Student Drug Use Research Articles

Identifying Psychosocial and Ecological Determinants of Enthusiasm In Youth: Integrative Cross-Sectional Analysis Using Machine Learning.

Understanding the factors contributing to mental well-being in youth is a public health priority. Self-reported enthusiasm for the future may be a useful indicator of well-being and has been shown to forecast social and educational success. Typically, cross-domain measures of ecological and health-related factors with relevance to public policy and programming are analyzed either in isolation or in targeted models assessing bivariate interactions. Here, we capitalize on a large provincial data set and machine learning to identify the sociodemographic, experiential, behavioral, and other health-related factors most strongly associated with levels of subjective enthusiasm for the future in a large sample of elementary and secondary school students. The aim of this study was to identify the sociodemographic, experiential, behavioral, and other health-related factors associated with enthusiasm for the future in elementary and secondary school students using machine learning. We analyzed data from 13,661 participants in the 2019 Ontario Student Drug Use and Health Survey (OSDUHS) (grades 7-12) with complete data for our primary outcome: self-reported levels of enthusiasm for the future. We used 50 variables as model predictors, including demographics, perception of school experience (i.e., school connectedness and academic performance), physical activity and quantity of sleep, substance use, and physical and mental health indicators. Models were built using a nonlinear decision tree-based machine learning algorithm called extreme gradient boosting to classify students as indicating either high or low levels of enthusiasm. Shapley additive explanations (SHAP) values were used to interpret the generated models, providing a ranking of feature importance and revealing any nonlinear or interactive effects of the input variables. The top 3 contributors to higher self-rated enthusiasm for the future were higher self-rated physical health (SHAP value=0.62), feeling that one is able to discuss problems or feelings with their parents (SHAP value=0.49), and school belonging (SHAP value=0.32). Additionally, subjective social status at school was a top feature and showed nonlinear effects, with benefits to predicted enthusiasm present in the mid-to-high range of values. Using machine learning, we identified key factors related to self-reported enthusiasm for the future in a large sample of young students: perceived physical health, subjective school social status and connectedness, and quality of relationship with parents. A focus on perceptions of physical health and school connectedness should be considered central to improving the well-being of youth at the population level.

Individual, parent, and school factors associated with e-cigarette use among Asian adolescents

ABSTRACT Objective E-cigarette use has become the predominant method of nicotine consumption among U.S. youth, posing significant public health implications. The current study addresses the scarce research on e-cigarette use among Asian American adolescents, a demographic group that has remained comparatively understudied. Methods Leveraging data from the 2019–2020 Student Drug Use survey, the cross-sectional study investigates the interplay between e-cigarette use and psychosocial determinants among Asian American adolescents in the metropolitan area. Results Results indicate an 8.0% prevalence of e-cigarette use in the past year, with notable variations based on grade level and risk behaviors. Psychosocial factors such as low parental influence [OR = 1.88, 95% CI (1.35,2.61)], engagement in low prosocial activities [OR = 1.78, 95% CI (1.30, 2.44)], and high-risk behaviors [OR = 25.34, 95% CI (15.39,41.71)] correlate significantly with increased odds of e-cigarette use. Logistic regression analysis reinforces these associations, emphasizing the impact of risky behavior and ease of access on e-cigarette usage. Conclusion The study informs targeted interventions at various levels, including schools, policy, community engagement, and cultural competency training, to address the escalating prevalence of e-cigarette use among Asian American adolescents.

Systematic review on the characteristics and efficacy of school preventive programs for drug addiction in Spain.

The school environment is of great relevance in the prevention of drug use in students because it is where they spend most of their time and, since education is compulsory until upper secondary school in Spain, interventions in this area can reach the majority of children up to that stage. The objective of this systematic review is to determine the level of efficacy of the school preventive programs that have been implemented in Spain. Following the PRISMA recommendations, a systematic literature search was carried out in the Web of Science, PubMed/MEDLINE, Embase, Scopus, and Cochrane Library databases. The search yielded 274 studies, of which 29 studies were selected. It was found that 48 drug addiction prevention programs have been implemented in Spanish school context, of which only 18 (37.5%) had an evaluation of their effectiveness following the criteria and standards of effective prevention. Conversely, the programs that were not evaluated are far from these standards in their design. It is concluded that there are two models of school prevention of drug addiction in Spain: a model that meets this description; and another model classified as "pseudo-prevention", since its design does not meet the standards of effective prevention nor has its preventive efficacy been demonstrated.

