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Background: In March 2020, as the coronavirus disease 2019 (COVID- 19) pandemic was spreading across the globe, many countries have implemented unprecedented lockdown measures. But how populations did react to these measures? We examined the case of France. Our aims were threefold: assessing some aspects of their impact on French's daily living conditions; investigating their attitudes toward the lockdown; investigating the factors associated with these attitudes.Methods: A cross-sectional online survey was carried out 10 days after the nationwide lockdown (from March 27th to March 29th 2020), among a representative sample of the mainland French population aged 18 and over. A quota sampling method was applied to achieve a sample of 1012 respondents. We used a cluster analysis to obtain contrasted attitudinal profiles, and logistic regressions to investigated which factors were associated to these profiles.Results: After 10 days of lockdown, there were already significant consequences regarding respondents' living conditions and mental health. Most respondents supported the current lockdown. However, it appeared as a stopgap measure due to a lack of alternatives, and a large majority acknowledged its heavy drawbacks. We found three contrasted attitudinal profiles: full support (38%), strong but critical support (31%), limited support (31%). Regarding respondents' SES, low-income and low-education respondents were more likely to display critical or limited support to the lockdown, as well as those who reported deteriorated living conditions or psychological distress.Conclusions: In France, the large public support to the lockdown was fragile. First, it was a critical consensus anchored in current controversies and recent social struggles. Second, it was weaker among people with a lows SES, especially since the lockdown have exacerbated preexisting social inequalities. [ABSTRACT FROM AUTHOR]

During the last decade, public health research has emphasised the growing public disaffection with vaccination. This contemporary vaccine hesitation (VH) refers to a delay in acceptance or refusal of vaccines, as well as agreement despite doubt and reluctance. We investigated VH among French parents of young children, with an emphasis on two key features of VH: trust towards physicians and commitment to vaccination issues. We targeted two populations with contrasting socioeconomic profiles, using in‐depth interviews (n = 25). Most parents exhibited some kind of VH, with differentiated attitudes across vaccines, including acceptance despite enduring doubts, especially for vaccines already provided to older siblings ('vaccine inertia'). Despite the rise of the Internet and social media, our participants still strongly relied on face‐to‐face interactions with peers and significant others. Most participants trusted their own physician but this was the result of a selection process: they had engaged resources to find a physician they could trust. Participants with contrasted socioeconomic profiles struggled with the same dilemmas, and they committed themselves to the same quest to find the 'right' physician. Nevertheless, parents with a higher socioeconomic status were able to engage more resources and use a wider repertoire of actions, and they also displayed greater health literacy. [ABSTRACT FROM AUTHOR]

Because the effectiveness of a coronavirus disease lockdown in curbing coronavirus disease spread depends on public support, acquiring real-time information about the way populations reacted to the lockdown is crucial. In France, such public support remained fragile among low-income persons, probably because the lockdown exacerbated preexisting social inequalities and conflicts. [ABSTRACT FROM AUTHOR]

Abstract: Background: In many countries, the decline in smoking prevalence has coincided with a growing concentration of smoking among people with lower socioeconomic status (SES). This concentration may reflect the social differentiation of risk perceptions. We investigated the factors associated with risk perception and fear of cancer, paying particular attention to SES indicators and health information seeking. Methodology: A cross-sectional telephone survey conducted in France in 2010 (including 826 current smokers aged 18–75) assessing how smokers perceive the risk of smoking-related cancer in terms of daily consumption and duration thresholds. Results: Among current smokers, 38% considered that smoking can cause cancer only for a daily consumption higher than their own consumption, and an additional 22% stated that tobacco-related cancer risk only becomes high for a longer smoking duration than their personal one. Predictors of such risk perceptions included low SES, material deprivation and mentioning either the internet or their relatives as one's main source of information on cancer. The same characteristics were also predictive of personal fear of tobacco-related cancer. Conclusion: Our results illustrate the challenges faced by prevention campaigns in the internet society, as information found on the web may fuel smokers' risk denial. Anti-tobacco policies should tailor interventions to people with low SES, who may be especially impervious to standard prevention campaigns because of material deprivation, and they should also address and challenge smokers' risk denial beliefs. [Copyright &y& Elsevier]

