Adolescent Hazardous Drinking and Socioeconomic Status in France: Insights Into the Alcohol Harm Paradox

PURPOSE

The "alcohol harm paradox" has been evidenced among adults, but it is still largely unexplored among adolescents. We examined in a sample of French adolescents the relation between family socioeconomic status (SES), family living arrangement and parental substance use on 1 hand, and heavy episodic drinking (HED), lifetime alcohol-induced emergency room visits (A-ERV), and number of alcoholic drinks and solitary drinking during the last episode on the other hand.

METHODS

A cross-sectional nationwide survey in March 2017 involved 13,314 French adolescents aged 17-18.5 years. They completed a pen and paper questionnaire about their own and their parents' alcohol and tobacco consumption. We used risk ratios (RRs) from modified Poisson regressions to assess the relationships.

RESULTS

Adolescents from the lowest SES had reduced likelihood of reporting 1-2 or 3-5 episodes of heavy drinking compared to those from the highest SES (RR = 0.58, 95% confidence interval = [0.50; 0.66] and 0.35 [0.27; 0.45]), but no difference for six or more episodes (RR = 0.81 [0.59; 1.12]). A-ERV was more frequent among lowest SES adolescents (RR = 1.86 [1.05; 3.30]), possibly due to drinking larger quantities of alcohol and to more frequent solitary drinking in their last episode (p < .001). SES, parental substance use, and family living arrangement were independently associated with HED.

DISCUSSION

Our findings reveal an "alcohol harm paradox" in late adolescence in France. Lower SES adolescents exhibit reduced HED but were more likely to consume large quantities alone and experience A-ERV. This emphasizes the significance of considering social determinants in alcohol-related research and interventions.

Country and sex measurement invariance of the Cannabis abuse screening test (CAST) in European Youth

BACKGROUND

Monitoring the prevalence of problematic cannabis use is an important public health issue. International surveys need invariant measurement tools to allow reliable comparisons across countries and between sexes. The Cannabis abuse screening test (CAST) has been developed for this purpose. This study is the first assessing its country and sex invariance in a sample of European pupils.

METHODS

The data come from the self-administered questionnaires completed in 2019 by pupils aged 15-16 in the European school survey project (Espad). The analytical sample was restricted to the 17 countries where at least 300 pupils reported a previous-year cannabis use (n = 8740); multigroup confirmatory factor analyses were used to assess the configural, metric and scalar invariance of the CAST toward country and sex in the 2019 Espad release.

RESULTS

Configural, metric and scalar invariance toward country hold for the 17 countries: Austria, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Greece, Italia, Latvia, Poland, Portugal, Slovakia, Slovenia and Spain. Scalar invariance toward sex was met in the 17 countries as a whole and in 11 of the 12 countries where the test could be run. Scalar invariance toward country was met with 6 additional countries comprising at least 250 respondents: Ireland, Lithuania, Malta, Montenegro, the Netherlands and Norway.

CONCLUSION

The CAST is a suitable test for comparing the measurement of problematic cannabis use amongst adolescents in Europe.

Systematic Review and Critical Analysis of Longitudinal Studies Assessing Effect of E-Cigarettes on Cigarette Initiation among Adolescent Never-Smokers

Prospective longitudinal studies mainly conclude on a causal role of e-cigarettes in the initiation of cigarettes in flagrant contradiction with conclusions drawn from epidemiology and other studies showing a sharp decline in cigarette use in parallel with the spread of e-cigarette use. This systematic review explores the reasons for this discrepancy.

METHODS

Among 84 publications on e-cigarette/cigarette association in adolescents identified in the Medline database from 2011 to 2022, 23 concern 22 never-smoker longitudinal sub-cohorts.

RESULTS

A link between e-cigarette experimentation at T1 and cigarette initiation at T2 is reported in sub-cohort analyses of never-smokers (AOR: 1.41 to 8.30). However, studies exclude 64.3% of T1 e-cigarette experimenters (because of dual-use) and 74.1% of T2 cigarette experimenters. With this study design, e-cigarettes contribute only to 5.3% of T2 cigarette experimentation, casting major doubt on the external validity of results and authors' conclusions that e-cigarettes have a significant effect on the initiation of cigarettes (Gateway effect) at the population level. This sub-cohort design prohibits highlighting any Diversion effect, which is the most likely mechanism accounting for the competition between these two products.

CONCLUSIONS

While nicotine abstinence remains the best medical option, over-regulation of e-cigarettes because of misinterpretation of longitudinal study results may be detrimental to public health and tobacco control.

Comparison of Depression and Anxiety Following Self-reported COVID-19-Like Symptoms vs SARS-CoV-2 Seropositivity in France

Importance

The long-term consequences of COVID-19 on mental health are a critical issue given the number of people infected with SARS-CoV-2 worldwide since the beginning of the pandemic.

Objective

To investigate the associations between self-reported COVID-19-like symptoms or SARS-CoV-2 seropositivity and subsequent depression or anxiety.

Design, Setting, and Participants

This propensity score-matched cohort study began in May 2020, with follow-ups in November 2020 and July 2021. The study used data from a large, randomly selected, national population-based cohort from France, the EpiCoV (Epidémiologie et Conditions de Vie) study. Of 85 074 individuals 15 years or older who completed the questionnaires at the 3 collection times, 28 568 were excluded because they did not return a blood sample for serologic testing, 1994 because of missing data on outcomes or exposures, and 9252 to respect the temporal sequence (exposure must precede the outcome).

Exposures

Propensity scores based on various socioeconomic, lifestyle, and health variables were computed to match participants who experienced COVID-19-like symptoms between February and November 2020 or showed SARS-CoV-2 seropositivity in November 2020.

Main Outcomes and Measures

Logistic regression models were used to estimate associations between these occurrences and depression or anxiety assessed in July 2021 using the Patient Health Questionnaire 9-item and Generalized Anxiety Disorder 7-item scales, respectively.

Results

Among the 45 260 included participants (mean [SD] age, 51.1 [18.9] years; 52.4% women; 8.0% with depression and 5.3% with anxiety in July 2021), COVID-19-like symptoms were associated with subsequent depression (adjusted odds ratio, 1.70; 95% CI, 1.45-1.99) and anxiety (adjusted OR, 1.57; 95% CI, 1.29-1.92), whereas SARS-CoV-2 seropositivity was not. Furthermore, COVID-19-like symptoms, but not anosmia or dysgeusia alone, were associated with subsequent depression and anxiety in both the seropositive and seronegative subgroups.

Conclusions and Relevance

In this cohort study of more than 45 000 individuals drawn from the French general population, SARS-CoV-2 infection was not found as a risk factor of subsequent depression or anxiety. Moreover, self-reported COVID-19-like symptoms were associated with depression and anxiety assessed at least 8 months later in both seropositive and seronegative subgroups, suggesting that factors other than SARS-CoV-2 infection are implied in this association.