Investigation of frequency and factors related to drug use in male students living in dormitories

ABSTRACT Introduction Students living in dormitories are more exposed to social harms due to a variety of reasons, including distance from family and educational problems. In this study, the frequency of drug use and its related factors in male students living in dormitories was investigated. Materials and methods In a cross-sectional study, 270 male dormitory students of Hamadan University of Medical Sciences were selected, and they were interviewed in terms of their drug use. Results Hookah (41.5%), cigarettes (35.5%), alcohol (24.1%), sedatives (20%), hypnotics (13%) and marijuana (13) were the most commonly used drugs in students. In total, 49.6% of cigarettes and hookahs). Lack of amusement and entertainment (25.2%), stress (14.1%), depression (11.9%) and love failure (11.5%) were the most important reasons for students’ tendency to use drugs. There was a statistically significant relationship between drug use and marital status, education of parents and field of study. Conclusion Due to the nature of the study, the obtained statistics are less than the reality and therefore, we must seriously make policy and plan to solve this social problem and prevent its dire consequences.

Associations between problem technology use, life stress, and self-esteem among high school students

BackgroundAdolescence is a critical period for development, with many risk factors resulting in long-term health consequences, particularly regarding mental health. The purpose of this study was to examine the associations between problem technology use, life stress, and self-esteem in a representative sample of adolescents residing in Ontario, Canada.MethodsSelf-reported data were obtained from a cross-sectional sample of 4,748 students (57.9% females) in grades 9 to 12 (mean age: 15.9 ± 1.3 years) who participated in the 2019 Ontario Student Drug Use and Health Survey. Problem technology use was measured using the 6-item Short Problem Internet Use Test, life stress was assessed using an item from the British Columbia Adolescent Health Survey and self-esteem was assessed using a global measure from the Rosenberg Self-Esteem Scale. Ordinal logistic regression models were adjusted for age, sex, ethnoracial background, subjective socioeconomic status, body mass index z-score, tobacco cigarette smoking, alcohol consumption and cannabis use.ResultsWe found that 18.3% of participants reported symptoms of moderate-to-high problem technology use, although symptoms were more common in females than males (22% vs. 14.7%, respectively). Moderate-to-high problem technology use was associated with 2.04 (95% CI: 1.77–2.35) times higher odds of reporting high life stress and 2.08 (95% CI: 1.76–2.45) times higher odds of reporting low self-esteem compared to all other response options.ConclusionsFindings from this study show that problem technology use is strongly associated with higher life stress and lower self-esteem in adolescents. This study supports the importance of developing and implementing effective strategies that help to mitigate the adverse effects of problem technology use on adolescent mental health.

Associations between cannabis use, opioid misuse and severe psychological distress in adolescents: A cross-sectional school-based study

BackgroundCannabis use and nonmedical use of prescription opioids are consumed by a small to moderate number of adolescents. However, little is known about their combined influence on mental health in this age group. This study examined the association between cannabis use, nonmedical use of prescription opioids, or both with serious psychological distress among adolescents and tested if sex could moderate these associations. MethodsWe based our analyses on cross-sectional data from the 2019 Ontario Student Drug Use and Health Survey, a provincially representative sample of students in grades 7 through 12 (aged 11–20 years or older) across Ontario, Canada (n= 7097; mean age: 15.2 ± 1.2 years). Logistic regression analyses were adjusted for important covariates. ResultsWe found that 20.5% reported cannabis use only, 5.8% reported opioid use only, and 5% reported both cannabis and opioid use. Cannabis use only (odds ratio [OR]:1.91; 95% confidence interval [CI]:1.53–2.37), opioid use only (OR: 2.21; 95% CI: 1.63–3.00), and both cannabis and opioid use (OR: 3.24; 95% CI: 2.25–4.66) were associated with greater odds of serious psychological distress after adjustment for covariates. Associations were similar for males and females. ConclusionThe use of both cannabis and opioids is significantly associated with serious psychological distress among adolescents. Adolescents who use both cannabis and opioids represent a small and vulnerable group that should be targeted in future interventions against mental health problems. Health professionals should consider screening for polysubstance use, especially when working with adolescents who use cannabis.

