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Fekom M, Nguyen TL, Lepeule J, Nakamura A, Keyes K, Martins S, Strandberg-Larsen K, Melchior M. Intergenerational transmission of tobacco smoking: The role of the child's behavioral difficulties. Data from the Danish National Birth cohort (DNBC). Drug Alcohol Depend 2024; 255:111056. [PMID: 38128363 DOI: 10.1016/j.drugalcdep.2023.111056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Abstract
AIMS This study explores the role of offspring behavioral difficulties in the intergeneration transmission of tobacco smoking. METHODS This longitudinal cohort study is based on children born in Denmark in 1996-2003 participating in the Danish National Birth Cohort (DNBC), followed-up until 18years of age. We included mother-child pairs with complete data regarding the exposure (4 trajectories of maternal daily smoking quantity during pregnancy: low, intermediate/stable, intermediate/decreasing and high), outcome (offspring daily smoking status at 18 years) and mediator (offspring symptoms of hyperactivity-inattention at 11 years), that is 24,588 mother-child pairs. RESULTS In our study population, during pregnancy respectively 86.2%, 6.80%, 4.08% and 2.97% mothers belonged to the low, intermediate/stable, intermediate/decreasing and high smoking trajectory groups. After controlling for covariates using propensity scores, the direct effect of maternal smoking in pregnancy on offspring smoking in adolescence was statistically significant, especially when the mother belonged to the intermediate/stable smoking trajectory group (ORIPW = 2.09, 95% CI: 1.70 - 2.61) or to the high smoking trajectory group (ORIPW = 2.08, 95% CI: 1.52 - 3.11) compared to the low smoking trajectory group. None of the indirect effects of maternal smoking in pregnancy were statistically significant, and neither were the proportions mediated. CONCLUSION Maternal pregnancy smoking seems to have an influence on offspring smoking in early adulthood, which does not appear to be mediated by offspring behavioral difficulties. Women should be strongly encouraged to quit smoking in pregnancy to reduce both short and long-term health risks among their offspring.
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Affiliation(s)
- Mathilde Fekom
- Pierre Louis Institute of Epidemiology and Public Health (iPLesp), Department of Social Epidemiology (ERES), INSERM, Sorbonne Université, Paris F-75012, France.
| | - Tri-Long Nguyen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
| | - Johanna Lepeule
- Université Grenoble Alpes, INSERM, CNRS, Institute for Advanced Biosciences (IAB), Grenoble, France
| | - Aurélie Nakamura
- Université Grenoble Alpes, INSERM, CNRS, Institute for Advanced Biosciences (IAB), Grenoble, France
| | - Katherine Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
| | - Silvia Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
| | | | - Maria Melchior
- Pierre Louis Institute of Epidemiology and Public Health (iPLesp), Department of Social Epidemiology (ERES), INSERM, Sorbonne Université, Paris F-75012, France
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Nakamura A, Broséus L, Tost J, Vaiman D, Martins S, Keyes K, Bonello K, Fekom M, Strandberg-Larsen K, Sutter-Dallay AL, Heude B, Melchior M, Lepeule J. Epigenome-Wide Associations of Placental DNA Methylation and Behavioral and Emotional Difficulties in Children at 3 Years of Age. Int J Mol Sci 2023; 24:11772. [PMID: 37511531 PMCID: PMC10380531 DOI: 10.3390/ijms241411772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/04/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
The placenta is a key organ for fetal and brain development. Its epigenome can be regarded as a biochemical record of the prenatal environment and a potential mechanism of its association with the future health of the fetus. We investigated associations between placental DNA methylation levels and child behavioral and emotional difficulties, assessed at 3 years of age using the Strengths and Difficulties Questionnaire (SDQ) in 441 mother-child dyads from the EDEN cohort. Hypothesis-driven and exploratory analyses (on differentially methylated probes (EWAS) and regions (DMR)) were adjusted for confounders, technical factors, and cell composition estimates, corrected for multiple comparisons, and stratified by child sex. Hypothesis-driven analyses showed an association of cg26703534 (AHRR) with emotional symptoms, and exploratory analyses identified two probes, cg09126090 (intergenic region) and cg10305789 (PPP1R16B), as negatively associated with peer relationship problems, as well as 33 DMRs, mostly positively associated with at least one of the SDQ subscales. Among girls, most associations were seen with emotional difficulties, whereas in boys, DMRs were as much associated with emotional than behavioral difficulties. This study provides the first evidence of associations between placental DNA methylation and child behavioral and emotional difficulties. Our results suggest sex-specific associations and might provide new insights into the mechanisms of neurodevelopment.
