Community- and individual-level risk factors of past month e-cigarette use among adolescents in France.

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 départements (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 département-level variation in both outcomes, with a considerable proportion of this variation explained by département-level factors. Net of numerous significant individual-level covariates, département-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 département-level percentage of adolescents using conventional tobacco daily was associated with individual-level any (OR=1.029, p < .001) and daily (OR=1.033, p < .01) e-cigarette use. Predicted probabilities demonstrate that département-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.

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.

Doping among high school students: findings from the French ESPAD survey.

BACKGROUND: The increasing use of doping by youth is a growing public health concern. The present study aimed to calculate robust estimates of the prevalence of doping among French high school students and study factors related to the use of licit vs. banned agents. METHODS: The European School Project on Alcohol and other Drugs (ESPAD), a nationally representative school-based survey, was distributed across France from April to May 2015, generating a final sample size of 6642 students. Multilevel modelling was used to examine covariates of doping to enhance athletic performance in sport in this population. RESULTS: Overall, 2.3% of students used banned agents, and 6.1% used licit and banned substances to improve athletic performance. Significant gender differences existed for both, with males more prone to doping than females. Our findings provide support for the existing gateway hypothesis that nutritional supplementation leads to doping banned agents. Multilevel modelling revealed the presence of both school and class-level influences on individual use of licit substances, vs. solely class-level factors impacting the use of banned agents, suggesting a strong peer-effect. CONCLUSIONS: These findings support the need to engage in early doping prevention through high schools. Programmes should draw attention to the role of licit substances, including nutritional supplementation, in the progression to using banned agents and encompass the continuum of adolescent risk taking through a behaviour-based approach to doping prevention.

On the question of non-medical cognitive enhancers among in-school adolescents: prevalence, predictors and potential health-related harms.

Little is known about the use of non-medical cognitive enhancers (NCEs) in the general population, and even less among youth. The study utilises a nationally representative, cross-sectional survey of adolescents attending high schools to provide a comprehensive overview of NCEs and to assess risk factors such as socio-demographics, schooling, mental health and related substance use among French adolescents. A total of 6692 students attending high school (secondary schools) answered an anonymous questionnaire collecting information on demographics, health, psychoactive substance uses (neuroleptics, tobacco, alcohol, cannabis, illicit substances) and patterns of sociability. The use of cognitive enhancers appears to be an underestimated phenomenon among youth. Prevalence of use is heavily gender-influenced, with females twice as likely to use NCEs than males. More than daily school commitments, the use of cognitive enhancers is related to the proximity of the national secondary education examination. Moreover, mental health, use of prescribed anxiolytics and other psychoactive substances are significantly independently associated with the use of cognitive enhancers, particularly among females. The unregulated use of cognitive enhancers is a predictor of potential mental frailty and a substance-based response to stressful events, a behaviour likely to persist during adulthood. The study underpins the lack of contextual and comparable data. Systematic monitoring of younger students in neighbouring countries is required to develop reliable prevention programmes.

Revisiting Factors Associated With Screen Time Media Use: A Structural Study Among School-Aged Adolescents.

BACKGROUND: Screen-based media overuse has been related to harmful consequences especially among children and adolescents. Given their complex interrelationships, predictors of screen time (ST) should be analyzed simultaneously rather than individually to avoid incomplete conclusions. METHODS: Structural equation models were conducted to examine associations between media ST (television, video games, and computers) along with harmful consequences in adolescents' well-being, such as underweight and overweight, depression, and school failure. Predictors included individual (gender, age, and physical activity), family (structure and socioeconomic background), and substance use variables. We used the Health Behaviour in School-aged Children survey organized in 2014, including eighth- and ninth-grade students living in France (N = 3720). RESULTS: Students reported spending 3 hours per day in front of each media. Spending more than 2 hours behind each of those 3 media was associated with lower life satisfaction, less physical activity, active school bullying, and grade repetition. Socioeconomic status was the most important predictor of ST, whereas regular substance uses showed modest associations. CONCLUSION: The main implication of our findings is to sensitize parents and stakeholders about the limitation of ST, including their own use that adolescents are likely to mimic. Alternative measures such as off-line time should be encouraged.

Opposite social gradient for alcohol use and misuse among French adolescents.