EXAMINING THE RELATIONSHIP BETWEEN E-HEALTH LITERACY AND RATIONAL DRUG USE: A STUDY ON UNIVERSITY STUDENTS

It is desired to provide rapid access to health information on the Internet and to determine the relationship between rational drug use that affects people's quality of life. In this study, it is aimed to examine the relationship between e-health literacy and rational drug use in university students. In line with the purpose of the research; The sample of the study consisted of 541 people determined by simple random sampling method among the students continuing their education at the university, and the data were collected by applying a face-to-face questionnaire. In the study, "Personal Information Form", "E-Health Literacy Scale" and "Rational Drug Use Scale" were used. The data were analyzed with the SPSS program. In addition, as an analysis method, it was determined that the data were normally distributed; t test, ANOVA and pearson correlation analyzes were applied in independent groups. 541 students participated in the research.As a result of the research, it was determined that there is a positive and significant relationship between the level of e-health literacy and rational drug use. It is predicted that as the level of e-health literacy increases, the level of rational drug use will increase.

Heavy social media use and posting regret are associated with lower self-esteem among middle and high school students.

Social media use has become ubiquitous among schoolchildren. This study examined the association of social media use and posting regret with self-esteem among middle and high school students, and tested whether school type (i.e., middle vs. high school) could moderate these associations. Data on 6944 schoolchildren (mean age: 15.2 ± 1.8years) were derived from the 2019 cycle of the Ontario Student Drug Use and Health Survey, a biennial repeated cross-sectional survey of students in grades 7 through 12 across Ontario, Canada. Students self-reported time spent using social media, regret of posting on social media, and their self-esteem. Ordinal logistic regression analyses were adjusted for age, sex, subjective socioeconomic status, ethnoracial background, and body mass index z-score. The proportional odds model showed that middle (OR: 2.36; 95% CI: 1.65-3.36) and high school (OR: 1.72; 95% CI: 1.44-2.06) students with daily social media use of 5h or more have higher odds of lower self-esteem across the categories of self-esteem. However, daily use of 3 to 4h was associated with lower self-esteem among middle school students (OR: 1.52; 95% CI: 1.14-2.04), but notamong their high school counterparts (OR: 1.13; 95% CI: 0.94-1.35). Posting regret was associated with lower self-esteem in high school students, but not inmiddle school students. Results suggest that heavy social media use and posting regret are associated with lower self-esteem among adolescents, and that younger students could be more vulnerable than their older counterparts.

Drug use in university students

Objectives. The general objective is to identify drug use in university students. The specific objective is to generate specific knowledge for the prevention of drug use at its various levels. Methodology. The research is descriptive, nonexperimental, cross-sectional. The participants are students of the subject “Risk behavior in educational contexts” at the Academic Unit of Psychology of the Autonomous University of Zacatecas. The Drug consumption Questionnaire (2009), prepared by the Social Security Institute of the State of Mexico and Municipalities, is used, the treatment of the data is through percentages. Contribution. Obtained data, that lead to the knowledge of drug use in university students, will allow to base the intervention through programs aimed at eliminating drug use through prevention.

Heavy social media use and psychological distress among adolescents: the moderating role of sex, age, and parental support.

Despite increasing evidence that social media use is associated with adolescents' mental well-being, little is known about the role of various factors in modifying the effect of this association during adolescence. This study examined the association between social media use and psychological distress among adolescents and explored whether sex, age, and parental support moderate this association. Data came from a representative sample of middle and high school students in Ontario, Canada. Cross-sectional analyses included 6,822 students derived from the 2019 Ontario Student Drug Use and Health Survey. Our results showed that 48% of adolescents used social media for 3 h or more per day, and 43.7% had moderate to severe psychological distress, with a higher prevalence among females (54%) than males (31%). After adjustment for relevant covariates, heavy social media use (≥3 h/day) was associated with increased odds of severe psychological distress [odds ratio (OR): 2.01; 95% confidence interval (CI):1.59-2.55]. The association of social media use with psychological distress was modified by age (p < 0.05) but not sex or parental support. The association was stronger among younger adolescents. Heavy social media use is associated with higher levels of psychological distress, with younger adolescents being the most vulnerable. Longitudinal studies are recommended for future research to examine in more depth the role of sex, age, and parental support in the association between social media use and psychological distress to better determine the strength and of the association.

