Associations between screen viewing at 2 and 3.5 years and drawing ability at 3.5 years among children from the French nationwide Elfe birth cohort.

The effect of screen viewing on children's cognitive development has been of concern among parents and researchers. This study investigated the association between children screen time, as reported by parents, and drawing ability, and the confounding effects of socioeconomic characteristics (such as parental education, household income, migration status) and children's competing activities (such as drawing practice, extracurricular activity, outdoor time, sleep time, time playing with parents). Participants included 7577 children aged 3.5 years (50% girls) who underwent the Draw-a-person test (McCarthy score [range = 0-12 points]) in the French nationwide Elfe birth cohort, initiated in 2011. Sex-stratified zero-inflated Poisson regression models were used. Increased screen time was associated with a higher likelihood to obtain a null score in boys (OR 1.15, 95% CI 1.07-1.23) and girls (1.13 [1.03-1.24]) and a lower score in girls only (ß = - 0.02, 95% CI - 0.04; - 0.01). After adjusting for SES, associations were no longer observed, indicating that the association between screen time and drawing abilities was confounded by socioeconomic characteristics.

Social patterning of childhood overweight in the French national ELFE cohort.

An inverse social gradient in early childhood overweight has been consistently described in high-income countries; however, less is known about the role of migration status. We studied the social patterning of overweight in preschool children according to the mother's socio-economic and migration background. For 9250 children of the French ELFE birth cohort with body mass index collected at age 3.5 years, we used nested logistic regression to investigate the association of overweight status in children with maternal educational level, occupation, household income and migration status. Overall, 8.3% (95%CI [7.7-9.0]) of children were classified as overweight. The odds of overweight was increased for children from immigrant mothers (OR 2.22 [95% CI 1.75-2.78]) and descendants of immigrant mothers (OR 1.35 [1.04-2.78]) versus non-immigrant mothers. The highest odds of overweight was also observed in children whose mothers had low education, were unemployed or students, or were from households in the lowest income quintile. Our findings confirm that socio-economic disadvantage and migration status are risk factors for childhood overweight. However, the social patterning of overweight did not apply uniformly to all variables. These new and comprehensive insights should inform future public health interventions aimed at tackling social inequalities in childhood overweight.

Sociodemographic and behavioural factors of adherence to the no-screen guideline for toddlers among parents from the French nationwide Elfe birth cohort.

BACKGROUND: Excessive screen time in infancy and childhood has been associated with consequences on children's development and health. International guidelines call for no screen time before age 2 years, whereas in France, the most prominent guidelines recommend no screen before age 3 years. However, data are lacking on parental adherence to the no-screen guideline for toddlers and factors of adherence in France. Using data from the French nationwide Elfe birth cohort, we estimated adherence to the no-screen guideline at age 2 years and examined related factors, including sociodemographic characteristics, parental leisure activities and screen time. METHODS: In 2011, 18,329 newborns and their parents were enrolled in 349 randomly selected maternity units across mainland France. At age 2 years, screen exposure of 13,117 toddlers was reported by parents in phone interviews. Data on sociodemographic characteristics, parental leisure activities and screen time were collected from both parents. Three patterns of parental leisure activities were derived by principal component analysis: literate (e.g.,reading), screen-based, and physical/artistic activities. Multivariable logistic regression models were used to examine the associations of sociodemographic characteristics, parental leisure activities and parental screen time with adherence to the no-screen guideline for toddlers. RESULTS: Overall, 1809/13,117 (13.5%) families adhered to the no-screen guideline for toddlers. Adherence was reduced with maternal age < 40 years, low parental education, single-parent household and parental migration status. After adjusting for sociodemographic characteristics, adherence to the guideline was positively associated with a parental literate activity pattern (mothers: odds ratio [95% confidence interval]: 1.15 [1.08, 1.22]); fathers: 1.15 [1.07, 1.23]) and negatively with a screen-based activity pattern (mothers: 0.73 [0.69, 0.77]; fathers: 0.81 [0.76, 0.87]). With each additional hour of parental screen time, mothers and fathers were less likely to adhere to the guideline (mothers: adjusted odds ratio 0.80 [0.77, 0.83]; fathers: 0.88 [0.85, 0.91]). CONCLUSIONS: Adherence to the no-screen guideline for toddlers in France was low. Parental leisure activities and parental screen time are major factors of adherence to the no-screen guideline and could be considered in targeted public health interventions.

Gestational weight gain in a migration context: are migrant women more at risk of inadequate or excessive weight gain during pregnancy?

