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BackgroundTesting for COVID-19 has been strongly recommended for individuals experiencing COVID-19-like symptoms or those with a close relative who tested positive. In France, tests were free of charge until mid-October 2021 and became widely available after June 2020. Our main objective was to investigate whether access to COVID-19 testing in France was associated with socio-economic conditions, considering gender and ethno-racial status.MethodsA random population-based cohort survey was conducted in France in May 2020 and November 2020, including 95,388 participants aged 18 and over. We used logistic regressions to identify how having been tested in 2020 was associated with socio-economic status and exposure factors among two groups of individuals. The first group consisted of individuals who had no close relative test positive but reported experiencing COVID-19-like symptoms, such as cough, fever, dyspnea, or sudden onset of ageusia, dysgeusia, or anosmia (N = 12,729). The second group included individuals, with or without symptoms, who reported that a close relative had tested positive for COVID-19 (N = 5,360).FindingsIn both groups, testing was more frequent among individuals living in urban areas. For individuals who had no close relative test positive but reported COVID-19-like symptoms, women were 1.04 (95%CI [1.01–1.06]) more likely than men to be tested, and testing decreased with age up to 35. Individuals holding a university degree were (1.08 [1.04–1.12]) more likely than those who only completed high school to be tested, as well as those in one of the three top income deciles with reference to the bottom decile (OR 1.07, [1.02–1.13] for the top decile). Ethno-racial status was not significantly associated with testing. For respondents who had a close relative test positive, testing was strongly associated with having experienced some symptoms, especially after September 1 (OR 1.34, 95%CI [1.30–1.39]). However, there was no link between testing and income, education, or ethno-racial status.InterpretationWhen an individual experiences symptoms but has no close relative who is positive, the motivation to test to avoid transmitting the virus to relatives by isolating oneself is particularly strong. This strategy makes sense when there are actual possibilities to isolate, which may explain why higher income and education positively impact the propensity to test. For individuals who had a close relative test positive, most socio-economic variables were no longer related to testing once infection risk was controlled for. The availability of tests at no cost is not sufficient in itself to eliminate socio-economic inequalities in testing.

ObjectivesThis study aimed to explore the associations between mental health status and experienced pain among undocumented migrants (UMs) in France.MethodsWe used data from the multicentric cross-sectional “Premier Pas” study conducted in the Parisian and Bordeaux regions from February to April 2019. Participants over 18 years of age were recruited from sixty-three sites. Pain was assessed through two variables: overall pain and musculoskeletal pain. Mental health conditions, including anxiety, sleep disorders, depression, and posttraumatic stress disorder (PTSD) were evaluated. Logistic regression models were used to explore associations, controlling for social determinants of health (SDHs).ResultsOur findings revealed significant associations between mental health status and pain among the 1,188 included participants. Sleep disorder was associated to higher odds of musculoskeletal pain (aOR = 2.53, 95% CI [1.20–5.33], p = 0.014). Stratified results indicated that among women, depression was associated to higher odds of pain (aOR = 4.85, 95% CI [1.53–13.36], p = 0.007).ConclusionThis large study confirms the connection between mental health status and pain among UMs, providing valuable evidence for clinicians to address mental health issues in this population.

Objectives Maternal smoking during pregnancy is associated with low birth weight (LBW). Reduction of cigarette consumption does not seem to improve birth weight but it is not known whether implementation of periods of smoking abstinence improves it. We assessed whether the number of 7-day periods of smoking abstinence during pregnancy may help reduce the number of newborns with LBW.Design and setting Secondary analysis of a randomised, controlled, multicentre, smoking cessation trial among pregnant smokers.Participants Pregnant women were included at

