Search

Background Migrants make up a growing share of European populations, and very little is known about the impact of migration on their smoking patterns. We develop a longitudinal analysis of smoking prevalence among native-born and immigrants in France based on retrospective data collected in the 2010 national Baromètre santé health survey. Methods Analyses concerned 19 578 individuals aged 18–70 years and born in metropolitan France, in the Maghreb or in sub-Saharan Africa. Person-years with and without smoking were reconstructed using migration and smoking histories and analyzed with discrete-time regression models. Results Prior to migration, immigrants from both the Maghreb and sub-Saharan Africa had lower smoking prevalence than the native-born of similar birth cohort, age and education. After migration, the prevalence increased over time among Maghrebin men up to levels beyond those of the native-born (odds ratio: 1.54 [1.09–2.17] for 10 years of residence or more), while it remained much lower throughout among men from sub-Saharan Africa (odds ratio: 0.36 [0.19–0.68] for 10 years of residence or more). Starting at extremely low levels, the prevalence in both groups of women rose considerably after migration. Women from sub-Saharan Africa nearly caught up to the native-born (odds ratio: 0.70 [0.37–1.32] for 10 years of residence or more), but this was not the case for those from the Maghreb (odds ratio: 0.52 [0.33–0.81] for 10 years of residence or more). Conclusion The findings uncover the low pre-migration prevalence and the diversity of post-migration trajectories. Tobacco control programs targeting recently arrived migrants would contribute to prevent unhealthy assimilation. [ABSTRACT FROM AUTHOR]

Purpose: This study explores mortality related to temporary employment, about which very little is known to date. Methods: In 1996, a health survey was carried out in the French region of Lorraine, and all members of 8,000 randomly chosen households were followed up for mortality over a 13-year period. Mortality of subjects in relation to their employment situation at baseline was analysed using a Cox survival regression. Results: In comparison with permanent workers, for unemployed men, we found age and occupation-adjusted hazard ratios (HR) of 4.1 for all-causes of death and 3.9 for non-violent causes, and for male temporary workers a HR of 2.2 for both all-causes and non-violent causes of death. Bad health, tobacco smoking and alcohol misuse explained 17 % of the excess risk for the unemployed and 41 % of that for temporary workers. Conclusion: The observation of large mortality inequalities across the labour market core-periphery structure has important policy implications, particularly in terms of prevention focused on unhealthy behaviours among male unemployed and temporary workers. [ABSTRACT FROM AUTHOR]

Abstract: Aims: This study investigates the evolution of educational inequalities in smoking initiation and cessation in France according to gender and birth cohort. Methods: We used a 2005 nationwide survey comprising 25,239 subjects aged 18–75 years. Three cohort groups were defined (born 1930–1945, 1946–1965 or 1966–1987). We compared their smoking histories until age 40 years with time-discrete logistic regressions. Educational differences in initiation and cessation were quantified using odds ratios and relative indices of inequality (RII), and the gender gap using odds ratios (gender ratios). Results: For smoking initiation, in the oldest cohorts, no educational gradient appeared in men, but there was a positive gradient in women (RII=0.19); in the middle cohorts, a negative gradient emerged in men (RII=1.55), while the positive gradient reduced in women (RII=0.74); in the youngest cohorts, there was a strengthening of the negative gradient in men (RII=2.72), and the emergence of a negative gradient for women (RII=1.86). The gender ratio narrowed from the oldest cohorts (3.23) to the youngest (1.09), and diminished with increasing educational level within each cohort. For smoking cessation, the educational gradients were negative in both genders, with wider gaps in the youngest cohorts, and gender ratios below 1 reflecting more marked cessation dynamics in women. Conclusion: Women are at an earlier stage in the tobacco epidemic than men for initiation and at a later stage for cessation and social inequalities are widening. We believe that they will not decrease unless gender and the psycho-social aspects of smoking are considered in prevention campaigns. [Copyright &y& Elsevier]

Background: Although the use of cannabis among young people has become a major public health concern, there is no such test in France for general population surveys. Objective: This article aims to present a short screening test for cannabis abuse among adolescents and young adults in general population surveys, the CAST (Cannabis Abuse Screening Test) designed at the French Monitoring Center for Drug and Drug addictions (OFDT). Methods: The survey was conducted in France among 1728 scholars aged 14-22, in secondary schools, high schools, and university. After presenting internal consistency and factorial structure, the authors compared the CAST with the part of the POSIT (Problem-Oriented Screening Instrument for Teenagers) dealing with alcohol and drug abuse among cannabis users in order to validate the optimal thresholds of the CAST for the high risk of abuse defined for the POSIT. Results: The CAST appears to be unidimensional and have high internal consistency (Cronbach's alpha equals 0.81). Among cannabis users whoa are low alcohol consumers, CAST presents very high sensitivity and specificity compared with the POSIT (respectively, 93 and 81%). Conclusions: The CAST seems to be an efficient tool in order to screen for cannabis use disorders among adolescents and young adults. Further research is needed to confirm this result. [ABSTRACT FROM AUTHOR]

A response from the author of the article "Mortality gradient across the labour market core-periphery structure: a 13-year mortality follow-up study in north-eastern France" in the March 10, 2015 issue is presented.

Purpose: The "alcohol harm paradox" has been evidenced among adults, but it is still largely unexplored among adolescents. We examined in a sample of French adolescents the relation between family socioeconomic status (SES), family living arrangement and parental substance use on 1 hand, and heavy episodic drinking (HED), lifetime alcohol-induced emergency room visits (A-ERV), and number of alcoholic drinks and solitary drinking during the last episode on the other hand., Methods: A cross-sectional nationwide survey in March 2017 involved 13,314 French adolescents aged 17-18.5 years. They completed a pen and paper questionnaire about their own and their parents' alcohol and tobacco consumption. We used risk ratios (RRs) from modified Poisson regressions to assess the relationships., Results: Adolescents from the lowest SES had reduced likelihood of reporting 1-2 or 3-5 episodes of heavy drinking compared to those from the highest SES (RR = 0.58, 95% confidence interval = [0.50; 0.66] and 0.35 [0.27; 0.45]), but no difference for six or more episodes (RR = 0.81 [0.59; 1.12]). A-ERV was more frequent among lowest SES adolescents (RR = 1.86 [1.05; 3.30]), possibly due to drinking larger quantities of alcohol and to more frequent solitary drinking in their last episode (p < .001). SES, parental substance use, and family living arrangement were independently associated with HED., Discussion: Our findings reveal an "alcohol harm paradox" in late adolescence in France. Lower SES adolescents exhibit reduced HED but were more likely to consume large quantities alone and experience A-ERV. This emphasizes the significance of considering social determinants in alcohol-related research and interventions., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Monitoring the prevalence of problematic cannabis use is an important public health issue. International surveys need invariant measurement tools to allow reliable comparisons across countries and between sexes. The Cannabis abuse screening test (CAST) has been developed for this purpose. This study is the first assessing its country and sex invariance in a sample of European pupils., Methods: The data come from the self-administered questionnaires completed in 2019 by pupils aged 15-16 in the European school survey project (Espad). The analytical sample was restricted to the 17 countries where at least 300 pupils reported a previous-year cannabis use (n = 8740); multigroup confirmatory factor analyses were used to assess the configural, metric and scalar invariance of the CAST toward country and sex in the 2019 Espad release., Results: Configural, metric and scalar invariance toward country hold for the 17 countries: Austria, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Greece, Italia, Latvia, Poland, Portugal, Slovakia, Slovenia and Spain. Scalar invariance toward sex was met in the 17 countries as a whole and in 11 of the 12 countries where the test could be run. Scalar invariance toward country was met with 6 additional countries comprising at least 250 respondents: Ireland, Lithuania, Malta, Montenegro, the Netherlands and Norway., Conclusion: The CAST is a suitable test for comparing the measurement of problematic cannabis use amongst adolescents in Europe., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objective: The measures put in place to contain the coronavirus epidemic in France have led to fears of a massive increase in the consumption of alcohol, tobacco, and other drugs., Method: Taking advantage of an ongoing weekly Internet survey monitoring living conditions of the French population during the containment, we introduced questions on alcohol and tobacco use 1 month after the start of the first containment. Analyses were conducted with multivariate Poisson regressions., Results: Tobacco consumption remained almost unchanged. By contrast, more than a third of French people did change their weekly alcohol intake: 13% increased it, whereas 21% decreased it, indicating that the containment measures were often taken as an opportunity to reduce alcohol consumption, especially among those who drank less than 4 days per week before. Men were more likely to decrease their alcohol intake and less likely to increase it than women, probably because of a differential impact of the reduction of social activities on gendered social roles. The people most affected were smokers and those living in a dwelling in which someone had been infected, including themselves., Conclusions: The crisis tended to polarize alcohol consumption toward extremes. If the new drinking habits were to continue, the consequences could be beneficial for occasional drinkers but harmful for heavier drinkers., Competing Interests: The authors have no conflicts of interest to declare.

