F. Grillo

Prevalence and socioeconomic and geographical inequalities of household food insecurity in the Paris region, France, 2010

BackgroundFood insecurity (FI) is the situation where people do not have, at all times, access to sufficient, safe and nutritious food that meets their dietary needs for an active and healthy life. The objectives of this study were to estimate the prevalence of FI in the Paris area by using, for the first time in France, a specific FI questionnaire and to identify the characteristics of food-insecure households, taking into account a potential neighbourhood effect.MethodsThis study is based on data from the third wave of the SIRS cohort study (a representative, population-based socioepidemiological study) that were analysed using a cross-sectional design. In 2010, 3000 individuals in the Paris metropolitan area (PMA) were interviewed. FI was investigated by means of the USDA’s HFSSM. We used stratified multilevel models across three household income categories to identify populations at risk for FI.ResultsIn 2010, 6.30% (95% CI = [4.99-7.97]) of the households in the PMA experienced FI (up to 13.59% in the most underprivileged neighbourhoods). About 2.50% of the households experienced severe FI and 2.85% of household living with an income above 1666 € experienced food insecurity, whereas the percentage raises to 23.38% among those living below the poverty threshold (<791 €). Depending on the income level, different household characteristics emerged as being associated with FI. In the poorest households, the presence of a child under 3 years of age was associated with an increased risk of FI (OR = 2.11; p = 0.03). Among higher-income households, the household composition appeared to be strongly associated with FI.ConclusionFI exists in several social groups in France. Its prevalence in the most underprivileged households should be considered an indicator of vulnerability, which could permit targeted social assistance policies.

Food Insecurity: Could School Food Supplementation Help Break Cycles of Intergenerational Transmission of Social Inequalities?

OBJECTIVE: The aim of our study was to investigate the moderating effect of school food programs in schools in disadvantaged neighborhoods on the association between household food insecurity and scholastic difficulties among adolescents. METHODS: We analyzed data from the Social and Health Survey of Children and Adolescents in Quebec, Canada, which was conducted in 1999 and included 2346 adolescent students 13 and 16 years of age (and 1983 of their parents). Sample-weighted regression analyses were performed to determine the association between household food insecurity and school difficulties and to explore the moderating role of food supplementation programs with respect to this association. RESULTS: Household food insecurity, which was linked to the indicators of family socioeconomic status, was strongly associated with the indicators of scholastic difficulties. This association disappeared for adolescents who benefited from food supplementation programs in schools in disadvantaged neighborhoods. The risk of school activity limitation decreased from OR = 2.76 (95% confidence interval [CI]: 1.41–5.41) to OR = 1.57 (95% CI: 1.35–3.40), the risk of below-average grades in the language of instruction decreased from OR = 2.19 (95% CI: 1.28–3.74) to OR = 0.59 (95% CI: 0.21–1.63), the risk of repeating a year decreased from OR = 2.14 (95% CI: 1.35–3.40) to OR = 0.87 (95% CI: 0.42–1.81), and the risk of self-rated poor academic performance decreased from OR = 1.74 (95% CI: 1.08–2.81) to OR = 0.81(95% CI: 0.37–1.78). CONCLUSION: School food supplementation is a moderating factor in the association between household food insecurity and scholastic difficulties for adolescents.

Inequalities in cervical cancer screening for women with or without a regular consulting in primary care for gynaecological health, in Paris, France.

OBJECTIVES To describe the individual characteristics associated with the absence of cervical smear (CCST); to investigate the role of residential neighbourhood, particularly practitioner density; and to explore changes in individual and contextual determinants after taking regular consulting in primary care for gynaecological health (RCGH) into account. METHODS DATA 1843 adult women from the SIRS survey conducted in 2005 in the Paris metropolitan area. Multilevel logistic regressions analysed factors associated with never-screening. RESULTS 10% of the women had never undergone CCST. Being single, less educated, of foreign origin, with no children, and without health insurance, having never worked, having never undergone a serious health problem and/or having nobody in their circle with cancer were associated with no CCST. Once adjusted on individual characteristics, living in a middle- (OR=1.95; IC=1.05-3.62) or in a lower-class neighbourhood (OR=2.31; IC=1.26-4.25) was associated with increased risks of never-screening, but neighbourhood physician density was not. Interactions were found between socioeconomic status and RCGH. Individual- and neighbourhood-level associations with CCST were different for women with or without an RCGH. CONCLUSION This study analysed individual and contextual inequalities in CCST practice in the Paris metropolitan area. To benefit from an RCGH did not seem to reduce all the social inequalities in CCST practice.

Are Immigrants and Nationals Born to Immigrants at Higher Risk for Delayed or No Lifetime Breast and Cervical Cancer Screening? The Results from a Population-Based Survey in Paris Metropolitan Area in 2010

Objectives This study aims to compare breast cancer screening (BCS) and cervical cancer screening (CCS) practices of French women born to French parents with those of immigrants and nationals born to immigrants, taking their socioeconomic status into account. Methods The study is based on data collected in 2010 in the Paris metropolitan area among a representative sample of 3000 French-speaking adults. For women with no history of breast or cervical cancer, multivariate logistic regressions and structural equation models were used to investigate the factors associated with never having undergone BCS or CCS. Results We confirmed the existence of a strong gradient, with respect to migration origin, for delaying or never having undergone BCS or CCS. Thus, being a foreign immigrant or being French of immigrant parentage were risk factors for delayed and no lifetime screening. Interestingly, we found that this gradient persisted (at least partially) after adjusting for the women’s socioeconomic characteristics. Only the level of income seemed to play a mediating role, but only partially. We observed differences between BCS and CCS which suggest that organized CCS could be effective in reducing socioeconomic and/or ethnic inequities. Conclusion Socioeconomic status partially explained the screening nonparticipation on the part of French women of immigrant origin and foreign immigrants. This was more so the case with CCS than with BCS, which suggests that organized prevention programs might reduce social inequalities.

Overweight according to geographical origin and time spent in France: a cross sectional study in the Paris metropolitan area

BackgroundFor the first time in France in a population-based survey, this study sought to investigate the potential impact of migration origin and the proportion of lifetime spent in mainland France on body mass index (BMI) and overweight in adults living in the Paris metropolitan area.MethodsA representative, population-based, random sample of the adult, French speaking population of the Paris metropolitan area was interviewed in 2005. Self-reported BMI (BMI = weight/height2) and overweight (BMI ≥ 25) were our 2 outcomes of interest. Two variables were constructed to estimate individuals’ migration origin: parental nationality and the proportion of lifetime spent in mainland France, as declared by the participants. We performed multilevel regression models among different gender and age groups, adjusted for demographics and socioeconomic status.ResultsIn women, a parental origin in the Middle East or North Africa (MENA) was associated with a higher risk of being overweight (especially before the age of 55) and a higher BMI (between 35 and 54 years of age), and so were women of Sub-Sahara African parental origin in the middle age category. Only in the youngest men (< 35 years of age) did we observe any association with parental nationality, with a higher BMI when having a MENA parentage. Regarding the association between the proportion of lifetime spent in France and overweight, we observed that, in women, a proportion of 50% to 99% appeared to be associated with overweight, especially after the age of 35. In men, having spent more than half of one’s lifetime in France was associated with a higher risk of overweight among oldest men.ConclusionsOur results plea for potential cultural determinants of overweight in the migrant and migrants-born populations in the French context of the capital region. Taking into account the people’ family and personal migration histories may be an important issue in public health research and policies on overweight and obesity prevention.