BACKGROUND AND AIMS:Early alcohol onset and its association with current use of illicit substances remains understudied in France, and specific information by gender is lacking. To address this question, this study examined the effects of age of alcohol onset and gender on past month use of illicit substances among patients treated for alcohol use disorder (AUD) in France. METHOD:The data come from the RECAP study, a national database containing detailed information on patients seeking treatment for substance use disorders collected between 2012 and 2022. The sample comprised 643 942 patients with AUD (21% females). We conducted multivariable modified Poisson regressions to identify factors associated with current use of cannabis, opioids and stimulants. Current use of illicit substances was expressed as incidence rate ratios (IRR). RESULTS:There has been a decreasing trend of age of alcohol onset over time among patients, particularly notable among women. Women in treatment for AUD were less likely to engage in illicit substance use relative to men. However, an interaction revealed a complementary mechanism: the earlier the age of alcohol onset, the more women with AUD used current opioids or stimulants relative to men. CONCLUSION:Early age of onset remains a key feature in the development of polysubstance use among patients treated for AUD, especially among women. Age of onset should be routinely incorporated into assessment protocols as it may help identify patients with high risks of polysubstance use, which is likely to disrupt their recovery process.

BACKGROUND:Cannabis supply methods vary depending on the country, legislation, availability, and population characteristics. In many countries, cannabis consumption remains illegal and poses a major public health concern. Therefore, it is essential to study the factors associated with cannabis supply. METHODS:Data were obtained from the 2017 French ESCAPAD and Health Barometer surveys (HBS). ESCAPAD is a national cross-sectional survey representative of 17-year-olds, while the HBS is a national cross-sectional telephone survey representative of French individuals aged 18-64. To ensure representativeness, data were weighted, and missing data were imputed. Three cannabis supply methods used in the past year were available in both databases and were analyzed using multivariate multinomial logistic regressions: (a) obtained for free; (b) bought from friends, relatives, or dealers; (c) home cultivation. RESULTS:The study included 2,943 17-years-old and 1,221 adults who reported using at least one of the analyzed methods to obtain cannabis. The majority had purchased cannabis (60% in ESCAPAD and 68% in HBS), while 33% and 24%, respectively, obtained it free, and only 5% and 8% had cultivated it. Among both 17-year-olds and adults, compared with obtaining cannabis for free, being male and experiencing problematic cannabis use were associated with buying or cultivating cannabis. Among 17-year-olds, being an apprentice was associated with a higher likelihood of cultivation, while earning money in the past 30 days and experiencing depression were associated with buying cannabis. Early experimentation with cannabis was associated with both supply methods among adolescents. Among adults, the 26-34 age group was associated with both buying and cultivating, while having less than a high school diploma was associated only with purchasing. CONCLUSION:Cannabis supply methods are similar between minors and adults, with buying from friends, relatives, or dealers being the most common source. This study identifies vulnerable people who use cannabis and their acquisition practices, providing valuable insights for public policies.

OBJECTIVE:The purpose of this research was to study the prevalence of alcohol use among French adolescents over time and factors associated with heavy episodic drinking (HED) among drinkers. METHOD:Our analysis relies on six waves of a standardized cross-sectional survey conducted in mainland France between 2005 and 2022. The overall sample comprises 179,905 adolescents age 17 (90,166 males and 89,739 females). Two outcomes were considered: declaring past-month HED (at least one) and repeated HED (at least three) in the past month between 2005 and 2022. Relative risks and probabilities according to years of survey, gender, and frequency of alcohol use (past 30 days) were estimated using modified Poisson regressions controlling for grade retention, schooling, living out of the parental household, socioeconomic status, and use of other substances (tobacco, cannabis, other illicit substances). RESULTS:Despite a steady decline in alcohol use among French adolescents over the past two decades, the prevalence of HED still concerned one third of 17-year-olds in 2022. The reduction in alcohol use conceals an increased likelihood of HED among occasional drinkers (<10 times a month). Moreover, the probability of HED among females is similar to that of males or even higher, depending on the frequency of use. CONCLUSIONS:HED is becoming an increasingly common behavior among adolescent drinkers. The decline in prevalence conceals a homogenization of behavior between genders. Our results also question underage access to alcohol despite increasing legal restrictions. These results support general prevention in early adolescence aimed at all drinkers and not only at the most frequent or "at-risk" drinkers.

