title: Early substance use initiation and suicide ideation and attempts among students in France and the United States.
abstract: OBJECTIVE
  In response to recent research documenting a link between early substance use and suicidal behaviors among youth, the current study sought to examine the associations between ages of substance use initiation and suicidal behavior among students in France and the USA.
  
  
  METHODS
  Cross-sectional logistic regression analyses based on the 2003 European School Survey Project on Alcohol and Other Drugs (ESPAD) survey (France; n = 13,187) and the 2003 Youth Risk Behavior Survey (YRBS) (United States; n = 15,136) assessed associations between early substance use initiation (i.e., alcohol, cigarette and cannabis/marijuana) and suicide ideation and attempts while controlling for potential confounders.
  
  
  RESULTS
  Early alcohol use initiation (OR(adj) = 1.52; 95% CI 1.17-1.97) and early cannabis/marijuana use initiation (OR(adj) = 2.90; 95% CI 2.20-3.83) were associated with suicide attempt in France. Early smoking was associated with suicide attempt in both France (OR(adj) = 1.92; 95% CI 1.55-2.37) and the USA (OR(adj) = 1.53; 95% CI 1.02-2.28). Sex differences were also noted.
  
  
  CONCLUSIONS
  The associations between substance use initiation and suicidal behaviors differed in the United States and France. These findings, placed into context, can assist the development and implementation of prevention strategies that seek to reduce the harmful consequences of early substance use among youth.
authors.affiliation: Institute of Public Health, Partnership for Urban Health Research, Georgia State University, Atlanta, GA 30302-3995, USA. MSwahn@gsu.edu
authors.forename: Monica H
authors.initials: MH
authors.lastname: Swahn
authors.forename: Robert M
authors.initials: RM
authors.lastname: Bossarte
authors.forename: Marie
authors.initials: M
authors.lastname: Choquet
authors.forename: Christine
authors.initials: C
authors.lastname: Hassler
authors.forename: Bruno
authors.initials: B
authors.lastname: Falissard
authors.forename: Nearkasen
authors.initials: N
authors.lastname: Chau
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D013334:Students / Q000523:psychology*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology