Cermes3/Cesames (Centre de recherche Médecine, Santé, Santé mentale, Société) Univ. Paris Descartes, Sorbonne Paris Cité/CNRS UMR 8211/Inserm U988/EHESS
Head of the Survey Unit at the French National Institute for Prevention and Health Education (Institut National de Prévention et d’Education pour la Santé, INPES)
Researcher at Cermes3 - Equipe Cesames (CNRS UMR 8211, Inserm U988, University of Paris Descartes, Sorbonne Paris Cité, EHESS)
Abstract: Cancer has become a major public health issue. It is thus crucial to measure the general population's behaviours, opinions and perceptions about cancer and its associated risk factors. This article describes some of the main findings of a 2005 French survey (n = 4,046). Cancer is considered by a large majority to be the most serious disease, far before HIV/AIDS and cardiovascular diseases. The carcinogenic risk that is associated to main risk factors, such as sun exposure, tobacco-smoking and alcohol use appears to be well-known. However, many people justify dangerous behaviours with strongly-anchored beliefs, which maintain dangerous behaviours for health on the long-term. What's more, the perception of risk proliferation can also generate risk denial. Because self-exempting beliefs are still widespread within the general opinion, it is essential to continue public health information campaigns dedicated to cancer prevention, so as to induce better prevention practices within the general population and to reduce stigmatisation and isolation experienced by cancer patients. If risk denial is not systematically a consequence of a lack of information, it is generally associated to a cognitive construction that gives coherence to behaviours.
Abstract: Background: Smoking cessation advice from health care providers (HCP) is well-known to be associated with increased quitting. This study sought to understand the extent to which smokers in France who visited a HCP around the time of the implementation of the national ban on smoking received encouragement to quit from a HCP and what kinds of intervention were provided. HCP may have a unique opportunity during the implementation phase of smoke-free laws to address their patients' smoking behaviours to increase the likelihood of success at a time when smokers' readiness and interest in quitting may be higher. Methods: Telephone interviews were conducted among adult smokers (n = 1067) before and after the two-phase (2007 and 2008) national ban on indoor smoking as part of the International Tobacco Control (ITC) France Survey. In the survey, smokers were asked whether they had visited a HCP in the past 6 months and, if so, whether they had received cessation encouragement, and/or other interventions to support quitting such as prescriptions for stop-smoking medication. RESULTS: Most smokers (61%) reported visiting a HCP in the 6 months prior to the first phase of the national smoke-free ban, and 58% after the time of the hospitality ban. Of these, most reported they did not receive any assistance from a HCP before (54%) or after (64%) the smoke-free law. Among those who reported an intervention, the most common were only encouragement to quit (58% in Wave 1 and 49% in Wave 2), or receiving both encouragement and a pamphlet (31% in both Wave 1 and 2). The combination of prescriptions for stop-smoking medicine and encouragement to quit increased from 8% in 2007 to 22% in 2008. The smokers who received an intervention were more likely (OR 1.9, 95% CI: 1.2-2.9) to report that they were thinking about quitting. Discussion: This study demonstrates that HCP in France are well positioned to provide smoking cessation encouragement and other interventions to a majority of smokers and thus the importance of taking measures to increase their involvement, particularly when population-level tobacco control policies, such as smoke-free laws, are being implemented.
Abstract: As exposure to tobacco smoke pollution (TSP) has been identified as a cause of premature death and disease in non-smokers, and studies have demonstrated that smoking in cars produces high levels of TSP, this study will investigate smokers' rules for smoking in their cars, and predictors of car smoking rules, including potentially modifiable correlates.
Abstract: On January 1, 2008, the French government implemented a national ban on indoor smoking in hospitality venues. Survey results indicate the indoor ban has been successful at dramatically reducing indoor smoking; however, there are reports of an increased number of outdoor hospitality spaces (patios) where smoking can take place. This study sought to understand if the indoor ban simply moved smoking to the outdoors, and to assess levels of support for smoking restrictions in outdoor hospitality settings after the smoke-free law.
