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Background: Many adolescents with allergy do not receive physician treatment (allergy untreated ). We explored its association with socioeconomic adversities and academic-behavior-health difficulties, which remain unaddressed., Methods: This cross-sectional school-based-population study compared the above factors of middle-school adolescents with allergy untreated and those with treated allergy (allergy treated ) (mean age = 13.5 ± 1.2) from north-eastern France. Participants completed a questionnaire collecting socioeconomic adversities (nonintact family, low parents' education, insufficient family income, poor social support, suffered verbal/physical violence, and sexual abuse), low academic performance, excessive screen time, substance use, sleep difficulty, poor physical health, depressive symptoms, suicide attempt, poor quality of life, and allergy treated /allergy untreated ., Results: Logistic regression models showed that allergy untreated was associated with all the factors considered (sex-age-class-level-adjusted odds ratio (saclOR) reaching 3.94, p < .001) and the risk score (number of main criteria: suffered sexual abuse, excessive screen time, poor quality of life, cannabis use, low parents' education, and poor social support): saclOR 4.75, 9.23, 15.64, and 31.73 (p < .001) for risk scores 1, 2, 3, and ≥4, versus risk score = 0 (pseudo-R 2  = 11.1%)., Conclusions: Socioeconomic adversities and academic-behavior-health difficulties may be used to detect adolescents with allergy untreated for care., (© 2024, American School Health Association.)

Objective: We assessed the associations of substance (alcohol, tobacco, cannabis, and other illicit drugs) use of adolescents with that of their family members (father, mother, step-parent, brothers/sisters, and grandparents) and peers, and the mediating role of school and mental difficulties (SMDs) which remained insufficiently addressed., Methods: This cross-sectional population-based study included 1,559 middle-school adolescents in France (mean age = 13.5 ± 1.3, 778 boys, 781 girls). They completed a questionnaire including socioeconomic features (nationality, family structure and parents' education, occupation, and income), substance use, cumulative number of substance use of family members (father, mother, step-parent, brothers/sisters, and grandparents) and peers (noted familySUcn and peerSUcn), SMDs (grade repetition, suffered physical/verbal violence, sexual abuse, lack of family/peer support, depressive symptoms, suicide attempt, and age at onset). Data were analyzed using logistic regression models and Kaplan-Meier estimates., Results: Most adolescents had familySUcn 1-2, 3-5, and ≥ 6 (39.1%, 23.0%, and 4.5%, respectively) and peerSUcn 1-2 and ≥ 3 (36.1% and 13.0%, respectively). Strong dose-effect associations were found between all substance use and familySUcn and peerSUcn (odds ratio adjusted for sex, age, and socioeconomic features reaching 13.44 and 9.90, respectively, most with p < .001). SMDs explained more the associations of all substance use with familySUcn than with peerSUcn (contributions reaching 69% and 34%, respectively). The proportion of subjects without each substance use decreased with age more quickly among the adolescents with higher familySUcn or peerSUcn., Conclusions: Early prevention reducing familySUcn, peerSUcn and SMDs among adolescents and their families may reduce efficiently initiation and regular use of substances during adolescents' life course.

Most adolescents spend excessive screen time (with television viewing, computer/console gaming, discussion forums/chatting online, internet surfing, doing homework, and electronic mails) which may impact the occurring of various types of school and out-of-school injuries. We assessed their associations and potential confounding factors among 1559 middle-school students from north-eastern France (mean age=13.5 ± 1.3). Participants completed a questionnaire including socioeconomic features, daily screen time for various screen-based activities (coded 1=<2, 2 = 2-4, 3=≥5 h; daily-total-screen time level (TDST) was defined as their sum, categorized into <7/7-11/≥12), various injury types during the school-year, behavior and health difficulties (BHDs; alcohol/tobacco/cannabis/other illicit drugs use, suffered physical/verbal violence, sexual abuse, poor family-peer support, sleep difficulty, depressive symptoms, suicide attempt, and time at onset). Most subjects had TDST≥7 (82.3 %). There were dose-effect associations of TDST with school-physical/sports training, school-free-time, out-of-school-sports, and single/repeated injuries (sex-age-adjusted odds ratio reaching 4.45). BHDs explained up to 39 % of these associations. The frequency of subjects without various BHDs decreased with age since age 10 more quickly among the participants with both TDST≥7 and injury than among the others. Our findings may inform health care providers, parents, schools, and public policy that reducing elevated screen time is efficient to prevent injuries and BHDs among adolescents., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest, no financial interest, and no contractual constraints on publishing. There is no connection of any of the researchers with the tobacco, alcohol, pharmaceutical or gaming industries or any body substantially funded by one of these organisations., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objective: School-behavior-health difficulties (SBHDs) may alter physical/mental capabilities and consequently increase injury risk during daily activities. This study assessed the associations of potential SBHDs and their cumulative number (SBHDcn) with various injury types among younger adolescents. Methods: The study population included 1,559 middle-school adolescents in France (10-18 years, 98% under 16,778 boys and 781 girls). They completed a questionnaire at school-year end collecting socioeconomic features (nationality, family structure, parents' education/occupation/income), school/out-of-school injuries during the school-year (dependent variables), and SBHDs starting before the school-year (low academic performance, alcohol/tobacco/cannabis/other-illicit-drugs use, physical/verbal violence, sexual abuse, perpetrated violence, poor social support, poor general health status, sleep difficulty, depressive symptoms, and suicide attempt). Data were analyzed using logistic regression models and Kaplan-Meier estimates. Results: Injuries were frequent during school-physical/sports-training (10.9%), other-school-training (4.7%), school-free-time (7.4%), out-of-school-sports-activity (16.5%), and traffic (2.2%). Single injury (one injury all injury types combined) and ≥2 injury types affected 23.3 and 7.9% of subjects, respectively. The proportion of adolescents without SBHDs decreased with age more quickly among those with each injury type than among those without injury. Various SBHDs were associated with most injury types, single injury, and ≥2 injury types (sex-age-adjusted odds/relative-risk ratios reaching 11, p < .001). A dose-effect association was found between SBHDcn 1-2/3-5/≥6 and both single injury and ≥2 injury types (sex-age adjusted relative risk ratios reaching 12.66, p < .001, vs. SBHDcn = 0). Socioeconomic features had a moderate confounding role in these associations. Conclusions: SBHDs strongly predict injuries among adolescents. Our findings may inform healthcare providers about their prominent role in detecting/reducing SBHDs and injuries.

