[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.

[A new cause of false positives when analyzing expired air carbon monoxide]. / Une cause nouvelle de faux positifs dans l'utilisation des analyseurs de CO dans l'air expiré.

INTRODUCTION: Measurement of expired air carbon monoxide expired is an essential examination to be conducted in smokers during consultation. However, this can be the source of errors, such as that identified in the case report we present here. OBSERVATION: A 65 year-old man, wishing to stop smoking, consumed a large quantity of polyol-rich sweets and exhibited increased expired air carbon monoxide levels, intestinal gases and increased volume of his liver. All these signs regressed when he stopped taking the sweets. COMMENTS: The production of intestinal gases related to polyol and isomalt contained in some products may be the cause of error in the measurement of expired air carbon monoxide.

[Nicotine substitution therapy: 10 years later]. / Le traitement de substitution nicotinique dix ans après.

To be efficient, nicotine substitution therapy (NST) must be part of a global strategy comprising several stages. The first consists in evaluating and re-enforcing motivation, since smoking cessation is impossible unless the patient is clearly motivated. The second stage is the withdrawal period that lasts for several days or months. NST is the first medicinal treatment that has demonstrated its efficacy in controlled studies: it reduces the withdrawal syndrome and doubles the chances of success at the end of the standard 3-month treatment. Recent studies have shown that the results can be improved: by adapting the dose to the degree of dependency and by using higher doses and/or associating two types of nicotine substitutes; by prolonging NST for as long as the withdrawal syndrome persists; by treating the anxiety and depression, often present in heavy smokers. The third stage is aimed at avoiding relapses, by ensuring prolonged follow-up and treating the various possible causes: eating disorders and weight gain, acute or chronic stress, depression, environment.... At all the stages of care, behavioural and cognitive therapy enhances the chances of success.