Suicidal ideation following self-reported COVID-19-like symptoms or serology-confirmed SARS-CoV-2 infection in France: A propensity score weighted analysis from a cohort study

BACKGROUND

A higher risk of suicidal ideation associated with self-report of Coronavirus Disease 2019 (COVID-19)-like symptoms or COVID-19 infection has been observed in cross-sectional studies, but evidence from longitudinal studies remains limited. The aims of this study were 2-fold: (1) to explore if self-reported COVID-19-like symptoms in 2020 were associated with suicidal ideation in 2021; (2) to explore if the association also existed when using a biological marker of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in 2020.

METHODS AND FINDINGS

A total of 52,050 participants from the French EpiCov cohort were included (median follow-up time = 13.7 months). In terms of demographics, 53.84% were women, 60.92% were over 45 years old, 82.01% were born in mainland France from parents born in mainland France, and 59.38% completed high school. COVID-19-like symptoms were defined as participant report of a sudden loss of taste/smell or fever alongside cough, shortness of breath, or chest oppression, between February and November 2020. Symptoms were self-reported at baseline in May 2020 and at the first follow-up in Autumn 2020. Serology-confirmed SARS-CoV-2 infection in 2020 was derived from Spike protein ELISA test screening in dried-blood-spot samples. Samples were collected from October 2020 to March 2021, with 94.4% collected in 2020. Suicidal ideation since December 2020 was self-reported at the second follow-up in Summer 2021. Associations of self-reported COVID-19-like symptoms and serology-confirmed SARS-CoV-2 infection in 2020 with suicidal ideation in 2021 were ascertained using modified Poisson regression models, weighted by inverse probability weights computed from propensity scores. Among the 52,050 participants, 1.68% [1.54% to 1.82%] reported suicidal ideation in 2021, 9.57% [9.24% to 9.90%] had a serology-confirmed SARS-CoV-2 infection in 2020, and 13.23% [12.86% to 13.61%] reported COVID-19-like symptoms in 2020. Self-reported COVID-19-like symptoms in 2020 were associated with higher risks of later suicidal ideation in 2021 (Relative Riskipw [95% CI] = 1.43 [1.20 to 1.69]), while serology-confirmed SARS-CoV-2 infection in 2020 was not (RRipw = 0.89 [0.70 to 1.13]). Limitations of this study include the use of a single question to assess suicidal ideation, the use of self-reported history of mental health disorders, and limited generalizability due to attrition bias.

CONCLUSIONS

Self-reported COVID-19-like symptoms in 2020, but not serology-confirmed SARS-CoV-2 infection in 2020, were associated with a higher risk of subsequent suicidal ideation in 2021. The exact role of SARS-CoV-2 infection with respect to suicide risk has yet to be clarified. Including mental health resources in COVID-19-related settings could encourage symptomatic individuals to care for their mental health and limit suicidal ideation to emerge or worsen.

Roles of parental smoking and family structure for the explanation of socio-economic inequalities in adolescent smoking

BACKGROUND AND AIMS

Among European countries, France is particularly concerned by adolescent tobacco smoking, especially in disadvantaged socio-economic backgrounds (SES). We measured the respective contributions of parental smoking and family living arrangement to social disparities in smoking during adolescence.

DESIGN

Secondary analysis of survey data.

SETTING

A cross-sectional nation-wide exhaustive 12-day survey in March 2017 of French youth aged 17-18.5 years participating in the national mandatory civic information day.

PARTICIPANTS

A total of 13 314 adolescents answering a pen-and-paper questionnaire about their own tobacco consumption and the smoking of their parents.

MEASUREMENTS

Risk ratios (RRs) were computed using modified Poisson regressions, and population-attributable fraction (PAF) was used as a measure of the explanatory roles of the different factors as mediators of SES.

FINDINGS

Adolescents living within very privileged and privileged SES were significantly less likely to report daily tobacco smoking (20.4 and 22.7%, respectively) than those within modest and disadvantaged ones (26.0 and 28.6%, respectively). Parental smoking and family living arrangement independently explained the smoking inequalities among adolescents. After adjusting for schooling factors, the risks associated with parental smoking ranged between RR = 1.64 [95% confidence interval (CI) = 1.50-1.79] when the father only smoked and RR = 2.17 (95% CI = 1.99-2.36) when both parents smoked, compared with non-smoking parents; the risk associated with living in a non-intact family was 1.35 (95% CI = 1.26-1.43) and that of living outside the parental home was 1.20 (95% CI = 1.10-1.30). Apprentices and adolescents out of school had higher risks than those at school (RR = 1.82, 95% CI = 1.68-1.98) and RR = 2.10, 95% CI = 1.92-2.29). The contribution of parental smoking to adolescent smoking (PAF = 32%) was greater than that of SES (PAF = 9%), family living arrangement (PAF = 17%) or schooling factors (14%). The share of SES decreased from 18 to 9% when considering these mediating factors.

CONCLUSION

In France, parental smoking appears to be the factor that most influences adolescent smoking, followed by family living arrangement; the role of family socio-economic status is small in comparison.

Moving towards a single-frame cell phone design in random digit dialing surveys: considerations from a French general population health survey

Background

Over the last two decades, telephone surveys based on random digit dialing have developed considerably. At the same time, however, the proportion of the population with a cell phone has increased, whereas landline frame coverage has declined, thus raising the possibility of discontinuing landline phone surveys. This paper aims to assess the impact of using a single-frame (SF) cell phone design instead of a dual-frame (DF) design with landlines and cell phones in the context of repeated health surveillance surveys in the general population. We analyze data from a random digit dialing health survey of the French population and assess differences between the DF and the counterfactual SF design that excludes the landline phone sample from the DF design. We evaluate the quality of the two survey designs in terms of survey productivity, response rates, representativeness, balancing of external covariates, and prevalence estimates of key health behavior indicators.

Results

Our results show that a SF cell phone survey has several advantages over a combined DF landline and cell phone survey. Cell numbers require fewer call attempts to complete an interview, leading to a substantial reduction in the mean data collection duration and weight dispersion. The global representativeness of the SF design was slightly better than its DF counterpart, although the elderly were underrepresented. After calibration, differences in health behavior estimates were small for the seven health indicators analyzed.

Conclusions

Switching from a DF random telephone survey to a SF cell phone design has a number of practical advantages and would have a minimal impact on general population health surveys for monitoring health behavior at the population level. However, the different aspects of the survey quality had to be studied to make a decision. Further studies are needed to explore the scope of possibilities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-022-01573-1.

Alcohol and Tobacco Use After One Month of Containment Measures for the COVID-19 Sanitary Crisis in France

OBJECTIVE

The measures put in place to contain the coronavirus epidemic in France have led to fears of a massive increase in the consumption of alcohol, tobacco, and other drugs.