BACKGROUND: This study investigates the association of the family occupational category (F-OC) with adolescent alcohol use and its potential variation according to the frequency of use. METHODS: A national survey representative of adolescents aged 17 living in continental France conducted in 2005 (n = 29,393). Three outcomes were considered: overall use describes the drinking status (lifetime abstinence, use before the month prior the survey, use in the month prior the survey) without considering the frequency of use; last month use and binge drinking detail the frequency of use (1-5 uses, 6-9, 10-19 and 20+ uses) and of binge drinking (0, 1-2, 3-5, 6+ episodes of 5+ glasses in a single occasion) of the previous month users. F-OC was described in 7 categories based on the highest occupational category of the parents (from managers/professionals to unemployed). Analysis used generalised logistic regressions, controlling for gender, F-OC, parental separation, autonomy, other substance use, being out of school and sociability. RESULTS: There was a double gradient: adolescents from high F-OC families were more often experimenters and drinkers during the previous month whereas those of low F-OC families were more often binge drinkers. Adolescents from farmers' families were the most at risk for frequent use and binge drinking in the last month. Interactions tests show that the effect of F-OC was not significantly related to gender. CONCLUSIONS: Except for gender, adolescents' patterns of use reflect those observed in the adult population. Mechanisms that favour and hinder progression in alcohol use should be studied in various socioeconomic groups.

Influence of cannabis use trajectories, grade repetition and family background on the school-dropout rate at the age of 17 years in France.

BACKGROUND: Research has shown that cannabis use contributes to school dropout, but few studies have distinguished the age at onset of use from the age at progression to daily use neither their interaction with grade repetition. METHODS: This study is based on a French representative cross-sectional survey (N = 29,393 teenagers aged 17 years) and uses retrospective data. The influence of drug-use patterns <16 years of age on school-dropout rates (5.3%) are modelled with logistic regressions among boys and girls. RESULTS: The main factors associated with dropout were a low family socio-economic status, early grade repetition, single-parent families and daily tobacco smoking (ORa > or = 2.6). The link with the move to daily cannabis use was more evident when it occurred <14 years of age (ORa = 2.05 for boys and 3.41 for girls) rather than at > or =15 years (ORa = 1.45 for both sexes). The onset of cannabis use was not significant when occurring <14 years of age, but was linked to school attainment when occurring at age 15-16 years (ORa = 0.80 for boys and 0.64 for girls). Results are similar for alcohol use. Repeating a grade before beginning to use cannabis increased the dropout rates compared with the opposite sequence. Girls were more affected by early grade repetition and by early and daily cannabis use. CONCLUSION: Cannabis use is rarely a trigger for grade repetition but can have either damaging or positive effects on school attainment depending of the level of use. Positive social competence reflected by peer initiation should be investigated to understand this paradoxical effect.

Violence risks in nursing--results from the European 'NEXT' Study.

BACKGROUND: Recent research suggests that violence in health care is increasing and that it strongly influences the recruitment and retention of nurses as well as sick leave and burnout levels. AIMS: To identify the prevalence of violence in nursing and to provide a basis for appropriate interventions. METHODS: Nurses from 10 European countries answered to a questionnaire and to a follow-up assessment. Stepwise adjusted multiple logistic regression was used to assess the association between frequency of violence, factors related to teamwork and other work-related factors and outcomes, such as burnout, intention to leave nursing and intention to change institution. RESULTS: A total of 39,894 nurses responded to the baseline questionnaire (51% response rate). After adjustment for age, gender and other risk factors, quality of teamwork appeared to be a major factor with odds ratio (OR) 1.35 (1.24-1.48) for medium quality and 1.52 (1.33-1.74) for low quality. Uncertainty regarding patients' treatments was linked with violence, with a clear gradient (OR 1.59, 1.47-1.72 for medium uncertainty and 2.13, 1.88-2.41 for high uncertainty). Working only night shift was at high risk (OR 2.17, 1.76-2.67). High levels of time pressure and physical load were associated with violence OR 1.45 (1.24-1.69) and 1.84 (1.66-2.04), respectively. High and medium frequency of violence was associated with higher levels of burnout, intent to leave nursing and intent to change institution. A 1-year follow-up assessment indicated stability in the relationships between outcomes. CONCLUSION: This study supports efforts aimed at improving teamwork-related factors as they are associated with a decrease in violence against nurses.

The impact of social work environment, teamwork characteristics, burnout, and personal factors upon intent to leave among European nurses.