Because the effectiveness of a coronavirus disease lockdown in curbing coronavirus disease spread depends on public support, acquiring real-time information about the way populations reacted to the lockdown is crucial. In France, such public support remained fragile among low-income persons, probably because the lockdown exacerbated preexisting social inequalities and conflicts.

Background: to date, little attention has been given to gender differences in the health of migrants relative to native-born. In this study, we examine the health profile of the largest immigrant groups in metropolitan France, considering several health indicators and with a special interest in the gendered patterns. Methods : The data originate from the 2017 Health Barometer survey representative of metropolitan France. A subsample of 19,857 individuals aged 18-70 years was analysed using modified Poisson regression, and risk ratio estimates (RR) were provided for the different migrant groups regarding alcohol use, current smoking, obesity and less-than-good self-reported health, adjusting for age and educational level. Results : None of the groups of male migrants differs from the native-born in terms of self-reported health, and they have healthier behaviours for alcohol (men from sub-Saharan Africa: 0.42 (0.29-0.61)) and from the Maghreb: 0.30 (0.1-0.54)) and smoking (men from sub-Saharan Africa: 0.64 (0.4-0.84)), with less frequent obesity (men from the Maghreb: 0.61 (0.3-0.95)). The latter, however, more frequently report current smoking (1.21 (1.0-1.46)). For women, less-than-good health is more frequently reported by the groups from sub-Saharan Africa (1.42 (1.1-1.75)) and from the Maghreb (1.55 (1.3-1.84)). Healthier behaviours were found for alcohol (women from overseas départements : 0.38 (0.1-0.85)) and from the Maghreb: (0.18 (0.0-0.57)) and current smoking (women from southern Europe: 0.68 (0.4-0.97), from sub-Saharan Africa: 0.23 (0.1-0.38) and from the Maghreb: 0.42 (0.2-0.61)). Conversely, some were more frequently obese (women from overseas départements : 1.79 (1.2-2.56) and from sub-Saharan Africa: 1.67 (1.2-2.23)). In the latter two groups from Africa, there is a larger relative male excess for tobacco than in the native-born (male-to-female ratios of respectively 2.87 (1.6-5.09) and 3.1 (2.0-4.65) vs 1.13 (1.0-1.20)) and there is a female excess for obesity (0.51 (0.2-0.89) and 0.41 (0.2-0.67)) in contrast with the native-born (1.07 (0.9-1.16)). The female disadvantage in terms of less-than-good self-reported health is more pronounced among migrants from the Maghreb than among the natives (0.56(0.4-0.46) vs. 0.86 (0.8-0.91)). Conclusion : Considering a set of four health indicators, we provide evidence for distinctive gender patterns among immigrants in France. Male immigrants have a healthy behavioural profile in comparison with the natives and no health disadvantage. Female immigrants have a more mixed profile, with a health disadvantage for the non-Western groups from Africa. The contribution to this discordance of socioeconomic factors and gender relations needs to be investigated.

Background: This paper studies the evolution of transitions from first cigarette use to daily use by socioeconomic status (SES) among French adolescents over the course of 17 years, in a context of decreasing prevalence of tobacco use., Methods: A total of 182 266 adolescents participated in the nationally representative ESCAPAD survey at nine different time points between 2000 and 2017. Discrete time-event analysis was used to model the transition to daily cigarette use as a function of SES, gender, age at onset and the use of other psychoactive substances., Results: Although lifetime cigarette smoking and daily cigarette smoking decreased significantly over the studied time span, suggesting a positive impact of prevention policies, disadvantaged adolescents were consistently more prone to engage in daily cigarette smoking, more so in 2017 than 15 years earlier. In the same time span, transitions from initiation to daily cigarette smoking have shortened, with an accelerated pace among underprivileged adolescents., Conclusions: Accelerated transitions from initiation to daily cigarette use are a prevalent trend among disadvantaged adolescents in France. Efforts to mitigate the impact of marketing strategies and to promote health literacy should be pursued to reduce social inequalities in health., (© The Author(s) 2019. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: France has one of the highest levels in Europe for early use of legal and illegal psychoactive substances. We investigate in this country disparities in adolescent problematic substance use by family living arrangement and parental socioeconomic group., Methods: The data used were from the 2017 nationally-representative ESCAPAD survey, conducted among 17-year-olds in metropolitan France (N = 39,115 with 97% response rate). Prevalence ratios (PR) were estimated using modified Poisson regression., Results: Adolescents living in non-intact families (44%) reported daily smoking, binge drinking and regular cannabis use (respectively ≥3 episodes and ≥ 10 uses in the last 30 days) much more frequently than those living in intact families (for example, the PR estimates for father single parent families were respectively 1.69 (1.55-1.84), 1.29 (1.14-1.45) and 2.31 (1.95-2.74)). Socioeconomic differences across types of families did little to explain the differential use. Distinctive socioeconomic patterns were found: a classical gradient for smoking (PR = 1.34 (1.22-1.47) for the most disadvantaged group relative to the most privileged); an inverse association for binge drinking (PR = 0.72 (0.64-0.81) for the most disadvantaged relative to the most privileged), and no significant variation for cannabis use., Conclusion: Our findings shed light on the consistency of the excess use of adolescents from non-intact families and on the substance-specific nature of the association with parental socioeconomic group. Preventive approaches at the population level should be complemented by more targeted strategies.

Background: Educational disparities in daily smoking begin during adolescence and can lead to educational disparities in health among adults. In particular, vocational students including apprentices have higher daily smoking rates compared to non-vocational students. This study aimed to identify the determinants of the gap in daily smoking between French apprentices and high school students aged 17 in 2008 and in 2017., Methods: We used data from a cross-sectional repeated survey representative of all French adolescents aged 17 in 2008 and 2017. We conducted a non-linear extension of the Oaxaca-Blinder decomposition technique and included the following variables: sociodemographic and familial characteristics, parental smoking, cannabis and alcohol use, suicidal attempt, grade repetition and money received., Results: Daily smoking was about two times higher among French apprentices compared to high school students in 2008. This gap did not decrease between 2008 and 2017. Differences in measured characteristics between the two groups explained this gap partly, from 28.6 to 51.2%. Cannabis and alcohol use, money received and parental smoking contributed the most to the daily smoking gap., Conclusions: Prevention programs could target cannabis and alcohol use as well as parental smoking to help decrease educational disparities in smoking status among French adolescents.

