Substance Use Among Middle School Adolescents: Association with Family Members' and Peers' Substance Use and the Mediating Role of School and Mental Difficulties.

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

Many adolescents had a high cumulative number of family members' and peers' substance (alcohol, tobacco, cannabis, or other illicit drugs) use (familySUcn and peerSUcn)Strong dose­effect links of substance use with familySUcn and peerSUcn (odds ratio up to 13)School and mental difficulties explained up to 69% of the link of substance use with familySUcn and up to 34% of that of substance use with peerSUcnThe proportion of subjects without each substance use decreased with age more quickly among the adolescents with higher familySUcn/peerSUcn than among the othersOur results may help implementing prevention to reduce substance use.

Untreated Allergy Among Middle School Students: Associations with Socioeconomic Adversities and Academic, Behavior, and Health Difficulties.

BACKGROUND: Many adolescents with allergy do not receive physician treatment (allergyuntreated ). We explored its association with socioeconomic adversities and academic-behavior-health difficulties, which remain unaddressed. METHODS: This cross-sectional school-based-population study compared the above factors of middle-school adolescents with allergyuntreated and those with treated allergy (allergytreated ) (mean age = 13.5 ± 1.2) from north-eastern France. Participants completed a questionnaire collecting socioeconomic adversities (nonintact family, low parents' education, insufficient family income, poor social support, suffered verbal/physical violence, and sexual abuse), low academic performance, excessive screen time, substance use, sleep difficulty, poor physical health, depressive symptoms, suicide attempt, poor quality of life, and allergytreated /allergyuntreated . RESULTS: Logistic regression models showed that allergyuntreated was associated with all the factors considered (sex-age-class-level-adjusted odds ratio (saclOR) reaching 3.94, p < .001) and the risk score (number of main criteria: suffered sexual abuse, excessive screen time, poor quality of life, cannabis use, low parents' education, and poor social support): saclOR 4.75, 9.23, 15.64, and 31.73 (p < .001) for risk scores 1, 2, 3, and ≥4, versus risk score = 0 (pseudo-R2 = 11.1%). CONCLUSIONS: Socioeconomic adversities and academic-behavior-health difficulties may be used to detect adolescents with allergyuntreated for care.

Development of an intervention program to reduce whole-body vibration exposure based on occupational and individual determinants among dumper operators.

Objectives. Studies related to a systematic approach for intervention design to reduce whole-body vibration (WBV) exposure are scarce. This study presents a systematic approach to identifying, selecting and prioritizing safety interventions to fulfill that research gap. Methods. A total of 130 vibration readings for dumper operators were taken from two surface iron ore mines to identify significant determinants of WBV exposure. Initially, age, weight, seat design, awkward posture, machine's age, load tonnage, dumper speed and haul road condition were hypothesized as determinants. Data were collected through standardized questionnaires and field-based observation. A multivariate statistical approach was applied for the practical use of the intervention program. Results. As some of the hypothesized factors were correlated, exploratory factor analysis (EFA) followed by multiple linear regression (MLR) was used to investigate their association with WBV exposure. As per EFA results, hypothesized factors were clubbed under individual, ergonomics and occupational factors. Occupational and ergonomics factors were found to be significantly associated with WBV exposure through MLR and used to form safety interventions to reduce WBV exposure. Conclusions. Our methodological approach is original in the occupational health research area and can be helpful to tailor the safety interventions for the unit level with minimum effort.

Associations between excessive screen time and school and out-of-school injuries among adolescents: A population-based study.