Abstract: In 2009–2010, the H1N1 episode occurred in a general context of decreasing public confidence in vaccination. We assumed opposition to vaccination in general to be an ‘unfounded fear’, reflecting ignorance and perceived vulnerability among low-socioeconomic status (SES) people, and opposition to the H1N1 vaccine a ‘legitimate concern’ reflecting the elite's commitment to ‘risk culture’ in a ‘risk society’. We indirectly tested these assumptions by investigating the socioeconomic profiles associated with opposition to vaccination in general and opposition to the H1N1 vaccine specifically. Our second aim was to determine whether or not opposition to the H1N1 vaccine fuelled opposition to vaccination in general. We used data from a telephone survey conducted in 2009–2010 among a random sample of French people aged 15–79 (N = 9480). Attitudes toward vaccination in general and toward the H1N1 vaccine specifically varied significantly between October 2009 and June 2010 with strong correlation being observed between these attitudes throughout the whole period. In multivariable analysis attitudes toward vaccination in general remained a significant predictor of attitudes to the H1N1 vaccine and vice versa, for distinct profiles as follows: males, older people, low-SES people for opposition to vaccination in general, versus females, people aged 35–49 and those with an intermediate SES for opposition to the H1N1 vaccine. Results also differed regarding indicators of social vulnerability, proximity to preventive medicine and vaccination history. The first profile supported the “unfounded fears expressed by low-SES people” hypothesis, while the second echoed previous work related to middle-classes’ “healthism”. Opposition to vaccination should not be reduced to irrational reactions reflecting ignorance or misinformation and further research is needed to acquire a greater understanding of the motives of opponents. [Copyright &y& Elsevier]

Abstract: Background: There is growing evidence that cigarette smoking has become a stigmatized behaviour, at least in western countries, and there is ongoing debate among experts about whether or not such stigma should be an instrument of anti-tobacco policy. Methods: We investigated French non-smokers attitudes toward cigarette smokers, using data from a telephone survey carried out in 2010 among a representative random sample of non-smokers aged 15–75 (N =3091). We carried out a cluster analysis to build contrasted attitudinal profiles and we also computed a score of stigmatization. Results: We found evidence for the existence of stigma associated with cigarette smoking in France: a majority of French non-smokers would not date a smoker, nor hire one to take care of their children. The cluster analysis identified four contrasting profiles, corresponding to different levels of stigmatization, including one cluster whose respondents demonstrated strong levels of moral condemnation and social rejection of smokers. Older people, those with a lower educational level and those reporting financial difficulties were more prone to stigmatize smokers, while those who reported that somebody smoked in their home were less likely to do so. Those who had never smoked and those who abstained from alcohol were more prone to stigmatize smokers. Obese people were also more likely to do so (in bivariate analysis only). Conclusion: The process of tobacco stigmatization seems well-advanced in France, despite a cultural context that may be less permeable to this process. Further research is needed as our results raise some questions regarding its efficiency as a policy tool. First, people who are familiar with smokers are less prone to stigmatize them. More generally, simultaneously stigmatizing several categories of people may provide each of these same categories with stereotyped ‘others’ onto whom they can deflect their stigma. [Copyright &y& Elsevier]

Thanks to data from the French Environmental Barometer EDF-R&D 2004 (national representative sample of French aged over 15), this paper investigated lay risk perceptions related to exposure to electromagnetic fields (from an electric power-line, a TV, a cellular phone or micro-wave oven). Answers to an opened-ended question suggested that many people worry about such exposure: it may interfere with natural electricity circulating in the human body, disturb the nervous system and cause cancer. These answers revealed a conception of human body, health and disease, and participants referred to various kinds of arguments, from expert knowledge to personal intuition. Statistical analyses showed that risk perceptions related to these four devices were strongly correlated with each other and shared common predictors. These results suggest that these risk perceptions are built within the same perceptive frame. One should not consider them as "false beliefs": they are based on consistent conceptions of the body, health and disease, they are fuelled by the contemporary levelling of knowledge, and they reflect the difficulties experienced by many people living in a changing world. [ABSTRACT FROM AUTHOR]

