Prevalence of Alcohol, Drug Use and Psychoactive Substance Consumption in Samples of French and Congolese High School Students

The aim of this study was to make a first comparative approach to teenagers'consumption of psychoactive substances within samples drawn in France and in Brazzaville the Congo. The samples consisted of 1637 French high-school students and 155 Congolese students. An anonymous questionnaire with 13 closed items was completed. Whilst 82.1% of the male and 74.5% of the female French students had already consumed some alcoholic drinks, only 42.4% of the male and 44.0% of female Congolese students had consumed alcohol. French high school students were more affected by tobacco addiction: 22.2% (male) and 22.9% (female) of the French students smoked daily; only 3.0% (male) and 1.9% (female) Congolese students were smokers. The consumption of psychotropic medicines (sedatives, anxiolytics or hypnotics) appeared overall to be less among French high school students than the Congolese, particularly in boys (11.9% versus 17.2%). This consumption was mainly from medicine taken without medical prescription or misused. The use of cannabis appeared overall to be higher among French high school students (45.9% of males and 31.6% of females) than the Congolese (12.5% of males and 7.4% of females).

Telling children their mother is seriously ill or dying: mapping French people's views

BACKGROUND

What to tell children when their mother's life is seriously endangered is a largely unstudied issue.

METHODS

We had 255 lay persons in France judge the appropriateness of the parents' behaviour in 48 scenarios of parents dealing with this problem. The scenarios comprised according to a four within-subject orthogonal design: child's age (4, 6, 8 or 10 years), severity of disease (lethal or worrisome but curable), child's concern or not about his or her mother's illness and parents' decision about how much to tell (tell nothing, minimize or tell the full truth).

RESULTS

Cluster analysis revealed four clusters, labelled 'always tell the truth' (33%), 'tell the truth or minimize' (16%), 'tell nothing or minimize' (22%) and 'depends on child's age and level of concern' (29%). Women and participants who had already faced breaking bad news like this to children were more frequently members of the two 'tell the truth' clusters than other participants.

CONCLUSIONS

People who have already experienced a situation of having to tell a child about their mother's bad health tend to think, more than others, that telling the truth is the best policy.

Lay people's and health professionals' views about breaking bad news to children

BACKGROUND

Bad health news is difficult to communicate, especially when parents must give bad news to their children.

METHODS

We had 170 lay persons, 33 nurses and six physicians in Toulouse, France, judge the appropriateness of the parents' behaviour in 64 scenarios of parents dealing with this problem. The scenarios were composed according to a four within-subject orthogonal design: child's age (4, 6, 8 or 10), severity of disease (lethal or worrisome but curable), child's concern or not about his illness and parents' decision about communicating the news (tell nothing, minimize, tell the truth or ask the physician to tell the truth).

RESULTS

Cluster analysis revealed four clusters, labelled 'Always Tell the Truth' (33%, including a majority of doctors and nurses), 'Tell Nothing or Minimize' (16%, with an older average age), 'Tell the Truth Except in Cases of Incurable Illness' (22%) and 'Depends on Child's Characteristics' (29%).

CONCLUSIONS

Physicians in training and in practice need to be aware that lay people--and likely parents as well--have diverse and complex opinions about when and how parents should give bad health news to their children.

Perception of the combined effects of smoking and alcohol on cancer risks in never smokers and heavy smokers

The issue addressed in the study is: How do people perceive the combined effect of alcohol consumption and tobacco consumption on risks of cancer? The method used was an application of Information Integration Theory. Sixty-four participants of both sexes were asked to estimate the risk of cancer associated with a number of situations described by a tobacco-consumption level associated with an alcohol-consumption level. Participants were subsequently presented with a questionnaire concerning the way alcohol and tobacco consumption can cause cancer. Results showed that French adults apparently considered that indulging in only one of these two behaviours represents a maximum health risk. The two effects were seen to combine disjunctively which runs counter to current medical data. However, there was total contradiction between the participants' answers to the questionnaire concerning their knowledge and the information integration task.

The acceptability among French lay persons of ending the lives of damaged newborns

BACKGROUND

Lay persons' judgements of the acceptability of the not uncommon practice of ending the life of a damaged neonate have not been studied.

METHODS

A convenience sample of 1635 lay people in France rated how acceptable it would be for a physician to end a neonate's life-by withholding care, withdrawing care, or active euthanasia-in 54 scenarios in which the neonate was diagnosed either with perinatal asphyxia or a genetic abnormality. The scenarios were all combinations of four factors: three levels of maturity or immaturity, three levels of severity of the health problem, three levels of parents' preference concerning prolonging care and two levels of decision-making (with or without consulting the other caregivers).