Abstract: To investigate the influence of the family socioeconomic status (F-SES) on various intensities and frequencies of cannabis use in late adolescence. DESIGN/SETTINGS/PARTICIPANTS: Data were obtained from a cross-sectional survey conducted in 2008, which was representative of French youth aged 17(n = 39,542). Outcomes were overall use (abstinence, lifetime use, 1-9, and 10+ uses in the past year) for all adolescents, and frequent use for those who smoked cannabis at least 10 times in the past year (â¤9, 10-19, 20+ uses in the past month). Additionally, cannabis use disorders and heavy use (having smoked at least 4 joints last time) were studied among previous-year users. F-SES was the highest occupational category of both parents (in 7 categories, from managers/professionals [used as the reference category] to inactive/unemployed). Multinomial logistic regressions were computed controlling for gender; other substances use; parental separation; parental use of alcohol, tobacco, and cannabis; housing, being out of school, and sociability.
Abstract: National level smoke-free legislation is implemented to protect the public from exposure to second-hand tobacco smoke (SHS). The first aim of this study was to investigate how successful the smoke-free hospitality industry legislation in Ireland (March 2004), France (January 2008), the Netherlands (July 2008), and Germany (between August 2007 and July 2008) was in reducing smoking in bars. The second aim was to assess individual smokers' predictors of smoking in bars post-ban. The third aim was to examine country differences in predictors and the fourth aim was to examine differences between educational levels (as an indicator of socioeconomic status). This study used nationally representative samples of 3147 adult smokers from the International Tobacco Control (ITC) Europe Surveys who were surveyed pre- and post-ban. The results reveal that while the partial smoke-free legislation in the Netherlands and Germany was effective in reducing smoking in bars (from 88% to 34% and from 87% to 44%, respectively), the effectiveness was much lower than the comprehensive legislation in Ireland and France which almost completely eliminated smoking in bars (from 97% to 3% and from 84% to 3% respectively). Smokers who were more supportive of the ban, were more aware of the harm of SHS, and who had negative opinions of smoking were less likely to smoke in bars post-ban. Support for the ban was a stronger predictor in Germany. SHS harm awareness was a stronger predictor among less educated smokers in the Netherlands and Germany. The results indicate the need for strong comprehensive smoke-free legislation without exceptions. This should be accompanied by educational campaigns in which the public health rationale for the legislation is clearly explained.
Abstract: Background
Increasing evidence suggests an association between short sleep with adverse health outcomes: obesity, type 2 diabetes and hypertension. But there are few or no data on âwho these short sleepers areâ in the general population.
Objectives
To describe short sleepers and the associated sleep disorders in young adults.
Methods
Cross-sectional telephone survey in a representative sample of 1004 French young adults (25â45years old). Total sleep time (TST), insomnia, snoring, sleepiness and daytime consequences were assessed using subjective validated tools. Short sleepers were defined as sleeping <6h a weekday (sleep+nap+pauses). Sleep debt was defined as those who âsleep 90min less than the sleep they need to be in good shape.â
Results
Prevalence of short sleep was 18%, insomnia 12%, and sleep debt 20% in the total group. Among short sleepers, 16% had insomnia, 45% sleep debt, and 39% neither. Short sleepers were significantly mostly males, blue collar workers and more overweight and obese compared to nonshort sleepers. Working >10h per day, smoking and drinking coffee after 5p.m. were also significantly associated with short sleep. Short sleepers had higher Epworth sleepiness scale ESS scores (7.8 vs 6.7; p=0.0058) and more sleepiness while driving (11.5% vs 2.9%; p<0.0001).
Conclusion
Short sleep is highly prevalent in young adults but is not an homogeneous group, including both insomniacs and subjects with or without sleep debt. Short sleep has to be defined more precisely in order to better understand its impact on public health.
Abstract: 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.
Abstract: 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.
