Cannabis-related driving and passenger behaviours among high school students: a cross-sectional study using survey data.

BACKGROUND: Many youth report driving under the influence of cannabis (DUIC) and riding with a cannabis-impaired driver (RWCD), and many perceive that cannabis causes limited impairment. We examined associations of perceived risk of regular cannabis use with DUIC and RWCD, exploring differences by sex and rural setting. METHODS: In a cross-sectional study, we examined DUIC and RWCD among high school students in grades 11 and 12 who participated in the 2016-2017 Canadian Student Tobacco, Alcohol and Drugs Survey. Private and public schools across 9 Canadian provinces were included. New Brunswick and the 3 territories were not included. Multinomial logistic regression models generated adjusted and unadjusted models for the associations. RESULTS: A total of 52 103 students in grades 7-12, from 117 school boards and 699 schools, participated in the survey. The survey response rate was 76.2% (n = 52 103/68 415). In total, 14 520 students in grades 11 and 12 participated in the survey. Greater perceived risk of regular cannabis use was associated with reduced risk of DUIC and RWCD in a dose-response manner. Students perceiving that regular cannabis use posed great risk had an adjusted relative risk (RR) of 0.06 (95% confidence interval [CI] 0.04-0.10) of DUIC in the past 30 days compared with students perceiving that regular use posed no risk. Students perceiving that regular cannabis use posed great risk had an adjusted RR of 0.09 (95% CI 0.07-0.12) of RWCD in the past 30 days compared with students perceiving no such risk. Associations were consistent for male and female students and for those living in urban and rural areas. INTERPRETATION: Students perceiving minimal risk from cannabis use reported greater engagement in cannabis-related risky driving behaviours. Given the importance of youth perceptions in shaping driving and passenger behaviours, efforts must be made to disseminate appropriate information regarding cannabis-related driving risks to high school students.

Designing an intervention to improve sexual health service use among university undergraduate students: a mixed methods study guided by the behaviour change wheel.

INTRODUCTION: University undergraduate students are within the population at highest risk for acquiring sexually transmitted infections, unplanned pregnancy, and other negative health outcomes. Despite the availability of sexual health services at university health centres, many students delay or avoid seeking care. In this study, we describe how the Behaviour Change Wheel was used as a systematic approach to design an intervention to improve sexual health service use among university undergraduate students. METHODS: This paper describes the intervention development phase of a three-phased, sequential explanatory mixed methods study. Phases one and two included a quantitative and qualitative study that aimed to better understand students' use of sexual health services. In phase three, we followed the Behaviour Change Wheel to integrate the quantitative and qualitative findings and conduct stakeholder consultation meetings to select intervention strategies, including intervention functions and behaviour change techniques. RESULTS: Key linkages between opportunity and motivation were found to influence students' access of sexual health services. Stakeholders identified six intervention functions (education, environmental restructuring, enablement, modelling, persuasion, and incentivization) and 15 behaviour change techniques (information about health consequences, information about social and environmental consequences, feedback on behaviour, feedback on outcomes of behaviour, prompts/cues, self-monitoring of behaviour, adding objects to the environment, goal setting, problem solving, action planning, restructuring the social environment, restructuring the physical environment, demonstration of the behaviour, social support, credible source) as relevant to include in a toolbox of intervention strategies to improve sexual health service use. CONCLUSIONS: This study details the use of the Behaviour Change Wheel to develop an intervention aimed at improving university students' use of sexual health services. The Behaviour Change Wheel provided a comprehensive framework for integrating multiple sources of data to inform the selection of intervention strategies. Stakeholders can use these strategies to design and implement sexual health service interventions that are feasible within the context of their health centre. Future research is needed to test the effectiveness of the strategies at changing university students' sexual health behaviour.

The Relationship Between Non-Consensual Sex and Risk of Depression in Female Undergraduates at Universities in Maritime Canada.