ANALYSES

Analyses of variance of the participants' responses were performed to determine the importance of each factor; the interactions among factors, with methods of ending life and with other patient characteristics; and the differences between asphyxia and genetic abnormality. A cluster analysis was performed to look for groups with different patterns of responses.

RESULTS

Lay people assigned most importance to the parents' request and to the severity of the problem. Except for a small group (12%) always opposed to ending life, they used a simple additive-type rule in integrating the information.

IMPLICATIONS

Most of this sample of French lay people are not categorically for or against ending the life of a damaged neonate, but judge its degree of acceptability by adding up those factors that seem most salient to them.

Knowledge of the risks associated with skin bleaching among Togolese users

We examined the extent of Togolese users’ knowledge of the health risks associated with the regular use of bleaching agents. A massive underestimation of some of the main risks was discovered. The more frequent the use of bleaching agents, the higher the underestimation.

Do French lay people and health professionals find it acceptable to breach confidentiality to protect a patient's wife from a sexually transmitted disease?

OBJECTIVE

To determine under what conditions lay people and health professionals find it acceptable for a physician to breach confidentiality to protect the wife of a patient with a sexually transmitted disease (STD).

METHODS

In a study in France, breaching confidentiality in 48 scenarios were accepted by 144 lay people, 10 psychologists and 7 physicians. The scenarios were all possible combinations of five factors: severity of the disease (severe, lethal); time taken to discuss this with (little time, much time); intent to inform the spouse about the disease (none, one of these days, immediately); intent to adopt protective behaviours (no intent, intent); and decision to consult an expert in STDs (yes, no), 2 x 2 x 3 x 2 x 2. The importance and interactions of each factor were determined, at the group level, by performing analyses of variance and constructing graphs.

RESULTS

The concept of breaching confidentiality to protect a wife from her husband's STD was favoured much more by lay people and psychologists than by physicians (mean ratings 11.76, 9.28 and 2.90, respectively, on a scale of 0-22). The patient's stated intentions to protect his wife and to inform her of the disease had the greatest impact on acceptability. A cluster analysis showed groups of lay participants who found breaching confidentiality "always acceptable" (n = 14), "depending on the many circumstances" (n = 87), requiring "consultation with an expert" (n = 30) and "never acceptable (n = 13)".

CONCLUSIONS

Most people in France are influenced by situational factors when deciding if a physician should breach confidentiality to protect the spouse of a patient infected with STD.

The acceptability of ending a patient's life

OBJECTIVES

To clarify how lay people and health professionals judge the acceptability of ending the life of a terminally ill patient.

DESIGN

Participants judged this acceptability in a set of 16 scenarios that combined four factors: the identity of the actor (patient or physician), the patient's statement or not of a desire to have his life ended, the nature of the action as relatively active (injecting a toxin) or passive (disconnecting life support), and the type of suffering (intractable physical pain, complete dependence, or severe psychiatric illness).

PARTICIPANTS

115 lay people and 72 health professionals (22 nurse's aides, 44 nurses, six physicians) in Toulouse, France.

MAIN MEASUREMENTS

Mean acceptability ratings for each scenario for each group.

RESULTS

Life ending interventions are more acceptable to lay people than to the health professionals. For both, acceptability is highest for intractable physical suffering; is higher when patients end their own lives than when physicians do so; and, when physicians are the actors, is higher when patients have expressed a desire to die (voluntary euthanasia) than when they have not (involuntary euthanasia). In contrast, when patients perform the action, acceptability for the lay people and nurse's aides does not depend on whether the patient has expressed a desire to die, while for the nurses and physicians unassisted suicide is more acceptable than physician assisted suicide.

CONCLUSIONS

Lay participants judge the acceptability of life ending actions in largely the same way as do healthcare professionals.

When is physician assisted suicide or euthanasia acceptable?

OBJECTIVES

To discover what factors affect lay people's judgments of the acceptability of physician assisted suicide and euthanasia and how these factors interact.

DESIGN

Participants rated the acceptability of either physician assisted suicide or euthanasia for 72 patient vignettes with a five factor design--that is, all combinations of patient's age (three levels); curability of illness (two levels); degree of suffering (two levels); patient's mental status (two levels), and extent of patient's requests for the procedure (three levels).

PARTICIPANTS

Convenience sample of 66 young adults, 62 middle aged adults, and 66 older adults living in western France.

MAIN MEASUREMENTS

In accordance with the functional theory of cognition of N H Anderson, main effects, and interactions among patient factors and participants' characteristics were investigated by means of both graphs and ANOVA.

RESULTS

Patient requests were the most potent determinant of acceptability. Euthanasia was generally less acceptable than physician assisted suicide, but this difference disappeared when requests were repetitive. As their own age increased, participants placed more weight on patient age as a criterion of acceptability.

