Emmanuel Wiernik

Cannabis use has been consistently associated with increased risks of depression, suicidal ideation, and suicide attempt. We aimed to compare the trajectories of depression and suicide attempt risk among individuals who used cannabis before or concomitantly with the onset of depressive symptoms, relative to depressed individuals who did not use cannabis. We used data from 24,446 participants of CONSTANCES, a French national cohort, recruited between 2013–2020. People who started using cannabis before the onset of a depressive episode showed shorter durations of depression, and were half as likely to attempt suicide than the general depressed population. On the other hand, people with concomitant onset of cannabis use and depression showed similar characteristics compared to the general depressed population. These findings suggest that specific patterns of cannabis use could be linked to a lower risk of adverse mental health outcomes.

Background: Social factors like gender and socio-economic position are insufficiently considered in medical practice despite their influence on various diseases. Many studies have focused on the development of respiratory diseases and their symptoms across SEP but have attributed these differences by poorer lung function, yet we don’t know whether the expression of dyspnea differs between people across gender and SEP for the same values of lung function, which could reveal social differences in semiology. We aim to assess whether there is a difference in the expression of dyspnea between educational attainment groups with comparable lung function among women and men. Methods: In this cross-sectional study we used data from the national French CONSTANCES population-based cohort at enrolment from 2012 to 2021. Participant with at least one measure of forced vital capacity and dyspnea, with non-missing values for covariates were selected. Main outcome measure was dyspnea assessed by “Do you get short of breath when hurrying or walking up a slight hill”. Social variables were sex and educational attainment. Potential confusion and intermediate factors were age, weight, height, physical activity, smoking, occupational exposures, constraints and physical demands at work, depressive symptoms, self-rated general health, number of medical antecedents, anaemia and a biological health score. Findings: The sample included 130,916 individuals aged 18 to 75 years (53% Women, 47% Men, 34% High, 44% Middle, 22% Low educational attainment). Dyspnea prevalence was 21%. Dyspnea decreased as FVC increased, from 35% in the lowest sextile to 8% in the highest. Women and men with lower educational attainment reported more dyspnea than those with higher educational attainment rate (40% compared with 28% and 20% in women, 21% compared with 12% and 8% in men) and at every FVC level. After adjustments for all covariables these, differences decreased but persisted for all FVCs. Interpretation: These results highlight the importance of considering the patient's social position in clinical practice, as the expression of symptoms differ for the same pulmonary function. Funding This project has received funding from the European Research Council (ERC) (grant agreement No. [856478]).

We aimed to identify substance use and work status co-trajectories and to describe the sociodemographic and clinical characteristics of each profile. From the French CONSTANCES cohort, 19,285 adults enrolled between 2012 and 2015, were included in the analyses. Clusters of co-trajectories of substance use (alcohol, tobacco and cannabis) and work status at baseline and 5-years period of follow-up were identified using finite mixture models. For each cluster, age, sex, indicator of social position (i.e. education, occupational grade, household monthly income and marital status) and self-rated health were described. Among the 12 identified clusters, participants in the cluster with the lowest non-working rate (4.3%) were at low-risk drinkers, nonsmokers and never consumed cannabis. In the cluster with the highest non-working rate (14.5%), participants were nondrinkers, smokers and consumed cannabis less than once per month. The 3 clusters with the highest non-working rates (i.e. Clusters 6, 7, 12) were characterized by fewer women overall, lower social position, poorer self-rated health, and high substance use. The present study identified different substance use and work co-trajectories underlining the heterogeneity in individual experiences with respect to these factors.

Tobacco smoking remains a public health challenge, particularly among low-income populations. Beyond individuals' own socioeconomic position, their family background and the type of social trajectory they experienced, could also be related to smoking behaviors as tobacco use starts generally in adolescence. In the present study, we tested the association between intergenerational social mobility and individuals' smoking trajectories up to midlife. Using data from the CONSTANCES cohort, a French longitudinal population-based study, we applied Group-Based Trajectory Modeling to analyze participants' smoking patterns from 2012 to 2020 among 201,731 participants. These groups were combined with baseline lifetime smoking status to differentiate between never smokers and former smokers. Participants were classified into four groups based on information about their own and their parents' occupational status: persistently high socioeconomic status (SES), upward mobility, downward mobility, and persistently low SES. Multinomial logistic regression models were used to study the relationship between social mobility patterns and smoking trajectories. Three groups of participants were identified: nonsmokers (75.4%), former smokers (9.3%), and long-term smokers (15.3%). Upward mobility was associated with decreased odds of long-term smoking, while downward mobility and persistently low SES was associated with increased odds of long-term smoking. Both upward social mobility and persistently low SES were associated with lower odds of quitting smoking compared to persistently high SES. Long-term smoking behaviors are significantly associated with social mobility patterns from childhood to adulthood. This highlights the necessity to consider early life influences in smoking cessation programs.