Mental health and drug use in college students: Should we take action?

BackgroundCollege students are vulnerable to suffering from anxiety and depression. Moreover, mental disorders can contribute to drug consumption or inappropriate use of prescribed drugs. Studies on this topic in Spanish college students are limited. This work analyses anxiety and depression and psychoactive drug intake pattern in the post-COVID era in college students. MethodsAn online survey was conducted among college students from UCM (Spain). The survey collected data including demographic, academic student perception, GAD-7 and PHQ-9 scales, and psychoactive substances consumption. ResultsA total of 6798 students were included; 44.1 % (CI95%: 42.9 to 45.3) showed symptoms of severe anxiety and 46.5 % (CI95%: 45.4 to 47.8) symptoms of severe or moderately severe depression. The perception of these symptoms did not change after returning to face-to-face university classes in the post-COVID19 era. Despite the high percentage of cases with clear symptoms of anxiety and depression, most students never had a diagnosis of mental illnesses [anxiety 69.2 % (CI95%: 68.1 to 70.3) and depression 78.1 % (CI95%: 77.1 to 79.1)]. Regarding psychoactive substances, valerian, melatonin, diazepam, and lorazepam were the most consumed. The most worrying issue was the consumption of diazepam, 10.8 % (CI95%: 9.8 to 11.8), and lorazepam, 7.7 % (CI95%: 6.9 to 8.6) without medical prescription. Among illicit drugs, cannabis is the most consumed. LimitationsThe study was based on an online survey. ConclusionsThe high prevalence of anxiety and depression aligned with poor medical diagnosis and high intake of psychoactive drugs should not be underestimated. University policies should be implemented to improve the well-being of students.

E-cigarette use by Ontario public elementary school and secondary school students: Has the use among sociodemographic groups changed from 2017 to 2019?

This project examined e-cigarette use among Elementary School (ES) (grades 7 and 8) and Secondary School (SS) (grades 9–12) students in Ontario, Canada, for 2017 and 2019 and relationships with sociodemographic variables and traditional cigarette use. The data came from the Ontario Student Drug Use and Health Survey OSDUHS (2017, 2019). Socio-demographics included grade, school performance, sex, race, years in Canada, living arrangements and language spoken at home. E-cigarette use and cigarette smoking were any past year use. For 2017, there are a greater percentage of ES males than females who used e-cigarettes, older students, those living in more than one home and those smoking cigarettes. For SS students a greater percentage for those of older age, higher grades, living in Canada all their lives, using only English language at home, self-identified as white, with lower school performance, those with multiple household living arrangements and who reported smoking traditional cigarettes reported using e-cigarettes. Use was lower among females in 2017 (OR = 0.63, 95% CI = 0.46, 0.86, p = 0.002), but by 2019 use was higher among females, which resulted in a non-significant difference between males and females (OR = 0.91, 95% CI = 0.77, 1.09). Greater use of e-cigarettes was found among students who smoked traditional cigarettes compared to those who did not smoke in both years. Monitoring the trends, patterns and trajectories of use and variables related to use needs to be continued which may help inform the development of further legislative and educational measures.

Psychological distress, non-medical use of prescription medications, and perceived unmet mental health care needs: a cross-sectional study of Ontario students.