PurposeWe investigated total sleep time (TST) and sleep paradigms during schooldays and leisure days in teenagers, and compared the findings to results from 8 years before.MethodsThe EnCLASS epidemiological survey is a representative sample of thousands of French middle and high schoolers. Specific sleep questions allowed us to assess TST, sleep debt, too short sleep, and screen use. Sleep debt as was defined as a difference between the total sleep time (TST) during schooldays (TSTS) non-schooldays (weekends or vacations; TSTN) of over 2 hours. Too short sleep was assesses when TSTS was < 7 hours. We detailed results of the 2018 bivariable analysis and adjusted by sex, age, class level, academic delay and socio-economic level, allowing us to compare the 2018 and 2010 results.ResultsTST decreases constantly from the beginning of middle school (MS) to the end of high school (HS). In 2018, 26.7% of middle and 43.7% of high schoolers were in "sleep debt". Additionally, 13.8% of middle and 29% of high schoolers reported too short sleep (less than 7 hours) on schooldays (vs. 7.8% in middle and 25.1% in high school in 2010). In 8 years, the TSTS of middle schoolers decreases by an average of 20 minutes of sleep per night on weekdays, dropping from 8 h 35 min to 8 h 14 min. Regarding screens at bedtime, an increase of 36.8 points was observed on schooldays in MS between 6th and 9th grade, with 13.9% more in HS, in 12th grade. This included 40.6% of middle and 60.6% of high schoolers using internet before sleep on schooldays.ConclusionFaced with this trend, teachers and parents need to take preventive action to avoid an inexorable decline in teenagers' sleep.

OBJECTIVE:To estimate the prevalence and identify factors associated with polystimulant use (2 or more stimulants during the past 30 d), a specific case of polysubstance use, among patients seeking treatment for stimulant use disorder (StUD). METHOD:The data come from a national database of patients seeking treatment for StUD in France between 2012 and 2022 (n = 60211, 21.7% females). We conducted multilevel logistic regression to assess sociodemographic and psychiatric factors as well as concurrent use of psychoactive substances on polystimulant use. RESULTS:Overall, the prevalence of polystimulant use was 12.5%. Descriptive findings suggested a slight increase over time; however, the result did not hold in the multivariable analysis. The odds of concurrent use were higher among patients aged 25-34 years, the more educated, who sought treatment for (meth)amphetamine disorders, who injected, with psychiatric disorders, and patients who used hallucinogens during the past 30 d. Polystimulant use was negatively associated with age at onset. No association with gender was detected. CONCLUSIONS:Our study suggests that polystimulant use varies by demographic factors and mostly occurs at later ages. Clinical strategies should target patients of younger age, with higher educational level, and should integrate mental health interventions as needed for those who were early initiators.

Background Consistent reports from health professionals suggest that heroin is commonly used by patients undergoing opioid maintenance treatment (OMT) in France, potentially jeopardizing their recovery process. However, there has been no formal epidemiological assessment on the matter. Methods We use a yearly updated compendium retrieving information on patients admitted in treatment centres in France between 2010 and 2020. Given the hierarchical nature of the data collection, we conduct 2-level modified Poisson regressions to estimate the risks of past month heroin use among patients on OMT. Results Despite an overall decreasing trend over time, heroin use among patients on OMT is indeed common, with half of patients declaring concurrent use. Our study unveils differentiated risks of heroin use vary according to the type of OMT, with patients on methadone more likely to use heroin compared to those on buprenorphine. The use of multilevel-related measures also uncovers high heterogeneity among patients’ profiles, reflecting different stages in the treatment process, as well as differentiated practices across treatment centres. Conclusion Opioid maintenance treatment is associated with heroin use, in particular when methadone is involved. The heterogeneity among patients on OMT should be given particular attention, as it underscores the need for tailored interventions.