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Affiliation(s)
- Aurélie Nakamura
- Team of Environmental Epidemiology Applied to Development and Respiratory Health, Institute for Advanced Biosciences (IAB), University Grenoble Alpes, INSERM, 38700 La Tronche, France;
| | - Lucile Broséus
- Team of Environmental Epidemiology Applied to Development and Respiratory Health, Institute for Advanced Biosciences (IAB), University Grenoble Alpes, INSERM, 38700 La Tronche, France;
| | - Jörg Tost
- Laboratory for Epigenetics and Environment, Centre National de Recherche en Génomique Humaine, CEA—Institut de Biologie François Jacob, University Paris Saclay, 91057 Evry, France;
| | - Daniel Vaiman
- From Gametes to Birth, Institut Cochin, U1016 INSERM, UMR 8104 CNRS, Paris Cité University, 75014 Paris, France;
| | - Silvia Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA; (S.M.); (K.K.)
| | - Katherine Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA; (S.M.); (K.K.)
| | - Kim Bonello
- Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Sorbonne Université, INSERM, 75571 Paris, France; (K.B.); (M.F.); (M.M.)
- Department of General Practice, School of Medicine, Sorbonne University, 75013 Paris, France
| | - Mathilde Fekom
- Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Sorbonne Université, INSERM, 75571 Paris, France; (K.B.); (M.F.); (M.M.)
| | - Katrine Strandberg-Larsen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, 1165 Copenhagen, Denmark;
| | - Anne-Laure Sutter-Dallay
- Bordeaux Population Health, Bordeaux University, INSERM, UMR 1219, 33076 Bordeaux, France;
- University Department of Child and Adolescent Psychiatry, Charles Perrens Hospital, 33000 Bordeaux, France
| | - Barbara Heude
- Center for Research in Epidemiology and Statistics (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, INSERM, INRAE, 75004 Paris, France;
| | - Maria Melchior
- Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Sorbonne Université, INSERM, 75571 Paris, France; (K.B.); (M.F.); (M.M.)
| | - Johanna Lepeule
- Team of Environmental Epidemiology Applied to Development and Respiratory Health, Institute for Advanced Biosciences (IAB), University Grenoble Alpes, INSERM, 38700 La Tronche, France;
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Bonello K, Gomajee R, Ibanez G, Martins S, Keyes K, Nakamura A, Lepeule J, Strandberg-Larsen K, Fekom M, Melchior M. Maternal tobacco smoking during pregnancy and children's emotional and behavioural trajectories : The EDEN mother-child birth cohort study. Nicotine Tob Res 2023; 25:1174-1183. [PMID: 36786235 DOI: 10.1093/ntr/ntad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 01/01/2023] [Accepted: 02/13/2023] [Indexed: 02/15/2023]
Abstract
INTRODUCTION The nature of the relationship between maternal tobacco smoking during pregnancy and the occurrence of children's behavioural problems is still a matter of controversy. We tested this association using data collected among a sample of pregnant women and their offspring followed from birth to early adolescence (age 12 years), accounting for multiple parent, child, and family characteristics. METHODS Data come from 1424 mother-child pairs participating in the EDEN mother-child cohort in France. Using repeated measures (3, 5.5, 8 and 11.5 years) of the mother-reported Strengths and Difficulties Questionnaire, we estimated trajectories of children's emotional and behavioural difficulties. Two aspects of maternal smoking were studied: the timing (non-smoker, smoking during the periconceptional period or throughout pregnancy) and the level of use (cigarettes/day) during the first trimester of pregnancy. Robust Poisson regression models controlled for confounding factors including maternal mental health and socioeconomic characteristics using propensity scores with the overlap weighting technique. RESULTS Contrary to bivariate analyses, in propensity score-controlled regression models, maternal smoking throughout pregnancy was no longer significantly associated with offspring emotional or behavioural difficulties. Maternal heavy smoking (≥10cigarettes/day) remained significantly associated with intermediate levels of conduct problems (RR 1.25 95%CI 1.19-1.31). CONCLUSION The association between maternal smoking in pregnancy and offspring emotional and behavioural difficulties appears to be largely explained by women's other characteristics. However, maternal heavy smoking appears to be related to offspring behavioural difficulties beyond the role of confounding characteristics. IMPLICATIONS The relationship between maternal smoking during pregnancy (in 2 modalities: timing and level of smoking) and behavioural difficulties in children is still a matter of debate. While the relationship between any maternal tobacco use and offspring behavioural difficulties appears to be largely explained by confounding factors, heavy maternal smoking in the first trimester of pregnancy seems to be associated with offspring behavioural difficulties beyond the socioeconomic and mental health characteristics transmitted across generations.
