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Context: In 2021, French health authorities strongly promoted vaccination against COVID-19. The authors assumed that refusing this vaccine became a stigma, and they investigated potential public stigma toward unvaccinated people among the French population. Methods: A representative sample of the French adult population (N = 2,015) completed an online questionnaire in September 2021. The authors focused on participants who were already vaccinated against COVID-19 or intended to get vaccinated (N = 1,742). A cluster analysis was used to obtain contrasted attitudinal profiles, and the authors investigated associated factors with logistic regressions. Findings: Regarding attitudes toward unvaccinated people, a majority of respondents supported several pejorative statements, and a significant minority also endorsed social rejection attitudes. The authors found four contrasting attitudinal profiles: moral condemnation only (32% of respondents), full stigma (26%), no stigma (26%), and stigma rejection (16%). Early vaccination, civic motives for it, faith in science, rejection of political extremes, and being aged 65 or older were the main factors associated with stigmatizing attitudes toward unvaccinated people. Conclusions: The authors found some evidence of stigmatization toward unvaccinated people, but further research is needed, especially to investigate perceived stigmatization among them. The authors discuss their results with reference to the concept of "folk devils" and from a public health perspective. [ABSTRACT FROM AUTHOR]

Objectives: To our best knowledge, no study in France has comprehensively investigated the prehospital history of patients admitted for severe cases of COVID-19. 'Patients' voice is an excellent means to capture data on primary care pathways. We aimed to identify clusters of COVID-19 hospitalised patients with similar prehospital symptom sequences, and to test whether these clusters were associated with a higher risk of poor clinical outcomes. Design: Cross-sectional online survey using life-event calendars. Setting: All patients hospitalised for COVID-19 between September 2020 and May 2021 in the Infectious Disease Departments in Nice and in Marseilles in France. Participants: 312 patients responded to the survey. Main outcome measures: From the day of symptom onset to the day of hospitalisation, we defined a symptom sequence as the time-ordered vector of the successive symptom grades (grade 1, grade 2, grade 3). State sequence analysis with optimal matching was used to identify clusters of patients with similar symptom sequences. Multivariate logistic regressions were performed to test whether these clusters were associated with admission to intensive care unit (ICU) and COVID-19 sequelae after hospitalisation. Results: Three clusters of symptom sequences were identified among 312 complete prehospital pathways. A specific group of patients (29%) experienced extended symptoms of severe COVID-19, persisting for an average duration of 7.5 days before hospitalisation. This group had a significantly higher probability of being admitted to ICU (adjusted OR 2.01). They were less likely to know a loved one who was a healthcare worker, and more likely to have a lower level of education. Similarly, this group of patients, who were more likely to have previously visited the emergency room without exhibiting severe symptoms at that time, may have been inclined to postpone reassessment when their health worsened. Their relatives played a decisive role in their hospitalisation. [ABSTRACT FROM AUTHOR]

Introduction: With France one of the European countries most strongly affected by COVID-19 in the spring of 2020, French authorities imposed a nationwide lockdown for 8 weeks (March 17–May 10). This study explored the perception of the adult population about the need for—and access to—psychological support from health care professionals (HCP) in response to concerns about the psychological needs during lockdown. Material and method: This online cross-sectional survey of a representative sample of the adult general population of mainland France (N = 2,003) took place during the last four days of the French lockdown (May 7–10, 2020). Results: One in eight respondents (12.2%) perceived a need for psychological support from an HCP during the lockdown; most had symptoms of depression and/or anxiety of at least moderate intensity. Only a third (29.8%, 3.6% of the entire sample) actually obtained this support. Factors associated with this perceived need included: age under 35, economic difficulties due to lockdown, pre-lockdown use of psychological support, infection with COVID-19, serious worries about becoming infected, and heavy media use to obtain information about the disease. Among those who perceived a need for psychological support, the elderly were the most likely not to consult an HCP. People aged 35–64, those with high income, and those seriously worried about developing COVID-19 were the most likely to forgo seeking access to care because of their fear of infection by the coronavirus-2019. Conclusion: The perceived need for psychological support from an HCP and access to it appeared to be strongly associated with COVID-19 exposure factor. More research about this association is needed to improve the health authorities' understanding of the population's psychological needs in this situation and to enhance HCPs' abilities to meet them. In particular, further research of its specific impact on youth is necessary. [ABSTRACT FROM AUTHOR]

