Search

This paper presents one of the first cross-nationally comparative studies on the economic and social returns to grit (perseverance and passion for long-term goals). Specifically, we investigated whether grit incrementally predicted objective (income) and subjective (job satisfaction) career success over and above cognitive skills and educational attainment; whether grit's association with career success was moderated by individual characteristics; whether grit's associations with career success varied across countries; and whether this variation could be explained by labour market conditions (unemployment rates). Multi-group structural equation models with data from 6,738 respondents from 19 countries revealed that grit was incrementally associated with income and job satisfaction in some but not all countries. Grit's effect sizes were mostly modest, yet there were some indications for variations by education and labour market conditions. Overall, these findings suggest that the associations between grit and career success are not uniform but vary across individuals and contexts.

Ample evidence indicates that a person's human capital is important for success on the labor market in terms of both wages and employment prospects. However, unlike the efforts to identify the impact of school attainment on labor-market outcomes, the literature on returns to cognitive skills has not yet provided convincing evidence that the estimated returns can be causally interpreted. Using the PIAAC Survey of Adult Skills, this paper explores several approaches that aim to address potential threats to causal identification of returns to skills, in terms of both higher wages and better employment chances. We address measurement error by exploiting the fact that PIAAC measures skills in several domains. Furthermore, we estimate instrumental-variable models that use skill variation stemming from school attainment and parental education to circumvent reverse causation. Results show a strikingly similar pattern across the diverse set of countries in our sample. In fact, the instrumental-variable estimates are consistently larger than those found in standard least-squares estimations. The same is true in two "natural experiments," one of which exploits variation in skills from changes in compulsory-schooling laws across U.S. states. The other one identifies technologically induced variation in broadband Internet availability that gives rise to variation in ICT skills across German municipalities. Together, the results suggest that least-squares estimates may provide a lower bound of the true returns to skills in the labor market.

Conspiracy Beliefs (CB) are a key vector of violent extremism, radicalism and unconventional political events. So far, social‐psychological research has extensively documented how cognitive, emotional and intergroup factors can promote CB. Evidence also suggests that adherence to CB moves along social class lines: low‐income and low‐education are among the most robust predictors of CB. Yet, the potential role of precarity—the subjective experience of permanent insecurity stemming from objective material strain—in shaping CB remains largely unexplored. In this paper, we propose for the first time a socio‐functional model of CB. We test the hypothesis that precarity could foster increased CB because it undermines trust in government and the broader political 'elites'. Data from the World Value Survey (n = 21,650; Study 1, electoral CB) and from representative samples from polls conducted in France (n = 1760, Study 2a, conspiracy mentality) and Italy (n = 2196, Study 2b, COVID‐19 CB), corroborate a mediation model whereby precarity is directly and indirectly associated with lower trust in authorities and higher CB. In addition, these links are robust to adjustment on income, self‐reported SES and education. Considering precarity allows for a truly social‐psychological understanding of CB as the by‐product of structural issues (e.g. growing inequalities). Results from our socio‐functional model suggest that implementing solutions at the socio‐economic level could prove efficient in fighting CB. [ABSTRACT FROM AUTHOR]

This paper describes the geography of multi-dimensional poverty across French communes in 2017. We build an extended data set documenting 7 key dimensions of well-being (income, unemployment, housing, education, civic engagement, life expectancy and air quality) in about 35,000 communes. Life expectancy at commune-level is obtained from an original small-area estimation method combining commune and department-level data. We derive an index of multi-dimensional poverty to provide an unprecedented degree of granularity in the description of spatial inequality and poverty in France. The results show that joint deprivation in at least 5 dimensions of well-being is starkly concentrated among 316 communes, representing as much as 5.2 million inhabitants (7.7% of the French population). About 70% of these people are also in extreme poverty, which suggests that the concepts of multi-dimensional poverty and extreme income poverty significantly overlap. [ABSTRACT FROM AUTHOR]

Background: Patient registration with a primary care providers supports continuity in the patient-provider relationship. This paper develops a framework for analysing the characteristics of patient registration across countries; applies this framework to a selection of countries; and identifies challenges and ongoing reform efforts., Methods: 12 jurisdictions (Denmark, France, Germany, Ireland, Israel, Italy, Netherlands, Norway, Ontario [Canada], Sweden, Switzerland, United Kingdom) were selected for analysis. Information was collected by national researchers who reviewed relevant literature and policy documents to report on the establishment and evolution of patient registration, the requirements and benefits for patients, providers and payers, and its connection to primary care reforms., Results: Patient registration emerged as part of major macro-level health reforms linked to the introduction of universal health coverage. Recent reforms introduced registration with the aim of improving quality through better coordination and efficiency through reductions in unnecessary referrals. Patient registration is mandatory only in three countries. Several countries achieve high levels of registration by using strong incentives for patients and physicians (capitation payments)., Conclusion: Patient registration means different things in different countries and policy-makers and researchers need to take into consideration: the history and characteristics of the registration system; the use of incentives for patients and providers; and the potential for more explicit use of patient-provider agreements as a policy to achieve more timely, appropriate, continuous and integrated care., Competing Interests: Conflict of interests None., (Copyright © 2021 Elsevier B.V. All rights reserved.)