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Affiliation(s)
- Kim Bonello
- Sorbonne University, School of Medicine, Department of general practice, Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology (ERES), F-75012 Paris, France
| | - Ramchandar Gomajee
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology (ERES), F-75012 Paris, France
| | - Gladys Ibanez
- Sorbonne University, School of Medicine, Department of general practice, Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology (ERES), F-75012 Paris, France
| | - Silvia Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York
| | - Katherine Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York
| | - Aurélie Nakamura
- Université Grenoble Alpes, INSERM, CNRS, Institute for Advanced Biosciences (IAB), Grenoble, France
| | - Johanna Lepeule
- Université Grenoble Alpes, INSERM, CNRS, Institute for Advanced Biosciences (IAB), Grenoble, France
| | | | - Mathilde Fekom
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology (ERES), F-75012 Paris, France
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology (ERES), F-75012 Paris, France
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Fekom M, Aarbaoui TE, Guignard R, Andler R, Quatremère G, Ducarroz S, Nguyen-Thanh V, Melchior M. Use of Tobacco Cessation Aids and Likelihood of Smoking Cessation: a French Population-Based Study. Prev Med Rep 2022; 30:102044. [DOI: 10.1016/j.pmedr.2022.102044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/02/2022] [Accepted: 11/05/2022] [Indexed: 11/14/2022] Open
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Fekom M, Bonello K, Gomajee R, Ibanez G, Martin S, Keyes K, Nakamura A, Lepeule J, Strandberg-Larsen K, Melchior M. Smoking during pregnancy and children’s emotional and behavioural trajectories. Eur J Public Health 2022. [PMCID: PMC9593937 DOI: 10.1093/eurpub/ckac129.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The nature of the relationship between maternal tobacco smoking during pregnancy and the occurrence of children's behavioural problems is still a matter of controversy. We tested this association using data collected among a sample of children followed from pregnancy to early adolescence (age 11.5 years), accounting for multiple parents’, children's and family characteristics. Methods Data come from 1424 mother-child pairs participating in the EDEN mother-child cohort set up in France. Using repeated measures (3, 5.5, 8 and 11.5 years) of the mother-reported Strengths and Difficulties Questionnaire, we estimated trajectories of children's emotional and behavioural difficulties. Two aspects of maternal smoking were studied: the timing and the level of use (cigarettes/day) during the first trimester of pregnancy. Multinomial regression models controlled for confounding factors including maternal mental health and socioeconomic characteristics using propensity scores with the overlap weighting technique. Results Contrary to bivariate analyses, in propensity score-controlled regression models, maternal smoking throughout pregnancy was no longer significantly associated with offspring emotional or behavioural difficulties. Maternal heavy smoking (≥10cigarettes/day) remained significantly associated with intermediate levels of overall emotional and behavioural difficulties (OR 1.64, 95%CI 1.04-2.58) and conduct problems (OR 3.05 95%CI 1.22-7.61), as well as with high levels of conduct problems symptoms (OR 2.82 95%CI 0.88-9.06) - although the latter did not reach statistical significance. Conclusions The association between maternal smoking in pregnancy and offspring emotional and behavioural difficulties appears to be largely explained by women's other characteristics. However, maternal heavy smoking appears to be related to offspring behavioural difficulties beyond the role of confounding characteristics. Key messages • The association between maternal smoking in pregnancy and offspring emotional and behavioural difficulties seem largely explained by the family's socio-demographic and behavioural characteristics. • Maternal heavy smoking appears to be related to offspring behavioural difficulties beyond the role of confounding characteristics.