Sexual victimization and depression are common on university campuses, especially among females. Both are associated with negative health outcomes and efforts are made to minimize these as much as possible on university campuses. The current study examines the prevalence of, and independent association between, non-consensual sex and current risk of depression after controlling for related factors. The primary study question is as follows: Are female undergraduate students who have been sexually victimized while attending university at an increased risk of depression compared with those who have not been victimized? Cross-sectional data collected online from female students below the age of 30 at eight universities in Maritime Canada were analyzed. Non-consensual sex while at university was measured using one dichotomous item and current risk of depression was measured using the validated Center for Epidemiologic Studies Depression (CES-D) Scale. All analyses were weighted and data were imputed using the sequential regression multiple imputation (SRMI) method. Analyses involved basic descriptive statistics, a series of unadjusted logistic regressions, and an adjusted multiple logistic regression. A total of 36.7% of female undergraduate students were found to be at risk of depression and 6.8% have been victim of non-consensual sex while attending university. After adjusting for covariates, females who were victimized were 2.11 times more likely to be at risk of depression than females who were not victimized (p < .0001). This study points to the possible unmet need for more mental health support for victims of sexual victimization and more efforts to prevent sexual violence on Canadian campuses. These findings can help to inform university mental health services such as mental health support for victims of sexual assault and can also be used to inform prevention and health promotion activities.

Self-rated health and health service use among bisexual female undergraduate students on Canadian Maritime campuses.

Objective: To identify predicting factors for self-rated health and use of health services among undergraduate bisexual women in the Maritime Provinces, and improve knowledge on the health needs of this population. Participants: A sample of 357 undergraduate bisexual women who participated in the Maritime Undergraduate Student Sexual Health Services Survey (N = 10, 232) between September and November 2012. Methods: Guided by the Prince Edward Island Conceptual Model for Nursing, a secondary analysis of cross-sectional data was conducted using descriptive statistics and simple/multiple logistic regression models. Results: Logistic regression models revealed that self-rated health was significantly predicted by perceived social support (OR = 1.04), while health service use was significantly predicted by previous experience of forced sex (OR = 0.26). Conclusions: It is hopeful that these findings will support the development of inclusive health strategies that target bisexual women's psychosocial health needs on Maritime university campuses.

Sexual orientation and alcohol-related harms in Canadian youth.

OBJECTIVES: To determine associations between experiencing alcohol-related harm, sex, and sexual orientation among Canadian high school students. METHODS: We used data from the 2012 Atlantic Student Drug Use Survey (ASDUS), including a comprehensive six-category measure of sexual orientation and nine different alcohol-related harms for analyses. Simple logistic regression was used to determine the association between experiencing any of the nine harms and each specific alcohol-related harm and sexual orientation, stratified by sex. Analysis was limited to those who indicated they had consumed alcohol in the year prior to the survey. RESULTS: High rates of having any alcohol-related harm were seen among both males (41.7%) and females (46.0%) attending Atlantic Canadian high schools. Mostly heterosexual males had a lower odds ratio for experiencing any alcohol-related harm compared to heterosexual males. Mostly heterosexual females and bisexual females had higher odds ratios for experiencing any alcohol-related harm than heterosexual females. CONCLUSIONS: High rates of alcohol-related harm in this population suggest that youth may benefit from a harm reduction approach to alcohol use. While we found that mostly heterosexual and bisexual female youth experience higher levels of alcohol-related harm than heterosexual females, further research is required to confirm this association and to determine its relevance to harm reduction strategies.

Barriers and enablers to sexual health service use among university students: a qualitative descriptive study using the Theoretical Domains Framework and COM-B model.

BACKGROUND: University students are within the age group at highest risk for acquiring sexually transmitted infections and other negative health outcomes. Despite the availability of sexual health services at university health centres to promote sexual health, many students delay or avoid seeking care. This study aimed to identify the perceived barriers and enablers to sexual health service use among university undergraduate students. METHODS: We used a qualitative descriptive design to conduct semi-structured focus groups and key informant interviews with university students, health care providers, and university administrators at two university health centres in Nova Scotia, Canada. The semi-structured focus group and interview guides were developed using the Theoretical Domains Framework and COM-B Model. Data were analyzed using a directed content analysis approach, followed by inductive thematic analysis. RESULTS: We conducted 6 focus groups with a total of 56 undergraduate students (aged 18-25) and 7 key informant interviews with clinicians and administrators. We identified 10 barriers and enablers to sexual health service use, under 7 TDF domains: knowledge; memory, attention and decision-making processes; social influences; environmental context and resources; beliefs about consequences; optimism; and emotion. Key linkages between students' social opportunity and motivation were found to influence students' access of sexual health services. CONCLUSIONS: We identified barriers and enablers related to students' capability, opportunity and motivation that influence sexual health service use. We will use these findings to design an intervention that targets the identified barriers and enablers to improve students' use of sexual health services, and ultimately, their overall health and well-being.