Aims This paper aimed to assess whether the increase of social differentiation of smoking is observed in France. Design and setting Five cross-sectional telephone surveys conducted in France between 2000 and 2007. Participants The surveys were conducted among national representative samples of French subjects aged 18–75 years ( n = 12 256, n = 2906, n = 27 499, n = 2887, n = 6007 in 2000, 2003, 2005, 2006 and 2007, respectively). We focused on three groups: executives, manual workers and the unemployed. Measurements Time trends of smoking prevalence were assessed, and socio-economic factors (especially occupation and job status) associated with smoking were identified and compared in 2000 and 2005. We also computed respondents' equivalized household consumption (EHI) and their cigarette budget to assess the financial burden of smoking. Findings Between 2000 and 2007, smoking prevalence decreased by 22% among executive managers and professionals and by 11% among manual workers, and did not decrease among the unemployed. Indicators of an underprivileged social situation were associated more markedly with smoking in 2005 than in 2000. In addition, the falling-off of smoking initiation occurred later and was less marked among manual workers than it was among executive managers and professionals. Finally, in 2005 15% of French smokers devoted at least 20% of their EHI to the purchase of cigarettes, versus only 5% in 2000, and smoking weighted increasingly heavily on the poorest smokers' budgets. Conclusions While these results point out an increased social differentiation in tobacco use, they underline the need to design and implement other forms of action to encourage people to quit, in particular targeting individuals belonging to underprivileged groups. [ABSTRACT FROM AUTHOR]

Abstract: Background: The relationship between smoking and poverty is a public health issue in many countries, and several studies have shown a link between living in deprived neighbourhoods and smoking. In France the prevalence of smoking has decreased since the year 2000s. We examined whether reduced smoking rates differed by socio-economic status, anticipating reductions to be smaller amongst lower socio-economic groups. We also investigated whether poor housing conditions and/or living in a deprived neighbourhood were significantly associated with smoking. Methods: Data were collected by telephone surveys conducted between 2000 and 2007 with representative samples of the French population aged 18–75. The data from the last of these surveys (2007, N =6007) were also used to carry out a cluster analysis on various indicators relating to housing conditions and neighbourhood. Results: Between 2000 and 2007 the social differential in smoking rates increased sharply in France. Specific types of neighbourhood and poor housing conditions (described as cramped housing in a noisy and stressful environment or deprived neighbourhood), which were closely correlated with socio-economic status, were found to be significantly correlated with smoking, even after adjusting for potential key confounders and especially for individual markers of social disadvantage. Conclusion: Interventions which do not specifically target smoking but which contribute to improving poor smokers’ living conditions, are necessary to promote smoking cessation. [Copyright &y& Elsevier]

This paper aims to illustrate the relevance of Howard S. Becker's sociological model of deviance for a better understanding of contemporary adult smoking. From this perspective, one crucial aspect of smoking is smokers' ability to develop and entertain convincing rationalizations that help them to deny smoking hazards and challenge anti-tobacco messages. Several hypotheses are derived from this model and most of them are successfully tested with quantitative data from a cross-sectional survey conducted in the Paris Ile-de-France Region. As expected, most smokers agreed that smoking damages health and considered being well-informed about smoking hazards, even those who denied these hazards for themselves. Moreover, smokers' rationalizations were closely correlated to cigarette consumption and duration since smoking initiation. Paradoxically, risk denial was also stronger among smokers who have some characteristics usually considered as protective factors against smoking (especially future-orientation and importance attached to one's health). More generally, our sociological perspective leads to consider smokers' risk denial as the result of acquired cognitive skills instead of the consequences of lack of information or psychological bias. We believe it provides a promising avenue for further research. [ABSTRACT FROM AUTHOR]