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Affiliation(s)
- M Fekom
- Social Epidemiology, Sorbonne Université, INSERM, Institut Pierre , Paris, France
| | - K Bonello
- General Practice, Sorbonne University, School of Medicine , Paris, France
- Social Epidemiology, Sorbonne Université, INSERM, Institut Pierre , Paris, France
| | - R Gomajee
- Social Epidemiology, Sorbonne Université, INSERM, Institut Pierre , Paris, France
| | - G Ibanez
- General Practice, Sorbonne University, School of Medicine , Paris, France
- Social Epidemiology, Sorbonne Université, INSERM, Institut Pierre , Paris, France
| | - S Martin
- Epidemiology, Mailman School of Public Health, Columbia University , New York, USA
| | - K Keyes
- Epidemiology, Mailman School of Public Health, Columbia University , New York, USA
| | - A Nakamura
- Institute for Advanced Biosciences, Université Grenoble Alpes, INSERM, CNRS , Grenoble, France
| | - J Lepeule
- Institute for Advanced Biosciences, Université Grenoble Alpes, INSERM, CNRS , Grenoble, France
| | | | - M Melchior
- Social Epidemiology, Sorbonne Université, INSERM, Institut Pierre , Paris, France
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Fekom M, Nguyen-Thanh V, Andler R, Quatremere G, Guignard R, Melchior M. Effect of Tobacco Cessation Aids on Smoking Cessation and Duration of Abstinence : a French Population-Based Study. Eur Psychiatry 2022. [PMCID: PMC9566949 DOI: 10.1192/j.eurpsy.2022.936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction Although smoking prevalence has been decreasing worldwide, sustained tobacco cessation remains a challenging goal for many smokers. Nicotine replacement therapy (NRT) products remain among the most widespread type of cessation tobacco aids, along with the more recently introduced electronic cigarette, the efficiency of which is still a matter of debate in the public health community. Objectives This study aims to contribute to the ongoing discussion about effective ways of encouraging tobacco cessation and in particular evaluating the role of the two aforementioned tobacco cessation aids with regard to lasting smoking abstinence in real-life settings. Methods The study is based on the French 2017 Health Barometer, a cross-sectional survey conducted by Santé Publique France. Two distinct outcomes related to tobacco cessation were used: smoking status at 6 months follow-up (yes vs. no) and the duration of smoking abstinence. These two study outcomes were examined respectively among N1 = 2783 and N2 = 1824 participants. All results were weighted based on inclusion probability weights and controlled for propensity scores via overlap weighting (OW), which is appropriate when exposure groups are disparate. Results After adjusting on potential confounders, tobacco cessation at 6 months remains significantly associated with e-cigarette use (OR: 1.50 (1.12-1.99)) and e-cigarette use combined with NRT (OR:1.88 (1.15-3.07)). This association did not reach statistical significance in the long-term analysis, nor did the results of NRT use alone in both analyses. Conclusions Overall, while electronic cigarette use alone and combined with NRT is associated with an increase in the likelihood of smoking cessation, the long-term effects are probably limited. Disclosure No significant relationships.
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Evgeniou T, Fekom M, Ovchinnikov A, Porcher R, Pouchol C, Vayatis N. Pandemic lockdown, isolation, and exit policies based on machine learning predictions. Prod Oper Manag 2022; 32:POMS13726. [PMID: 35601842 PMCID: PMC9115407 DOI: 10.1111/poms.13726] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 02/04/2022] [Indexed: 06/15/2023]
Abstract
The widespread lockdowns imposed in many countries at the beginning of the COVID-19 pandemic elevated the importance of research on pandemic management when medical solutions such as vaccines are unavailable. We present a framework that combines a standard epidemiological SEIR (susceptible-exposed-infected-removed) model with an equally standard machine learning classification model for clinical severity risk, defined as an individual's risk of needing intensive care unit (ICU) treatment if infected. Using COVID-19-related data and estimates for France as of spring 2020, we then simulate isolation and exit policies. Our simulations show that policies considering clinical risk predictions could relax isolation restrictions for millions of the lowest risk population months earlier while consistently abiding by ICU capacity restrictions. Exit policies without risk predictions, meanwhile, would considerably exceed ICU capacity or require the isolation of a substantial portion of population for over a year in order to not overwhelm the medical system. Sensitivity analyses further decompose the impact of various elements of our models on the observed effects. Our work indicates that predictive modeling based on machine learning and artificial intelligence could bring significant value to managing pandemics. Such a strategy, however, requires governments to develop policies and invest in infrastructure to operationalize personalized isolation and exit policies based on risk predictions at scale. This includes health data policies to train predictive models and apply them to all residents, as well as policies for targeted resource allocation to maintain strict isolation for high-risk individuals.
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Affiliation(s)
| | - Mathilde Fekom
- Centre BorelliUniversité Paris‐SaclayGif‐sur‐YvetteFrance
| | - Anton Ovchinnikov
- INSEADBd de ConstanceFontainebleauFrance
- Smith School of BusinessQueen's UniversityKingstonOntarioCanada
| | - Raphaël Porcher
- Centre de Recherche Épidémiologie et Statistiques CRESS‐UMR1153, InsermUniversité Paris CitéParisFrance
| | - Camille Pouchol
- FP2M, CNRS FR 2036, MAP5 UMR 8145Université Paris CitéParisFrance
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