Introduction: According to multiple studies, e-cigarette use among adolescents is associated with subsequent smoking initiation. However, little is known about its effect on the transition from smoking initiation to daily smoking., Methods: Using retrospective data from a French national representative survey collected in 2017 (n = 39,115), we analyzed the role of ever using e-cigarettes on daily cigarette smoking status at 17 among ever smokers (n = 21,401). Risk-ratios (RR) were computed through modified Poisson regressions with an inverse probability of treatment weighting (IPTW) approach., Results: Among French adolescents aged 17, 16.8 % declared current e-cigarette use (1.9 % reported daily use) and 34.1 % cigarette smoking (25.1 % reported daily smoking). Among ever-smokers, adolescents who declared having ever used e-cigarettes were less likely than those who did not to transition to daily smoking at 17: RR = 0.62 95 %CI [0.60 - 0.64]. We found similar results for those who experimented with e-cigarettes before initiating smoking, RR = 0.76 95 %CI [0.66 - 0.89]., Conclusions: Our results found no evidence of an increased risk of transitioning to daily smoking at 17 among ever-smokers who also experimented with e-cigarettes. Further studies should investigate the longer-term role of vaping on future smoking habits with the use of causal inference methods., Competing Interests: Declaration of Competing Interest No conflict declared., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Multiple substances (alcohol, tobacco, cannabis and other illicit drugs (OID)) have been frequently used in early adolescents maybe due to school, violence and mental-health difficulties. We investigated the associations between substance-use patterns and related difficulties among 1559 middle-school adolescents from north-eastern France (mean age 13.5 ± 1.3). They completed a questionnaire including socioeconomic features, school, violence and mental-health difficulties (school grade repetition, sustained physical/verbal violence, sexual abuse, perpetrated violence, poor social support, depressive symptoms and suicide attempt; cumulated number noted SVMD score ) and the time of their first occurrence during the life course. Data were analyzed using logistic and negative binomial regression models. Alcohol, tobacco, cannabis and OID use affected 35.2, 11.2, 5.6 and 2.8% of the subjects respectively. The risk of using tobacco only, alcohol and tobacco, alcohol plus tobacco and cannabis, or all alcohol, tobacco, cannabis and OID strongly increased with the SVMD score (socioeconomic features-adjusted odds ratio reaching 85). The risk began in early years in middle schools and then steadily increased, more markedly for elevated SVMD score . Exposure to several SVMDs may be a transmission vector towards the substance use, starting mostly with alcohol/tobacco, and then shifting to cannabis/OID. These findings help to understand substance-use risk patterns and identify at-risk adolescents., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Although the French population comprises large and diverse immigrant groups, there is little research on smoking disparities by geographical origin. The aim of this study is to investigate in this country smoking among immigrants born in either north Africa, sub-Saharan Africa or French overseas départements., Methods: The data originate from the 2010 Health Barometer survey representative of metropolitan France. The subsample of 20,211 individuals aged 18-70 years (born either in metropolitan France or in the above-mentioned geographical regions) was analysed using logistic regression., Results: Both immigrants from sub-Saharan Africa and immigrants from overseas départements were protected from smoking compared to the reference population, and the former had a distinctive strongly reversed educational gradient in both genders. Returned former settlers from the French colonies in North Africa (repatriates) had the highest smoking levels. Natives from the Maghreb (Maghrebins) showed considerable gender discordance, with men having both a higher prevalence (borderline significance) and a reversed gradient and women having lower prevalence than the reference population., Conclusion: Immigrants from regions of the world in stage 1 of the cigarette epidemic had relatively low smoking levels and those from regions in stage 2 had relatively high smoking levels. Some groups had a profile characteristic of late phases of the cigarette epidemic, and others, some of which long-standing residents, seemed to be positioned at its early stages. The situation for Maghrebins reflected the enduring influence of gendered norms post-migration. Based on their educational gradients, immigrants from overseas départements (particularly men) and Maghrebin women may be at risk of losing their particularly low prevalence. Immigrants from sub-Saharan Africa could retain it. In-depth analysis of smoking profiles of immigrants' groups is essential for a better targeting of smoking prevention and cessation programs.

Background: Worldwide, millions of deaths each year are attributed to alcohol. We sought to examine French people's beliefs about the risks of alcohol, their correlates, and their associations with alcohol use., Methods: Data came from the 2010 Baromètre Cancer survey, a random cross-sectional telephone survey of the French general population (n = 3359 individuals aged 15-75 years). Using principal component analysis of seven beliefs about alcohol risks, we built two scores (one assessing risk denial based on self-confidence and the other risk relativization). Two multiple linear regressions explored these scores' socio-demographic and perceived information level correlates. Multiple logistic regressions tested the associations of these scores with daily drinking and with heavy episodic drinking (HED)., Results: About 60% of the respondents acknowledged that alcohol increases the risk of cancer, and 89% felt well-informed about the risks of alcohol. Beliefs that may promote risk denial were frequent (e.g. 72% agreed that soda and hamburgers are as bad as alcohol for your health). Both risk denial and risk relativization scores were higher among men, older respondents and those of low socioeconomic status. The probability of daily drinking increased with the risk relativization score and that of HED with both scores., Conclusions: Beliefs that can help people to deny the cancer risks due to alcohol use are common in France and may exist in many other countries where alcoholic beverages have been an integral part of the culture. These results can be used to redesign public information campaigns about the risks of alcohol., (© The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Objectives: The study investigates the life cycle patterns of educational inequalities in smoking according to gender over three successive generations., Methods: Based on retrospective smoking histories collected by the nationwide French Health Barometer survey 2010, we explored educational inequalities in smoking at each age, using the relative index of inequality., Results: Educational inequalities in smoking increase across cohorts for men and women, corresponding to a decline in smoking among the highly educated alongside progression among the lower educated. The analysis also shows a life cycle evolution: for all cohorts and for men and women, inequalities are considerable during adolescence, then start declining from 18 years until the age of peak prevalence (around 25), after which they remain stable throughout the life cycle, even tending to rise for the most recent cohort., Conclusions: This analysis contributes to the description of the "smoking epidemic" and highlights adolescence and late adulthood as life cycle stages with greater inequalities.