Objective: Lack of regular physical activity (LPA) and the number of days/week with physical activity >60 minutes/day (Ndw) may be associated with school-health-relational difficulties (SHRDs) during the life-course. This study assessed their associations and the confounding role of socioeconomic features (nationality, family structure, parents' education/occupation/income) among younger adolescents. Methods: This cross-sectional population-based study included 1,559 middle-school adolescents from north-eastern France (10-18 years, 98% under 16 years, 778 boys and 781 girls). They completed over one-hour teaching period a questionnaire collecting last-12-month LPA and last-7-day Ndw (dependent variables), and risk factors including socioeconomic features, SHRDs (previous grade repetitions, last-12-month poor general health status/physical health/psychological health/social-relationships, depressive symptoms (and age at onset and duration from onset); cumulated number noted SHRDcn). Data were analyzed using logistic/linear regression models. Results: LPA was common (32.5%) and associated with all SHRDs (sex-age-adjusted odds ratio saOR reaching 1.99, p  < .001) and depressive-symptoms duration (saOR 1.63 ( p  < .05) and 2.11 ( p  < .001) for 1-2 and ≥3 years, respectively, vs. no depressive symptoms). A dose-effect association was found between SHRDcn and LPA (24.0, 33.7, 45.6, and 53.5%; saOR 1.59, 2.58, and 3.43; for SHRDcn 1-2, 3-4, and ≥5 respectively, vs. SHRDcn = 0, p  < .001). Ndw was similarly associated with all SHRDs and SHRDcn (sex-age-adjusted regression coefficient reaching -1.10 day/week, p  < .001). These results were robust when controlling for socioeconomic features (18%

Purpose: Low back pain (LPB) is mostly left untreated (LBP untreated ) and may increase the injury risk due to associated behavioral-health difficulties (BHDs) among adolescents. This study assessed the association between LBP untreated (vs. treated LBP (LBP treated )) and injuries and the mediating role of BHDs among younger adolescents (10-16 years)., Methods: This population-based study compared 328 adolescents with LBP untreated (mean age = 13.7 ± 1.3) with 291 with LBP treated (mean age = 13.3 ± 1.2) from north-eastern France. They completed a questionnaire collecting, at school-year end, socioeconomic features, LBP treated /LBP untreated , BHDs (alcohol/tobacco use, excessive screen-time, poor social support, poor physical health, depressive symptoms, and pain limiting activities), and injuries during the current school-year. Data were analyzed using multinomial logistic regression models and Kaplan-Meier estimates., Results: The proportion of subjects without alcohol/tobacco use or depressive symptoms decreased with time more quickly since age 10 among the adolescents with LBP untreated than among those with LBP treated . Hence, most LBP early started and the subjects with LBP untreated had a higher risk of single injury (sex-age-class-level-socioeconomic-features-adjusted relative risk ratio RR = 1.63, p < 0.05, vs. LBP treated ) and a much higher risk of ≥ 2 injuries (RR = 2.60, p < 0.001). BHDs played a strong mediating role in the association between LBP untreated and ≥ 2 injuries (contribution = 48%) but a modest mediating role in that between LBP untreated and single injury (contribution = 10%) (pseudo R 2  = 7.6%)., Conclusion: LBP untreated is common and associated with injuries partly due to BHDs (which may alter physical/mental capabilities, risk perception/awareness, and vigilance) among younger adolescents. Our results may inform healthcare providers that they can detect/treat LBP and BHDs to prevent their aggravation and injuries., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

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: The roles of age, length of service and job in various work-related injury types are unknown and deserve investigations among female workers. This study assessed their roles in the occurrence of injury., Methods: Three-year prospective study of all 22,952 permanently employed women at the French national railway company: 63,620 person-years, 756 injuries with working days lost, coded using the company's injury classification derived from that of the French health insurance scheme. We investigated the incidence of four types of injury: fall on same level, fall to lower level, materials/equipment/objects handling, and other injuries. Data were analyzed using negative binomial regression., Results: Workers aged <25 were subject to a higher risk for all types of injuries. Older workers (45-55 years) were subject to a higher injury risk for fall on same level and fall to lower level. For fall on same level as for fall to lower level the relative risk decreased steadily with increasing length of service with the company, from 1.60 for 1 year to 0.50-0.60 for ≥30 years. For injuries due to materials/equipment/objects handling the relative risk decreased from 1.05 for one year to 0.49 for 5-9 years, and then increased to about 1.50 for 20-29 years and ≥30 years., Conclusions: Younger and shorter lengths of service were at risk for various types of injuries. Higher length of service was at risk for injury due to materials/equipment/objects handling. Preventive measures should consider the respective risks associated with age, years of employment and job., (© 2013 Wiley Periodicals, Inc.)

To develop satisfactorily, adolescents require good health-related quality of life (QOL, including physical health, psychological health, social relationships and living environment). However, for poorly understood reasons, it is often lacking, especially among immigrants with lower family and socioeconomic resources. This study assessed health-related QOL of European and non-European immigrant adolescents and the contributions of socioeconomic difficulties, unhealthy behaviors, and violence. It included 1,559 middle-school adolescents from north-eastern France (mean age 13.5, SD 1.3; 1,451 French adolescents, 54 European immigrants and 54 non-European immigrants), who completed a self-administered questionnaire including sex, age, socioeconomic characteristics (family structure, parents' education, occupation, and income), unhealthy behaviors (uses of tobacco/alcohol/cannabis/hard drugs, obesity, and involvement in violence), having sustained violence, sexual abuse, and the four QOL domains measured with the World Health Organization's WHOQOL-BREF (poor: score < 25PthP percentile). Data were analyzed using logistic regression models. Poor physical health, psychological health, social relationships, and living environment affected more European immigrants (26% to 35%) and non-European immigrants (43% to 54%) than French adolescents (21% to 26%). European immigrants had a higher risk of poor physical health and living environment (gender-age-adjusted odds ratio 2.00 and 1.88, respectively) while non-European immigrants had a higher risk for all poor physical health, psychological health, social relationships, and living environment (3.41, 2.07, 3.25, and 3.79, respectively). Between 20% and 58% of these risks were explained by socioeconomic difficulties, parts of which overlapped with unhealthy behaviors and violence. The associations between the two sets of covariates greatly differed among French adolescents and immigrants. Poor QOL was more common among European and non-European immigrants due to socioeconomic difficulties and associated unhealthy behaviors and violence. The different risk patterns observed between French adolescents and immigrants may help prevention.

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.