School Connectedness and Protection From Symptoms of Depression in Sexual Minority Adolescents Attending School in Atlantic Canada.

BACKGROUND: In examining associations of sexual orientation, school connectedness (SC), and depression, no studies have used a continuum of sexual orientation. Additionally, no study has examined whether individuals with higher SC within subgroups of the continuum of sexual orientation are protected from symptoms of depression when compared to others within their own group. Our study aimed to address these deficiencies. METHODS: Data were from a cross-sectional survey of 6643 public high school students. Logistic regression was used to determine if higher SC was associated with protection from symptoms of depression comparing students with minority sexual orientations to heterosexual students, and whether SC was protective within subgroups of orientation. RESULTS: Mean SC scores were higher in heterosexuals than in all other orientation subgroups. Except for bisexual boys, compared with being heterosexual, being in other subgroups of orientation was associated with symptoms of depression, independent of SC. In both sexes SC was protective against depression risk within all categories of orientation except mostly/100% homosexual girls. CONCLUSIONS: Within all subgroups of sexual orientation except mostly/completely homosexual girls, SC was protective for symptoms of depression, indicating its potential importance for prevention of depression in all students, including perhaps particularly those with minority orientation.

[Estimating the Prevalence and Incidence Rate of Autism Spectrum Disorder (ASD): Interprovincial Comparisons]. / Estimation de la prévalence et du taux d'incidence du trouble du spectre de l'autisme (TSA). Comparaison interprovinciale.

Objective The prevalence of diagnosed autism spectrum disorders (ASD) has risen steadily over time. There is therefore a need for the monitoring of treated ASD for timely policy making. The objective of this study is to report and compare over a 10-year period the prevalence and incidence rate of diagnosed ASD in four Canadian provinces. Methods This study utilized data from the provinces of Manitoba, Ontario, Quebec and Nova Scotia with access to linked administrative database sources used in the Canadian Chronic Diseases Surveillance Systems to assess the prevalence and incidence rate of a physician diagnosis of ASD. Estimates were produced using health datasets for outpatient and inpatient care (Med-Echo in Quebec, the Canadian Institute of Health Information Discharge Abstract Database in the three other provinces, plus the Ontario Mental Health Reporting System). Dates of service, diagnosis, and physician specialty were extracted. The target population consisted of all residents aged 24 and under eligible for healthcare coverage under provincial law between 1999 and 2012. To be considered as having ASD, an individual had to have at least one physician claim or hospital discharge abstract indicating one of the following: ICD-9 codes 299.0 to 299.9 or their ICD-10 equivalents, F84.0 to F84.9. The estimates were presented in yearly brackets between 1999-2000 and 2011-2012 by sex and age groups. The main analyses focused on those aged 17 years or less, with the 18 to 24 years group added to show the subsequent progression of the disorder. Results Our findings show that the annual prevalence of ASD rose steadily between 1999 and 2012 in all provinces and for all age groups although this increase varied across Canadian provinces. There were higher annual prevalence estimates in Ontario (4.8 per 1,000) and Nova Scotia (4.2 per 1,000) compared to Quebec (3.0 per 1,000) and Manitoba (2.5 per 1,000), among persons aged 17 years and younger in 2011. As compared to 1999, Quebec and Ontario reported a fivefold and fourfold increase in 2010-2012, the highest among provinces. The prevalence was four times higher in boys than in girls. By age group, the highest prevalence was observed in those aged between 1 to 4 and 5 to 9 years depending on the province. ASD was generally diagnosed before age 10. Incident cases were more frequently diagnosed by pediatricians followed by either psychiatrists or general practitioners depending on the province. Conclusion Our research confirms that ASD has risen steadily in terms of prevalence and incidence rate and that it varies considerably across provinces. It also demonstrates that health administrative databases can be used as registers for ASD. Information derived from these databases could support and monitor development of improved coordination and shared care to meet the continuous and changing needs of patients and families over time. Implication for future research include exploring the etiology of ASD in more recent cohorts as well as investigating the association between variations in health service availability and the prevalence of ASD.