METHOD

Taking advantage of an ongoing weekly Internet survey monitoring living conditions of the French population during the containment, we introduced questions on alcohol and tobacco use 1 month after the start of the first containment. Analyses were conducted with multivariate Poisson regressions.

RESULTS

Tobacco consumption remained almost unchanged. By contrast, more than a third of French people did change their weekly alcohol intake: 13% increased it, whereas 21% decreased it, indicating that the containment measures were often taken as an opportunity to reduce alcohol consumption, especially among those who drank less than 4 days per week before. Men were more likely to decrease their alcohol intake and less likely to increase it than women, probably because of a differential impact of the reduction of social activities on gendered social roles. The people most affected were smokers and those living in a dwelling in which someone had been infected, including themselves.

CONCLUSIONS

The crisis tended to polarize alcohol consumption toward extremes. If the new drinking habits were to continue, the consequences could be beneficial for occasional drinkers but harmful for heavier drinkers.

Increasing socioeconomic disparities in tobacco smoking decline among French adolescents (2000-2017)

BACKGROUND

This paper studies the evolution of transitions from first cigarette use to daily use by socioeconomic status (SES) among French adolescents over the course of 17 years, in a context of decreasing prevalence of tobacco use.

METHODS

A total of 182 266 adolescents participated in the nationally representative ESCAPAD survey at nine different time points between 2000 and 2017. Discrete time-event analysis was used to model the transition to daily cigarette use as a function of SES, gender, age at onset and the use of other psychoactive substances.

RESULTS

Although lifetime cigarette smoking and daily cigarette smoking decreased significantly over the studied time span, suggesting a positive impact of prevention policies, disadvantaged adolescents were consistently more prone to engage in daily cigarette smoking, more so in 2017 than 15 years earlier. In the same time span, transitions from initiation to daily cigarette smoking have shortened, with an accelerated pace among underprivileged adolescents.

CONCLUSIONS

Accelerated transitions from initiation to daily cigarette use are a prevalent trend among disadvantaged adolescents in France. Efforts to mitigate the impact of marketing strategies and to promote health literacy should be pursued to reduce social inequalities in health.

Experimenting first with e-cigarettes versus first with cigarettes and transition to daily cigarette use among adolescents: the crucial effect of age at first experiment

BACKGROUND AND AIMS

Most studies in English-speaking countries have found a positive association between e-cigarette experimentation and subsequent daily tobacco smoking among adolescents. However, this result may not be valid in other cultural contexts; in addition, few studies have assessed whether this association varies with the subject' age at the time of e-cigarette experimentation. This study aimed to estimate the association between experimenting first with e-cigarette (rather than tobacco) and subsequent daily smoking according to age at the time of experimentation.

DESIGN

Secondary analysis; risk ratios (RRs) computed using modified Poisson regressions with inverse probability weighting.

SETTING

A cross-sectional nation-wide representative survey performed in 2017 in France.

PARTICIPANTS

French adolescents (n = 24 111), aged 17 to 18.5 years, who had previously experimented with either e-cigarettes or tobacco.

MEASURES

Exposure was defined as the experimentation with e-cigarettes first (whether or not followed by experimentation with tobacco); the outcome as daily tobacco smoking at the time of data collection. Gender, age, literacy, socio-economic status, pre-exposure repeat school years and experimentation with drunkeness, 3 licit and 8 illicit drugs were adjusted for. Uncertainties about the sequence of events defining exposure were handled by the definition of three patterns of exposure, to avoid a misclassification bias.

FINDINGS

Exposure reduced the risk of transition to daily smoking: RR = 0.58, 95% confidence interval (CI) = 0.54, 0.62. This effect increased in a linear manner with age at exposure (RR = 0.87, 95% CI = 0.78; 0.98 for 1 year, P < 0.001): from RR = 1.30, 95% CI = 1.09; 1.54 at age 9 to RR = 0.38, 95% CI = 0.32; 0.45 at age 17.

CONCLUSIONS

Experimenting with e-cigarettes first (as opposed to tobacco first) appears to be associated with a reduction in the risk of daily tobacco smoking among French adolescents aged 17-18.5, but this risk varies negatively with age at experimentation, and early e-cigarette experimenters are at higher risk.

Attitudes about COVID-19 Lockdown among General Population, France, March 2020

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

Migration-related changes in smoking among non-Western immigrants in France

Background

Migrants make up a growing share of European populations, and very little is known about the impact of migration on their smoking patterns. We develop a longitudinal analysis of smoking prevalence among native-born and immigrants in France based on retrospective data collected in the 2010 national Baromètre santé health survey.

Methods

Analyses concerned 19 578 individuals aged 18–70 years and born in metropolitan France, in the Maghreb or in sub-Saharan Africa. Person-years with and without smoking were reconstructed using migration and smoking histories and analyzed with discrete-time regression models.

Results

Prior to migration, immigrants from both the Maghreb and sub-Saharan Africa had lower smoking prevalence than the native-born of similar birth cohort, age and education. After migration, the prevalence increased over time among Maghrebin men up to levels beyond those of the native-born (odds ratio: 1.54 [1.09–2.17] for 10 years of residence or more), while it remained much lower throughout among men from sub-Saharan Africa (odds ratio: 0.36 [0.19–0.68] for 10 years of residence or more). Starting at extremely low levels, the prevalence in both groups of women rose considerably after migration. Women from sub-Saharan Africa nearly caught up to the native-born (odds ratio: 0.70 [0.37–1.32] for 10 years of residence or more), but this was not the case for those from the Maghreb (odds ratio: 0.52 [0.33–0.81] for 10 years of residence or more).

Conclusion

The findings uncover the low pre-migration prevalence and the diversity of post-migration trajectories. Tobacco control programs targeting recently arrived migrants would contribute to prevent unhealthy assimilation.

Use of tobacco, alcohol and cannabis in late adolescence: roles of family living arrangement and socioeconomic group

BACKGROUND

France has one of the highest levels in Europe for early use of legal and illegal psychoactive substances. We investigate in this country disparities in adolescent problematic substance use by family living arrangement and parental socioeconomic group.

METHODS

The data used were from the 2017 nationally-representative ESCAPAD survey, conducted among 17-year-olds in metropolitan France (N = 39,115 with 97% response rate). Prevalence ratios (PR) were estimated using modified Poisson regression.

RESULTS

Adolescents living in non-intact families (44%) reported daily smoking, binge drinking and regular cannabis use (respectively ≥3 episodes and ≥ 10 uses in the last 30 days) much more frequently than those living in intact families (for example, the PR estimates for father single parent families were respectively 1.69 (1.55-1.84), 1.29 (1.14-1.45) and 2.31 (1.95-2.74)). Socioeconomic differences across types of families did little to explain the differential use. Distinctive socioeconomic patterns were found: a classical gradient for smoking (PR = 1.34 (1.22-1.47) for the most disadvantaged group relative to the most privileged); an inverse association for binge drinking (PR = 0.72 (0.64-0.81) for the most disadvantaged relative to the most privileged), and no significant variation for cannabis use.