Most adolescents spend excessive screen time (with television viewing, computer/console gaming, discussion forums/chatting online, internet surfing, doing homework, and electronic mails) which may impact the occurring of various types of school and out-of-school injuries. We assessed their associations and potential confounding factors among 1559 middle-school students from north-eastern France (mean age=13.5 ± 1.3). Participants completed a questionnaire including socioeconomic features, daily screen time for various screen-based activities (coded 1=<2, 2 = 2-4, 3=≥5 h; daily-total-screen time level (TDST) was defined as their sum, categorized into <7/7-11/≥12), various injury types during the school-year, behavior and health difficulties (BHDs; alcohol/tobacco/cannabis/other illicit drugs use, suffered physical/verbal violence, sexual abuse, poor family-peer support, sleep difficulty, depressive symptoms, suicide attempt, and time at onset). Most subjects had TDST≥7 (82.3 %). There were dose-effect associations of TDST with school-physical/sports training, school-free-time, out-of-school-sports, and single/repeated injuries (sex-age-adjusted odds ratio reaching 4.45). BHDs explained up to 39 % of these associations. The frequency of subjects without various BHDs decreased with age since age 10 more quickly among the participants with both TDST≥7 and injury than among the others. Our findings may inform health care providers, parents, schools, and public policy that reducing elevated screen time is efficient to prevent injuries and BHDs among adolescents.

Associations between depressive symptoms with suicide behaviors and negative relationships with mother and father in early adolescents: a population-based study.

BACKGROUND: Adolescent-parent negative relationships may favour depressive symptoms only (DSonly) and more strongly those plus suicide ideation (DSSI) or attempt (DSSA) in early adolescents (10-16 years). We assessed their associations which remain poorly addressed. METHODS: This study included 1256 middle-school adolescents from north-eastern France (mean age 13.5±1.3). They completed a questionnaire gathering socioeconomic features, academic performance, substance (alcohol, tobacco, cannabis and other substances) use, relationships with father and mother, depressive symptoms, last-12-month suicide ideation, and lifetime suicide attempt. For depressive symptoms and suicide attempt, the time of the first occurrence during adolescent's life course was also gathered. Data were analyzed using multinomial logistic regression models and Kaplan-Meier survival estimates. RESULTS: Many adolescents suffered from DSonly (8.0%), DSSI (2.5%) and DSSA (3.9%) and from negative relationships with father only (NRfather, 11.2%), mother only (NRmother, 6.1%), and both parents (NRboth parents, 10.9%). DSSA was more strongly associated (P<0.001) with NRmother (sex-age-adjusted odds ratio saOR=14.34) and NRboth parents (saOR=12.15) than NRfather (saOR=4.57). Similar results were found for DSSI (saOR 12.90, 12.23 and 2.16, respectively) and DSonly (saOR 4.18, 4.84 and 3.18, respectively). These results remained strong when controlling for socioeconomic features, academic performance and substance use (contribution reaching 62%). The risk early began and then steadily increased over time. CONCLUSIONS: Adolescent-parent negative relationships favor DSonly and more strongly DSSI and DSSA. Mother had a much higher role than father. The role and support of both parents should be considered for prevention and care to reduce adolescents' mental health difficulties.

Associations between School-Behavior-Health Difficulties and Subsequent Injuries among Younger Adolescents: A Population-based Study.

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

Association of School Health Relationship Difficulties with Lack of Regular Physical Activity in Younger Adolescents: A Population Based Study.

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

• Lack of physical activity (LPA) is strongly associated with school-health-relational difficulties (SHRDs) affecting most adolescents.• There are dose-effect associations between cumulative number of SHRDs and both LPA and number of days/week with physical activity >60 min/day (Ndw).• These links are robust when controlling for socioeconomic features which have a strong confounding role.• The risk of LPA and reduced Ndw increase with the duration of depressive symptoms from their onset.• Prevention to detect/reduce SHRDs may improve physical activity, especially for most at-risk adolescents.

Association between untreated low back pain and injury proneness and confounding role of behavioral-health difficulties among younger adolescents: a population-based study.

