Characteristics and correlates of seclusion and mechanical restraint measures in a Parisian psychiatric hospital group.

Introduction: Seclusion or restraint (S/R) are last-resort measures used in psychiatry to ensure the safety of the patient and the staff. However, they have harmful physical and psychological effects on patients, and efforts to limit their use are needed. We describe the characteristics and correlates of S/R events in four Parisian psychiatric centers. Methods: Within a 3-month period, November 5, 2018 to February 3, 2019, we recorded data for patients experiencing an S/R measure as well as characteristics of the measures. We studied the mean duration of a S/R event, the time between hospital admission and the occurrence of the event, as well as correlates of these durations. We also examined factors associated with use of a restraint versus a seclusion measure. Results: For the 233 patients included, we recorded 217 seclusion measures and 64 mechanical restraints. Seclusion measures mostly occurred after the patient's transfer from the emergency department. The duration of a seclusion measure was about 10 days. Patients considered resistant to psychotropic treatments more frequently had a longer seclusion duration than others. The mean duration of a mechanical restraint measure was 4 days. Male sex and younger age were associated with experiencing mechanical restraint. Discussion: S/R measures mostly occur among patients perceived as resistant to psychotropic drugs who are arriving from the emergency department. Developing specific emergency department protocols might be useful in limiting the use of coercive measures.

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

Introduction: 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.

Evolution of smoking rates among immigrants in France in the context of comprehensive tobacco control measures, and a decrease in the overall prevalence.

BACKGROUND: The evolution of smoking rates according to migrant status has not been examined in France, despite a recent reduction in overall smoking rates. METHODS: DePICT is a two waves (2016: n = 4356; 2017: n = 4114) nationwide telephone survey, representative of the French adult population. We compared smoking-related behaviors before and after implementation of tobacco-control measures (2017), according to the geographical region of birth. RESULTS: Compared to 2016, individuals originating from Africa or the Middle East had a slightly higher smoking prevalence in 2017 (34.7% vs 31.3%), despite a higher intention to quit or attempt in the preceding year (adjusted OR(ORa) = 2.72[1.90; 3.90]) compared to non-immigrants. They were also less likely to experience an unsuccessful quit attempt (ORa = 1.76[1.18; 2.62]). CONCLUSION: Tobacco-control measures could have widened smoking inequalities related to migrant status. The evolution of smoking-related behaviors among immigrants should be examined when studying the long-term effects of such policies.

Smoking cessation using preference-based tools: a mixed method pilot study of a novel intervention among smokers with low socioeconomic position.

BACKGROUND: Compared to smokers with favorable socio-economic position (SEP), those with low SEP are less likely to have a successful smoking cessation attempt. Tailored approaches are therefore needed, and general practitioners could help reaching and assisting usually hard-to-reach population. METHOD: STOP (Sevrage Tabagique à l'aide d'Outils dédiés selon la Préférence) is a pilot study, examining the feasibility, acceptability and potentiality of a smoking cessation intervention centered on smoker's preference. Smokers with low SEP, wishing to quit, were recruited in six healthcare centers in the Greater Paris area. They were asked to choose between different types of nicotine replacement therapy (NRT) products and/or e-cigarette with liquids delivered free of charge to aid their smoking cessation attempt. We describe the characteristics of recruited participants, their perception of smoking cessation aids, and the evolution of their smoking status 4 to 6 weeks after recruitment. RESULTS: We recruited 49 participants, of which 29% chose an e-cigarette, 29% chose NRT and 42% chose both an e-cigarette and NRT. The intervention was shown to be acceptable by participants and health professionals. Among the 24 participants followed for at least one month, 14 (28% of all participants) stopped smoking, and 9 (18%) considerably reduced their consumption. CONCLUSION: The STOP intervention is feasible and acceptable, even if more efforts should be made to limit lost-to-follow-up. This preference-based intervention also shows interesting prospect in helping smokers with low SEP quit smoking. We will test the efficacy of this preference-based intervention in a randomized controlled trial.

Decrease in cross-border tobacco purchases despite intensification of antitobacco policies in France.