The non-medical use of prescription medications among adolescents has become a concerning public health issue. This study assessed the prevalence of the non-medical use of prescription medications in Ontario high school students, and explored the moderating effect of this use on the relationship between psychological distress and unmet mental health needs. Cross-sectional data for 4896 students, age 14-18, were drawn from the 2019 Ontario Student Drug Use and Health Survey. Psychological distress was measured using the Kessler-6 Distress Scale, unmet mental health needs were defined by self-report (yes/no), and non-prescription medication use was defined by self-reported frequency of use. Using logistic regression, we explored the effect of the non-medical use of prescription medications on the relationship between psychological distress and unmet mental health needs. High proportions of Ontario students reported serious psychological distress (22%), some degree of unmet mental health need (38%), and/or non-medical use of prescription medications (13%). While there were strong associations between psychological distress and unmet mental health need, this association was weaker among those reporting non-medical use of prescription medications (OR = 3.3, 95% CI 1.9-5.7) compared to non-users (OR = 5.6, 95% CI 4.5-7.1). Our findings suggest that Ontario students experiencing distress and using non-prescribed medications are less likely to identify a need for mental health support, highlighting the consequences of apparent self-medication through misuse of prescription medications. To assist in the redirection of adolescent perceptions of healthy coping strategies, population-based educational programming, with targeted promotion of both formal and informal mental health care resources, should be considered.

Effectiveness of a Mobile App to Increase Risk Perception of Tobacco, Alcohol, and Marijuana Use in Mexican High School Students: Quantitative Study

Young people have the highest rate of drug use worldwide. Recent data from Mexico in this population show that the prevalence of illicit drug use doubled between 2011 and 2016 (2.9%-6.2%), with marijuana being the one with the highest increase (2.4%-5.3%), but also point out that alcohol and tobacco use have remained steady or decreased. Mexican adolescents are at high risk for drug use owing to a low perception of risk and the availability of drugs. Adolescence is an ideal period to reduce or prevent risky behaviors using evidence-based strategies. In this study, we aimed to test the short-term effectiveness of a mobile intervention app ("What Happens if you Go Too Far?" ["¿Qué pasa si te pasas?"]) that seeks to increase risk perception of tobacco, alcohol, and marijuana use in a sample of Mexican high school students. A nonexperimental evaluation based on pretest-posttest design was used to measure the effectiveness of a preventive intervention using a mobile app, "What Happens If You Go Too Far?" The dimensions analyzed were knowledge of drugs and their effects, life skills, self-esteem, and risk perception. The intervention was conducted on a high school campus with 356 first-year students. The sample included 359 first-year high school students (mean 15, SD 0.588 years; women: 224/359, 62.4% men: 135/359, 37.6%). The intervention increased the overall risk perception of tobacco (χ24=21.6; P<.001) and alcohol use (χ24=15.3; P<.001). There was no significant difference in the perception that it is dangerous to smoke 5 cigarettes, and there was a marginal difference in the perception that it is very dangerous to smoke 1 cigarette or to use alcohol or marijuana. We used a generalized estimating equation method to determine the impact of the variables on risk perception. The results showed that knowledge about smoking increased the risk perception of smoking 1 cigarette (odds ratio [OR] 1.1065, 95% CI 1.013-1.120; P=.01), and that knowledge about marijuana use (OR 1.109, 95% CI 1.138-1.185; P=.002) and self-esteem (OR 1.102, 95% CI 1.007-1.206; P=.04) produced significant increases in the risk perception of consuming 5 cigarettes. Resistance to peer pressure and assertiveness also increased the perceived risk of using tobacco and alcohol. The intervention has the potential to increase the perception of risk toward drug use in high school students by providing knowledge about the effects and psychosocial risks of drug use and by strengthening life skills that are associated with increased risk perception. The use of mobile technologies in intervention processes may broaden the scope of preventive work for adolescents.

An Agent-Based Social Impact Theory Model to Study the Impact of In-Person School Closures on Nonmedical Prescription Opioid Use among Youth

Substance use behavior among youth is a complex peer-group phenomenon shaped by many factors. Peer influence, easily accessible prescription opioids, and a youth’s socio-cultural environment play recognized roles in the initiation and persistence of youth nonmedical prescription opioid use. By altering the physical surroundings and social environment of youth, in-person school closures may change risk factors for youth drug use. Acknowledging past research on the importance of the presence of peers in youth substance use risk behavior, this paper reports the findings from the use of an agent-based simulation grounded in social impact theory to investigate possible impacts of in-person school closures due to COVID-19 on the prevalence of nonmedical prescription opioid use among youth. The presented model integrates data from the Ontario Student Drug Use and Health Survey and characterizes the accessibility of within-home prescription opioids. Under the status quo, the lifting of in-person school closures reliably entails an increase in the prevalence of youth with nonmedical prescription opioid use, but this effect is ameliorated if the prescription opioids are securely stored during the in-person school closures period.