This study investigates the evolution of educational disparities in smoking uptake across cohorts for men and women in three countries. Nationally representative surveys of adults in France, Germany and the United States in 2009-2010 include retrospective measures of age of uptake that are compared for three cohorts (born 1946-1960, 1961-1975, and 1976-1992). Discrete logistic regressions and a relative measure of education are used to model smoking histories until age 34. The following patterns are found: a strengthening of educational disparities in the timing of uptake from older to younger cohorts; an earlier occurrence of the strengthening for men than women and for the United States than France or Germany; a faster pace of the epidemic in France than in the United States, and; a divide between the highest level of education and the others in the United States, as opposed to a gradient across categories in France. Those differences in smoking disparities across cohorts, genders and countries help identify the national and temporal circumstances that shape the size and direction of the relationship between education and health and the need for policies that target educational disparities., (Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Cannabis is the most popular illicit drug in the world, but the process of its diffusion through the population has rarely been studied. The unfolding of the tobacco epidemic was accompanied by a shift in the educational gradient of users across generations. As a consequence, cannabis may show the same pattern of widening social inequalities. We test the diffusion hypotheses that a positive value in older cohorts - the more educated experimenting more - shifts to a negative one in younger cohorts - the more educated experimenting less, first for males and then females., Methods: Three nationwide subsamples (18-64 years old) of representative surveys conducted in France (n=21,818), Germany (n=7887) and USA (n=37,115) in 2009-2010 recorded age at cannabis experimentation (i.e., first use), educational level, gender, and age. Cumulative prevalence of experimentation was plotted for three retrospective cohorts (50-64, 35-49, 18-34 years old at data collection) and multivariate time-discrete logistic regression was computed by gender and generation to model age at experimentation adjusted on age at data collection and educational level. This latter was measured according to four categories derived from the International Standard Classification of Education (ISCED) and a relative (rather than absolute) index of education., Results: The findings demonstrate a consistent pattern of evolution of the prevalence, gender ratio and educational gradient across generations and countries that support the hypothesis of an "epidemic" of cannabis experimentation that mimics the epidemic of tobacco., Conclusion: We provide evidence for a cannabis epidemic model similar to the tobacco epidemic model. In the absence of clues regarding the future of cannabis use, our findings demonstrate that the gender gap is decreasing and, based on the epidemic model, suggest that we may expect widening social inequalities in cannabis experimentation if cannabis use decreases in the future., (Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: In many countries, the decline in smoking prevalence has coincided with a growing concentration of smoking among people with lower socioeconomic status (SES). This concentration may reflect the social differentiation of risk perceptions. We investigated the factors associated with risk perception and fear of cancer, paying particular attention to SES indicators and health information seeking., Methodology: A cross-sectional telephone survey conducted in France in 2010 (including 826 current smokers aged 18-75) assessing how smokers perceive the risk of smoking-related cancer in terms of daily consumption and duration thresholds., Results: Among current smokers, 38% considered that smoking can cause cancer only for a daily consumption higher than their own consumption, and an additional 22% stated that tobacco-related cancer risk only becomes high for a longer smoking duration than their personal one. Predictors of such risk perceptions included low SES, material deprivation and mentioning either the internet or their relatives as one's main source of information on cancer. The same characteristics were also predictive of personal fear of tobacco-related cancer., Conclusion: Our results illustrate the challenges faced by prevention campaigns in the internet society, as information found on the web may fuel smokers' risk denial. Anti-tobacco policies should tailor interventions to people with low SES, who may be especially impervious to standard prevention campaigns because of material deprivation, and they should also address and challenge smokers' risk denial beliefs., (Copyright © 2014. Published by Elsevier Ltd.)

Background: Psychological distress (PD) in students is under-investigated, since its prevalence can be high in certain subgroups of students and it has been seen to be associated with other mental health issues and academic achievement. In a sample of French college students, this study investigated factors associated with PD, and looked more closely at the impact of social and interpersonal variables., Methods: Data were extracted from the 2010 French "National Health Barometer". 946 students were interviewed. Mental health was assessed using the MH-5 five-item scale., Results: The PD rate in this sample was 13.8% (7.2% in males, 19.5% in females). Low income, nonsexual assault in the last 12 months, studying law and low social participation were associated with PD in multivariate analyses., Conclusions: French students show specific characteristics that are discussed in order to explain the relatively low rate of PD observed. The impact of loneliness and social isolation are a major focus for preventive policies based on community resources and early detection of the symptoms of PD.

Background: There is growing evidence that cigarette smoking has become a stigmatized behaviour, at least in western countries, and there is ongoing debate among experts about whether or not such stigma should be an instrument of anti-tobacco policy., Methods: We investigated French non-smokers attitudes toward cigarette smokers, using data from a telephone survey carried out in 2010 among a representative random sample of non-smokers aged 15-75 (N=3091). We carried out a cluster analysis to build contrasted attitudinal profiles and we also computed a score of stigmatization., Results: We found evidence for the existence of stigma associated with cigarette smoking in France: a majority of French non-smokers would not date a smoker, nor hire one to take care of their children. The cluster analysis identified four contrasting profiles, corresponding to different levels of stigmatization, including one cluster whose respondents demonstrated strong levels of moral condemnation and social rejection of smokers. Older people, those with a lower educational level and those reporting financial difficulties were more prone to stigmatize smokers, while those who reported that somebody smoked in their home were less likely to do so. Those who had never smoked and those who abstained from alcohol were more prone to stigmatize smokers. Obese people were also more likely to do so (in bivariate analysis only)., Conclusion: The process of tobacco stigmatization seems well-advanced in France, despite a cultural context that may be less permeable to this process. Further research is needed as our results raise some questions regarding its efficiency as a policy tool. First, people who are familiar with smokers are less prone to stigmatize them. More generally, simultaneously stigmatizing several categories of people may provide each of these same categories with stereotyped 'others' onto whom they can deflect their stigma., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Background: Previous studies have shown that survey methodology can greatly influence prevalence estimates for alcohol and illicit drug use. The aim of this article is to assess the effect of data collection modes on alcohol misuse and drug use reports by comparing national estimates from computer-assisted telephone interviews (CATI) and audio-computer-assisted self interviews (A-CASI)., Design: Two national representative surveys conducted in 2005 in France by CATI (n = 24,674) and A-CASI (n = 8,111)., Participants: French-speaking individuals aged [18]-[64] years old., Measurements: Alcohol misuse according to the CAGE test, cannabis use (lifetime, last year, 10+ in last month) and experimentation with cocaine, LSD, heroin, amphetamines, ecstasy, were measured with the same questions and wordings in the two surveys. Multivariate logistic regressions controlling for sociodemographic characteristics (age, educational level, marital status and professional status) were performed. Analyses were conducted on the whole sample and stratified by age (18-29 and 30-44 years old) and gender. 45-64 years old data were not analysed due to limited numbers., Results: Overall national estimates were similar for 9 out of the 10 examined measures. However, after adjustment, A-CASI provided higher use for most types of illicit drugs among the youngest men (adjusted odds ratio, or OR, of 1.64 [1.08-2.49] for cocaine, 1.62 [1.10-2.38] for ecstasy, 1.99 [1.17-3.37] for LSD, 2.17 [1.07-4.43] for heroin, and 2.48 [1.41-4.35] for amphetamines), whereas use amongst women was similar in CATI and A-CASI, except for LSD in the 30-44 age group (OR = 3.60 [1.64-7.89]). Reported alcohol misuse was higher with A-CASI, for all ages and genders., Conclusions: Although differences in the results over the whole population were relatively small between the surveys, the effect of data collection mode seemed to vary according to age and gender.

Background: Body mass index assessment using self-reported height and weight (BMIsr) can encounter refusals and under/over-reporting while for assessment with measured data (BMIm) refusals can be more frequent. This could relate to socioeconomic and health-related factors. We explored these issues by investigating numerous potential factors: gender, age, family structure, father's occupation, income, physical/sports activity, subjective weight perception, school performance, unhealthy behaviours, physical/psychological health, social relationships, living environment, having sustained violence, sexual abuse, and involvement in violence., Methods: The sample included 1559 adolescents from middle schools in north-eastern France. They completed a questionnaire including socioeconomic and health-related data, self-reported height/weight, measured height/weight, and weight perception (participation rate 94%). Data were analysed using logistic regression models., Results: BMIsr encountered under-reporting (with change in BMI category, 11.8%), over-reporting (6.0%), and reporting refusals (3.6%). BMIm encountered more numerous refusals (7.9%). Reporting refusal was related to living with a single parent, low school performance, lack of physical/sports activity, sustained violence, poor psychological health, and poor social relationships (gender/age-adjusted odds ratios 1.95 to 2.91). Further to these factors, measurement refusal was related to older age, having divorced/separated parents, a father being a manual worker/inactive, insufficient family income, tobacco/cannabis use, involvement in violence, poor physical health, and poor living environment (1.30 to 3.68). Under-reporting was related to male gender, involvement in violence, poor psychological health, and overweight/obesity (as assessed with BMIm) (1.52 to 11). Over-reporting was related to male gender, younger age, alcohol consumption, and underweight (1.30 to 5.35). Weight perception was linked to reporting refusals and under/over-reporting, but slightly linked to measurement refusal. The contributions of socioeconomic and health-related factors to the associations of weight perception with reporting refusal and under/over-reporting ranged from -82% to 44%. There were substantial discrepancies in the associations between socioeconomic/health-related factors and overweight/obesity assessed with BMIsr and BMIm., Conclusions: BMIsr and BMIm were affected by numerous biases related to vulnerability which were also obesity risk factors. BMIsr encountered under/over-reporting which were related to some socioeconomic and health-related factors, weight perception, and BMIm. BMIm was more affected by refusals than BMIsr due to socioeconomic and health-related factors. Further research is needed.

