OBJECTIVES:Teachers' mental health, an important asset for society, may be impacted by security or health crises alongside more structural changes. Our primary aim was to assess 2012-2022 trends in depressive symptoms among French teachers compared to similar employees. We further examined concomitant trends in job dissatisfaction. METHODS:Within the ongoing French national CONSTANCES cohort, depressive symptoms were regularly assessed (up to four times between 2012 and 2022) using the Center for Epidemiologic Studies-Depression scale (CES-D, score 0-60). We used mixed models adjusted for sociodemographic factors to estimate mean parameters (95% CI) of CES-D variations between 2012 and 2022 among teachers (n=15 022) compared with other intermediate or managerial/professional occupations (n=21 361). We similarly studied changes in job dissatisfaction (score 1-8) from 2018 (first occurrence in questionnaires) to 2022. RESULTS:In 2012, teachers' CES-D was slightly lower on average compared with that of non-teachers (-0.66 point (-1.19 to -0.12)), but tended to increase more rapidly over the decade, particularly in the years concomitant to the COVID-19 pandemic (+0.14 point/year (0.01 to 0.27)). By 2022, the gap had closed. Job dissatisfaction followed a somewhat different pattern: slightly lower among teachers in 2018, it increased at first more rapidly compared with non-teachers, but then stabilised, in parallel with the waning of the pandemic. CONCLUSIONS:Our study highlights unfavourable long-term trends in the mental well-being of French teachers. Although clinical changes at individual levels would be mostly imperceptible, our findings concern a large population of key professionals, suggesting their growing needs for mental health support in the long run.

OBJECTIVE:Besides psychosocial stressors, teachers are exposed to disturbing noise at work, such as students' irrelevant speech. Few studies have focused on this issue and its health consequences. We explored occupational noise exposure among teachers within the French workforce and analyzed how noise and work-related stress are related to their health. MATERIALS AND METHODS:The prevalence of perceived noise exposure, evaluated through the question "Do you work in an environment where you sometimes have to raise your voice to talk to people 2 to 3 m away?" was compared between teachers (n = 13,843) and various occupational groups (n = 34,338) using inclusion data (2012-2020) from the ongoing French population-based CONSTANCES cohort (>217,000 participants). Additionally, the relationships between perceived noise and two health dimensions, perceived health (poor vs. good) and depressive symptoms (Centre for Epidemiologic Studies-Depression Scale, high vs. low/moderate), among teachers were alternately investigated using logistic regressions. Moreover, how perceived noise may interact with work-related stress (effort-reward imbalance/strained relationships) was explored. RESULTS:Thirty-two percent of teachers reported working in a noisy environment, compared with 14% of noneducation employees (P < 0.001). Primary school teachers were the most likely to report noise exposure (43%). Independent of stress, teachers exposed to noise had poorer perceived health and higher odds of depressive symptoms than nonexposed teachers, with odds ratios (95% confidence interval) of 1.21 (1.07; 1.37) and 1.14 (1.01; 1.28), respectively. Evidence of an interaction between perceived noise and strained relationships was observed on perceived health (P = 0.05). CONCLUSION:French teachers commonly reported disturbing noise at work, and those exposed showed poorer health indicators, particularly when facing strained relationships. The findings call for further studies on noise in schools, especially longitudinal studies, to ascertain its long-term effect on teachers' health and its potential interaction with the psychosocial environment.