CONCLUSIONS

People's judgments concur with legislation to require a repetition of patients' requests for a life ending act. Younger people, who frequently are decision makers for elderly relatives, place less emphasis on patient's age itself than do older people.

[Predictors of quality of life in refractive surgery]

PURPOSE

To investigate predictors of quality of life in refractive surgery: psychological status, quality of vision, visual acuity, and patient satisfaction.

METHODS

In a prospective study, 143 patients were evaluated preoperatively and after the third postoperative month using the same questionnaire. Quality of vision, visual acuity, well-being, self-esteem, coping, and patient satisfaction were analyzed with 47 parameters. Refractive procedures included PRK, LASIK, and phakic IOL. Four groups of low (G1), medium (G2), and high myopia (G3) and hyperopia (G4) were individualized to compare the results.

RESULTS

We noted a mean postoperative best corrected visual acuity (BCVA) of 20/25 or more for the G1, G2, and G4 groups. For the G3 group, the mean BCVA was increased, with a gain of two Snellen Lines from 20/50 to 20/32. Postoperative patient satisfaction improved, with a significant difference (p<0.05) in all groups. We noted no significant difference in all myopic groups in well-being and no significant decrease in G4. Concerning self-esteem and coping, scores improved, with a significant difference in G3 group (p<0.05). Quality of vision was directly correlated with improvement of quality of life (psychological status), satisfaction scores, and BCVA preoperatively and postoperatively in all patients, but no correlation was noted between visual acuity and patient satisfaction.

CONCLUSION

In spite of good refractive results, modification of patient satisfaction depends on quality of vision and quality of life (psychological status) scores. These results give us a new tool that provides useful additional information in refractive surgery.

Prevention and treatment of post-partum depression: a controlled randomized study on women at risk

BACKGROUND

Research is needed to evaluate the efficacy of prevention and treatment for post-partum depression.

METHOD

Subjects were screened with the Edinburgh Post-natal Depression Scale (EPDS) at the obstetric clinic. Mothers at risk (N = 258) (EPDS scores > or = 9) were randomly assigned to a prevention/treatment group or a control group. The prevention group received one cognitive-behavioural prevention session during hospitalization. At 4 to 6 weeks post-partum, subjects were screened again with the EPDS, after drop-out rates (refusals plus no return of the second EPDS) of 25.4% (33/130) in the intervention group and 10.9% (14/128) in the control group. Mothers with probable depression (EPDS scores > or = 11) were assessed using the Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory (BDI). Mothers with major depression continued in the treatment group (N = 18) or in the control group (N = 30). Treated subjects received a cognitive-behavioural programme of between five and eight weekly home-visits.

RESULTS

Compared with the control group, women in the prevention group had significant reductions in the frequency of probable depression (30.2 % v. 48.2%). Recovery rates based on HDRS scores of < 7 and BDI scores of < 4 were also significantly greater in the treated group than in the control group.

CONCLUSIONS

The study suggests that this programme for prevention and treatment of post-partum depression is reasonably well-accepted and efficacious.

Judging the pleasantness of form-color combinations

The way people with various degrees of aesthetic expertise integrate form and color information in a pleasantness judgment was investigated in 2 experiments. Participants were asked to assign an overall pleasantness value to combinations of forms and colors. In Experiment 1, the factors manipulated were form and color inside the form. In Experiment 2, they were form and color of the ground. In judging the pleasantness of form-color combinations, participants applied a complex rule in which the weight attributed to one element depends on the value of the other element. When the value of an element is medium (when it is neither liked nor disliked), its weight is lower than when its value is low (when it is disliked). As a result, the weight of the other element is proportionally altered. The data support a nonequal averaging combination rule. Very few differences between experts and nonexperts were observed. This result supports the view that the pleasantness judgments were based largely on automatic reactions.

Frequency of borderline personality disorder in a sample of French high school students

OBJECTIVE

To estimate the frequency of borderline personality disorder (BPD) in French high school students.

METHOD

A random sample of high school students (n = 1363) ranging in age from 13 to 20 years agreed to complete a questionnaire, the Screening Test for Comorbid Personality Disorders (STCPD); 107 of them volunteered to be interviewed. We assessed this group using the Revised Diagnostic Interview for Borderlines (DIB-R). We conducted a regression analysis to determine a cut-off for BPD diagnosis with the STCPD.

RESULTS

We estimated the overall frequency of BPD to be 10% for boys and 18% for girls. After a peak of frequency at age 14 years for both sexes, the frequency increased significantly again in late adolescence.

CONCLUSION

This study found a high frequency of BPD in French adolescents, which adds to questions regarding the validity of diagnosing this disorder in adolescents.