Objective: The role of occupational hazards in occupational injury may be mediated by individual factors across various age groups. This study assessed the role of occupational hazards as well as contribution of individual factors to injuries among Indian and French coalminers., Material and Methods: We conducted a case-control study on 245 injured workers and on 330 controls without any injuries from Indian coal mines using face-to-face interviews, and a retrospective study on 516 French coalminers using a self-administered questionnaire including potential occupational and personal factors. Data were analyzed using logistic models., Results: The annual rate of injuries was 5.5% for Indian coalminers and 14.9% for the French ones. Logistic model including all occupational factors showed that major injury causes were: hand-tools, material handling, machines, and environment/work-geological/strata conditions among Indian miners (adjusted odds-ratios 2.01 to 3.30) and biomechanical exposure score among French miners (adjusted odds-ratio 3.01 for score the 1-4, 3.47 for the score 5-7, and 7.26 for score ≥ 8, vs. score 0). Personal factors among Indian and French coalminers reduced/exacerbated the roles of various occupational hazards to a different extent depending on workers' age., Conclusion: We conclude that injury roles of occupational hazards were reduced or exacerbated by personal factors depending on workers' age in both populations. This knowledge is useful when designing prevention which should definitely consider workers' age.

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: Multi-morbidity such as cumulating mental health, behavioral, and school difficulties (consumptions of alcohol, tobacco, cannabis, and hard drugs, obesity, depressive symptoms, suicide attempts, involvement in violence, and low school performance) is common in early adolescence and can be favored by a number of socioeconomic factors (gender, age, nationality, family structure, parents' education, father' occupation, and income). This study assessed the concurrent roles of various socioeconomic factors in multi-morbidity defined as cumulated number of difficulties (CD) which has been partially documented., Methods: Adolescents from middle schools in north-eastern France (N = 1,559) completed a questionnaire measuring socioeconomic characteristics and mental health, behavioral, and school difficulties. Data were analyzed using logistic regression models., Results: Alcohol use affected 35.2% of subjects, tobacco use 11.2%, cannabis use 5.6%, hard drugs use 2.8%, obesity 10.6%, depressive symptoms 13.3%, suicide attempts 9.9%, involvement in violence 10.3%, and low school performance 8.2%. Insufficient income and non-intact families impacted most mental health, behavioral, and school difficulties with adjusted odds ratios (ORa) between 1.51 and 3.72. Being immigrant impacted illicit drugs use and low school performance (ORa 2.31-4.14); low parents' education depressive symptoms (1.42) and school performance (3.32); and manual-worker/inactive offspring low school performance (2.56-3.05). Multi-morbidity was very common: CD0 44.1%, CD1 30.8%, CD2-3 18.4%, and CD ≥ 4 6.7%. Insufficient income, divorced/separated parents, reconstructed families, and single parents played impressive roles with strong ORa gradients (reaching 4.86) from CD1 to CD ≥ 4. Being European immigrant, low parents' education, and low fathers' occupations had significant gender-age-adjusted odds ratios for CD2-3 and CD ≥ 4, but these became non-significant when adjusted for all socioeconomic factors. Older adolescents had higher risks for multi-morbidity which did not change when adjusting for all socioeconomic factors., Conclusions: Multi-morbidity including a wide range of mental health, behavioral, and school difficulties was common in early adolescence. Insufficient income and non-intact families played impressive roles. Being immigrant, low parents' education, and low fathers' occupations also played strong roles but these were explained by insufficient income and non-intact families. Prevention against multi-morbidity should be designed to help adolescents to solve their difficulties, especially among adolescents with socioeconomic difficulties.

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.)

Background: School is a multi-cultural setting where students need social, material, physical, and mental resources to attain school achievement. But they are often lacking, especially for immigrant students. In an early adolescence context, this study assessed risk for school difficulties among European and non-European immigrants and the roles of socioeconomic characteristics, physical health, psychological health, social relationships, living environment, and unhealthy behaviours., Methods: This cross-sectional study included 1,559 middle-school adolescents from north-eastern France, who completed a self-administered questionnaire including socioeconomic characteristics (gender, age, family structure, father's occupation, and family income), WHO-Quality of life (measuring the four dimensions physical health, psychological health, social relationships, and living environment), unhealthy behaviours (last-30-day uses of tobacco, alcohol, cannabis, and other illicit drugs and no regular sports/physical activities), grade repetition, low school performance (<10/20), and school dropout ideation at 16 years. Data were analyzed using logistic models., Results: Grade repetition affected 14.8% of students, low school performance 8.2%, and school dropout ideation 3.9%. European immigrants had a higher risk for grade repetition only with a gender-age-adjusted odds ratio (OR) of 2.44, vs. French students. This odds ratio decreased to 1.76 (contribution 47%) with further adjustment for all confounders (family structure, father's occupation, family income, physical health, psychological health, social relationships, living environment, and unhealthy behaviours). Non-European immigrants had a statistically higher risk for all grade repetition, low school performance, and school dropout ideation with ORs of 3.29, 3.02, and 3.42, respectively vs. French students. These odds ratios decreased to 1.76, 1.54, and 1.54, respectively (contributions 66%, 73%, and 78%) with further adjustment for all confounders., Conclusions: Compared with French students, European immigrant students were more affected only by grade repetition while non-European immigrant students by all grade repetition, low school performance, and school dropout ideation. The contribution of socioeconomic characteristics, physical health, psychological health, social relationships, living environment, and unhealthy behaviours was very high and much higher for non-European than for European immigrant students. Public policy should focus on these factors and services to reduce school difficulties.

Objective: In response to recent research documenting a link between early substance use and suicidal behaviors among youth, the current study sought to examine the associations between ages of substance use initiation and suicidal behavior among students in France and the USA., Methods: Cross-sectional logistic regression analyses based on the 2003 European School Survey Project on Alcohol and Other Drugs (ESPAD) survey (France; n = 13,187) and the 2003 Youth Risk Behavior Survey (YRBS) (United States; n = 15,136) assessed associations between early substance use initiation (i.e., alcohol, cigarette and cannabis/marijuana) and suicide ideation and attempts while controlling for potential confounders., Results: Early alcohol use initiation (OR(adj) = 1.52; 95% CI 1.17-1.97) and early cannabis/marijuana use initiation (OR(adj) = 2.90; 95% CI 2.20-3.83) were associated with suicide attempt in France. Early smoking was associated with suicide attempt in both France (OR(adj) = 1.92; 95% CI 1.55-2.37) and the USA (OR(adj) = 1.53; 95% CI 1.02-2.28). Sex differences were also noted., Conclusions: The associations between substance use initiation and suicidal behaviors differed in the United States and France. These findings, placed into context, can assist the development and implementation of prevention strategies that seek to reduce the harmful consequences of early substance use among youth.

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.)

