Lower smoking rates and increased perceived harm of cigarettes among French adults one year after comprehensive tobacco control measures

International audienceCONTEXT: France has high smoking rates, and recently intensified tobacco control policies spearheaded by the introduction of plain tobacco packaging (PP), and an increase in graphic health warnings (GHW). We examine smoking and e-cigarettes use rates, as well as smoking-related perceptions before (2016) and one year after (2017) comprehensive tobacco control measures.METHODS: DePICT is a two waves cross-sectional national telephone survey of French adults aged 18-64 years (2016: 4456 - 2017: 4114). Data were weighted to be representative of the French adult population. Adjusted prevalence ratios (PR, 95% CI) estimating changes between the two study waves were calculated using multivariate Log-Binomial regression models.MAIN FINDINGS: In 2017, as compared with 2016, smoking rates (PR = 0.93 (0.88-0.99) and current e-cigarette use (PR = 0.76 (0.61-0.96)) decreased in France. Further, French adults were more likely to report fear of the consequences of smoking (PR = 1.10 (1.06-1.14)) and that smoking is dangerous (PR = 1.08 (1.06-1.11)). Smokers were also more likely to report that health messages on tobacco products are efficient (PR = 1.18 (1.05-1.32)).CONCLUSIONS: Our study provides early and encouraging results on potential effects of the comprehensive tobacco control strategies in France introduced in 2017, including PP and larger GHW. Our findings also suggest that e-cigarettes did not replace traditional smoking

Early life childcare and later behavioral difficulties: a causal relationship? Data from the French EDEN study

The EDEN mother-child cohort study groupInternational audienceAmong 1428 children participating in the French EDEN cohort study, we examined the relationship between childcare from 0 to 3 years(childminder, center-based, informal) and later trajectories of behavioral difficulties (ascertained via the Strengths and Difficulty Questionnaire at 3, 5.5 and 8 years) established using group-based trajectory modeling. Family and child characteristics were controlled for using Inverse Probability Weights. Children who were in center-based childcare had lower levels of emotional and behavioral difficulties in bivariate analyses, however these associations were no longer statistically significant after controlling for covariates. Compared to children who spent at least 1 year in center-based childcare, those who spent less than 1 year with a childminder as well as those who were in informal care had higher levels of emotional and behavioral difficulties in multivariate analyses. Early life childcare may have long-term benefits for children's behavioral and emotional development, particularly if it is of high quality and lasts at least 1 yea

Do Determinants of Smoking Cessation and Relapse Differ between Men and Women? Data from a French National Study

International audienceIntroduction: There is limited understanding of different predictors of smoking cessation success (SCS) among women and men, despite well-documented differences in smoking behavior.Methods: Using data from DePICT (Description des Perceptions, Images, et Comportements liés au Tabagisme), a national survey of French adults which recruited 2377 regular and former smokers we investigated whether major determinants of SCS differed by sex. Factors associated with unsuccessful vs. No successful quit attempt; vs. SCS were studied using multivariate multinomial logistic regression analyses stratified by sex.Results: Women and men share some determinants of SCS including no cannabis use, living in a nonsmoker household and importance giving to being a nonsmoker. However, no e-cigarette use, low-to-moderate alcohol consumption, early smoking initiation, and higher education were associated with SCS only among women. No use of nicotine replacement, having family members who smoke, family opinion on smoking and current employment, were associated with SCS only among men. Neutral or negative friends’ opinion on smoking or living with a smoker were associated with unsuccessful smoking attempts among men.Conclusions: Our results show differences between determinants of SCS according to sex, which highlights the importance of developing tailored interventions that account for sex/gender differences in smoking cessation

Paternity leave uptake and parental post-partum depression: findings from the ELFE cohort study