Background: The outbreak of COVID-19 has been a major interrupting event, challenging how societies and individuals deal with risk. An essential determinant of the virus' spread is a series of individual decisions, such as wearing face masks in public space. Those decisions depend on trade-offs between costs (or benefits) and risks, and beliefs are key to explain these. Methods: We elicit beliefs about the COVID-19 pandemic during lockdown in France by means of surveys asking French citizens about their belief of the infection fatality ratio (IFR) for COVID-19, own risk to catch the disease, risk as perceived by others, and expected prevalence rate. Those self-assessments were measured twice during lockdown: about 2 weeks after lockdown started and about 2 weeks before lockdown ended. We also measured the quality of these beliefs with respect to available evidence at the time of the surveys, allowing us to assess the calibration of beliefs based on risk-related socio-demographics. Finally, comparing own risk to expected prevalence rates in the two successive surveys provides a dynamic view of comparative optimism with respect to the disease. Results: The risk perceptions are rather high in absolute terms and they increased between the two surveys. We found no evidence for an impact of personal experience with COVID-19 on beliefs and lower risk perceptions of the IFR when someone in the respondent's family has been diagnosed with a disease. Answers to survey 1 confirmed this pattern with a clear indication that respondents were optimistic about their chances to catch COVID-19. However, in survey 2, respondents revealed comparative pessimism. Conclusion: The results show that respondents overestimated the probabilities to catch or die from COVID-19, which is not unusual and does not necessarily reflect a strong deviation from rational behavior. While a rational model explains why the own risk to catch COVID-19 rose between the two surveys, it does not explain why the subjective assessment of the IFR remained stable. The comparative pessimism in survey 2 was likely due to a concomitant increase in the respondents' perceived chances to catch the disease and a decreased expected prevalence rate. [ABSTRACT FROM AUTHOR]

The Covid‐19 pandemic has disrupted the habits of billions of people around the world. Lockdown at home is mandatory, forcing many families, each member with their own sleep–wake habits, to spend 24 hr a day together, continuously. Sleep is crucial for maintaining immune systems and contributes deeply to physical and psychological health. To assess sleep problems and use of sleeping pills, we conducted a cross‐sectional study of a representative sample of the general population in France. The self‐reported sleep complaint items, which covered the previous 8 days, have been used in the 2017 French Health Barometer Survey, a cross‐sectional survey on various public health issues. After 2 weeks of confinement, 74% of the participants (1,005 subjects) reported trouble sleeping compared with a prevalence rate of 49% in the last general population survey. Women reported more sleeping problems than men, with greater frequency or severity: 31% vs. 16%. Unusually, young people (aged 18–34 years) reported sleep problems slightly more frequently than elderly people (79% vs. 72% among those aged 35 or older), with 60% of the younger group reporting that these problems increased with confinement (vs. 51% of their elders). Finally, 16% of participants reported they had taken sleeping pills during the last 12 months, and 41% of them reported using these drugs since the lockdown started. These results suggest that the COVID crisis is associated with severe sleep disorders among the French population, especially young people. [ABSTRACT FROM AUTHOR]

Copyright of International Journal of Qualitative Studies on Health & Well-Being is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

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]

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]