This study assessed the anthropometric status of 451 hospitalised female patients aged 70 or over, at their admission to hospital, in reference to 77 healthy women of the same age. The most frequent diseases were circulatory diseases (40.8%), mental disorders (29.9%), respiratory diseases (12.4%), endocrine and metabolic diseases (11.5%), osteomuscular diseases (8.4%), and traumatisms (6.9%). The differences were significantly high for mid-arm circumference (MAC), triceps skinfold thickness (TSF), weight, weight/height, and body mass index (BMI). The patients with cancers, blood diseases, mental disorders, respiratory disease, digestive diseases, or traumatisms had the lowest values. All the indicators correlated in a similarly negative way with age. The decreased TSF was more pronounced among subjects with respiratory diseases. Measurement of anthropometric indicators, TSF in particular, should be part of preventive measures aimed at reducing malnutrition and its consequences in a hospital setting.

The respective contribution of occupational and behavioural factors to social disparities in all-cause mortality has been studied very seldom. The objective of this study was to evaluate the role of occupational and behavioural factors in explaining social inequalities in premature and total mortality in the French working population. The study population consisted of a sample of 2,189 and 1,929 French working men and women, who responded to a self-administered questionnaire in mid-1996, and were followed up until the end of 2008. Mortality was derived from register-based information and linked to the baseline data. Socioeconomic status was measured using occupation. Occupational factors included biomechanical and physical exposures, temporary contract, psychological demands, and social support, and behavioural factors, smoking, alcohol abuse, and body mass index. Significant social differences were observed for premature and total mortality. Occupational factors reduced the hazard ratios of mortality for manual workers compared to managers/professionals by 72 and 41%, from 1.88 (95% CI: 1.17-3.01) to 1.25 (95% CI: 0.74-2.12) for premature mortality, and from 1.71 (95% CI: 1.18-2.47) to 1.42 (95% CI: 0.95-2.13) for total mortality. The biggest contributions were found for biomechanical and physical exposures, and job insecurity. The role of behavioural factors was very low. Occupational factors played a substantial role in explaining social disparities in mortality, especially for premature mortality and men. Improving working conditions amongst the lowest social groups may help to reduce social inequalities in mortality.

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.)

Aims: Various types of musculoskeletal disorders (MSDs) have comorbid mental disorders, which may in turn have a negative influence on disease course and role impairment, but the contribution of social factors to this type of comorbidity is a much under-researched area. This study investigates whether there is a socially patterned association of MSDs with different dimensions of mental malaise., Methods: The sample included 3,368 economically active participants aged 18-64 years, randomly selected from the Lorraine region in north-eastern France. Information was provided through a post-mailed questionnaire on fatigue, sadness/depression (Duke questionnaire) and cognitive disability during the last eight days., Results: MSDs were significantly more prevalent in manual workers, clerks and other occupations than in upper and intermediate professionals, and similar occupational disparities were found for cognitive disability, fatigue and sadness/ depression. Stratifying the sample, we found the occupational disparities in cognitive disability to be much stronger among participants suffering from MSDs than among participants not suffering from MSDs, and the occupational disparities in fatigue and sadness/depression to be limited to the subsample of subjects suffering from MSDs., Conclusions: The findings demonstrate that the association of MSDs with mental malaise is much stronger in the lower occupational groups than in the higher groups. Given that psychological factors are implicated in disease prognosis and in the development of disabilities, awareness of the social dimension of the association and treatment of the comorbid mental disorders could open a promising avenue for reducing social inequalities in disability related to MSDs.

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.)

Objectives: Because work-related injuries are common and yet the mechanisms through which various types of injuries relate to age, length of service and job remain unknown, this study assessed the role of age, length of service and job in work-related injury., Methods: Prospective study of all 164,814 permanently employed male workers at the French national railway company during 1998-2000, based on the company's injury database: 446,120 person-years, 15,195 injuries with working days lost, coded using the company's injury classification, which is derived from that of the French health insurance scheme. We investigated the incidence of 10 types of injury: fall on same level, fall to lower level, handling materials/machine parts during assembly, handling objects, lifting/handling equipment, collision with/by moving objects, collision with/by vehicles, operating machines/equipment, using hand tools and other injuries. Data were analysed using negative binomial regression., Results: Workers aged <25 years were subject to a higher injury risk from handling materials/machine parts during assembly, and collision with/by moving objects or vehicles. Older workers, especially those aged 50-55 years, were subject to a higher risk of fall and injury resulting from lifting/handling materials/equipment/objects or from collision with/by moving objects/vehicles. Using hand tools was a risky task for workers aged <30 or > or =40 years. The relative risk decreased steadily with increasing length of service with the company, from 2.6 for 1 year to 1.0 for > or =30 years, and the slope of the trend is stronger for fall to lower level, lifting/handling materials/equipment and collision with/by moving objects., Conclusion: Younger and older ages and shorter length of service are at risk for various types of injuries. Preventive measures should improve working conditions, especially for younger/older ages, provide knowledge through specific training during the first years in a job and help workers to be more aware of risks associated with their age, years of employment and job.

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

Purpose: To assess the association between physical job demands (PJD) and physical/cognitive functional limitations, and the role of adverse health behaviours, obesity, and socio-demographic factors as confounders of those associations., Methods: The sample included 3,368 active subjects aged 18-64 years, randomly selected from North-eastern France. Subjects completed a post-mailed questionnaire. PJD score was defined as the product of years of employment with the cumulative number of a wide range of high job demands. Data were analysed through the logistic regression models., Results: The physical and cognitive functional limitations affected 16.9 and 28.6% of subjects, respectively. A strong relationship was found between PJD and physical functional limitation: significant odds ratios (OR) adjusted for all the factors studied 1.41 for PJD1-29, 1.72 for PJD30-99, and 2.57 for PJD >or=100 versus PJD0; and between PJD and cognitive functional limitation: OR 1.28 for PJD1-29, 1.60 for PJD30-99, and 2.00 for PJD >or=100 versus PJD0. Adverse health behaviours, obesity and job category were modest confounders of those associations., Conclusions: This study identified a wide range of job demands and individual characteristics related to physical/cognitive functional limitations. Prevention should aim at improving working conditions and adverse health behaviours.