This article reports changes in tobacco and vaping consumption in France over the last thirty years and the issues they raise for public authorities in terms of prevention and management of the social and health consequences. This report is the result of a joint analysis by Santé publique France (SpF) and the French Monitoring Center for Drugs and Drug Addiction (OFDT). It shows that there has been a "generational shift" in tobacco consumption and social representations of cigarettes since the mid-2010s, with a sharp decline in tobacco initiation among adolescents, which has become less common and reported at an older age, which was one of the objectives of the national tobacco reduction plans. However, smoking remains fairly stable among adults, predominantly among men, with gaps between men and women persisting since the early 2000s. Beyond the gender gap, social disparities in consumption remain significant, both among youth and adults. However, while the prevalence of smoking is no longer increasing, the prevalence of vaping is rising, which is a public health concern since some of these practices involve nicotine consumption. This also entails the risk of a "renormalization" of the act of smoking, a matter of concern for health authorities in France as in other European countries. The analysis concludes that the statistical information system and qualitative surveys need to be adapted to ensure a reliable monitoring of the situation, taking into account the rapid transformations of the market.

This article reports changes in tobacco and vaping consumption in France over the last thirty years and the issues they raise for public authorities in terms of prevention and management of the social and health consequences. This report is the result of a joint analysis by Santé publique France (SpF) and the French Monitoring Center for Drugs and Drug Addiction (OFDT). It shows that there has been a “generational shift” in tobacco consumption and social representations of cigarettes since the mid-2010s, with a sharp decline in tobacco initiation among adolescents, which has become less common and reported at an older age, which was one of the objectives of the national tobacco reduction plans. However, smoking remains fairly stable among adults, predominantly among men, with gaps between men and women persisting since the early 2000s. Beyond the gender gap, social disparities in consumption remain significant, both among youth and adults. However, while the prevalence of smoking is no longer increasing, the prevalence of vaping is rising, which is a public health concern since some of these practices involve nicotine consumption. This also entails the risk of a “renormalization” of the act of smoking, a matter of concern for health authorities in France as in other European countries. The analysis concludes that the statistical information system and qualitative surveys need to be adapted to ensure a reliable monitoring of the situation, taking into account the rapid transformations of the market.

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.

Il faut attendre la fin des années 1990 pour que la France se dote d’un dispositif d’observation statistique des comportements d’usages de drogues en population générale. Ces enquêtes vont, dès le départ, viser l’ensemble de la population française et notamment les plus jeunes eu égard à l’enjeu de santé publique que constitue l’initiation précoce aux substances psychoactives aux premiers rangs desquelles on trouve les boissons alcoolisées, les cigarettes et le cannabis. Initier une enquête auprès des adolescents sur des comportements illicites n’allait pas de soi mais, en innovant tout en s’inspirant des enquêtes réalisées aux États-Unis, comme l’enquête Monitoring the future (MTF) ou l’ European School Survey Project on Alcohol and Other Drugs (ESPAD) menée dans d’autres pays européens, l’Observatoire français des drogues et des toxicomanies (OFDT) va concevoir en 2000 la première enquête ESCAPAD auprès des adolescents âgés de 17 ans, enquête dont le 9 e exercice se déroulera en 2022. À partir de quelques exemples de résultats emblématiques de l’enquête, cet article revient sur les apports spécifiques d’un dispositif d’observation quantitatif et s’interroge sur son adaptation aux nouveaux enjeux méthodologiques comme à l’évolution du champ de l’addictologie.