This paper presents an analysis of heating expenses in a large social housing stock in the North of France. An artificial neural network (ANN) approach is taken for the analysis of heating consumption data collected over four years in 84 social housing residences containing 13,179 dwellings that use collective heating. Analysis provides an understanding of the influence of both physical and socio-economic parameters on heating expenses and proposes a predictive model for these expenses. The model shows that the heating expenses are influenced by both the buildings' physical parameters and social indicators. Concerning the physical parameters, the most important indicators are the area of the dwellings, followed by the building age and the DPE (energy performance diagnostic). The family size as well as tenant age and income have an important influence on heating expense. The model is then used for establishing a data-based strategy for social housing stock renovation. [ABSTRACT FROM AUTHOR]

This paper analyzes the joint long-run evolution of wealth and income inequality. We find that top wealth and income shares were cointegrated over the past century in France and the US. We rationalize this finding in two macroeconomic heterogeneous agent models featuring growth and incomplete markets, respectively. In both frameworks, the co-movement of top wealth and income shares is determined by the relative saving rate at the top, i.e. the ratio of the saving rate of rich individuals to the aggregate saving rate. Our empirical results suggest that relative saving rates at the top have been fairly stable over time, thus explaining the observed tight co-movement between top wealth and income shares over the past century. [ABSTRACT FROM AUTHOR]

In this paper, we examine the variation in the outbreak of COVID-19 across departments in continental France. We use information on the cumulated number of deaths, discharged patients and infections from COVID-19 at the department level, and study how these relate to income inequality, controlling for other factors. We find that unfortunately, inequality kills: departments with higher income inequality face more deaths, more discharged (gravely ill) patients and more infections. While other papers have studied the impact of the level of income on the severity of COVID-19, we find that it is in fact the dispersion across incomes within the same department that drives the results. Our results suggest that individuals in relatively more precarious conditions deserve dedicated policies, to avoid that temporary shocks such as COVID-19 lead to permanent increases in inequality.

This paper analyzes and compares different policy scenarios as well as discusses price elasticities and willingness to pay and to accept using revealed preference (RP) data from the French new-car market in 2014 by means of a cross-nested logit (CNL) model. We focus particularly on electric and hybrid vehicles. We use interactions between the cost (both fixed and running costs) and the household income to analyze the sensitivity towards different policy scenarios per income level. Results show that the willingness to pay and to accept obtained in our study is consistent with the real-market conditions. We also find that the most effective scenario to increase the market shares of new sold electric vehicles is that of a major technological advance such as a decrease in price due to cheaper manufacturing costs and an increase in driving range, rather than a policy-based scenario. In addition, the market segment that has more potential to increase the market shares of electric vehicle purchase is the middle-income level. In the paper, we discuss how to overcome the difficulties of working with revealed preference data, and propose multiple imputations to impute the attributes of the unchosen alternatives, by drawing from their empirical distributions. [ABSTRACT FROM AUTHOR]

In most developed countries, the average income of female physicians remains much lower than that of their male counterparts. This paper analyses how much of the gender earnings gap among French self-employed physicians can be attributed to women's family responsibilities, choice of medical specialty, and opportunity to charge extra billings. The question is of growing concern for regulators because it may influence patients' future access to care. We used an exhaustive administrative database that merges information on the medical activity, earnings, and family structure of self-employed doctors in 2005, 2008, and 2011. Using the 2011 database, results suggest that when demographic and professional characteristics are controlled, female physicians still exhibit an annual earnings gap that varies according to family structure: having young children worsens the situation of female physicians, particularly GPs. Using our panel datasets from 2005, we show that there is a 'carer effect' of having children for female doctors that exacerbates the gender income gap, particularly for GPs. We do not highlight any real strategic behaviour of female specialists authorised to charge extra fees to increase their extra billings after a birth to maintain their previous income., (Copyright © 2019 Elsevier B.V. All rights reserved.)

This paper adopts a dynamic general nesting spatial panel data model with common factors to explore the effect of population density, real household income per capita, car fleet per capita, and real price of gasoline on departmental traffic per light vehicle in France over the period 1990–2009. Spatial heterogeneity is modeled by a translog function in the first three explanatory variables, which are dominated by variation in the cross-sectional domain, while the real price of gasoline, which is dominated by variation in the time domain, is treated as an observable common factor. Additional unobservable common factors are controlled for by principal components with heterogenous coefficients, building on previous work of Shi and Lee (2017a), thereby, generalizing the dynamic spatial panel data model with spatial and time period fixed applied in recent studies. It is found that the spatial lag in the dependent variable becomes insignificant due to these extensions. This paper explains the wider implications of this finding for spatial econometric modeling of cross-sectional dependence. In addition, the elasticities of the first three explanatory variables are shown to vary across space and time and to follow a plausible structure. Among other, an important result is that the long run income elasticity of car traffic diminished from 1.0 in 1990 to 0.4 in 2003, and then remained almost constant until the end of our sample period in 2009, i.e., during the peak-car traffic period. [ABSTRACT FROM AUTHOR]

Response-based unit segmentation (REBUS) is an advanced partial least squares–structural equation modelling technique that clusters observations into classes based on the relationships among model constructs. In this paper, we demonstrate the application of REBUS in examining human capital (HC) and firm performance in the upscale restaurant sector – an important segment of gastronomic tourism in a destination. The model framework is developed from HC theory which posits individuals who develop higher levels of knowledge, skills, education and other competencies will outperform others [(Bruce, M., McNally, J. J., & Kay, M. (2013, March). Examining the formation of human capital in entrepreneurship: A meta-analysis of entrepreneurship education outcomes. Journal of Business Venturing, 28(2), 211–224; Mincer, J. (1958). Investment in human capital and personal income distribution. Journal of Political Economy, 66, 281–302)]. We operationalize HC to include operators' (1) previous ownership/management experience, (2) level of education, (3) length of time in current position, (4) years spent in hospitality and (5) entrepreneurial qualifications and examine the structural effects on performance. Data were collected through telephone-based surveys of 308 restaurant operators in Australia and France. REBUS results found that the effects of HC on performance differed across identified segments from the data, presenting new insights on the complexity of the relationship and the presence of moderator effects. [ABSTRACT FROM AUTHOR]

