Predictors of concurrent heroin use among patients on opioid maintenance treatment in France: a multilevel study over 11 years.

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.

An overview of tobacco use in France: Observed trends and new challenges / État des lieux de la situation du tabagisme en France : tendances observées et nouveaux enjeux

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.

Cet article fait le point sur les évolutions en matière de consommation de tabac et de produits de vapotage, en France, depuis une trentaine d'années, et les enjeux qu'elles soulèvent pour les pouvoirs publics, en termes de prévention et de prise en charge des conséquences sociosanitaires. Produit d'une analyse conjointe de Santé publique France (SpF) et de l'Observatoire français des drogues et des tendances addictives (OFDT), il montre d'abord un « tournant générationnel ¼ dans la consommation de tabac et les représentations sociales de la cigarette depuis le milieu des années 2010, avec un recul marqué de l'expérimentation parmi les adolescents, qui est devenue à la fois moins courante et plus tardive, ce qui était un des objectifs des plans nationaux de réduction du tabagisme successivement mis en place depuis 2014. Le tabagisme reste néanmoins assez stable parmi les adultes, prédominant chez les hommes, avec des écarts entre hommes et femmes qui se maintiennent depuis le début des années 2000. Au-delà du différentiel de genre, les disparités sociales de consommation restent importantes, parmi les jeunes comme à l'âge adulte. Cependant, si la prévalence du tabagisme ne progresse plus, celle du vapotage augmente, ce qui constitue un point d'attention dès lors qu'une partie de ces pratiques induit une consommation de nicotine. Cela induit également le risque d'une « renormalisation ¼ de l'acte de fumer, qui constitue un point de vigilance des autorités sanitaires, en France comme dans d'autres pays européens. L'analyse se conclut sur la nécessité de continuer à adapter le système d'information statistique et les enquêtes qualitatives pour permettre un suivi épidémiologique de la situation qui reste performant.

État des lieux de la situation du tabagisme en France : tendances observées et nouveaux enjeux.

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.

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.

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

BACKGROUND: Educational disparities in daily smoking begin during adolescence and can lead to educational disparities in health among adults. In particular, vocational students including apprentices have higher daily smoking rates compared to non-vocational students. This study aimed to identify the determinants of the gap in daily smoking between French apprentices and high school students aged 17 in 2008 and in 2017. METHODS: We used data from a cross-sectional repeated survey representative of all French adolescents aged 17 in 2008 and 2017. We conducted a non-linear extension of the Oaxaca-Blinder decomposition technique and included the following variables: sociodemographic and familial characteristics, parental smoking, cannabis and alcohol use, suicidal attempt, grade repetition and money received. RESULTS: Daily smoking was about two times higher among French apprentices compared to high school students in 2008. This gap did not decrease between 2008 and 2017. Differences in measured characteristics between the two groups explained this gap partly, from 28.6 to 51.2%. Cannabis and alcohol use, money received and parental smoking contributed the most to the daily smoking gap. CONCLUSIONS: Prevention programs could target cannabis and alcohol use as well as parental smoking to help decrease educational disparities in smoking status among French adolescents.

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.

Socialization instances linked to cannabis experimentation among French teenagers.

France presents one of the highest prevalence of teenagers aged 15-year-olds who report they already have experienced cannabis in Europe. Data from the French 2010 Health Behavior in School-aged Children (HSBC) survey and environmental parameters typifying schools' neighborhoods were used to study cannabis experimentation. We conducted a two-level logistic regression (clusters being schools) on 4,175 French 8th-10th graders from 156 schools. Several individual parameters were linked to cannabis experimentation. Living in a non-intact family, feeling insufficiently monitored, having poor communication with mother and being from a family with a high socio-economic status (SES) were all associated with increased risk of cannabis experimentation. At environmental level, only being in a priority education area was linked to this behavior, without explaining differences among schools.

Heavy episodic drinking among French adolescents between 2005 and 2022: decreasing prevalence rates and increased risks.

