Adverse Childhood Experiences and Illegal Drug Use Among College Students: Findings from a French Sample

BACKGROUND

While studies have demonstrated the negative impact of adverse childhood experiences (ACEs) on lifelong health, less is known about the relationship between ACEs and illegal drug use. Thus, the objective of the study was to examine the relationship between ACEs and illegal drug use among college students.

METHODS

French college students between 18 and 30 years enrolled in a university cohort study were eligible for inclusion. Multivariate logistic regression models were conducted for each drug.

RESULTS

Among the sample (n = 1,157), 30.6% had no ACE exposure, 29.6%, 19.2%, and 20.7% had 1, 2 and ≥ 3 ACEs, respectively. Students with ACEs had a higher likelihood of using illegal drugs (p = 0.0067). After controlling for potential confounders, having ≥ 3 ACEs increased the risk of lifetime use of multiple drugs (aOR:10.9; 95% CI: 4.6-26.0), stimulants (aOR: 3.6; 95% CI:1.7-7.7), hallucinogens (aOR: 2.0; 95% CI: 1.1-3.5), cannabis (aOR: 4.7; 95% CI: 2.7-8.0), and risky illegal drugs (e.g., higher lifetime frequency drug use) (aOR: 2.9; 95% CI: 1.5-5.8). Estimates for illegal drug use were highest with parental substance use (aOR: 2.6; 95% CI; 1.5-4.4), sexual abuse (aOR: 2.3; 95% CI; 1.4-3.8), and divorce (aOR: 1.9; 95% CI: 1.3-2.7).

CONCLUSIONS

ACEs increase the risk for lifetime illegal drug use and risky drug use in a dose-respondent fashion. These findings suggest that university students with higher levels of ACEs may benefit from additional support and services from clinical practitioners and university administrators.

An interactive video increasing French students' mental health literacy: a mixed-methods randomized controlled pilot study

Mental health literacy (MHL) is a determinant of psychological well-being in young people. A randomized controlled design was used to evaluate the appreciation and effectiveness of an interactive video on French University students' MHL (knowledge about depression and suicidal behavior, mental health help-seeking behaviors, stigma and misconceptions about mental health). At the baseline, all participants (n = 101) completed a questionnaire including several scales on MHL. One month after, participants were randomly assigned to two homogeneous groups (intervention, n = 50 or control, n = 51) and again completed the questionnaire on MHL. Through a mixed-methods approach, semi-structured interviews were also conducted with the intervention group to collect information on the appreciation of the interactive video. Quantitative data indicated that MHL scores increased or remained stable in the intervention group. Comparison with the control group and multivariate logistic regression models did not show statistically significant differences, due to the small sample of the study. According to qualitative data, users appreciated the content and the format of the intervention. It was suggested that the video could be disseminated in other University campuses in France and internationally to promote MHL among students.

Estimating and characterizing the burden of multimorbidity in the community: A comprehensive multistep analysis of two large nationwide representative surveys in France

BACKGROUND

Given the increasing burden of chronic conditions, multimorbidity is now a priority for healthcare and public health systems worldwide. Appropriate methodological approaches for assessing the phenomenon have not yet been established, resulting in inconsistent and incomplete descriptions. We aimed to estimate and characterize the burden of multimorbidity in the adult population in France in terms of number and type of conditions, type of underlying mechanisms, and analysis of the joint effects for identifying combinations with the most deleterious interaction effects on health status.

METHODS AND FINDINGS

We used a multistep approach to analyze cross-sectional and longitudinal data from 2 large nationwide representative surveys: 2010/2014 waves of the Health, Health Care, and Insurance Survey (ESPS 2010-2014) and Disability Healthcare Household Survey 2008 (HSM 2008), that collected similar data on 61 chronic or recurrent conditions. Adults aged ≥25 years in either ESPS 2010 (14,875) or HSM 2008 (23,348) were considered (participation rates were 65% and 62%, respectively). Longitudinal analyses included 7,438 participants of ESPS 2010 with follow-up for mortality (97%) of whom 3,798 were reinterviewed in 2014 (52%). Mortality, activity limitation, self-reported health, difficulties in activities/instrumental activities of daily living, and Medical Outcomes Study Short-Form 12-Item Health Survey were the health status measures. Multiple regression models were used to estimate the impact of chronic or recurrent conditions and multimorbid associations (dyads, triads, and tetrads) on health status. Etiological pathways explaining associations were investigated, and joint effects and interactions between conditions on health status measures were evaluated using both additive and multiplicative scales. Forty-eight chronic or recurrent conditions had an independent impact on mortality, activity limitations, or perceived heath. Multimorbidity prevalence varied between 30% (1-year time frame) and 39% (lifetime frame), and more markedly according to sex (higher in women), age (with greatest increases in middle-aged), and socioeconomic status (higher in less educated and low-income individuals and manual workers). We identified various multimorbid combinations, mostly involving vasculometabolic and musculoskeletal conditions and mental disorders, which could be explained by direct causation, shared or associated risk factors, or less frequently, confounding or chance. Combinations with the highest health impacts included diseases with complications but also associations of conditions affecting systems involved in locomotion and sensorial functions (impact on activity limitations), and associations including mental disorders (impact on perceived health). The interaction effects of the associated conditions varied on a continuum from subadditive and additive (associations involving cardiometabolic conditions, low back pain, osteoporosis, injury sequelae, depression, and anxiety) to multiplicative and supermultiplicative (associations involving obesity, chronic obstructive pulmonary disease, migraine, and certain osteoarticular pathologies). Study limitations included self-reported information on chronic conditions and the insufficient power of some analyses.

CONCLUSIONS

Multimorbidity assessments should move beyond simply counting conditions and take into account the variable impacts on health status, etiological pathways, and joint effects of associated conditions. In particular, the multimorbid combinations with substantial health impacts or shared risk factors deserve closer attention. Our findings also suggest that multimorbidity assessment and management may be beneficial already in midlife and probably earlier in disadvantaged groups.