This paper analyses long‐term trends in intergenerational earnings persistence in France for male cohorts born between 1931 and 1975. This time period has witnessed important changes in the French labour market and educational system, in particular an important compression of earnings differentials as well as a large expansion in access to secondary and higher education. Using a two‐sample instrumental variables approach, I estimate two measures of intergenerational economic persistence: the intergenerational earnings elasticity (IGE) and the intergenerational correlation (IGC). Over the period, the IGE exhibits a V‐shaped pattern. It falls from a high of value of 0.6 for cohorts born in the 1930s to around 0.4 for those born in the 1950s, but subsequently rises to a level close to that at the beginning of the period. In contrast, the IGC remains relatively stable over the period. This suggests that changes in the IGE are partly driven by transitory responses to changes in cross‐sectional inequality rather than long‐term changes in the degree of intergenerational persistence. [ABSTRACT FROM AUTHOR]

Many localities are able to survive without competitive export industries. The economic base of regional development rests upon various wage and non-wage external incomes. However, suitable regional data are often unavailable, and particularly those related to external consumer spending in urban regions and short-stay tourism. Three geo-localized databases are here combined into a circular-flow template from former consumer spending to the final wage income. By doing so, the paper contributes to identifying ‘transient custom’ as a new inflow driving local development and it provides a first estimate of its magnitude, using the Paris Region as a case study. [ABSTRACT FROM AUTHOR]

Breastfeeding is recommended until 6 months of age, but a wide range of infant formula is available for nonbreastfed or partially breastfed infants. Our aim was to describe infant formula selection and to examine social- and health-related factors associated with this selection. Analyses were based on 13,291 infants from the French national birth cohort Etude Longitudinale Française depuis l'Enfance. Infant diet was assessed at Month 2 by phone interview and monthly from Months 3 to 10 via internet/paper questionnaires. Infant formulas were categorized in 6 groups: extensively or partially hydrolysed, regular with or without prebiotics/probiotics, and thickened with or without prebiotics/probiotics. Associations between type of infant formula used at 2 months and family or infant characteristics were assessed by multinomial logistic regressions. At Month 2, 58.1% of formula-fed infants were fed with formula enriched in prebiotics/probiotics, 31.5% with thickened formula, and 1.4% with extensively hydrolysed formula. The proportion of formula-fed infants increased regularly, but the type of infant formula used was fairly stable between 2 and 10 months. At Month 2, extensively hydrolysed formulas were more likely to be used in infants with diarrhoea or regurgitation problems. Partially hydrolysed formulas were more often used in families with high income, with a history of allergy, or with infants with regurgitation issues. Thickened formulas were used more with boys, preterm infants, infants with regurgitation issues, or in cases of early maternal return to work. The main factors related to the selection of infant formula were family and infant health-related ones. [ABSTRACT FROM AUTHOR]

In 2021, the federal government of the United States expanded a set of income transfers that led to strong reductions in child poverty. This research note uses microdata from more than 50 countries and U.S. data spanning more than 50 years to place the 2021 child poverty rate in historical and international perspective. We demonstrate that whether using the Supplemental Poverty Measure (SPM), relative poverty measures, or an absolute poverty measure, the U.S. child poverty rate in 2021 was at its lowest level since at least 1967. The U.S. tax and transfer system reduced the 2021 SPM child poverty rate by more than 75% relative to the pre-tax/transfer child poverty rate; this reduction was three times the mean reduction effect between 1967 and 2019. These policy changes improved the country's standing from having a relative poverty rate twice that of Germany's in 2019 to the same as Germany's in 2021. Moreover, the U.S. progressed from reducing child poverty at less than half the rate of Norway in 2019 to a rate comparable to Norway in 2021. However, the U.S. success was temporary: after the expiration of the 2021 income provisions, the child poverty rate doubled and returned to being higher than in most other high-income countries. [ABSTRACT FROM AUTHOR]

The aim of this paper is to investigate, from a generational perspective, the effect of human capital on individual earnings and earnings differences in Germany, France and Italy, three developed countries in Western Europe with similarconservativewelfare regimes but with important differences in their education systems. Income inequalitiesbetweenandwithineducation levels are explored using a two-stage probit model with quantile regressions in the second stage. More precisely, drawing upon 2005 EU-SILC data, returns on schooling and experience are estimated separately for employees and self-employed full-time workers by means of Mincerian earnings equations with sample selection; the sample selection correction accounts for the potential individual self-selection into the two labour force types. Although some determinants appear to be relatively similar across countries, state-specific differentials are drawn in light of the institutional features of each national context. The study reveals how each dimension of human capital differently affects individuals’ earnings and earnings inequality and, most of all, how their impacts differ along the conditional earnings distribution and across countries. In the comparative perspective, the country's leading position in terms of the highest rewards on education also depends on which earnings distribution (employee vs. self-employed) is analysed. [ABSTRACT FROM PUBLISHER]

How much do citizens value democracy? How willing are they to sacrifice their liberties and voting rights for growth, equality, or other social outcomes? We design a conjoint experiment in nationally representative surveys in Brazil, France, and the United States in which respondents choose between different societies that randomly vary in their economic outcomes (country income, income inequality, social mobility), political outcomes (democracy, public health insurance), and the level of personal income for each respondent. Our research allows us to estimate the respondents' willingness to trade off democracy for individual income (as well as other societal attributes). We find that, on average, individuals are strongly attached to democracy and a robust welfare state. They prefer to live in a country without free democratic elections only if their individual income multiplies by at least three times and in a country without public health insurance only if their individual income more than doubles. After estimating these preferences at the individual level for all respondents, we show that, although there is an authoritarian minority in all three countries, forming a nondemocratic majority (by offering more income and/or other goods to respondents) is very unlikely. Our findings imply that, contrary to a growing discussion about the crisis of democracy, liberal democratic values remain substantially robust in high and middle income democracies. [ABSTRACT FROM AUTHOR]