This study assessed the relationships of lifetime smoking and initiating smoking with job demands among 2,888 randomly selected workers, aged 15 yr or over, using a post-mailed questionnaire. Cumulated job demands (CJD) was defined as the number of: using pneumatic tools, other vibrating hand tools, hammer, tasks at height, working in adverse climate, pace of working, cold, heat, and noise exposure. Lifetime smoking was reported by 63.8% of subjects, and 5.9% initiated smoking during present job. Logistic model shows that lifetime smoking related to the CJD: OR adjusted for years with job 2.47 (95%CI 1.69-3.60) for CJD> or =4, 1.50 (1.21-1.85) for CJD2-3, and 1.20 (1.00-1.44) for CJD1, vs. CJD0. Initiating smoking also related to the CJD: ORs 3.72 (1.95-7.11), 1.51 (0.96-2.39) and 1.47 (0.97-2.24), respectively. These associations were partly confounded by gender, income, obesity and job. Smoking related to job demands and their limitation should help preventing smoking.

Background: Physical job demands (PJD), age, disability and lifestyle may influence the risk of occupational injury., Aim: To assess the relationships between PJD, lifestyle and injury in workers of various ages., Methods: A total of 2888 randomly selected workers from northeastern France, aged >or=15, completed a postal questionnaire. The PJD score was defined as the total number of the following reported job demands: using pneumatic tools, other vibrating hand tools, hammers, machine tools or vibrating platforms and exposure to manual handling tasks, awkward postures, high pace of work, high physical workload, work at heights, work in adverse climates or exposure to noise, cold or heat. Data were analysed using logistic regression., Results: Nine per cent of subjects reported an injury during the previous 2 years. The PJD score was related to the injury rate for workers aged >or=45: crude odds ratio (OR) 3.5 (95% confidence interval = 1.5-8.0) for PJD = 1, 5.0 (2.2-11.3) for PJD = 2-3 and 14.5 (6.5-32.2) for PJD >or=4, versus PJD = 0. Lower ORs were found for those aged <30 (1.4, 4.2 and 9.9, respectively) and 30-44 (1.5, 4.4 and 6.5, respectively). The differences between age groups remained when controlling for all factors studied. Obesity, smoking and musculoskeletal disorders were associated with injury risk in workers aged >or=45 (adjusted ORs 1.7-2.6). Smoking was also an injury risk factor for workers aged <30., Conclusions: PJD and lifestyle have a higher impact on injury rates among older workers than among younger ones. Injury prevention should address reducing PJD and improving relevant lifestyle factors, especially for older workers.

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.

Objective: Injury proneness is common in adolescents, but the role of individual factors has received little attention. This study assessed the relationships of a number of individual characteristics with frequency of school injuries., Methods: This prospective study was conducted on 2396 students from middle schools and high schools in an urban area in France over one school year. A questionnaire was completed by each student at the beginning of the school year, and an injury questionnaire was completed for all injuries that occurred at school during the year. Data were analysed using the chi2 independence test and logistic models., Results: Over the study year, 10.6% of the students had a single injury. Frequent injuries (two or more) were common (2.3%) and were strongly related to younger age [adjusted odds ratio (aOR) 1.52, 95% confidence interval (95%CI) 1.28-1.79], frequent use of psychotropic drugs (aOR 2.03, 95%CI 1.06-3.86) and a poorer average school mark (<10/20, aOR 2.58, 95%CI 1.30-5.12). The occurrence of a single injury was less strongly related to younger age (aOR 1.20, 95%CI 1.11-1.30) and frequent use of psychotropic drugs (aOR 1.43, 95%CI 1.04-1.96), and was also associated with parental absence (aOR 1.33, 95%CI 1.00-1.77), not being calm (aOR 1.41, 95%CI 1.03-1.89) and not being easily irritated (aOR 1.56, 95%CI 1.14-2.13)., Conclusions: This study identified a number of factors associated with injury frequency. This information could be useful for injury prevention. Physicians could help students, parents, teachers and school staff to be more aware of the risks and to find remedial measures.

Objective: To assess occupational disparities with regard to the occurrence of occupational, traffic, domestic and sports accidents, and the role of factors such as smoking, excessive alcohol consumption, obesity, psychotropic drug intake and disability in mediating these disparities., Methods: The sample included 3368 economically active subjects aged 18-64 years, selected at random in north-eastern France. Subjects completed a postal questionnaire about sociodemographic and lifestyle information, and recorded the occurrence of accidents by type during the previous 2 years. Data were analysed using a logistic regression model with different sets of independent variables and covariates in order to describe the disparities and investigate the role of personal factors., Results: During the 2 years preceding the survey, 11.8% of men and 5.4% of women had an occupational accident, 3.7% of men and 4.5% of women had a traffic accident, 4.1% of men and 1.5% of women had a domestic accident, and 6.1% of men and 1.9% of women had a sports accident. Personal factors were strongly related to the occurrence of accidents, with different patterns in men compared with women, and according to the type of accident. Men in intermediary occupations, clerks, craftsmen and tradesmen and, to an even greater extent, manual workers and farmers had a much higher occurrence of occupational accidents than men in the upper occupations, while craftsmen and tradesmen had a much higher occurrence of traffic accidents. Manual workers had a lower occurrence of sports accidents. After adjustment for lifestyle factors and disability, estimated odds ratios were reduced slightly but remained significant. Occupational disparities in accidents were virtually non-existent among women., Conclusion: Occupational disparities in accidents mainly concern men and are predominantly observed in occupational and traffic accidents. Lifestyle factors do play a role in explaining these disparities, but are fairly limited. Improved work conditions, equipment, health behaviours, safe driving practices and accommodation of people with disabilities are needed to reduce the risk of accidents.

Aims: To assess associations between parental control or parental emotional support and current tobacco, alcohol or cannabis use among 12-18-year-old students, according to gender and family structure (intact family, reconstituted family, single-parent family)., Methods: A cross-sectional survey was conducted in a national representative sample in France (2003) of 6-12th grade students (N = 16,532), as a part of the ESPAD study (European Study Project on Alcohol and Other Drugs). The self-administered questionnaire included questions on last 30 days' consumption of alcohol, tobacco and cannabis as well as on socio-demographic characteristics, school characteristics, and some simple questions on parental control and parental emotional support. Logistic modelling was carried out and (adjusted Odds Ratio) Ora calculated, adjusted for age, parental educational and characteristics of the school., Results: A negative relationship exists between parental control and substance use, but this relationship is more marked for tobacco (OR a between 1.8 and 5.6 according to level of control, family status and gender) and cannabis (OR between 1.5 and 6.4) than for alcohol (OR a between 1.0 and 2.7). Parental control is more markedly related to substance use in girls than in boys. These tendencies were observed for intact families as well as for single-parent families or reconstituted families. Parental control has a greater impact than emotional support. Among girls, emotional support has a greater impact than among boys., Conclusions: There is a gradient relationship between parental control and current consumption, especially among girls. Thus, there may be a need for parental control, whatever the family structure.