OBJECTIVE: 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 size comprises 179905 adolescents aged 17 (90166 males and 89739 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 parental household, socioeconomic status, and other substance (tobacco, cannabis, other illicit substances) use. 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.

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

BACKGROUND: Monitoring the prevalence of problematic cannabis use is an important public health issue. International surveys need invariant measurement tools to allow reliable comparisons across countries and between sexes. The Cannabis abuse screening test (CAST) has been developed for this purpose. This study is the first assessing its country and sex invariance in a sample of European pupils. METHODS: The data come from the self-administered questionnaires completed in 2019 by pupils aged 15-16 in the European school survey project (Espad). The analytical sample was restricted to the 17 countries where at least 300 pupils reported a previous-year cannabis use (n = 8740); multigroup confirmatory factor analyses were used to assess the configural, metric and scalar invariance of the CAST toward country and sex in the 2019 Espad release. RESULTS: Configural, metric and scalar invariance toward country hold for the 17 countries: Austria, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Greece, Italia, Latvia, Poland, Portugal, Slovakia, Slovenia and Spain. Scalar invariance toward sex was met in the 17 countries as a whole and in 11 of the 12 countries where the test could be run. Scalar invariance toward country was met with 6 additional countries comprising at least 250 respondents: Ireland, Lithuania, Malta, Montenegro, the Netherlands and Norway. CONCLUSION: The CAST is a suitable test for comparing the measurement of problematic cannabis use amongst adolescents in Europe.

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.

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

BACKGROUND AND AIMS: Most studies in English-speaking countries have found a positive association between e-cigarette experimentation and subsequent daily tobacco smoking among adolescents. However, this result may not be valid in other cultural contexts; in addition, few studies have assessed whether this association varies with the subject' age at the time of e-cigarette experimentation. This study aimed to estimate the association between experimenting first with e-cigarette (rather than tobacco) and subsequent daily smoking according to age at the time of experimentation. DESIGN: Secondary analysis; risk ratios (RRs) computed using modified Poisson regressions with inverse probability weighting. SETTING: A cross-sectional nation-wide representative survey performed in 2017 in France. PARTICIPANTS: French adolescents (n = 24 111), aged 17 to 18.5 years, who had previously experimented with either e-cigarettes or tobacco. MEASURES: Exposure was defined as the experimentation with e-cigarettes first (whether or not followed by experimentation with tobacco); the outcome as daily tobacco smoking at the time of data collection. Gender, age, literacy, socio-economic status, pre-exposure repeat school years and experimentation with drunkeness, 3 licit and 8 illicit drugs were adjusted for. Uncertainties about the sequence of events defining exposure were handled by the definition of three patterns of exposure, to avoid a misclassification bias. FINDINGS: Exposure reduced the risk of transition to daily smoking: RR = 0.58, 95% confidence interval (CI) = 0.54, 0.62. This effect increased in a linear manner with age at exposure (RR = 0.87, 95% CI = 0.78; 0.98 for 1 year, P < 0.001): from RR = 1.30, 95% CI = 1.09; 1.54 at age 9 to RR = 0.38, 95% CI = 0.32; 0.45 at age 17. CONCLUSIONS: Experimenting with e-cigarettes first (as opposed to tobacco first) appears to be associated with a reduction in the risk of daily tobacco smoking among French adolescents aged 17-18.5, but this risk varies negatively with age at experimentation, and early e-cigarette experimenters are at higher risk.

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.

