The Impact of Stressful Life Events on Excessive Alcohol Consumption in the French Population: Findings from the GAZEL Cohort Study

Background: Major life changes may play a causative role in health through lifestyle factors, such as alcohol. The objective was to examine the impact of stressful life events on heavy alcohol consumption among French adults. Methods: Trajectories of excessive alcohol consumption in 20,625 employees of the French national gas and electricity company for up to 5 years before and 5 years after an event, with annual measurements from 1992. We used repeated measures analysis of time series data indexed to events, employing generalized estimating equations. Results: For women, excessive alcohol use increased before important purchase (p = 0.021), children leaving home (p<0.001), and death of loved ones (p = 0.03), and decreased before widowhood (p = 0.015); in the year straddling the event, increased consumption was observed for important purchase (p = 0.018) and retirement (p = 0.002); at the time of the event, consumption decreased for marriage (p = 0.002), divorce, widowhood, and death of loved one (all p<0.001), and increased for retirement (p = 0.035). For men, heavy alcohol consumption increased in the years up to and surrounding the death of loved ones, retirement, and important purchase (all p<0.001), and decreased after (all p<0.001, except death of loved one: p = 0.006); at the time of the event, consumption decreased for all events except for children leaving home and retirement, where we observed an increase (all p<0.001). For women and men, heavy alcohol consumption decreased prior to marriage and divorce and increased after (all p<0.001, except for women and marriage: p = 0.01). Conclusion: Stressful life events promote healthy and unhealthy alcohol consumption. Certain events impact alcohol intake temporarily while others have longer-term implications. Research should disentangle women's and men's distinct perceptions of events over time

The CONSTANCES cohort: an open epidemiological laboratory

<p>Abstract</p> <p>Background</p> <p>Prospective cohorts represent an essential design for epidemiological studies and allow for the study of the combined effects of lifestyle, environment, genetic predisposition, and other risk factors on a large variety of disease endpoints. The CONSTANCES cohort is intended to provide public health information and to serve as an "open epidemiologic laboratory" accessible to the epidemiologic research community. Although designed as a "general-purpose" cohort with very broad coverage, it will particularly focus on occupational and social determinants of health, and on aging.</p> <p>Methods/Design</p> <p>The CONSTANCES cohort is designed as a randomly selected representative sample of French adults aged 18-69 years at inception; 200,000 subjects will be included over a five-year period. At inclusion, the selected subjects will be invited to fill a questionnaire and to attend a Health Screening Center (HSC) for a comprehensive health examination: weight, height, blood pressure, electrocardiogram, vision, auditory, spirometry, and biological parameters; for those aged 45 years and older, a specific work-up of functional, physical, and cognitive capacities will be performed. A biobank will be set up. The follow-up includes a yearly self-administered questionnaire, and a periodic visit to an HSC. Social and work-related events and health data will be collected from the French national retirement, health and death databases. The data that will be collected include social and demographic characteristics, socioeconomic status, life events, behaviors, and occupational factors. The health data will cover a wide spectrum: self-reported health scales, reported prevalent and incident diseases, long-term chronic diseases and hospitalizations, sick-leaves, handicaps, limitations, disabilities and injuries, healthcare utilization and services provided, and causes of death.</p> <p>To take into account non-participation at inclusion and attrition throughout the longitudinal follow-up, a cohort of non-participants will be set up and followed through the same national databases as participants.</p> <p>A field-pilot was performed in 2010 in seven HSCs, which included about 3,500 subjects; it showed a satisfactory structure of the sample and a good validity of the collected data.</p> <p>Discussion</p> <p>The constitution of the full eligible sample is planned during the last trimester of 2010, and the cohort will be launched at the beginning of 2011.</p

À qui profite le couple ? Une étude longitudinale de l’alimentation à l’intersection du genre, de la situation conjugale et du statut social

La vie en couple est-elle bénéfique pour les hommes et pour les femmes, ou pour les hommes au détriment des femmes ? Comment un événement biographique comme la perte du conjoint s’insère-t-il dans le processus du vieillissement ? Nous abordons ces questions à travers une pratique quotidienne qui se déroule largement dans l’espace domestique tout en étant un bon indicateur d’un style de vie conforme aux recommandations de santé et aux goûts dominants : la consommation quotidienne de légumes. Nous utilisons la cohorte épidémiologique Gazel de l’Inserm dont les 20 625 enquêtés sont suivis depuis 1989. Les hommes voient leur consommation de légumes décroitre plus que les femmes quand ils connaissent une rupture d’union. Leur consommation est aussi plus sensible à la position sociale de leur conjointe. La consommation de légumes des femmes ne diminue qu’après la rupture d’une union avec un homme de situation socioprofessionnelle modeste. Nous concluons que, dans notre population d’étude vieillissante, la conjugalité bénéficie aux deux conjoints, mais plus aux hommes qu’aux femmes. Cet article propose un apport méthodologique sur le traitement des non-réponses dans des données de cohorte, et théorique en discutant la possibilité d’une intersection entre genre, classe et statut conjugal dans la sphère domestique