Abstract Background While noise at school is a well-known issue concerning students’ well-being, data on its potential effect on teachers’ health are limited. Methods Among teachers (n = 13,843) and a sample of non-education employees (n = 34,338) participating in the French CONSTANCES cohort (enrollment phase 2012-2020), we evaluated self-reported noise exposure at inclusion with the question “do you work in an environment where you sometimes have to raise your voice to talk to people 2 or 3 meters away?”(yes/no). First, we compared proportions of teachers who reported noise exposure to different groups of non-education employees. Second, among teachers, we cross-sectionally assessed, using logistic regressions adjusted for potential confounders, how combined exposure to occupational noise and work-related stress (defined alternately as effort-reward imbalance or tension with the public) was associated with two health indicators: self-perceived health (poor vs. good) and depressive symptoms (Centre of Epidemiologic Studies Depression scale, sex-specific cut-points, high vs. low to moderate), respectively. Results Thirty-two percent of teachers declared working in a noisy environment compared to 14% among non-education employees included. Primary school teachers were particularly exposed (42.6%), in comparable proportions to manual workers (43.3%). Among teachers, noise alone was not significantly related to self-perceived health but slightly associated with higher odds of depressive symptoms. We further observed evidence of an interaction effect on depressive symptoms between noise and tension with the public. Conclusions This large study highlights that noise is a common occupational exposure among teachers in France. As it may interact with sense of physical insecurity to weight particularly on mental health, our results advocate for a better considering of such every day and long-term exposure on teachers’ health. Key messages • Noise is a common occupational exposure for French teachers. • As it may interact with work-related stress to affect mental health, noise at school should not be overlooked as an occupational hazard.

Lay Summary Education professionals play a crucial role in health education, notably as role-models, since they come into contact with students on a daily basis. Therefore, examining their health behaviours may be instructive. In this nationwide French study, teachers appeared to behave more healthily compared with non-education sector employees in important domains such as alcohol consumption or tobacco use. However, certain non-teaching education professional groups were more likely to be physically inactive or overweight/obese. Our results highlight opportunities for interventions aimed at raising health awareness and empowerment among school staff. A comprehensive health promotion approach integrating our findings would draw less on a vertical or top-down transfer of knowledge and depend more on participation and exchange among school staff, on teachers leading by example, as well as on the development of a supportive school environment. Education professionals play a critical role in health education, both as knowledge providers and as role-models. Drawing on the CONSTANCES French cohort (baseline 2012-19) and adjusting for important confounders, we compared education professionals (n = 14 730) with a random sample of non-education sector employees (n = 34 244) on three indicators of high-risk behaviour (at-risk drinking, current smoking, past-year cannabis use) and three indicators of unhealthy lifestyle (low physical activity, poor adherence to nutritional guidelines, overweight/obesity). Among education professionals, we distinguished between teachers (n = 12 820), school principals (n = 372), senior education advisers (n = 189), school health professionals (n = 128) and school service staff (n = 1221). Compared with non-education sector employees with similar demographic and socioeconomic profiles, teachers were less likely to be at-risk drinkers, to smoke, to have used cannabis in the past year and to be overweight/obese. Other non-teaching education professionals were also less involved in high-risk behaviours than non-education employees, but results were more mixed concerning some lifestyle indicators, with certain non-teaching education professional groups showing a higher likelihood of being physically inactive or overweight/obese. In this nationwide French study, our results suggest a window of opportunity to promote school staff health but also indirectly, that of the youth with whom they interact daily. We suggest that school staff should be supported in health matters not only through the provision of health information but also most importantly, through the development of a favourable and supportive environment enabling them to put health knowledge into practice.

Teachers’ health is a key factor of any successful education system, but available data are conflicting. To evaluate to what extent teachers’ health could be at risk, we used pre-pandemic data from the CONSTANCES population-based French cohort (inclusion phase: 2012–2019) and compared teachers (n = 12,839) included in the cohort with a random subsample selected among all other employees (n = 32,837) on four self-reported health indicators: perceived general health, depressive symptoms (CES-D scale), functional limitations in the last six months, and persistent neck/back troubles (Nordic questionnaire). We further restricted our comparison group to the State employees (n = 3583), who share more occupational similarities with teachers. Lastly, we focused on teachers and evaluated how their health status might differ across teaching levels (primary, secondary, and higher education). As compared to non-teacher employees, and even after adjusting for important demographic, socioeconomic, lifestyle, and occupational confounders, teachers were less likely to report bad perceived health and depressive symptoms but were more likely to present functional limitations. Trends were similar in the analyses restricted to State employees. Within the teaching population, secondary school teachers were more likely to report depressive symptoms but less frequently declared persistent neck/back troubles than primary school teachers. Our descriptive cross-sectional study based on a probability sampling procedure (secondary use of CONSTANCES inclusion data) did not support the idea that teachers’ health in France was particularly at risk in the pre-pandemic period. Both cross-cultural and longitudinal studies are needed to further gain information on the topic of teachers’ health around the world and to monitor its evolution over time, particularly during crises impacting the education system such as the COVID-19 pandemic.