PURPOSE: Low back pain (LPB) is mostly left untreated (LBPuntreated) and may increase the injury risk due to associated behavioral-health difficulties (BHDs) among adolescents. This study assessed the association between LBPuntreated (vs. treated LBP (LBPtreated)) and injuries and the mediating role of BHDs among younger adolescents (10-16 years). METHODS: This population-based study compared 328 adolescents with LBPuntreated (mean age = 13.7 ± 1.3) with 291 with LBPtreated (mean age = 13.3 ± 1.2) from north-eastern France. They completed a questionnaire collecting, at school-year end, socioeconomic features, LBPtreated/LBPuntreated, BHDs (alcohol/tobacco use, excessive screen-time, poor social support, poor physical health, depressive symptoms, and pain limiting activities), and injuries during the current school-year. Data were analyzed using multinomial logistic regression models and Kaplan-Meier estimates. RESULTS: The proportion of subjects without alcohol/tobacco use or depressive symptoms decreased with time more quickly since age 10 among the adolescents with LBPuntreated than among those with LBPtreated. Hence, most LBP early started and the subjects with LBPuntreated had a higher risk of single injury (sex-age-class-level-socioeconomic-features-adjusted relative risk ratio RR = 1.63, p < 0.05, vs. LBPtreated) and a much higher risk of ≥ 2 injuries (RR = 2.60, p < 0.001). BHDs played a strong mediating role in the association between LBPuntreated and ≥ 2 injuries (contribution = 48%) but a modest mediating role in that between LBPuntreated and single injury (contribution = 10%) (pseudo R2 = 7.6%). CONCLUSION: LBPuntreated is common and associated with injuries partly due to BHDs (which may alter physical/mental capabilities, risk perception/awareness, and vigilance) among younger adolescents. Our results may inform healthcare providers that they can detect/treat LBP and BHDs to prevent their aggravation and injuries.

School, behavior and health-related difficulties in early adolescents with contraceptive consultation: a population-based study in eastern France.

BACKGROUND: Early adolescence (10-16 years) is a crucial period for physical, mental and cognitive development where a wide range of school, behavior and health-related difficulties may occur. These issues may be aggravated in adolescents with early affective/sexual live and contraceptive consultation. This study assessed the risk of school, behavior and health-related problems among younger boys and girls having a contraceptive consultation. Such knowledge would inform care providers about their main role in monitoring and caring adolescent problems. METHODS: This cross-sectional study included 1559 middle-school adolescents from north-eastern France (mean age 13.5±1.3). They completed a questionnaire gathering socioeconomic features, obesity, school difficulties, substances use, physical health, psychological health, social relationship, violence, sexual abuse, and suicide behaviors. Data were analyzed for each gender separately using logistic regression models. RESULTS: The contraceptive consultation concerned 6.7% of girls and 3.2% of boys (P=0.002). Based on Odds Ratio (adjusted for age, school-class level and socioeconomic factors), both boys and girls with contraceptive consultation had 2-to-7-time higher risk of consumption of alcohol, tobacco, cannabis and other drogues, poor physical health, relational problems, and perpetrated violence. Additionally, the girls had a 4-time higher risk of low academic-performance and obesity while the boys had 6-to-37-time higher risk of sexual abuse, school dropout ideation, suicide ideation and suicide attempts. CONCLUSIONS: Although based on self-reported data, we found that primary care providers play a prominent role in detecting and monitoring school, behavior and health-related problems during adolescent contraceptive consultations.

Re-engagement of Early Adolescents with Severe School Issues in School/Professional Project Reduces School-Behavior-Health Problems.