Driving under the influence behaviours among high school students who mix alcohol with energy drinks.

Alcohol and energy drinks are commonly used substances by youth in Canada, and are often mixed (AmED). While several studies have shown that AmED can have dangerous effects, less well understood is how AmED is associated with driving under the influence of either alcohol or drugs. This study sought to determine whether youth who use AmED were more likely to engage in driving, or being a passenger of a driver, under the influence of alcohol or cannabis compared to youth who use either alcohol or energy drinks alone. This study used data from grade 10-12 students who took part in the 2014/2015 Canadian Student Tobacco, Alcohol and Drugs Survey (N=17,450). The association of past-year AmED use with past-30day: driving under the influence of alcohol or cannabis, and riding with an alcohol- or cannabis-influenced driver, was assessed using logistic regression. One in four youth had consumed AmED in the previous 12months. AmED users were more likely to engage in all risk behaviours except riding with a drinking driver, relative to youth who only consumed alcohol. No association was observed for youth who consumed alcohol and energy drinks on separate occasions. Youth who use AmED demonstrate a higher risk profile for driving under the influence of alcohol or cannabis, than youth who use alcohol alone. Future research should explore the biopsychosocial pathways that may explain why using energy drinks enhances the already heightened risk posed by alcohol on other health-related behaviours such as driving under the influence.

When parents supply alcohol to their children: Exploring associations with drinking frequency, alcohol-related harms, and the role of parental monitoring.

BACKGROUND: Youth obtain alcohol from many sources, including friends, siblings, parents and other adults. Whether parental supply, relative to other sources, is associated with experiencing a negative alcohol-related outcome is an area of considerable debate. Less well understood is whether the observed association is further contextualized by level of parental monitoring of the child. OBJECTIVES: This study has two main objectives: 1) determine if there is a relationship between parental supply, drinking frequency, and alcohol-related harms among youth; and 2) assess whether parental monitoring moderates this relationship. METHODS: Participants were drawn from the 2012 Student Drug Use Survey in Canada's Atlantic Provinces, an anonymous cross-sectional survey of high school students (ages 15-19 years). Adjusted regression models assessed the association between drinking frequency, experiencing alcohol-related harms, and four different sources of supply. Additional analyses stratified on levels of parental monitoring. RESULTS: Relative to receiving alcohol from friends, parental supply was associated with lower odds of experiencing any alcohol-related harm (AOR 0.42; 95% CI 0.28-0.61) and loss of control (AOR = 0.42; 95% CI 0.29-0.62). Drinking frequency did not differ by source of supply. Associations between parental supply and harm were absent among youth reporting low levels of parental monitoring. CONCLUSIONS: Youth who receive alcohol from parents' report fewer alcohol-related harms relative to those who obtain their alcohol from friends, despite no observed differences in drinking frequency. Understanding how parents may help to minimize experiences of alcohol-related harm among youth beyond the simple promotion of abstinence from drinking is warranted.

Development of a Behavior Change Intervention to Improve Sexual Health Service Use Among University Undergraduate Students: Mixed Methods Study Protocol.