Utilisation de la cigarette électronique et du tabac : premières données de la cohorte Constances, France, 2014

International audienceINTRODUCTION – The use of electronic cigarettes (E-cig) is rapidly growing, but only scarce information is available about their safety or their efficacy in quitting or reducing tobacco smoking. These preliminary data describing the prevalence of tobacco and E-Cig use and the trajectories over one year follow-up come from the population-based CONSTANCES cohort. METHODS –  A cross-sectional analysis (n=24,157) describes the use of tobacco and E-Cig according to sociodemographic characteristics, self-rated health and depressivity. Changes regarding habits over one year are also presented (n=8,042). RESULTS – The use of E-cig is very rare among non-smokers (11 subjects), slightly more frequent among ex-smokers, and mixed use is twice more frequent. Prevalence is similar among men and women, and decreases with age among ex-smokers and mixed users. Frequency of mixed use seems to be higher among employees and blue-collar workers. Mixed users show the lowest prevalence of Very good-Good self-rated health and the highest prevalence of depressivity. There is a clear gradient in E-cig use according to the number of pack-years of tobacco smoking. Trends over one year show that no E-cig exclusive user had become a smoker one year later. DISCUSSION – These preliminary findings do not show that the use of E-Cig induces initiation to smoking, and suggest it is rather largely used for trying to quit tobacco-smoking. A longer follow-up in CONSTANCES is needed for studying long-term effects.Introduction-L'usage de la cigarette électronique (Ecig) s'est très rapidement répandu. Cependant, on dispose de peu de données concernant son innocuité, son efficacité pour l'arrêt du tabagisme ou sa facilitation vers le passage au tabac. Les données préliminaires issues de la cohorte Constances décrivent la prévalence de l'usage du tabac et de la Ecig et les trajectoires sur un an. Matériel-méthodes-Une analyse transversale (n=24 157) décrit l'usage de la Ecig et du tabac selon des caractéristiques sociodémographiques, l'état de santé perçu et la dépressivité. Sont également présentées les trajectoires de consommation sur un an (n=8 042). Résultats-L'usage de la Ecig chez les nonfumeurs est très rare (11 sujets), un peu plus fréquent chez les exfumeurs (1%) ; l'usage mixte de la cigarette avec la Ecig est deux fois plus fréquent. Les prévalences sont voisines dans les deux genres et diminuent avec l'âge pour les consommateurs mixtes et exfumeurs. La fréquence de l'usage mixte semble plus importante parmi les employés et ouvriers. Les consommateurs mixtes présentent la plus faible proportion de personnes se jugeant en Très bon / Bon état de santé et la fréquence de dépressivité la plus élevée. Il existe un gradient de la fréquence de Ecig en fonction des paquetsannées de tabac. L'évolution sur un an montre qu'aucun usager exclusif de Ecig n'est devenu fumeur un an après. Discussion-Ces résultats préliminaires ne suggèrent pas que la Ecig puisse faciliter le passage au tabac et suggèrent qu'elle est plutôt largement utilisée pour arrêter de fumer ; un suivi de longue durée dans Constances est prévu

Awareness of driving while sleepy and road traffic accidents: prospective study in GAZEL cohort

Objectives To examine the association between self assessed driving while sleepy and the risk of serious road traffic accidents (RTAs). Design Prospective cohort study. Setting France. Participants 13 299 of the 19 894 living members of the GAZEL cohort, workers and recent retirees of a French national utility company followed up since 1989. Main outcome measures Frequency of driving while sleepy in the previous 12 months, reported in 2001; rate ratios for serious RTAs in 2001-3, estimated by using generalised linear Poisson regression models with time dependent covariates. Results The risk of serious RTAs increased proportionally with the frequency of self reported driving while sleepy. After adjustment for sociodemographic characteristics, driving behaviour variables, work conditions, retirement, medical conditions and treatments, depressive symptoms, and sleep disorders, the adjusted rate ratios of serious RTAs for participants who reported driving while sleepy in the previous 12 months “a few times” or “once a month or more often” were 1.5 (95% confidence interval 1.2 to 2.0) and 2.9 (1.3 to 6.3) respectively compared with those who reported not driving while sleepy over the same period. These associations were not explained by any reported sleep disorders. Conclusions Self assessed driving while sleepy was a powerful predictor of serious RTAs, suggesting that drivers' awareness of their sleepiness while driving is not sufficient to prevent them from having RTAs. Messages on prevention should therefore focus on convincing sleepy drivers to stop driving and sleep before resuming their journey

Does cognition predict mortality in midlife? Results from the Whitehall II cohort study.