This study examines attitudes to smoking among adolescents. Data for the study is derived from a large quantitative French cross-sectional survey of school students. Attitudes toward smoking were found to be associated with regularity and quantity of consumption, and the type of school attended. These associations are explained according to Becker's concept of a 'moral career', for attitudes differ among occasional, regular and heavy smokers. The association with school type indicates advanced formal schooling enables students to offer sophisticated rationalisations for smoking, combining an acknowledgement of health-related risks of smoking, emphasis on personal benefits derived from smoking, and claims that smoking is a private matter. [ABSTRACT FROM AUTHOR]

Abstract: In most developed countries, a significant part of the population is still smoking despite comprehensive tobacco control policies. Among other reasons, many smokers may endorse self-exempting beliefs that help them to deny the smoking hazards for themselves. We investigated the relationship between smokers'' risk denial and their readiness to quit making use of a French cross-sectional survey conducted in the Paris Ile-de-France Region (N =939 smokers). Self-exempting beliefs were quite widespread among participants and two of them were significant predictors of a low readiness to quit: considering that one''s cigarette consumption is too low to be harmful and believing that one''s way of smoking can protect from smoking-related diseases. Future tobacco control messages and interventions should specifically address these self-exempting beliefs that reduce smokers'' cognitive dissonance and then inhibit their willingness to quit. [Copyright &y& Elsevier]

Using the data from the French Environment Barometer EDF-R&D 2004 (national representative sample of French citizens aged over 15) and surveys by ADEME between 2000 and 2005, the paper investigates lay perceptions of the causes and consequences of the greenhouse effect, which may be considered as archetypal of contemporary environmental risks. Beyond lay lack of knowledge, the greenhouse effect gives rise to coherent and meaningful cognitions, including causal explanations, shaped by the pre-existing cognitive framework. This cognitive work, based on analogic rather than scientific thought, strings together the greenhouse effect, ozone depletion, air pollution and even nuclear power. The cognitive process is also fed by the individuals' general conceptions of Nature and of the rights and duties of humankind towards Nature. People are not greatly worried about the unseen and controversial consequences of the greenhouse effect: such worry could be one of those "elite fears" mentioned by Beck. Finally, while the efficiency of public policies to counter the greenhouse effect requires extensive societal involvement, low confidence towards both political and scientific authorities may prevent the population from becoming aware of the environmental stakes tied to the greenhouse effect. [ABSTRACT FROM AUTHOR]

This study investigated attitudes toward buprenorphine maintenance treatment (BMT) among general practitioners (GPs) and their maintained patients' propensity to turn to several prescribers (doctor shopping), among a sample of 345 GPs prescribing BMT in South-East-em France. Survey data were anonymously matched to administrative data that provided information about GPs' patients. A simultaneous equation model suggests that GPs' attitude influenced doctor shopping, not the reverse. Doctor shopping was lower among GPs who reported inducting BMT with 8 mg of buprenorphine per day or more, and was higher for GPs endorsing a stringent attitude toward patients. Thus doctor shopping should not be understood exclusively as a deviant behaviour. It is partially physician-driven, and further research is needed to assess whether it reflects patients' dissatisfaction toward inappropriate care supply and the difficulty to establish a good therapeutic relationship between an opiate-dependent patient and a general practitioner. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Despite a large public health interest in substance use among athletes, only a few works have addressed illicit drug use in relation with sport practice. We have studied cannabis use to enhance both sportive and non-sportive performance among French sport university students. Methods: An anonymous self-reported questionnaire was administered to a sample of students from six Sport Science Universities from Southern France. Information on sport practice and cannabis use (frequency, quantity, motives) was collected. Results: Males were more prone to have already used cannabis to enhance non-sportive performance as well as sportive performance. The simultaneous equation model indicated that both kinds of enhancing-substance use were endogenous: cannabis use to enhance sportive performance leads to cannabis use to enhance non-sportive performance and reciprocally. Moreover, the relaxing properties of cannabis may be frequently used to enhance performance. Cannabis use to enhance sportive performance was positively related to the competitive level and to sliding sports. Conclusions: The present study helps to improve understanding on an empirical paradox about the relationship between doping agents use and so-called ‘recreational’ drug use among athletes. Indeed, people who use doping agents may also use ‘recreational’ drugs for a ‘non-recreational’ purpose. [Copyright &y& Elsevier]