To highlight effective levers to promote teachers’ wellbeing worldwide, particularly during difficult times such as the COVID-19 pandemic, we investigated work-related factors associated with teacher wellbeing, across borders and cultures. In six countries/territories, we examined the factors that were most consistently and strongly associated with two indicators of wellbeing at work: (i) job satisfaction; and (ii) work/life balance, and three indicators of general wellbeing: (i) subjective health; (ii) mental health; and (iii) life satisfaction. Between May and July 2021, after 18 months of the pandemic, 8000 teachers answered the first edition of the International Barometer of Education Personnel’s Health and Wellbeing (I-BEST): 3646 teachers from France, 2349 from Québec, 1268 from Belgium, 302 from Morocco, 222 from The Gambia, and 215 from Mexico. For each country/territory and each wellbeing indicator, we used a forward stepwise regression procedure to identify important determinants among a carefully selected set of 31 sociodemographic, private, and professional life factors. Aside from healthcare access, the factors most consistently and strongly associated with teacher wellbeing in France, Québec and Belgium (samples whose size were ≥1000) were related to the psychosocial and the organizational dimensions of work, namely: feeling of safety at school, autonomy at work, and the quality of relationships with superiors and quality of relationships with students. In the smaller samples of teachers from the three remaining countries (Morocco, The Gambia and Mexico), exploratory analyses showed that the feeling of safety and autonomy at work were, there too, consistently associated with wellbeing indicators. During the COVID-19 pandemic, the factors most consistently associated with teachers’ wellbeing across countries were related to security and autonomy at work, supporting the importance to consider these aspects in a continuous, structural way at school. Factors associated with teachers’ wellbeing in very different contexts require further cross-cultural study.

Household disinfectant and cleaning products (HDCPs) assessment is challenging in epidemiological research. We hypothesized that a newly-developed smartphone application was more objective than questionnaires in assessing HDCPs. Therefore, we aimed to compare both methods, in terms of exposure assessments and respiratory health effects estimates. The women of the SEPAGES birth cohort completed repeated validated questionnaires on HDCPs and respiratory health and used an application to report HDCPs and scan products barcodes, subsequently linked with an ingredients database. Agreements between the two methods were assessed by Kappa coefficients. Logistic regression models estimated associations of HDCP with asthma symptom score. The 101 participants (18 with asthma symptom score ≥1) scanned 617 different products (580 with available ingredients list). Slight to fair agreements for sprays, bleach and scented HDCP were observed (Kappa: 0.35, 0.25, 0.11, respectively). Strength of the associations between HDCP and asthma symptom score varied between both methods but all odds ratios (OR) were greater than one. The number of scanned products used weekly was significantly associated with the asthma symptom score (adjusted-OR [CI 95%]: 1.15 [1.00–1.32]). This study shows the importance of using novel tools in epidemiological research to objectively assess HDCP and therefore reduce exposure measurement errors.

