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Background: Persons experiencing unstable housing – including recently arrived migrants – are at elevated risk of contracting COVID-19 and suffer from high morbidity and mortality. In this context, the COVID-19 vaccine was foreseen as a promising way to control the pandemic and reduce social inequalities in this area. Understanding the motives of COVID-19 vaccine acceptability in people with unstable housing, including migrants, is therefore crucial to tailor public health communication and outreach. Thus, the main objective of our study was to investigate - both quantitatively and qualitatively – the motivations behind vaccine hesitancy in people experiencing unstable housing when vaccines became available in France.Methods: A cross-sectional study was performed in Spring 2021, using convergent mixed-methods approach. Participants were recruited from homeless shelters and day centres and face-to-face interviews were offered, with help, where necessary, from phone-based interpreters. Factors associated with motives for COVID-19 vaccine hesitancy were explored using logistic regression models. Qualitative data – collected through semi-structured individual interviews - were analysed via an inductive thematic approach. Both quantitative and qualitative data were then integrated. Results: Vaccine hesitancy was found to be at an elevated rate (58.0%). The three most reported motives of hesitancy were related to COVID-19 vaccine effectiveness, safety, and trust in information about the vaccine. Factors of elevated hesitancy comprised the interviewees’ age, level of education, French-language aptitude, feeling of worry about COVID-19, and time of residence in France. Generic distrust in official information was a shared associated factor for the 3 motives of hesitancy. This result was expanded upon by the interview data where participants described having differential trust depending on who is recommending the vaccination. Another emerging key theme related to hopes that the vaccine would release them from the burden of the pandemic. Conclusions: Our mixed methods study provides a comprehensive understanding of COVID-19 vaccine hesitancy among persons with unstable housing in France in Spring 2021. Elevated levels of hesitancy remain a public health concern as “No one is safe until everyone is safe”. The already established role of trust in vaccine hesitancy is still to be adequately addressed as a potentially effective route of intervention.

Background There has been an increased focus on active transport, but the measurement of active transport is still difficult and error-prone. Sensor data have been used to predict active transport. While heart rate data have very rarely been considered before, this study used random forests (RF) to predict transport modes using Global Positioning System (GPS), accelerometer, and heart rate data and paid attention to methodological issues related to the prediction strategy and post-processing. Methods The RECORD MultiSensor study collected GPS, accelerometer, and heart rate data over seven days from 126 participants living in the Ile-de-France region. RF models were built to predict transport modes for every minute (ground truth information on modes is from a GPS-based mobility survey), splitting observations between a Training dataset and a Test dataset at the participant level instead at the minute level. Moreover, several window sizes were tested for the post-processing moving average of the predicted transport mode. Results The minute-level prediction rate of being on trips vs. at a visited location was 90%. Final prediction rates of transport modes ranged from 65% for public transport to 95% for biking. Using minute-level observations from the same participants in the Training and Test sets (as RF spontaneously does) upwardly biases prediction rates. The inclusion of heart rate data improved prediction rates only for biking. A 3 to 5-min bandwidth moving average was optimum for a posteriori homogenization. Conclusion Heart rate only very slightly contributed to better predictions for specific transport modes. Moreover, our study shows that Training and Test sets must be carefully defined in RF models and that post-processing with carefully chosen moving average windows can improve predictions.

Personal exposure to noise has been shown to be associated with concomitant increases and lagged decreases of short-term heart rate variability (HRV). It is however unknown whether this association differs between contexts defined by visited places or mobility as both exposure sources and expectations may be different between these contexts. Between July 2014 and June 2015, the RECORD MultiSensor Study collected sound level and heart rate data for 75 participants, aged 34–74 years, in their living environments for 7 days using a personal dosimeter and electrocardiography sensor on the chest. Their whereabouts were collected using a GPS receiver and a mobility survey. Short-term concomitant and lagged associations between sound level and HRV parameters were assessed within types of visited places and transport modes using mixed effects models with a random intercept for participants. Increases in sound level were associated with a concomitant increase in all HR/HRV parameters, and delayed decreases in the overall HRV. Interactions between the sound level and the visited place/mobility context were documented. Compared with home, the concomitant association of sound level with HR and rMSSD was doubled within active and private-motorized transport modes, respectively. The association of sound level with HR/HRV varies between visited places/mobility contexts. Future studies investigating these context-dependent associations in ambulatory settings will need to assess additional acoustical factors relating to the visited environments as well as non-acoustical factors impacting the perception of noise.