We evaluated people living with Human Immunodeficiency Virus' (PLWH) quality of life (QoL) and assessed whether their demographic, disease-related, socioeconomic, or behavioral characteristics were associated with poorer QoL. ANRS CO3 AQUIVIH-NA cohort participants (Nouvelle Acquitaine, France) were recruited to a cross-sectional study (2018–2020) and their QoL assessed (WHOQOL-BREF). We calculated median (Q1, Q3) QoL domain scores and assessed factors associated with poorer median QoL using bivariable and multivariable quartile regression. Of the 965 PLWH included, 98.4% were on antiretroviral therapy, 94.7% were virally-suppressed, 63.5% reported good/very good QoL. Median scores (0–100) were highest for physical (69;Q1, Q3: 56, 81) and environmental (69; 56, 75) QoL and lowest for social (56; 44, 69) and psychological (56; 44, 69) QoL. PLWH with ≥ 3 comorbidities, HIV-related stigma, or income of < 1500€/month had poorer median adjusted physical, psychological, social, and environmental QoL scores compared to reference groups. While more than half of PLWH reported good/very good QoL, we have not achieved good QoL in 90% of PLWH. Multi-morbidity, HIV-related stigma, and social determinants were consistently and independently associated with poorer QoL. Addressing structural factors in addition to those indirectly related to HIV is required to attain good QoL in all PLWH. [ABSTRACT FROM AUTHOR]

This article examines fertility and labor supply responses to a 2014 French policy reform that consisted of conditioning the amount of child allowances on household income. Employing regression discontinuity design and French administrative income data, I find that restricting family allowance eligibility criteria decreases fertility among the richest households. The results also highlight that receiving half the amount of the allowances or none leads to an increase in both male and female labor supply through an increase in overtime work. The implied change in earned income, due to an increase in weekly working hours, is found to be comparable to the euro value reduction in benefits. Auxiliary regression analyses show that the fertility decline reflects a decrease in the probability of having an additional child for parents rather than in the probability of becoming parents for households without children. [ABSTRACT FROM AUTHOR]

Objective: We aimed to explore the relationship between socio-economic characteristics and sustainable dietary patterns. Design: Dietary data were derived from a web-based FFQ. Diet sustainability was evaluated using a modified Sustainable Diet Index, comprising nutritional, environmental and cultural components (higher scores expressing higher sustainability). The socio-economic position markers were education, household income and occupation status. Multi-adjusted linear and Poisson regression models were used to assess the cross-sectional association of the markers of socio-economic status with a sustainable diet and sustainability subcomponents, respectively. Setting: France. Participants: 29 119 NutriNet-Santé participants. Results: Individuals with a more sustainable diet had slightly higher diet monetary cost, lower total energy intake and consumed less animal-based foods than their counterparts. Lower education level was associated with lower overall diet sustainability (β primary v. postgraduate = -0·62, 95 % CI (-0·72, −0·51)) and nutrition, socio-cultural and environmental subscores. Manual workers and employees had a lower modified Sustainable Diet Index than intermediate professionals (β manual workers v. intermediate professionals = -0·43, 95 % CI (−0·52, −0·33) and β employees v. intermediate professionals = -0·56, 95 % CI (−0·64, −0·48)). Participants with the lowest v. highest incomes had a higher environmental subscore but a lower socio-cultural subscore, whereas the results were less marked for occupational status. Conclusions: Overall, our results documented associations between socio-economic status and the level of diet sustainability, arguing for the implementation of appropriate food policies to promote sustainable diets at lower cost. [ABSTRACT FROM AUTHOR]

The obesity epidemic and inequalities in access to food are prompting increasing numbers of food environment studies, which rely on secondary data sources for mapping. This article assesses the reliability of the two main food outlet data sources in France: the volunteered geographical information (VGI) collaborative map OpenStreetMap (OSM) and the national business register Sirene. Their information on food outlets was assessed through ground‐truthing in the city‐region of Montpellier. Sensitivity, positive predictive value, and concordance were computed for each database. We analyzed the socio‐spatial variability of these measures according to households' income level. The sensitivity of Sirene is good and that of OSM moderate, while the opposite holds for positive predictive value, and the concordance of both OSM and Sirene is fair. Sirene provides more reliable data on deprived neighborhoods and OSM on wealthy neighborhoods. Caution is recommended regarding the classifications on which they are based, the time required to update the institutional database, and socially influenced contributions to VGI. [ABSTRACT FROM AUTHOR]

I provide estimates of compensated elasticities of labour income with respect to the marginal net‐of‐tax rate on the 2006–15 period for France, exploiting not only income tax reforms but also means‐tested benefits reforms. I use semi‐parametric graphical evidence and a classic two‐stage least‐squares estimation applied to a rich data set including both financial and socio‐demographic variables. I obtain an estimated compensated elasticity on the intensive margin around 0.2–0.3 in response to income tax reforms, and around 0.1 in response to in‐work benefit reforms, while I found no statistically significant response to family allowance reforms. I show that the difference between elasticities contradicts the theoretical prediction of the classical labour supply model. These asymmetric responses are very robust to a large number of robustness checks. The most plausible explanation is that income tax reforms are more salient and better perceived than benefit reforms. I also highlight an average compensated elasticity of 0.1 for all transfers on the intensive margin and provide heterogeneous elasticities depending on types of people, which could be used for optimal tax analyses. [ABSTRACT FROM AUTHOR]