BACKGROUND:Asthma control is suboptimal in nearly half of adults with asthma. Household exposure to disinfectants and cleaning products (DCP) has been associated with adverse respiratory effects, but data on their association with asthma control are scant. OBJECTIVES:To investigate the association between household use of DCP and asthma control in a large cohort of French elderly women. METHODS:We used data from a case-control study on asthma (2011-2013) nested in the E3N cohort. Among 3023 women with current asthma, asthma control was defined by the Asthma Control Test (ACT). We used a standardized questionnaire to assess the frequency of cleaning tasks and DCP use. We also identified household cleaning patterns using a clustering approach. Associations between DCP and ACT were adjusted for age, smoking status, body mass index, and education. RESULTS:Data on ACT and DCP use were available for 2223 women (70 ± 6 years old). Asthma was controlled (ACT = 25), partly controlled (ACT = 20-24), and poorly controlled (ACT ≤ 19) in 29%, 46%, and 25% of the participants, respectively. Weekly use of sprays and chemicals was associated with poorly controlled asthma (odds ratio [95% confidence interval]: 1 spray: 1.31 [0.94-1.84], ≥2 sprays: 1.65 [1.07-2.53], P trend: .01; 1 chemical: 1.24 [0.94-1.64], ≥2 chemicals: 1.47 [1.03-2.09], P trend: .02). Risk for poor asthma control increased with the patterns "very frequent use of products" (1.74 [1.13-2.70]) and "infrequent cleaning tasks and intermediate use of products" (1.62 [1.05-2.51]). CONCLUSION:Regular use of DCP may contribute to poor asthma control in elderly women. Limiting their use may help improve asthma management.

Objectif Face à l’augmentation progressive et continue du nombre d’enseignants non-titulaires en France, notre objectif a été d’évaluer, dans le second degré, leurs conditions de travail et leur bien-être professionnel et général par comparaison aux enseignants titulaires. Méthodes Dans l’enquête postale nationale « Qualité de Vie des Enseignants », mise en œuvre en 2013 par la Fondation MGEN et l’Éducation nationale, 118 enseignants non-titulaires et 1298 enseignants titulaires du second degré ont répondu aux questions sur leur bien-être professionnel (satisfaction professionnelle, souhait de changer de profession, trois dimensions du Maslach Burnout Inventory) et général (questionnaire de qualité de vie WHOQOL-BREF). Après stratification sur le secteur d’enseignement (public/privé), ces indicateurs de bien-être ont été modélisés en fonction du statut d’emploi dans des modèles de régression ajustés sur de nombreux facteurs de confusion potentiels (âge, conditions d’exercice, etc.). Résultats Les enseignants non-titulaires exerçaient dans des conditions globalement moins favorables que les titulaires dans les deux secteurs (plus d’établissements, plus de temps de trajet, élèves d’origine sociale moins favorisée). Pourtant, dans le secteur public, les non-titulaires (n=70) présentaient de meilleurs indicateurs de bien-être professionnel que les titulaires (n=1051): ils souhaitaient moins souvent changer de profession (OR[95 %IC]=0,36 [0,20; 0,66]) et présentaient un épuisement émotionnel plus faible (OR[95 %IC]=0,37 [0,18; 0,78]). Par contraste, les enseignants non-titulaires du privé (n=48) tendaient à être moins satisfaits de leur expérience professionnelle et à avoir plus de symptômes d’épuisement émotionnel que leurs homologues titulaires (n=247). Concernant le bien-être général, les enseignants non-titulaires du privé étaient moins satisfaits de leur qualité de vie (OR[95 %IC]=0,29 [0,12; 0,66]) que les titulaires. Enfin, les non-titulaires étaient significativement moins satisfaits de leur environnement de vie, qu’ils travaillaient dans un établissement public (β[95 %IC]=−4,94 points [−8,17; −1,71]) ou privé (β[95 %IC]=−6,33 points [−10,97; −1,69]). Conclusions Les enseignants non-titulaires du second degré privé présentaient de moins bons indicateurs de bien-être professionnel et général. Dans le second degré public, les résultats étaient plus contrastés, mais on retrouvait une moindre satisfaction vis-à-vis de l’environnement de vie. D’autres études, notamment qualitatives et dans le premier degré, doivent être menées pour consolider les résultats. Le statut « non-titulaire » chez les enseignants doit être un point de vigilance pour le médecin de prévention de l’éducation nationale.