BackgroundAccumulating evidence suggests that the COVID-19 pandemic has negatively affected global mental health and well-being. However, the impact amongst homeless persons has not been fully evaluated. The ECHO study reports factors associated with depression amongst the homeless population living in shelters in France during the Spring of 2020.MethodsInterview data were collected from 527 participants living in temporary and/or emergency accommodation following France’s first lockdown (02/05/20 – 07/06/20), in the metropolitan regions of Paris (74%), Lyon (19%) and Strasbourg (7%). Interviews were conducted in French, English, or with interpreters (33% of participants, ∼20 languages). Presence of depression was ascertained using the Patient Health Questionnaire (PHQ-9).ResultsAmongst ECHO study participants, 30% had symptoms of moderate to severe depression (PHQ-9≥ 10). Multivariate analysis revealed depression to be associated with being female (aOR: 2.15; CI: 1.26-3.69), being single (aOR: 1.60; CI: 1.01-2.52), having a chronic illness (aOR: 2.32; CI: 1.43:-3.78), facing food insecurity (aOR: 2.12; CI: 1.40-3.22) and participants’ region of origin. Persons born in African and Eastern Mediterranean regions showed levels of depression comparable to those of French participants (30-33%) but higher than migrants from European countries (14%). Reduced rates of depression were observed amongst participants aged 30-49 (aOR: 0.60; CI: 0.38-0.95) and over 50 (aOR: 0.28; CI: 0.13-0.64), compared to 18-29-year-olds.ConclusionsOur results indicate high levels of depression among homeless persons during the COVID-19 pandemic. The value of these findings extends beyond the health crisis, as predicted future instability and economic repercussions could particularly impact the mental health of this vulnerable group.

Background: Gold standard measures in mental health are composed of structured clinical interviews. The design of a study could impede using gold standard measures. Several self-report questionnaires are then used to screen for a number of psychiatric symptoms. Therefore, the need to understand which among those would be most appropriate to be applied after terrorism. The present study examined the performance of self-report questionnaires used to assess post-traumatic stress disorder (PCL-S) and symptoms of depression and anxiety (HADS) compared to the MINI among civilians and first responders involved in terror attacks. Methods: This study was based on the data from the IMPACTS Survey conducted from 6 to10 months among civilians (N=190) and first responders (N=232) after the January 2015 terrorist attacks in the Paris Region, France. Sensitivity and specificity of the PCL-S and HADS were estimated by the ROC curve. The optimal threshold for each of the questionnaires was defined using the Youden index. The area under the curve was determined to assess the ability of the instruments to diagnose or score the proposed disorders. Results: Data of 190 civilians and 232 first responders were used to assess the performance of PCL-S and HADS. Concerning the PCL-S: for civilians, the overall AUC was 0.947, and the optimal threshold was 38.5; for first responders, the overall AUC was 0.899, and the optimal threshold was 39.5. Regarding the HADS-D: for civilians, the overall AUC was 0.908 and optimal threshold was 7.5; for first responders, the overall AUC was 0.617 and the “optimal” threshold was 1.5. About the HADS-A for civilians, the overall AUC was 0.823 and the optimal threshold was 9.5; for first responders, the overall AUC was 0.717 and the optimal threshold was 6.5. Conclusions: Our findings demonstrated a satisfactory performance of the PCL-S and the HAD-D to screen for PTSD or depression (respectively) compared to the MINI, and an unsatisfactory performance of the HAD-A to assess anxiety disorders compared to the MINI. It would be interesting if the study were replicated in other countries and in different types of disaster.

Objective To contain the COVID-19 epidemic preventive measures including social distancing, economic shutdown, and school closures were introduced, carrying risk of mental health burden in adults and children. Although the knowledge base regarding children's response to trauma and adverse events has broadened, descriptions of their mental health during epidemics remain scarce. In particular, the role of family socioeconomic characteristics and parental mental health are poorly understood. Methods We assessed the correlates of children's emotional difficulties and symptoms of hyperactivity/inattention during the COVID-19 lockdown in a French community-based sample. 432 community-based parents (27-46 years, TEMPO cohort) and their children (mean age 6.8 +/- 4.1) were interviewed online. Children's symptoms of emotional difficulties and hyperactivity/inattention were assessed using the parent reported Strengths and Difficulties Questionnaire during the 5th week of home confinement. Family socioeconomic characteristics and parental mental health and substance use were assessed weekly during the first 5 weeks of home confinement. Data were analyzed using multivariate logistic regression models. Results 7.1% of children presented symptoms of emotional difficulties and 24.7% symptoms of hyperactivity/inattention. The presence of psychological difficulties was significantly associated with family characteristics including financial difficulties (OR = 4.3) and parental symptoms of anxiety and depression (OR = 2.5). Children's sleeping difficulties and screen time were statistically significant in bivariate analyses but lost statistical significance in multivariate models. Conclusions Children's emotional and behavioural difficulties are associated with parental mental health and socioeconomic difficulties. In the COVID-19 epidemic, parents and professionals involved in caring for children should pay special attention to mental health needs.