This study assessed the relationships of physical job demands (PJD), smoking, and alcohol abuse, with premature mortality before age 70 (PM-70) among the working or inactive population. The sample included 4,268 subjects aged 15 or more randomly selected in north-eastern France. They completed a mailed questionnaire (birth date, sex, weight, height, job, PJD, smoking habit, alcohol abuse (Deta questionnaire)) in 1996 and were followed for mortality until 2004 (9 yr). PJD score was defined by the cumulative number of the following high job demands at work: hammer, vibrating platform, pneumatic tools, other vibrating hand tools, screwdriver, handling objects, awkward posture, tasks at heights, machine tools, pace, working on a production line, standing about and walking. The data were analyzed using the Poisson regression model. Those with PM-70 were 126 (3.81 per 1,000 person-years). The leading causes of death were cancers (46.4% in men, 57.1% in women), cardiovascular diseases (20.2% and 11.9%), suicide (9.5% and 7.1%), respiratory diseases (6.0% and 4.8%), and digestive diseases (2.4% and 4.8%). PJD3, smoker, and alcohol abuse had adjusted risk ratios of 1.71 (95% CI 1.02-2.88), 1.76 (1.08-2.88), and 2.07 (1.31-3.26) respectively for all-cause mortality. Manual workers had a risk ratio of 1.84 (1.00-3.37) compared to the higher socio-economic classes. The men had a two-fold higher mortality rate than the women; this difference became non-significant when controlling for job, PJD, smoker and alcohol abuse. For cancer mortality the factors PJD3, smoker, and alcohol abuse had adjusted risk ratios of 2.00 (1.00-3.99), 2.34 (1.19-4.63), and 2.22 (1.17-4.20), respectively. Health promotion efforts should be directed at structural measures of task redesign and they should also concern lifestyle.

Background: The aim was to assess the relationships between social and material deprivation and the use of tobacco, excessive alcohol and psychotropic drugs by both sexes and in various age groups. Greater knowledge concerning these issues may help public health policy-makers design more effective means of preventing substance abuse., Methods: The sample comprised 6,216 people aged > or 15 years randomly selected from the population in north-eastern France. Subjects completed a post-mailed questionnaire covering socio-demographic characteristics, occupation, employment, income, smoking habit, alcohol abuse and "psychotropic" drug intake (for headache, tiredness, nervousness, anxiety, insomnia). A deprivation score (D) was defined by the cumulative number of: low educational level, manual worker, unemployed, living alone, nationality other than western European, low income, and non-home-ownership. Data were analysed using adjusted odds ratios (ORa) computed with logistic models., Results: Deprivation was common: 37.4% of respondents fell into category D = 1, 21.2% into D = 2, and 10.0% into D > or 3a re men than women reported tobacco use (30.2% vs. 21.9%) and alcohol abuse (12.5% vs. 3.3%), whereas psychotropic drug use was more common among women (23.8% vs. 41.0%). Increasing levels of deprivation were associated with a greater likelihood of tobacco use (ORa vs. D = 0: 1.16 in D = 1, 1.49 in D = 2, and 1.93 in D > or = 3), alcohol abuse (1.19 in D = 1, 1.32 in D = 2, and 1.80 in D > or = 3) and frequent psychotropic drug intake (1.26 in D = 1, 1.51 in D = 2, and 1.91 in D > or = 3). These patterns were observed in working/other non-retired men and women (except for alcohol abuse in women). Among retired people, deprivation was associated with tobacco and psychotropic drug use only in men., Conclusion: Preventive measures should be designed to improve work conditions, reduce deprivation, and help deprived populations to be more aware of risk and to find remedial measures.

Objective: To estimate the prevalence of functional disability in France and assess its association with the health-related quality of life (HRQoL)., Methods: Each member in 8,000 households randomly selected in the Lorraine population were mailed a questionnaire asking about their sociodemographic characteristics; the presence of chronic locomotor or non-rheumatic diseases; functional disability on the Health Assessment Questionnaire (HAQ); and HRQoL on the Duke Health Profile. The prevalence of functional disability was described, and its relationship with HRQoL was assessed by logistic regression analysis., Results: Among the 6,148 subjects who responded (mean age 46 years +/- 18.3, 48% men), the prevalence of moderate (HAQ >or= 1) and severe (HAQ >or= 2) functional disability, adjusted for age and sex, was 6.5% and 1.6% respectively. HRQoL was significantly low in all dimensions for subjects with severe functional disability. Functional disability of locomotor origin significantly affected the physical (OR = 10.6 [5.1-22.1]), mental (OR = 4.4 [2.5-7.8]), and social (OR = 2.4 [1.4-4.3]) dimensions, with a threshold effect according to the disability level and perceived health (OR= 10.6 [5.8-19.4]), with a cause-effect relationship., Conclusion: The prevalence of reported (i.e., not observed) functional disability in terms of its impact on HRQoL helps physicians to better understand its differential consequences, which should ease patient dependence, facilitate the analysis of health care needs and the development of prevention measures, and improve the HRQoL of patients and their families.

Objectives: To assess the contributions of environmental hazards, technical dysfunctions, lack of work organization, know-how and job knowledge, and other human factors in occupational injuries and their relationships with job, age and type of accidents in railway workers., Methods: The sample included 1,604 male workers, having had at least one occupational injury with sick leave during a 2-year period in voluntary French railway services. A standardized questionnaire was filled in by the person-in-charge of prevention, with the injured worker. Data analysis was performed via the chi(2) independence test and adjusted odds ratios (OR) with Mantel-Haenszel test., Results: The environmental hazards were implicated in 24.7%, technical dysfunctions in 16.0%, lack of work organization in 13.7%, lack of know-how in 17.6%, lack of job knowledge in 5.2%, and the other human factors in 31.9% of occupational injuries. The injuries caused by lack of know-how or job knowledge were more represented in workers aged less than 30 (ORs adjusted for job 1.45, 95% CI 1.02-2.06 and 2.06, 1.22-3.49, respectively), those by environmental hazards in energy and electrical traction maintenance operators and train drivers (ORs adjusted for age 2.04, 1.16-3.58 and 1.80, 1.01-3.20, respectively), and those by lack of work organization in mechanical maintenance operators and in energy and electrical traction maintenance operators (ORs adjusted for age 2.24, 1.13-4.45 and 1.83, 1.30-2.57, respectively). The causes considered were strongly related with the type of injuries., Conclusions: This study found that environmental hazards, technical dysfunctions, lack of work organization, lack of knowledge and other human factors had important contributions in injuries, and they were related to job, age and type of injuries. These findings are useful for prevention. Training is necessary for young workers. The occupational physician could help the workers to be more aware of the risks.