Background The prevalence of overweight and obesity has increased in various countries. Normal weight before pregnancy is important to protect maternal and newborn health. This study aimed to describe the evolution of body mass index (BMI) before pregnancy in France and explore its association with two measures of socioeconomic status (SES), education and household income. Methods Data were from four national perinatal surveys in France in 1998, 2003, 2010 and 2016 to describe the time evolution of maternal BMI. We explored the links between BMI and women's characteristics in the most recent period (2010–2016 surveys) since income information was not available before. Risk ratios (RRs) of underweight, overweight and obesity for each measure of SES were computed by using multivariable Poisson regression models. Results Overweight and obesity prevalence increased between 1998 and 2016, from 6% to 12% for obesity. Both were inversely associated with SES (higher prevalence among least educated and poorest women), with strong variations for each social indicator, even in multivariable analyses including both. Combining education and income revealed a wide gradient; RR for obesity was 6.01 (95% confidence interval 4.89–7.38) with low education and income <2000 euros/month vs. high education and income ≥4000 euros/month. Conclusions Public policies must implement programs to limit the increase in overweight and its unequal distribution in the population, alongside other policies to address the societal determinants of the obesogenic environment. Health professionals need to advise women to improve their eating and physical activity to limit weight gain from childhood to early adulthood. [ABSTRACT FROM AUTHOR]

Copyright of Population (00324663) is the property of Institut National d'Etudes Demographiques and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Several studies have been performed on the relationship between working conditions and health. Numerous parameters still require further study, including working hours and obesity among different groups, specifically older workers in national, regional, and international levels. OBJECTIVE: Working hours have considerable effects on the socio-cultural, psychological, and economic aspects of people's lives and health. While long working hours increases income level and raises living standards, it increases the risk of certain health problems. This study investigated whether working hours are associated with obesity in upper-middle-aged workers. METHODS: The Survey of Health, Ageing and Retirement in Europe (SHARE) dataset was used for the analyses. Analyses were carried out by means of a Cox regression of the panel dataset created with the data in question, surveyed by European Commission to 12,000 participants. RESULTS: The survey was performed in Austria, Belgium, Switzerland, Germany, Denmark, Spain, France, Greece, Italy, the Netherlands, Sweden, the Czech Republic, Poland, and Ireland. We found that in most countries, especially Sweden and the Netherlands, upper-middle-aged employees working > 59 hours per week are more likely to gain weight than their counterparts working < 59 hours. CONCLUSIONS: Our findings raise awareness of obesity in older workers, and highlight the need to regulate working conditions and hours in the European Union and other countries. [ABSTRACT FROM AUTHOR]

We develop a method for comparing levels and trends in inequality in mortality in the United States and France between 1990 and 2010 in a similar framework. The comparison shows that while income inequality has increased in both the United States and France, inequality in mortality in France remained remarkably low and stable. In the United States, inequality in mortality increased for older groups (especially women) while it decreased for children and young adults. These patterns highlight the fact that despite the strong cross-sectional relationship between income and health, there is no necessary connection between changes in income inequality and changes in health inequality. [ABSTRACT FROM AUTHOR]

Worldwide, around 18 million people receive a cancer diagnosis each year, most of whom survive long enough to face additional cancer-related costs. In France, most costs directly related to cancer are covered by the National Health Insurance Fund, and cancer patients can receive treatments without paying advance fees. In this context, the costs faced by cancer survivors are mostly social costs. Drawing on fundamental cause theory, this study aimed to explore the socially-differentiated evolution of cancer survivor’s income five years after diagnosis. Our study draws on the findings of VICAN5, a French national survey that was conducted in 2015/2016 in a representative sample of 4,174 cancer survivors to obtain information on living conditions five years after diagnosis, and that was restricted to 12 tumour sites accounting for 88% of global cancer incidence in France. We used the multiple imputation method and the Heckman selection model to identify the factors associated with a decrease in household income per consumption unit (HICU), while accounting for missing data. Among survivors still working five years after diagnosis, 17.6% reported lower income at survey than at diagnosis. After adjustment for socio-demographic and medical characteristics, the decrease in HICU was more frequent in women, singles, low educated survivors, and survivors with reduced working time. Finally, subjective measures of income variation and economic well-being were a useful complement to objective measures since 31.6% of cancer survivors still working five years after diagnosis reported a perceived decrease in household income. In conclusion, inequalities in economic well-being persist long after diagnosis in France, and this despite the fact that most cancer-related costs are covered by the French National Health Insurance Fund. Consequently, more attention should be paid to cancer patients with low socio-economic status to help reduce inequalities in post-diagnosis living conditions. [ABSTRACT FROM AUTHOR]

Objectives Even during pregnancy women may suffer from violence. We estimated the prevalence of physical abuse during pregnancy, we analyzed the main risk factors and described the relationship between physical violence, psychological wellbeing and pregnancy outcome. Methods We used a national representative sample of births, in all public and private maternity units, in 2016 in France. Women were interviewed after delivery, on their living conditions and occurrence of physical violence at least once during pregnancy. The study of risk factors and pregnancy outcome was done with multivariable logistic regressions. Results Of 12,330 women included in the analysis 1.8% (95% CI 1.6–2.0) had been exposed to physical violence during pregnancy. Risk of violence was associated with the couple situation [women without a partner or in couple not cohabiting (OR 2.89, 95% CI 1.96–4.26)], household income (less than 3000 euros monthly), and state medical assistance coverage. Physical violence was more prevalent in case of a history of induced abortion or cannabis use during pregnancy. Psychological distress was more frequent with than without physical violence (e.g., 62% vs. 24% had a sadness period during pregnancy, p < 0.001). The risk of spontaneous preterm birth and transfer of the newborn to a neonatal intensive care unit were significantly higher among women experiencing physical violence during pregnancy compared to other women. Conclusions for Practice Main factors associated with increased risk of violence during pregnancy were socio-economics. The identification by caregivers of women exposed to violence during pregnancy needs to be improved to develop preventive and care strategies. [ABSTRACT FROM AUTHOR]