Abstract: Sleep is usually considered as a factor for good health and personal equilibrium. However, the epidemiology of insomnia, which is the most frequent of sleep disorders, is still unknown in France.
Abstract: BACKGROUND: Make an inventory of screening of addictive behaviours among general practice since the end of the 1990s. METHODS: A representative sample of 2,083Â general practitioners was surveyed in 2008/2009. They were asked about their prevention practices. RESULTS: Two thirds of the general practitioners (GPs) reported discussing tobacco consumption at least once with each patient. This assessment was less systematic for alcohol (23% of GPs) and cannabis (8% of GPs). Approximatively 70% reported addressing cannabis or alcohol use issues only with patients at risk. One third reported using tobacco smoking screening questionnaires, while there were only 6% in 2003. Only 13% of GPs used alcohol standardized questionnaires, a clear rise since 1998 (1.4% in 1998, 2.0% in 2003). Using alcohol standardized screening tests was more frequent among GPs belonging to a drug addiction network, but no significant link was found with gender, age or area. Only 2% of GPs used cannabis use screening tests. The care for cannabis users seemed particularly linked to the practitioners' inclination to discuss this issue without waiting for a demand arising from the patient. The proportion of practitioners reporting helping patients kick their nicotine addiction in the last seven days proved stable since 2003, after a very significant increase between 1998Â and 2003. The proportion of GPs reporting seeing a patient for an alcoholic weaning (52%) was stable since 1998. CONCLUSION: This study illustrates the development of addiction care practices integrating smoking cessation help and, to a more limited extent, screening of alcohol and cannabis abuse, evidenced by the expanded application of standardized questionnaires in general practice. Consideration given to cannabis and alcohol use assessment appeared correlated to GPs feeling at ease with addressing drug use issues, this feeling being linked to their ability to rely on institutional directives or validated screening tools. It seems thus important to encourage the implementation of a health educational approach including early screening and brief intervention during consultation.
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.
Abstract: BACKGROUND: The European Commission requires tobacco products sold in the European Union to display standardized text health warnings. This article examines the effectiveness of the text health warnings among daily cigarette smokers in four Member States. METHODS: Data were drawn from nationally representative samples of smokers from the International Tobacco Control Policy Evaluation Project surveys in France (2007), Germany (2007), the Netherlands (2008) and the UK (2006). We examined: (i) smokers' ratings of the health warnings on warning salience, thoughts of harm and quitting and forgoing of cigarettes; (ii) impact of the warnings using a Labels Impact Index (LII), with higher scores signifying greater impact; and (iii) differences on the LII by demographic characteristics and smoking behaviour. RESULTS: Scores on the LII differed significantly across countries. Scores were highest in France, lower in the UK, and lowest in Germany and the Netherlands. Across all countries, scores were significantly higher among low-income smokers, smokers who had made a quit attempt in the past year and smokers who smoked fewer cigarettes per day. CONCLUSION: The impact of the health warnings varies greatly across countries. Impact tended to be highest in countries with more comprehensive tobacco control programmes. Because the impact of the warnings was highest among smokers with the lowest socioeconomic status (SES), this research suggests that health warnings could be more effective among smokers from lower SES groups. Differences in warning label impact by SES should be further investigated.
Abstract: The purpose of health surveillance is to contribute to health planning, information and prevention. Surveillance involves repeated data collections based on epidemiological studies and follow-up of data collected from medical-administrative databases. This paper provides an overview of mental health surveillance in France and examines the relevance and limitations of the collected data.
Abstract: 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.
Abstract: 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.
Abstract: Cocaine has become an essential part of the French drug scene and is the most commonly abused stimulant worldwide. The principal routes of cocaine administration are intranasal ("snorting"), intravenous ("injecting"), and inhalation ("smoking" freebase or crack cocaine). Distinct classes of primary cocaine users were identified in the literature. Cocaine dependence is a multifactorial disorder, variable in its manifestations, and heritable. It comprises distinct clinical phenomena that drive a cycle of addiction: cocaine-induced euphoria, acute withdrawal, cue-induced craving (people, places, things), loss of control with poor decision making, cocaine seeking behaviour with multiple risks taken and cocaine administration.