Education professionals have a role to play in health education, both as knowledge providers and role-models. To appraise their health awareness, we compared their health behaviours to those of non-education employees. Using inclusion data of the CONSTANCES French cohort (2012-2019) and adjusting for important confounders (sex, age, education,...), we alternately compared three indicators of risky conducts (at-risk drinking, current smoking, past year-cannabis use) and two indicators of unhealthy lifestyle (low physical activity, overweight/obesity) between education professionals (n = 14730) and a random sample of non-education employees (n = 34244). Among education professionals, we distinguished between teachers (n = 12820), school principals (n = 372), principal educational advisers (n = 189), school health professionals (n = 128), and school manual/service staff (n = 1221). Teachers were less likely than non-education employees to be at-risk drinker, to smoke, to have used cannabis in the past year and to be overweight/obese. Other non-teaching education professionals were also rather less involved in risky conducts than non-education employees. Nonetheless, school principals and principal educational advisers reported more often low physical activity and school principals and manual/service staff were more prone to overweight/obesity than non-education employees. In this large nationwide sample of French employees, education professionals were rather less involved in risky conducts than other non-education employees with a similar demographic and socioeconomic profile. Yet, non-teaching education professionals showed punctually unhealthy lifestyle indicators, suggesting a window of opportunity to improve both their own health and, indirectly through role-model, that of the youth with whom they interact daily. Education professionals, especially teachers, appear more health-conscious than average. There may still be room for improvement toward a healthier lifestyle. In addition, the average observed may be quite far from the recommended public health target, so that any action to enhance education professional’s health behaviours will have societal benefits.

PurposeTo investigate the relationship between social support at work and burnout among teachers, independent of the teachers' private social and environmental context.MethodsIn the 2013 Teachers' Quality of Life population-based study (France, n=2653), burnout symptomatology was assessed using the Maslach Burnout Inventory. The score for each dimension (emotional exhaustion, depersonalization and personal accomplishment) was dichotomized using extreme tertiles. Global score for social support at work, and subscores by source and type were derived from the Karasek Job Content Questionnaire and were categorized into tertiles (low, medium, and high). The private context was appraised through the social relationships and environment subscales of the short version of the World Health Organization Quality of Life Questionnaire. Associations between social support at work and burnout indicators were evaluated among 2473 teachers with complete data, using logistic regression models adjusted for the private context plus sociodemographic and work-related characteristics.ResultsEight percent of the teachers showed simultaneously high emotional exhaustion, high depersonalization and low personal accomplishment symptoms and were considered as burnout cases. After controlling for the private context, teachers who reported high social support at work were significantly less likely to report burnout [odds ratio (95% confidence interval) high vs. low=0.62 (0.40, 0.98)]. When distinguishing the source of social support at work, only high social support from supervisors remained significantly associated with a lower risk of burnout [0.43 (0.27, 0.71)].ConclusionsImproving social support at work, especially from a hierarchical point of view, may be an effective target to promote teacher's well-being.