Objectives: Race/ethnicity, combined with sex, is an important determinant of hypertension prevalence and management in high-income countries, but data for France are lacking. This study aims to explore hypertension prevalence and each stage of the cascade of care (i.e., awareness, treatment, and control), at the intersection of sex and race/ethnicity in a French cohort. Design: We used data from the population-based CONSTANCES cohort, linked with the French National Health Data System. Participants: 180 459 individuals were included, aged 18–69 (mean age 47, SD: 13), among which 53% (n=95 395) women and 81% (n=145 983) of the majority group, and 4.9% (n=8 775) of North African, 1.2% (n=2 220) of sub-Saharan African (SSA), 1.2% (n=2 204) of Asian, 1.4% (n=4 462) of Overseas France départements and regions (DROMs) and 10% of European and other descents. Among these 180 459 individuals, 54 009 (29.9%) had hypertension. Primary and secondary outcome measures: Migration status was used as a proxy for race/ethnicity. Age-standardized hypertension rates were estimated by sex and race/ethnicity. Multinomial logistic regressions, adjusted for age, were used to compare ethnoracial differences in the cascade of care. Results: Individuals from SSA or DROMs had higher prevalence rates than the majority group, especially among women (37.6% and 26.8% vs 20.8%, respectively). These groups also had higher odds of entering a hypertension care path, although women from SSA tended to remain treated, instead of achieving control (OR 1.39 (0.99 to 1.96)). Women of Europe and others (OR 1.46 (1.14 to 1.87)) and men originating from Asia (OR 1.85 (1.03 to 3.33)) were more likely to remain at the awareness step. Conclusion: Race/ethnicity impacts hypertension prevalence and management in France, with variations by sex. Our findings underscore the necessity to consider these results when designing intervention strategies to reduce the burden of uncontrolled hypertension.

Objectives Uncertainty exists as to what extent common risk factors are involved in the associations of unemployment with major health outcomes and mortality. Design A retrospective and prospective observational study. Setting A large population-based French cohort (CONSTANCES). Participants 99 430 adults at baseline who have been exposed to unemployment during their lifetime and 54 679 of them who were followed for 7 years after baseline. Primary outcome measures Testing the mediating roles of several risk factors at baseline in the associations of lifetime unemployment exposure with cardiovascular disease, cancer and mortality rates during a 7-year follow-up. Direct and indirect effects were calculated for each risk factor and all together using logistic regression models adjusted for major confounders including sex, age, parental histories of cardiovascular disease and cancer, social position and working conditions. Results Estimates (95% CIs) of the direct and indirect effects for smoking are 0.0083 (0.0044 to 0.0122), pConclusions These analyses show that common risk factors such as smoking, alcohol consumption, depressive symptoms, leisure-time physical inactivity and blood triglycerides mediate up to 10% of the associations of lifetime unemployment exposure with cardiovascular disease, cancer and mortality rates when tested separately and approximately 20% when tested all together. This highlights the existence of other major mediating pathways that have yet to be identified.

Aim: To assess the prevalence of severe periodontitis based on the population‐based CONSTANCES cohort using a validated self‐reported questionnaire.Materials and Methods: Individuals were selected from the adult population in France using a random sampling scheme. Analyses were restricted to those invited in 2013–2014 who completed the periodontal health questionnaire at the 2017 follow‐up. The risk of severe periodontitis was assessed using the periodontal screening score (PESS) and weighting coefficients were applied to provide representative results in the general French population.Results: The study included 19,859 participants (9204 men, mean age: 52.8 ± 12.6 years). Based on a PESS ≥ 5, 7106 participants were at risk of severe periodontitis, corresponding to a weighted prevalence of 31.6% (95% confidence interval: 30.6%–32.7%). This prevalence was higher among participants aged 55 and over, those with lower socio‐economic status as well as current smokers, e‐cigarette users and heavy drinkers. Among individuals at risk of severe periodontitis, only 18.8% (17.3%–20.4%) thought they had gum disease, although 50.5% (48.6%–52.5%) reported that their last dental visit was less than 6 months.Conclusions: The present survey indicates that (1) self‐reported severe periodontitis is highly prevalent with marked disparities between groups in the general French adult population, and (2) periodontitis could frequently be under‐diagnosed given the low awareness.