In France as in other developed countries, cigarette smoking has been acknowledged as the most preventable cause of death and disability. Tobacco control has become a priority for the French government, which decided a 20% rise of the cigarette price at the end of 2003 and plans further rise in 2004. This study adopted a life-course perspective with retrospective data extracted from a national telephone survey for assessing the impact of pricing policy and some other predictors on smoking behaviours in France during the period 1965–1999. Our findings suggest that during a period marked by cultural trends favouring more frequent and earlier initiation of cigarette smoking, pricing policy has been a poor deterrent to youth smoking. Such findings highlight the necessity to implement simultaneously other preventive strategies, including restrictions on tobacco advertising, youth access and smoking in public places, as well as mass media campaigns and school-based educational interventions. [Copyright &y& Elsevier]

In France, since 1996, any general practitioner (GP) can prescribe high-dosage buprenorphine maintenance treatment (BMT) for opioid-dependent patients. The health authorities initially provided mandatory specific training, but since 1998, such training is only delivered by specialized networks and the pharmaceutical industry. Among a random sample of GPs from southeastern France (N=345), we found that many untrained GPs, as well as a significant minority of trained GPs, were likely to prescribe an ineffective dosage of buprenorphine or a potentially dangerous treatment (BMT+a short half-life benzodiazepine). These results highlight the necessity to edit clear guidelines, especially concerning situations of polyaddiction and psychiatric comorbidity, and to extend and improve BMT training in France with a renewed involvement of health authorities for quality control of such training. They even suggest that GPs'' participation to specialized training sessions should become a mandatory prerequisite for prescribing BMT. [Copyright &y& Elsevier]

Worldwide, around 18 million people receive a cancer diagnosis each year, most of whom survive long enough to face additional cancer-related costs. In France, most costs directly related to cancer are covered by the National Health Insurance Fund, and cancer patients can receive treatments without paying advance fees. In this context, the costs faced by cancer survivors are mostly social costs. Drawing on fundamental cause theory, this study aimed to explore the socially-differentiated evolution of cancer survivor’s income five years after diagnosis. Our study draws on the findings of VICAN5, a French national survey that was conducted in 2015/2016 in a representative sample of 4,174 cancer survivors to obtain information on living conditions five years after diagnosis, and that was restricted to 12 tumour sites accounting for 88% of global cancer incidence in France. We used the multiple imputation method and the Heckman selection model to identify the factors associated with a decrease in household income per consumption unit (HICU), while accounting for missing data. Among survivors still working five years after diagnosis, 17.6% reported lower income at survey than at diagnosis. After adjustment for socio-demographic and medical characteristics, the decrease in HICU was more frequent in women, singles, low educated survivors, and survivors with reduced working time. Finally, subjective measures of income variation and economic well-being were a useful complement to objective measures since 31.6% of cancer survivors still working five years after diagnosis reported a perceived decrease in household income. In conclusion, inequalities in economic well-being persist long after diagnosis in France, and this despite the fact that most cancer-related costs are covered by the French National Health Insurance Fund. Consequently, more attention should be paid to cancer patients with low socio-economic status to help reduce inequalities in post-diagnosis living conditions. [ABSTRACT FROM AUTHOR]