International audienceSeveral countries are expanding their paternity leave policies, which can have positive effects on parental mental health. Using data from the French nationally representative longitudinal birth cohort study (ELFE), we examined whether 2 weeks of paid paternity leave are associated with post-partum depression in mothers and fathers at 2 months after the birth of their child. ). Logistic regression models, using survey-weighted data and adjusted for confounders using inverse probability weights, yielded odds ratios (ORs). We included 10975 fathers and 13075 mothers with reported information on paternity leave and post-partum depression at 2 months in the statistical analyses. Fathers who took paternity leave had reduced odds of post-partum depression (OR 0∙74 [95% CI 0∙70–0∙78]) as did fathers who intended to take paternity leave (0∙76 [0∙70–0∙82]) compared with fathers who did not take paternity leave. However, we did not find such beneficial effects for mothers whose partners took (1∙13 [1∙05–1∙20]) or intended to take paternity leave (1∙02 [0∙96–1∙08]). Taking and intending to take 2-weeks’ paid paternity leave was associated with a reduced likelihood of reporting post-partum depression in fathers. However, offering 2-weeks’ paternity leave might place mothers at a greater risk of post-partum depression, suggesting that optimal length and timing of the leave, among other factors, need further investigation

Trajectoires de difficultés psychologiques chez les enfants : apport des données de la cohorte EDEN

Les conditions de la grossesse et de vie dans la petite enfance – notamment les comportements de santé et la santé mentale des parents, sont associées au développement et au devenir à moyen terme des enfants, ce que montrent les données de cohortes longitudinales telles qu’EDEN. En particulier, les données de la cohorte EDEN qui suit des enfants nés entre 2003 et 2006, est unique en France et fait partie d’un faible nombre de cohortes de ce type à l’échelle internationale, ont montré les effets néfastes à long terme sur le développement émotionnel et/ou psychologique des enfants du tabagisme et d’une alimentation peu équilibrée de la mère pendant la grossesse ou encore des trajectoires de dépression de la mère. Néanmoins, l’accès à un mode de garde professionnel, et en particulier une crèche collective, est associé à un développement émotionnel plus favorable. Dans l’ensemble, ces résultats confirment la place importante des conditions de la grossesse et de vie dans les premières années, vis-à-vis du développement psychologique des enfants à moyen terme, et la place des supports sociaux collectifs. Il ne s’agit pas ici de pointer du doigt certaines familles, mais plutôt d’éclairer des mécanismes sous-jacents aux difficultés psychologiques et alerter les décideurs sur l’importance des déterminants précoces vis-à-vis de la santé psychique au long cours. Le recueil de données se poursuivant, les données de la cohorte EDEN permettront d’évaluer les déterminants précoces de la santé mentale des enfants au long cours, apportant de nouvelles connaissances au cours des prochaines années.Pregnancy circumstances and living conditions in early childhood – in particular in terms of parental health behaviors and mental health – are associated with children's developmental outcomes in the mid-term, which is illustrated by data of longitudinal cohort studies such as EDEN. In particular, data from the EDEN cohort study, which is set among children born in 2003–2006 and which are unique in France and rare internationally, show negative long-term effects of maternal smoking and unhealthy dietary patterns during pregnancy, and depression from pregnancy onwards, with regard to children's psychological development. However, access to a daycare center is positively related to children's emotional development, highlighting the importance of collective sources of social supports. Overall, these findings suggest an important role of pregnancy and early childhood living circumstances with regard to children's mid-term psychological development. The point of these data are not to stigmatize certain groups of the population but rather to shed light upon mechanisms underlying mental health risk and alert decision makers to the role of early life determinants with regard to long-term psychological health. Data collection procedures remain ongoing, and EDEN cohort data to come will enable testing the role of these characteristics early in life with regard to children's long-term mental health

Sex differences in cigarette brand purchases among adult smokers: results from the DePICT national repeated survey of French adults (2016–2017)