Objective In many countries, before COVID-19 vaccines became available, reluctance to get vaccinated was particularly prevalent among women, the most disadvantaged social groups and ethnoracial minorities, known to be at higher risk for the virus. Using a longitudinal perspective, we analyse the social determinants that are associated with the transition from attitudes towards vaccination to actual vaccination practices.Design Representative population-based prospective cohort.Settings From November 2020 to July 2021.Participants Adults included in the Epidemiology and Living Conditions (EpiCoV) cohort (n=86 701).Main outcome measures Attitudes towards vaccination in November 2020 before COVID-19 vaccines were available in France (in January 2021) and vaccination practices in July 2021.Results Among those who were initially reluctant in November 2020, the youngest, the poorest 10% (OR=0.68, 0.59–0.77), non-European immigrants (OR=0.72, 0.59–0.88) and descendants of non-European immigrants (OR=0.72, 0.61–0.86) were less likely to be vaccinated in July 2021, irrespective of trust in government and scientists. The same social factors were associated with non-vaccination among those who initially were undecided or who favoured vaccination.Conclusion Despite the fact that COVID-19 vaccines were relatively available and free of charge in France in July 2021, social inequalities in vaccination against the virus remained the same than those observed in vaccination reluctance in November 2020, before vaccines were available. While adjusting for trust, migration background, younger age and lower income were associated with lower vaccination uptake irrespective of initial intention. By neglecting to genuinely target specific groups that were initially reluctant to be vaccinated, vaccination policies contributed to strengthening pre-existing social inequalities around COVID-19 burden.

Abstract Background Significant differences in COVID-19 incidence by gender, class and race/ethnicity are recorded in many countries in the world. Lockdown measures, shown to be effective in reducing the number of new cases, may not have been effective in the same way for all, failing to protect the most vulnerable populations. This survey aims to assess social inequalities in the trends in COVID-19 infections following lockdown. Methods A cross-sectional survey conducted among the general population in France in April 2020, during COVID-19 lockdown. Ten thousand one hundred one participants aged 18–64, from a national cohort who lived in the three metropolitan French regions most affected by the first wave of COVID-19. The main outcome was occurrence of possible COVID-19 symptoms, defined as the occurrence of sudden onset of cough, fever, dyspnea, ageusia and/or anosmia, that lasted more than 3 days in the 15 days before the survey. We used multinomial regression models to identify social and health factors related to possible COVID-19 before and during the lockdown. Results In all, 1304 (13.0%; 95% CI: 12.0–14.0%) reported cases of possible COVID-19. The effect of lockdown on the occurrence of possible COVID-19 was different across social hierarchies. The most privileged class individuals saw a significant decline in possible COVID-19 infections between the period prior to lockdown and during the lockdown (from 8.8 to 4.3%, P = 0.0001) while the decline was less pronounced among working class individuals (6.9% before lockdown and 5.5% during lockdown, P = 0.03). This differential effect of lockdown remained significant after adjusting for other factors including history of chronic disease. The odds of being infected during lockdown as opposed to the prior period increased by 57% among working class individuals (OR = 1.57; 95% CI: 1.00–2.48). The same was true for those engaged in in-person professional activities during lockdown (OR = 1.53; 95% CI: 1.03–2.29). Conclusions Lockdown was associated with social inequalities in the decline in COVID-19 infections, calling for the adoption of preventive policies to account for living and working conditions. Such adoptions are critical to reduce social inequalities related to COVID-19, as working-class individuals also have the highest COVID-19 related mortality, due to higher prevalence of comorbidities.

IntroductionAn increase in migration rates to the European Union has been observed over the last few years. Part of these migrants is undocumented. This work aimed to describe the reported frequency of infectious diseases and their associated factors among unselected samples of undocumented migrants in France.MethodologyThe Premier Pas survey is a cross-sectional epidemiological survey of a random sample (two-stage sample design) conducted among undocumented migrants recruited in Paris and the Bordeaux region, in places and facilities likely to be frequented by undocumented migrants. The percentages were weighted. The analysis was performed using Stata 15.1 software.ResultsA total of 1,223 undocumented migrants were recruited from 63 places and facilities, with a participation rate of 50%. Most of them were between 30 and 40 years of age (36%), 69% were men, aged mainly 30–40 (36%) years old, from sub-Saharan Africa (60%) or North Africa (25%), and 60% had arrived