Purpose: The prostate cancer impacts on the future life of survivors. The complexity of sexual health problems in prostate cancer survivors is underestimated or often reduced to the erectile dysfunction. Especially, factors influencing sexual desire of patients have to be more explored. This study aims to describe the therapeutic management of patients with prostate cancer and assess their sexual desire 2 years after diagnosis.Methods: This study is part of the National VICAN survey (Vie après le CANcer) implemented in France in 2012. This analysis was performed on a population of 414 men who had prostate cancer. The questionnaire dealt with several topics including socioeconomic status, treatments received, and sexual desire.Results: Prostatectomy (42.8%), radiotherapy + hormonotherapy (17.6%), and radiotherapy alone (12.8%) were the main treatments used. 41.3% of men stated that their sexual desire was all gone since disease. The "satisfying" perceived financial situation was significantly associated to a sexual desire loss (p = 0.008). Radiotherapy + hormonotherapy treatment only is significantly associated with a loss of sexual desire (P = 0.003).Conclusions: Two years after diagnosis, the sexual desire of prostate cancer survivors is deteriorated with the cancer experience. However, clinical characteristics do not seem to be decisive unlike a "satisfying" financial situation. Research about the impact of socio economics characteristics on sexual health should probably be engaged. Programs have to be developed in France to have personalized sexual support progressed for survivors and take spouses into consideration in this context. [ABSTRACT FROM AUTHOR]

Background and purpose: Introducing palliative care earlier in the disease trajectory has been found to provide better management of physical and psychological suffering. In France, the proportion of cancer patients who receive palliative care is unclear. This study aimed primarily to measure the prevalence of access to inpatient palliative care and associated patient-level factors, and to identify the time between access to palliative care and death. Patients and methods: A nationwide retrospective cohort study using data from the French national health system database (SNDS). All those diagnosed with cancer in 2013 who died between 2013 and 2015 were included. Access to inpatient palliative care was the main outcome. Results: Of the 313,059 patients diagnosed with cancer in 2013 in France, 72,315 (23%) died between 2013 and 2015. Overall, 57% had access to inpatient palliative care. The following groups were the most likely to have access to palliative care: women (adjusted odds ratio, aOR: 1.15; 95% CI: 1.11–1.20), people aged 18–49 (aOR: 1.38; 95% CI: 1.26–1.51), individuals with metastatic cancer (aOR: 2.04; 95% CI: 1.96–2.13), and patients with cancer of the nervous system (aOR: 1.80; 95% CI: 1.62–2.01). The median time between palliative care and death was 29 (interquartile range: 13–67) days. Conclusion: More than half of cancer patients who died within 2 years after diagnosis had access to inpatient palliative care. Access to palliative care occurs late in the disease trajectory, often during the final month of life. Further research and guidelines are warranted to optimize access to early, standardized palliative care. [ABSTRACT FROM AUTHOR]

Background: Pain management, especially at the end of life, varies depending on the prescriber's characteristics and attitudes. Little is known about the practices of general practitioners (GPs) regarding end-of-life management for patients with cancer. Objectives: To provide an overview of the characteristics associated with GPs' attitudes and practices regarding opioids prescribing and to explore GPs' perceived role and difficulties in managing end-of-life care for patients with cancer. Design: A cross-sectional study (December 2015 to March 2016). Subjects and Analyses: Data were collected from a representative sample of 376 GPs in southeastern France recruited to participate in a survey on medical practices and opinions regarding cancer patient management. Descriptive analyses and multivariate logistic regressions were conducted to study the characteristics, attitudes, and practices associated with GPs' opioids prescribing attitudes. Results: Almost 97% of GPs stated that they prescribe opioids to end-of-life cancer patients. Among these, 77% said that they prescribe opioids on their own initiative, while 23% declared doing so in coordination with a specialist team. Female GPs, GPs working in solo practices, and GPs reporting more difficulties in managing end-of-life cancer patients were significantly less likely to prescribe opioids on their own initiative. Conclusion: Our results suggest that GPs' characteristics and practices influence the prescribing attitudes at the end of life. Given the dearth of studies on this topic, further research is recommended to better understand the impact of GPs' characteristics on their prescriptive attitudes. The possible interactions between patients' and physicians' characteristics—in particular gender—should also be investigated. [ABSTRACT FROM AUTHOR]