Abstract: 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%).
Abstract: Data are from the European School Survey Project on Alcohol and other Drugs (ESPAD) in eight countries (Sweden, United Kingdom, France, Malta, Slovenia, Hungary, Bulgaria, and the Czech Republic) in spring 2003. Two scales were constructed, measuring beliefs that alcohol and cannabis harm people. Relationships of these scales with measures of parental control, parental attitudes, respondent's own drug use, friend's drug use, and gender were assessed within each country. Both at the country and the individual level, subject's own drug use showed strong inverse relationships with risk perceptions. Parental control and parental attitudes also showed associations with risk perception but these seemed largely mediated by the parental influence on subject's own use and by choice of friends. In countries with low prevalence of drug use the extent to which the predictor variables accounted for risk perceptions was lowest. Also the predictor variables showed greater associations with cannabis risk perception than with alcohol risk perception. For cannabis the explained variance in risk of harm varied from 8.1% in Sweden to 30.4% in the Czech Republic. For alcohol harm this range was from 3.1% in Bulgaria to 15.1% in Malta.
Abstract: Cancer has become a major public health issue. It is thus crucial to measure the general population's behaviours, opinions and perceptions about cancer and its associated risk factors. This article describes some of the main findings of a 2005 French survey (n = 4,046). Cancer is considered by a large majority to be the most serious disease, far before HIV/AIDS and cardiovascular diseases. The carcinogenic risk that is associated to main risk factors, such as sun exposure, tobacco-smoking and alcohol use appears to be well-known. However, many people justify dangerous behaviours with strongly-anchored beliefs, which maintain dangerous behaviours for health on the long-term. What's more, the perception of risk proliferation can also generate risk denial. Because self-exempting beliefs are still widespread within the general opinion, it is essential to continue public health information campaigns dedicated to cancer prevention, so as to induce better prevention practices within the general population and to reduce stigmatisation and isolation experienced by cancer patients. If risk denial is not systematically a consequence of a lack of information, it is generally associated to a cognitive construction that gives coherence to behaviours.
Abstract: The relationship between smoking and poverty is a public health issue in many countries, and several studies have shown a link between living in deprived neighbourhoods and smoking. In France the prevalence of smoking has decreased since the year 2000s. We examined whether reduced smoking rates differed by socio-economic status, anticipating reductions to be smaller amongst lower socio-economic groups. We also investigated whether poor housing conditions and/or living in a deprived neighbourhood were significantly associated with smoking.
Abstract: Background: Individual experience with substance use is considered as one of the principal factors influencing risk perception and attitudes of young people towards substance use. The aim of this paper is to show the relationship between self-reported prevalence and the subjectively perceived risks of substance use, both for individuals and at the country level.
Methodology: The relationships were analyzed on a sample of students participating in the ESPAD survey in 8 European countries. The sample of 22 899 students was divided into five groups: abstainers (9.3%), experimental alcohol consumers (52.0%), regular alcohol consumers (14.2%), experimental drug users (12.3%) and regular drug users (12.2%).
Findings: Significant differences were observed in the risk perception of use of selected substances among 5 types of users. The percentage of students perceiving moderate or great risks of substance use tends to fall across the groups with increasing prevalence of more risky patterns of substance use. Highest perceived risks of alcohol and illicit drugs use were found among abstainers and experimental alcohol consumers while both experimental and regular drug users tend to perceive lower risks. Regular alcohol consumers perceive relatively high risks of illicit drug use; however, they underestimate the risks of alcohol consumption. Country differences were observed in the level of perceived risks. These differences correspond to a different distribution of types of users and to the overall prevalence of substance use in individual countries.