CONCLUSION

Our findings shed light on the consistency of the excess use of adolescents from non-intact families and on the substance-specific nature of the association with parental socioeconomic group. Preventive approaches at the population level should be complemented by more targeted strategies.

Why do apprentices smoke much more than high school students? Understanding educational disparities in smoking with a Oaxaca-blinder decomposition analysis

Background

Educational disparities in daily smoking begin during adolescence and can lead to educational disparities in health among adults. In particular, vocational students including apprentices have higher daily smoking rates compared to non-vocational students. This study aimed to identify the determinants of the gap in daily smoking between French apprentices and high school students aged 17 in 2008 and in 2017.

Methods

We used data from a cross-sectional repeated survey representative of all French adolescents aged 17 in 2008 and 2017. We conducted a non-linear extension of the Oaxaca-Blinder decomposition technique and included the following variables: sociodemographic and familial characteristics, parental smoking, cannabis and alcohol use, suicidal attempt, grade repetition and money received.

Results

Daily smoking was about two times higher among French apprentices compared to high school students in 2008. This gap did not decrease between 2008 and 2017. Differences in measured characteristics between the two groups explained this gap partly, from 28.6 to 51.2%. Cannabis and alcohol use, money received and parental smoking contributed the most to the daily smoking gap.

Conclusions

Prevention programs could target cannabis and alcohol use as well as parental smoking to help decrease educational disparities in smoking status among French adolescents.

Does e-cigarette experimentation increase the transition to daily smoking among young ever-smokers in France?

INTRODUCTION

According to multiple studies, e-cigarette use among adolescents is associated with subsequent smoking initiation. However, little is known about its effect on the transition from smoking initiation to daily smoking.

METHODS

Using retrospective data from a French national representative survey collected in 2017 (n = 39,115), we analyzed the role of ever using e-cigarettes on daily cigarette smoking status at 17 among ever smokers (n = 21,401). Risk-ratios (RR) were computed through modified Poisson regressions with an inverse probability of treatment weighting (IPTW) approach.

RESULTS

Among French adolescents aged 17, 16.8 % declared current e-cigarette use (1.9 % reported daily use) and 34.1 % cigarette smoking (25.1 % reported daily smoking). Among ever-smokers, adolescents who declared having ever used e-cigarettes were less likely than those who did not to transition to daily smoking at 17: RR = 0.62 95 %CI [0.60 - 0.64]. We found similar results for those who experimented with e-cigarettes before initiating smoking, RR = 0.76 95 %CI [0.66 - 0.89].

CONCLUSIONS

Our results found no evidence of an increased risk of transitioning to daily smoking at 17 among ever-smokers who also experimented with e-cigarettes. Further studies should investigate the longer-term role of vaping on future smoking habits with the use of causal inference methods.

Association between cumulating substances use and cumulating several school, violence and mental health difficulties in early adolescents

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

Smoking Among Immigrant Groups in the United States: Prevalence, Education Gradients, and Male-to-Female Ratios

Introduction

Immigrants in the United States are less likely to smoke than those born in the United States, but studies have not fully described the diversity of their smoking patterns. We investigate smoking by world region of birth and duration of residence in the United States, with a comprehensive approach covering current prevalence levels, education gradients, and male-to-female ratios.

Methods

The data originate from the National Health Interview Surveys, 2000–2015, and the sample of 365 404 includes both US-born and foreign-born respondents aged 25–70 years. World region of birth and duration of residence in the United States measure immigrant characteristics. Current cigarette smoking was analyzed using logistic regression.

Results

Immigrant groups were protected from smoking and had weaker education gradients in smoking and larger male-to-female smoking ratios than the US-born population. However, large differences emerged among the immigrant groups for region of birth but less so for duration of residence in the United States. For example, immigrants from sub-Saharan Africa and the Indian subcontinent have low prevalence, weak education gradients, and high male-to-female ratios. Immigrants from Europe have the opposite pattern, and immigrants from Latin America fall between those two extremes.

Conclusion

The stage of the cigarette epidemic in the region of birth helps explain the diverse group profiles. Duration of residence in the United States does less to account for the differences in smoking than region of birth. The findings illustrate the heterogeneity of immigrant populations originating from diverse regions across the world and limited convergence with the host population after immigration.

Implications

The study identifies immigrant groups that, because of high smoking prevalence related to levels in the host country, should be targeted for cessation efforts. It also identifies immigrant groups with low prevalence for which anti-smoking programs should encourage maintenance of healthy habits. Many immigrant groups show strong education disparities in smoking, further suggesting that smokers with lower levels of education be targeted by public health programs.

Alcohol and cancer: risk perception and risk denial beliefs among the French general population

Background

Worldwide, millions of deaths each year are attributed to alcohol. We sought to examine French people's beliefs about the risks of alcohol, their correlates, and their associations with alcohol use.

Methods

Data came from the 2010 Baromètre Cancer survey, a random cross-sectional telephone survey of the French general population (n = 3359 individuals aged 15-75 years). Using principal component analysis of seven beliefs about alcohol risks, we built two scores (one assessing risk denial based on self-confidence and the other risk relativization). Two multiple linear regressions explored these scores' socio-demographic and perceived information level correlates. Multiple logistic regressions tested the associations of these scores with daily drinking and with heavy episodic drinking (HED).

Results

About 60% of the respondents acknowledged that alcohol increases the risk of cancer, and 89% felt well-informed about the risks of alcohol. Beliefs that may promote risk denial were frequent (e.g. 72% agreed that soda and hamburgers are as bad as alcohol for your health). Both risk denial and risk relativization scores were higher among men, older respondents and those of low socioeconomic status. The probability of daily drinking increased with the risk relativization score and that of HED with both scores.

Conclusions

Beliefs that can help people to deny the cancer risks due to alcohol use are common in France and may exist in many other countries where alcoholic beverages have been an integral part of the culture. These results can be used to redesign public information campaigns about the risks of alcohol.

The Cannabis Abuse Screening Test and the DSM-5 in the general population: Optimal thresholds and underlying common structure using multiple factor analysis

The Cannabis Abuse Screening Test (CAST) aims at screening the problematic use of cannabis. It has never been validated against the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 and its relationships with this latter have never been studied. We used a probabilistic telephone survey collected in 2014 (1351 past-year cannabis users aged 15-64) implementing the CAST and a DSM-5 adaptation of the Munich Composite International Diagnostic Interview assessing cannabis use disorders. Data were weighted, and CAST items were considered categorical. Factorial structures were assessed with confirmatory factor analyses; the relationships between the instruments were studied with multiple factor analysis (MFA). One factor for the DSM-5 and two correlated factors for the CAST were the best confirmatory factor analyses solutions. The CAST thresholds for screening moderate/severe and severe cannabis use disorders were 5 (sensitivity = 78.2% and specificity = 79.6%) and 8 (sensitivity = 86.0% and specificity = 86.7%), respectively. The MFA identified two orthogonal dimensions: The first was equally shared by both instruments; the second was the second CAST dimension (extreme frequencies of use before midday and alone, memory problems, and reproaches from friends/family). The CAST structure and screening properties were confirmed. The MFA explains its screening performances by its first dimension and identified the problematic patterns (the second dimension) that are not captured by the DSM-5.