Background: This study investigates the association of the family occupational category (F-OC) with adolescent alcohol use and its potential variation according to the frequency of use., Methods: A national survey representative of adolescents aged 17 living in continental France conducted in 2005 (n = 29,393). Three outcomes were considered: overall use describes the drinking status (lifetime abstinence, use before the month prior the survey, use in the month prior the survey) without considering the frequency of use; last month use and binge drinking detail the frequency of use (1-5 uses, 6-9, 10-19 and 20+ uses) and of binge drinking (0, 1-2, 3-5, 6+ episodes of 5+ glasses in a single occasion) of the previous month users. F-OC was described in 7 categories based on the highest occupational category of the parents (from managers/professionals to unemployed). Analysis used generalised logistic regressions, controlling for gender, F-OC, parental separation, autonomy, other substance use, being out of school and sociability., Results: There was a double gradient: adolescents from high F-OC families were more often experimenters and drinkers during the previous month whereas those of low F-OC families were more often binge drinkers. Adolescents from farmers' families were the most at risk for frequent use and binge drinking in the last month. Interactions tests show that the effect of F-OC was not significantly related to gender., Conclusions: Except for gender, adolescents' patterns of use reflect those observed in the adult population. Mechanisms that favour and hinder progression in alcohol use should be studied in various socioeconomic groups., (Copyright © 2012 Elsevier B.V. All rights reserved.)

The aim of this study was to confirm the influence of cannabis use patterns on the probability of initiation with other illicit drugs (OID). A French nationwide retrospective cohort on drug use was reconstituted on 29,393 teenagers. A Markov multi-state model was fitted, modelling all possible pathways from initial abstinence to cannabis initiation, daily cannabis use and OID initiation. The model was adjusted for tobacco and alcohol use. The risk for OID initiation appeared 21 times higher among cannabis experimenters and 124 times higher among daily cannabis users than among non-users. Tobacco and alcohol use were associated with a greater risk of moving on to cannabis initiation (hazard ratio (HR)=1.2 for tobacco initiation, HR=2.6 for daily tobacco use and HR=2.8 for drunkenness initiation). The results of this study provide a confirmation of a stage process in drug use, mediated by cannabis and liable to lead to OID experiment. This is compatible with the literature on the gateway theory, but goes further by modelling the entire sequence of use. OID experiment could be a consequence of initial opportunity to use the more accessible illicit drug, cannabis., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the associations between biomechanical, physical, and psychological demands and occupational injury according to depressive symptoms severity., Methods: Two thousand eight hundred eighty-two French working people completed a questionnaire covering sociodemographic characteristics, smoking, alcohol consumption, obesity, job, chronic diseases, depressive symptoms, and injuries during the previous 2-year period. Data were analyzed using logistic regression., Results: Occupational injury (9.2%) strongly related to biomechanical, physical, and psychological demands among depressive-symptoms-free workers (odds ratios ranging from 1.35 to 3.15). These relationships were stronger among the workers with depressive symptoms without medical treatment (11.9%) and among those with persistent symptoms despite a treatment (1.7%), with odds ratios up to 12. These associations were partially confounded (up to 51%) by unhealthy behaviors, health status, and chronic diseases., Conclusions: High-occupational demands and depressive symptoms can be early identified and monitored to prevent injury.

Use of a given substance may follow a stage process leading from onset to regular use, and use of one substance can be strongly associated with use of another. The aim of this study was to describe the transitions between tobacco and cannabis use. Data was derived from a French nationwide survey involving 29,393 teenagers. A homogenous Markov multi-state model (MSM) was fitted. The substance use pattern modeled was: no lifetime use→1 (2) substance(s) initiation→1 (2) daily substance(s) use, with pathways between tobacco and cannabis. The likelihood of first initiating tobacco appeared 17.6 times greater than the likelihood of initiating cannabis. Once a subject has experimented with one substance, the risk of another substance experiment was much greater. Transition intensity from tobacco initiation to daily use was 4.8 times higher than that from cannabis. Our results are compatible with a process mixing the gateway theory, the reverse gateway theory and the route of administration model, but do not explore a common liability to addictions, which could be explored by using a MSM on a prospective cohort with initial collection of some explanatory factors., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: This study assessed the associations of short-term employment, physical and psychological occupational demands, and job dissatisfaction with alcohol abuse (using the Audit-C test) and daily smoking among working French men and women in different age groups., Methods: The sample included 13,241 working people, 18-29, 30-39, and 40-59-years-old, randomly selected in France and interviewed by phone. Occupation, type of employment, physical demands, psychological demands, job dissatisfaction, gender, age, educational level, and income were considered. Data were analyzed with logistic models., Results: Alcohol abuse affected 20.4% of men and 7.5% of women; smoking 32.1% and 24.2%, respectively. Their patterns of association with the occupational factors varied with gender and age. Job dissatisfaction was the leading factor among young men (adjusted odds ratio for alcohol abuse and smoking: 1.71 and 2.02), whereas short-term employment was the leading factor among young women (1.69 and 1.58), this pattern being reversed in older generations. The pattern of associations of physical and psychological demands with outcomes is more complex, but overall psychological demands were more important for women (especially the younger ones) than men, especially for smoking (OR>1.6). Smoking within 5 min after waking was much more common among male and female smokers with these occupational factors, suggesting a potential dependency., Conclusions: Workers with short-term employment and occupational demands are subject to a higher risk for alcohol abuse and smoking with high gender and age disparities. Gender and age should be considered when designing measures to prevent substance abuse related to occupation., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Aims: This study explores whether the family socio-economic status (F-SES) and school situation could have an impact on tobacco and cannabis initiation and transition to daily use during adolescence., Design and Setting: A French cross-sectional nation-wide survey conducted in 2005 containing retrospective data., Participants: French teenagers aged 17 (n = 29 393)., Measurement: The F-SES was defined by the highest occupational category of either parent, with seven categories ranging from unemployed/inactive to managers/professionals. Ages at repeat school years, at leaving school, at the first episode of drunkenness and at initiation of illicit drug use were used to model tobacco and cannabis initiation and transition to daily use with time-discrete logistic regressions., Findings: The risk for tobacco initiation was almost equally distributed across F-SES groups, but the risk of a progression to daily use was higher in every F-SES category compared to managers/professionals [odds ratio (OR) from 1.17 to 1.90]. Compared to managers/professionals, risk of cannabis initiation was lower in all F-SES categories (OR from 0.63 to 0.87), but all categories except farmers were at increased risk of transition to daily use: the OR range between 1.29 (intermediate) and 1.98 (unemployed/inactive). Repeating school years and leaving school predicted daily use of tobacco (OR = 2.00 and 2.37) and cannabis (4.58 and 2.07)., Conclusions: Adolescents from the highest family socio-economic status categories are at risk for tobacco and cannabis experimentation but are less prone to engage in daily use. Psychological and social mechanisms that inhibit transition to daily use should be investigated, including school attainment and performance., (© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.)