BACKGROUND: Inadequate or excessive gestational weight gain (GWG) is associated with adverse maternal and neonatal outcomes. Little is known on adequacy of GWG in migrant women. This study investigates whether migrant women in France are at higher risk of inadequate or excessive GWG, and what characteristics are associated with GWG in migrant and non-migrant groups. METHODS: We used data from the PreCARE multicentric prospective cohort (N=10 419). The study includes 5403 women with singleton deliveries, with non-migrant (n=2656) and migrant (n=2747) status. We used multinomial logistic regression, adjusting for maternal age and parity, to investigate the association of migrant status, socioeconomic status-related variables and GWG. In stratified analyses, we identified factors associated with GWG in both groups. RESULTS: Compared with non-migrant women, migrant women had increased risk of inadequate GWG (adjusted odds ratio (aOR) 1.18; 95% CI 1.03 to 1.34). Non-migrant women with foreign origins had increased risk of excessive GWG (aOR 1.58; 95% CI 1.30 to 1.92). Women born in Sub-Saharan Africa had increased risk of both inadequate and excessive GWG. Regardless of migration status, women with lower education and women who did not start pregnancy with a normal weight were less likely to gain adequately. Inadequate prenatal care was associated with inadequate GWG only among non-migrant women. CONCLUSION: Migrant women are at higher risk of inadequate GWG.

The role of organization of care in GPs' prevention practice.

BACKGROUND: General practitioners (GPs) do not systematically include preventive recommendations in their practice, and some characteristics of health care organization are associated with more systematic prevention. But the characteristics of health care organization may act in a nonuniform manner depending on the type of preventive care. Thus, one characteristic can be positively associated with one type of preventive care and negatively associated with another. Our aim was to investigate the association between health care organization in general practice and different areas of preventive care (immunization and addiction prevention), in search of nonuniform associations. METHODS: We used a representative survey of 1,813 French GPs conducted in 2009. Four preventive care practices were studied: immunization through flu and HPV vaccination, and prevention of addictive behaviors concerning tobacco and alcohol use.Characteristics of GPs' health care organization and the social context of their practice were collected (spatial accessibility to GPs and socioeconomic level of the area of practice). We constructed mixed models to study associations and interactions between the organization variables and preventive care. RESULTS: Four out of five characteristics of GPs' organization have uneven impacts on different types of preventive care (p-interaction < 10-4). For example, number of daily consultations is associated with better immunization prevention but with poorer prevention counseling in addictive behaviors. In contrast, working with digital medical files is uniformly associated with both types of preventive care (OR = 1.29 [1.15-1.45]; P < 10-4). CONCLUSION: An approach centered on specific types of preventive care should help deepen our understanding of prevention and possibly help to identify a new typology for preventive care.

Do vulnerable groups access prevention services? Cervical cancer screening and HIV testing among homeless migrant women in the Paris metropolitan area.

INTRODUCTION: Homeless migrant women, facing adverse living conditions and barriers to legal status, are at risk of cervical cancer, HIV infection and may encounter barriers to screening services. We investigate factors associated with each screening in a population of migrant women in France and aim to determine the mean time since last HIV testing according to duration of residence in France. METHODS: We use data from the DSAFHIR study (Rights and Health of Migrant Women in Emergency Housing) investigating health and migration experience of homeless migrant women housed in emergency housing hotels in the Paris Metropolitan area in 2017. We computed multivariate logistic regression models to investigate no lifetime cervical cancer screening (CCS) and no lifetime HIV test. We used linear regression models to analyze time since last HIV test. RESULTS: We included 469 women. 46% of respondents had no lifetime CCS, 31% had no lifetime HIV test. Both screenings were associated with educational attainment and French proficiency. Compared with duration of residence < 1 year, duration ≥ 7 years was associated with a lower likelihood of no lifetime CCS (adjusted Odd Ratio = 0.17; 95% CI = 0.07-0.39). Compared to women born in North Africa, women born in West (aOR = 0.15; 95% CI = 0.07-0.33) and East Africa (aOR = 0.06; 95% CI = 0.02-0.20) were less likely to have no lifetime HIV test. Time since last HIV test increased for each additional year spent in France (coef = 0.21; 95% CI = 0.09, 0.33). CONCLUSION: While access to CCS remains poor for recent migrants, HIV testing is more likely to occur shortly after migration.

Caesarean delivery in a migration context: the role of prior delivery in the host country.

Migrant women in industrialised countries experience high caesarean section (CS) rates but little is known about the effect of a previous delivery in the host country. This study set out to investigate this effect among migrant women in France, using data from the DSAFHIR study on healthcare access of migrant women living in emergency housing hotels, collected in the Paris Metropolitan area in 2017. Respondents reported life-long history of deliveries. We focused on deliveries occurring in France in 2000-2017: 370 deliveries reported by 242 respondents. We conducted chi-square tests and multivariate logistic regressions, adjusting for the clustering of deliveries among respondents by computing standard errors allowing for intragroup correlation. Mode of delivery was associated with duration of residence among multiparous women with no prior CS, with a higher CS rate with shorter duration of residence (16% vs. 7%, p = 0.04). In this group, a previous delivery in France was associated with a lower CS rate (5% vs. 16%, p = 0.008). In multivariate analysis, compared with women with previous birth in France, women giving birth in France for the first time had a higher risk of CS, regardless of duration of residence (aOR = 4.0, 95% CI = 1.3-12.1 for respondents with short duration of residence, aOR = 4.7, 95% CI = 1.2-18.0 for respondents with longer duration of residence). Efforts directed at decreasing the CS rate among migrant women should target women giving birth in the host country for the first time.

General practitioners who never perform Pap smear: the medical offer and the socio-economic context around their office could limit their involvement in cervical cancer screening.