This study assessed the role of certain individual characteristics in school injury among male and female adolescents. The sample included 2,398 subjects attending middle schools and high schools. Respondents completed a self-administered questionnaire at the beginning of the school year. School nurse completed a questionnaire on injury for each school injury occurred during the school year. The data was analyzed with the adjusted odds ratios (ORa) computed via the logistic models. The school injury was common (13% for both sexes). Sports/physical training injury was more frequent among girls (8.8% vs. 6.6%, P < 0.05) contrarily to the other types of injury (4.6% vs. 8.8%, P = 0.001). Sports/physical training injury was strongly associated with age <15 years (ORa 3.42) and presence of previous injury (2.63) among boys, and with age <15 years (2.02), presence of previous injury (2.94), not easily irritated (1.89), and irresponsible (1.59) among girls. The other types of injury were highly related to age <15 years (ORa 4.18), frequent use of psychotropic drugs (1.76), not living with both parents (1.65), being not calm (2.03), and presence of previous injury (1.82) among boys, and to age <15 years (2.59), obesity (3.24), and being not calm (1.84) among girls. The present study identified a number of potential risk factors for school injury among male and female adolescents. Preventive measures should be taken to make adolescents, their parents and teachers more aware of the risks and to find remedial measures.

This study assesses the effects of individual and family characteristics on psychotropic drug use among male and female adolescents. The sample included 2,396 subjects attending two middle schools and two high schools. Respondents completed self-administered questionnaires covering gender, age, body mass index, smoking, alcohol use, illicit drug use, tiredness during the daytime, self-reported personality traits, family conditions, and psychotropic drug use. The data were analyzed using logistic models. The prevalence of frequent psychotropic drug use (for headache, tiredness, nervousness, anxiety, insomnia) was 43.0% overall; twice as high among girls than boys. Among the girls, frequent psychotropic drug use was associated with frequent tiredness during the daytime (adjusted odds ratio OR 2.03, 95% CI 1.61-2.57), smoking (2.02, 1.50-2.71), alcohol use (1.34, 1.04-1.74), higher body mass index (>18 kg/m(2), 1.54, 1.16-2.04), poor family atmosphere (1.33, 1.03-1.72), and being worried (1.93, 1.53-2.43) or easily becoming irritable (1.28, 1.01-1.62). In boys the factors with significant ORs were frequent tiredness during the daytime (2.21, 1.67-2.93), alcohol use (1.52, 1.15-2.01), and being worried (1.70, 1.28-2.26) or easily becoming irritable (1.42, 1.06-1.89); univariate analysis revealed a significant relationship with smoking and family atmosphere. An association was also observed for illicit drugs in both sexes and for age > or = 17 years in girls. Individual and family characteristics have marked influence on psychotropic drug use among both male and female adolescents. Preventive measures should be taken to make adolescents and their parents more aware of the risks and to improve their living conditions.

Background: Accident proneness or workers who have more frequent occupational injuries is common but the role of occupational and individual factors has rarely been studied., Aim: To assess the relationships of certain occupational and individual characteristics with frequency of occupational injuries., Method: This case-control study included 1305 male workers with occupational injuries during 1999-2000 and 1305 controls from a railway company. A standardized questionnaire was completed by the occupational physician in the presence of the subject. The data were analysed using logistic regression., Results: Having more than one injury was associated with short service in the present job, younger age, sleep disorders, smoking, requesting a job change, physical disability and lack of physical activity. Safety training was negatively related to injury frequency. Short service in the present job was the only significant factor for single injuries., Conclusion: This study identified a number of work and individual factors that predicted occupational injury frequency and may be useful in designing preventative measures. Occupational physicians could assist workers to be more aware of the risks and to find remedial measures.

Background: Population ageing and longer duration of the working career could increase the prevalence of impairments and disabilities whereas there have been few data to help prevention and care. This study aimed at describing the prevalence of various types of impairments and assessing their social inequalities in the Lorraine population (north-eastern France)., Methods: The sample included 6.214 subjects aged 15 or more from 8.000 households randomly selected in the Lorraine population. A mailed questionnaire including socio-demographical characteristics, job, and various types of impairments was used. The data were analysed with the chi2 independence test, the adjusted odds ratio (OR) and the Mantel-Haenszel test., Results: The prevalence of at least one impairment was 30% in both sexes. It varied from about 20% for subjects aged less than 40 years to about 60% for the subjects aged 70 years or more. It was higher in men than in women among the individuals aged more than 50 years (OR adjusted on age: 1.22, 95% CI: 1.04-1.44). The impairments were generally multiple for the subjects aged over 50. The prevalence of at least one impairment was higher for workmen (OR adjusted on age: 2.11, 95% CI: 1.68-2.66), farmers, craftsmen, traders and heads of firms (OR adjusted on age: 1.60, 95% CI: 1.17-2.18) and for employees (OR adjusted on age: 1.62, 95% CI: 1.29-2.03) in comparison with executives, intellectual professionals and teachers. For workmen a higher prevalence was observed for all types of impairments: intellectual and psychological functions, language, hearing, vision, visceral functions, and skeleton and posture. Farmers, craftsmen, traders, heads of firms and employees showed an excess for most types of impairments. Social inequalities were significant for various age groups during their period of occupational activity, but not after retirement. Unemployed people also had an excess of impairments., Conclusion: The prevalence of impairments strongly increased with advancing age. Marked inequalities were observed between various socio-occupational categories. Men were more affected than the women over 50 years of age. Impairments represent a health index which is useful for prevention to reduce their causes and consequences.

The aim of this study is to determine the prevalence of the use of tobacco, alcohol and psychotropic drugs by the people of Lorraine and characterise the consumption behaviours of that population. The sample consisted of 6571 people from the ages of 18 to 74 who were randomly selected from the telephone directory and were interviewed through the use of a self-questionnaire sent out by mail. The behaviours vary according to sex and gender. Tobacco is the product with the highest prevalence rate of consumption. This rate decreases with age and is most frequent in sectors of the population who are less educated, holding low or poorly skilled jobs or unemployed. Excessive alcohol consumption is observed in 13.8% of men and 3.8% of women. Regular consumption of psychotropic drugs is two times higher in women than in men, and it increases with age. Women who are single, divorced or widowed are at the most risk, as are those who are not engaged in any professional activity. The prevalence of the consumption of psycho-active licit toxic substances in the Lorraine population differs little from the national French average as far as men are concerned, yet appears to be higher for women. These results are very useful for regional prevention activities such as those within the Regional Health Programmes framework.