As Covid-19 spreads across the world, governments turn a hopeful eye towards research and development of a vaccine against this new disease. But it is one thing to make a vaccine available, and it is quite another to convince the public to take the shot, as the precedent of the 2009 H1N1 influenza illustrated. In this paper, we present the results of four online surveys conducted in April 2020 in representative samples of the French population 18 years of age and over (N = 5018). These surveys were conducted during a period when the French population was on lockdown and the daily number of deaths attributed to the virus reached its peak. We found that if a vaccine against the new coronavirus became available, almost a quarter of respondents would not use it. We also found that attitudes to this vaccine were correlated significantly with political partisanship and engagement with the political system. Attitudes towards this future vaccine did not follow the traditional mapping of political attitudes along a Left-Right axis. The rift seems to be between people who feel close to governing parties (Centre, Left and Right) on the one hand, and, on the other, people who feel close to Far-Left and Far-Right parties as well as people who do not feel close to any party. We draw on the French sociological literature on ordinary attitudes to politics to discuss our results as well as the cultural pathways via which political beliefs can affect perceptions of vaccines during the COVID-19 pandemic. • Almost a quarter of the French population would not get vaccinated against COVID-19. • Attitudes are correlated with political partisanship and engagement with politics. • Attitudes do not follow the traditional separation between Left-wing and Right-wing. • Refusal is associated with proximity radical parties and to abstention. [ABSTRACT FROM AUTHOR]

Purpose: Vaccine hesitancy is common in France, including among general practitioners (GPs). We aimed to understand vaccine hesitant GPs' views towards vaccines. Method: We conducted in-depth interviews that were thematically analysed. Result: We found that, facilitated by health scandals and vaccine controversies—that according to participants were not effectively handled by health authorities—the implicit contract existing between health authorities and GPs has been ruptured. This contract implies that health authorities support GPs in making vaccine recommendations by addressing GPs' own concerns, providing them with adequate and up-to-date information and advice, and involving them in vaccine decision-making. In turn, GPs encourage vaccination to reach vaccine coverage targets. Conclusion: The rupture of this implicit contract has led to a breach in trust in the health authorities and the vaccines that they recommend. [ABSTRACT FROM AUTHOR]

Purpose: To address the gap highlighted in the literature on the effect of professional interventions to facilitate continued employment, this study aims to evaluate the effect of workplace accommodations on the continued employment 5 years after a cancer diagnosis. Methods: This study is based on VICAN5, a French survey conducted in 2015–2016 to examine the living conditions of cancer survivors 5 years after diagnosis. Two subsamples, one with and one without workplace accommodations, were matched using a propensity score to control for the individual, professional, and medical characteristics potentially associated with receipt of workplace accommodations. Results: The study sample was composed of 1514 cancer survivors aged 18–54 and employed as salaried at diagnosis. Among them, 61.2% received workplace accommodations within 5 years after diagnosis: 35.5% received a modified workstation, 41.5% received a modified schedule, and 49.2% received reduced hours. After matching, receipt of workplace accommodations appeared to improve the continued employment rate 5 years after cancer diagnosis from 77.8% to 95.0%. Conclusions: Receipt of workplace accommodations strongly increases the continued employment of cancer survivors 5 years after diagnosis. More research is needed to better understand the differences in receipt of workplace accommodations along with the related selection effect. [ABSTRACT FROM AUTHOR]