Smoking among immigrant groups in metropolitan France: prevalence levels, male-to-female ratios and educational gradients

Background

Although the French population comprises large and diverse immigrant groups, there is little research on smoking disparities by geographical origin. The aim of this study is to investigate in this country smoking among immigrants born in either north Africa, sub-Saharan Africa or French overseas départements.

Methods

The data originate from the 2010 Health Barometer survey representative of metropolitan France. The subsample of 20,211 individuals aged 18–70 years (born either in metropolitan France or in the above-mentioned geographical regions) was analysed using logistic regression.

Results

Both immigrants from sub-Saharan Africa and immigrants from overseas départements were protected from smoking compared to the reference population, and the former had a distinctive strongly reversed educational gradient in both genders. Returned former settlers from the French colonies in North Africa (repatriates) had the highest smoking levels. Natives from the Maghreb (Maghrebins) showed considerable gender discordance, with men having both a higher prevalence (borderline significance) and a reversed gradient and women having lower prevalence than the reference population.

Conclusion

Immigrants from regions of the world in stage 1 of the cigarette epidemic had relatively low smoking levels and those from regions in stage 2 had relatively high smoking levels. Some groups had a profile characteristic of late phases of the cigarette epidemic, and others, some of which long-standing residents, seemed to be positioned at its early stages. The situation for Maghrebins reflected the enduring influence of gendered norms post-migration. Based on their educational gradients, immigrants from overseas départements (particularly men) and Maghrebin women may be at risk of losing their particularly low prevalence. Immigrants from sub-Saharan Africa could retain it. In-depth analysis of smoking profiles of immigrants’ groups is essential for a better targeting of smoking prevention and cessation programs.

Age Invariance of the Cannabis Abuse Screening Test in a Probabilistic Sample of Cannabis Users

The Cannabis abuse screening test (CAST) is a short test used for screening those with problematic cannabis use. Recently, its invariance toward age was tested in an Israeli sample of cannabis users, but this study had some sample and methodological limitations: it was conducted in a volunteer sample aged 18-40 and considered the CAST items as continuous variables, although they are based on 5-point Likert scales. We thus tested the CAST invariance toward age (15-24, 25-34, and 35-64 years old) using a French probabilistic sample of 1,351 past-year cannabis users aged 15-64 and using appropriate methods for categorical items and survey weights. Factors retained (non-recreational use and problems) were the same as those mentioned in previous studies. Scalar invariance held for the "problems" factor but only partial scalar invariance was supported for the "non-recreational use" factor. Caution is thus needed when the CAST score is compared across age groups.

Changes in Smoking Behavior over Family Transitions: Evidence for Anticipation and Adaptation Effects

The study of changes in smoking behaviors over the life course is a promising line of research. This paper aims to analyze the temporal relation between family transitions (partnership formation, first childbirth, separation) and changes in smoking initiation and cessation. We propose a discrete-time logistic model to explore the timing of changes in terms of leads and lags effects up to three years around the event in order to measure both anticipation and adaptation mechanisms. Retrospective biographical data from the Santé et Itinéraires Professionnels (SIP) survey conducted in France in 2006 are used. Partnership formation was followed for both genders by a fall in smoking initiation and an immediate rise in smoking cessation. Childbirth was associated with increased smoking cessation immediately around childbirth, and additionally, females showed an anticipatory increase in smoking cessation up to two years before childbirth. Couple separation was accompanied by an anticipatory increase in smoking initiation for females up to two years prior to the separation, but this effect only occurred in males during separation. Our findings highlight opportunities for more targeted interventions over the life course to reduce smoking, and therefore have relevance for general practitioners and public policy elaboration.

Assessing the structure of the CAST (Cannabis Abuse Screening Test) in 13 European countries using multigroup analyses

Our aims are to describe and explain the structure of the Cannabis Abuse Screening Test (CAST) across countries. Standard statistical analyses fail to describe and explain several variables simultaneously while taking account of the group structure of individuals. The 2011 European School Survey Project on Alcohol and other Drugs (ESPAD): 5204 last-year cannabis users aged 15-16 from 13 European countries. Multigroup principal component analysis (mgPCA) and multigroup partial least squares (mgPLS). MgPCA shows that the CAST has a two-dimensional structure (frequency of use/problems and non-recreational use/dependency symptoms). All the countries present a good concordance with the common structure, except Kosovo, Lichtenstein and Romania. MgPLS shows that three explanative variables (in a total of eight) are mainly related with the CAST (the frequencies of cannabis use in the last 12 months and in the last 30 days and the age at first cannabis use) while Kosovo, Lichtenstein and Romania also present specificities. The CAST structure appears stable in the 13 countries except for Kosovo, Lichtenstein and Romania that also show specific relationships between the CAST variables and their determinants.

Life Course Changes in Smoking by Gender and Education: A Cohort Comparison Across France and the United States

Widening of educational disparities and a narrowing female advantage in mortality stem in good part from disparities in smoking. The changes in smoking and mortality disparities across cohorts and countries have been explained by an epidemic model of cigarette use but are also related to life course changes. To better describe and understand changing disparities over the life course, we compare age patterns of smoking in three cohorts and two nations (France and the United States) using smoking history measures from the 2010 French Health Barometer (N = 20,940) and the 2010 U.S. National Health Interview Survey Sample Adult File (N = 20,444). The results demonstrate statistically significant widening of gender and educational differences from adolescence to early and middle adulthood, thus accentuating the disparities already emerging during adolescence. In addition, the widening disparities over the life course have been changing across cohorts: Age differences in educational disparities have grown in recent cohorts (especially in France), while age differences in gender disparities have narrowed. The findings highlight the multiple sources of inequality in smoking and health in high-income nations.

From cannabis initiation to daily use: educational inequalities in consumption behaviours over three generations in France

AIMS

The diffusion of cannabis initiation has been accompanied by a reversal in the educational gradient: contrary to older generations, the less educated in recent generations are more likely to initiate than the more educated. We tested whether the educational gradient for the transition from initiation to daily use evolved in the same way.

DESIGN/SETTING

A French telephone random survey conducted in 2010 (21 818 respondents aged 15-64 years), asking interviewees about their ages at initiation to daily use, if any.