International audienceObjectiveThe tobacco industry has been reported to employ sex-specific marketing strategies, which include different types of tobacco packaging, publicity, as well as price strategies. We examined whether characteristics associated with the purchase of more expensive cigarette brands varied by sex, in the context of the introduction of plain tobacco packaging and the strengthening of tobacco control policies in France.MethodsOur study population consists of 1380 regular smokers of manufactured cigarettes from the DePICT study, a nation-wide two-wave survey of French adults aged 18–64 years. Participants were interviewed by telephone in 2016 and 2017. Factors associated with the use of more vs. less expensive cigarette brands were determined by multivariable logistic regression stratified by sex.ResultsSeveral sex-specific factors were associated with the purchase of more expensive cigarette brands. In women, those factors included higher education, cannabis use, and no use of roll-your-own tobacco. While in men purchase of more expensive cigarette brands was linked to younger age, being born outside of France, living with a non-smoker, and attachment to the cigarette brand.DiscussionFactors which predict tobacco purchase patterns are different in women and men, highlighting the need for sex-specific tobacco control initiatives to counter the tobacco industry’s gendered marketing

Paternity leave uptake and parental post-partum depression: findings from the ELFE cohort study

BACKGROUND: Several countries are expanding their paternity leave policies, which can have positive effects on parental mental health. We examined whether 2 weeks of paid paternity leave are associated with post-partum depression in mothers and fathers at 2 months after the birth of their child. METHODS: We used data from the Etude Longitudinale Française depuis l'Enfance (ELFE) cohort study. Participating mothers gave birth in 2011 in a representative sample of 320 maternity hospitals in mainland France. Inclusion criteria were single or twin livebirths born after at least 33 weeks' gestation; mother's age at least 18 years; no plans to leave metropolitan France within 3 years. Mothers were interviewed face-to-face shortly after the child's birth. Fathers and mothers were both interviewed by telephone 2 months after the child's birth, reporting whether the father had the right to paternity leave and if yes, if he had taken or intended to take it. We used the Edinburgh Postnatal Depression Scale to assess post-partum depression among fathers and mothers at 2 months. Logistic regression models, using survey-weighted data and adjusted for confounders using inverse probability weights, yielded odds ratios (ORs). FINDINGS: We included 10 975 fathers and 13 075 mothers with reported information on paternity leave and post-partum depression at 2 months in the statistical analyses. Fathers had a median age of 32·6 years (IQR 36·9-22·6) and mothers had a median age of 30·5 years (34·0-27·1) at the time of the ELFE child's birth. The prevalence of depression in fathers according to paternity leave status was 4·5% among those who used paternity leave, 4·8% among those who intended to use paternity leave, and 5·7% among those who did not use paternity leave. For mothers, the prevalence of post-partum depression was 16·1% among those whose partner used paternity leave, 15·1% among those whose partner intended to use paternity leave, and 15·3% among those whose partner did not use paternity leave. Fathers who took paternity leave had reduced odds of post-partum depression (OR 0·74 [95% CI 0·70-0·78]) as did fathers who intended to take paternity leave (0·76 [0·70-0·82]) compared with fathers who did not take paternity leave. However, we did not find such beneficial effects for mothers whose partners took (1·13 [1·05-1·20]) or intended to take paternity leave (1·02 [0·96-1·08]). INTERPRETATION: Taking and intending to take 2-weeks' paid paternity leave was associated with a reduced likelihood of reporting post-partum depression in fathers. However, offering 2-weeks' paternity leave might place mothers at a greater risk of post-partum depression, suggesting that optimal length and timing of the leave, among other factors, need further investigation. FUNDING: The French National Research Agency

Plain tobacco packaging, increased graphic health warnings and adolescents\u27 perceptions and initiation of smoking: DePICT, a French nationwide study

