[Cannabis cessation interventions offered to young French users: predictors of follow-up]. / Facteurs prédictifs de suivi des jeunes fumeurs de cannabis consultant pour sevrage.

INTRODUCTION: Cannabis use is very problematic among young French people, because of the young age of first consumption and its health consequences. Indeed, the average age of cannabis experimentation is about 15 in France and 49.5% of 17 year-olds report having used cannabis in their lives. To prevent this problem, tobacco and cannabis cessation services are dedicated to handle patients who want to stop tobacco and/or cannabis. Moreover, in 2004, specific medical outpatient services have been implemented to address the problem of young cannabis users. Since their establishment, some studies have reported demographic and clinical characteristics of the patients attending these services, but we still lack data on their follow-up and their medical and psychological care. OBJECTIVE: The aim of this study is to describe the clinical and psychiatric characteristics of young patients referred to tobacco/cannabis cessation consultations or specific young cannabis users' consultations and to evaluate their medical care and monitoring. PATIENTS AND METHODS: We designed a retrospective study in seven cessation clinics in the Paris area between 2005 and 2007. Eligible patients were regular cannabis users aged under 40. An electronic medical database was completed using patients' medical records. Medical files reported demographic and clinical data. Psychiatric disorders were assessed using the HAD and the Beck scores. Nicotine dependence was evaluated by Fagerström's score. The history of addictions, and data about consumption of cannabis, tobacco, alcohol and other drugs were recorded in the medical file. The follow-up of patients was defined by having at least two visits at the medical outpatient services. Tobacco and cannabis cessations were assessed at one-month follow-up. Univariate and multivariate logistic models were used to assess factors associated with patients' follow up and monitoring. RESULTS: Four cessation clinics accepted to participate in our study. One hundred and eight eligible patients were listed during the study period. One hundred and eleven patients (75%) were males and seventy-nine (53%) were employed. The average age of patients was 26 years old (±6.8). Fifty patients (34%) came to the clinic on their own decision, thirty-three (22%) were referred by a hospital and twenty-eight (19%) came because of their family's advice. The mean age of first cannabis consumption was 16 years old (±7.3) and cannabis consumption was most often associated with tobacco use. Fifty-nine percent of patients had anxiety disorders and 28% had depression according to D-HAD score. The dropout rate after first visit was about 40%. The most frequent therapy proposed to young cannabis users was nicotine replacement therapy. Follow-up data were collected for 135 patients and only 85 (37%) patients made at least two visits at the outpatient services. The average number of consultations was five (±3.8). Multivariate analysis found an association between follow-up and previous cannabis cessation (P=0.04), pharmacological treatment of tobacco withdrawal (P=0.04), and antidepressant treatment (P=0.04). Only one quarter of patients had quit cannabis and/or tobacco at one-month follow-up. DISCUSSION: This study describes clinical characteristics of patients attending cannabis consultations in France. As reported in other studies, anxiety disorders and depression are important problems in this population and should be considered during their medical care. The efficacy of specific French medical outpatient services is difficult to evaluate because of the high rate of dropout. Some patients' characteristics seem linked to their monitoring but other studies should be assessed to confirm these results. As pharmacological treatments seem associated with patients' follow-up, new research should be implemented to develop therapeutic solutions for cannabis addiction.

[Identifying addictive behaviors among adolescents: a school-based survey]. / Repérer les comportements addictifs chez les adolescents : enquête en milieu lycéen.

