Young Adults in France: Becoming Adult in the Context of Increased Autonomy and Dependency

Cancer incidence and survival among adolescents and young adults in France (1978-1997)

The combined effects of parental divorce and parental history of depression on cannabis use in young adults in France

Job insecurity, unemployment, and job strain can predict psychological distress and suicide risk. Young people, who are particularly at risk of suicide, may be especially vulnerable to the deterioration of labor market conditions as a result of the current economic crisis in Europe. We aimed to examine the effects of work and employment characteristics on suicidal ideation in a contemporary sample of young adults. Using data from a sample of French young adults surveyed in 2011 (TEMPO study, N = 1,214, 18-37 years old) and their parents who took part in a longitudinal cohort study, we used multiple logistic regression to examine the relationship between job insecurity, lifetime and recent unemployment and suicidal ideation in the past 12 months. Our analyses were adjusted for factors associated with suicidal risk including age, sex, educational attainment, living with a partner, insufficient social support, alcohol abuse, depression and parental history of depression. Five percent of the sample reported suicidal ideation in the preceding 12 months. Controlling for all covariates, the likelihood of suicidal ideation was associated with job insecurity (OR 2.24, 95% CI 1.08-4.63), lifetime unemployment (OR 2.25, 95% CI 1.17-4.29), and recent unemployment (OR 2.10, 95% CI 1.04-4.25). After stratifying by educational attainment, the association between suicidal ideation and job insecurity was particularly notable for participants with low educational attainment (OR 9.28, 95% CI 1.19-72.33). Young adults who have unstable and unfavorable employment characteristics are disproportionately likely to be suicidal, which should be monitored, particularly in times of economic downturn.

1758 – Comparison of the patterns of antidepressant use among young and older adults in france

This study aimed to describe cancer incidence (2000–2008) and survival (2000–2004) in France in adolescents and young adults (AYA). All cases of cancer diagnosed in 15–24 years, recorded by all French population-based registries (14% of the French population), over the 2000–2008 period, were included. Incidence change over time was described with the conventional annual percentage change (cAPC). The survival of cases diagnosed (2000–2004) was estimated using Kaplan–Meier method. A total of 1022 in adolescents and 1396 in young adults were diagnosed. Overall incidence rates were 219.4/106 in 15–19 year olds and 293.1/106 in 20–24 year olds. The most frequently diagnosed cancers in male AYA were malignant gonadal germ-cell tumors and Hodgkin's disease, and were melanoma, thyroid carcinoma, and Hodgkin's disease in females. The age-standardized rates appeared stable over time in AYA, with a cAPC of +2.0% (P = 0.68). The 5-year overall survival for all cancers was different between genders and age groups, with 78.8% (95%CI: 75.6–82.0) for males and 85.2% (95%CI: 82.2–88.1) for females (P = 0.01), and 78.5% (95%CI: 75.0–82.1) in 15–19 year olds and 84.3% (95% CI: 81.6–87.0) in 20–24 year olds (P = 0.02). Noteworthy, the frequency and the distribution of tumor types in AYA are unique and different from the observed at any other age group. Survival in French AYA has improved over time. Epidemiological data might reflect major trends in the risk factors and preventive interventions. Thus, further research into etiology of cancers affecting AYA should become key priorities for cancer control among AYA.

The COVID-19 outbreak has generated significant uncertainty about the future, especially for young adults. Health and economic threats, as well as more diffuse concerns about the consequences of COVID-19, can trigger feelings of anxiety, leading individuals to adopt uncertainty-reducing behaviours. We tested whether anxiety was associated with an increase in willingness to be exposed to the risk of COVID-19 infection (WiRE) using an online survey administered to 3,110 French individuals aged between 18 and 35 years old during the lockdown period (April 2020). Overall, 56.5% of the sample declared a positive WiRE. Unemployment was associated with a higher WiRE (+8.2 percentage points (pp); 95% CI +0.9-15.4 pp). One standard deviation increases in income (+1160€) and psychological state anxiety raised the WiRE by +2.7 pp (95% CI: +1.1-4.4 pp) and +3.9 pp (95% CI: +1.6-6.2 pp), respectively. A one standard deviation increase in perceived hospitalisation risk was associated with a -4.1 pp (95% CI: -6.2-2.1 pp) decrease in the WiRE. Overall, our results suggest that both the prospect of economic losses and psychological anxiety can undermine young adults’ adherence to physical distancing recommendations. Public policies targeting young adults must consider both their economic situation and their mental health, and they must use uncertainty-reducing communication strategies.