ObjectiveTo assess whether lack of trust in the government and scientists reinforces social and racial inequalities in vaccination practices.DesignA follow-up of the EpiCov random population-based cohort survey.SettingIn July 2021, in France.ParticipantsEighty-thousand nine hundred and seventy-one participants aged 18 years and more.Main Outcome MeasuresAdjusted odds ratios of COVID-19 vaccination status (received at least one dose/ intends to get vaccinated/ does not know whether to get vaccinated/refuses vaccination) were assessed using multinomial regressions to test associations with social and trust factors and to study how these two factors interacted with each other.ResultsIn all, 72.2% were vaccinated at the time of the survey. The population of unvaccinated people was younger, less educated, had lower incomes, and more often belonged to racially minoritized groups, as compared to vaccinated people. Lack of trust in the government and scientists to curb the spread of the epidemic were the factors most associated with refusing to be vaccinated: OR = 8.86 (7.13 to 11.00) for the government and OR = 9.07 (7.71 to 10.07) for scientists, compared to vaccinated people. Lack of trust was more prevalent among the poorest which consequently reinforced social inequalities in vaccination. The poorest 10% who did not trust the government reached an OR of 16.2 (11.9 to 22.0) for refusing to be vaccinated compared to the richest 10% who did.ConclusionThere is a need to develop depoliticised outreach programmes targeted at the most socially disadvantaged groups, and to design vaccination strategies conceived with people from different social and racial backgrounds to enable them to make fully informed choices.

Abstract Background Our main objectives were to estimate the incidence of illnesses presumably caused by SARS-CoV-2 infection during the lockdown period and to identify the associated risk factors. Methods Participants from 3 adult cohorts in the general population in France were invited to participate in a survey on COVID-19. The main outcome was COVID-19-Like Symptoms (CLS), defined as a sudden onset of cough, fever, dyspnea, ageusia and/or anosmia, that lasted more than 3 days and occurred during the 17 days before the survey. We used delayed-entry Cox models to identify associated factors. Results Between April 2, 2020 and May 12, 2020, 279,478 participants were invited, 116,903 validated the questionnaire and 106,848 were included in the analysis. Three thousand thirty-five cases of CLS were reported during 62,099 person-months of follow-up. The cumulative incidences of CLS were 6.2% (95% Confidence Interval (95%CI): 5.7%; 6.6%) on day 15 and 8.8% (95%CI 8.3%; 9.2%) on day 45 of lockdown. The risk of CLS was lower in older age groups and higher in French regions with a high prevalence of SARS-CoV-2 infection, in participants living in cities > 100,000 inhabitants (vs rural areas), when at least one child or adolescent was living in the same household, in overweight or obese people, and in people with chronic respiratory diseases, anxiety or depression or chronic diseases other than diabetes, cancer, hypertension or cardiovascular diseases. Conclusion The incidence of CLS in the general population remained high during the first 2 weeks of lockdown, and decreased significantly thereafter. Modifiable and non-modifiable risk factors were identified.

Abstract Background and purpose Access to evidence-based mental health care for children is an international priority. However, there are significant challenges to advancing this public health priority in an efficient and equitable manner. The purpose of this international colloquium was to convene a multidisciplinary group of health researchers to build an agenda for addressing disparities in mental health care access and treatment for children and families through collaboration among scholars from the United States and Europe engaged in innovative implementation science and mental health services research. Key highlights Guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework, presentations related to inner, outer, and bridging context factors that impact the accessibility and quality of mental health evidence-based practices (EBPs) for children and families. Three common topics emerged from the presentations and discussions from colloquium participants, which included: 1) the impact of inner and outer context factors that limit accessibility to EBPs across countries, 2) strategies to adapt EBPs to improve their fit in different settings, 3) the potential for implementation science to address emerging clinical and public health concerns. Implications The common topics discussed underscored that disparities in access to evidence-based mental health care are prevalent across countries. Opportunities for cross-country and cross-discipline learnings and collaborations can help drive solutions to address these inequities, which relate to the availability of a trained and culturally appropriate workforce, insurance reimbursement policies, and designing interventions and implementation strategies to support sustained use of evidence-based practices.

