and consistently with a moral value, and completed a vignette-based measure of moral mindsets. Moral incrementalism was associated with references to the psychological and emotional facets of experiences and engaging in meaning-making processes in narratives. Adolescents who endorsed incrementalism disengaged less only when narrating a self-discrepant experience, indicating some context-specificity across moral event types. Overall, results contribute to scholarship on moral mindset and narrative identity construction. Findings illuminate how individual differences in youth's views of moral traits and behavior may be associated with important aspects of moral identity development such as delving into the psychological and emotional aspects of their experiences and engaging in meaning-making processes.