Inserm Publishes Its Latest Collective Expert Review on the Health Effects of Pesticides


Through a critical analysis of the international scientific literature, this most recent publication takes stock of what we know about the links between exposure to pesticides and human health. © Adobe Stock


Pesticides are all products that are used to control undesirable plant species and organisms considered harmful, raising many concerns about their potential effects on human health and the environment. In 2013, at the request of the French Directorate General for Health (DGS), Inserm had published a Collective Expert Review called “Pesticides: Effects on Health”. In 2018, five ministerial directorate generals1 had tasked the Institute with updating its publication and including new topics.

The group of experts gathered by Inserm analyzed the recent scientific literature in order to examine the link between pesticides and some twenty diseases. It also analyzed the health effects of two active substances and one family of pesticides: chlordecone, glyphosate, and succinate dehydrogenase inhibitor (SDHI) fungicides.

Through a critical analysis of the international scientific literature, the 2021 Collective Expert Review takes stock of what we know about the links between exposure to pesticides and human health. It looks at neuropsychological and motor development disorders in children, cognitive disorders, anxiety and depression in adults, as well as neurodegenerative diseases and cancers in people of any age. Respiratory health, thyroid diseases, and endometriosis are also discussed. All in all, the multidisciplinary group of researchers analyzed over 5,300 documents.

For each topic, the experts studied the new epidemiological data available in order to evaluate whether there was a presumed link between the exposure of different populations to the pesticides and the onset of a disease. As in 2013, this presumed link was then graded as being strong (++), moderate (+), or weak (±). These results were then examined in relation to those of the toxicological studies, in order to evaluate the biological plausibility of the links observed.

Links established between exposure to pesticides and certain diseases

The first epidemiological studies on the subject tended to characterize exposure to pesticides without precisely distinguishing the family of pesticides or the active substance. They often concerned people who in principle were most exposed due to having regularly handled such products as part of their work. More recent studies have sought to specify the disease subtypes (for example, the different types of leukemia), identify the active substances involved or investigate the link with populations supposedly less exposed than those who work with pesticides, such as those living near agricultural areas, the general population, or more sensitive populations such as children.

  • In adults

The expert review confirms a strong presumed link between occupational exposure to pesticides and four diseases: non-Hodgkin lymphomas (NHLs), multiple myeloma, prostate cancer, and Parkinson’s disease. It also highlights the strong presumed link between occupational exposure to pesticides and two other diseases: cognitive disorders and chronic obstructive pulmonary disease (COPD)/chronic bronchitis (see boxed text).

A moderate presumed link has also been revealed between exposure to pesticides, mainly in an occupational context, and Alzheimer’s disease, anxiety, depression, certain cancers (central nervous system, bladder, kidney, leukemia, soft tissue sarcomas), asthma and thyroid diseases.

A closer look at the six adult diseases for which a strong presumed link has been established with occupational exposure to pesticides

Non-Hodgkin lymphoma (NHL): links between exposure to malathion, lindane, DDT, and organophosphates (++) had been identified in 2013. Recent data support a stronger presumed link in 2021 for diazinon (++) and chlordane (+). For glyphosate, the presumed link is reinforced for occupational exposure (+). A weak presumed link has been reported for the first time with dicamba (±). The data also suggest links between NHL subtypes and certain pesticides.

Multiple myeloma: for the first time, links with active substances have been revealed for permethrin (+) and for carbaryl, captan, DDT, and glyphosate (±).

Prostate cancer: this analysis reinforces the role mentioned in 2013 of occupational exposure to certain organophosphate insecticides, such as fonofos (+) and highlights that of terbufos (+) and malathion (+) as well as an organochlorine insecticide (aldrin, +). It emphasizes a higher risk of developing an aggressive form of the disease, suggesting a possible role in the progression of the disease and not only in its onset. For chlordecone, the expert review considers there to be a strong presumed link (++) and that a causal relationship is likely.

Parkinson’s disease: the data confirm the link with paraquat (+) and new studies suggest weak presumed links (±) with active ingredients of the dithiocarbamate fungicide family (zineb, ziram and mancopper). The new studies on the exposure of people living near agricultural areas suggest a weak presumed link with pesticides in general.

Cognitive impairment: the presumed link increased from moderate to strong (++) with exposure to pesticides, mainly organophosphates, in farmers. The most recent studies have been extended to include people living near agricultural areas or the general population and consider the presumed link to be moderate (+).

Respiratory health (not covered in 2013): a strong presumed link between occupational exposure to pesticides and the onset of COPD and chronic bronchitis has been established. Seventeen active substances were found to be associated with a disease or the impairment of a respiratory function parameter, with the majority having a weak presumed link (±). To evaluate the biological plausibility of this link, three effects were studied in a toxicology setting (oxidative stress, mitotoxicity, and immunomodulation) and among these 17 pesticides, 11 are associated with at least two toxicological effects and two, permethrin and chlorpyrifos, with all three effects.


  • In children

Certain periods of life such as pregnancy and early childhood are more vulnerable in the face of a toxic event or agent.