Personality correlates of risk perception

The aim of the present study was to systematically examine the variations of the effects of (1) transitional anxiety states and enduring anxiety dispositions, and (2) worldviews (hierarchic, egalitarian, individualist, and fatalist), as a function of the type of hazard considered. Ten risk factors were identified. Transitional anxiety contributed significantly to the prediction of four of these risk factors. The more anxious the respondents, the higher were their scores for the Common Individual Hazards, Pollutants, and Outdoor Activities factors, and the lower were their scores for the Public Transportation and Energy Production factor. Enduring anxiety contributed significantly to the prediction of the Psychotropic Drugs factor. The more anxious the respondents, the lower were their scores. The four worldview factors contributed significantly to the prediction of three of these risk factors. The more fatalistic the respondents, the lower were their scores for the Pollutants factor, and the higher were their scores for the Public Transportation and Energy Production factor; the more egalitarian the respondents, the higher were their scores for the Pollutants factor; the more hierarchic the respondents, the lower were their scores for the Public Transportation and Energy Production factor; and the more individualistic the respondents, the higher were their scores for the Pollutants and Deviance, Sex, and Addiction factors.

Eliciting patient disutilities for the adverse outcomes of cardiopulmonary resuscitation

BACKGROUND

in helping patients decide about treatments, such as whether to authorize cardiopulmonary resuscitation (CPR), physicians typically present information about the possible outcomes and their likelihoods. The aim of this study was to elicit patient disutilities for the adverse outcomes of cardiopulmonary resuscitation (CPR) using the methodology of NH Anderson's functional theory of cognition and to determine how patients integrate the disutility and the likelihood of an outcome.

METHODS

77 French adults rated scenarios of possible outcomes of CPR on a linear scale with anchors "what would be the best (or worst) for me." In 25 of the 27 scenarios, the result would be either total recovery or one of five adverse outcomes (chest injury, mild reversible brain damage, severe irreversible brain damage, death after intensive care, immediate death) with one of five likelihoods (one to five chances out of ten). In the other two, the only possible result was either total recovery or immediate death.

RESULTS

the mean disutilities relative to 0 for chest injury and 100 for severe brain damage were 13 for mild brain injury, 68 for death after intensive care, and 69 for immediate death. The graphs of the ratings of each adverse outcome in relation to its frequency were fan-shaped, showing that participants integrated this information multiplicatively.

CONCLUSIONS

the functional theory of cognition provides an alternate method of eliciting patient utilities for the outcomes of CPR and supports clinicians' assumption that people combine utility and likelihood multiplicatively.

[Survey on sexual behavior by Congolese and French high-school students in an AIDS context]

The social and economic impact of AIDS add to those of a recent civil war in 1997. There were fratricidal confrontations before and after this period. Pointe-Noire, the second city of Congo and the economic Capital, was on the whole spared. We carried out a survey of 292 high-school students: 39% of girls and 61% of boys, from 14 old to 25 years old (average age of 19 years). They were from 5 general and technical schools, which are representative of the school recruitment of the city of Pointe-Noire. This study made in 1998 was the second part of a work achieved in France in 1997 with 1,859 high-school students: 70% of girls and 30% of boys, mean age 17.7 years, range 15-25 years. They came from 3 general, technical and professional schools of two departments of the region "Centre" ("Indre-et-Loire" and "Loir-et-Cher"). The material, corresponding to this study, is an anonymous self-questionnaire of 55 closed items presented in the form of assertions to which the student respond either yes or no. Items investigated: 1) pubertal maturation and subjective maturation; 2) different aspects of sexual experience in adolescence (components of sexual experience) [9] and 3) sexual behaviour (including sexual risk taking). All items have been formulated in the most accessible possible way for the youngsters. Previously, in 1996, we had made a pre-test with this material near sample of French people from 16 to 68 years old. The results of the study highlight that the Congolese youngsters present more risk than their French homologues. Although the pubertal status (the menarche and the spermarche) occurs slightly later, Congolese boys present a greater number of sexual partners and greater sexual precocity. Among 54% of Congolese pupils from the sample which had already had a sexual intercourse (68% of boys and 42% of girls) versus 52% of French pupils (58% of boys and 49% of girls), 88% of the Congolese boys have sexual intercourse at the age of 15, versus 72% of the girls at 16.5 versus 65% of the French boys in their 15.5 and 52% of the girls at 16. These differences are significant (p < 0.001) like all the following ones. Congolese students declare more sexual partners (4 during the last 12 months and 5 for all their life versus 3.2 and 4.4 for the French students); the boys more than the girls (6.5 sexual partners on the whole versus 3.7 for the girls in Congo and 5.7 versus 3.8 in France). Congolese girls generally have fewer sexual relations (over 12 months or during their entire life) than French high-school girls (respectively 5.9, 6.9 versus 8.7 and 9.3). We can see with French and Congolese students, a "traditional" dichotomy between boys and girls: that is to say girls tend to engage later in sexual relations and to favour the long and regular relations, while the boys have more short, and spaced sentimental relations. The relations of these last ones tend to evolve on a more preparatory mode, genital and intermittent, contrary to those girls who seem more sentimental and continuous. The use of the condom concerns 72% of the French pupils for the first sexual intercourse (74% of boys versus 72% of girls) - which is close to results of French reference surveys [1, 3]. On the other hand, they are only 39% to make use of it in Congo in this circumstance (36% of the boys and 34% of the girls). All Congolese young people present more STD (6% versus 4% for the French pupils) and more pregnancy (11% versus 3%). The other risky situations appear also more important in Congo: as the fact of having sexual intercourse after having drunk too much (6% of case where it arrives systematically versus 2% in France); to have sexual intercourse with a injecting drug user (4% versus 1%); paying or to have been paid (in a systematic way 7% versus 1%). The Congolese answers concerning the recourse to prostitution are more dissimilar and alarming concerning Congolese young people, especially if one takes into account all the situations where it occurred at least once (29% of the boys and 13% of the Congolese girls who declare to have had a sexual intercourse by paying (with money). Homosexual relations are more frequent in Congo (4 and 6% versus 2 and 3% for France). Homosexual experience concerned 13% of the Congolese pupils versus less than 5% of the French ones. The answers concerning a sexual partner who is "not sure" (20% in Congo versus 2% in France) can get clearer in the Congolese context with an elevated prevalence rate of infection by HIV. However, other cultural factors should not be neglected. The same applies for the answers relative to the sexual intercourse under duress (29% for Congo versus less than 7% in France). The answers relative to the fact of having a sexual intercourse with a much older partner (21% versus 13%) do not seem surprising for Congo. But it does not free risks. All these elements are not associated with a better estimate of the personal risk. (ABSTRACT TRUNCATED)