We aimed to analyze inequalities in social isolation among older adults in a time of COVID-19 social restrictions, using a gender perspective. A random population-based survey, including 21,543 older adults (65+) was conducted during and post COVID-19 lockdown in France. Our main outcome was a three-dimension indicator of social isolation based on living conditions, i.e., living alone (i) and not having gone out in the past week (ii), completed by an indicator measuring Internet use i.e., never using the Internet (iii). Logistic regressions were used to identify factors associated with isolation for women and men. Women were more likely to live alone (aOR = 2.72 [2.53; 2.92]), not to have gone out in the past week (aOR = 1.53 [1.39; 1.68]), and not to use the Internet (aOR = 1.30 [1.20; 1.44]). In addition to gender effects, being older, at the bottom of the social hierarchy, and from an ethno-racial minority was also associated with social isolation. Preventive policies should take into account these inequalities when addressing the issue of social isolation among older women and men, so as to enable all social groups to maintain social contacts, and access health information.

In France, the first pandemic peak fell disproportionately on the most disadvantaged, as they were overrepresented in contaminations and in developing severe forms of the virus. At that time, and especially during lockdown, the French healthcare system was severely disrupted and limited. The issue of social differences in the use of healthcare by people experiencing symptoms of Covid-19 arose. Based on a random sample of 135,000 persons, we selected respondents who reported Covid-19-like symptoms (cough, fever, dyspnea, anosmia and/or ageusia) during the first lockdown (n = 12,422). The aim of this study was to determine if the use of health care services was likely to contribute to widen Covid-19 social inequalities. Use of health care services was classified in three categories: (1) no consultation, (2) out-of-hospital consultation(s) and (3) in-hospital consultation(s). We estimated odds ratio of utilization of health care using multinomial regressions, adjusted on social factors (age, gender, class, ethno-racial status, social class, standard of living and education), contextual variables, health variables, and symptoms characteristics. Altogether, 37.8% of the individuals consulted a doctor for their symptoms; 32.1% outside hospital and 5.7% in hospital. Use of health care services was strongly associated with social position2: the most disadvantaged social groups and racially minoritized immigrants were more likely to use health care, particularly for in-hospital consultation(s). The highest utilization of health care were found among older adults (OR 9.51, 95%CI 5.02-18.0 compared to the youngest age group), the racially minoritized first-generation immigrants (OR 1.61, 95%CI 1.09-2.36 compared to the mainstream population), the poorest (OR 1.31, 95%CI 1.00-1.72) and the least educated (OR 2.20, 95%CI 1.44-3.38). To conclude, we found that the use of health care services counteracted the potential impact of social inequalities in exposure and infection to the Covid-19.

Objective Although social inequalities in COVID-19 mortality by race, gender and socioeconomic status are well documented, less is known about social disparities in infection rates and their shift over time. We aim to study the evolution of social disparities in infection at the early stage of the epidemic in France with regard to the policies implemented.Design Random population-based prospective cohort.Setting From May to June 2020 in France.Participants Adults included in the Epidémiologie et Conditions de Vie cohort (n=77 588).Main outcome measures Self-reported anosmia and/or ageusia in three categories: no symptom, during the first epidemic peak (in March 2020) or thereafter (during lockdown).Results In all, 2052 participants (1.53%) reported anosmia/ageusia. The social distribution of exposure factors (density of place of residence, overcrowded housing and working outside the home) was described. Multinomial regressions were used to identify changes in social variables (gender, class and race) associated with symptoms of anosmia/ageusia. Women were more likely to report symptoms during the peak and after. Racialised minorities accumulated more exposure risk factors than the mainstream population and were at higher risk of anosmia/ageusia during the peak and after. By contrast, senior executive professionals were the least exposed to the virus with the lower rate of working outside the home during lockdown. They were more affected than lower social classes at the peak of the epidemic, but this effect disappeared after the peak.Conclusion The shift in the social profile of the epidemic was related to a shift in exposure factors under the implementation of a stringent stay-at-home order. Our study shows the importance to consider in a dynamic way the gender, socioeconomic and race direct and indirect effects of the COVID-19 pandemic, notably to implement policies that do not widen health inequalities.