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

INTRODUCTION: According to multiple studies, e-cigarette use among adolescents is associated with subsequent smoking initiation. However, little is known about its effect on the transition from smoking initiation to daily smoking. METHODS: Using retrospective data from a French national representative survey collected in 2017 (n = 39,115), we analyzed the role of ever using e-cigarettes on daily cigarette smoking status at 17 among ever smokers (n = 21,401). Risk-ratios (RR) were computed through modified Poisson regressions with an inverse probability of treatment weighting (IPTW) approach. RESULTS: Among French adolescents aged 17, 16.8 % declared current e-cigarette use (1.9 % reported daily use) and 34.1 % cigarette smoking (25.1 % reported daily smoking). Among ever-smokers, adolescents who declared having ever used e-cigarettes were less likely than those who did not to transition to daily smoking at 17: RR = 0.62 95 %CI [0.60 - 0.64]. We found similar results for those who experimented with e-cigarettes before initiating smoking, RR = 0.76 95 %CI [0.66 - 0.89]. CONCLUSIONS: Our results found no evidence of an increased risk of transitioning to daily smoking at 17 among ever-smokers who also experimented with e-cigarettes. Further studies should investigate the longer-term role of vaping on future smoking habits with the use of causal inference methods.

[Use of electronic cigarette in France among adolescents aged 17: Results from the ESCAPAD 2017 survey]. / Usages de la cigarette électronique en France à 17 ans : résultats de l'enquête nationale ESCAPAD 2017.

INTRODUCTION: The use of electronic cigarettes has become relatively popular in France since 2010, including among adolescents. However, its use in relation to smoking and other factors is not well understood today. METHODS: The data come from the ESCAPAD 2017 survey, a nationally representative cross-sectional survey taking place at a 1-day session of civic and military information compulsory for all French nationals around 17 (39,115 respondents). Descriptive analyses and multivariate regressions were undertaken to describe the recent use of e-cigarette at 17 and its associated factors. RESULTS: e-cigarettes were experimented by 52.4 % of 17 year-olds, and used by 16.8 % in the preceding month, 1.9 % daily. Most recent users were also daily smokers (62.5 %), and only 7.6 % had never experimented cigarettes before. Among those who experimented with both products, only 13.3 % tried e-cigarettes before cigarettes. The associated uses of other products were the most striking factors: daily smoking (relative risk [RR]=2.73), ever use of hookah (RR=2.31), cannabis use in the last year (RR=1.60), regular alcohol drinking (RR=1.20) and ever use of another illicit drug (RR=1.11). Recent vapers that were also daily smokers had a more pronounced sociodemographic profile and a higher level of other drugs consumptions than recent vapers only. DISCUSSION: Although a majority of French adolescents experiment with vaping, they are fewer to use it regularly and its current use is frequently associated with daily smoking. Future trends and the relationship between smoking and vaping among adolescents will have to be further investigated, including the motivations of its use.

[Alcohol consumption in France in 2017]. / La consommation d'alcool en France métropolitaine en 2017.

Alcohol consumption in France in 2017. Alcohol consumption was still a very common habit in France: 86.5% of 18-75 years old had drank alcohol during the last 12 months and 40.0% did at least once a week. One quarter of adults stated they consumed above the low-risk alcohol drinking guidelines (no more than 10 drinks per week and 2 drinks per day and alcohol-free days every week). Regardless of the indicator, women consumed less often than men. Besides, alcohol consumption levels and patterns and reasons for use were closely related to the age: the youths drank less often but more intensively than the elder. First alcohol uses are seen in middle school and some regular uses are already established in high school. Overall, pure alcohol intake per capita has been divided by more than two since the sixties but the decline observed every year tends to slow down.

Consommation d'alcool en France métropolitaine en 2017. En 2017, la consommation d'alcool restait une pratique très courante en France : 86,5 % des 18 à 75 ans ont bu de l'alcool au cours des 12 derniers mois et 40,0 % au moins une fois par semaine. Un quart des adultes déclaraient dépasser les repères de consommation à moindre risque (maximum 10 verres par semaine, maximum 2 verres par jour et des jours sans consommation dans la semaine). Quel que soit l'indicateur de consommation, les femmes sont moins fréquemment consommatrices que les hommes. De plus, les niveaux, modes et motifs de consommation sont très liés à l'âge : les plus jeunes consomment moins souvent mais plus intensément que les plus âgés. Les premières expérimentations se font dès le collège, et certains usages réguliers sont déjà en place au lycée. Au global, la quantité d'alcool pur consommé par habitant a été divisé par plus de 2 depuis le début des années 1960, mais la diminution observée presque chaque année tend à se ralentir.