In the so-called post-truth age and the rise of social media, news circulates widely and quickly, leading to information overload. In this context, individuals experiencing high issue involvement tend to engage more with information. Literature has recently focused on news literacy interventions to protect people from fake news. However, few have addressed these initiatives’ immediate and differential effects simultaneously on young adults’ vulnerability to deception. Through three experiments involving undergraduate university students in France, we demonstrate that intervention-based educational methods can mitigate the impact of issue involvement on belief in fake news. Yet, they do not enable individuals to protect themselves in the long run and may even prove counterproductive by triggering information overload. Our study contributes to the research investigating preventive practices to help users arm themselves against fake news in media communication, social media, and social marketing.

Amid escalating mental health challenges among young individuals, intensified by the COVID-19 pandemic, analyzing postpandemic trends is critical. To examine mental health care utilization and prescription rates for children, adolescents, and young adults before and after the COVID-19 pandemic. This population-based time trend study used an interrupted time series analysis to examine mental health care and prescription patterns among the French population 25 years and younger. Aggregated data from the French national health insurance database from January 2016 to June 2023. Data were analyzed from September 2023 to February 2024. The number of individuals with at least 1 outpatient psychiatric consultation, those admitted for full-time psychiatric hospitalization, those with a suicide attempt, and those receiving psychotropic medication was computed. Data were stratified by age groups and sex. Quasi-Poisson regression modeled deseasonalized data, estimating the relative risk (RR) and 95% CI for differences in slopes before and after the pandemic. This study included approximately 20 million individuals 25 years and younger (20 829 566 individuals in 2016 and 20 697 169 individuals in 2022). In 2016, the population consisted of 10 208 277 of 20 829 566 female participants (49.0%) and 6 091 959 (29.2%) aged 18 to 25 years. Proportions were similar in 2022. Significant increases in mental health care utilization were observed postpandemic compared with the prepandemic period, especially among females and young people aged 13 years and older. Outpatient psychiatric consultations increased among women (RR, 1.13; 95% CI, 1.07-1.20), individuals aged 13 to 17 years (RR, 1.15; 95% CI, 1.06-1.23), and individuals aged 18 to 25 years (RR, 1.08; 95% CI, 1.03-1.14). Hospitalizations for suicide attempt increased among women (RR, 1.14; 95% CI, 1.02-1.27) and individuals aged 18 to 25 years (RR, 1.07; 95% CI, 1.03-1.12). Regarding psychotropic medications, almost all classes, except hypnotics, increased in prescriptions between 2016 and 2022 for females, with a particularly marked rise in the postpandemic period. For men, only increases in the prescriptions of antidepressants (RR, 1.03; 95% CI, 1.01-1.06), methylphenidate (RR, 1.09; 95% CI, 1.06-1.12), and medications prescribed for alcohol use disorders (RR, 1.08; 95% CI, 1.04-1.13) were observed, and these increases were less pronounced than for women (antidepressant: RR, 1.13, 95% CI, 1.09-1.16; methylphenidate: RR, 1.15; 95% CI, 1.13-1.18; alcohol use dependence: RR, 1.12; 95% CI, 1.08-1.16). Medications reserved for severe mental health situations, such as lithium or clozapine, were prescribed more frequently starting at the age of 6 years. In this study, an interrupted time-series analysis found a marked deterioration in the mental health of young women in France in the after the COVID-19 pandemic, accentuating a trend of deterioration that was already observed in the prepandemic period.

We studied whether patterns of substance use in relation to unemployment vary depending on educational level. Data come from 1,126 community-based young adults in France (18-35 years of age in 2011) and their parents (TEMPO and GAZEL studies). Tobacco use (≥1 cigarette/day, 22.5% prevalence), nicotine dependence (Fagerström test ≥2, 7.1% prevalence), alcohol use (≥2 units/week, 25.3% prevalence), alcohol abuse (WHO AUDIT ≥7 in women and ≥8 in men, 10.8% prevalence), cannabis use (≥1 time, 16.5% prevalence), and cannabis abuse (CAST ≥2, 5.0% prevalence) were assessed by interview. We conducted logistic regression analyses controlled for inverse probability weights of unemployment, calculated based on demographics, negative life events, health, and juvenile and parental characteristics. Compared to participants who were always employed, those who were unemployed and had no higher education were more likely to smoke tobacco (OR: 2.76, 95% CI: 1.86-4.10), to be nicotine dependent (OR: 5.70, 95% CI: 3.03-10.73), to use cannabis (OR: 2.27, 95% CI: 1.42-3.64), and to abuse cannabis (OR: 3.38, 95% CI: 1.63-7.04). Those who were unemployed and had higher education were especially likely to abuse alcohol (OR: 1.89, 95% CI: 1.16-3.09). Increases in unemployment may impact population levels of substance use, particularly in young adults with low educational attainment.