Cyberbullying involvement, parental support, and cannabis use among adolescents

BackgroundCyberbullying victimization has been associated with cannabis use among adolescents. However, it is unclear if this relationship also holds for cyberbullying perpetrators. ObjectiveThis cross-sectional study examined the association between cyberbullying involvement and cannabis use among adolescents and tested if parental support was associated with cyberbullying involvement and cannabis use. Participants and settingData from 7229 students aged 11–20 years were obtained from the 2019 Ontario Student Drug Use and Health Survey, a province-wide survey of middle and high school students across Ontario, Canada. MethodsParticipants self-reported their cannabis use frequency, their involvement in cyberbullying, and their perception of parental support. Cyberbullying involvement was operationalized as an action taking place at least two times. Multivariable logistic regression models were adjusted for age, sex, ethnoracial background, and subjective socioeconomic status. ResultsOverall, 8.6 % of students were cyberbullying victims only, 2 % were cyberbullying perpetrators only, and 2.8 % were both cyberbullying victims and perpetrators. Results showed that experience of cyberbullying victimization only (OR: 2.17; 95 % CI: 1.64–2.88), perpetration only (OR: 2.64; 95 % CI: 1.51–4.63), or both (OR: 3.34; 95 % CI: 2.12–5.28) was associated with greater odds of cannabis use. Results further indicated that higher parental support was associated with lower odds of cannabis use in a dose-response fashion. Higher parental support was also associated with a lower risk of cyberbullying involvement. ConclusionsThese findings suggest that involvement in cyberbullying in any role is associated with greater cannabis use among adolescents and that parental support is associated with less cannabis use and cyberbullying involvement.

Cross-sectional Study of Factors Associated With Suicide Ideation in Ontario Adolescents.

Suicide is the second leading cause of death in Canadian adolescents. The Interpersonal Theory of Suicide attempts to explain suicide etiology and proposes that feelings of perceived burdensomeness or thwarted belongingness lead to suicide ideation, but this has not been extensively studied in adolescents. This study aimed to use the Interpersonal Theory of Suicide to examine factors that may be associated with suicide ideation in adolescents. The factors of interest were school connectedness, perceived availability of support, self-esteem, feelings of worthlessness, feelings of hopelessness, bullying and cyberbullying victimization, substance use, and social media use. Data were from the 2017 Ontario Student Drug Use and Health Survey, a survey of 7th to 12th graders enrolled in a publicly funded school in Ontario. Weighted multivariate logistic regression of suicide ideation on all exposure variables was conducted. 13.6% of students in the sample endorsed having suicidal ideation in the preceding 12 months. Not knowing where to turn to for support, feeling worthless, endorsing low self-esteem, being bullied, and using cannabis were each associated with greater odds of suicide ideation. Feeling hopeless, social media use, using alcohol and tobacco, and being cyberbullied were not associated with suicide ideation in the weighted multivariate logistic regression model. This study is consistent with the Interpersonal Theory of Suicide as low self-esteem and feelings of worthlessness, two indicators of perceived burdensomeness, and not knowing where to turn to for support, an indicator of thwarted belongingness, were associated with greater odds of suicide ideation. These findings can help guide interventions aimed at reducing the burden of suicidality during adolescence and demonstrate the need to provide accessible mental health support for youth.

Can substance abuse media literacy increase prediction of drug use in students?