PARTICIPANTS

A total of 6824 cannabis initiators aged 18-64 years at data collection. Three birth cohort groups (generations) were compared: 1946-60 (n = 767), 1961-75 (n = 2632) and 1976-92 (n = 3425) with, respectively, 47, 42 and 45% of women.

MEASURES

Risks of transition to daily use from ages 11-34 were compared through time-discrete logistic regressions and educational gradients were quantified through a relative index of inequality (RII). Control variables include age and time-varying variables (ages at tobacco daily use, at first drunkenness and at first other use of an illicit drug in a list of 13 products).

FINDINGS

Twenty-four per cent of the initiators reported daily use before age 35, the proportions tripling from the oldest to the youngest generation (from 11.7 to 38.6% in men, from 7.7 to 22.2% in women). Whatever the generation, the less educated initiators more often shifted to daily use than the most educated: from the oldest to the youngest generation, RII = 2.13, 95% confidence interval (CI) = [0.65, 7.02]; 2.19 95% CI = [1.33, 3.63]; and 2.24, 95% CI = [1.60, 3.15] in men; RII = 3.31, 95% CI = [0.75, 14.68]; 3.17, 95% CI = [1.49, 6.76]; and 3.56, 95% CI = [2.07, 6.14] in women, respectively.

CONCLUSION

In France, the risk of transition from cannabis initiation to daily use has remained consistently higher among less educated cannabis initiators over three generations (1946-60, 1961-75, 1976-92), in contrast to what is observed for initiation.

Risk factors for suicide attempts and hospitalizations in a sample of 39,542 French adolescents

BACKGROUND

The high frequency of suicide attempts during adolescence is a serious public health concern. In particular attempts leading to hospitalization, often due to their severity, require careful consideration.

METHODS

Participants were drawn from a large adolescent general population survey conducted by the French Monitoring Center for Drugs and Drug Addiction and the National Service department. The final sample included 39,542 adolescents aged 17. Participants were surveyed during the "one-day session of civic and military information" using a pen and paper self-administered questionnaire.

RESULTS

Depressive symptoms, family socio-economic status, familial situation, relationship with parents, school situation, substance use and body image were significant independent predictors of lifetime suicide attempts. Among suicide attempts, hospitalization was independently predicted by daily smoking in both genders, school dropout, grade repetition, absence of relationship with the mother, regular cannabis smoking and lifetime other illicit drug use in girls.

LIMITATIONS

The main limitation of the present study is the absence of a thorough assessment of psychiatric disorders, depressive symptomatology being the only indicator of mental health status at the time of the survey. Second, the survey was cross-sectional thus limiting the interpretation of the findings.

CONCLUSIONS

The variables associated with suicide attempts and among them, those associated with hospitalization should be used to identify and provide additional services to adolescents at risk for serious suicidal behavior. Primary prevention in the field of parenting and family support, as well as intervention tackling normative beliefs related to body image should be considered.

The Gateway Hypothesis, Common Liability to Addictions or the Route of Administration Model A Modelling Process Linking the Three Theories

BACKGROUND

The aim of this study was to describe the transitions between tobacco (T), cannabis (C) and other illicit drugs (OIDs) initiations, to simultaneously explore several substance use theories: gateway theory (GT), common liability model (CLM) and route of administration model (RAM).

METHODS

Data from 2 French nationwide surveys conducted in 2005 and 2010 were used (16,421 subjects aged 18-34). Using reported ages at initiations, we reconstituted a retrospective cohort describing all initiation sequences between T, C and OID. Transition probabilities between the substances were computed using a Markov multi-state model that also tested the effect of 2 latent variables (item response theory scores reflecting propensity for early onset and further substance use) on all transitions.

RESULTS

T initiation was associated with increased likelihood of subsequent C initiation, but the reverse relationship was also observed. While the most likely initiation sequence among subjects who initiated the 3 groups of substances was the 'gateway' sequence T x2192; C x2192; OID, this pattern was not associated with substance use propensity more than alternative sequences. Early use propensity was associated with the 'gateway' sequence but also with some alternative ones beginning with T, C or OID.

CONCLUSION

If the gateway sequence appears as the most likely pattern, in line with GT, the effects of early onset and substance use propensities were also observed for some alternative sequences, which is more in line with CLM. RAM could explain reciprocal interactions observed between T and C. This suggests shared influences of individual (personality traits) and environmental (substance availability, peer influence) characteristics.

Changes in mortality due to major alcohol-related diseases in four Nordic countries, France and Germany between 1980 and 2009: a comparative age-period-cohort analysis

AIMS

To investigate age, period and cohort effects on time trends of alcohol-related mortality in countries with different drinking habits and alcohol policies.

DESIGN AND SETTING

Age-period-cohort (APC) analyses on alcohol-related mortality were conducted in Denmark, Finland, Norway, Sweden, France and Germany.

PARTICIPANTS

Cases included alcohol-related deaths in the age range 20-84 years between 1980 and 2009.

MEASUREMENTS

Mortality data were taken from national causes of death registries and covered the ICD codes alcoholic psychosis, alcohol use disorders, alcoholic liver disease and toxic effect of alcohol.

FINDINGS

In all countries changes across age, period and cohort were found to be significant for both genders [effect value with confidence interval (CI) shown in Supporting information, Table S1]. Period effects pointed to an increase in alcohol-related mortality in Denmark, Finland and Germany and a slightly decreasing trend in Sweden, while in Norway an inverse U-shaped curve and in France a U-shaped curve was found. Compared with the cohorts born before 1960, the risk of alcohol-related mortality declined substantially in cohorts born in the 1960s and later. Pairwise between-country comparisons revealed more statistically significant differences for period (P < 0.001 for all 15 comparisons by gender) than for age [P < 0.001 in seven (men) and four (women) of 15 comparisons] or cohort [P < 0.01 in two (men) and three (women) of 15 comparisons].

CONCLUSIONS

Strong period effects suggest that temporal changes in alcohol-related mortality in Denmark, Finland, Norway, Sweden, France and Germany between 1980 and 2009 were related to secular differences affecting the whole population and that these effects differed across countries.

Properties of the Cannabis Abuse Screening Test (CAST) in the general population

This paper explores the DSM-IV latent structure of cannabis users (especially its invariance towards gender and age) and assesses the psychometric properties of the Cannabis Abuse Screening Test (CAST) by confrontation with the theoretical diagnoses [dependence and cannabis use disorders (CUD)] and the latent class structure of the DSM-IV. The random sample comprised 550 French cannabis smokers aged 15-62 years interviewed by telephone. DSM-IV diagnoses were assessed with the Munich Composite International Diagnostic Interview. Internal structures of both instruments were assessed using factor analysis and latent class analysis. Optimal CAST cutoffs were determined by sensitivity, specificity and area under the receiver operating curve (AUC). CAST and DSM-IV were unidimensional (Cronbach's α = 0.742 and 0.752, respectively), although a two-factor solution showed a better fit for the CAST. CAST cutoffs for screening CUD and dependence were three (AUC = 0.851) and five (AUC = 0.868), respectively. DSM-IV latent class structure varied only marginally in age and gender. Three classes of cannabis smokers were determined, ordered along a continuum of symptoms: non-symptomatic (61.1%), moderate (32.9%) and severe (6.0%). CAST cutoff scores for screening moderate/severe and severe were, respectively, three (AUC = 0.869) and eight (AUC = 0.952). Results are compared to those obtained in previous CAST studies and discussed in line with the DSM-5.