Background Accumulating evidence suggests that the COVID-19 pandemic has negatively affected global mental health and well-being. However, the impact amongst homeless persons has not been fully evaluated. The ECHO study reports factors associated with depression amongst the homeless population living in shelters in France during the spring of 2020. Methods Interview data were collected from 527 participants living in temporary and/or emergency accommodation following France's first lockdown (02/05/20 – 07/06/20), in the metropolitan regions of Paris (74%), Lyon (19%) and Strasbourg (7%). Interviews were conducted in French, English, or with interpreters (33% of participants, ∼20 languages). Presence of depression was ascertained using the Patient Health Questionnaire (PHQ-9). Results Amongst ECHO study participants, 30% had symptoms of moderate to severe depression (PHQ-9 ≥ 10). Multivariate analysis revealed depression to be associated with being female (aOR: 2.15; CI: 1.26–3.69), single (aOR: 1.60; CI: 1.01–2.52), chronically ill (aOR: 2.32; CI: 1.43: 3.78), facing food insecurity (aOR: 2.12; CI: 1.40–3.22) and participants’ region of origin. Persons born African and Eastern Mediterranean regions showed higher levels of depression (30–33% of participants) than those migrating from other European countries (14%). Reduced rates of depression were observed amongst participants aged 30–49 (aOR: 0.60; CI: 0.38–0.95) and over 50 (aOR: 0.28; CI: 0.13–0.64), compared to 18–29-year-olds. Limitations These data are cross-sectional, only providing information on a given moment in time. Conclusions Our results indicate high levels of depression amongst homeless persons during the COVID-19 pandemic. Predicted future instability and economic repercussions could particularly impact the mental health of this vulnerable group.

Personal exposure to noise has been shown to be associated with concomitant increases and lagged decreases of short-term heart rate variability (HRV). It is however unknown whether this association differs between contexts defined by visited places or mobility as both exposure sources and expectations may be different between these contexts.Between July 2014 and June 2015, the RECORD MultiSensor Study collected sound level and heart rate data for 75 participants, aged 34-74 years, in their living environments for 7 days using a personal dosimeter and electrocardiography sensor on the chest. Their whereabouts were collected using a GPS receiver and a mobility survey. Short-term concomitant and lagged associations between sound level and HRV parameters were assessed within types of visited places and transport modes using mixed effects models with a random intercept for participants.Increases in sound level were associated with a concomitant increase in all HR/HRV parameters, and delayed decreases in the overall HRV. Interactions between the sound level and the visited place/mobility context were documented. Compared with home, the concomitant association of sound level with HR and rMSSD was doubled within active and private-motorized transport modes, respectively.The association of sound level with HR/HRV varies between visited places/mobility contexts. Future studies investigating these context-dependent associations in ambulatory settings will need to assess additional acoustical factors relating to the visited environments as well as non-acoustical factors impacting the perception of noise.

Background/aim Part of the complexity of noise assessment resides in its temporal variations as so, it is still unclear which indicators of exposure are appropriate. This study aims at (1)describing the concomitant associations between personal noise exposure summarised using various noise indicators and heart rate variability (HRV) parameters (2)identifying the noise indicators that best predict HRV parameters. Methods The RECORD MultiSensor Study collected between July 2014 and June 2015 noise and heart rate (HR) data for 75 participants, aged 34–74 years, in their living environments for 7 days using an electrocardiography sensor on the chest and a personal dosimeter recording 1 s A-weighted equivalent sound pressure levels (L Aeq,1s ). HRV parameters and noise levels were calculated for 5 min windows. Noise was summarised as L Aeq , L AX (noise level exceeded X% of the time) with L A90 , L A50 , L A10 , L A01 , L A10 -L A90 and the standard deviation of L Aeq,1s . Short-term associations of noise level and HRV parameters were assessed using mixed effects models with a random intercept for participants adjusted for HR, accelerometry, context and short-term trends. The models’ goodness of fit was assessed using the BIC. Results The classically used indicator, the LAeq, was highly correlated with L A10 (r=0.94) and L A01 (r=0.97) and moderately with L A90 (r=0.66) and L A10 -L A90 (r=0.52). All of the noise indicators, when examined in separate models, were positively associated with the Standard deviation of N-N intervals (SDNN) and with the Low frequency on High frequency HRV ratio (LF/HF), with the exception of the association between the L A90 and SDNN which decreased by −0.17% (95% CI: −0.21 to −0.13) per increase of one dB(A). Based on the BIC, the noise indicators that best predicted HRV parameters were the standard deviation of L Aeq,1s for the SDNN followed by L A10 -L A90 (ΔBIC=221.66) and L A01 for the LF/HF ratio followed by L A10 (ΔBIC=190.36). Conclusion The results suggest that short-term effects of noise on overall heart rate variability (SDNN) are better explained by the amplitude of noise level variations (σ LAeq,1s ), while those on the balance of the autonomic nervous system (LF/HF) are better explained by sporadic noise events (L A01 ). In addition a negative association between the background noise level (L A90 ) and SDNN was found.