Few studies have simultaneously addressed the role of occupational factors, individual characteristics and living conditions in occupational injuries, and to the best of our knowledge none on railway workers. This survey assessed the roles of these factors in various types of injuries and for various jobs in French railway workers. This case-control study was conducted on 1,305 male workers with an occupational injury during a one-year period and 1,305 male controls. A standardized questionnaire was administrated by an occupational physician. Data were analyzed by the logistic regression method. The significant factors found for all the injuries combined were: young age (<30 yr) (adjusted odds ratio 1.47, 95% CI 1.01-2.14), 5 yr or less in present job (1.43, 1.15-1.78), sleep disorders (1.30, 1.08-1.57), current smoker (1.27, 1.08-1.50), and no do-it-yourself or gardening activity (1.23, 1.02-1.48). Young age, sleep disorders, and smoking were common for several types of injuries. The role of these factors differed between various job categories. Among injured workers sick leaves of eight days or over were more frequent in current smokers and overweight subjects. In conclusion, young age, lack of experience, job dissatisfaction, sleep disorders, smoking, and lack of physical activity increase the risk of occupational injuries. The risks induced were related with jobs. Preventive measures concerning work conditions and these factors could be conducted in railway workers generally, and especially in workers most at risk. The occupational physician could make workers more sensitive to these risks and help them to improve their living conditions during medical examinations.

Objectives: To assess the relationships of job, age, and life conditions with the causes and severity of occupational injuries in male construction labourers., Methods: The sample included 880 male construction workers having had at least one occupational injury with subsequent sick leave. The survey used a standardised questionnaire, filled in by the occupational physician in the presence of the subject: socio-demographic data, job, safety training, smoking habit, alcohol consumption, sporting activities, physical disabilities, hearing, vision, and sleep disorders. Statistical analysis was via the logistic regression method., Results: Logistic models showed that falls and injuries from the handling of objects or hand tools was similar for all jobs, while masons, plumbers and electricians had a higher risk of injury from moving objects, and carpenters, roofers and civil-engineering workers were more exposed to injury from construction machinery and devices. Age <30 was related to injury from hand tools [adjusted OR (95%CI) 2.20 (1.28-3.79)]; sleep disorders and hearing disorders to those from moving objects [ORs 2.29 (1.27-4.12) and 1.85 (1.01-3.41) respectively]; no sporting activity to those from the handling of objects [OR 1.54 (1.09-2.17)]; and being overweight to falls on the same level [OR 2.04 (1.30-3.21)] and falls to a lower level [OR 1.55 (1.13-2.13)]. Injuries from the handling of objects were less frequent in overweight workers [OR 0.62 (0.46-0.84)]. Injuries with hospitalisation or sick leave > or =60 days were associated with age > or =30 and hearing disorders., Conclusions: The causes of injuries were related to jobs. Prevention through working conditions could be made against the revealed risks. The risks for each worker depended on age, body mass index, hearing disorders, sleep disorders, and sporting activities. The occupational physician could inform the workers of these risks and encourage them to practise sporting activities and reduce their hearing disorders and sleep disorders.

This study assessed the associations of job and some individual factors with occupational injuries among employed people from a general population in north-eastern France; 2,562 workers were randomly selected from the working population. A mailed auto-questionnaire was filled in by each subject. Statistical analysis was performed with loglinear models. The annual incidence rate of at least one occupational injury was 4.45%. Significant contributing factors for occupational injuries were job category (60.8%), sex (16.2%), regular psychotropic drug use (8.5%), age groups (7.5%), and presence of a disease (7.0%). The men had higher risk than the women (adjusted odds-ratio 1.99, 95% CI 1.43-2.78). Compared to executives, intellectual professionals and teachers, labourers had the highest risk (6.40, 3.55-11.52). They were followed by farmers, craftsmen and tradesmen (6.18, 2.86-13.08), technicians (3.14, 1.41-6.70), employees (2.94, 1.59-5.48) and other subjects (3.87, 1.90-7.88). The young (< or = 29 yr) showed an increased risk. Similar odds-ratios were observed for regular psychotropic drug use (1.54, 1.16-2.05) and the presence of a disease (1.50, 1.11-2.02). Univariate analysis showed that smoking habit, overweight and excess alcohol use were also associated with injuries. The loglinear model results showed that there were associations between some of these independent factors. It was concluded that job, sex, young age, smoking habit, excess alcohol use, overweight, psychotropic drug use, and disease influenced the occupational injuries. Preventive measures concerning work conditions, risk assessment and job knowledge should be conducted in overall active population, especially in men, young workers, smokers, alcohol users, overweight workers and in individuals with a disease or psychosomatic disorders.

Background: Falls are frequent occupational accidents, and are responsible for a significant amount of lost working time and, more importantly, for a high mortality. The factors involved in falling mechanisms can be of external or individual origin, the latter being less well identified., Aims: To assess the relations between certain individual characteristics and occupational accidents due to imbalance., Methods: A total of 427 male employees, who had been victims of at least one occupational accident with sick leave due to imbalance (cases) and 427 controls were recruited among the employees of a large French railway company. A standardised questionnaire on life conditions and professional factors, and a description of the accidents was filled in by an occupational physician for each subject., Results: Some job categories were more affected by a specific release mechanism of work related falls. Certain individual characteristics such as smoking, alcohol consumption, inactivity, sleep disorders, and request for a job change were correlated with the occurrence of occupational accidents. Sick leaves of eight days or over were more frequent in older and overweight injured workers. Some lesions were linked with the specific fall released mechanisms., Conclusions: Individual characteristics can increase the risk of occupational accidents, especially falling. This study identified subjects most at risk on whom prevention related to working conditions and falls could be focused.

Objective: To determine the prevalence rates of morbidity in the general population through bibliographic research., Methods: Articles relating to impairment, disability, handicap, quality of life and their prevalence in the general population, published between January 1990 and March 1998, were selected on the MEDLINE database., Findings: The 20 articles retained out of 433 used 41 different indicators. Indicators of impairment, disability, handicap and low quality of life showed prevalence rates of 0.1-92%, 3.6-66%, 0.6-56% and 1.8-26% respectively, depending on age and the accuracy of indicators. The heterogeneity of the conceptual framework and insufficient recognition of the importance of indicator accuracy, the age factor and the socioeconomic characteristics of the studied populations impede reliable international comparison., Conclusion: Further standardization of indicators is therefore required. The revision of the International Classification of Impairments, Disabilities and Handicaps may make it possible to resolve some of the difficulties encountered.