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.

'Are The Times A-Changin'? Trends in adolescent substance use in Europe.

AIMS: To estimate temporal trends in adolescents' current cigarette, alcohol and cannabis use in Europe by gender and region, test for regional differences and evaluate regional convergence. DESIGN AND SETTING: Five waves of the European School Survey Project on Alcohol and Other Drugs (ESPAD) from 28 countries between 1999 and 2015. Countries were grouped into five regions [northern (NE), southern (SE), western (WE), eastern Europe (EE) and the Balkans (BK)]. PARTICIPANTS: A total of 223 814 male and 211 712 female 15-16-year-old students. MEASUREMENTS: Daily cigarette use, weekly alcohol use, monthly heavy episodic drinking (HED) and monthly cannabis use. Linear and quadratic trends were tested using multi-level mixed-effects logistic regression; regional differences were tested using pairwise Wald tests; mean absolute differences (MD) of predicted prevalence were used for evaluating conversion. FINDINGS: Daily cigarette use among boys in EE showed a declining curvilinear trend, whereas in all other regions a declining linear trend was found. With the exception of BK, trends of weekly drinking decreased curvilinear in both genders in all regions. Among girls, trends in WE, EE and BK differed from trends in NE and SE. Monthly HED showed increasing curvilinear trends in all regions except in NE (both genders), WE and EE (boys each). In both genders, the trend in EE differed from the trend in SE. Trends of cannabis use increased in both genders in SE and BK; differences were found between the curvilinear trends in EE and BK. MD by substance and gender were generally somewhat stable over time. CONCLUSIONS: Despite regional differences in prevalence of substance use among European adolescents from 1999 to 2015, trends showed remarkable similarities, with strong decreasing trends in cigarette use and moderate decreasing trends in alcohol use. Trends of cannabis use only increased in southern Europe and the Balkans. Trends across all substance use indicators suggest no regional convergence.

[Drug consumptions by the young adolescents: 1. Epidemiological data]. / Les usages de drogues des plus jeunes adolescents: 1. Données épidémiologiques.

Adolescence is often the time of experimentation with psychoactive substances, sometimes leading to more regular use. This paper gives an update of drug consumptions by the young adolescents, from results of recent general population surveys in France, and focuses on the specificity of this consumption when compared to that of older adolescents. It shows that regular uses of such substances usually do not start before the age of 14, but that early initiated adolescents show a higher risk of moving towards more intensive or problematic uses. Through presenting the limitations of such surveys, the authors discuss the nature of the link observed between early experimentation and level of use: while acknowledging the unquestionable prognostic value of early initiation to predict future problematic use, they show that its interpretation should be made with caution when based on such transversal epidemiological surveys.

[The levels of use of cannabis by adolescents and young adults: a comparison of European consumption]. / L'usage de cannabis chez les adolescents et les jeunes adultes: comparaison des consommations européennes.

The French figure among the largest consumers of cannabis in Europe, both according to general population surveys of adults from various European countries and the European School Survey Project on Alcohol and Other Drugs (ESPAD survey) carried out among more than 100,000 15-16 year old adolescents from most countries in Europe. Among the countries surveyed who have the most strict and suppressive policies concerning the use of psychotropic drugs, the level of consumption of cannabis appears particularly high in France and lowest in Sweden; although in a country diametrically opposed in terms of policy measures in this regard, The Netherlands (a country which carries the image of much freedom and leeway in this matter), actually occupies the position of average consumption rates in the middle of the two extreme cases aforementioned. Even more important than legislation is the presence of networks of close-knit relationships between young people; this is a critical aspect which has a strong influence in determining the choice whether or not to consume a product such as cannabis. In this manner, adolescents' behaviour and practices are integrally linked to the opinions, perceptions and use of his/her peers.