BACKGROUND: In France, with the growing scarcity of gynecologists and a globally low and socially differentiated coverage of cervical cancer screening (CCS), general practitioners (GPs) are valuable resources to improve screening services for women. Still all GPs do not perform Pap smears. In order to promote this screening among GPs, the characteristics of physicians who never perform CCS should be more precisely specified. Besides already-known individual characteristics, the contextual aspects of the physicians' office, such as gynecologist density in the area, could shape GPs gynecological activities. METHODS: To analyze county (département) characteristics of GPs' office associated with no performance of CCS, we used a representative sample of 1063 French GPs conducted in 2009 and we constructed mixed models with two levels, GP and county. RESULTS: Almost 35% (n = 369) of the GPs declared never performing CCS. GPs working in counties with a poor GP-density per inhabitants were more likely to perform CCS (odds ratio (OR) = 0.52 for each increase of density by 1 GP per 10,000 inhabitants, 95% confidence interval (CI) = 0.37-0.74). On the contrary, GPs working in counties with an easier access to a gynecologist were more likely not to perform CCS (OR = 1.06 for each increase of density by 1 gynecologist per 100,000 women, 95%CI = 1.03-1.10 and OR = 2.02 if the first gynecologist is reachable in less than 15 min, 95%CI = 1.20-3.41) as well as GPs working in areas with a poverty rate above the national average (OR = 1.66, 95%CI = 1.09-2.54). These contextual characteristics explain most of the differences between counties concerning rates of not performing CCS. CONCLUSIONS: Specific programs should be developed for GPs working in contexts unfavorable to their involvement in CCS.

Disengagement of general practitioners in cervical cancer screening.

In the absence of organized cervical cancer screening (CCS) programs, gynecologists remain principal actors in obtaining a Pap smear, followed by general practitioners (GPs). In France, with the growing scarcity of gynecologists and social inequalities in access to opportunistic screening, GPs are valuable resources for women's gynecologic follow-up. We aimed to investigate the characteristics of GPs who do not perform CCS, analyzing the effect of GPs' sex and their evolution over time. On the basis of data from three cross-sectional surveys conducted among representative samples of French GPs in 1998, 2002, and 2009 (n=5199), we constructed univariate and multivariate logistic mixed models (level 2: county, level 1: GP) with random intercept stratified on GPs' sex to investigate the characteristics of the GPs associated with no practice of CCS ever. Almost one-third of all GPs did not perform CCS ever and it increased with time. Male GPs were always more likely not to perform it (odds ratio=0.50, 95% confidence interval=0.42-0.59). The percentage of GPs not performing CCS increased more markedly among male than among female GPs, and increased more among the youngest age group. Increasingly fewer GPs engage in CCS when the growing scarcity of medical gynecologists calls for more participation. Female GPs remain significantly more active in CCS than male GPs. The participation in CCS is determined differently according to the practitioner's sex.

[To answer rare cancer issues. Geographical analysis of EMS sarcoma cohort in the Rhône-Alpes region]. / Répondre aux enjeux des cancers rares. Approche géographique de la cohorte EMS des sarcomes en région Rhône-Alpes.

Rare cancer issues have not been much explored yet because of their low incidence. That is why epidemiological studies have difficulties in identifying indisputable etiological risk factors. An expert opinion, mainly concentrated in some establishments, is required for these cancers' management. However, on account of the potential remoteness of these therapeutic resources, the patients' way of care remains also unstudied. By means of a geographical analysis of a regional exhaustive cohort of sarcoma, diagnosed in 2006 and 2007 and followed during five years at least, we can make progress on these different issues. Gastro-Intestinal and Stromal Tumors (GIST) occur more frequently in privileged territories while liposarcomas arise in more deprived areas. The association between liposarcomas and areas deprivation is significant (P=0.05). Moreover, pre-operative biopsy and some clinical patient characteristics, age, grade or tumor localization, are associated with an increase in the distance covered by patients for the first-line treatment (p ≤ 0,001). In the scope of an interdisciplinary collaboration, the geographical approach develops some hypothesis for rare cancers research, which must be tested by other larger scale studies.

Contraceptive use and method among immigrant women in France: relationship with socioeconomic status.

OBJECTIVES: We investigated the relationship between socioeconomic status and the use and method of contraception among immigrant, second-generation immigrant, and non-immigrant women in France. METHODS: We analysed data from the 2008-2009 survey 'Trajectories and origins: Survey on the diversity of populations in France'. A total of 7070 women aged 18 to 45 years were identified, and information concerning contraceptive use and choice was obtained by self-report. Polytomous logistic regression models were used to assess association estimates. RESULTS: Recent contraceptive use among immigrant and second-generation immigrant women was significantly lower than that of non-immigrant women. Lower educational attainment and unemployment were associated with an estimated 31˜59% reduction in odds of contraceptive use for immigrant and second-generation immigrant women; however, this was not the case for non-immigrant women. Among the latter, lower educational attainment appeared to be associated with increased use of oral contraceptives. CONCLUSIONS: Our findings suggest the need to advance our understanding of potential barriers to contraceptives created by socioeconomic forces across different societal/cultural contexts.