The recent results have made it possible to specify the type of pediatric leukemia concerned during exposure of the mother during pregnancy: acute leukemia and domestic uses (strong presumed link) and acute myeloid leukemia and occupational exposure. A new link has been found between the risk of acute lymphoblastic leukemia in case of paternal occupational exposure in the preconception period (moderate presumption).

Concerning central nervous system tumors, the expert review confirms the strong presumed link between the occupational exposure of the parents to pesticides (without distinction) during the prenatal period. In addition, the recent results lead to a strong presumed link between central nervous system tumors and domestic exposure to pesticides (without distinction) during pregnancy or childhood.

Other research focuses on the links between occupational or environmental exposure of mothers during pregnancy and neuropsychological and motor developmental disorders in children. They confirm the existence of a strong presumed link, especially for certain families of pesticides, such as the organophosphates. Regarding the pyrethroids, whose use has increased as a replacement for organophosphate insecticides, the results of new studies are consistent and show a link between pyrethroid exposure during pregnancy and an increase in internalized behavioral problems such as anxiety (strong presumed link). Toxicological data support the biological plausibility of an effect based on the modes of action of these pesticides.

Consider the most recent scientific data to better protect populations

The confirmation and highlighting of strong presumed links between certain diseases and exposure to pesticides should encourage the authorities to take better account of these issues. In addition, the scientific literature on the subject is raising new concerns, particularly regarding the indirect effects of certain pesticides on human health through their effects on ecosystems, which should be taken into account more by researchers and decision-makers.

What can be said about chlordecone, glyphosate and SDHIs?

  • Chlordecone, an insecticide that was used in the French West Indies from 1973 to 1993, persists in these natural island environments. Consumption of the contaminated foodstuffs has led to a significant contamination of the whole population. The causal relationship between chlordecone exposure and the risk of prostate cancer is considered likely.


  • Glyphosate is an herbicide for which the expert review concludes a moderate presumed link with non-Hodgkin lymphoma. Other links have been reported in the scientific literature for multiple myeloma and leukemia, but the results are less strong. Experimental carcinogenesis studies in rodents show excess cases, but are not convergent. Different tumors are observed in males and females, but they occur only at very high doses of glyphosate and only in certain strains of rodents.


  • Finally, the SDHIs are a family of broad-spectrum fungicides that have been used for 30 years and inhibit cell respiration in target species. To date, there is virtually no epidemiological data on the health effects of these substances on farmers or the general population. Experimental studies in fish suggest that some SDHIs may have endocrine disrupting effects, at least in the model used. Some show carcinogenic effects on rats or mice but these results are discussed on the basis of a mechanism that cannot be extrapolated to humans. The experts emphasize the need for further research to improve the assessment of the carcinogenic potential of the SDHIs and to fill the data gap in humans.


1 The Directorates General for Risk Prevention, Health, Labor, Research and Innovation, and the Secretary General of the Ministry of Agriculture and Food

Creation of a patient-centered biocluster in oncology



Sanofi, Gustave Roussy, Inserm, Institut Polytechnique de Paris and the University of Paris-Saclay are committed to developing personalized medicine in France through a patient-centered oncology cluster – the Paris Saclay Cancer Cluster.

Following the announcements made by French President Emmanuel Macron at the Strategic Council for Health Industries, Sanofi, Gustave Roussy, Inserm, Institut Polytechnique de Paris and the University of Paris-Saclay have announced plans to create the Paris Saclay Cancer Cluster, a center bringing together key players in oncology innovation. This project, which is unique in Europe, will bring together the best scientific, human and technological expertise to shape the future of personalized medicine and accelerate the discovery of new customized cancer treatments. Within ten years, the objective is to be able to offer rapid diagnosis at the patient’s bedside, including disease modeling and the construction of an individualized and personalized therapy.

Oncology is a field where the medical needs of patients remain largely unmet and where innovations must lead to improved diagnosis, treatment and survival.  Ensuring that France and Europe are leaders in oncology innovation in 2030 is a key challenge. France has world-renowned strengths in oncology (quality of academic research with a number of publications that ranks France 2nd in the world, hospitals, industrial companies, venture capital funds, incubators); these assets must lead to the emergence of therapeutic and diagnostic solutions that will transform the lives of patients and enable the emergence of a truly global innovation ecosystem.

The Paris Saclay Cancer Cluster project aims to build on this high-potential ecosystem by bringing together the key players in oncology innovation (patients, hospitals, universities, pharma companies, investors, national research organizations, patient associations and public authorities) to develop the most effective synergies. With strong political support, the project will lead to the creation of a Prospective Oncology Center in the Paris region.