ObjectiveThe present study aimed to determine the predictors of drug use among students based on the Extended Prototype willingness model (EPWM).MethodsThis cross-sectional study was performed at Hamadan universities. The participants were selected via multi-stage sampling. Finally, out of 721 students participated. The questionnaire consisted of four sections: (a) socio-demographic characteristics, (b) Questionnaire about the prototype willingness model constructs, (c) Questionnaire about the status of drug use behavior, (d) Substance Abuse Media Literacy (SAML) scale. Data were analyzed using a structural equations partial least squares confirmatory composite approach and SPSS-23.ResultsThe mean age of students was of 23.47 ± 4.14 years. Based on results, behavioral willingness (β = 0.420, t-value = 9.010, p < 0.001) and behavioral intention (β = 0.291, t-value = 6.957, p < 0.001) significantly predicted drug use. The presented results of analysis, 66% of the variance of the drug use, 62% of the variable of the behavioral willingness, and 56% of the behavioral intention could be explained by the EPWM.ConclusionThe present study demonstrated that EPWM could predict drug use in students. Therefore, designing and implementing educational and promotional intervention programs to reduce behavioral willingness and increase students’ skills in substance abuse media literacy is necessary to prevent drug use behavior.

Smoking Susceptibility in Canadian Adolescent Electronic-Cigarette Users

Background: E-cigarette use is increasing among Canadian youth, with experimentation especially prevalent among never-smoking youth. Among this group, there is concern e-cigarette use contributes to future initiation of smoking through a gateway effect. However, e-cigarette use and smoking share many common risk factors; a postulated mechanism to explain the apparent causal pathway from e-cigarette use to smoking initiation in previously smoking-naïve youth. A better understanding of the relationships between smoking susceptibility and e-cigarette use among never-smoking youth is needed. Purpose/objectives: The primary aim of this study was to gain a deeper understanding of the risk factors associated with smoking susceptibility in youth who have recently used e-cigarettes. Methods: This study used data (n = 40,363) from the 2018/2019 Canadian Student Tobacco Alcohol and Drug Use Survey (CSTADS) to compare the risk factor profiles of susceptible and non-susceptible never-smoking e-cigarette users, as well as susceptible and non-susceptible never-smoking youth who have never used an e-cigarette. Results: E-cigarette use, independent of susceptibility status, was associated with a sociodemographic and behavioral risk factor profile likely to confer a higher risk of initiating smoking. Among e-cigarette users, smoking susceptibility was associated with more smoking risk factors. Conclusions/importance: Study findings support a common risk-factor model, rather than e-cigarette use itself, to explain differences in the likelihood of smoking initiation among e-cigarette users. E-cigarette use and smoking initiation may be interchangeable outcomes amongst those with smoking risk factors. The risks of e-cigarette use, and their regulatory status, need to be balanced with their potential as harm reduction tools.

Canadian 24-h Movement Guidelines, Life Stress, and Self-Esteem Among Adolescents.

BackgroundAdolescence is often considered a period of heightened stress, and healthy active living behaviors may help those experiencing it to better cope with life stressors and increase their self-esteem. The 24-h movement guidelines for children and adolescents recommend ≥60 min per day of moderate-to-vigorous physical activity, ≤ 2-h per day of recreational screen time, and 9–11-h of sleep per night for school-aged children or 8–10-h per night for adolescents. The objective of this study was to examine the association of meeting the 24-h movement guidelines with life stress and self-esteem among students in Ontario, Canada.MethodsSelf-reported data on movement behaviors, life stress and self-esteem were derived from the 2019 cycle of the Ontario Student Drug Use and Health Survey, a cross-sectional and province-wide survey of students in grades 7–12 aged 11 to 20 years (N = 6,932). Multivariable ordered logistic regression analyses were adjusted for the complex sample design of the survey and for important covariates.ResultsOverall, meeting all combinations of movement behavior recommendations were associated with lower life stress and better self-esteem compared with meeting none of the recommendations, except meeting the physical activity only or screen time only recommendations that were not associated with lower life stress. Meeting all 3 recommendations was associated with lower life stress (OR: 0.40; 95 CI: 0.30–0.53) and better self-esteem (OR: 0.29; 95% CI: 0.21–0.40). There was a dose-response gradient between the number of recommendations met (3 > 2 > 1) and lower life stress (p < 0.001) and higher self-esteem (p < 0.001), with meeting all 3 recommendations being the best combination.ConclusionsThese findings suggest that meeting the recommendations of the 24-h movement guidelines is associated with lower life stress and better self-esteem among adolescents.