Highlights Impulsivity mediates the effect of childhood adversity on addictive behaviors. Mediation part of impulsivity is higher with exposure to intra-familial violence. Great mediation part of impulsivity (37.5%) for cyberaddiction. Screening addictive behaviors among impulsive youth is needed.

Background and Aim The COVID‐19 is a stigmatizing infectious disease even after healing. Until now, no COVID‐19 stigma scale validated in Tunisian Arabic language among the general population is available. Developing such tools is necessary to detect COVID‐19 stigma and reduce it effectively. Indeed, stigmatization of COVID‐19 patients could increase the spread of this disease and its related mental health issues. We aimed at testing the validity of a translated and modified version of the 12‐item HIV stigma scale among Tunisian COVID‐19 patients. Methods A cross‐sectional study was conducted between November and December 2020 among a representative sample of COVID‐19 patients in the governorate of Sousse, Tunisia, after quarantine. The 12‐item HIV stigma scale was translated in Tunisian Arabic and then modified to be adapted to the Tunisian context. The preliminary modified version was administrated to the participants by pretrained medical doctors during phone calls. It consisted on 20 items covering the four stigma dimensions (personalized stigma, disclosure concerns, concerns with public attitudes, and negative self‐image). The psychometric evaluation of this version included internal consistency as well as principal component analysis (PCA). Results The responses of 346 COVID‐19 patients were obtained. Their median age was 40 years (interquartile range: 30‐54.5). Females represented 60.4% of them. The PCA resulted in a three factor solution with 14 items. This 14‐item scale demonstrated good internal consistency with a global Cronbach's α of 0.91 and values of 0.94, 0.93, and 0.98 for social stigma, negative self‐image, and disclosure concerns, respectively. Conclusion This study provides a reliable and valid instrument for stigma measuring among Tunisian COVID‐19 patients. The use of this scale would contribute in reducing the spread of this new infectious disease and its related mental health issues.

BackgroundAccumulating research suggests that exposure to intra-familial adversities are significant risk factors for adverse pregnancy outcomes. However, the relationship between social violence (peer violence, witnessing community violence and exposure to collective violence) and pregnancy outcomes has not been extensively investigated. Our study aims to examine the association between social Adverse Childhood Experiences (ACEs) and pregnancy outcomes and to explore the role of depression during pregnancy as a mediator of this association.MethodsWe performed a prospective follow-up study of pregnant women in five Primary Health care Centers (PHC) in the region of Monastir (Tunisia) from September 2015 to August 2016. Enrolled women were followed during the second trimester, third trimester of pregnancy and during the postnatal period. Exposure to violence was assessed retrospectively using the validated Arabic version of the World Health Organization (WHO) ACE questionnaire. The Self Reporting Questionnaire 20-Item (SRQ-20) was used as a screening tool for depression during pregnancy.ResultsWe recruited and followed a total of 593 women during the study period. Witnessing community violence was the most frequently reported social ACE among pregnant women (237; 40%), followed by peer violence (233; 39.3%). After adjustment for high risk pregnancies, environmental tobacco smoke, and intra-familial ACEs, the risk of premature birth was significantly associated with exposure to collective violence (P < 0.001) and witnessing community violence (P < 0.05). The risk of low birth weight was significantly associated with witnessing community violence (P < 0.001). In the mediation analysis, depression mediated significant proportions of the relationship between the cumulative number of ACEs and pregnancy outcomes.ConclusionsSocial ACEs may have a long-term effect on maternal reproductive health, as manifested by offspring that were of reduced birth weight and shorter gestational age. A public health framework based on the collaboration between pediatric, psychiatric obstetrical health professionals, education professionals and policy makers could be applied to ensure primary prevention of childhood adversities and pay attention to expected mothers with history of exposure to such adversities.