Abstract: The study examines data from teenagers from 35 countries taking part in surveys conducted within the European School Survey Project on Alcohol and Other Drugs (ESPAD). The main hypothesis tested was that the higher the prevalence of use of a particular drug the fewer will be the respondents who perceive great harm in using it. The hypothesis was tested for cannabis, alcohol, ecstasy and inhalants and was strongly confirmed for the former two in the data from the 1999 and 2003 surveys. For cannabis the perceived risk of harm changed in the expected direction as prevalence changed between 1999 and 2003. The results, although always in the expected direction, were inconclusive regarding ecstasy and inhalants.
Abstract: Abstract
AIMS:
This paper aimed to assess whether the increase of social differentiation of smoking is observed in France.
DESIGN AND SETTING:
Five cross-sectional telephone surveys conducted in France between 2000 and 2007.
PARTICIPANTS:
The surveys were conducted among national representative samples of French subjects aged 18-75 years (n=12â256, n=2906, n=27â499, n=2887, n=6007 in 2000, 2003, 2005, 2006 and 2007, respectively). We focused on three groups: executives, manual workers and the unemployed.
MEASUREMENTS:
Time trends of smoking prevalence were assessed, and socio-economic factors (especially occupation and job status) associated with smoking were identified and compared in 2000 and 2005. We also computed respondents' equivalized household consumption (EHI) and their cigarette budget to assess the financial burden of smoking.
FINDINGS:
Between 2000 and 2007, smoking prevalence decreased by 22% among executive managers and professionals and by 11% among manual workers, and did not decrease among the unemployed. Indicators of an underprivileged social situation were associated more markedly with smoking in 2005 than in 2000. In addition, the falling-off of smoking initiation occurred later and was less marked among manual workers than it was among executive managers and professionals. Finally, in 2005 15% of French smokers devoted at least 20% of their EHI to the purchase of cigarettes, versus only 5% in 2000, and smoking weighted increasingly heavily on the poorest smokers' budgets.
CONCLUSIONS:
While these results point out an increased social differentiation in tobacco use, they underline the need to design and implement other forms of action to encourage people to quit, in particular targeting individuals belonging to underprivileged groups.
Abstract: The levels of drug use among youths under 14 have remained extremely low for the past few years, as well as in most European countries. Yet, patterns of early drug use are often related to high-risk behaviours that require specific public policy strategies. Over the last years, the Government has set the target of reducing levels of drug use among specific groups such as young people: an awareness-raising media campaign has been launched and a specific outpatients clinics setting has been implemented for cannabis users in particular. This paper examines the relationship between health service providers and criminal justice authorities underlying the effectiveness of the current system. It underlines the need for an early screening and early interventions so as to avoid the shift from simple use to misuse or dependence.
Abstract: 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.
Abstract: This paper examines the drinking behaviour of young adults aged 24-32 who were married or were cohabiting. Data on this subject were available from surveys in 10 European countries. These were carried out under the auspices of the major investigation entitled 'Gender, Alcohol and Culture: An International Study (GENACIS)'. In general married people were similar to those cohabiting on annual frequencies of alcohol consumption, but lower on amounts consumed on each occasion and, therefore, on annual volumes. However, the extent of these differences varied in different countries. On the usual consumption per occasion measure, there were larger differences between married and cohabiting in Sweden, Spain, the United Kingdom, the Czech Republic and Norway than in Germany, Finland, Denmark, Iceland and Hungary. The differences between married and cohabiting people were, however, not associated with gender or with the presence of children. At the aggregate country level no associations could be shown with women's empowerment, age of first marriage or per capita alcohol consumption.
Abstract: The French figure among the largest consumers of cannabis in Europe, both according to general population surveys of adults from various European countries and the European School Survey Project on Alcohol and Other Drugs (ESPAD survey) carried out among more than 100,000 15-16 year old adolescents from most countries in Europe. Among the countries surveyed who have the most strict and suppressive policies concerning the use of psychotropic drugs, the level of consumption of cannabis appears particularly high in France and lowest in Sweden; although in a country diametrically opposed in terms of policy measures in this regard, The Netherlands (a country which carries the image of much freedom and leeway in this matter), actually occupies the position of average consumption rates in the middle of the two extreme cases aforementioned. Even more important than legislation is the presence of networks of close-knit relationships between young people; this is a critical aspect which has a strong influence in determining the choice whether or not to consume a product such as cannabis. In this manner, adolescents' behaviour and practices are integrally linked to the opinions, perceptions and use of his/her peers.