The Paris Saclay Cancer Cluster would stand out with:

  • The co-location and multi-disciplinary nature of the five founding players, which will promote the conversion of fundamental research into concrete and transforming applications for the benefit of patients,
  • Its ability to generate massive economic impact (creation of several thousand direct jobs, patents, several billion euros in fundraising, etc.),
  • The choice to support the most ambitious projects, and the proposal of a “unique, facilitating place” with secure access to the anonymized data of over 100,000 patients,
  • The mobilization of skills, services and infrastructures to develop the future of personalized medicine and the emergence of leading companies in oncology in the region. These research projects would be conducted by new joint public-private teams, in addition to existing units, for example those of Inserm/UP-Saclay at Gustave Roussy,
  • A solid foundation for the re-emergence of European therapeutic sovereignty by locating R&D and production capacities for new cancer therapies and diagnostics in Europe (with the ambition of five French unicorns in oncology),
  • The will to open up and attract many players in the world of oncology, beyond the founding members, very quickly.


The Paris Saclay Cancer Cluster intends to be both unique and complementary to existing facilities through its research strategy, which integrates all dimensions – clinical, fundamental, academic, industrial, transdisciplinary, etc. – on a single theme, located in a single location, as close as possible to patients. The ambition of this major project is to enable France and Europe to become world leaders in cancer research,” said Professor Jean-Charles Soria, CEO of Gustave Roussy.

“Improving the care of cancer patients is fundamental for Sanofi. Facing an opponent as challenging as cancer, I am delighted that public and private players bringing together the best medical, academic, and scientific expertise, join forces to advance research and create a European dynamic. The convergence of biology and medicine with data science and artificial intelligence offer major opportunities to accelerate therapeutic innovation and create future leading companies in oncology, positioning France at the forefront of innovation in Europe and the world,” said Paul Hudson, Chief Executive Officer of Sanofi.

I am delighted with this strong impetus that will combine the best of academic research with ambitious industrial development and will fully contribute to scientific advances in the fight against cancer,” said Dr. Gilles Bloch, President and CEO of Inserm.

The University of Paris-Saclay is very pleased to be a founding member of the Paris Saclay Cancer Cluster, which is part of a will to respond with our industrial partners to one of the major challenges of our time. This common trajectory with our faculties of medicine and pharmacy irrigates training, research and innovation in cancerology. The University’s high disciplinary level in this field is enriched by interfaces in AI, data sciences, applied mathematics and engineering, also at the highest world level,” said Sylvie Retailleau, President of Université Paris-Saclay.

By participating in the creation of the Paris Saclay Cancer Cluster, Institut Polytechnique de Paris affirms its strong commitment to a major challenge facing our society, cancer research, by contributing its skills in AI, data science and engineering. This union of all the public and private players around a great ambition, allowing us to bring innovations in this field to scale, will help our country achieve its therapeutic sovereignty,” said Eric Labaye, President of Institut Polytechnique de Paris.

Next steps

After a preparation and scoping phase, the first projects of the cluster should start by the end of 2021. They will focus on identifying new therapeutic targets based on a large collection of patient samples. Beforehand, a legal structure that will host the Paris Saclay Cancer Cluster will be created and its first employees, including its Managing Director, will be recruited, while the technological platforms, data and first training courses will be accessible (via the Cluster) from 2021/2022. The founders are already meeting with various players in the fields of oncology, data and AI, who could join the cluster in the near future.

From 2023/2024, the opening of the Prospective Oncology Center on a site close to Gustave Roussy will mark a real acceleration for the cluster: the objective will be to select at least ten new projects per year.

After 2025, the cluster will enter a phase of sustainability and expansion, notably through the emergence of projects focused on the creation and optimization of new treatments and drugs and their development (accelerated and facilitated by artificial intelligence), on the invention of new administration systems to provide patients with personalized treatment, and on the deployment of innovative treatment methods directly at their bedside, while disseminating these models so that they benefit all patients regardless of where they are treated in the territories.

Neonatal meningitis: the immaturity of microbiota and epithelial barriers implicated


© Choroid plexus of mouse neonates. Blue: cell nuclei, green: phalloidin-actin, red: fluorochrome. Credits: Biology of Infection Unit, Institut Pasteur

Meningitis is associated with high mortality and frequently causes severe sequelae. Newborn infants are particularly susceptible to this type of infection; they develop meningitis 30 times more often than the general population. Group B streptococcus (GBS) bacteria are the most common cause of neonatal meningitis, but they are rarely responsible for disease in adults. Scientists from the Institut Pasteur, in collaboration with Inserm, Université de Paris and Necker-Enfants Malades Hospital (AP-HP), set out to explain neonatal susceptibility to GBS meningitis. In a mouse model, they demonstrated that the immaturity of both the gut microbiota and epithelial barriers such as the gut and choroid plexus play a role in the susceptibility of newborn infants to bacterial meningitis caused by GBS. The findings were published in the journal Cell Reports on June 29, 2021.

Newborn infants are more likely to develop bacterial meningitis than children and adults. Group B streptococcus (GBS) is the pathogen responsible for a significant proportion of cases of neonatal meningitis. In most instances, infection is preceded by bacterial colonization of the gut. The commensal bacterial gut flora (known as the microbiota) plays a key physiological role, as it is involved in digestion, offers protection from gut pathogens and contributes to tissue differentiation and immune development. Newborns have no gut microbiota; it gradually develops in the first few weeks after birth.

