The impact of social capital and social environmental factors on mental health and flourishing: the experiences of asylum-seekers in France.

BACKGROUND: There is growing interest on how social capital and related social environmental factors impact overall population health and well-being. The nature of asylum-seekers' social environment alters once they migrate to a new context and these changes influence their mental health and well-being. However, there is limited scholarship on how these social environmental factors impact the mental health, well-being, and capacity to flourish of asylum-seekers. METHODS: The aim of the study, therefore, was to examine how specific social environmental factors-social networks, social support, and social cohesion at various levels (micro, meso, and macro)-influence the mental health, well-being, and capacity to flourish of asylum-seekers in France. In collaboration with a community-based organization, we used a qualitative research design to conduct 120 semi-structured interviews with asylum-seekers in France. RESULTS: The emerging salient themes depicted how the asylum-seekers' usual informal social networks comprised of family and friends had been disrupted since they migrated to France, which impacted their mental health and well-being. Conversely, staying connected with their informal transnational social networks via social media and developing ties with new local informal and formal social networks allowed them to receive different forms of social support, and buffered some of the negative mental health consequences. However, the lack of social cohesion due to a lack of belonging, marginalization, and current harmful migration-related policies impeded asylum-seekers' capacity to flourish. CONCLUSION: While social support derived from social networks buffered some negative impacts on mental health and well-being, the overall lack of social cohesion ultimately impeded asylum-seekers' capacity to flourish within their host communities, which was further exacerbated by harmful migration policies of exclusion within France. Introducing more inclusive policies related to the governance of migration and an intersectoral approach that views health in all policies is key to promoting social cohesion and flourishing among asylum-seekers in France.

"Living in Confinement, Stopped in Time": Migrant Social Vulnerability, Coping and Health during the COVID-19 Pandemic Lockdown in France.

The COVID-19 pandemic has exposed health and social inequities among migrant populations. Less empirical evidence exists about the impact of COVID-19 lockdown measures on migrants. This study aimed to investigate the impact of the first lockdown in France between March and May 2020 on migrants' lives and livelihoods. We adopted a social vulnerability framework to conceptualize how the pandemic and the consequential lockdown in France contributed to a 'compounded crisis' for asylum seekers and undocumented migrants. This crisis encompassed health, protection, and socio-economic challenges for migrants and exposed the shortcomings of existing government policies that exclude migrants and do not address the root causes of health inequities. The study draws on in-depth qualitative interviews conducted with 75 asylum seekers and undocumented migrants during the pandemic lockdown in the French regions of Auvergne-Rhône-Alpes and Île-de-France. The findings of this paper highlight the importance of implementing a cohesive pandemic response approach that views health as a fundamental inclusive right for all human beings and all policies as health policies to promote well-being for all.

Impact of the COVID-19 pandemic on vulnerable groups, including homeless persons and migrants, in France: A qualitative study.

Social inequalities tended to increase in the context of the pandemic, particularly in relation to the measures taken to manage and reduce the risk of COVID-19. When lockdown measures required the general population "to stay home", what were homeless people expected to do? The ECHO study is a cross-sectional, descriptive study with a convergent mixed-method design. Data were collected across shelters in France both during and immediately following the lockdown (April - June 2020). This article presents the study's qualitative findings, with a focus on understanding both the experiences and perceptions among these populations of the measures taken to limit the COVID-19 infection. A total of 26 semi-directed individual interviews were conducted across seven shelters in both Lyon (42%) and Paris (58%). Data were analysed using thematic content analysis with partial blinded coding. Four key themes were identified: 1- Reactions to the introduction of lockdown: a sudden implementation reminiscent of prior violent or traumatic circumstances amongst participants, 2- Accommodation during lockdown: participants' conflicting visions of the shelter, 3- Influence of the media and public communication: an abundant flow of information impacting participant's wellbeing and representations on the pandemic, and 4- The individual impact of lockdown: perceived health and limitations to daily life activities. The most vulnerable populations have borne the heaviest burden during the pandemic. It is therefore crucial that we improve both the availability of information, and the health literacy of, all groups within the national population.