Background/Aim: Studies revealed long-term associations between noise exposure and cardiovascular health, but the underlying mechanisms remain uncertain. Few studies on noise and heart rate variabi...

Background Studies revealed long-term associations between noise exposure and cardiovascular health, but the underlying short-term mechanisms remain uncertain. Objectives To explore the concomitant and lagged short-term associations between personal exposure to noise and heart rate variability (HRV) in a real life setting in the Ile-de-France region. Methods The RECORD MultiSensor Study collected between July 2014 and June 2015 noise and heart rate data for 75 participants, aged 34–74 years, in their living environments for 7 days using a personal dosimeter and electrocardiography (ECG) sensor on the chest. HRV parameters and noise levels were calculated for 5-min windows. Short-term relationships between noise level and log-transformed HRV parameters were assessed using mixed effects models with a random intercept for participants and a temporal autocorrelation structure, adjusted for heart rate, physical activity (accelerometry), and short-term trends. Results An increase by one dB(A) of A-weighted equivalent sound pressure level (Leq) was associated with a 0.97% concomitant increase of the Standard deviation of normal to normal intervals (SDNN) (95% CI: 0.92, 1.02), of 2.08% of the Low frequency band power (LF) (95% CI: 1.97, 2.18), of 1.30% of the High frequency band power (HF) (95% CI: 1.17, 1.43), and of 1.16% of the LF/HF ratio (95% CI: 1.10, 1.23). The analysis of lagged exposures to noise adjusted for the concomitant exposure illustrates the dynamic of recovery of the autonomic nervous system. Non-linear associations were documented with all HRV parameters with the exception of HF. Piecewise regression revealed that the association was almost 6 times stronger below than above 65 Leq dB(A) for the SDNN and LF/HF ratio. Conclusion Personal noise exposure was found to be related to a concomitant increase of the overall HRV, with evidence of imbalance of the autonomic nervous system towards sympathetic activity, a pathway to increased cardiovascular morbidity and mortality.

Background Studies investigating the association between spatial accessibility to environmental resources from the various places a person visits during daily activities and use of corresponding resources often do not account for potential biases related to selective daily mobility. This bias occurs when accessibility is also measured from places intentionally visited to access the resources of interest. The aim of this study was to examine associations between spatial accessibility to sports facilities from multiple places and sport practice while addressing the selective daily mobility bias. Methods The second wave of the RECORD Cohort was used to examine the relationship between the spatial accessibility to sport facilities and the practice of three sport categories (swimming, racket, and team sports), using multilevel linear probability models (n = 5327 participants) adjusted for individual and contextual characteristics. Street network distance to the nearest sport facility was considered as a measure of spatial accessibility [from the residence; from the residence and workplace; from all visited locations (full activity space), biased; and from all locations excluded those visited for sports (truncated activity space), corrected]. Results The residential and residential-workplace accessibility to facilities was not associated with sport practice. The spatial accessibility to facilities from all places visited (full activity space) was associated with the practice of the three categories of sports (biased relationships). After correcting the bias (truncated activity space), the strength of the relationships was markedly reduced. An association remained only for swimming sports. Conclusion This study underlines the need to account for selective daily mobility bias when determining spatial accessibility to resources from the various places visited. Such bias, if not addressed, may result in overestimated associations between spatial accessibility and use, leading to potentially erroneous conclusions in terms of planning.

International audience; Environmental health studies have examined associations between context and health with individuals as statistical units. However, investigators have been unable to investigate momentary exposures, and such studies are often vulnerable to confounding from, for example, individual-level preferences. We present a Global Positioning System (GPS)-based methodology for segmenting individuals' observation periods into visits to places and trips, enabling novel life-segment investigations and case-crossover analysis for improved inferences. We analyzed relationships between built environments and walking in trips. Participants were tracked for 7 days with GPS receivers and accelerometers and surveyed with a Web-based mapping application about their transport modes during each trip (Residential Environment and Coronary Heart Disease (RECORD) GPS Study, France, 2012–2013; 6,313 trips made by 227 participants). Contextual factors were assessed around residences and the trips’ origins and destinations. Conditional logistic regression modeling was used to estimate associations between environmental factors and walking or accelerometry-assessed steps taken in trips. In case-crossover analysis, the probability of walking during a trip was 1.37 (95% confidence interval: 1.23, 1.61) times higher when trip origin was in the fourth (vs. first) quartile of service density and 1.47 (95% confidence interval: 1.23, 1.68) times higher when trip destination was in the fourth (vs. first) quartile of service density. Green spaces at the origin and destination of trips were also associated with within-individual, trip-to-trip variations in walking. Our proposed approach using GPS and Web-based surveys enables novel life-segment epidemiologic investigations.