In a new study, scientists from the Institut Pasteur, in collaboration with Inserm, Université de Paris and Necker-Enfants malades Hospital (AP-HP), demonstrated in a mouse model that the immaturity of the gut microbiota in neonates is involved in neonatal susceptibility to meningitis caused by GBS. In the absence of a mature microbiota, the bacteria can extensively colonize the gut. In the absence of a mature microbiota, the barrier function of blood vessels in the gut that the bacteria must cross to reach the brain through the bloodstream is also less effective, and the immune system is unable to control infection.

Unexpectedly, the scientists also demonstrated that, independently of the microbiota, the epithelial barriers formed by the gut and the choroid plexus (the interface between the blood and the cerebrospinal fluid that irrigates the brain) are not entirely mature in newborns, which facilitates bacterial access to the brain.

The signaling pathway known as the Wnt pathway, which is involved in tissue growth and differentiation, is more active in newborns, resulting in a less effective barrier function at the gut and choroid plexus levels in neonates.

In this study, we show how two factors associated with infancy – the immaturity of the gut microbiota and the growth of gut and choroidal epithelial tissues – play a role in the susceptibility of newborn infants to meningitis caused by GBS, at all stages of infection from gut colonization to dissemination in the brain,” explains Marc Lecuit (university professor/hospital practitioner, Université de Paris and Necker-Enfants Malades Hospital), head of the Biology of Infection Unit at the Institut Pasteur and Inserm and last author of the study.

The results of this research illustrate the importance of the microbiota and its critical role in protecting against infection.

Vers la jeunesse éternelle… vraiment ?

Carotenoid-Rich Diet Reduces Risk of Developing AMD

Fruit and vegetables, some of which contain carotenoids © Engin Akyurt/Unsplash photos


A Mediterranean diet – high in fruit, vegetables, legumes, whole grains, olive oil and oily fish – may prevent the development of age-related macular degeneration (AMD), which is the leading cause of visual impairment in people over the age of 50. A new study published by researchers from Inserm and University of Bordeaux at the Bordeaux Population Health Research Center reveals in an unprecedented way a link between circulating carotenoids – plant pigments that protect the retina – and the reduced risk of developing advanced AMD. Based on the follow-up of 609 people over an eight-year period, this research constitutes the first longitudinal study to identify this link and has been published in the journal Nutrients.

Age-related macular degeneration (AMD) is the leading cause of vision loss in industrialized countries. This degenerative disease affects the central part of the retina, which is crucial for daily living tasks (reading, driving, recognition of faces, etc.). At an advanced stage, it takes two forms: the neovascular “wet” form which is treated with anti-VEGF[1] injected directly into the eye, and the atrophic “dry” form for which there is no treatment at present.

Although there is no cure, it is possible to prevent or slow the progression of the disease. We are already familiar with the risk factors for AMD, which are linked to age and genetic background – factors which we cannot do anything about.

For the past twenty years, researchers have studied the link between nutrition and AMD. We now know that many foods make it possible to slow the degeneration: fatty acid (omega 3), antioxidants (vitamin C, zinc, etc.). These protect the macula, the area of the eye affected by the disease and which is located in the center of the retina.

Through a prospective study based on the eight-year follow-up period of the ALIENOR cohort, the researchers’ objective was to study the link between the presence of lutein and zeaxanthin in plasma and the development of AMD.

Lutein and zeaxanthin belong to the large carotenoids family and are notably found in yellowy-orange fruit such as citrus and tomatoes, as well as in leafy green vegetables such as spinach, cabbage, and chard. Highly concentrated in the macula, these pigments play a very specific role for the eyes. Our bodies do not synthesize them, which is why we have to get them from our diet.

Unlike previous studies, based only on information given by participants about their diet, the team of Inserm researcher and study author Bénédicte Merle analyzed blood samples and demonstrated an objective link between circulating levels of lutein and zeaxanthin and a reduction in the risk of AMD.

This research reveals that higher plasma levels of carotenoids, particularly lutein and zeaxanthin, reduce the risk of developing advanced AMD by 37%.

This result remains similar, whether the form is atrophic or neovascular. However, apart from lutein and zeaxanthin, no other carotenoids have been associated with such a reduction in risk.

Lutein and zeaxanthin provide real protection to the retina. They absorb blue light, which is known to damage it over the long term, and act as antioxidants to protect it from oxidative stress[2] – which is a factor of AMD.

ALIENOR is a population-based study aiming at assessing the associations of age-related eye diseases with nutritional factors. For this research, 609 participants with an average age of 73 years were recruited between 2006 and 2008. At enrollment they had a blood test to measure their plasma levels of lutein and zeaxanthin. They then saw an ophthalmologist in order to diagnose AMD. Among them, 54 developed AMD during the eight-year follow-up period.