Peritoneal dialysis (PD) remains the modality of choice in children, but there is no clear evidence to support a better outcome in children treated with PD. We aimed to assess factors that have an impact on the choice of dialysis modality in children and young adults in France and sought to determine the roles of medical factors and center practices. We included all patients aged <20years at the start of renal replacement therapy (RRT), recorded in the French RRT Registry between 2002 and 2013. Hierarchical logistic regression models were used to study the association between the patient/center characteristics and the probability of receiving PD as the first dialysis modality. We included 806 patients starting RRT in 177 centers, 23 of which were specialized pediatric centers. Six hundred and one patients (74.6%) started with hemodialysis (HD), whereas 205 (25.4%) started with PD. A greater probability of PD was found in younger children, whereas starting the treatment in an emergency setting was associated with a low use of PD. We found a significant variability among centers that accounted for 43% of the total variability. The probability of PD was higher in adult centers and was proportional to the rate of PD in the center. Center practices are a major factor in the choice of dialysis modality. This raises concerns about patient and family choices and to what extent doctors may influence the final decision. Further pediatric studies focusing on children's and parents' wishes are needed to provide care as close as possible to patients' and families' expectations.

While head and neck cancer incidence decreased worldwide due to reduced tobacco and alcohol consumption, oral tongue cancer (OTC) incidence has been reported to be increasing in several countries. Our study examines the incidence trends of OTC in France from 1990 to 2018, globally and by age; and compares the incidence trends with the evolution of the incidence of other human papilloma virus-unrelated head and neck squamous cell carcinoma, that is, cancers of the remaining subsites of the oral cavity (RSOCC) and laryngeal cancers for the period 1990 to 2018. World age-standardized incidence rates of oral tongue cancers (C02), cancers of the remaining subsites of the oral cavity (RSOCC, C03-06) and laryngeal cancers (C32) were estimated using the French National Network of Cancer Registries for the period 1990 to 2018. Trends in national incidence rates were estimated from a mixed-effect Poisson model including age and year effects using penalized splines and a district-random effect. In women aged 30 and 40, a significant increase in OTC incidence was observed, while ROSCC showed a nonsignificant incidence decrease. In young men aged 25, a marginally significant increase of OTC incidence years was observed, while incidence rates of RSOCC significantly declined. The results suggest a tendency towards diverging incidence trends for OTC compared to RSOCC and laryngeal cancer in young adults. The observed trends may reflect changes in underlying exposures or emerging exposures not yet identified, and stress the need to further investigate the etiology of oral tongue cancers.

BackgroundThe Internet is one of the main resources of health information especially for young adults, but website content is not always trustworthy or validated. Little is known about this specific population and the importance of online health searches for use and impact. It is fundamental to assess behaviors and attitudes of young people looking for online health-related information and their level of trust in such information.ObjectiveThe objective is to describe the characteristics of Internet users aged 15-30 years who use the Web as a health information resource and their trust in it, and to define the context and the effect of such use on French young adults’ behavior in relation to their medical consultations.MethodsWe used the French Health Barometer 2010, a nationally representative survey of 27,653 individuals that investigates population health behaviors and concerns. Multivariate logistic regressions were performed using a subsample of 1052 young adults aged 15-30 years to estimate associations between demographics, socioeconomic, and health status and (1) the use of the Internet to search for health information, and (2) its impact on health behaviors and the physician-patient relationship.ResultsIn 2010, 48.5% (474/977) of Web users aged 15-30 years used the Internet for health purposes. Those who did not use the Internet for health purposes reported being informed enough by other sources (75.0%, 377/503), stated they preferred seeing a doctor (74.1%, 373/503) or did not trust the information on the Internet (67.2%, 338/503). However, approximately 80% (371/474) of young online health seekers considered the information found online reliable. Women (P<.001) and people with higher sociocultural positions (OR 0.5, 95% CI 0.3-0.9 and OR 0.4, 95% CI 0.2-0.7 for employees and manual workers, respectively, vs individuals with executive or manager positions) were more likely to use the Internet for health purposes. For a subsample of women only, online health seeking was more likely among those having a child (OR 1.8, 95% CI 1.1-2.7) and experiencing psychological distress (OR 2.0, 95% CI 1.0-4.0). Finally, for online health seekers aged 15-30 years, one-third (33.3%, 157/474) reported they changed their health behaviors (eg, frequency of medical consultations, way of taking care of one’s own health) because of their online searches. Different factors were associated with different outcomes of change, but psychological distress, poor quality of life, and low income were the most common.ConclusionsThe Internet is a useful tool to spread health information and prevention campaigns, especially to target young adults. Young adults trust online information and consider the Internet as a valid source of health advice. Health agencies should ensure the improvement of online health information quality and the creation of health-related websites and programs dedicated to young adults.

