Ashok Chaurasia

Clustering of risk-related modifiable behaviours and their association with overweight and obesity among a large sample of youth in the COMPASS study

BackgroundCanadian youth exhibit a number of risky behaviours, some of which are associated with overweight and obesity. The purpose of this study was to examine the prevalence of 15 modifiable risk behaviours in a large sample of Canadian youth, to identify underlying subgroups based on patterns of health behaviours, and to examine the association between identified subgroups and overweight/obesity.MethodsData from 18,587 grades 9–12 students in Year 1 (2012–13) of the COMPASS study and latent class analysis were used to identify patterns and clustering among 15 health behaviours (e.g., physical inactivity, sedentary behaviour, unhealthy eating, substance use). A logistic regression model examined the associations between these clusters and overweight/obesity status.ResultsFour distinct classes were identified: traditional school athletes, inactive screenagers, health conscious, and moderately active substance users. Each behavioural cluster demonstrated a distinct pattern of behaviours, some with a greater number of risk factors than others. Traditional school athletes (odds ratio (OR) 1.15, 95% CI 1.03–1.29), inactive screenagers (OR 1.33; 1.19–1.48), and moderately active substance users (OR 1.27; 1.14–1.43) were all significantly more likely to be overweight/obese compared to the health conscious group.ConclusionsFour distinct subpopulations of youth were identified based on their patterns of health and risk behaviours. The three clusters demonstrating poorer health behaviour were all at an increased risk of being overweight/obese compared to their somewhat healthier peers. Obesity-related public health interventions and health promotion efforts might be more effective if consideration is given to population segments with certain behavioural patterns, targeting subgroups at greatest risk of overweight or obesity.

Post-High School Changes in Tobacco and Cannabis Use in the United States

ABSTRACT Background: The transition from high school into young adulthood is a critical developmental period with many young people going to college, moving residence, and entering the work force for the first time. The NEXT Generation Health Study (NEXT) is a nationally representative longitudinal study of adolescent health behaviors. Previous NEXT research has found that the post-high school environment is associated with changes in alcohol use. Objectives: The current study investigated the impact of school status, residential status, and work status on cannabis and cigarette use among post-high school participants. Results: Living in a dorm/fraternity/sorority was associated with an increased prevalence in cannabis use while attending a 4-year college was associated with a decreased prevalence in cigarette use. Conclusions: Some aspects of the post-high school environment are related to cannabis and cigarette use. Differences in the social circumstances of cigarette and cannabis use and recent campaigns in colleges to reduce smoking may explain some of these trends.

The Effect of Religion and Spirituality on Cognitive Function: A Systematic Review

PURPOSE OF THE STUDY The maintenance of cognitive health is an important component of healthy aging. Abnormal cognitive decline can signal the onset of dementing disorders such as Alzheimers disease (AD). Normal cognitive decline can also adversely affect the health of aging populations. We investigated the association between religious/spiritual involvement (R/SI) and cognitive function in adults of any age and any setting. We also examined whether social engagement acts as a mediator or moderator of the effect of R/SI on cognitive function, and whether the association between R/SI and cognitive function differs according to how each of these constructs is measured. DESIGN AND METHODS We conducted a systematic review of articles published between 1990 and September 2016 by searching OVID MEDLINE, PSYCHINFO, EMBASE, and Google Advanced Search. We included studies with a comparison group (cohort, case-control, cross-sectional) that reported on R/SI (exposure) and cognitive function (outcome). RESULTS Of the 6,300 citations obtained in the literature search, 17 met our eligibility criteria and were included in the review. Most of the included studies (82%) reported positive associations between R/SI and cognitive function. R/SI appears to be protective against cognitive decline in middle- and old-age adults. IMPLICATIONS Public health practitioners should not overlook the benefits of enabling religious/spiritual practices among religious adults (i.e., offering ride programs could help isolated elders attend religious gatherings).

Effect of religious involvement on cognition from a life-course perspective: protocol for a systematic review and meta-analysis

Introduction Preserving cognitive health is a crucial aspect of healthy ageing. Both abnormal and normal cognitive decline can adversely affect the health of ageing populations. Evidence suggests religious involvement (RI) can preserve cognition in ageing populations. The primary purpose of this review is to examine the evidence regarding the association between RI and cognition from a life-course perspective. Methods and analysis This systematic review and meta-analysis has been registered with PROSPERO (registration number CRD42016032331). We will search MEDLINE, PSYCHINFO and EMBASE, and include primary studies with a comparison group, for example, cohort, cross-sectional and case–control studies. To supplement the database search, we will also search the grey literature and the reference lists of included studies. Two reviewers will independently assess and extract data from the articles. Risk of bias and the strength of evidence will be assessed. For sufficiently homogeneous data in domains such as study methods and measures of RI and cognition, we will pool the results using DerSimonian and Laird meta-analysis. Ethics and dissemination Since this is a protocol for a systematic review, ethics approval is not required. The findings of this review will be extensively disseminated through peer-reviewed publications and conference presentations.