An estimated 28,000 French people infected with HIV remain undiagnosed, leading to HIV transmission and late-stage HIV infections. An over-the-counter HIV self-test has been available since September 2015. We thus aimed to explore people’s perceptions of and intentions to use the test. An anonymous online questionnaire, targeting the general population and men who have sex with men (MSM) was distributed between November 2015 and January 2016. It explored at-risk sexual behavior, perceptions of the HIV self-test, and past and intended future use. A total of 1,082 participants completed ≥90% of the questionnaire (67.1% male, 32.4% female, 0.5% other; mean age 32.8 ± 12 years). 44.8% were MSM. 41.5% declared that they did not always use or make their partner use a condom in the case of penetration with someone other than their usual partner (if applicable). 9.9% had already used the HIV self-test, with this proportion being higher in multivariate analysis for individuals with a monthly income exceeding €1,000 and those declaring to be informed about HIV. 38.5% stated their intention to use the self-test in the coming month or year; in multivariate analysis, this proportion was lower for MSM and higher for those who did not always use or make their partner use a condom in the case of penetration with someone other than their usual partner. The majority (68.4%) underestimated the testing delay to rule out HIV infection. The most frequently cited concerns were that self-test does not test for other sexually transmitted infections (49.5%) and is not free of charge (44.4%), and that users are left alone with the result (41.0%). The HIV self-test was identified as a useful tool by different at-risk populations; it may therefore enhance the number of diagnoses. The test delay must be appropriately communicated to users, while a lower purchase price may increase usage. [ABSTRACT FROM AUTHOR]

Background Food insecurity is a major concern in homeless population, however nutritional consequences remain poorly documented, especially for children. The objective of this study was to assess the prevalence of anaemia and to investigate the relation between both food insecurity and dietary intake to moderate-to-severe anaemia (MSA) in homeless sheltered children. Methods In 2013, a cross-sectional survey was conducted on a random sample of 801 sheltered homeless families in the Paris region. Haemoglobin concentration was measured in 630 mother/child dyads and questionnaires administrated to mothers collected socio-demographic, socioeconomic, health and dietary data. Factors associated with MSA were analysed in two stratified child age groups; 0.5–5 and 6–12 years old. Results Anaemia was detected in 39.9% of the children and 50.6% of the mothers, and MSA in 22.3% and 25.6%, respectively. In both age groups, MSA was positively associated with maternal MSA. In the 0.5–5 years group, it was also positively associated with child food insecurity, no cooking facilities and household monthly income. In the 6–12 years group, it was positively associated with household food insecurity and children’s age. Conclusion A higher food insecurity score was associated with greater prevalence of moderate-to-severe anaemia in children. Considering the high prevalence of anaemia among homeless mothers and their children, these findings highlight the need for reducing food insecurity in shelters so as to prevent anaemia in this vulnerable population. [ABSTRACT FROM AUTHOR]

BACKGROUND: Enabling cancer survivors to resume employment has become a public health issue in France, but not all survivors wish to or would benefit from doing so. OBJECTIVE: This French exploratory qualitative study was designed to identify the psychological factors that influence the decision of some cancer survivors not to return to work, despite their doctor’s permission. METHODS: We conducted semi structured interviews with two women and one man. Each interview lasted around 90 minutes. Qualitative analysis of the interviews (clinical case studies) highlighted a number of similarities and differences among these three patients. RESULTS: Comparisons revealed six similarities: 1. the issue of income and its importance had no part in the decision-making process; 2. patients anticipated work return problems; 3. they therefore abandoned their plans to go back; 4. work lost its meaning for them; 5. repressed affects surfaced or they reassessed their career plans; and 6. their life trajectories were disrupted, with the stages being telescoped together. There were also two differences: 1. feelings of social exclusion for two participants, and 2. gendered experiences of quitting employment. CONCLUSIONS: Health professionals and job retention support services need to take this clinical reality into account and acknowledge that not all patients wish to resume work or would benefit from doing so. [ABSTRACT FROM AUTHOR]

Background: Few studies have focused on the influence of retirement on dietary behaviors. Our study aimed at assessing the associations between transition to retirement and changes in dietary intake in French adults, particularly according to spousal retirement and baseline income. Methods: This prospective study included 577 French participants from the NutriNet-Santé cohort who retired over a 5-year follow-up (2009-2014 or 2010-2015). At baseline and every year, dietary intakes were assessed using 24 h records. Repeated measures of dietary intake were analysed using mixed models adjusted for energy with random effects of time and period (before and after retirement) to assess changes following retirement for each gender. Results: After retirement, intakes of saturated fatty acids and sodium increased in both genders. Women showed specific changes after retirement: decrease in the score of adherence to recommendations and in intakes of fruits, proteins, vitamins; increase in intakes of fatty sweet products. In men with the lowest income at baseline, specific changes in intake were associated with retirement such as decrease in intake of dairy products and increase in intake of lipids. Conclusions: Transition to retirement was associated with unhealthier dietary intakes. These results may help defining interventions during this vulnerable life-period. Trial registration: This study was conducted according to guidelines laid down in the Declaration of Helsinki and all procedures were approved by the Institutional Review Board of the French Institute for Health and Medical Research (IRB Inserm No. 0000388FWA00005831) and the French Data Protection Authority (Commission Nationale Informatique et Libertés No. 908450 and No. 909216). Electronic informed consents were obtained from all participants. [ABSTRACT FROM AUTHOR]