BACKGROUND: Plain packaging (PP) of tobacco products and increased graphic warnings may contribute to lower attractiveness of smoking, particularly among youths. In France, this policy was introduced on 1 January 2017. We examined changes in smoking-related perceptions and behaviours among a nationwide sample of French adolescents before (2016) and 1 year post (2017) implementation. METHODS: DePICT is a two-wave cross-sectional national telephone survey of adolescents aged 12-17 years per study wave (2016: n=2046 2017: n=1999). All participants reported smoking-related perceptions, as well as ever and current tobacco use. Smokers were also asked about their perceptions of tobacco brands. Data were weighted to be representative of youths in the French population: adjusted prevalence ratios (PRs, 95% CI) estimating changes between the two study waves were calculated using multivariate log-binomial regression models. RESULTS: In 2017, as compared with 2016, French adolescents were more likely to report fear of the consequences of smoking (PR=1.06, 95% CI 1.02 to 1.09) and that smoking is dangerous (PR=1.08, 95% CI 1.05 to 1.11). They were also less likely to report that their friends (PR=0.61, 95% CI 0.54 to 0.70) and family (PR=0.51, 95% CI 0.44 to 0.60) accept smoking. Additionally, smoking initiation significantly decreased (PR=0.96, 95% CI 0.93 to 0.98) and a non-statistically significant drop in current tobacco use was observed (PR=0.93, 95% CI 0.78 to 1.11). Smokers\u27 attachment to their tobacco brand also decreased (PR=0.47, 95% CI 0.30 to 0.73). CONCLUSION: Our findings suggest that PP and increased graphic warnings could contribute to changes in smoking norms and rates among adolescents

Early Childcare and Developmental Delay Risk at 3.5 Years: Insights from the French ELFE Cohort

International audienceWe tested the association between early childcare attendance in the first three years of life and child development at age 3.5 years in the French context, where early childcare is subsidized. In the ELFE (Étude Longitudinale Français depuis l'Enfance) birth cohort study set in metropolitan France, children’s development was reported by parents at age 3.5 years (n = 11,033) via the Child Development Inventory (CDI) questionnaire. CDI scores were transformed into a development quotient (DQ), with a DQ < 90 corresponding to possible and a DQ < 85 corresponding to a probable developmental delay. Inverse probability weighted multivariable regression models were used to analyse whether early childcare in the first three years of life (centre-based, childminder, informal or parental care) was associated to development delay. Compared to children in exclusive parental care, those in centre-based childcare (CBC) or with a childminder prior to school entry were significantly less likely to experience possible (OR = 0.56, [95% CI = 0.51–0.61] for CBC and OR = 0.77, [95% CI = 0.72–0.83] for childminder attendance) and probable developmental delay (OR = 0.62, [0.58–0.67] for CBC and OR = 0.80 [0.76–0.83] for childminder). Informal childcare attendance was not significantly associated with children’s possible nor probable developmental delay ((OR = 0.97, [0.84–1.12]) and (OR = 0.97, [0.82–1.15]), respectively). Conclusions: Overall, our findings add to the existing scientific literature, showing that in the French context, where childcare can start as early as 3 months of age, early childcare attendance can contribute to child’s development

Poor Perceived Health is Associated with Current use of Electronic Cigarette among Current and Former Smokers: Findings from the CONSTANCES Cohort

International audienceBACKGROUND - Electronic cigarettes (e-cigarettes) have become increasingly popular, yet beyond social or technical features, the specific health-related reasons adults use e-cigarettes remain poorly understood. OBJECTIVE - To explore the cross-sectional associations between perceived health and current e-cigarette use in a large population-based cohort. METHODS - From the participants included in the French CONSTANCES cohort (a large general-purpose national population-based cohort) from 2015 to 2017, we included 18,300 ever tobacco smokers with data on their e-cigarette use. We used logistic regressions to estimate the associations between e-cigarette use and perceived health (global and respiratory), stratifying on participants' smoking status and adjusting for sociodemographic characteristics. To examine the role of objective health features (reported diagnoses and measured parameters during a health examination), we adjusted for prior history of respiratory and cardiovascular diseases, diabetes, cancer, spirometry, and blood pressure. Finally, we examined the effect of additionally adjusting for several health-related behaviors. RESULTS - Participants with poor perceived health (global and respiratory) were at greater risk of e-cigarette use. These associations remained unchanged after adjustment for objective health features and health-related behaviors (e.g., in current smokers, for global perceived health, an odds ratio of 1.10 [95% CI 1.03-1.16] per increase on an 8-point scale from very good to very poor). CONCLUSIONS - Our findings suggest that the more current and former smokers felt unhealthy, the more they tended to currently use e-cigarettes. People who regularly use e-cigarettes should obtain medical supervision that takes into account not only objective diagnoses and measurements but also perceived health. Counseling practices could include assessing perceived health status to reinforce motivation to quit smoking