BACKGROUND: Recently, France has intensified tobacco control policies which included gradual increase in tobacco product price and the introduction of plain packaging. However, there has been suggestion that cross-border tobacco purchases from neighbouring countries, with lower tobacco prices, will increase. We examine trends in cross-border tobacco purchases among smokers concurrent with the implementation of tobacco control measures between 2016 and 2017. METHODS: Description des Perceptions, Images, et Comportements liés au Tabagisme is a two-wave cross-sectional national telephone survey of French adults aged 18-64 years, which recruited a total of 2167 smokers (2016: n=1238; 2017: n=929). Data were weighted to be representative of the French adult population. The association between study wave and cross-country tobacco purchases was examined across study waves using a multivariable logistic regression model (adjusted ORs: ORa (95% CI)). RESULTS: Less than half (38.5%) of smokers declared cross-border tobacco purchases in the last year, which were mostly done on occasional basis: 22.6% purchased tobacco cross-border once or twice yearly. In 2017, as compared with 2016, cross-border tobacco purchases by French smokers decreased (ORa=0.81, 95% CI 0.68 to 0.98). Other factors associated with cross-border tobacco purchases included sex, and driving distance to a border. CONCLUSION: In France, the increase in tobacco product price and the introduction of plain packaging did not contribute to increasing rates of out-of-country purchases of tobacco products, probably due to the overall decrease in smoking levels. However, a harmonisation of tobacco product prices and plain packaging policies across Europe might further improve tobacco control throughout the continent.

Maternal education and offspring birth weight for gestational age: the mediating effect of smoking during pregnancy.

BACKGROUND: Small for gestational age (SGA) birth weight, a risk factor for infant mortality and delayed child development, is associated with maternal educational attainment. Maternal tobacco smoking during pregnancy could contribute to this association. We aimed to quantify the contribution of maternal smoking during pregnancy to social inequalities in child birth weight for gestational age (GA). METHODS: Data come from the French nation-wide ELFE cohort study, which included 17 155 singletons. Birth weights for GA were calculated using z-scores. Associations between maternal educational attainment, tobacco smoking during pregnancy and child birth weight for GA were ascertained using mediation analysis. Mediation analyses were also stratified by maternal pre-pregnancy body mass index. RESULTS: Low maternal educational attainment was associated with an increased odd of tobacco smoking during pregnancy [adjusted OR (ORa) = 2.58 (95% CI 2.34-2.84)] as well as a decrease in child birth weight for GA [RRa = 0.94 (95% CI 0.91-0.98)]. Tobacco smoking during pregnancy was associated with a decrease in offspring birth weight for GA [RRa = 0.73 (95% CI 0.70-0.76)]. Mediation analysis suggests that 39% of the effect of low maternal educational attainment on offspring birth weight for GA was mediated by smoking during pregnancy. A more important direct effect of maternal educational attainment on child birth weight for GA was observed among underweight women [RRa = 0.82 (95% CI 0.72-0.93)]. CONCLUSIONS: The relationship between maternal educational attainment and child birth weight for GA is strongly mediated by smoking during pregnancy. Reducing maternal smoking could lessen the occurrence of infant SGA and decrease socioeconomic inequalities in birth weight for GA.

The role of prenatal social support in social inequalities with regard to maternal postpartum depression according to migrant status.

BACKGROUND: An advantaged socioeconomic position (SEP) and satisfying social support during pregnancy (SSP) have been found to be protective factors of maternal postpartum depression (PDD). An advantaged SEP is also associated with satisfying SSP, making SSP a potential mediator of social inequalities in PPD. SEP, SSP and PPD are associated with migrant status. The aim of this study was to quantify the mediating role of SSP in social inequalities in PPD regarding mother's migrant status. METHODS: A sub-sample of 15,000 mothers from the French nationally-representative ELFE cohort study was used for the present analyses. SEP was constructed as a latent variable measured with educational attainment, occupational grade, employment, financial difficulties and household income. SSP was characterized as perceived support from partner (good relation, satisfying support and paternal leave) and actual support from midwives (psychosocial risk factors assessment and antenatal education). Mediation analyses with multiple mediators, stratified by migrant status were conducted. RESULTS: Study population included 76% of non-migrant women, 12% of second and 12% of first generation migrant. SEP was positively associated with support from partner, regardless of migrant status. Satisfying partner support was associated with a 8 (non-migrant women) to 11% (first generation migrant women) reduction in PPD score. LIMITATIONS: History of depression was not reported. CONCLUSIONS: Partner support could reduce social inequalities in PPD. This work supports the need of interventions, longitudinal and qualitative studies including fathers and adapted to women at risk of PPD to better understand the role of SSP in social inequalities in PPD.

Informal and formal social support during pregnancy and joint maternal and paternal postnatal depression: Data from the French representative ELFE cohort study.