BACKGROUND: In France, 3.2 million middle-school students have serious/persistent school difficulties and are re-engaged in adapted-general/vocational-education class (AGVEC), created to early re-engage them in school/professional projects. We assessed the AGVEC's benefits for school-behavior-health-related difficulties (SBHDs). METHODS: This population-based study compared 83 AGVEC students (mean age = 14.4 ± 1.1) with 1559 regular-class students (mean age = 13.5 ± 1.3) from north-eastern France. They completed a questionnaire collecting socioeconomic features and SBHDs. The data were analyzed using logistic regression models and Kaplan-Meier estimates. RESULTS: The AGVEC students had similar academic performance but fewer school absences due to health problems, less sleep difficulty, fewer depressive symptoms, and more social support as compared with regular-class students: sex-age-class-level-adjusted odds ratio (saclOR) 0.31-0.56 (p < 0.05/0.001). The AGVEC students had fewer skipping school, better health status, less sleep difficulty, fewer depressive symptoms, fewer suicide ideation/attempt, and more social support as compared with regular-class students with low academic performance: saclOR 0.22-0.52 (most with p < 0.01). Socioeconomic features played modest roles. The benefits for depressive symptoms and suicide attempt increased with age since age 10. CONCLUSIONS: Re-engagement in the AGVEC is particularly effective in reducing SBHDs.

Association between screen time and cumulating school, behavior, and mental health difficulties in early adolescents: A population-based study.

Early adolescents may daily spend excessive screen-time (with television viewing, computer/console gaming, discussion forums/chatting online, internet surfing, doing homework, and electronic mails) while its association with cumulating several school-behavior-mental-health difficulties (SBMDs) (poor-academic-performance, being obese, alcohol/tobacco/cannabis/other-illicit-drugs use, suffered violence, sexual abuse, perpetrated violence, poor social support, depressive symptoms, and suicide attempt) is poorly addressed. We investigated this association among 1559 middle-school adolescents from north-eastern France (mean age 13.5 ± 1.3). They completed a questionnaire including socioeconomic features, daily screen-time for various screen-based activities (coded 1=<2/2=2-4/3=≥5 h; daily-total-screen-time level DSAtotal was defined as their sum and categorized into 4 levels: 6-7/8-9/10-12/≥13), various SBMDs and the time of their onset during the life course (their cumulated number SBMDscore was categorized into 5 levels: 0/1/2/3-4/≥5). Logistic regression modeling showed that the DSAtotal was strongly associated with all SBMDs (gender-age-adjusted odds ratio reaching 8.28, p < 0.001) and SBMDscore (gender-age-adjusted relative risk reaching 11.60, p < 0.001, pseudo R2 = 0.039). These associations remained strongly significant when controlling for socioeconomic adversities (contributions 20-38%). The proportion of subjects without each SBMD steadily decreased with age according to DSAtotal levels. These findings help to understand the impacts of high DSAtotal on SBMDs in early adolescents and identify at-risk adolescents for prevention and care.

Associations between school difficulties and family type and the role of socioeconomic, behavior and health-related difficulties in early adolescents: a population-based study.

OBJECTIVES: Nowadays many early adolescents are living in non-intact families (parents divorced/separated, reconstructed families or single parents) and have many school difficulties (learning difficulty, skipping school, school absence due to family problems, grade repetition, low school performance, and school dropout ideation). This study assessed the associations between school difficulties and family type which remain little addressed and the confounding role of socioeconomic adversities and behavior, social support and health-related difficulties (BSSHDs). METHODS: The study population included 1559 middle-school adolescents from north-eastern France (mean age 13.5 ± 1.3). They completed at the end of school-year a questionnaire gathering socioeconomic adversities, school difficulties and BSSHDs (being obese, substances use, sustained physical/verbal violence, sexual abuse, perpetrated violence, poor social support, depressive symptoms, and suicide attempt; cumulated number noted BSSHDCM). Data was analyzed using logistic regression models. RESULTS: The adolescents with parents divorced/separated, reconstructed families or single parents had a much higher risk for various school difficulties than those in intact families (sex-age-adjusted odds ratios 1.60-4.70, mostly with p < 0.001). These risks were robust and remained significant (often with p < 0.01/0.001) after adjustment for socioeconomic adversities and BSSHDCM. The contributions of socioeconomic adversities plus BSSHDCM to the risks were mostly elevated (>40%, reaching 65%) while those of socioeconomic adversities alone were mostly moderate (<30%, but reaching 52%). CONCLUSIONS: Family type plays a strong role in school difficulties among early adolescents, mainly due to socioeconomic adversities and BSSHDCM. Our results may help primary care providers identify at-risk adolescents and their problems and establish timely prevention and care.HighlightsLearning difficulty, school absence, grade repetition, low academic performance, and school dropout ideation are common in early adolescents.The adolescents with parents divorced/separated, reconstructed families or single parents have up to 4.7-time higher risk for these school difficulties than those in intact families.These risks are robust after adjustment for socioeconomic, behavior and health-related difficulties which explain up to 65% of the risks.School-difficulty prevention should consider family features and include early monitoring behavior and health-related difficulties in adolescents.