How much does endorsement of complementary and alternative medicine (CAM) correlate with negative attitudes towards vaccines? One of the difficulties of analysing the relationship between attitudes to CAM and attitudes towards vaccines rests in the complexity of both. Which form of CAM endorsement is associated with what type of reticence towards vaccines? While the literature on the relationship between CAM and attitudes towards vaccines is growing, this question has not yet been explored. In this study we present the results of a survey conducted in July 2021 among a representative sample of the French mainland adult population (n = 3087). Using cluster analysis, we identified five profiles of CAM attitudes and found that even among the most pro-CAM group, very few respondents disagreed with the idea that CAM should only be used as a complement to conventional medicine. We then compared these CAM attitudes to vaccine attitudes. Attitudes to CAM had a distinct impact as well as a combined effect on attitudes to different vaccines and vaccines in general. However, we also found a) that attitudes to CAM provide a very limited explanation of vaccine hesitancy and b) that, among the hesitant, pro-CAM attitudes are often combined with other traits associated with vaccine hesitancy such as distrust of health agencies, radical political preferences and low income. Indeed, we found that both CAM endorsement and vaccine hesitancy are more prevalent among the socially disadvantaged. Drawing on these results, we argue that, to better understand the relationship between CAM and vaccine hesitancy, it is necessary to look at how both can reflect lack of access and recourse to mainstream medicine and distrust of public institutions. • We explore endorsement of CAM and Vaccine Hesitancy in their multifaceted nature. • VH is more prevalent among the socially disadvantaged and so is CAM endorsement. • Radical forms of endorsement of CAM are associated with distrust of vaccines. • But endorsement of CAM must be combined with other factors to result in strong VH. • CAM endorsement is a very limited explanation of negative attitudes to vaccines. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) vaccination coverage in France has fallen substantially since 2010 and the onset of a media controversy on the subject of its safety and efficacy. In this article we examine how and why mothers agree or do not agree to HPV vaccination for their daughters. We draw on data from a survey of French mothers of girls within the HPV vaccination target population (11–14 years old). We used semi-structured interviews to examine their perceptions of this relatively new vaccine and how such perceptions were shaped by their past experiences of vaccines and health in general. We also talked to them about their sources of information, their level of trust in these sources, and how their perception of risk changed as they accessed different and often contradictory information. We found that mothers’ fears of side effects and of ‘new’ vaccines was one of the main reason why they either refused to get their daughters vaccinated or hesitated. Mothers told us that they consulted several different sources, tended to trust their doctors most, but still questioned their recommendations. Although they presented the media and the Internet as untrustworthy, the information from those sources, whether gathered proactively or in passing, significantly influenced their decisions by introducing doubt or by prompting more information-seeking. In this article we show the dynamic nature of this decision-making process and we found that a substantial number of the mothers in our study said that they had been advised by at least one of their doctors not to have their daughter vaccinated. [ABSTRACT FROM AUTHOR]

Aims The diffusion of cannabis initiation has been accompanied by a reversal in the educational gradient: contrary to older generations, the less educated in recent generations are more likely to initiate than the more educated. We tested whether the educational gradient for the transition from initiation to daily use evolved in the same way. Design/setting A French telephone random survey conducted in 2010 (21 818 respondents aged 15-64 years), asking interviewees about their ages at initiation to daily use, if any. Participants A total of 6824 cannabis initiators aged 18-64 years at data collection. Three birth cohort groups (generations) were compared: 1946-60 ( n = 767), 1961-75 ( n = 2632) and 1976-92 ( n = 3425) with, respectively, 47, 42 and 45% of women. Measures Risks of transition to daily use from ages 11-34 were compared through time-discrete logistic regressions and educational gradients were quantified through a relative index of inequality (RII). Control variables include age and time-varying variables (ages at tobacco daily use, at first drunkenness and at first other use of an illicit drug in a list of 13 products). Findings Twenty-four per cent of the initiators reported daily use before age 35, the proportions tripling from the oldest to the youngest generation (from 11.7 to 38.6% in men, from 7.7 to 22.2% in women). Whatever the generation, the less educated initiators more often shifted to daily use than the most educated: from the oldest to the youngest generation, RII = 2.13, 95% confidence interval (CI) = [0.65, 7.02]; 2.19 95% CI = [1.33, 3.63]; and 2.24, 95% CI = [1.60, 3.15] in men; RII = 3.31, 95% CI = [0.75, 14.68]; 3.17, 95% CI = [1.49, 6.76]; and 3.56, 95% CI = [2.07, 6.14] in women, respectively. Conclusion In France, the risk of transition from cannabis initiation to daily use has remained consistently higher among less educated cannabis initiators over three generations (1946-60, 1961-75, 1976-92), in contrast to what is observed for initiation. [ABSTRACT FROM AUTHOR]