French epidemiological data show that adolescents today experiment with tobacco at an earlier age than in the 1990s. Half of them combine tobacco consumption with other psychoactive products such as alcohol or cannabis. Tobacco consumption usually begins in adolescence and early smoking initiation is related to stronger nicotine dependence and problems quitting in adulthood. Occasional tobacco consumption rapidly leads to nicotine dependence. The national smoking cessation questionnaire is a tool to assess addictive behaviors among adolescents. It includes validated scales such as the loss of autonomy over tobacco and psychological evaluation. The aim of this school-based study was to assess addictive behaviors among adolescents (specifically loss of autonomy over tobacco) and psychological profile. Data were collected from a cross-sectional study conducted in a high school in the Paris metropolitan area (Nogent-sur-Marne) in 2007 by the smoking cessation team of the Albert-Chenevier Hospital. Three hundred adolescents filled in a questionnaire concerning tobacco, alcohol, and cannabis consumption as well as their psychological profile. Loss of autonomy over tobacco use was evaluated with the Hooked on Nicotine Checklist (HONC). Anxiety and depressive disorders were identified using the Hospital Anxiety and Depression scale (HAD). Self-administered questionnaires were anonymously completed in the classroom by 151 girls and 149 boys aged 15-16 years (mean, 15.4 years): 34% of the adolescents smoked and most of them smoked at least one cigarette a day; 38% had used cannabis at least once in their life and one-third of them smoked more than 10 cannabis joints per month. Adolescents who frequently smoked cannabis had started smoking tobacco earlier than the other smokers (mean, 11.7 years versus 13.2 years). Adolescents often used different tobacco products. Manufactured cigarettes were the most frequently used, followed by shisha (waterpipe) and hand-rolled cigarettes. Among those who only smoked shisha, 76% had declared being non-smokers. Alcohol was the first psychoactive drug experimented by these adolescents; 73% had used alcohol at least once in their life and 10% used alcohol several times a week. According to the HONC, 94% of the smokers had lost control of their tobacco consumption. Concerning anxiety and depressive disorders, anxiety and depression scores were higher among smokers than non-smokers. Less than 6% of never-smokers had a depression score greater than 8 compared to 26% of adolescents smoking cannabis more than 10 times a month. The rapidity of the loss of autonomy among young smokers emphasizes the need for early interventions for tobacco prevention and cessation among adolescents. Tobacco use was often associated with anxiety and depressive symptoms, suggesting a need for professional support. The national smoking cessation questionnaire may be helpful in pediatric wards and consultations.

Trends in the profile of smokers registered in a national database from 2001 to 2006: changes in smoking habits.

OBJECTIVE: In 2001, an electronic medical record system was designed to collect data from smoking cessation services in France. By comparing two periods (2001-2003 and 2004-2006), this study assessed trends in the profile of smokers registered in the database. STUDY DESIGN: A cross-sectional analysis on the 33,219 smokers registered in the database in 2001. METHODS: Sociodemographic details, psychological and medical history, and characteristics of tobacco consumption at baseline were examined. RESULTS: The proportion of young smokers increased from 5.1% to 6.9%, and the proportion of underprivileged smokers increased from 9.3% to 10.9% between 2001-2003 and 2004-2006 (P<0.0001). The medical profile was unchanged, with about 37% of cases with tobacco-related diseases and 31% of cases with past depressive episodes in 2001-2003 and 2004-2006. The main finding was an increase in the mean concentration of carbon monoxide (CO) in expired air [from 18.8 parts per million (ppm) (SD 14.4) to 23.5 ppm (SD 14.1)], despite a decrease in the number of cigarettes smoked per day. The concentration of CO per cigarette also increased from 0.9 (SD 0.9) to 1.3 (SD 1.4). CONCLUSION: As the number of cigarettes smoked per day decreased, the increase in mean concentration of CO per cigarette implies that increases in cigarette prices may have led to new smoking habits and/or compensatory smoking.

[Characteristics of smoker adolescents seeking smoking cessation services]. / Caractéristiques des adolescents fumeurs s'adressant aux consultations de tabacologie.

UNLABELLED: In France, the prevalence of tobacco consumption is 31% for teenagers between 15 and 19 years old. Nevertheless, few French studies have been published on the characteristics of young smokers seeking smoking cessation services. The development of smoking cessation centres in France since 1999 was associated to the setting up of a e-transfer system in order to evaluate the adequacy between these services and the needs of smokers. OBJECTIVE: To analyse the characteristics of smokers aged less than 19 years registered in the smoking cessation services national database. METHODS: A cross-sectional population-based study has been conducted in the smoking cessation services participating in the national database. The study population included 321 young smokers attending the smoking cessation centres during the period 2001-2005. RESULTS: The 321 smokers (mean age 16.6 years) were mostly girls (56.4%). A background of depression was declared by 19% of young smokers and an abnormal result was found for the hospital anxiety depression-screening test among 34% of the population for the anxiety scale and 6% for the depression scale. Mean daily tobacco consumption was 15.3 cigarettes per day and heavy nicotine dependence was found for 24.1% of the population. A nicotine replacement therapy was prescribed for every smoker. CONCLUSION: Nicotine dependence was heavy for 24.1% of the 321 young smokers seeking smoking cessation services. More than 1/3 had an abnormal result for the hospital anxiety depression-screening test. Tailored interventions for smoking cessation should be available for adolescent's smokers, especially school-based services.