BACKGROUND: University students are at risk for acquiring sexually transmitted infections and suffering other negative health outcomes. Sexual health services offer preventive and treatment interventions that aim to reduce these infections and associated health consequences. However, university students often delay or avoid seeking sexual health services. An in-depth understanding of the factors that influence student use of sexual health services is needed to underpin effective sexual health interventions. OBJECTIVE: In this study, we aim to design a behavior change intervention to address university undergraduate students' use of sexual health services at two universities in Nova Scotia, Canada. METHODS: This mixed methods study consists of three phases that follow a systematic approach to intervention design outlined in the Behaviour Change Wheel. In Phase 1, we examine patterns of sexual health service use among university students in Nova Scotia, Canada, using an existing dataset. In Phase 2, we identify the perceived barriers and enablers to students' use of sexual health services. This will include focus groups with university undergraduate students, health care providers, and university administrators using a semistructured guide, informed by the Capability, Opportunity, Motivation-Behaviour Model and Theoretical Domains Framework. In Phase 3, we identify behavior change techniques and intervention components to develop a theory-based intervention to improve students' use of sexual health services. RESULTS: This study will be completed in March 2018. Results from each phase and the finalized intervention design will be reported in 2018. CONCLUSIONS: Previous intervention research to improve university students' use of sexual health services lacks a theoretical assessment of barriers. This study will employ a mixed methods research design to examine university students' use of sexual health service and apply behavior change theory to design a theory- and evidence-based sexual health service intervention. Our approach will provide a comprehensive foundation to co-design a theory-based intervention with service users, health care providers, and administrators to improve sexual health service use among university students and ultimately improve their overall health and well-being.

Temporal Trends in the Prevalence and Incidence of Diagnosed ADHD in Children and Young Adults between 1999 and 2012 in Canada: A Data Linkage Study.

OBJECTIVE: There is a need for the routine monitoring of treated attention-deficit hyperactivity disorder (ADHD) for timely policy making. The objective is to report and assess over a decade the prevalence and incidence of diagnosed ADHD in Canada. METHODS: Administrative linked patient data from the provinces of Manitoba, Ontario, Quebec, and Nova Scotia were obtained from the same sources as the Canadian Chronic Diseases Surveillance Systems to assess the prevalence and incidence of a primary physician diagnosis of ADHD ( ICD-9 and ICD-10 codes: 314, F90.x) for consultations in outpatient and inpatient settings (Med-Echo in Quebec, the Canadian Institute of Health Information Discharge Abstract Database in the 3 other provinces, plus the Ontario Mental Health Reporting System). Dates of service, diagnosis, and physician specialty were retained. The estimates were presented in yearly brackets between 1999-2000 and 2011-2012 by age and sex groups. RESULTS: The prevalence of ADHD between 1999 and 2012 increased in all provinces and for all groups. The prevalence was approximately 3 times higher in boys than in girls, and the highest prevalence was observed in the 10- to 14-year age group. The incidence increased between 1999 and 2012 in Manitoba, Quebec, and Nova Scotia but remained stable in Ontario. Incident cases were more frequently diagnosed by general practitioners followed by either psychiatrists or paediatricians depending on the province. CONCLUSION: The prevalence and incidence of diagnosed ADHD did not increase similarly across all provinces in Canada between 1999 and 2012. Over half of cases were diagnosed by a general practitioner.

Age at First Drink, Experiences of Drunkenness, and Alcohol-Related Problems in Canadian Youth: Is Early Onset Bad If You Are a Moderate Drinker?

OBJECTIVE: This article examines early age at first drink (AFD) (14 years and younger) and alcohol-related problems, with a focus on experiences of drunkenness. It challenges the assumption that all early AFD is harmful by investigating whether early drinkers who typically consume alcohol in moderation experience minimal problems or harms. METHOD: Participants were drawn from the 2012 Student Drug Use Survey in Canada's Atlantic Provinces of New Brunswick, Nova Scotia, and Newfoundland and Labrador, an anonymous cross-sectional survey of high school students (ages 15-19 years). Negative binomial regression techniques were used to assess alcohol problems and harms (12-item scale) in association with early-onset drinking. RESULTS: Among ever-drinking high school students (n = 4,752), 65% had their first drink before age 15, 73% reported having ever been drunk, and 55% indicated at least one alcohol-related problem in the past 12 months, with a mean of 1.39 problems. Analyses revealed that experiencing an alcohol-related problem was more strongly associated with ever being drunk than with early AFD. Modeled together, individuals who reported early AFD and who had never been drunk reported significantly fewer problems relative to individuals who reported early AFD and late AFD but had been drunk. CONCLUSIONS: Early AFD is commonly linked to alcohol-related problems in youth and is predictive of future alcohol-related harms in adulthood. However, considerable heterogeneity in the likelihood of suffering alcohol-related problems exists, contextualized by individual drinking patterns. Given the high prevalence of early AFD, harm minimization efforts could achieve greater success by directing youth to consume alcohol in moderation, rather than focusing solely on abstinence.