[Approach to sexuality in an AIDS context in Congo]

The pandemic due to the human immunodeficiency virus (HIV) is extensive in Sub-Saharan Africa and especially in Congo. Congo is a small country on the Atlantic coast and characterized by plentiful equatorial forests and low population density (essentially urban). In Congo, there is a high prevalence of HIV. The social and economic consequences of AIDS add to those of a recent civil war in 1997. There were fratricidal confrontations before and after this period. These confrontations have led to a massive exodus of the inhabitants of the capital, Brazzaville, to the forests and neighbouring cities, essentially towards Pointe-Noire. Pointe-Noire, chief place of the region of Kouilou, in the South of the country, is the second city of Congo and the economic Capital. It is undoubtedly for this reason that it has been globally saved. In this context, a sanitary policy of prevention of sexual risky behavior can appear as a challenge. While it supposes a better knowledge of the sexual activity of the young people, it cannot be dissociated from the analysis of the other factors. These factors can be of socio-economic political or cultural order. Thus the influence of cultural variables in the field of sexuality is certainly preponderant in African countries, where sexuality is taboo. Sexuality is a private matter (personal intimacy and the couple), but concerns also the family (in the sense of membership in an extended domestic group or in a system of relationship) in its aspects related to procreation and to the social field (power, alliances). Such individual behaviour can be lived as a questioning of the social order. In this article, the authors question the place of sexuality in Congo, particularly based on the work of anthropologists [2, 6, 7, 9]. Research in the field of sexuality at adolescence is rather recent in France and investigations that have been done in Congo these last ten years do not exist. Meetings and exchanges in 1998 with high-school pupils and schoolboys and girls of Pointe-Noire, have shown that they had a high level of knowledge (about contamination by HIV). On the other hand, this has also been associated with a number of beliefs, which are higher than in France: relating to the possibilities of interpersonal contagion by saliva (by kissing), food. but also a contagion by mosquito bites. Some of these pupils (essentially boys) have asked us about the greater risk of contagion when the male sexual partner presents an irritation or a wound in the penis. This recurring question seemingly concerns a point of knowledge. However a more attentive analysis lets us think that there could be various interpretations. First of all, if the penis is healthy, the risk is low, nearly absent. The concern about a friction or about a wound in the penis could be associated with the concept of forbidden sexual positions (similar to animal positions). Proscriptions are explained by their traumatic character for the feminine device and because they are able to induce an infertility or dystocia (difficult) childbirth. Other beliefs have connected the origin of AIDS with prohibited sexual practices, committed by foreigners, who passed on them secondarily to the natives of the country. They are clearly blamed in their contributions to the decline of customs and the corruption of tradition. However this unfavourable evolution is not longer only their privilege. Sexual superactivity and "sexual wandering" are also concerned. It is dialectic of the pure and the impure. The rejection or the stigmatisation of foreign values can allow the group to find its led astray identity. Condoms are well known by Congolese pupils, but there is mistrust of their use, notably for the "elders", guarantor for the moral order. This mistrust is probably connected with the beliefs of risks of infertility, infection or weakening of the virile force. Condoms are mechanical barriers, made by foreigners, to protect native people from foreign troubles, which foreigners generate. The investigation of chains of significant from the primary couple "nature/artificial (synthetic)" can establish a bait of understanding. The contraceptive action of condoms is a problem. Reproduction remains family business. Moreover, the place of the "morality", the official speech of condemnation from the Roman Catholic Church and the ambivalent positioning of certain Congolese religious congregations does not encourage condom use. Finally, one should not neglect their cost compared to the standard of living. The religious faith is a source of comfort for many Congolese. AIDS can be lived as a spiritual probation that certain traditional healers would have foreseen. Certain ideologies can be a source of intolerance for people who transgress "ways of life" (alcohol, tobacco, anal sexual intercourse.). The religious congregations have invaded the public space. The medical world and the political institutions cannot ignore them any more. (ABSTRACT TRUNCATED)