Sleep effects of a 24-h versus a 16-h nicotine patch: a polysomnographic study during smoking cessation.

BACKGROUND AND PURPOSE: Sleep disturbance is a common symptom of tobacco withdrawal and might contribute to early relapse vulnerability in abstinent smokers. This study was designed to compare the effects on sleep of nicotine patches applied either for 24 h (Nicopatch) or 16 h (Nicorette). PATIENTS AND METHODS: During a short smoking cessation period (48 h), this open-label, randomised, two-period crossover study compared the effects on sleep of the two nicotine patches in 20 heavy smokers (9 women, 11 men). During each period, polysomnographic recordings were performed from 12 pm to 7 am for two consecutive nights (baseline and treatment nights). Smoking cessation started from 8 pm the day of the baseline sleep recordings, and treatments were applied around 8 am the following morning. RESULTS: Compared to the 16-h nicotine patch, smokers who received the 24-h nicotine patch experienced significantly less microarousals, a greater proportion of slow wave sleep, a higher REM density and higher rapid eye movement (REM) beta activities. CONCLUSIONS: The results of this study suggest that a 24-h nicotine patch is more efficient than a 16-h nicotine patch to alleviate tobacco withdrawal-induced sleep disturbances.

Ability of a new oral nicotine substitute to reduce smoking urge in moderate smokers.

The aim of this study was to assess the effectiveness of a new nicotine lozenge ( Nicopass 1.5 mg) in reducing smoking urge after an overnight abstinence. Twenty-four moderate smokers participated in a randomized, double-blind, placebo-controlled, 2-period crossover trial. The results showed that 1.5 mg-nicotine lozenge is superior to placebo in reducing smoking urge (p = 0.0001). In addition, nicotine lozenge, but not placebo, significantly improved vigilance and psychomotor performances (p < 0.05) and displayed a cardiac chronotropic effect. Thus, the 1.5-mg nicotine lozenge appears as an effective aid to alleviate acute tobacco withdrawal symptoms in moderate smokers.

[Chewing tobacco. An emerging habit among adolescents]. / L'utilisation du tabac à chiquer. Une pratique émergente chez les adolescents.

INTRODUCTION: In France, unlike in the United States and Scandinavia, the use of "smokeless tobacco" (also called "chewing tobacco") was rare, but this habit is starting to expand, especially in the world of sports. At ski championships, for example, it is used as a doping agent. Adolescents in mountain areas are now imitating their competitive-skiing peers. CASE: A 16-year-old girl living in a ski resort became addicted to the tobacco paste, "Snuss", and consumed 15-20 doses of Snuss daily, together with a dozen cigarettes. DISCUSSION: "Smokeless tobacco" is emerging as a habit in France, its use encouraged by its discretion, low cost, and rapid induction of addiction. Its growth in Alpine areas requires the urgent development of impact studies to facilitate the organization of information campaigns to treat and prevent its use.

Smoking cessation guidelines: evidence-based recommendations of the French Health Products Safety Agency.

Tobacco use is the leading preventable cause of death in developed countries. Millions of smokers are willing to stop, but few of them are able to do so. Clinicians should only use approaches that have demonstrated their efficacy in helping patients to stop smoking. This article summarizes the evidence-based major findings and clinical recommendations for the treatment of tobacco dependence of the French Health Products Safety Agency (AFSSAPS). Clinicians should enquire about the smoking status of each patient and provide information about health consequence of smoking and effective treatments available. These treatments include counseling (mainly individual or social support and behavioral and cognitive therapy) and pharmacological treatment with either nicotine replacement therapy (NRT) or bupropion LP. Pharmacological treatments should be used only for proven nicotine dependence, as assessed by the Fagerstrom test for Nicotine Dependence. The choice of pharmacologic treatment depends of the patient's preference and history and of the presence of contra-indications. The clinician should start with a single agent, but these treatments may be used in combination. Smoking behavior is a chronic problem that requires long-term management and follow-up. Access to intensive treatment combining pharmacological treatment and extensive behavioral and cognitive therapy should be available for highly dependent patients.