What to eat to prevent or slow the progression of AMD

For sufficient plasma levels of lutein and zeaxanthin, yellowy-orange fruits and vegetables should be preferred (tomatoes, carrots, citrus fruits), and leafy green vegetables (cabbage, spinach). “In addition to this, the most beneficial diet for preventing AMD is a Mediterranean diet high in fruit and vegetables and enough omega 3 from oily fish,” emphasizes Merle.

Beyond the nutritional recommendations, the discovery of the role of these carotenoids opens up avenues for identifying the population groups most at risk of developing AMD based on their diet. This study therefore offers strategies for prevention but also for the identification of risk factors that will be useful for the future of research.


[1] Anti-VEGFs are novel therapies that act on the cell membrane and are often used to prevent tumor survival.

[2] Oxidative stress refers to the various aggressions of our body’s cells caused by molecules derived from oxygen. The most well-known of these harmful substances are free radicals.

“Give Meaning to Your Work: Join Health Research! ” Inserm launches its recruitment campaign for 2021

RH Campagne 2021 Inserm

For 2021, Inserm has chosen to honor its staff through a colorful and dynamic digital communication campaign. Credits: © Inserm; photos: © François Guénet


Lawyers, biologists, computer scientists, statisticians and administrators: join Inserm and give meaning to your work! The first public organization dedicated entirely to human health research is launching its national recruitment campaign to encourage registration for external civil service competitive examinations. An opportunity for Inserm to present several of its staff and their sometimes little-known roles. A total of 83 positions are available across France. Registration is now open and accessible online until July 15.

Give meaning to your work by joining Inserm! Registration for the 2021 external competitive examinations is open, offering candidates a range of opportunities with over 83 positions in a wide variety of professions. The profiles sought concern many fields: biological techniques, virology, value creation, financial and administrative management, human resources, information technology, communication… All the positions open to the Inserm competitive examinations allow entry into the French State civil service.

Joining Inserm’s teams means joining a structure grouping over 15,000 researchers, engineers, technicians and administrative staff, all united by a shared objective: to promote health by furthering knowledge on living organisms and diseases, to develop innovative treatments, and to conduct public health research.

Full information on the competitive examinations and their terms and conditions is available at:


A colorful and dynamic digital campaign that gives Inserm employees a voice

For 2021, Inserm has chosen to honor its staff through a colorful and dynamic digital communication campaign. Rolled out on LinkedIn, Twitter, Instagram and Facebook, as well as on several online press websites, the “Give meaning to your work: join health research!” campaign presents the profiles of several Inserm staff members who have agreed to share their stories. In the form of interviews, the participants talk about their career paths, professions, and the meaning of what they do at Inserm.

One of these is Marie Metzger, a biostatistician who has been with Inserm for twelve years: “By helping researchers and doctors analyze and interpret data, biostatisticians help to improve the health of everyone,” she explains. Oguz Kulaksiz, meanwhile, has been with Inserm as external resources administrator since April 2019. “I enjoy being in the thick of project management and interacting with numerous networks. I am at the center of interactions between researchers and funding parties and work in total synergy with Inserm’s internal teams,” he emphasizes.

This quest for meaning and service to citizens, embodied in the slogan “Give meaning to your work,” resonates even more after a year and a half of a health crisis that has seen Inserm rise to the forefront of the fight against COVID-19. This campaign, orchestrated by Inserm’s Communication Department, is one of the main thrusts of its communication strategy aimed at improving the public’s perception of its missions and actions.


The interviews can be found at:

Using Artificial Intelligence to Predict Suicidal Behaviors in Students

risque suicidaire

With the number of vulnerable students increasing under the effects of the health crisis, detecting those in severe distress and at risk of suicide is essential to enable the earliest possible intervention. © Ben Blennerhassett – Unsplash


How do we predict suicide risk in students? This is a pertinent issue at a time when the harmful effects of the health crisis on student mental health are becoming increasingly apparent and the importance of early detection and management of this risk is well-known. A team of researchers from Inserm and Université de Bordeaux, in collaboration with the Universities of Montreal and McGill in Quebec, have used artificial intelligence to identify a small set of mental health indicators that accurately predict suicidal behavior in students. Their findings have been published in Scientific Reports.

Suicide is the second leading cause of death among 15-24-year-olds, and students are at particular risk of suicidal behaviors. Several known factors may contribute to the increased risk in this population: the transition from high school to college, the added workload, psychosocial stress and academic pressures, and the adaptation to a new environment. Risks that have also been exacerbated by the health crisis related to the COVID-19 pandemic.

The early detection of suicidal behaviors (suicidal thoughts and attempts) is essential to enable access to appropriate treatment. Using a machine learning method[1], researchers at Inserm and Université de Bordeaux have developed an algorithm that accurately identifies the main predictive factors of suicidal behaviors in a student population.

Over 5,000 French students followed for one year

The findings of this study are based on the analysis of data collected from 5,066 students who were followed for at least one year between 2013 and 2019. They all belong to the i-Share cohort on student health led by Christophe Tzourio, professor of epidemiology at Université de Bordeaux, practitioner at Bordeaux University Hospital and director of the Bordeaux Population Health research center.  