Smokers' risk perception, socioeconomic status and source of information on cancer

BACKGROUND

In many countries, the decline in smoking prevalence has coincided with a growing concentration of smoking among people with lower socioeconomic status (SES). This concentration may reflect the social differentiation of risk perceptions. We investigated the factors associated with risk perception and fear of cancer, paying particular attention to SES indicators and health information seeking.

METHODOLOGY

A cross-sectional telephone survey conducted in France in 2010 (including 826 current smokers aged 18-75) assessing how smokers perceive the risk of smoking-related cancer in terms of daily consumption and duration thresholds.

RESULTS

Among current smokers, 38% considered that smoking can cause cancer only for a daily consumption higher than their own consumption, and an additional 22% stated that tobacco-related cancer risk only becomes high for a longer smoking duration than their personal one. Predictors of such risk perceptions included low SES, material deprivation and mentioning either the internet or their relatives as one's main source of information on cancer. The same characteristics were also predictive of personal fear of tobacco-related cancer.

CONCLUSION

Our results illustrate the challenges faced by prevention campaigns in the internet society, as information found on the web may fuel smokers' risk denial. Anti-tobacco policies should tailor interventions to people with low SES, who may be especially impervious to standard prevention campaigns because of material deprivation, and they should also address and challenge smokers' risk denial beliefs.

A randomized trial of survey participation in a national random sample of general practitioners and gynecologists in France

BACKGROUND

Healthcare professionals play a critical role in women's choice of contraceptive methods. However, national surveys on sexual and reproductive health (SRH) among physicians are rare and present low participation rates. We conducted a randomized trial to test for the effectiveness of three interventions to improve survey participation of private physicians delivering reproductive health services in France.

METHODS

The study comprised a national random sample of 500 general practitioners and 500 gynecologists working in private offices. All received a postal invitation to participate either by completing a paper, phone or online questionnaire. Physicians were randomly assigned to six groups to test for the effect of three interventions: a non-monetary incentive in the form of a scientific book, telephone contact, and the possibility of completing the questionnaire by phone.

RESULTS

Overall, 362 questionnaires were collected (26 online, 2 by phone) and 58 physicians were ineligible. The completion rate increased from 26.7% in physicians who received no intervention to 42.7% in those who received the book and a phone call. The phone call increased the completion rate by 11% percentage points (P=0.01), while the book had no significant effect. Results from multivariate logistic regressions also indicate that gynecologists (OR=1.6) and female physicians (OR=1.5) were more likely to participate than others.

CONCLUSION

The results suggest that phone calls substantially increase participation of physicians in sexual and reproductive health surveys but have little impact on sampling distortion. Differentials in response rates by physicians' characteristics should be considered in future SRH studies among physicians.

Factors influencing report of common mental health problems among psychologically distressed adults

This study investigates the sociodemographic factors associated with self-report of common mental problems by the psychologically distressed in order to gain insight into the profile of the population subgroups least likely to receive mental health support whenever needed. Data from the 2006-2008 french National Survey on Health, Health Care and Insurance, were used, measuring psychological distress based on the Mental Health Inventory MHI-5. The patterns associated with education, employment situation and living arrangement were investigated in a sample of 11,543 subjects aged 30-54 years. Men with lower educational level were found to be doubly disadvantaged, as they were more subjected to distress than those with higher educational level and at the same time less likely to report common mental problems whenever distressed. While in both genders subjects not living with a spouse and non-employed subjects were also more subjected to distress, they were more likely than the others to report common mental problems in presence of distress. The findings were discussed in terms of living conditions, stigma, mental health literacy and help-seeking behaviour. Mental health promotion programmes should aim at educating the public, and particularly men and the lower educated public, on the signs of distress and their significance.

A quantitative exploration of attitudes out of line with the prevailing norms toward alcohol, tobacco, and cannabis use among European students

The study examines groups of 15-16-year-old students whose attitudes toward drug use are out of line with the prevailing norms. It analyzes data from eight countries from the 2003 European School Survey on Alcohol and Other Drugs (ESPAD): Bulgaria, the Czech Republic, Hungary, France, Malta, Slovenia, Sweden, and the United Kingdom. In those countries, 22,900 15-16-year-old pupils answered the ESPAD questionnaire. Groups of subjects whose responses are far removed from the modal value are sought and studied. The aim is to explore "rare answers" compared to what is perceived by the majority of students. In order to explore what can lead a pupil to an atypical perception of risk, a cluster analysis, based on the risk perceptions of alcohol, tobacco, and cannabis use, was run to isolate the groups in which pupils tend to answer differently. Six clusters were established classifying students into those who failed to respond, deny the risks, do not know about the risks, see any drug use as great risk, see regular use as great risk, and who see a moderate risk for most frequencies of use. The nonresponders, risk deniers, and those ignorant of the risks are infrequent making up, in all, only 16.9% of the total sample. Gender, country, alcohol use, cannabis use, tobacco use, and friends' consumption were used to describe both the individual risk perceptions and the clusters based on them. Both global context (country) and "micro" context (frequencies of drug use, peers lifestyle, and parental permissiveness) appear to play a major role in the risk perception of drug use.

Psychological distress in French college students: demographic, economic and social stressors. Results from the 2010 National Health Barometer

Background

Psychological distress (PD) in students is under-investigated, since its prevalence can be high in certain subgroups of students and it has been seen to be associated with other mental health issues and academic achievement. In a sample of French college students, this study investigated factors associated with PD, and looked more closely at the impact of social and interpersonal variables.

Methods

Data were extracted from the 2010 French “National Health Barometer”. 946 students were interviewed. Mental health was assessed using the MH-5 five-item scale.

Results

The PD rate in this sample was 13.8% (7.2% in males, 19.5% in females). Low income, nonsexual assault in the last 12 months, studying law and low social participation were associated with PD in multivariate analyses.

Conclusions

French students show specific characteristics that are discussed in order to explain the relatively low rate of PD observed. The impact of loneliness and social isolation are a major focus for preventive policies based on community resources and early detection of the symptoms of PD.

Does computer survey technology improve reports on alcohol and illicit drug use in the general population? A comparison between two surveys with different data collection modes in France

Background

Previous studies have shown that survey methodology can greatly influence prevalence estimates for alcohol and illicit drug use. The aim of this article is to assess the effect of data collection modes on alcohol misuse and drug use reports by comparing national estimates from computer-assisted telephone interviews (CATI) and audio-computer-assisted self interviews (A-CASI).