BACKGROUND: Insufficient social support has been intensively studied as a risk factor of postpartum depression (PPD) among mothers. However, to date, no study has examined the role of informal and formal dimensions of social support during pregnancy with regard to joint maternal and paternal depression after birth. AIM: Study associations between insufficient informal and formal support during pregnancy and joint parental PPD. METHODS: Using data from the nationally representative French ELFE (Etude Longitudinale Française depuis l'Enfance) cohort study (N = 12,350), we estimated associations between insufficient informal and formal support received by the mother during pregnancy and joint parental PPD in multi-imputed multivariate multinomial regression models. RESULTS: In 166 couples (1.3%), both parents were depressed. The likelihood of joint parental PPD was increased in case of insufficient informal support (insufficient partner support: odds ratio (OR) = 1.68 (95% confidence interval (CI): 1.57-1.80); frequent quarrels: OR = 1.38 (95% CI: 1.19-1.60)). We also observed associations between formal support during pregnancy and joint parental PPD (early prenatal psychosocial risk assessment: OR = 1.13 (95% CI: 1.05-1.22); antenatal education: OR = 1.13 (95% CI: 1.05-1.23)), which disappeared when analyses were restricted to women with no psychological difficulties during pregnancy. CONCLUSION: Insufficient informal social support during pregnancy appears to predict risk of joint PPD in mothers and fathers and should be identified early on to limit complications and the impact on children.

Unintended pregnancy prevention in women using psychoactive substances: A systematic review.

This systematic review seeks to evaluate the efficacy of interventions aimed at preventing unintended pregnancies in women using psychoactive substances. Seven electronic databases (Medline, EMBASE, CINAHL, Web of Science Core Collection, PsycINFO, Cochrane CENTRAL database) were searched in October 2017. Twenty-two articles met our inclusion criteria. Interventions based on behavior change theory yielded an increase in the initiation of effective contraception as compared with provision of written information materials. The effect was more pronounced when the intervention provided on-site contraceptive counseling and free access to birth control. Financial incentives also seemed to effectively increase women's contraception intake. Case management interventions including pregnant and postpartum women with heavy levels of substance use showed promising results in terms of initiation of contraception, but rates of unintended pregnancy over long-term follow-up were nevertheless elevated. Finally, some interventions integrated family planning services into specialized centers taking care of pregnant and postpartum women with substance abuse. However, most studies aimed at postpartum and post-abortion contraception used a non-comparative design and had a number of methodological flaws. The risk of bias in most studies is high. All interventions with a primary or secondary focus on the prevention of unintended pregnancy in women using psychoactive substances short-term improvements in contraception intake, but it is unclear if these effects last or have any impact on unintended pregnancy rates in the long-term.

Factors Associated with Electronic Cigarette Use among Young Adults: The French "Trajectoires EpidéMiologiques en POpulation" (TEMPO) Cohort Study.

Background: Electronic cigarettes (e-cigarettes) are sold in France since 2010 and have rapidly become popular. However, factors associated with e-cigarette use among young adults are not well known. Methods: We used data from the 2015 French TEMPO community based cohort study, restricted to current and former smokers with data on e-cigarette use (n = 368 adults, 23-41 years). Participants completed a self-administered questionnaire including information on family status, educational attainment, occupation and type of work contract, health problems, alcohol and cannabis use, electronic cigarette use, as well as perceptions of e-cigarettes. Use of traditional tobacco was assessed in 2011 and 2015. Data were analyzed using logistic regression models. Results: Among current and former smokers, 26.9% reported lifetime e-cigarettes use and 15.2% current use. Factors associated with lifetime use were: low socioeconomic position (OR = 2.2; 95% CI = 1.2-4.2), traditional cigarette use (OR associated with smoking in 2011 and 2015 = 13.1; 95% CI = 5.2-32.6) and positive perceptions of e-cigarettes (OR = 4.4; 95% CI = 2.4-8.1) as well as asthma (OR = 2.1; 95% CI = 0.9-4.9) and overweight/obesity (OR = 2.5, 95% CI = 0.9-6.9). Factors associated with current use were traditional cigarette smoking (OR associated with smoking in 2011 and 2015 = 3.9; 95% CI= 1.3-12.2) and positive perceptions of e-cigarettes (OR =4.4; 95% CI = 2.3-8.4). Conclusions: Young adults who use e-cigarettes tend to persist in smoking traditional cigarettes. The conditions under which e-cigarette use can help individuals quit traditional tobacco products remain to be elucidated.

Maternal immigrant status and signs of neurodevelopmental problems in early childhood: The French representative ELFE birth cohort.