Using local administrative data from 1826 to 1936, we document the evolution of crime rates in nineteenth century France and we estimate the impact of a negative income shock on crime. Our identification strategy exploits the phylloxera crisis. Between 1863 and 1890, phylloxera destroyed about 40% of French vineyards. We use the geographical variation in the timing of this shock to identify its impact on property and violent crime rates, as well as minor offences. Our estimates suggest that the phylloxera crisis caused a substantial increase in property crime rates and a significant decrease in violent crimes. [ABSTRACT FROM AUTHOR]

Background: In aggregate studies, ecological indices are used to study the influence of socioeconomic status on health. Their main limitation is ecological bias. This study assesses the misclassification of individual socioeconomic status in seven ecological indices.Methods: Individual socioeconomic data for a random sample of 10,000 persons came from periodic health examinations conducted in 2006 in 11 French departments. Geographical data came from the 2007 census at the lowest geographical level available in France. The Receiver Operating Characteristics (ROC) curves, the areas under the curves (AUC) for each individual variable, and the distribution of deprived and non-deprived persons in quintiles of each aggregate score were analyzed.Results: The aggregate indices studied are quite good "proxies" for individual deprivation (AUC close to 0.7), and they have similar performance. The indices are more efficient at measuring individual income than education or occupational category and are suitable for measuring of deprivation but not affluence.Conclusions: The study inventoried the aggregate indices available in France and evaluated their assessment of individual SES. [ABSTRACT FROM AUTHOR]

We analyze the existence and persistence of moral hazard over time to test the assumption of pent-up demand. We consider the effects of supplemental health insurance provided by a private insurer when added to compulsory public insurance that is already supplemented by private insurance. Using original panel data from a French mutuelle, we study the influence of insurance on all of the dimensions of healthcare expenditures: (1) the probability of using health care, (2) the number of uses conditional on use, and (3) the per unit cost of care. To conduct this study, we control, to the extent possible, for endogeneity because of adverse selection using the characteristics of our panel data. Our study allows us to confirm a positive and significant effect of the extra complementary health insurance on healthcare consumption, primarily in terms of the probability of using care. More interestingly, our results show that these effects are principally transitory mainly for the probability of using dental care and optical care and depend on income. Finally, we show that individuals did not postpone health care before enrollment. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aim A split-mouth randomized clinical trial was carried out to assess the effectiveness of a school-based dental sealant ( SBDS) program for French children from low-income backgrounds within 3 years of follow-up. The secondary objectives were to determine the risk factors for the occurrence of new carious lesions ( ICDAS 3-6) on first permanent molars, to evaluate the effectiveness of the program according to risk factors and to assess sealant retention. Methods The study included 276 6- to 7-year old pupils (457 pairs of first permanent molars) from Nice. The sealing was performed in first- or second-grade children. The first permanent molars were randomized into two groups: One received resin-based sealant and the other formed a nontreatment group. Carious lesions ICDAS 3-6 on permanent and primary teeth, visible plaque, streptococcus mutans and/or lactobacillus counts were recorded at baseline to assess individual caries risk ( ICR). The putative confounders recorded at baseline were sex, grade level, and characteristics of first permanent molars. An intent-to-treat analysis was performed, where the study outcome was the occurrence of new carious lesions within 3 years of follow-up. Univariate and multivariate Cox proportional hazards models (hazard risk, HR) using the procedure PHREG with the option of Covsandwich were performed in SAS to assess the effectiveness of the SBDS program. Results At 3 years of follow-up, 228 children (378 tooth pairs) remained in the analysis. The survival analysis showed that first permanent molars that received sealants had 67% (adjusted HR: 0.33; 95% CI: 0.24-0.46) less risk of developing new carious lesions during all the follow-up than molars without sealant. In addition, children with carious lesions ICDAS 3-6 on permanent and primary teeth, that is, high ICR, had three times the risk of having a new carious lesion than others without, independently of the sealant treatment (adjusted HR: 3.00; 95% CI: 1.55-5.75). Effectiveness of the SBDS program at 3 years of follow-up depended on the presence of carious lesions ICDAS 3-6 ( HR in 173 children with carious lesions: 0.32; 95% CI: 0.23-0.46) at baseline ( HR in 103 children without carious lesions: 0.42; 95% CI: 0.16-1.12). Finally, the overall retention rate was 32.3%. Conclusion The effectiveness of the SBDS program was demonstrated in low socioeconomic areas. Selection of schoolchildren according to the presence of carious lesions ICDAS 3-6 should be considered in a SBDS program. [ABSTRACT FROM AUTHOR]

Past cross-national comparisons of socioeconomic segregation have been undercut by lack of comparability in measures, data, and concepts. Using IRIS data from the French Census of 2008 and the French Ministry of Finance as well as tract data from the American Community Survey (2006-2010) and the U.S. Department of Housing and Urban Development Picture of Subsidized Households, and constructing measures to be as similar as possible, we compare socioeconomic segregation in metropolitan areas with a population of more than 1 million in France and the United States. We find much higher socioeconomic segregation in large metropolitan areas in the United States than in France. We also find (1) a strong pattern of low-income neighborhoods in central cities and high-income neighborhoods in suburbs in the United States, but varying patterns across metropolitan areas in France; (2) that high-income persons are the most segregated group in both countries; (3) that the shares of neighborhood income differences that can be explained by neighborhood racial/ethnic composition are similar in France and the United States; and (4) that government-assisted housing is disproportionately located in the poorest neighborhoods in the United States but is spread across many neighborhood income levels in France. We conclude that differences in government provision of housing assistance and levels of income inequality are likely important contributing factors to the Franco-U.S. difference in socioeconomic segregation. [ABSTRACT FROM AUTHOR]