Methods

Design: Two national representative surveys conducted in 2005 in France by CATI (n = 24,674) and A-CASI (n = 8,111).

Participants: French-speaking individuals aged [18]–[64] years old.

Measurements: Alcohol misuse according to the CAGE test, cannabis use (lifetime, last year, 10+ in last month) and experimentation with cocaine, LSD, heroin, amphetamines, ecstasy, were measured with the same questions and wordings in the two surveys.

Multivariate logistic regressions controlling for sociodemographic characteristics (age, educational level, marital status and professional status) were performed. Analyses were conducted on the whole sample and stratified by age (18–29 and 30–44 years old) and gender. 45–64 years old data were not analysed due to limited numbers.

Results

Overall national estimates were similar for 9 out of the 10 examined measures. However, after adjustment, A-CASI provided higher use for most types of illicit drugs among the youngest men (adjusted odds ratio, or OR, of 1.64 [1.08–2.49] for cocaine, 1.62 [1.10–2.38] for ecstasy, 1.99 [1.17–3.37] for LSD, 2.17 [1.07–4.43] for heroin, and 2.48 [1.41–4.35] for amphetamines), whereas use amongst women was similar in CATI and A-CASI, except for LSD in the 30–44 age group (OR = 3.60 [1.64–7.89]). Reported alcohol misuse was higher with A-CASI, for all ages and genders.

Conclusions

Although differences in the results over the whole population were relatively small between the surveys, the effect of data collection mode seemed to vary according to age and gender.

Mortality gradient across the labour market core-periphery structure: a 13-year mortality follow-up study in north-eastern France

PURPOSE

This study explores mortality related to temporary employment, about which very little is known to date.

METHODS

In 1996, a health survey was carried out in the French region of Lorraine, and all members of 8,000 randomly chosen households were followed up for mortality over a 13-year period. Mortality of subjects in relation to their employment situation at baseline was analysed using a Cox survival regression.

RESULTS

In comparison with permanent workers, for unemployed men, we found age and occupation-adjusted hazard ratios (HR) of 4.1 for all-causes of death and 3.9 for non-violent causes, and for male temporary workers a HR of 2.2 for both all-causes and non-violent causes of death. Bad health, tobacco smoking and alcohol misuse explained 17 % of the excess risk for the unemployed and 41 % of that for temporary workers.

CONCLUSION

The observation of large mortality inequalities across the labour market core-periphery structure has important policy implications, particularly in terms of prevention focused on unhealthy behaviours among male unemployed and temporary workers.

Self-reporting and measurement of body mass index in adolescents: refusals and validity, and the possible role of socioeconomic and health-related factors

Background

Body mass index assessment using self-reported height and weight (BMIsr) can encounter refusals and under/over-reporting while for assessment with measured data (BMIm) refusals can be more frequent. This could relate to socioeconomic and health-related factors. We explored these issues by investigating numerous potential factors: gender, age, family structure, father’s occupation, income, physical/sports activity, subjective weight perception, school performance, unhealthy behaviours, physical/psychological health, social relationships, living environment, having sustained violence, sexual abuse, and involvement in violence.

Methods

The sample included 1559 adolescents from middle schools in north-eastern France. They completed a questionnaire including socioeconomic and health-related data, self-reported height/weight, measured height/weight, and weight perception (participation rate 94%). Data were analysed using logistic regression models.

Results

BMIsr encountered under-reporting (with change in BMI category, 11.8%), over-reporting (6.0%), and reporting refusals (3.6%). BMIm encountered more numerous refusals (7.9%). Reporting refusal was related to living with a single parent, low school performance, lack of physical/sports activity, sustained violence, poor psychological health, and poor social relationships (gender/age-adjusted odds ratios 1.95 to 2.91). Further to these factors, measurement refusal was related to older age, having divorced/separated parents, a father being a manual worker/inactive, insufficient family income, tobacco/cannabis use, involvement in violence, poor physical health, and poor living environment (1.30 to 3.68). Under-reporting was related to male gender, involvement in violence, poor psychological health, and overweight/obesity (as assessed with BMIm) (1.52 to 11). Over-reporting was related to male gender, younger age, alcohol consumption, and underweight (1.30 to 5.35). Weight perception was linked to reporting refusals and under/over-reporting, but slightly linked to measurement refusal. The contributions of socioeconomic and health-related factors to the associations of weight perception with reporting refusal and under/over-reporting ranged from −82% to 44%. There were substantial discrepancies in the associations between socioeconomic/health-related factors and overweight/obesity assessed with BMIsr and BMIm.

Conclusions

BMIsr and BMIm were affected by numerous biases related to vulnerability which were also obesity risk factors. BMIsr encountered under/over-reporting which were related to some socioeconomic and health-related factors, weight perception, and BMIm. BMIm was more affected by refusals than BMIsr due to socioeconomic and health-related factors. Further research is needed.

A validation of the Cannabis Abuse Screening Test (CAST) using a latent class analysis of the DSM-IV among adolescents

This paper explored the latent class structure of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) (assessed with the Munich Composite International Diagnostic Interview). Secondly, the screening properties of the Cannabis Abuse Screening Test (CAST) in adolescents were assessed with classical test theory using the latent class structure as empirical gold standard. The sample comprised 3266 French cannabis users aged 17 to 19 from the general population. Three latent classes of cannabis users were identified reflecting a continuum of problem severity: non-symptomatic, moderate and severe. Gender-specific analyses showed the best model fit, although results were almost identical in the total sample. The latent classes were good predictors of daily cannabis use, number of joints per day and age of first experimentation. The CAST showed good screening properties for the moderate/severe class (area under receiver operating characteristic curve > 0.85) and very good for the severe class (0.90). It was more sensitive for boys, more specific for girls. Although structural equivalence across gender was rejected, results suggest small gender differences in the latent structure of the DSM-IV. The performance of the CAST in screening for the latent class structure was good and superior to those obtained with the classical DSM-IV diagnoses.

The influence of socioeconomic status on cannabis use among French adolescents

PURPOSE

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 (≤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.

FINDINGS

For overall use, we found a strong positive social gradient: the lower the F-SES or the higher the frequency of use, the lower the odds ratio (OR) (from .85 to .52 for 10+ uses in the past year among farmers). For frequent use, we found a strong negative gradient: the lower the F-SES category, the higher the OR (from 1.02 to 2.05 among inactive/unemployed), and likewise for cannabis use disorder and heavy use (OR = 1.85 and 2.03 among inactive/unemployed).

CONCLUSIONS

Adolescents from affluent families are more prone to experimentation with cannabis and to use it at low levels but present lower levels of frequent, heavy, or problematic use than those from other SES categories. Mechanisms that hinder transition to intensive use should be investigated.