Purpose: Psychometric and screening properties of the Cannabis Abuse Screening Test (CAST) were investigated using DSM-IV diagnoses of cannabis dependence (CD) and cannabis use disorders (CUD) as external criteria. Performance of the binary and the full version of the CAST were compared., Methods: The sample consisted of 2566 French adolescents aged 17 who reported cannabis use 12 months prior to the survey. The Munich Composite International Diagnostic Interview (M-CIDI) was used as a gold standard for DSM-IV diagnoses. Internal consistency (Cronbach's α), construct validity (exploratory and confirmatory factor analyses, correlation of CAST scores with related variables), and criterion validity (Receiver Operating Characteristic analyses) were assessed., Results: Both CAST versions were unidimensional and Cronbach's α was 0.748 for the binary and 0.775 for the full version. High and comparable AUC values indicate a good ability of both test versions to discriminate between individuals with and without a clinical diagnosis. Based on balanced sensitivity and specificity, the optimal cut-off scores for CD and CUD were 2 for the binary and 3 or 4 for the full version. While both versions largely overestimated CD prevalence, CUD prevalence was slightly underestimated., Conclusions: The binary and the full version of the CAST are equally useful for screening for cannabis-related disorders. Both clinical and research applications of the scale are possible. The CAST may be used for estimating CUD prevalence rather than CD prevalence. The ultimate choice of the cut-off depends on the purpose of the specific study using the CAST., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Licit substance use could be an early stage leading on to cannabis use. The aim of the study was to test a hypothetical sequential process leading from socializing to cannabis use so as to evaluate the mediator role of tobacco and alcohol. Data was derived from a French nationwide survey carried out in 2005 involving 29,393 teenagers aged 17. The analysis used structural equation modelling. The sequence tested was: socializing with friends-tobacco/alcohol use-cannabis use-cannabis use disorders (CUD). Tobacco and alcohol consumptions appeared to be similarly influenced by the time spent with friends. However, tobacco mediation explained 57% of the sequence leading to cannabis use and 61% of the sequence leading to CUD, while the role of alcohol was weaker, at around 13%. Our results underline the effect of peer influence, in the course of night-out socializing, on substance use among adolescents, and the importance of tobacco mediation in the process leading to cannabis use and misuse. This suggests that prevention in places frequented by adolescents should primarily target tobacco consumption, which explains the largest part of cannabis use variance. However, processes linking substance uses seem to be more complex, with the existence of reverse pathways from cannabis to licit drugs. Thus, the gateway effects of tobacco and alcohol require further exploration in relation to simultaneous polysubstance use., (2010. Published by Elsevier Ltd.)

Background: There is little knowledge about the composition and cocaine content of street cocaine, nor about what users know about it., Method: 373 cocaine users were face to face interviewed between May and December 2006 about the last sample of cocaine they had consumed and residual amounts of the substances actually used were analysed using gas phase chromatography coupled to mass spectrometry (GC-MS). Users rated the perceived quality of their product ("good", "average", "poor"), its "estimated percentage of cocaine" and any cutting agents it contained. Price, quantity, place of purchase (street, dealer's premise, appointment), mode of administration (sniffing, injection, smoking) and the supposed nature of the sample (natural, synthetic, no distinction ever made) were also reported. Perceived quality was modelled using multivariate multinomial regression., Results: The median cocaine content was 22%. Altogether, 343 samples contained cocaine, among which 75% contained at least one adulterant. The most frequently occurring were phenacetin (54% of the samples), caffeine (17%), paracetamol (14%), diltiazem and lidocaïne (11%). Users showed relatively poor discrimination concerning cocaine purity, and only 12% reported at least one of the detected adulterants. The major determinants of their perception of cocaine quality were: place of purchase, natural origin, price per gram, actual cocaine content and mode of administration., Conclusion: The composition of street cocaine is largely unknown to users. Users' perceptions of cocaine quality are based partly on false beliefs and certain administration modes. This may contribute to favouring very risky practices. The effects of adulterants on users' health should be investigated., (Copyright 2010 Elsevier B.V. All rights reserved.)

Background: To assess associations among young adults between suicidal ideation in the previous year and adverse childhood events, occupation, education, tobacco use, alcohol abuse, cannabis use in the previous month, illicit drug use, sexual orientation and activity, depression, physical violence in the previous year, and lifetime forced sexual intercourse., Methods: A subsample of 4075 French adults aged 18-30 years was drawn from a random national telephone survey in 2005. Major depressive episode and alcohol abuse were assessed using CIDI-SF and AUDIT-C (score above 4). Data were analysed with logistic regressions., Results: Suicidal ideation affected 5.7% of men and 4.9% of women. Among men depression had the highest adjusted odds ratio (ORa=8.06, 5.07-12.79), followed by homosexual intercourse (3.37, 1.62-7.04), absence of sexual activity (2.83, 1.80-4.44); ORa between 1.6 and 2.0 were observed for living alone, daily tobacco smoking, being unemployed, serious health event concerning the father, age 26-30 and bad relationships between parents. Among women, depression had the highest ORa (7.60, 4.70-12.29), followed by lifetime experience of forced sexual intercourse (5.37, 2.89-9.96), having consumed illicit drugs other than cannabis (4.01, 1.48-10.89); ORa between 1.7 and 2.5 were observed for living alone, being unemployed, bad relationship between parents and age 26-30., Limitations: Cross-sectional survey, sexual orientation inferred from sexual activity., Conclusion: Suicide prevention should integrate the fact that besides depression, unemployment, family history, age, and sexual activity and orientation are specific risk factors among men, whereas illicit drug use, violence and forced sexual intercourse are more important among women., (Copyright 2009 Elsevier B.V. All rights reserved.)

Background: Research has shown that cannabis use contributes to school dropout, but few studies have distinguished the age at onset of use from the age at progression to daily use neither their interaction with grade repetition., Methods: This study is based on a French representative cross-sectional survey (N = 29,393 teenagers aged 17 years) and uses retrospective data. The influence of drug-use patterns <16 years of age on school-dropout rates (5.3%) are modelled with logistic regressions among boys and girls., Results: The main factors associated with dropout were a low family socio-economic status, early grade repetition, single-parent families and daily tobacco smoking (ORa > or = 2.6). The link with the move to daily cannabis use was more evident when it occurred <14 years of age (ORa = 2.05 for boys and 3.41 for girls) rather than at > or =15 years (ORa = 1.45 for both sexes). The onset of cannabis use was not significant when occurring <14 years of age, but was linked to school attainment when occurring at age 15-16 years (ORa = 0.80 for boys and 0.64 for girls). Results are similar for alcohol use. Repeating a grade before beginning to use cannabis increased the dropout rates compared with the opposite sequence. Girls were more affected by early grade repetition and by early and daily cannabis use., Conclusion: Cannabis use is rarely a trigger for grade repetition but can have either damaging or positive effects on school attainment depending of the level of use. Positive social competence reflected by peer initiation should be investigated to understand this paradoxical effect.

Epidemiological monitoring of drug use among adolescents or young adults is a major concern for public policy makers. This surveillance requires the use of adapted methodological solutions. This article presents how far epidemiological surveillance is a useful tool for monitoring drug use at adolescence. It also presents the results of the French general population surveys among adolescents or young adults, and the trends in the last decade. It relies on a survey among 17 years old adolescents and a general population survey among adults (analysis is restricted to people aged 18-25). A European school survey among 16 years old is also presented to compare the French situation to other European countries levels of use. The use of psychoactive substance increases fast with age during adolescence however results vary from one substance to another. Since year 2000, tobacco use is decreasing when alcohol use frequency appears stable between 2003 and 2005, although drunkenness has increased from 2000 to 2005. The frequency of lifetime or occasional use of cannabis appears stable since 2000. Among 17 years old, the proportion of regular users of cannabis has been stable between 2000 and 2005. Finally, the prevalence of ecstasy and cocaine increased during this period of time, despite being less than 4%, but the levels of the other illicit substances are low and stable. The results on alcohol variables and tobacco use in France are rather close to the European average. Four out of five 16 years old students had drunk alcohol during the past 12 months and 36 percent had been drunk during this period (vs 39% in the average European country). About one-third of the students had smoked cigarettes during the past 30 days (close to the 29% in the average European country). The use of cannabis, however, is clearly more prevalent in France. Almost one-third (31%) of the students had already used cannabis (vs 19% in the average European country). The use of inhalants was reported by 12 percent, which is close to the average, while 15 percent of the students had used tranquillisers or sedatives without a doctor's prescription, which is more than twice the European average (6%).