The participants are over 18 years old, French-speaking and enrolled in a French university. They completed two detailed online questionnaires: one at the time of enrollment, the other a year later. The information gathered through this process provides researchers with information about their health, their drug and alcohol use, their medical and psychiatric history, and their psychological state.

This follow-up revealed that approximately 17% of the participating students, both girls (17.4%) and boys (16.8%), exhibited suicidal behaviors in the year elapsing between the two questionnaires.

Before initiating the modeling work based on artificial intelligence, the researchers identified 70 potential predictive factors, collected in the inclusion questionnaire, having an influence on suicidal behaviors according to the scientific literature. These include sociodemographic data, certain physical and mental health parameters, personal and family history of suicidal behaviors, living conditions and lifestyle, substance use, and childhood trauma.

The machine learning method, which simultaneously analyses many factors associated with suicidal risk, then ranked these 70 potential predictors according to their importance in predicting student suicidal behaviors.

The results of the study show that out of these 70 potential predictors measured at inclusion, four detect around 80% of suicidal behaviors at follow-up. These are suicidal thoughts, anxiety, depressive symptoms and self-esteem.

To the researchers, these findings suggest that validated and commonly used psychological scales, such as the Rosenberg Self-Esteem Scale, Spielberger’s STAI-YB scale for anxiety, and the PHQ-9 for depression, would be sufficiently informative to identify students at risk for suicidal behavior.

“This research needs to be confirmed, but it opens up the possibility of large-scale screening by identifying students at risk of suicide using short, simple questionnaires, in order to refer them to appropriate care,” explains Tzourio, coordinator of the study.

Self-esteem: an important and previously unrecognized marker

In secondary analyses conducted on a subsample of 3,946 students who did not exhibit suicidal behaviors at cohort entry, the primary predictors that stood out in the statistical analysis were depressive symptoms, self-esteem, and academic stress in girls and predominantly self-esteem in boys. Self-esteem would therefore represent an independent and important predictive marker of suicidal risk.

“The mental health specialists on our teams did not expect self-esteem to be one of the four major predictors of suicidal behaviors,” says Melissa Macalli, a doctoral student in epidemiology and author of the study. “This finding, which would not have been obtained without the use of artificial intelligence techniques making it possible to cross-tabulate a large number of data simultaneously, opens up new avenues for both research and prevention,” she concludes.

The impact of the COVID-19 epidemic on students

The COVID-19 epidemic has had a significant impact on the mental health of students, a population already known for its high levels of stress, anxiety, depressive symptoms, and suicidal behaviors. The causes have been identified: social isolation linked to the closure of universities, the collapse of financial resources with the disappearance of student jobs, concerns about the course of studies and future prospects. The CONFINS study (, Kappa Santé and the i-Share team) launched in April 2020 to measure the impact of the epidemic on wellbeing and mental health, showed that 33% of students had depressive symptoms compared to 16% of non-students. With the number of vulnerable students increasing under the effects of the health crisis, detecting those in severe distress and at risk of suicide is essential to enable the earliest possible intervention.

[1]Machine learning is a form of artificial intelligence (AI) that allows a system to learn from data rather than through explicit programming.

Television During Meals Linked to Poorer Language Development in Young Children

repas devant la TV

Between 3 and 6 years of age, children spend an average of around 2 hours a day in front of screens. © iStock – skynesher


Between 3 and 6 years of age, children spend an average of around 2 hours a day in front of screens[1]. While many researchers have identified links between screen time and cognitive development in children, few have looked at the context in which screens are used. Inserm researchers at the Center of Research in Epidemiology and Statistics – Université de Paris (CRESS) have identified a link between the television being on all the time during family meals and poorer language development. Their findings have been published in Scientific Reports.

Language is a social practice and human interaction plays an important role in its acquisition. Language development in children is therefore greatly influenced by their immediate environment, namely the interactions they have with their parents, siblings, and other children. Over the last few decades, screens have become an essential part of this environment. Even preschoolers spend a considerable amount of time in front of them.

Thanks to the follow-up over several years of children from the French cohort EDEN[2], researchers from Inserm and Université de Paris have been able to measure the amount of screen time and more specifically the frequency of exposure during family meals, which are key moments of verbal interaction between adults and children. Language assessments were conducted alongside this to identify how the context of screen exposure may influence language development in children.


1,562 children followed up at 2, 3 and 5.5 years of age

In order to measure the times and contexts of screen use, questionnaires were completed by the parents of the 1,562 children in the cohort followed up at 2, 3, and 5.5 years of age. In the study, the parents noted how often the television was on during meals. For the children’s screen time, only the time spent in front of the television, computer, and playing video games was taken into consideration.

The children’s language development was assessed by questionnaires completed by the parents when the children were 2 years old[3], and then by psychologists when they reached 3 and 5.5 years of age. In order to consider the potential role played by other factors, several other variables were included in the statistical analysis, such as family socioeconomic characteristics (income, parental level of education, etc.) and child-related characteristics (sex, childcare arrangements, activities with parents, etc.).