Background: While uncontrolled asthma in adults is frequent in Europe, the impact of socioeconomic position (SEP) was little investigated. We aimed to investigate the respective association of individual- and area-level SEP with uncontrolled asthma among French elderly women. Methods: Analyses were conducted in the Asthma-E3N study, among participants with current asthma (i.e., asthma attacks, treatment, or symptoms in previous year). Asthma control was evaluated using Asthma Control Test (uncontrolled: score <= 19); SEP was defined at both individual- and area-level, using educational level (low, medium, high), the French Deprivation index (tertiles defined at national level), and by merging them in a combined-SEP index. Associations between SEP and asthma control were estimated for 2258 women by logistic regression adjusted for age. Analyses were stratified by asthma controller medication use estimated through a drug reimbursement database. Results: Women were 70 years on average and 24% had uncontrolled asthma. A low educational level (11%) was associated with an increased risk of uncontrolled asthma [odds ratio (95% confidence interval) = 1.9 (1.4,2.6)], especially among women not using controller medication [3.1 (1.9,5.1)]. Using the combined-SEP index, the highest risk of uncontrolled asthma was observed among women with the most disadvantaged socioeconomic profile (low educational level and low-SEP neighborhood) [2.5 (1.5,4.2)]. Conclusions: Women with low SEP had more often uncontrolled asthma, which might be partly explained by inadequate asthma treatment. To achieve the best management of asthma for elderly patients, a specific attention should be given not only to disadvantaged population and neighborhoods, but also to disadvantaged populations in affluent neighborhoods.

Objectives As a human service profession, teaching presents specific risk factors that could be intensified in socially disadvantaged schools and, ultimately, impact the service quality. The aim of the present study was to evaluate the association between school socioeconomic status and teachers' well-being. Design Population-based postal survey 'Teachers' Quality of Life' (MGEN Foundation for Public Health/French Ministry of Education; 2013). To categorise the school socioeconomic status, we used the 'Education Priority Area (EPA)' administrative classification, which is chiefly based on the proportion of underprivileged students and is available for primary and lower secondary state schools. Participants In-service French teachers randomly selected from among the teaching staff administrative list of the French Ministry of Education after stratification by sex, age and type of school. Outcome measures Indicators of well-being at work included a question on job satisfaction, job difficulty evolution and the Maslach Burnout Inventory. The short version of the WHO Quality of Life questionnaire was used to evaluate overall well-being. Among primary and lower secondary school teachers, we evaluated cross-sectional associations between school EPA status and indicators of well-being, using logistic or linear regressions stratified by school level and adjusted for sociodemographic and work-related characteristics. Results In the adjusted models, there was no significant difference in work-related well-being between teachers in EPA and non-EPA schools, both in primary school (n=154vs n=788) and in lower secondary school (n=113vs n=452). Regarding overall well-being, the only significant differences were seen among primary school teachers, with teachers in EPA schools reporting a worse perception of physical health and living environment than teachers in non-EPA schools. Conclusion Using a representative sample of French teachers, we did not observe substantial differences in work-related well-being between teachers in EPA and non-EPA schools.

Ambient air pollution is a leading environmental risk factor and its broad spectrum of adverse health effects includes a decrease in lung function. Socioeconomic status (SES) is known to be associated with both air pollution exposure and respiratory function. This study assesses the role of SES either as confounder or effect modifier of the association between ambient air pollution and lung function. Cross-sectional data from three European multicenter adult cohorts were pooled to assess factors associated with lung function, including annual means of home outdoor NO2. Pre-bronchodilator lung function was measured according to the ATS-criteria. Multiple mixed linear models with random intercepts for study areas were used. Three different factors (education, occupation and neighborhood unemployment rate) were considered to represent SES. NO2 exposure was negatively associated with lung function. Occupation and neighborhood unemployment rates were not associated with lung function. However, the inclusion of the SES-variable education improved the models and the air pollution-lung function associations got slightly stronger. NO2 associations with lung function were not substantially modified by SES-variables. In this multicenter European study we could show that SES plays a role as a confounder in the association of ambient NO2 exposure with lung function.