Background: The aim of this work is to estimate the French frequencies of dispensed psychotropic prescriptions in children and adolescents. Prevalence estimations of dispensed prescriptions are compared to the frequencies of use of psychotropic reported by 17 year-old adolescents., Methods: Prescription data is derived from national health insurance databases. Frequencies of dispensed prescriptions are extrapolated to estimate a range for the 2004 national rates. Self-report data is derived from the 2003 and 2005 ESCAPAD study, an epidemiological study based on a questionnaire focused on health and drug consumption., Results: The prevalence estimation shows that the prevalence of prescription of a psychotropic medication to young persons between 3 and 18 years is about 2.2%.In 2005, the self-report study (ESCAPAD) shows that 14.9% of 17 year-old adolescents took medication for "nerves" or "to sleep" during the previous 12 months. The same study in 2003 also shows that 62.3% of adolescents aged 17 and 18 reporting psychotropic use, took the medication for anxiety and 56.8% to sleep. Only 49.7% of these medications are suggested by a doctor., Conclusion: This study underlines a similar range of prevalence of psychotropic prescriptions in France to that observed in other European countries. Nevertheless, the proportion of antipsychotics and benzodiazepines seems to be higher, whereas the proportion of methylphenidate is lower.Secondly, a disparity between the prevalence of dispensed prescriptions and the self-report of actual use of psychotropics has been highlighted by the ESCAPAD study which shows that these treatments are widely used as "self-medication".

Background: Individuals with certain personal, family and job characteristics are at elevated risk of poor mental health. Yet, the respective role of obesity, smoking, alcohol abuse, low education, income, living and family conditions, and socio-occupational category in fatigue/insomnia (FI), nervousness (N) and frequent drug use for those disorders (DFI and DN) among men and women and in gender disparities are not well known., Methods: We studied gender differences in FI, N, DFI, DN, and in their correlated, and whether the gender differences were mediated by individual and lifestyle factors among 3,450 active subjects aged 18-64, randomly selected from North-eastern France. Subjects completed a post-mailed questionnaire. Data were analyzed via adjusted odds ratio (ORa) computed with the logistic regression model., Results: Women were more affected than men for FI (21.3 vs. 13.1%, OR adjusted for age ORa 1.80, 95% CI 1.50-2.16), DFI (11.6 vs. 7.1%, ORa 1.74, 1.38-2.21), N (14.7 vs. 9.9%, ORa 1.58, 1.28-1.94), and for DN (12.1 vs. 5.7%, ORa 2.29, 1.79-2.94). These differences were not mediated by the individual characteristics studied. Multivariate analysis showed that the risk patterns varied between the two sexes. Smoking was related to N in men as well as in women; alcohol abuse to DFI in men only; lack of family support to all outcome variables in men and women; low educational level to DFI in men only; low income to FI, N and DN in men and to FI and DN in women; being unmarried to DN in men; being divorced/separated to N and DN in women; being a manual worker to FI and being a farmer to DFI in men; and being a manual worker to DN and being an employee to FI in women (1.50

Background: General population surveys do not provide reliable estimates of problem drug users, which are essential for drug use prevention and treatment policies. Indirect estimation methods, especially capture-recapture method, are preferred. Problem drug use receives now a growing interest on a European level. Very few studies using this method have been carried out in France especially on a multicentric level., Method: Six three-sample capture-recapture analyses were carried out in urban areas of Lille, Lyon, Marseille, Metz, Rennes, Toulouse. Data were collected in 2006 from different sources including treatment data, harm reduction and social data and law enforcement data. Users of opiates, cocaine/crack, stimulants and/or hallucinogens aged 15-64 were identified. Log-linear models were fitted to the data in order to test different interactions between the data sources representing potential dependencies. The simplest model was selected on the basis of its Akaike Information Criterion (AIC) and log-likelihood ratio tests. Confidence intervals were estimated using the likelihood interval method., Results: The total number of problem drug users was estimated to be 7900 (95% CI 6300-10 200) in Lille, 8400 (6300-11 800) in Lyon, 5600 (4200-7700) in Marseille, 2300 (1700-3200) in Metz, 1500 (1100-2300) in Rennes and 5400 (4300-6900) in Toulouse (estimates are rounded to nearest 100). These figures correspond to the following prevalence rates of the population aged 15-64 years: 10.8 per thousand (8.6-14.0) in Lille, 10.6 (8.0-15.0) in Lyon, 10.3 (7.7-14.2) in Marseille, 10.8 (8.0-15.0) in Metz, 7.6 (5.6-11.7) in Rennes, 10.1 (8.0-12.9) in Toulouse., Conclusions: Although the confidence intervals are wide, the method provides valuable information on the extent of problem drug use.

Background: In France, drug use levels of college students remain quite unknown, mainly because of the lack of representative samples of this specific part of the population. There is also a lack of studies concerning gender and drug use., Methods: The Health barometer 2005 is a wide national telephone survey which is representative of the 12-75-year-olds (n=30,514). Among the 18-25-year-olds, 1290 students were surveyed, besides 1480 employed and 538 unemployed people. Various licit and illicit drug use levels of these three groups were compared using logistic regression models for men and women, controlling for age, level of diploma, category of area of residence, living in couple, religion and type of phone equipment. These results were compared with those obtained in the Health Barometer 2000, with exactly the same variables and definitions., Results: Analysis showed that among women, alcohol and cannabis use as well as drunkenness were more frequent among unemployed and college students than among workers. For men, drug use, and especially illicit drug use, appeared more frequent among unemployed. As a consequence, gender differences for alcohol and cannabis use were lower among students than among workers or unemployed. For both sexes, logistic models controlling for age showed that alcohol consumption as well as daily tobacco smoking were less frequent among students than among employed people, contrarily to drunkenness and cannabis use. For almost all drug uses, differences between genders are smaller among students. Except for alcohol and tobacco use, these differences disappeared when controlling for other sociodemographic variables. Compared with data from year 2000, differences among the three groups appeared smaller, especially for drunkenness and cannabis smoking among college students., Conclusion: Alchol and tobacco uses are less frequent among students than active people, employed or not, but there is no significant difference for drunkenness and cannabis use. For both genders, unemployment is associated with increased levels of drug use, but pursuing higher education is associated with an increased level of alcohol and cannabis use among women, which is not the case among men.

Introduction: The most recent health surveys in general population are used in order to estimate the annual market size for cannabis in France in 2005., Methods: Two methods for arriving at an estimate are proposed: the first based on reported consumption, the other on reported expenditure on cannabis., Results: The annual sales figure for cannabis in France is between 746 and 832 million euro. Men's expenditure accounts for between 80 and 85% of total expenditure and those aged between 15 and 24 years account for the greatest part of the size of the cannabis market, between 57 and 60%, depending upon the method., Conclusions: According to these estimates, consumers' average annual expenditure on cannabis is around euro 202 in France, compared to estimates obtained for New Zealand and Holland (euro 124) and the United States (euro 362).