Pattern–mixture models with incomplete informative cluster size: application to a repeated pregnancy study

The incomplete informative cluster size problem is motivated by the NICHD Consecutive Pregnancies Study, aiming to study the relationship between pregnancy outcomes and parity. These pregnancy outcomes are potentially associated with the number of births over a womans lifetime, resulting in an incomplete informative cluster size (censored at the end of the study window). We develop a pattern mixture model for informative cluster size by treating the lifetime number of births as a latent variable. We compare this approach with a simple alternative method that approximates the pattern mixture model. We show that the latent variable approach possesses good statistical properties for estimating both the mean trajectory of birthweight and the proportion of gestational hypertension with increasing parity.

Exploring the Predictive Validity of the Susceptibility to Smoking Construct for Tobacco Cigarettes, Alternative Tobacco Products, and E-Cigarettes

INTRODUCTION Within tobacco prevention programming, it is useful to identify youth that are at risk for experimenting with various tobacco products and e-cigarettes. The susceptibility to smoking construct is a simple method to identify never-smoking students that are less committed to remaining smoke-free. However, the predictive validity of this construct has not been tested within the Canadian context or for the use of other tobacco products and e-cigarettes. METHODS This study used a large, longitudinal sample of secondary school students that reported never using tobacco cigarettes and noncurrent use of alternative tobacco products or e-cigarettes at baseline in Ontario, Canada. The sensitivity, specificity, and positive and negative predictive values of the susceptibility construct for predicting tobacco cigarette, e-cigarette, cigarillo or little cigar, cigar, hookah, and smokeless tobacco use 1 and 2 years after baseline measurement were calculated. RESULTS At baseline, 29.4% of the sample was susceptible to future tobacco product or e-cigarette use. The sensitivity of the construct ranged from 43.2% (smokeless tobacco) to 59.5% (tobacco cigarettes), the specificity ranged from 70.9% (smokeless tobacco) to 75.9% (tobacco cigarettes), and the positive predictive value ranged from 2.6% (smokeless tobacco) to 32.2% (tobacco cigarettes). Similar values were calculated for each measure of the susceptibility construct. CONCLUSIONS A significant number of youth that did not currently use tobacco products or e-cigarettes at baseline reported using tobacco products and e-cigarettes over a 2-year follow-up period. The predictive validity of the susceptibility construct was high and the construct can be used to predict other tobacco product and e-cigarette use among youth. IMPLICATIONS This study presents the predictive validity of the susceptibility construct for the use of tobacco cigarettes among secondary school students in Ontario, Canada. It also presents a novel use of the susceptibility construct for predicting the use of e-cigarettes, cigarillos or little cigars, cigars, hookah, and smokeless tobacco among secondary school students in Ontario, Canada.

Identifying behavioural characteristics of tobacco product and e-cigarette use clusters: A repeat cross-sectional analysis

BACKGROUND Youth may use a variety of tobacco products and e-cigarettes. However, there is a lack of evidence for the combinations of tobacco products and e-cigarettes commonly used by youth in Canada and whether youth from different usage classes share similar characteristics. METHODS A cohort of 9th grade students from Ontario, Canada was identified at baseline (2013-14) of the COMPASS study (n = 4651). Classes of youth that currently use similar combinations of tobacco products and e-cigarettes were identified at baseline, one (FY1) and two years later (FY2) using latent class analysis. Multinomial logistic regression models identified demographic and behavioural characteristics (e.g., environmental influences, substance use behaviours, etc.) of youth in current tobacco and e-cigarette use classes relative to youth in non-current use classes. RESULTS At baseline, a three-class model was identified as best, while a four-class model was identified at FY1 and FY2. A non-current use group and an all-product use group were identified every year. Students that reported having friends that smoked cigarettes, binge drinking, and using marijuana were more likely to be classified into a current use class. CONCLUSIONS Tobacco cigarettes were more likely to be used with other products than on their own. An all-product use group was identified across all three survey waves and the prevalence of this group increased over time. Given that many youth in this study used more than one tobacco product or e-cigarette and commonly reported binge drinking and using marijuana, prevention and cessation activities should address the use of multiple products.