International audienceThe authors examined the association of 'g' (general intelligence) factor and five specific cognitive measures assessed in 1997-1999 with mortality till 2006 (mean follow-up of 8 years) in the middle-aged Whitehall II cohort study. In age- and sex-adjusted analysis, a decrease in 1 S.D. in memory (hazard ratio (HR), 1.19; 95% confidence interval (CI): 1.02, 1.39) and in Alice Heim 4-I (AH4-I) (HR, 1.16; 95% CI: 1.01, 1.35) was found to be associated with higher mortality. The association with 'g' factor, phonemic and semantic fluency did not reach significance at p<0.05. No association was found with vocabulary. Out of education, health behaviours and health measures, it was health behaviours that explained the greater part of the association between cognition and mortality, ranging from 21% for memory to 70% for semantic fluency. All the covariates taken together explained only 26% of the association with memory and between 33 and 90% for the other cognitive measures. This study suggests that 'g' type composite measure of cognition might not be enough to understand the associations between cognition and health

Self-rated health and mortality: short- and long-term associations in the Whitehall II study.

International audienceTo determine if self-rated health (SRH), a single-item measure of health status where individuals are asked to rate their own health, predicts mortality in a middle-aged sample and if the predictive ability of SRH diminishes with time. Data (6316 men and 3035 women) are drawn from the Whitehall II study. SRH and covariates were measured at baseline (1985-1988) when the average age of individuals was 44.5 years (SD = 6.1). The mortality follow-up was available for a mean of 17.5 years and was classified as having occurred in the first 10 years or the subsequent follow-up period (range 6 to 9 years). The association between SRH and mortality was assessed using a Cox regression model with relative index of inequality (RII) to summarize associations. There were no sex differences in the association between SRH and mortality in either the short (p = .39) or the long term (p = .16). Sex-adjusted short-term association (RII = 3.80; 95% confidence interval (CI) 2.28, 6.35) was significantly (p = .004) stronger than the long-term association (RII = 1.56; 95% CI 1.04, 2.34). Explanatory variables accounted for 80% of the SRH-mortality association in men and 29% in women. SRH predicts mortality equally well in men and women. However, the covariates explained a much larger proportion of the SRH-mortality relationship in men compared with women. In this middle-aged cohort, SRH predicts mortality strongly in the short term but only weakly in the long term

Socioeconomic status moderates the association between carotid intima-media thickness and cognition in midlife: evidence from the Whitehall II study.

International audienceBACKGROUND: Common carotid artery intima-media thickness (IMT) is a measure of generalized atherosclerosis and has been shown to be associated with cognitive function. We examine two questions: does socioeconomic status (SES) moderate this association and is IMT more strongly associated with specific aspects of cognitive function? METHODS: Data are drawn from the Phase 7 (2003-2004) of the Whitehall II study (N=3896). In cross-sectional analyses the association between IMT and six measures of cognition (short-term verbal memory, inductive reasoning, vocabulary, semantic and phonemic fluency and a measure of global cognitive status) was examined in analyses adjusted for previous history of coronary heart disease, health behaviours and other vascular risk measures such as blood pressure, cholesterol and body mass index. RESULTS: The overall association between IMT and the six measures of cognition was restricted to the low SES group (p=0.02). Within this group, IMT was significantly associated with inductive reasoning (p=0.001), vocabulary (p=0.002), phonemic (p=0.006) and semantic fluency (p=0.02). The covariates examined explained about a quarter of the association between IMT and cognition in the low SES group. The associations with the measure of inductive reasoning (p=0.02), vocabulary (p=0.02) and phonemic fluency (p=0.04) remained after adjustment for all covariates. CONCLUSIONS: SES is an important modifier of the association between IMT and cognition, an inverse association between the two was observed only in the low SES group. It is possible that high cognitive reserve among the high SES individuals prevents the functional manifestations of atherosclerosis. Verbal memory was not one of the cognitive domains associated with IMT