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Background Public health emergencies such as the Covid-19 pandemic can affect the health, safety and well-being of individuals and communities. This pandemic may lead to emotional reactions such as stress, anxiety and depression in the general population. Aim To evaluate the perceived stress among Tunisian adults during the period of lockdown. Methods A cross-sectional study was conducted during the lockdown period targeting adults using online social networks. The data was collected through a “Google Form” questionnaire published on Face book. Perceived stress was measured using the ‘Perceived Stress scale'. Results A total of 164 adults participated in our study with a majority of women (77.4%) and a mean age of 34.57 ± 12.1 years. Almost half of our participants (48.1%) were from the Governorate of Sousse. Among the respondents, 58.5% felt in perpetual threat and only 15.4% knew how to manage their stress. Univariate analyses showed that perpetual threat was significantly associated with age (p = 0.015), being single (p = 0.03) jobless (p = 0.02), and spending more than one hour documenting on COVID-19 (p = 0.02). After adjusting to sex and age; the multivariate analysis showed a statistically significant association between stress level and anxiety p &lt; 10-3; OR: 8.62; IC [3.1-23.8]); fear of catching the virus (p = 0.031; OR: 3.10; IC [1.1-6.7]) and insomnia (p = 0.001; OR: 7.46; IC [2.4-24.7]). Conclusions Our results showed that there is a high prevalence of stress in the general population during confinement. A national program of population mental health management should be implemented along with the pandemic management. Key messages The COVID 19 may lead to emotional reactions such as stress, anxiety and depression in the general population. A national program of population mental health management should be implemented along with the pandemic management.

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Introduction The COVID-19 pandemic is causing considerable lifestyle changes through barriers measures, lockdown and social distancing. These changes include: Preoccupation with Covid-19 pandemic news, sleep disturbances and eating habits changes. Aim To assess the lifestyle changes after exposure to a risk of coronavirus contamination. Methods We conducted a cross sectional study during November and December 2020 among adults tested for COVID-19 in Mahdia (Tunisia).To assess the life habits changes (sleep, physical exercises and diet), the compliance with barrier measures and preoccupation with COVID-19 pandemic news, a reliable tool was developed and pretested by experts at the department of Preventive and Community Medicine Results A total of 277 participants were enrolled, the average age was 34.32 years ± 13.7. Among them 60.8% were women (sex-ratio = 0.51).Almost two thirds 62.2% were tested positive for Covid-19. Doctors presented 29.2% of the respondents. Among the study sample, 38.6% lived with elderly people. Approximately three quarters 77.8% reported an improvement in compliance with barrier measures. The majority 92.1% respected more the social distancing. As for hand washing and for mask wearing, 87.7% said to wash their hands more, and 95.3% were more concerned about wearing masks. A life habits change was observed among 16.7% of the respondents. Almost half of the participants 45.5% increased their physical activity, while 76.2% tried to get a healthy diet. Sleep disorders were registered among 48.7% of respondents. Preoccupation with the COVID news was observed in approximately half of the participants (57.8%). Conclusions The COVID19 pandemic affected different aspects of our lives. Research related to lifestyle, social and behavioral studies are as important as those related to medical and biological science. Key messages A life habits change was observed among 16.7% of the respondent, sleep disorder were registered among 48.7%, and 77.8% reported and improvement in applying barrier measures. Research related to lifestyle, social and behavioral studies are as important as those related to medical and biological science.

Background Health Care workers (HCWs) are constantly on the front line during the current pandemic, facing a permanent influx of patients with a significant risk of viral contamination. Our study aimed at estimating the corona virus disease high risk perception and evaluating determinant factors of the perceived vulnerability to Covid-19 among HCWs in the region of Mahdia (Tunisia). Methods We conducted a cross sectional study among HCWs in the University Hospital Tahar Sfar Mahdia in Tunisia in December 2020. The perceived vulnerability to disease was assessed using the validated perceived vulnerability to disease scale (PVDS). Results A total of 173 professionals were recruited with a mean age of 35.35 ± 9.4 years. Among them, 66% were women. One third of participants (33.3%) were doctors. The majority of them (86%) have experienced a high level of risk perception. The older HCWs (p = 0.04), the nursing personnel (p = 0.02), as well as, those with pre-existing chronic diseases (p = 0.04) perceived greater vulnerability to Covid-19. It was also significantly associated (p = 0.01) with undressing faults. Being older (standardized β = 0.193, CI = 0.601-7.707, p = 0.003), having pre-existing chronic diseases (β = 0.184, CI = 0.478-8.888, p = 0.05), high risk perception (β = 0.162, CI= -0.087-10.47, p = 0.02) and undressing faults (β = 0.224, CI = 0.582-1.306, p = 0.008), were found to be the determinant factors of the perceived vulnerability to disease PVD in a multivariate linear logistic regression model (adjusted R2=0.129). Conclusions Perceived vulnerability to Covid-19 is mainly manifested by an atmosphere of fear of getting infected, but also by compliance with barrier measures. This fact is aligned with health authorities's strategies to ensure a society totally free of Covid-19. Key messages During the current Covid-19 pandemic the majority of health care workers worldwide have experienced a high level of risk perception which negatively impacts their mental health. Health care workers must be provided with the personal protective equipment PPE essential to protect themselves against the Covid-19 transmission.