[Study of nicotine dependence among 342 adolescent smokers]

OBJECTIVE

This research evaluated nicotine dependence in adolescent smokers, their motivation to smoke and/or stop smoking, and their knowledge of how to stop smoking as well as the potential difficulties involved.

METHOD

Three hundred forty-two high school students completed questionnaires using two measures of dependence (the Fagerstrom tolerance test and a visual-analog self-evaluation scale), a test to measure motivation to smoke (the Horn test), and a questionnaire exploring motivations to stop smoking, methods used to stop smoking, and the anticipated difficulties.

RESULTS

On the Fagerstrom tolerance test, 14.6% of the students indicated strong dependence, whereas 32.3% indicated intermediate dependence. The Fagestrom score was strongly correlated to the self-evaluation test (r = 0.54, P < 0.001) and negatively correlated with the subjects' ages at the onset of smoking (r = -0.28, P < 0.001). The Horn test revealed that the main motivation to smoke is the search for relaxation and a decrease of negative emotions, indicating that cigarette smoking is primarily a means to manage stress and anxiety. Eighty-nine percent of the subjects stated that they would like to stop smoking, primarily because of the financial cost and health concerns. Among those subjects wishing to stop, 64.5% had previously tried to stop and had failed and 72% believed that it would be 'difficult' or 'very difficult' to stop. The main anticipated difficulties were an increase in stress and anxiety and, for the girls, weight gain. The anticipation of these difficulties was strongly correlated to dependence scores (r = 0.43, P < 0.001). Despite awareness of these difficulties, only 19.6% of the subjects wishing to stop smoking expected to seek medical assistance. For most of the measured variables, there was no difference between boys and girls.

CONCLUSION

This study confirms the seriousness of tobacco consumption in adolescence. The results suggest the need for early programs aimed at preventing or delaying onset of use as well as the need to develop programs to aid high school students to stop smoking.

Self-assessment of inebriation from external indices

OBJECTIVE

The objective was to study people's judgments, through the use of external indices, of their expected degree of inebriation and to characterize the cognitive processes involved in making these judgments.

METHOD

The participants were 143 adults living in France. In accordance with N. H. Anderson's functional theory of cognition (1982, 1996), their primary task was to read 64 cards depicting drinking situations characterized by three parameters: number of glasses, type of drink, and temporal relation to eating; to associate with each situation a certain degree of personal intoxication; and to indicate this degree of expected intoxication on linear scale anchored by Not at all drunk and Extremely drunk.

RESULTS

Participants were able to judge the general direction and combination of effects. They indicated incorrectly, however, that incremental effects decrease at higher levels of consumption (4 or more glasses) and at higher concentrations of alcohol in a drink. On the other hand, they indicated correctly that eating food decreases the impact of drinking alcohol. Drinkers and nondrinkers used different rules for self-assessment from external indices. IMPICATIONS: The systematic errors in both drinkers' and nondrinkers' use of external clues could, unless corrected, result in their becoming more inebriated than intended.

Perception of "appropriate" age for retirement among young adults, middle-aged adults, and elderly people

The "appropriate" age for retirement as it is perceived by young adults, middle-aged adults, and elderly people has been studied. No respondents were surprised or had trouble expressing an opinion about the minimum and maximum "appropriate" ages for retirement. Representations of the "appropriate" retirement age vary primarily as a function of the perceived physical constraints involved in the occupation, and also depend on the age of the person being questioned; the younger the respondent, and lower the perceived "appropriate" minimum age. There was no tendency among the young adults to prolong the work life of older individuals. Nor was there a tendency to associate aging with the loss of intellectual capacities likely to lead to early retirement.