Abstract: 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: 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.
Abstract: 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.
Abstract: BACKGROUND: Past studies on smokers' risk perception have produced mixed results. We endorsed a new approach to assess smokers' perceptions of risk by asking them to estimate threshold values for the cancer risk associated with daily consumption of tobacco and number of smoking years. We expected that many smokers would endorse a "risk denial" attitude, with threshold estimates higher than their own smoking consumption and duration. METHODOLOGY: A French national telephone survey (n = 3820; 979 current smokers) included several questions about smoking behaviours and related beliefs. RESULTS: Among current smokers, 44% considered that smoking can cause cancer only for a daily consumption higher than their own consumption, and an additional 20% considered that the cancer risk becomes high only for a smoking duration higher than their own. Most smokers also agreed with other "risk denial" statements ("smoking is not more dangerous than air pollution," "some people smoke their whole life but never get sick"). Those who considered they smoked too few cigarettes to be at risk were less likely to report personal fear of smoking related cancer. CONCLUSION: Risk denial is quite widespread among smokers and does not simply reflect a lack of information about health risks related to tobacco. Fully informing smokers about their risks may necessitate changing the way they process information to produce beliefs and limiting their capacity to generate self exempting beliefs.
Abstract: INTRODUCTION: Since the late 1990s, several French surveys have studied perceptions about and the use of tobacco and other drugs among adolescents. This enables to track trends in tobacco use at this crucial age. This article presents the main epidemiological data gathered since 2000 and also reviews older surveys in order to place recent trends in a broader perspective. STATE OF THE ART: Thus, tobacco use has been decreasing in adolescents for several years but remains at a higher level than in the adult French population or than in many other European countries. This pattern is linked with a clearer view of the dangers of tobacco in terms of addiction and related harms, compared with alcohol and cannabis. PERSPECTIVES: The results vary according to social background and level of educational attainment and echo similar trends in adult populations. CONCLUSIONS: General population surveys can provide useful data for the monitoring and the understanding of trends in tobacco use. They can also provide useful information regarding prevention for policy makers and other health professionals.
Abstract: 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.
Abstract: 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.
Abstract: Female alcohol consumption habits, often studied with reference
to those of men in the context of gender difference studies,
can be described on the basis of a representative sample
of women between the ages of 20 and 59 years. The ENVEFF
survey, conducted in 2000 in order to describe the violence
experienced by women, quantifies alcohol consumption and
identifies several alcohol abuse settings, consisting of high
consumption in a party setting or during difficult times, or the
need to decrease alcohol consumption. Most women only drink
alcohol exceptionally. The modes of consumption vary according
to age: older women tend to drink daily, while younger
women drink less frequently, in the context of parties. The
modes of alcohol consumption therefore appear to be very
diverse. A need to decrease alcohol consumption is only rarely
experienced and is not systematically related to regular use.
Finally, there is a close correlation between being a victim of
violence and presenting alcohol consumption symptomatic of
addiction.
Abstract: 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.
Abstract: This article aims to assess the hypothesis of Charlton & Bates about a negative correlation between cigarette smoking and mobile phone ownership among adolescents. This hypothesis is discussed and tested by using data from a national survey conducted in France in 2000 (n = 8414; age 17). The results show that, in France, owning a mobile phone is positively correlated with smoking, and this relationship remains significant once confounding factors are controlled. Thus, cigarette smoking and mobile phone ownership could turn out to be complementary rather than substitutable goods or could be considered as two characteristics of the same lifestyle.
Abstract: 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.