Association between depressive symptoms and subsequent injuries in early adolescents: a population-based study.

OBJECTIVES: Depressive symptoms (DSs) may be frequent and highly increase the risk of injuries in early adolescents (10-16 years). This study assessed the association between DSs and subsequent school and out-of-school injuries in early adolescents. METHODS: The study population included 1219 middle-school adolescents from north-eastern France (mean age =12.7 ± 1.3) who completed at the end of school-year a questionnaire gathering socioeconomic features (nationality, family structure, parents' occupation, parents' education, and family income), obesity, alcohol use, tobacco use, health status, DSs (Kandel scale higher than the median value, hence including moderate levels), and school and out-of-school injuries during the present school-year. Were only considered the DSs and confounders that had started before the school-year. Data was analyzed using multinomial logistic regression models. RESULTS: DSs were strongly associated with one or more school-physical/sports-training injuries (sex-age-adjusted odds ratio ORsa 2.08, p < 0.001), other-school-training injuries (ORsa 2.13, p < 0.01), school-free-time injuries (ORsa 2.84, p < 0.001), out-of-school-sports injuries (ORsa 1.95, p < 0.001), and traffic injuries (ORsa 3.78, p < 0.001). The risk was higher for having two or more injury categories (ORsa 4.03, p < 0.001) than for only one injury category (ORsa 1.80, p < 0.001). These results were robust and remained after further adjustment for socioeconomic features, obesity, alcohol use, tobacco use, and health status. CONCLUSIONS: DSs strongly increase the injury risk in early adolescents. Injury prevention should include DSs screening and monitoring and help adolescents and their neighborhood be aware of the risk.HighlightsInjuries and depressive symptoms (DSs) are frequent in early adolescents.DSs highly predict subsequent school and out-of-school injuries and cumulating several injury types.These results are robust after adjustment for socioeconomic features, being obese, alcohol use, tobacco use and poor health status.Injury prevention should include early DSs screening and monitoring and help adolescents and their neighborhood be aware of the risk.

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 ±â€¯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 SVMDscore) 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 SVMDscore (socioeconomic features-adjusted odds ratio reaching 85). The risk began in early years in middle schools and then steadily increased, more markedly for elevated SVMDscore. 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.

Assessment of participation biases for a confidential non-anonymous adolescent study: A based population study.

A prospective study often receives a low participation rate that may alter the results quality. This study assessed the participation bias for a confidential non-anonymous adolescent survey among 1559 middle-school adolescents from north-eastern France (mean age 13.5 ±â€¯1.3). They completed an anonymous questionnaire gathering demographic/socioeconomic features as well as school, behavior and health-related difficulties, and adolescent's assent to participate with perceived parents' consent (APC) if they were contacted for a confidential non-anonymous survey at home. Such a survey received an APC of 60%. The logistic model including all socioeconomic factors and school, behavior and health-related difficulties showed that the adolescents with APC were less often male (adjusted odds ratio = 0.77, p = 0.014), non-European immigrant (0.48, p = 0.016), living with a single parent (0.72, p = 0.046), in manual-worker families (0.69, p = 0.007), had less often low parents' education (0.70, p = 0.002), body-mass-index measurement refusal (0.60, p = 0.010), no regular physical/sports activity (0.70, p = 0.035), poor social relationships (0.73, p = 0.046) and poor living environment (0.63, p = 0.007). The percentage of subjects with APC steadily decreased with the number of these criteria: from 74% for 0 criterion to 19% for 6-8 criteria. Because of these possible strong participation biases the construction of adolescent cohorts and the results interpretation should be made with prudence.