Background: Over the past decades, both health inequalities and income inequalities have been increasing in many European countries, but it is unknown whether and how these trends are related. We test the hypothesis that trends in health inequalities and trends in income inequalities are related, i.e. that countries with a stronger increase in income inequalities have also experienced a stronger increase in health inequalities. Methods: We collected trend data on all-cause and cause-specific mortality, as well as on the household income of people aged 35-79, for Belgium, Denmark, England & Wales, France, Slovenia, and Switzerland. We calculated absolute and relative differences in mortality and income between low- and high-educated people for several time points in the 1990s and 2000s. We used fixed-effects panel regression models to see if changes in income inequality predicted changes in mortality inequality. Results: The general trend in income inequality between high- and low-educated people in the six countries is increasing, while the mortality differences between educational groups show diverse trends, with absolute differences mostly decreasing and relative differences increasing in some countries but not in others. We found no association between trends in income inequalities and trends in inequalities in all-cause mortality, and trends in mortality inequalities did not improve when adjusted for rising income inequalities. This result held for absolute as well as for relative inequalities. A cause-specific analysis revealed some association between income inequality and mortality inequality for deaths from external causes, and to some extent also from cardiovascular diseases, but without statistical significance. Conclusions: We find no support for the hypothesis that increasing income inequality explains increasing health inequalities. Possible explanations are that other factors are more important mediators of the effect of education on health, or more simply that income is not an important determinant of mortality in this European context of high-income countries. This study contributes to the discussion on income inequality as entry point to tackle health inequalities. More research is needed to test the common and plausible assumption that increasing income inequality leads to more health inequality, and that one needs to act against the former to avoid the latter. [ABSTRACT FROM AUTHOR]

This study analyzes the circumstances that enabled France to become in the late nineteenth century the first stable parliamentary democracy with universal (male) suffrage in Europe. It establishes a causal relationship between short-term variations in local income and the electoral support for the coalition of republican parties that represented the newly established regime. The results suggest the republican coalition won the parliamentary elections because most French regions did not suffer from transitory negative income shocks stemming from heavy precipitations. They thus raise questions about the rationality of voters and, ultimately, the actual causes of the consolidation of democracy in France. [ABSTRACT FROM AUTHOR]

In any fee-for-service system, doctors may be encouraged to increase the number of services (private activity) they provide to receive a higher income. Studying private activity determinants helps to predict doctors' provision of care. In the context of strong feminization and heterogeneity in general practitioners' (GP) behavior, we first aim to measure the effects of the determinants of private activity. Second, we study the evolution of these effects along the private activity distribution. Third, we examine the differences between male and female GPs. From an exhaustive database of French GPs working in private practice in 2008, we performed an ordinary least squares (OLS) regression and quantile regressions (QR) on the GPs' private activity. Among other determinants, we examined the trade-offs within the GPs' household considering his/her marital status, spousal income, and children. While the OLS results showed that female GPs had less private activity than male GPs (−13 %), the QR results emphasized a private activity gender gap that increased significantly in the upper tail of the distribution. We also find gender differences in the private activity determinants, including family structure, practice characteristics, and case-mix variables. For instance, having a youngest child under 12 years old had a positive effect on the level of private activity for male GPs and a negative effect for female GPs. The results allow us to understand to what extent the supply of care differs between male and female GPs. In the context of strong feminization, this is essential to consider for organizing and forecasting the GPs' supply of care. [ABSTRACT FROM AUTHOR]

The restructuring of the allocation of governmental competencies in France has increased the importance of subnational governments by transferring additional tasks. We analyse the efficiency of public spending on the intermediate government level for the 96 départements in metropolitan France in 2008. Spending efficiency is measured using Data Envelopment Analysis. Results indicate significant room for improvement and we detect an average spending inefficiency of 12%. To explain efficiency, a bootstrapped truncated regression is applied. The second-stage regression shows that efficiency is also determined by exogenous factors and identifies the distance to the national capital, inhabitants’ income and the share of inhabitants older than 65 as significant determinants of efficiency. [ABSTRACT FROM PUBLISHER]

Background: Few studies have specifically focused on demographic and socio-economic characteristics associated with snacking in adults, whereas their identification could be useful for defining effective public health measures. The aim of our study was to assess the associations of these factors with daily snacking behavior and its dietary quality. Methods: This cross-sectional study included 84,692 women and 23,491 men from the NutriNet-Santé cohort study. Occurrence of snacking, energy intake from snacks, snack nutrient, and energy densities were assessed using 24-h dietary records of weekdays at baseline. Associations between socio-economic and demographic factors (age, presence of children in the household, education, income, occupation), and snacking behavior were examined using multivariable logistic regression and analysis of covariance, stratified by sex and adjusted for total daily energy intake. Results: Older individuals were more likely to snack during the day in both sexes while individuals with primary education (OR = 0.79 (0.71;0.87) in women; OR = 0.71 (0.60;0.83) in men), female employees (OR = 0.94 (0.89;0.99), and self-employed women were less likely to snack during the day. Older individuals, in particular middle-aged subjects, had higher snack nutrient density, and lower energy intake and density from snacks compared with younger adults. Presence of a child in the household was associated with higher energy density, lower nutrient density (in women), and lower energy intake from snacks (in men), compared with those who lived without a child in household. In low income individuals and manual workers, snacks had lower nutrient density and higher energy content than in higher socioeconomic categories. At last, energy intake from daily snacking occasions was higher in women with low education level. Conclusions: Although snacking was less prevalent in low socioeconomic categories and young adults, their snacks had higher energy content and were of poorer nutrient density. Such findings provide useful information on mechanisms of social disparities in dietary behavior. Trial registration: This study was conducted according to the guidelines laid down in the Declaration of Helsinki. All procedures were approved by the Institutional Review Board of the French Institute for Health and Medical Research (IRB Inserm No0000388FWA00005831) and the French Data Protection Authority (Commission Nationale Informatique et Libertés No.908450 and No.909216). Clinical Trial no. NCT03335644 [ABSTRACT FROM AUTHOR]