A growing body of evidence suggests that children of immigrants may have increased risks of neurodevelopmental disorders. However, evidence based on parent report and on very young children is lacking. We therefore investigated the association between maternal immigrant status and early signs of neurodevelopmental problems in a population-based sample of 2-year-old children using standardized parent-report instruments. We used data from the French representative Étude Longitudinale Française depuis l'Enfance birth cohort, initiated in 2011. The study sample included 9,900 children of nonimmigrant French, 1,403 children of second, and 1,171 children of first generation immigrant women followed-up to age 2 years. Neurodevelopment was assessed using the Modified Checklist for Autism in Toddlers (M-CHAT) and an adaptation of the MacArthur-Bates Communicative Development Inventories (MB-CDI). In fully adjusted linear regression models, maternal immigrant status was associated with M-CHAT scores, with stronger associations in children of first (ß-coefficient: 0.19; 95% CI 0.08-0.29) than second generation immigrants (0.09; 0.01-0.17). This association was especially strong among children of first generation immigrant mothers native of North Africa (vs. nonimmigrant French: 0.33; 0.16-0.49) and French-speaking Sub-Saharan Africa (0.26; 0.07-0.45). MB-CDI scores were lowest among children of first generation immigrant mothers, particularly from mostly non-francophone regions. Children of first generation immigrant mothers were most likely to have simultaneously low MB-CDI and high M-CHAT scores. Our findings suggest that maternal immigrant status is associated with early signs of neurodevelopmental difficulties, with strong variations according to maternal region of origin. Further research is necessary to test whether these associations persist and to determine the underlying mechanisms. Autism Res 2019, 12: 1845-1859. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: We asked immigrant and nonimmigrant mothers in France about early signs of neurodevelopmental problems in their 2-year-old children. Overall, we found that children of immigrants may be at higher risk of showing these early warning signs, as compared to children of nonimmigrants. This is in line with previous studies, which were based on doctors' diagnoses at later ages. However, our results differed depending on the mothers' regions of origin. We found the highest risks in children of first generation immigrants from North and French-speaking Sub-Saharan Africa, who also seemed especially at risk of neurodevelopmental problems combined with low language development.

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.

Plain tobacco packaging, increased graphic health warnings and adolescents' 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' 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.

The perinatal health of immigrant women in France: a nationally representative study.

OBJECTIVES: Despite the healthy migrant effect, immigrants and descendants of immigrants face health challenges and socio-economic difficulties. The objective of this study is to examine the perinatal health of women of migrant origin. METHODS: The nationwide French ELFE (Etude Longitudinale Française Depuis l'Enfance) birth cohort study recruited approximately 18,000 women. We studied pre-pregnancy BMI, gestational diabetes mellitus (GDM), as well as tobacco, and alcohol consumption during pregnancy according to migrant status and region of origin. RESULTS: Women from North Africa and Turkey had a higher risk of pre-pregnancy overweight and GDM, while women from Eastern Europe and Asia had a lower risk of pre-pregnancy overweight and obesity, but a higher risk of GDM compared to non-immigrants. Women from Sub-Saharan Africa had a higher risk of being overweight or obese pre-pregnancy. Compared to non-immigrants, immigrants-but not descendants of immigrants-had lower levels of tobacco smoking, while descendants of immigrants were less likely to drink alcohol during pregnancy. CONCLUSIONS: Pregnant women of migrant origin have particular health needs and should benefit from a medical follow-up which addresses those needs.

Factors associated with successful vs. unsuccessful smoking cessation: Data from a nationally representative study.

INTRODUCTION: A substantial proportion of smokers who attempt to stop smoking relapse in the first months. Yet to date, there is limited understanding of the predictors of smoking attempts and their success. We examine the role of tobacco use characteristics, other substance-related factors, as well as socio-demographic characteristics in relation to successful and unsuccessful smoking cessation. METHODS: DePICT (Description des Perceptions, Images, et Comportements liés au Tabagisme) is a nationally representative sample of adults aged between 18 and 64years residing in metropolitan France, who were interviewed by telephone survey (n=4342). Among current or former smokers (n=2110) we distinguished participants characterized by: a) no quit attempt or quit <6months; b) unsuccessful smoking cessation (current smokers who previously quit smoking ≥6months); c) successful smoking cessation (≥6months). Factors associated with successful vs. unsuccessful smoking cessation were studied using multivariate multinomial logistic regression analyses. RESULTS: Successful and unsuccessful smoking cessation share some predicting factors including no cannabis use, older age, and intermediate or high occupational grade. Factors specifically associated with successful smoking cessation included no e-cigarette use, no environmental tobacco exposure, fear of the health consequences of smoking, perceived harmfulness of smoking, and high educational attainment and a good overall health. CONCLUSIONS: Smokers' environmental tobacco exposure, concurrent cannabis use, and the perception of the health consequences of smoking should be taken into account in efforts aiming to promote smoking cessation at the individual as well as collective levels. Our data also suggest that e-cigarette use is associated with unsuccessful rather than successful smoking cessation, which should be verified in additional, longitudinal, studies.