Purpose: Studies of adolescent e-cigarette use infrequently consider how environmental effects impact use. Adolescent e-cigarette use in France is also understudied, yet an important contrast since e-cigarette use rarely precedes conventional tobacco use and daily tobacco use is common. We examine whether there is significant variation in e-cigarette use across the geographic unit of de acute accent partements (n = 95), and whether community factors explain these differences and individual-level probabilities of e-cigarette use. Methods: The ESCAPAD survey is a cross-sectional, nationally representative survey collected at a day of civic and military information mandatory for French 17-year-olds. We use the 2014 (n = 22,023) and 2017 (n = 39,115) surveys and geographic information from Eurostat and INSEE. Multilevel, multiple logistic regression models examine any and daily past month e-cigarette use. Results: We find significant de acute accent partement-level variation in both outcomes, with a considerable proportion of this variation explained by de acute accent partement-level factors. Net of numerous significant individual-level covariates, de acute accent partement-level unemployment (OR = 1.049, p < .05), poverty (OR=0.975, p < .05), age structure (OR=0.720, p < .01), and population growth (OR=0.987 p < .01) were associated with any past month use. The de acute accent partement-level percentage of adolescents using conventional tobacco daily was associated with individuallevel any (OR=1.029, p < .001) and daily (OR=1.033, p < .01) e-cigarette use. Predicted probabilities demonstrate that de acute accent partement-level and individual-level tobacco use together were associated with e-cigarette use. Conclusions: Researchers should incorporate community effects into studies of e-cigarette use. Particularly, the tobacco use environment contributes to risk of e-cigarette use. For policymakers, resources may be mobilized to address local socioeconomic, demographic, and tobacco use patterns to potentially affect adolescent e-cigarette use.

Background While typologies of substance use disorder are very informative, they are still scarcer. The aim of this study was to consider a classification system of substance use among adolescents based on types of substance used and levels of use, and to compare identified groups on sociodemographic characteristics, mental and physical health factors, and other psychological indices. Methods A total of 23,294 17-year-old French adolescents were assessed on mental health factors (depression, suicide, visits to a mental health professional), physical health factors (health self-perception, body shape perception, body mass index), family relationships, perceptions of substance use risk, and vision of the future. Results Hierarchical Cluster Analysis identified four classes of adolescents: 'Adolescents who use Occasionally/experimentally Tobacco and Alcohol' (n = 7328, 35.3%), 'Adolescents who do not use drugs' (n = 5218, 25.1%), 'Adolescents who use Tobacco, Alcohol, Cannabis' (n = 6804, 32.8%), and 'Adolescents who use Multi-drugs' (n = 1403, 6.8%). The two first were mostly high school girls, with no mental and physical health issue, accurate perception of substances uses risk, and positive vision of their future. They differed regarding parental socioeconomic status and body mass index. The two latest were mostly boys, with poor school performance, bad family relationships, mental health issues, incorrect perception of substances uses risk, and negative vision of their future. They differed regarding parental socioeconomic status, weight and weight perception. Conclusions Our results confirm the heterogeneous nature of drug use in adolescents, the relevance of typologies, and their importance for future public health policy.

Background: Studies have proved the positive link between truancy and substances use in school surveys. In spite of this, no adapted weighting treatment is generally provided; even when the share of missing and truant pupils is high, and all drug use estimates are biased downward. The necessary data can be collected: on one side, individual current drug use and past episodes of absence and truancy of the respondents; on the other, the count of the presents and absents the day of the survey, including truants, in each class. However, the nature of these data prevents any classical modelling of the survey response without additional assumptions. Methods: We review one method proposed in 2002 by Guttmacher and al. that uses only the individual data and propose two methods that combine both kind of data and in which we can distinguish or not between truancy and legitimate absence. We apply them to the French release of the 2015 Espad survey (European survey project on alcohol and other drugs). The theoretical number of pupils was n=7166; 981 were absent (including 359 truants), while 178 were discarded because of the poor quality of their questionnaires and 6007 were considered final respondents. Assumptions, point estimates and variances are compared. Results: Guttmacher’ method is not conceptually valid and can lead to irrelevant corrections with high variances. Our estimate of cannabis regular use is 8.6% (std=0.75) instead of 7.7% (std=0.67), that is a non-response bias of circa 14%. Conclusion: The proposed approach relies on simple and plausible assumptions; it is preferable to any speculative consideration about the magnitude of the underestimation yielded by the classical weighting procedures. Survey designers should evaluate and discuss the potential bias of their surveys and eventually correct it.

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.

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.