OBJECTIVES: Europe's nursing shortage calls for more effective ways to recruit and retain nurses. This contribution aims to clarify whether and how social work environment, teamwork characteristics, burnout, and personal factors are associated with nurses' intent to leave (ITL). METHODS: Our sample comprises 28,561 hospital-based nurses from 10 European countries. Different occupational levels have been taken into account: qualified registered nurses (n = 18,594), specialized nurses (n = 3957), head nurses (n = 3256), and nursing aides and ancillary staff (n = 2754). RESULTS: Our outcomes indicate that ITL is quite prevalent across Europe, although we have found some differences across the countries depending on working conditions and economic situation. Quality of teamwork, interpersonal relationships, career development possibilities, uncertainty regarding treatment, and influence at work are associated with nurses' decision to leave the profession across Europe, notwithstanding some country-specific outcomes. A serious lack of quality of teamwork seems to be associated with a 5-fold risk of ITL in 7 countries. As far as personal factors are concerned, our data support the hypothesized importance of work-family conflicts, satisfaction with pay, and burnout. A high burnout score seems to be associated with 3 times the risk of ITL in 5 countries. CONCLUSIONS: To prevent premature leaving, it is important to expand nurses' expertise, to improve working processes through collaboration and multidisciplinary teamwork, and to develop team training approaches and ward design facilitating teamwork.

[Factors associated with violence against healthcare workers: results of the European Presst-Next study]. / Facteurs liés aux épisodes violents dans les soins: résultats de l'enquête européenne Presst-Next.

INTRODUCTION: The respective roles of medical specialties and work organization on violent events against healthcare workers (HCW) in different countries was examined. METHODS: Using the results of the Presst-Next study, we analyzed data from 27134 HCW in 7 European countries. Multivariate logistic analyses were conducted with SPSS 12 software. RESULTS: After adjustment for age, gender and other occupational risk factors, the factors indicating insufficient team work were highly associated with an increased risk of violent events. Dissatisfaction with shift change (OR=1.35; 95%CI 1.23-1.47), uncertainty about treatment (OR=1.57; 95%CI 1 .44-1.71), and frequent interruptions (OR=2.04; 95%CI 1.81-2.31) were linked to violent events, up to twice the number among HCW reporting better team work. Contradictory orders, dissatisfaction with psychological support, and harassment by superiors were all significantly associated with increased reporting of frequent violent events. We observed a positive gradient between violent events and job demand (time pressure) (OR=1.25 for an intermediate score and OR=1.55 for a high score, compared with a low score). Loneliness at work, certain work schedules, and physical load increased the risk. Nurses' aides were exposed to violent events more often (OR=1.57; 95%CI 1.38-1.79) than head nurses. Older HCW and those with more experience were less exposed. The highest risks were associated with working in psychiatric (OR=4.89; 95%CI 3.82-6.25) and emergency (OR=2.68; 95%CI 2.10-3.44) departments, compared with home care and day care. The excess risk was an additional 30% in geriatrics and long-stay departments. Significantly less risk was observed in pediatrics, obstetrics and gynecology departments (OR=0.70; 95%CI 0.56-0.88). CONCLUSION: Team building requires time, and shift change is a key period. This time is far from nonproductive. Rather, its effective use reduces treatment errors, enhances quality of care, and reduces the frequency of violent events. It is crucial in every department.

[Health behavior of healthcare personnel: The European Presst-Next Study]. / Comportements de santé du personnel soignant: Résultats de l'étude européenne Presst-Next.

OBJECTIVES: The objective of the NEXT (Nurses' Early Exit) study was to identify the organizational and health factors in the 10 participating countries associated with job satisfaction of nurses and nurses' aides or with their desire to change occupation or stop working prematurely. METHODS: Questions about health were somewhat more detailed in the French version of the questionnaire and allowed us to determine health behaviors of this representative sample of French caregivers (PRESST: Promotion of Health and Job Satisfaction of European Healthcare Workers [www.next-study.net; www.presst-next.fr]). RESULTS: Of the 6980 (796 men and 6184 women) nurses and nurses' aides studied in late 2002 and early 2003, 32.6% reported that they smoked at least occasionally and 24.3% regularly. Only 24.4% of the staff in our sample exercised at least weekly. Overweight was observed in 27,6% of the sample, mostly women (42% of men and 24.7% of women), and obesity affected 6,4% of men and 7% of women. Overweight was slightly less frequent than among the general adult population of France, 39.8% according to the CREDES SPS survey in 2002, but these healthcare workers were younger. On the whole, burnout was higher among French caregivers than among those from other European nations in the Next study. CONCLUSION: This study demonstrates the need to conduct and assess interventions for the dual purpose of (1) reducing the morbidity and mortality associated with the conditions most sensitive to these risk factors in healthcare personnel and (2) improving their knowledge, motivations and credibility in providing health education to patients.