How well do elderly people cope with uncertainty in a learning task?

The relation between age, task complexity and learning performance in a Multiple Cue Probability Learning task was studied by systematically varying the level of uncertainty present in the task, keeping constant the direction of relationships. Four age groups were constituted: young adults (mean age = 21), middle-aged adults (45), elderly people (69) and very elderly people (81). Five uncertainty levels were considered: predictability = 0.96, 0.80, 0.64, 0.48, and 0.32. All relationships involved were direct ones. A strong effect of uncertainty on 'control', a measure of the subject's consistency with respect to a linear model, was found. This effect was essentially a linear one. To each decrement in predictability of the task corresponded an equal decrement in participants' level of control. This level of decrement was the same, regardless of the age of the participant. It can be concluded that elderly people cope with uncertainty in probability learning tasks as well as young adults.

Relationship between cigarette dose and perceived risk of lung cancer

BACKGROUND

Most people are aware that smoking cigarettes increases the risk of ill health, in particular of lung cancer. The precise way in which they relate amount of exposure to smoke and level of health risk has not, however, been determined.

METHODS

A convenience sample of 155 French adolescents and adults ages 15 to 75 rated the risk of "smoker's cancer"--the popular term for lung cancer--in 24 scenarios depicting eight levels of daily cigarette consumption of three concentrations of nicotine. The data were analyzed according to functional measurement methodology to ascertain the forms of the relationship between exposure and perceived risk.

RESULTS

All subjects perceived that the risk of smoker's cancer increased as smoking increased. Yet at high levels of consumption, additional cigarettes were generally judged to result in decreasing increments of risk, regardless of the nicotine content of the cigarettes and the sex and smoking status of the participants. Adolescents, however, were more likely than adults to perceive a linear, rather than a negatively accelerated, relationship.

CONCLUSIONS

The actual form of the relationship between the dose of cigarette smoke and risk of lung cancer is either linear or positively accelerated. Public health educators and physicians should be aware that, at least in France, many people, particularly adults, incorrectly perceive this relationship as negatively accelerated.

Area judgment from width and height information: the case of the rectangle

We assessed the effect on performance of shifting from a perceptual area judgment situation, in which the physical quantity to be judged (the area) is present in the stimulus, to a situation in which it is not present in the stimulus. Adults, 9-year-olds, and 5-year-olds were shown combinations of horizontal and vertical lines of various sizes, presented on the same wall or on different walls, and asked to estimate the corresponding area. The following main results were obtained (a) When width and height information items were completely separated, 5- and 9-year-old children gave the same weight to both dimensions in their estimations; (b) when width and height information items were on two different walls, adults gave a greater weight to the larger dimension; (c) when width and height were joined, 9-year-old children gave a greater weight to the larger dimension but when they were separated, they did not.

Aging and multiple cue probability learning: the case of inverse relationships

Multiple Cue Probability Learning (MCPL) is an important cognitive ability for all age groups that, like other cognitive abilities, depends on information processing speed and working memory capacity--skills that have been found to decline with age. The relation between age and ability to learn direct and inverse probabilistic relationships was studied in two MCPL experiments involving subjects in three age groups. In the first experiment, subjects learned two three-cue tasks following the MCPL paradigm. In the first task, all cues had a direct relation (DR) with the criterion. In the second, one cue had an inverse relation (IR) with the criterion. In the DR task, older subjects were able to learn nearly as well as younger subjects. In the IR task, older subjects performed significantly worse than younger subjects due to an inability to use the inverse cue. In a second experiment involving the IR task, task information (TI) was given, that is, the relation between each cue and the criterion was explicitly described. This eliminated the need for subjects to discover the inverse relation on their own, thus reducing the burden on working memory. Provision of TI resulted in improved performance for the 20-30 and 65-75 year old groups, but not in the 76-90 year old group. Significant differences in performance among age groups remained. These results cannot be fully explained by differences in working memory capacity. It is suggested that flexibility of functioning also plays a role.

Prediction of performance from motivation and ability information in Burkina Faso adolescent

Many studies, using information integration theory, have been devoted to the prediction of performance on the basis of ability and motivation information. However, it appears that only two societies. American and East Indian, have been examined with regard to their prevalent performance prediction model. Participants in this study were school children in Burkina Faso, West Africa. Considerable differences between individuals were expected because, as a consequence of colonization, Burkina Faso has been torn between two different value systems: a collectivistic system, with traditional tribal Burkinabè values, and an individualistic system, with occidental values. The study's most notable finding was the coexistence of these two value systems within the same society. The predominant logic of Western societies, that increased motivation will result in increased rewards when initial ability is high, was utilized by 42% of the children; in contrast, 38% of the children applied the dominant logic expressed by East Indian researchers, who have found that regardless of the level of ability, any amount of motivation will result in an identical improvement in performance.