Introduction: Asthma in the elderly is considered as a specific phenotype at high risk of progression towards ACO (asthma chronic obstructive pulmonary disease overlap). Around 20% of old patients with asthma are affected by ACO. The progression remains poorly characterized at population level, mainly because it is difficult to define ACO in epidemiological studies. Objectives: To identify asthma progression towards ACO in old women by using a pharmacoepidemiological approach, and to assess individual and phenotypic characteristics associated with this progression. Methods: The study relied on 4240 women (64.5±6.1y), from the Asthma-E3N study (Etude épidémiologique auprès des femmes de la Mutuelle Générale de l’Education Nationale), with current asthma but not affected by ACO (not treated by long-acting muscarinic antagonists [LAMA] or long-acting beta2-agonists [LABA] as monotherapy) at baseline. Asthma progression towards ACO was defined through 7-year prospective drug administrative databases, by at least 4 added reimbursements of LAMA or LABA as monotherapy over a year. Multiple logistic regression was conducted to estimate associations between ACO onset and individual or phenotypic characteristics. Results: 5.9% of women developed ACO during the 7 years. ACO onset was associated with active smoking (OR[95%CI], 3.3[2.0;5.7]), late asthma onset (>40y vs. ≤40; OR[95%CI], 1.4[1.1;2.0]), and obesity (OR[95%CI], 1.8[1.2;2.6]). No association was found with education level or rhinitis. Conclusions: Our findings provide first evidence for the use of drug administrative databases to identify ACO in old women with asthma. Active smoking, late onset asthma, and obesity increased the risk of progression towards ACO.

Background/aim Occupational exposure is a risk factor for asthma. However, its impact on asthma control, the main target of asthma management, has rarely been studied. The healthy worker effect (HWE) can affect occupational studies. We aimed to investigate the effect of occupational exposures on asthma control in a longitudinal study, taking into account a potential HWE by a marginal structural model (MSM). Methods Analyses were conducted in EGEA (Epidemiological study on the Genetics and Environment of Asthma), a case-control and family-based study (EGEA1: 1991–1995), with 2 follow-ups (EGEA2: 2003–2007; EGEA3: 2011–2013). Occupational exposure (no, ‘irritants and/or low level of chemicals/allergens’, ‘known asthmagens’) was defined using an asthma-specific job-exposure matrix. Asthma control was defined using international guidelines (GINA 2014); subjects with partly controlled/uncontrolled asthma were compared to those with controlled or non-current asthma. Associations between occupational exposures and asthma control were evaluated among subjects with asthma using (1) a standard pooled multinomial logistic model and (2) a MSM to control the HWE modelled as a time-varying confounding situation. Results Asthma was partly controlled or uncontrolled in 39% of person-periods (n=822). Occupational exposure to ‘irritants and/or low level of chemicals/allergens’ and to ‘known asthmagens’ was observed in 14% and 13% of all person-periods, respectively. In the standard analysis, after adjustment for age, sex, smoking status and time period, no statistically significant association was found between exposure to ‘irritants and/or low level of chemicals/allergens’ (OR [95% CI]: 0.91 [0.58–1.41]) or ‘known asthmagens’ (1.27 [0.79–2.04]) and partly controlled/uncontrolled asthma. Using the MSM, the association remained similar for exposure to ‘irritants and/or low level of chemicals/allergens’ (0.86 [0.55–1.35]) whereas the association increased for ‘known asthmagens’ (1.55 [0.96–2.52], p=0.08). Conclusion No significant association between occupational exposure and asthma control was observed; however after correcting for a HWE using a MSM, a positive association between exposure to known asthmagens and partly controlled or uncontrolled asthma was suggested. Results support the presence of a healthy worker effect in the study and the deleterious effect of exposure to asthmagens on asthma control.