Behavioural patterns only predict concurrent BMI status and not BMI trajectories in a sample of youth in Ontario, Canada

Background Youth are engaging in multiple risky behaviours, increasing their risk of overweight, obesity, and related chronic diseases. The objective of this study was to examine the effect of engaging in unique clusters of unhealthy behaviours on youths’ body mass index (BMI) trajectories. Methods This study used a linked-longitudinal sample of Grades 9 and 10 students (13 to 17 years of age) participating in the COMPASS host study. Students reported obesity-related and other risky behaviours at baseline and height and weight (to derive BMI) at baseline (2012/2013) and annually for 2 years post-baseline (2013/14 and 2014/15). Students were grouped into behavioural clusters based on response probabilities. Linear mixed effects models, using BMI as a continuous outcome measure, were used to examine the effect of engaging in clusters of risky behaviours on BMI trajectories. Results There were significant differences in BMI of the four behavioural clusters at baseline that remained consistent over time. Higher BMI values were found among youth classified at baseline to be Typical High School Athletes (β = 0.232 kg/m2, [confidence interval (CI): 0.03–0.50]), Inactive High Screen-User (β = 0.348 kg/m2, CI: 0.11–0.59) and Moderately Active Substance Users (β = 0.759 kg/m2, CI: 0.36–1.15) compared to students classified as Health Conscious. Despite these baseline differences, BMI appeared to increase across all behavioural clusters annually by the same amount (β = 0.6097 kg/m2, (CI) = 0.57–0.64). Conclusions Although annual increases in BMI did not differ by behavioural clusters, membership in a particular behavioural cluster was associated with baseline BMI, and these differences remained consistent over time. Results indicate that intervening and modifying unhealthy behaviours earlier might have a greater impact than during adolescence. Health promotion strategies targeting the highest risk youth as they enter secondary school might be promising means to prevent or delay the onset of obesity.

Food Purchasing Behaviors and Sugar-Sweetened Beverage Consumption among Canadian Secondary School Students in the COMPASS Study

Objectives To examine whether several food purchasing behaviors (ie, sources of meals or snacks) are associated with adolescents’ sugar‐sweetened beverage (SSB) consumption and whether these associations vary by province. Design Cross‐sectional observational study. Setting Alberta and Ontario, Canada. Participants Secondary school students from Alberta (n = 3,300) and Ontario (n = 37,999) participating in year 2 (2013–2014) of the Cannabis Use, Obesity, Mental Health, Physical Activity, Alcohol Use, Smoking, Sedentary Behavior (COMPASS) study. Main Outcome Measures Participants’ self‐reported frequency of consuming 3 SSB types (soft drinks, sweetened coffees/teas, and energy drinks) in a typical week. Analysis Hierarchical Poisson regression analyses. Results Participants from Alberta had a significantly (P < .05) higher rate of consuming SSBs and purchasing meals or snacks from school food outlets compared with their Ontario counterparts. Most of the food purchasing behaviors were significantly (P < .05) and positively associated with greater rates of SSB consumption. Meal or snack purchases on weekends (vs weekdays) and from food outlets off school property (vs on school property) had a greater association with SSB consumption. Eating a home‐packed lunch was protective against SSB consumption across models. Conclusions and Implications Adolescents’ food purchasing behaviors have a significant impact on their propensity for SSB consumption. These data demonstrate potentially important contexts for SSB consumption and have implications for possible settings and strategies for future interventions to reduce adolescents’ SSB intake.

THE EFFECT OF RELIGIOUS INVOLVEMENT ON COGNITION ACROSS THE AGING LIFESPAN: A SYSTEMATIC REVIEW

Background:Preserving cognitive health is a crucial aspect of successful aging. We propose to conduct a systematic review and explore the association between religious involvement (RI) and cognition across the aging lifespan from young adulthood to old age.Methods:Wewill conduct a systematic review of the literature in order to establish the current scope of knowledge on RI and cognitive function. We will assess the risk of bias of included articles using the Newcastle-Ottawa Scale and evaluate the strength of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: We will qualitatively synthesize the extracted data from all included articles and for subsets of studies that are sufficiently homogeneous in terms of sample characteristics, measures of RI and cognition, and methods, we will pool results using meta-analysis. Conclusions:The systematic review will provide the most comprehensive assessment of the state of knowledge on the subject to date and will provide information that will permit us to confirm our suspicions about knowledge gaps which could be used to guide future research in the field. We estimate that the results of the review would be available in time for the conference.