Imperfect biomarkers for adjuvant chemotherapy in early stage breast cancer with good prognosis.

The proliferation of biomarkers has raised concerns regarding the possibility for clinical judgment to be improperly removed from clinician's jurisdiction and included in laboratory tests. To evaluate the ways in which the diffusion of biomarkers questions the autonomy of clinicians, we consider the case of chemotherapy prescription to women with early stage breast cancer and a good prognosis. Drawing on a qualitative study of clinicians working in a diversity of institutional contexts, we follow three biomarkers available to guide this routinely made decision. We show that, biomarkers able to reduce all the uncertainties associated with, what we analyse as an uncomfortable decision, are sought more than dreaded by clinicians. If such ideal tools are unavailable, the fact is well acknowledged by the profession. Rather than precluding their usage, the imperfection of existing biomarkers is controlled by the profession, through their integration as additional tools in the decision process. The fact that the biomarkers are recognized as imperfect biomedical entities reinforces the importance of local material, organizational and financial constraints over that of international science, technology and clinical data, in their diffusion. The regulation of the uncertainties associated with these imperfections is organized at the professional level. Through an important work, relying on guidelines and enforced in collective bodies, the series of heterogeneous bioclinical evidences available are articulated. Biomarkers tend to be subordinated to the clinic. While maintaining the professional autonomy, the process also strengthens the internal professional hierarchy. When the most expert clinicians manage to inhabit a space for clinical autonomy, the nonexpert are torn between stronger professional rules and patient preferences. In this alliance between biomarkers and experts, their clinical autonomy tends to be the price for the professional autonomy.

To smoke or not to smoke? A qualitative study among young adults.

Smoking is the major preventable cause of disease and premature death in many countries, including France, where approximately 30% of adults are daily smokers. About 60% of them want to quit, however, long-term smoking cessation rates are low, particularly among individuals with low socio-economic position. The aim of this study is to examine whether motivations for smoking cessation among young adults differ across socio-economic groups. 3 focus groups of smokers and former smokers aged 22-40 years were constituted and conducted in November 2014 in Paris. Data from the focus groups were analyzed thematically and in a cross-cutting manner. Our study shows the existence of social "communities" of smokers, in occupational and festive contexts. In addition, new forms of resistance to public health messages are observed ("neutralization"), particularly among smokers with low socioeconomic position. Finally, stress is often cited as a source of unsuccessful smoking cessation or smoking relapse. Tobacco smoking is a social behavior and is associated with symbolic as well as relational benefits, particularly among smokers who have low socioeconomic position. To be effective, interventions aiming to decrease smoking levels in the population should aim to create group dynamics encouraging smokers to quit and address the physical as well as the psychological consequences of smoking withdrawal.

"Cancer Survivors" as Voluntary Helpers in Cancer Associations in France. Limits of the Balance between Service Offer and Social Demand.

Historically, in France, cancer associations have been managed by doctors. Despite this, the French healthcare system has increasingly encouraged them to attract voluntary helpers who are not health workers. This development has given rise to the question of the competence and legitimacy of voluntary workers in cancer associations. The aim of the present study was to identify the skills possessed by voluntary helpers who have survived the disease and the extent to which their skills meet the needs of cancer associations in responding to the demands that have emerged in this new context. This is a qualitative study based on data collected during semi-directed interviews, focus group sessions and on-site observations in a variety of French cancer associations. Categorical and thematic analyses were then carried out separately for each ethnographic method used. The study showed that because the commitment of survivor voluntary helpers derives from their own experience of the disease, it is inconsistent with the fulfilment of the association's collective aims, such as the search for funding or project development. These helpers nevertheless play an important role that involves a special link between the individual and the group, between the community and society. To conclude, "involved" volunteers have to reconcile their individual expectations with the association's collective aims.