Objective Healthcare workers are highly exposed to various types of disinfectants and cleaning products. Assessment of exposure to these products remains a challenge. We aimed to investigate the feasibility of a method, based on a smartphone application and bar codes, to improve occupational exposure assessment among hospital/cleaning workers in epidemiological studies. Methods A database of disinfectants and cleaning products used in French hospitals, including their names, bar codes and composition, was developed using several sources: ProdHyBase (a database of disinfectants managed by hospital hygiene experts), and specific regulatory agencies and industrial websites. A smartphone application has been created to scan bar codes of products and fill a short questionnaire. The application was tested in a French hospital. The ease of use and the ability to record information through this new approach were estimated. Results The method was tested in a French hospital (7 units, 14 participants). Through the application, 126 records (one record referred to one product entered by one participant/unit) were registered, majority of which were liquids (55.5%) or sprays (23.8%); 20.6% were used to clean surfaces and 15.9% to clean toilets. Workers used mostly products with alcohol and quaternary ammonium compounds (>90% with weekly use), followed by hypochlorite bleach and hydrogen peroxide (28.6%). For most records, information was available on the name (93.7%) and bar code (77.0%). Information on product compounds was available for all products and recorded in the database. Conclusion This innovative and easy-to-use method could help to improve the assessment of occupational exposure to disinfectants/cleaning products in epidemiological studies.

An adverse role of frequent domestic use of cleaning agents, especially in spray form, on asthma has been reported. However, sparse studies have investigated respiratory health effects of chronic domestic exposure to irritant cleaning agents. This study aims to investigate associations between weekly use of irritant domestic cleaning products and current allergic and non-allergic asthma in a large cohort of elderly women. We used data from the Asthma-E3N nested case-control study on asthma (n = 19,404 women, response rate: 91%, 2011), in which participants completed standardized questionnaires on asthma and on the use of domestic cleaning products including irritants (bleach, ammonia, solvents and acids). Allergic multimorbidity in asthma was assessed from allergic-related medications recorded in drug refunds database. The association between use of irritants and current asthma was estimated by logistic regression (current vs. never asthma) and multinomial logistic regression (never asthma, non-allergic asthma, allergic asthma) adjusted on age, smoking status and body mass index (BMI). In the 12,758 women included in the analysis (mean age: 70 years, current smokers: 4%, BMI ≥ 25 kg/m2: 32%, low education: 11%, current asthma: 23%), 47% reported weekly use of at least one irritant cleaning product at home. Weekly use of irritant products was associated with a higher risk of current asthma (adjusted Odds-Ratio: 1.17, 1.07-1.27). A statistically significant dose-response association was reported (p trend < 0.0001), with both the number of irritant products used weekly (1 irritant: 1.12, 1.02-1.23; 2 irritants: 1.21, 1.05-1.39; 3 irritants or more: 2.08, 1.57-2.75) and the frequency of use (1-3 days/week: 1.12, 1.02-1.23; 4-7 days/week: 1.41,1.22-1.64). A dose-response association was observed with the frequency of products used (p trend < 0.05), for both non-allergic (4-7 days/week: 1.27, 1.02-1.57) and allergic asthma (1.52, 1.27-1.82). In conclusion, weekly use of common cleaning irritants was associated with an increased risk of current asthma, whatever the allergic status.

Multimedication related to multimorbidity is common in the elderly with asthma. We aimed at comprehensively characterising medications used by elderly women and assessing how multimedication impacts on asthma prognosis. We performed network-based analyses on drug administrative databases to visualise the prevalence of drug classes and their interconnections among 17458 elderly women from the Asthma-E3N study, including 4328 women with asthma. Asthma groups sharing similar medication profiles were identified by a clustering method relying on all medications and were studied in association with adverse asthma events (uncontrolled asthma, attacks/exacerbations and poor asthma-related quality of life). The network-based analysis showed more multimedication in women with asthma than in those without asthma. The clustering method identified three multimedication profiles in asthma: "Few multimorbidity-related medications" (43.5%), "Predominantly allergic multimorbidity-related medications" (32.8%) and "Predominantly metabolic multimorbidity-related medications" (23.7%). Compared with women belonging to the "Few multimorbidity-related medications" profile, women belonging to the two other profiles had an increased risk of uncontrolled asthma and asthma attacks/exacerbations, and had lower asthma-related quality of life. The integrative data-driven approach on drug administrative databases identified specific multimorbidity-related medication profiles that were associated with poor asthma prognosis. These findings support the importance of multimorbidity in the unmet needs in asthma management.