Sexually transmitted infection testing among heterosexual Maritime Canadian university students engaging in different levels of sexual risk taking.

OBJECTIVES: Individuals aged 15-29 years have the highest rates of diagnosed sexually transmitted infection (STI), and in Canada routine STI testing is recommended for sexually active individuals under 25 years of age. Despite its being readily available to most Canadian university students, testing is not accessed by all sexually active students. This study examines correlates of STI testing among sexually active heterosexual university students. Specifically, we sought to determine: i) the lifetime incidence of STI testing overall and stratified by biological sex; ii) whether those most at risk of STI are being tested; and iii) which other characteristics are associated with ever having been tested for STI. METHODS: A cross-sectional survey of undergraduate students at eight universities in Maritime Canada was carried out in 2012, gathering information on student demographic characteristics, sexual behaviours and use of sexual health services. We conducted a sex-stratified descriptive analysis of each covariate and of STI testing at three levels of STI risk. We then performed multiple logistic regressions to determine the factors associated with lifetime STI testing. RESULTS: Only 34% of the study population and 51% of those at higher risk of STI acquisition had ever been tested for STI. Individuals at moderate or higher risk of STI were more likely to be tested than those at lower risk. In both sexes, older students, those who reported experiencing non-consensual sex while enrolled at university and those with more sexual health knowledge were more likely to be tested. Higher perceived risk was associated with STI testing only among females. CONCLUSIONS: Individuals at higher risk of STI acquisition are more likely to be tested; however, STI testing rates are low in this sample. Health promotion with campaigns designed to increase general sexual health knowledge may be more effective in increasing testing when targeting younger students.

Cord blood vitamin D status and neonatal outcomes in a birth cohort in Quebec, Canada.

PURPOSE: Some evidence suggests that low maternal vitamin D status adversely affects perinatal health but few studies have examined cord blood vitamin D status. This project aimed to determine the association between the cord blood concentration of 25-hydroxyvitamin D [25(OH)D] and neonatal outcomes. METHODS: A nested case-control study was conducted in Quebec City, Canada from 2005 to 2010. Included were 83 cases of low birthweight (LBW; <2500 g), 301 cases of small for gestational age (SGA; <10th percentile), 223 cases of preterm birth (PTB; <37 weeks' gestation), and 1027 controls. Levels of 25(OH)D were determined by chemiluminescence immunoassay. Adjusted odds ratios (OR) and 95 % confidence intervals (CI) were estimated with logistic regression. RESULTS: Cord blood [25(OH)D] <50 nmol/L was associated with a lower risk of LBW compared to [25(OH)D] ≥75 nmol/L (OR 0.47 95 % CI 0.23-0.97). For 25(OH)D levels 50-75 nmol/L, a significant association was not demonstrated (OR 0.58, 95 % CI 0.34-1.01). No significant associations were observed between [25(OH)D] and either SGA or PTB after adjustment. CONCLUSIONS: Although our findings suggest that [25(OH)D] <50 nmol/L is associated with reduced risk of having a LBW infant, prenatal vitamin D recommendations require an examination of the literature that considers the full spectrum of maternal and neonatal outcomes.

Sexual health among female Aboriginal university students in the Maritime Provinces of Canada: risk behaviours and health services use.