Health-related determinants of undiagnosed arterial hypertension: a population-based study.

BACKGROUND: Undiagnosed arterial hypertension is frequent. Whether it is associated with gender and the absence of cardiovascular-disease warning signs is unknown. Knowledge of the features of undiagnosed-hypertension subjects may help their identification in primary care. OBJECTIVE: To examine whether gender, alcohol consumption, smoking status, health status, cardiovascular diseases/diabetes, familial hypertension history, anti-cholesterol treatment, GP-consultation frequency, body mass index (BMI), waist circumference and metabolic measurements were associated with having undiagnosed hypertension among hypertensive subjects. METHODS: This population-based study included 281 hypertensive adults (aged 50-76 years): 222 subjects with diagnosed and treated-hypertension and 59 undiagnosed-hypertension subjects (no hypertension history, office and 24-h ambulatory blood pressures ≥140/90 and ≥130/80 mmHg, respectively). Subjects' characteristics, clinical and biological measurements, health problems and blood pressures were collected. Data were analyzed using adjusted odds ratios (OR) computed with multivariable logistic regression models. RESULTS: Undiagnosed-hypertension represented 21% of hypertensive subjects. Multivariable logistic regression modeling showed that five risk factors were associated with undiagnosed-hypertension among hypertensive subjects: male gender (OR = 4.61, P < 0.001), no cardiovascular diseases/diabetes (OR=8.51, P < 0.001), no familial hypertension history (OR = 3.15, P = 0.002), number of GP consultations per year (3+, 1-2, and 0; OR = 3.18 per 1-category increase, P < 0.001), and lower waist circumference (OR = 1.05 per 1-cm decrease, P = 0.002). Living alone, alcohol consumption, health status, anti-cholesterol treatment, BMI, and blood glucose were also significant factors (P < 0.05) in bivariate analysis. CONCLUSION: Undiagnosed-hypertension subjects exhibit specific features associated with their hypertension awareness. These findings help understand undiagnosed-hypertension risk patterns and enable better identification of affected subjects for lifestyle management and care.

Association between abdominal adiposity and 20-year subsequent aortic stiffness in an initially healthy population-based cohort.

BACKGROUND: Aortic stiffness is a feature of arterial aging and is associated with dismal cardiovascular prognosis. We examined whether central and general adiposity is an independent predictor of accelerated aortic stiffening 20 years later in initially healthy midlife individuals. METHODS: Participants from the STANISLAS cohort study (826 initially healthy participants aged 30-60 from the Lorraine region in France) underwent clinical and biological measurements at baseline (1994-1995) and after ≈20 years (2011-2016). Adiposity measurements included waist circumference/BMI ratio, BMI, waist circumference, and 'body shape index' [waist circumference/(BMI height)]. Real carotid-femoral pulse wave velocity (cfPWV) was measured at end of follow-up. Our primary analysis was to test the association between waist circumference/BMI ratio and cfPWV. RESULTS: In a multiple linear regression model adjusted for sex, age and mean arterial pressure, waist circumference -to-BMI ratio was positively associated (for 1SD increase) with higher cfPWV [regression coefficient ß = 0.32, 95% confidence interval (CI) 0.19-0.45, P < 0.001]. The cfPWV was less strongly associated with body shape index (ß = 0.17, 95% CI 0.022-0.32, P < 0.05) and negatively associated with BMI (-0.20, 95% CI -0.31 to -0.093, P < 0.001) and waist circumference (-0.14, 95% CI -0.28 to 0.00, P < 0.05). Sensitivity analyses demonstrated that the risk of cfPWV associated with waist circumference-to-BMI ratio remained significant after adjustment for heart rate, metabolic risk factors and inflammatory markers. CONCLUSION: Central adiposity (and more specifically waist circumference-to-BMI ratio) is an independent predictor of 20-year subsequent aortic stiffness in initially healthy midlife subjects.