Cross-tabulation of these data revealed that the more the television was on (whether watched or simply used as a sound or image backdrop) during family meals, the poorer the language outcomes. In contrast, the children’s language did not appear to be directly related to the amount of time spent in front of screens.

In an approach that analyzed these relationships at each age, the language level at age 2 was lower among children who were “always” exposed to television during family meals compared to children who were “never” exposed[4]. At ages 3 and 5.5, the language assessment and verbal IQ results were higher for children who were “never” exposed to television during family meals, compared to those who were “sometimes” or more frequently exposed.

In an approach looking at the temporality between screen exposure and language development, the verbal IQ tested at 5.5 years of age was found to be lower in children who were always exposed to television during family meals at 2 years of age compared to those who were never exposed (mean difference of 3 IQ points). These results therefore encourage us to take better account of the context of screen exposure, and not just the duration.

“Although children are exposed to language through cartoons and other programs viewed on screens, verbal interaction between adult and child is strongly associated with better child language development. Having the television on during meals can therefore act as a brake on children’s verbal interactions, reducing both the quality and quantity of exchanges between children and adults,” explains Jonathan Bernard, Inserm researcher and co-author of the study.

Having the television on during family meals can affect both the child, by distracting him or her, and the parents, by diverting the conversations with their children.

Auditory and visual stimuli can increase distractions for children and parents in their home environment and make it more difficult for a child to extract from the background soundscape the phonological distinctions and syntactic features of the language needed for quality learning.


[1] Figures from the INCA 3 survey (Anses), 2014-2015

[2] The Eden cohort was created from the recruitment of 2,002 pregnant women between 2003 and 2006 in the public maternity hospitals of Poitiers and Nancy. EDEN is the first generalist cohort study conducted in France on early pre- and post-natal determinants of child health and psychomotor development.

[3] At 2 years of age, the children’s language skills were assessed using the French Communicative Development Inventories (IFDC). At 3 years of age, the NEPSY and ELOLA verbal language assessment batteries were used. And at 5-6 years of age, an IQ test was used.

[4] Exposure to television during family meals was assessed repeatedly at all three ages with the following question: “How often is the television on in the dining room when the child is eating at home?” with four response items: never, sometimes, often, or always.

Inserm Publishes Its Collective Expert Review on the Reduction of Alcohol-Related Harm


Alcohol was the world’s 7th leading cause of healthy life years lost in 2016 and is the leading cause of hospitalization in France. © adobe stock


Alcohol consumption is both directly and indirectly implicated in the onset of some 60 diseases, making it a major health risk factor. In France, around 43 million people consume alcohol. Faced with its inherent health, social and financial impacts, the country’s Health Directorate and Interdepartmental Mission to Combat Drugs and Addictive Behavior asked Inserm to take stock of the harm related to alcohol and formulate research avenues and measures to tackle it. The group of experts gathered by Inserm for the collective expert review procedure has published a report concerning the reduction of alcohol-related harm. It discusses social prevention strategies and uses data taken from the scientific literature available in the first half of the year 2020.

The collective expert review coordinated by Inserm began by making a critical analysis of the latest scientific knowledge in the field and establishing findings. The expert group then made recommendations aimed at reducing the risks and harm to health associated with alcohol consumption. Around 3,600 documents were collected from a variety of disciplines, such as clinical research, social marketing and sociology.


Alcohol consumption, leading cause of hospitalization in France

In France, high levels of consumption affect both teenagers and adults. Alcohol consumption in adolescence becomes regular (10 or more times per month) for 8% of 17-year-olds, while 40-50% report binge-drinking (5 or more drinks on one occasion) at least once a month. Among adults, the average daily intake is 27 g of pure alcohol per person (around 3 glasses).

Alcohol was the 7th leading cause of healthy life years lost worldwide in 2016 and is also the leading cause of hospitalization in France. Alcohol accounts for 11% of deaths of men and 4% of those of women from the age of 15, namely 41,000 deaths (30,000 for men and 11,000 for women according to the latest figures from 2015), making them the highest of any European country.

The expert review emphasizes that the price of alcohol, its availability and the norms relating to its consumption are associated with positive perceptions, encouraging its use. It shows that, in addition to individual factors, the marketing of alcohol (product, price, advertising, access) influences the modes and levels of consumption and plays a key role in young people’s drinking behavior. Alcohol producers are particularly present on the Internet and social media, where there is very little regulation of advertising.

The recommendations made by the experts address the issues of the law governing the sale of alcohol and the regulation of that sale, as well as communication and interventions to be considered.

For the tightening of the Évin law on the regulation of advertising and the control of the sale of alcohol

In France, the 1991 Évin law provides a framework to combat alcohol (and tobacco) related harm, but the experts note that not only is its current version not always respected, it has also been considerably modified and weakened by the lobbying of alcohol producers.