In Response:We thank Gabet and Kaul and their colleagues for their interest in our article and important discussions.Gabet et al 1 pointed out that hospitalization rates for heart failure (HF) among young adults in France between 2000 and 2012 was stable (in contrast with declining rates in older individuals) despite an increase in prevalence of obesity and diabetes mellitus.Therefore, they suggested that other factors may underlie our observations of increasing HF incidence rates.Similar trends in hospitalizations have also been noted in the United States and Slovenia. 2,3lthough we certainly agree that more studies are needed to understand the mechanisms behind our and others observations, caution is needed when comparing HF incidence rates with HF hospitalization rates because these are not necessarily measuring the same thing.Changes in hospitalization rates may depend on the incidence of the condition as well as reflect changes in patient management, including hospitalization versus outpatient management and associated mortality.For instance, some data suggest that more patients are managed primarily on an outhospital basis today compared with a decade ago.The proportion of patients managed primarily by outhospital visits likely varies depending on multiple factors, including national variation, hospital capacity, age, etiology, and HF severity. 4,5imilar to our study, Kaul et al 6 observed diverse trends in incidence of HF in a large region of Canada for young versus old individuals, with significant declines in older but not younger individuals.For young men, incidence rates were increasing.In addition, Kaul et al 6 noted that half of the young patients were diagnosed in the outpatient setting, compared with 38% for older individuals.As a sensitivity analysis presented in our online supplementary material, we included patients diagnosed in the outpatient setting, which did not alter the results, but we did not look further into which types of patients were diagnosed in the outpatient setting or whether this pattern has changed over time. 7We also did not look at the burden of future hospitalizations, which might have yielded additional insights.Clearly, as illustrated by the similarities and discrepancies in data between studies, the current HF epidemiology in young adults needs careful interpretations.Although much data suggest that the HF incidence among young individuals has unfortunately not followed the declines observed for older individuals and because mortality is substantial, further efforts are needed to better understand the trends in young adults.Given the overall rarity of the condition, spatial differences, disparities in population characteristics, and heterogeneity in diagnostic criteria between studies, we agree with Kaul and colleagues 6 that a collaborative research consortium could be a great opportunity to provide further important insights into this subject.

Introduction Recent studies suggested that younger women were more likely to suffer from an ischemic stroke than men of the same age. Purpose Our aim is to confirm whether younger women in France are more exposed to ischemic strokes. Methods We compared male and female one-year hospitalization numbers for ischemic stroke in different age groups in France. We also used the French population data by sex and similar age group. Chi-square Tests of Homogeneity were used to assess statistical significance of the differences among men and women hospitalization numbers for each age group. Results Women in the age group 15–24 y-o experienced more ischemic strokes than men (151 hospitalizations for women vs 113 for men; p=0,0088). In the 25–34 y-o group, no differences were found between men and women (385 hospitalizations for men vs 370 for women; p=0,3497). In the 35–44 y-o group, women experienced less ischemic strokes than men (906 hospitalizations for women vs 1200 for men; p&amp;lt;0,0001). Women older than 85 y-o also had significantly more hospitalizations than men (15143 vs 6950; p=0,0073). All the other age groups showed a significative male predominance. Conclusion Younger women (15–24 y-o) are at higher risk of ischemic strokes than men of the same age in France. As far as ischemic stroke incidence is rising among young adults in France, an urgent awareness should be raised and further studies should focus on the possible etiologies. Funding Acknowledgement Type of funding sources: None.

Food insecurity has been found to be related to anxiety and depression; however, the association with other psychiatric disorders, particularly among young adults, is not well known. We examined whether food insecurity is independently associated with four common mental health problems among a community sample of young adults in France. Data are from the TEMPO longitudinal cohort study. In 1991, participants' parents provided information on health and family socioeconomic characteristics. In 2011, participants' (18-35years) reported food insecurity, mental health symptoms, and socioeconomic conditions (n=1214). Mental health problems ascertained included major depressive episode, suicidal ideation, attention deficit and hyperactivity disorder, and substance abuse and/or dependence (nicotine, alcohol and cannabis). Cross-sectional associations between food insecurity and mental health problems were tested using modified Poisson regressions, weighted by inverse probability weights (IPW) of exposure. This makes food insecure and not food insecure participants comparable on all characteristics including socioeconomic factors and past mental health problems. 8.5% of young adults were food insecure. In IPW-controlled analyses, food insecurity was associated with increased levels of depression (RR=2.01, 95% CI 1.01-4.02), suicidal ideation (RR=3.23, 95% CI 1.55-6.75) and substance use problems (RR=1.68, 95% CI 1.15-2.46). Food insecurity co-occurs with depression, suicidal ideation and substance use problems in young adulthood. Our findings suggest that reductions in food insecurity during this important life period may help prevent mental health problems. Policies aiming to alleviate food insecurity should also address individuals' psychiatric problems, to prevent a lifelong vicious circle of poor mental health and low socioeconomic attainment.