Obesity and metabolic features associated with long-term developing diastolic dysfunction in an initially healthy population-based cohort.

BACKGROUND: Diastolic dysfunction (DD) is increasingly common. However, its metabolic determinants are poorly known. This study aims to determine which metabolic and inflammatory features predict DD in initially healthy adults. METHODS: We prospectively analyzed the association between metabolic features and DD in 728 initially healthy adults aged 30-60 from Eastern France enrolled in the STANISLAS population-based cohort. Clinical and biological cardiovascular features were collected at baseline (1994-1995). DD was assessed twenty years later (2011-2016) by echocardiography using current international guidelines. For replication purposes, 1463 subjects from the Malmö Preventive Project cohort were analyzed. RESULTS: In the STANISLAS cohort, 191 subjects (26.2%) developed DD. In age-sex-adjusted logistic models, significant predictors of DD were body mass index (BMI, odds ratio for 1-standard-deviation increase (OR) 1.28, 95% CI 1.08-1.52), waist circumference (WC, OR 1.48, 95% CI 1.18-1.84), waist-hip ratio (OR 1.53, 95% CI 1.16-2.02), systolic blood pressure (OR 1.19, 95% CI 1.00-1.43) and triglycerides (TG, OR 1.18, 95% CI 1.00-1.40). Subjects with elevated WC (> 80th percentile) and TG (> 50th percentile) had a twofold higher DD risk (age-sex-adjusted odds ratio 2.00, 95% CI 1.20-3.31, P = 0.008), whereas no such interplay was observed for BMI. In the Malmö cohort, BMI was similarly associated with DD; participants with both elevated BMI and TG were at higher DD risk (age-sex-adjusted odds ratio 1.61, 95% CI 1.18-2.20, P = 0.002). CONCLUSIONS: Subjects with elevated WC and TG may have a higher long-term DD risk. Prevention targeting visceral obesity may help reduce the incidence of DD.

Variations in perceived primary healthcare access across family structures and their predictors in adolescents.

Families have greatly changed over time and little is known about primary care access barriers for adolescents associated with family type. We assessed family disparities in lack of listening and treatment explanations (LLTE) by general practitioners (GP), lack of treatment adherence (LTA) and GP change and the confounding roles of socioeconomic factors, school, behaviour and health difficulties among 1559 middle-school-aged (9.9-18.8 years old) adolescents who completed a questionnaire on sex, age, socioeconomic characteristics (family structure, nationality, parents' occupation, education and income), school performance, substance use, physical health, psychological health, social relationships, living environment, LLTE by GPs, LTA and GP change. Data were analysed using logistic regression models. LLTE, LTA and GP change affected 22.3, 38.0 and 7.3% of subjects respectively. Compared with the adolescents living in intact families, and controlling for sex and age, those with separated or divorced parents or reconstructed families and those with single parents respectively had 1.58- and 1.96-times higher LLTE risk and 1.48- and 1.72-times higher LTA risk. Adolescents with separated or divorced parents or reconstructed families had 1.92-times higher GP-change risk. Socioeconomic factors explained 16-36% of LLTE or LTA risks, but not GP-change risk. Further considering school, behaviour and health difficulties explained 55-87% of LLTE or LTA risks and 27% of GP-change risk. In conclusion, changes in family situations may have produced more non-intact families and adolescents with greater socioeconomic, school, behaviour and health difficulties. These factors are strong barriers to primary care access and may warrant prevention targets for adolescents, their parents, schools and GP.