The expert group particularly recommends reducing the attractiveness of alcohol and the positive messages disseminated, and limiting its access, namely by:

  • reinforcing the Évin law to prohibit advertising on the Internet, in public spaces, and to counter the effects of marketing by making health warnings more visible.
  • increasing prices (taxation according to the number of grams of alcohol along the lines of the soda tax, or minimum price as in Scotland) – wine, for example, is subject to very little tax.
  • better and automatic control of its access by minors.
  • reducing its availability (times during which it can be sold and number of stores or licenses).


For reinforced communication by the authorities and health education for the general public

The expert group recommends the use of prevention messages aimed at the general population that are clear, specific and easy to implement and that are designed to be disseminated by digital means. These messages must also be adapted when aimed at the most vulnerable groups.

According to the collective expert review, the following must be reiterated:

  • the recommended maximum intake for those wishing to drink[2],
  • the need for zero alcohol, especially during pregnancy and the period before conception,
  • that women are biologically more vulnerable to the damaging effects of alcohol.

The expert review highlights that a priority issue when it comes to prevention is reinforcing:

  • protection factors while people are still very young. Interventions to target the prevention of consumption and strengthen users’ knowledge and “competence” should be developed, particularly through the use of digital means.
  • generic protection factors such as parenting competence and psychosocial competence: such interventions are effective in schools, with parents or families, and in the workplace.
  • health warnings and encouraging campaigns to stop drinking, such as “Dry January”, whose benefits (and low cost) have been proven.

For interventions to improve and adapt diagnosis and care

The experts suggest that these preventive actions should be supplemented by a strategy of systematic screening for high-risk alcohol consumption in order to enable appropriate care. The report suggests that primary care professionals should be better trained in screening strategies and effective intervention methods.

As such, the expert group recommends:

  • “short interventions” by trained staff, consisting of minimal personalized counseling, aimed at people whose use puts them at risk or who are experiencing difficulties with their consumption. Such interventions are often beneficially associated with screening and have a clearly established positive cost-effectiveness ratio. They can be used on electronic media adapted for community interventions (schools, armed forces, etc.).
  • strengthening the quality of the long-term follow-up of alcohol-dependent patients to avoid relapse, promoting effective therapeutic strategies (psychotherapy, medication, cognitive remediation, social rehabilitation, and the management of comorbidities).

The collective expert review concludes by stating that the major health, social and financial consequences of alcohol consumption, even at low levels, represent a burden for French society without the resources assigned to combat them being equal to the challenge. It should be possible for the measures recommended in this expert review, which are intended for the general public and public authorities, to be integrated at the heart of a policy of risk and harm reduction based on reduced consumption.


[1] By establishing a link between genetic variations associated specifically with a given biological trait and by measuring their effects on the risk of disease, Mendelian randomization makes it possible to establish a causal relationship between biological traits and risk of disease.

[2] Santé Publique France (French Public Health Agency): no more than 2 drinks per day and not every day

Interchangeability of COVID 19 mRNA vaccines: start of inclusions for the AP-HP – ARNCombi trial

Vaccin contre la Covid-19

Covid-19 vaccine injection © AdobeStock

In order to facilitate the organization of the vaccination campaign, it may be proposed to use one or the other of the two mRNA vaccines for the 2nd dose (Pfizer-BioNTech or Moderna) of vaccination . The aim of the AP-HP – ARNCombi trial is to compare the immunological efficacy of the standard vaccine regimen with two doses of the same mRNA vaccine against Covid-19 with a regimen combining two different mRNA vaccines (one dose of Moderna vaccine after one dose of Pfizer vaccine or a dose of Pfizer vaccine after a dose of Moderna vaccine). It is promoted by Assistance Publique – Hôpitaux de Paris and made possible thanks to the COVIREIVAC platform coordinated by Inserm.

400 participants are expected for this randomized trial. Participants must be over 18 years of age, have already received one of two doses of messenger RNA vaccine with a second scheduled injection within 4-6 weeks of the first injection.

A blood sample to test for the presence of specific antibodies directed against the SARS Cov-2 virus (Covid-19 virus) will be taken before the 2nd dose and then four weeks later.

The first inclusions took place on May 28, 2021. The trial is being carried out in 17 centers in France: three AP-HP hospitals and 14 other centers throughout France. Some of these centers are part of the COVIREIVAC platform.

Launched in October 2020, the COVIREIVAC platform coordinated by Inserm and F CRIN in conjunction with 32 university hospitals and a network of 11 immunology laboratories aims to conduct and promote excellent clinical vaccine research in France. Since October 1, 2020, 50,000 volunteers have registered to participate in research efforts and improve knowledge about these new vaccines. This is an unprecedented initiative in our country. The platform is managed by Inserm, and the clinical operational component is coordinated by the Assistance Publique-Hôpitaux de Paris of the various CHUs. New research projects are regularly launched within the framework of COVIREIVAC.

Even if several vaccines against Covid-19 are available, it is imperative to continue research in order to deepen scientific knowledge, in particular the duration of protection and the quality of the immune response.

The objective of the clinical studies coordinated by COVIREIVAC is to provide answers to these research questions.