Perception of the combined effect of smoking and alcohol on health

Because smoking is significantly associated with drinking, the consumption of alcohol can be associated with indirect consumption of tobacco (passive smoking), and alcohol and tobacco can have synergetic effects, the ways people perceive their combined effects were investigated. Information integration theory was applied, and the results showed that rather than representing the combined effects of tobacco consumption and alcohol consumption in a synergetic or summative way, the sample of 40 French adults apparently considered that indulging in only one of these two behaviors results almost unilaterally in maximal alteration of health. The two effects were seen to combine disjunctively, a way of perceiving the combined effects of the two substances that runs counter to current medical data on the subject.

Societal risk perception and media coverage

The study compares societal risk ratings by inhabitants of two countries which differ markedly in terms of geography, economics, politics, and ethnic background, but which are similar as regards media coverage. The two populations were represented by a sample of French students and a sample of Burkina Faso intellectuals. The overall Burkinabè mean ratings appeared much closer to the mean observed in France (and in the United States-roughly 40 out of 100) than the means reported for other countries like Norway or Hungary. The correlation between Burkinabè and French ratings was very high: .852. The findings argue in favor of a practically totally determinant effect of the media in risk perception.

Understanding the combination of memory variables: a re-examination

This study was a direct prolongation of a study by Wellman, Collins, and Glieberman (1981), which showed that, provided a sufficiently sensitive methodology is used, it is possible to demonstrate experimentally that even 5-year-old children are capable of integrating two types of information--effort and difficulty of task--in their judgment of performance (number of items recalled). We prolonged this study by adopting Anderson's information integration methodology in order to provide evidence concerning the type of combinatorial rule describing subjects' use of both pieces of information and to refine analysis to the individual level. In terms of group results, it was possible to describe the algebraic aspects of the information integration process by an additive model in children and adolescents, and by a multiplicative model in adults. Conclusions changed considerably, however, when individual results were studied. In the 5- and 8-year-old children, the dominant rule was clearly unifactorial, involving effort. Only in the adult group was true integration seen in all subjects.

The height + width = area of a rectangle rule in five-year-olds: effects of stimulus distribution and graduation of the response scale

This study attempts to account for disparities between the Anderson and Cuneo (1978), Leon (1982), and Lautrey, Mullet, and Paques (1989) studies in regard to children's area judgment. Two task variables were manipulated: stimulus distribution (biased/unbiased) and the type of response scale (graduated/ungraduated). Three age groups (5, 6, and 7 year olds) were tested. The mean integration pattern for 5-year-olds presented a negatively biased stimulus distribution, and an ungraduated response scale was highly convergent and suggested the use of a centration rule (replication of the Lautrey et al. results). When 5-year-olds were presented with an unbiased stimulus distribution and a graduated scale, the integration pattern was only slightly convergent (as in Leon). The effects of two factors (age and graduation) were significant and combined additively: The older the child, the more graduated the response scale and the more the integration pattern tended to form three ascending parallel lines (the Anderson & Cuneo results).

Information integration in an area judgment task: effect of aids on children's perceptual judgments

This study was designed to examine the cognitive processes involved in perceptual judgments of area with the methodology and concepts of Anderson's (1981) information integration theory. The Area = Height + Width rule, which Anderson and Cuneo (1978) showed to be operant in children's judgments, can in fact cover two different processes. Children may make a height judgment and then a length judgment and apply an additive integration operation to both. Alternatively, children may base themselves on the figure outline and estimate total length directly as a function of the distance scanned. Similarly, the multiplicatory integration pattern can result either from applying a multiplicatory operation to separate estimates or from visual exploration of the area bounded by the figure. In the present experiment, the characteristics of the areas of the test figures were modified (perimeter marking, rows of Xs covering the area, etc.) to elicit additive or multiplicatory integration patterns as a function of condition. The findings demonstrate that the second interpretation of both rules is more likely.

Judgments of quantity and conservation of quantity: the area of a rectangle

This study examines the relationships between perceptive judgment of quantity and conservation judgment of quantity with regard to the concept of area. Twenty children who passed an area conservation task (mean age = 8) and 20 children who failed it (mean age = 6, 7) were administered an area judgment task. This task was a replication of Anderson and Cuneo's study (1978, Journal of Experimental Psychology: General, 107, 335-378). The conserving children generally appeared to apply an additive rule (the height and width rule) observed by Anderson and Cuneo in 5 year olds. The nonconserving children in contrast generally presented patterns suggesting centration on one of the two dimensions. The implications for Anderson's and Piaget's conceptions of conservation development are discussed.