UNLABELLED: Background Young Aboriginal Canadian people are at increased risk of negative sexual health outcomes, including sexually transmissible infections (STIs) and unplanned pregnancy. Associations between Aboriginal ethnicity and sexual risk behaviours and related health services use among sexually active female university students in eastern Canada were examined. METHODS: A secondary analysis of online survey data collected from sexually active female university students under age 30 years from eight post-secondary institutions in the Maritime Provinces of Canada was carried out (N=5010). Students were asked about their ethnic backgrounds, health services use and sexual health behaviours. Logistic regressions were used to compare Aboriginal students to Caucasian students regarding their sexual health behaviours and services use. RESULTS: In adjusted analyses, Aboriginal students were seen to be more likely to not have used a condom (OR 2.37; 95% CI 1.34-4.18) or any form of effective contraception (OR 3.05; 95% CI 1.75-5.31) at last intercourse. They also were more likely to report any lifetime testing for pregnancy (OR 5.81; 95% CI 3.07-10.99) and STIs (OR 2.95; 95% CI 1.11-7.82). Aboriginal students accessed university health services as often as their Caucasian counterparts. CONCLUSIONS: Aboriginal women attending university in the Maritime Provinces of Canada engage in greater sexual risk taking than Caucasian women and report more related testing. Health services providers working with university students should be aware of these lower rates of barrier protection and use of contraception among Aboriginal women, and use healthcare visits as opportunities to engage these women in reducing their sexual risk taking.

Associations of School Connectedness With Adolescent Suicidality: Gender Differences and the Role of Risk of Depression.

OBJECTIVE: Previous studies have not examined associations of school connectedness with adolescent suicidal behaviours stratified by gender, while including a measure of depression. We analyzed survey data to determine whether there are independent protective associations of higher school connectedness with suicidal behaviours in Canadian adolescents, while controlling for potential confounders, including risk of depression; and whether such associations differ by gender. METHOD: Using data from a stratified cluster sample of randomly selected classes of students in schools in 3 of Canada's Atlantic provinces, we used multiple logistic regression to examine whether associations of risk of depression, measured using the 12-item Center for Epidemiologic Studies-Depression scale, lessened protective associations of higher school connectedness with suicidal behaviours in grades 10 and 12 students, while stratifying by gender. RESULTS: After adjusting for risk of depression, higher school connectedness was independently associated with decreased suicidal ideation in both genders and with suicidal attempt in females. In males, higher connectedness was no longer protective for suicide attempt when risk of depression was included in the model. CONCLUSIONS: School connectedness, which is felt to have positive influences on many types of adolescent behaviour, appears to also be both directly and indirectly protective for suicidality. These effects may occur through different pathways in females and males. Given the protection it offers both genders, including those at risk and not at risk of depression, increasing school connectedness should be considered as a universal adolescent mental health strategy. Studies that examine school connectedness should include analyses that examine potential differences between males and females.

University Students' Sexual Health Knowledge: A Scoping Literature Review.

Sexual health plays an important role in the well-being of university students. The literature shows that the majority of university undergraduates are sexually active and at high risk of contracting sexually transmitted infections (STIs); however, the breadth and degree of the literature on their sexual health knowledge is unclear. The purpose of this scoping review was to gain a deeper understanding of the state of research on the sexual health knowledge of university/college students globally. A 5-stage framework was used to guide the review and to characterize the literature on sexual health knowledge. Articles published in English between 2000 and 2014 were reviewed if they included university students as a population of interest and described the methods used to measure sexual health knowledge. Of the 2,386 articles retrieved, 91 met the criteria. The majority of the articles (n = 79) used a cross-sectional design to investigate students' knowledge about HIV/AIDS (n = 45), STIs (n = 23), HPV (n = 9), and contraception (n = 24). The review highlights gaps in the literature and in findings relating to the research dominance of various geographic locations, common research designs, the wide range of measurement tools used, and the variety of sexual health knowledge outcomes of interest. The review provides a useful description of the literature on sexual health knowledge among university/college students and some recommendations for moving the field forward.