Objective: To quantify the different forms of polydrug use in the French population and the principal factors associated with it., Methods: Data came from the Baromètre Santé 2005, a general population study. Polydrug use was approached by 2 indicators: regular use of at least 2 products among alcohol, tobacco and cannabis, and the use during the year of at least 2 illegal drugs besides cannabis (not necessarily concomitantly)., Results: Regular use of some combination of alcohol, tobacco and cannabis was reported by 8.3% of the population. Those aged 20-24 years combined tobacco and cannabis most frequently, with 11.6% reporting this joint use. Regular consumption of all 3 products was rare, reported by less than 1% of those aged 15-64 years. It was highest among those aged 20-29 years, but still less than 2% of the age group. The principal combination for those aged 35 years or older was alcohol and tobacco, and those in this group rarely combined cannabis with another substance. There was a strong association between cannabis use and use of other illicit psychoactive substances. Lifetime use of illicit psychoactive substances except for cannabis was reported by 10.0% of the 15-34 year-olds; for use during the previous year, it was 2.3%. The factors associated with these practices were unemployment, male gender, and youth. Postsecondary education appeared to distance young adults from the different forms of polydrug use., Discussion: Because use of multiple psychoactive substances is often associated with risk-taking or vulnerability, particular attention to these practices is justified. Surveys in the general population do not cover the most vulnerable or most "desocialized" populations and do not allow the most dangerous forms of polydrug use to be described. They supply useful information for assessing the extent of the most common combined uses in the population and their probable health and social repercussions.

Adolescence is often the time of experimentation with psychoactive substances, sometimes leading to more regular use. This paper gives an update of drug consumptions by the young adolescents, from results of recent general population surveys in France, and focuses on the specificity of this consumption when compared to that of older adolescents. It shows that regular uses of such substances usually do not start before the age of 14, but that early initiated adolescents show a higher risk of moving towards more intensive or problematic uses. Through presenting the limitations of such surveys, the authors discuss the nature of the link observed between early experimentation and level of use: while acknowledging the unquestionable prognostic value of early initiation to predict future problematic use, they show that its interpretation should be made with caution when based on such transversal epidemiological surveys.

Background: Adolescents and young adults seeing a nurse or physician for any reason should be screened for psychoactive substance use. Several English-language questionnaires are available to screen for and assess harmful use of psychoactive substances among adolescents, but to our knowledge, no such instrument exists in French. The aim of the ADOTECNO study was therefore to develop simple and efficient tools for this purpose., Methods: Two questionnaires widely used in French epidemiologic studies (CRAFFT-ADOSPA to screen for harmful use and POSIT to assess the seriousness of consumption from physical, psychological and social viewpoints) were completed by 1728 secondary and post-secondary school students. Statistical analyses assessed correlations between the questionnaires and calibrated optimal cutoff points for the different tools included in ADOTECNO., Results: Correlations between psychoactive substance consumption, responses to the CRAFFT-ADOSPA questionnaire, and POSIT factor A scores showed that CRAFFT-ADOSPA provided early detection of regular alcohol intoxication and of regular and daily cannabis use. At a score of 2, CRAFFT-ADOSPA detects harmful substance use, and at a score higher than or equal to 3 it demonstrates serious substance use., Conclusion: These findings enabled us to recommend useful cutoff values for the CRAFFT-ADOSPA tools for screening subjects at moderate or high risk of substance abuse. This simple broad screening should be complemented for the subjects found to be at risk by a computer-assisted POSIT to guide practitioners in selecting an approach (educational, school, family, psychological, psychiatric, etc.) to care and management according to the specific types of impairment resulting from substance use.

Unlabelled: Many alcohol-related problems at adolescence occur during or as a result of peer-oriented activities, so it is necessary to understand how drinking habits are embedded in sociability and lifestyle., Objective: to study patterns of peer-oriented activities among heavy drinkers, and to investigate factors associated with these patterns., Study Group: A national random sample of 13,623 French adolescents aged 17-18 years, and a subgroup of 762 heavy drinkers (reporting either 20 drinking occasions or more during the prior 30 days, or 20 episodes of drunkenness or more during the previous 12 months)., Methods: Respondents answered to a self-administered closed-ended questionnaire. Questions on peer-oriented activities were used for conducting a cluster analysis among heavy drinkers. Logistic regressions were used for studying factors associated with the resulting clusters., Results: Among heavy drinkers the dominant pattern was characterized by the combination of heavy drinking and peer-oriented activities. But in two other profiles heavy drinking was associated with either strong involvement in formal sporting practice or low participation in peer-oriented activities. The expected relationship between heavy drinking, mood disorders, other drug use, violence and victimization depended on which pattern was considered., Conclusions: The strong links observed between drinking habits and sociability underline the need to counteract the social acceptability of drinking and focus on the social contexts in which it occurs, but preventive action programs should also take into account the diversity of sociability patterns among heavy drinkers.

Cannabis is the most consumed illicit drug in France. Its use concerns especially men, in all social groups. It is mainly consumed by young adults and teenagers. Over the last ten years the consumption of cannabis strongly increased amongst French young people, the rise has been even stronger for regular use. Prevalence use in France has now reached the highest European levels. Cannabis use can lead to a treatment demand and a research will soon allow to screen problematic users in general population in France. The part of the cannabis in the activity of specialised centres for drug addicts progresses. Due to a lack of indicators, the sanitary impact is not well-informed; nevertheless there are presumptions that cannabis is involved in road accidents, cancers and psychiatric pathologies. The cannabis constitutes the main part of the arrests for drug use.

Background: Alcohol consumption is still a major public health problem in France. A recent survey in the general population provided an overall picture of regional differences of alcohol consumption and demonstrated the difficulty encountered in comparing declarative data and economic and health data., Methods: A method based on standardisation was applied to control the effects of age and gender in order to demonstrate regional differences in daily alcohol intake and episodes of drunkenness during the year as well as differences in weekly alcohol intake. A hierarchical clustering was performed based on these indicators in order to obtain a regional map., Results: Three classes of regions were distinguished. The first group included regions where the prevalence of drunkenness or alcohol intake was particularly high (Brittany, Pays de la Loire, Burgundy, Alsace, Franche-Comté, Rhône-Alpes). The second group included regions where daily consumption was frequent and rather high in quantity (Limousin, Auvergne, Aquitaine, Midi-Pyrénées, Languedoc-Roussillon). The third group included regions where daily intake and drunkenness were exceptional. These results were compared with external data: household data, alcohol-related mortality data, medical consultation data. In some regions in southwestern France or northern France, results showed a poor fit between economic and social data., Conclusion: Measuring the quality of declarative data on alcohol consumption is essential for public health decision-makers. Comparing economic and sanitary data remains a difficult task. Differences related to the source of the data lead to very different concepts of the problem, requiring in-depth knowledge and new hypotheses to correctly interpret such differences. Further work is needed to better ascertain the different aspects of the problem of alcohol consumption in France. For example, general population surveys might include more precise questions for identifying excessive drinkers or questions on economic data related to alcohol (e.g. purchasing practices).

Aims: This study aimed at increasing understanding of the relationship between sporting activities and alcohol, cigarette and cannabis use among adolescents, by examining gender, age and the context of sporting practice., Design, Setting, Subjects: The study was a national school survey (n=10807; ages 14-19 years) conducted in France in 1999., Measures: Respondents were asked confidentially by self-administered questionnaire (pen and paper) about their use of licit and illicit drugs and life-style (including sporting activities outside school: hours per week, registration in a club, type of sport)., Findings: The U-shaped curve between the intensity of physical activities and licit and illicit drug use appeared not to be systematic. It depended mainly on the product and the level of use. It only remained significant for boys and heavy smoking once gender and age effect were taken into account., Conclusion: The results stress the need to control for age and gender when the survey participants are teenagers. The relationship between drug use and sporting activity also depends on the type of sport.