Efficacy of bupropion and predictors of successful outcome in a sample of French smokers: a randomized placebo-controlled trial.

BACKGROUND: Previous published studies assessed the efficacy of bupropion in smoking cessation only in North American populations of smokers. Results of therapeutic drug trials are not always directly applicable in other populations. AIMS: To confirm the efficacy of bupropion in smoking cessation in European smokers. DESIGN: A multi-centre, randomized, double-blind placebo-controlled trial. SETTING: Seventy-four smoking cessation out-patient clinics in France. PARTICIPANTS: The study included 509 smokers motivated to quit smoking. Intervention Subjects were randomized to either slow-release bupropion 150 mg b.i.d. (B) or to placebo (Pl) in a 2 : 1 ratio, treated for 7 weeks, and followed-up for 26 weeks. MAIN OUTCOME MEASURE: 6 months' point prevalence abstinence, determined by self-report and expired air carbon monoxide measurement. SECONDARY OUTCOME MEASURES: weeks 4-7 and weeks 4-26 continuous abstinence rates, craving, withdrawal symptoms, weight and cigarette consumption in smokers unable to quit. Adverse events were recorded systematically. FINDINGS: Six months' point prevalence abstinence rates were 31% and 16%[odds ratio = 2.3, confidence interval (CI) 95%: 1.4-3.7] in the B and Pl groups, respectively. Continuous abstinence rates were 41% (B) and 21% (P) with OR = 2.5 (CI 95%: 1.6-3.9) for weeks 4-7, and 25% (B) and 13% (P) with OR = 2.2 (CI 95%: 1.3-3.6) for weeks 4-26, respectively. Craving decreased significantly more with B than with Pl during treatment period, but there was no difference for total withdrawal symptoms score. Abstinent subjects gained significantly less weight at week 7 with B than with Pl. Low level of nicotine dependence, high motivation, absence of smoking-related disease, long duration of previous quit attempts, male gender, low level of current alcohol problems and living as a couple were predictive of successful cessation. With the exception of marital status, no interaction was observed between any of these predictive factors and the efficacy of bupropion. More of those who continued smoking in the B group than the P group reduced their consumption by at least 50%. CONCLUSIONS: Sustained-release bupropion is efficacious as an aid to smoking cessation in European smokers. No outcome predictors were identified that might indicate that certain subgroups of smokers would benefit more than others from treatment with bupropion.

[Usefulness of biological markers in evaluation of smoking]. / Intérêt des différents marqueurs biologiques dans l'évaluation du tabagisme.

Tobacco exposure can be assessed by the measurement of several markers in biological fluids. These markers are more or less specific for tobacco and the different methods to measure them out differ in terms of sensibility, specificity, ease of use and cost. The clinician prescribing a dosage for a patient has to take all these parameters into account to make an accurate choice. In this article, we have analysed the usefulness of the main biological tobacco markers in the follow-up of smokers and compared their methods of dosage. We propose several indications and point out the interest of relevant markers to realize objective measurements of smoking habits.

Nicotine protects rat brain mitochondria against experimental injuries.

Epidemiological studies have reported that cigarette smoking may protect from neurodegenerative diseases such as Parkinson's disease. These protective effects are thought to be mediated by nicotine. Recent data showed that nicotine significantly decreases respiratory control ratio (RCR) and superoxide anion generation of brain mitochondria. Thus, we investigated nicotine effects on rat brain in two experimental models: first, an in vitro anoxia/reoxygenation experiment and secondly, an in vivo rotenone-induced Parkinson-like syndrome. Anoxia/reoxygenation impaired mitochondrial respiration by 43.68% whereas in the presence of nicotine, it was less impaired, by 31.1% at 10(-7) M. In rats chronically administered rotenone (3 mg/kg/day), we observed profound mitochondrial damage: the RCR decreased by 50.36% and the superoxide anion generation and the membrane anisotropy increased by 56.03 and 13.43%, respectively. All of these indications of mitochondrial damage were limited by chronic administration of nicotine. Nicotine developed mitochondrial effects in vivo and in vitro at very low concentration. All these results were in accordance with epidemiological studies, which report a protective effect of nicotine in neurodegenerative diseases. Thus, we propose that one effect of nicotine is to preserve mitochondrial functions of the rat central nervous system.