La santé sexuelle joue un rôle important dans le bien-être des étudiants universitaires. La littérature indique que la majorité des étudiants de premier cycle sont actifs sexuellement et présentent un risque élevé de contracter une infection transmissible sexuellement (ITS). Toutefois, l'étendue et la profondeur des études et travaux de recherche sur la connaissance que possède cette population des questions de santé sexuelle demeurent mal connues. L'objectif de la présente revue de la littérature est de mieux comprendre l'état actuel de la recherche sur la connaissance qu'ont les étudiants universitaires et de niveau collégial à l'échelle mondiale des questions de santé sexuelle. Un cadre d'analyse en cinq étapes a été utilisé pour orienter l'exercice d'examen et caractériser la littérature quant à la question des connaissances relatives à la santé sexuelle. Un corpus d'articles publiés en anglais entre 2000 et 2014 a été évalué de manière à repérer les études ayant comme population cible les étudiants universitaires et proposant une méthode pour mesurer les connaissances de cette population en matière de santé sexuelle. Parmi les 2 386 articles évalués, 91 répondaient à ces critères. La majorité d'entre eux (n = 79) s'appuyaient sur un modèle d'étude transversale pour examiner les connaissances des étudiants concernant le VIH/sida (n = 45), les ITS (n = 23), le virus du papillome humain (n = 9) et la contraception (n = 24). Cette revue de la littérature a permis de relever des lacunes dans les études et travaux de recherche ainsi que dans leurs conclusions concernant la prédominance de certaines régions géographiques dans la recherche, la présence de modèles de recherche communs, la grande diversité des outils de mesure utilisés et la variété des résultats liés aux connaissances en matière de santé sexuelle ciblés par les études. L'article fournit une description utile de la littérature touchant la question des connaissances en matière de santé sexuelle chez les étudiants universitaires ou de niveau collégial et formule certaines recommandations afin de contribuer à la progression de ce domaine de recherche.

Knowledge and practice of childhood motor vehicle restraint use in Nova Scotia: phase II.

OBJECTIVE: To examine changes to knowledge and practice of childhood motor vehicle restraint (CMVR) use in Nova Scotia after the implementation of stricter car seat and new booster seat (BS) legislation in 2007. METHODS: A random telephone survey of households (at least one child <12 years) was performed in 2004 and 2010. Logistic regression determined variables independently associated with correct knowledge and/or practice of CMVR use. RESULTS: Families were surveyed in the pre- (N=426 families, 728 children) and post- (N=453 families, 723 children) legislative periods. Reported appropriate use of forward-facing car seats (FFCSs) and BSs increased significantly (74-92% and 58-95%, respectively). After adjusting for covariates, the post-law period remained a significant predictor of increased knowledge of when to graduate to a BS or a seat belt alone (SB) (OR:1.4(95% CI:1.0-2.0) and 1.9(1.4-2.7), respectively), which was significantly associated with correct use. The strongest independent predictor of the correct use of FFCSs and BSs was the post-law period (OR:14(3.0-68) and 43(17-114), respectively). With regards to rear-facing car seats (RFCSs), new legislation and associated social marketing on graduating from a rear-facing car seat was not associated with increases in correct practice. CONCLUSIONS: Legislation, combined with social marketing at the time of introduction, is an effective means to educate parents on when to graduate from a FFCS and the importance of BSs while also influencing parents to use them, though not for RFCS graduation. The known protective effect of BSs dictates the need for all regions in Canada to adopt comprehensive BS legislation.

Driving under the influence of opioids among high school students in Atlantic Canada: prevalence, correlates, and the role of medical versus recreational consumption.

OBJECTIVE: Employing a sample of 3655 senior students (grades 10 and 12, median ages of 16 and 18, respectively) in Atlantic Canada, this paper examines the risk factors associated with driving under the influence of opioids (DUIO), comparing medical versus recreational opioid users. The associations of DUIO with driving under the influence of alcohol, cannabis, and being a passenger of an impaired driver are also examined. METHODS: Participants were drawn from the 2012 Student Drug Use Survey in the Atlantic Provinces, an anonymous cross-sectional survey of junior and senior high school students in three Atlantic Canadian provinces. Logistic regression techniques were employed in the analysis of unadjusted and adjusted models. RESULTS: Among all senior students, the prevalence of DUIO in the past year was 4.3%. For those who had used a prescription opioid at least once in the past year, the rate of DUIO was 14%, with a higher rate among medical and recreational users (25.1%) compared to those using opioids only for medical purposes (9.6%). The predictors of DUIO were higher SES, higher sensation seeking, lower parental attachment, and being a recreational prescription opioid user. DUIO was strongly associated with other risky driving and passenger behaviours among recreational opioid users. CONCLUSIONS: DUIO is an emerging socio-legal and road safety issue, with implications for public health. Prescription opioid use intentions matter, with recreational users exhibiting most risky driving behaviour than medical users. Effort must be placed on educating prescription opioid users about potential impairment while driving.