Background: Worldwide, millions of deaths each year are attributed to alcohol. We sought to examine French people's beliefs about the risks of alcohol, their correlates, and their associations with alcohol use. Methods: Data came from the 2010 Baromè tre Cancer survey, a random cross-sectional telephone survey of the French general population (n = 3359 individuals aged 15-75 years). Using principal component analysis of seven beliefs about alcohol risks, we built two scores (one assessing risk denial based on self-confidence and the other risk relativization). Two multiple linear regressions explored these scores' socio-demographic and perceived information level correlates. Multiple logistic regressions tested the associations of these scores with daily drinking and with heavy episodic drinking (HED). Results: About 60% of the respondents acknowledged that alcohol increases the risk of cancer, and 89% felt well-informed about the risks of alcohol. Beliefs that may promote risk denial were frequent (e.g. 72% agreed that soda and hamburgers are as bad as alcohol for your health). Both risk denial and risk relativization scores were higher among men, older respondents and those of low socioeconomic status. The probability of daily drinking increased with the risk relativization score and that of HED with both scores. Conclusions: Beliefs that can help people to deny the cancer risks due to alcohol use are common in France and may exist in many other countries where alcoholic beverages have been an integral part of the culture. These results can be used to redesign public information campaigns about the risks of alcohol. [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]

Purpose: The purpose of this study is to assess French cancer survivors' sexual health 2 years after diagnosis.Methods: Using the French National Health Insurance System database, the representative national VICAN survey was created comprising 4349 adults (12 cancer sites), still alive 2 years after diagnosis and aged 18-52 ("younger") or 53-82 ("older"). Sexual health was evaluated using six items from the Relationship and Sexuality Scale, and an overall indicator was created.Results: Among the study's 1955 sexually active participants, 18.6 % (versus 13.1 %), 39.8 % (versus 39.9 %) and 29.4 % (versus 29.8 %) of men (versus women) were affected, respectively, by "strong", "moderate" and "weak" sexual health deterioration, while 12.2 % (versus 17.1 %) were spared sexual problems (P = 0.001). Strong deterioration more often concerned older men with prostate (27.7 %) and lung (26.1 %) cancers, younger men with upper aero-digestive tract cancers (25.2 %) and women (younger/older) with cervical cancer (24.2 %). Substantial (strong/moderate) sexual health deterioration was observed for all cancer sites, rates ranging from 68.3 % (prostate) to 37.2 % (melanoma). In all four gender/age subgroups, increasing age predicted poorer sexual health, although statistical significance was not reached in older women. Apart from genital cancer, perceived consequences, such as general sequelae and fatigue, were the primary factors associated with severe sexual problems.Conclusions: Two years after diagnosis, the majority of sexually active French cancer survivors reported impaired sexual health. Younger and older men and women with cancer in non-reproductive sites also reported problems.Implications For Cancer Survivors: Interventions aimed at improving sexual health irrespective of age and cancer site should be developed. [ABSTRACT FROM AUTHOR]

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]

Background: Tobacco control policies have succeeded in reducing tobacco use, but the negative correlation between smoking prevalence and socioeconomic status (SES) has increased. This study focused on the relationships between time preferences, SES, and smoking behaviour, attitudes and risk awareness. Methods: A cross-sectional telephone survey was conducted in France in 2008 on a representative national sample of people aged 18–75 (N = 2000, including 621 smokers) years. Two scales measuring planning horizon and impulsivity and various indicators of SES were introduced into the logistic regressions performed on smoking status and smokers’ attitudes to anti-smoking campaigns, quitting attempts, attempts to quit or smoke less, fear of smoking-related cancer and risk perception. Results: Indicators of lower SES and smoking status were correlated with present time orientation and impulsivity. On modelling smoking status, time orientation and lower SES were found to be significant predictors. Among smokers, lower SES and present time orientation were predictive of smoking-related outcomes: little personal concern with anti-tobacco campaigns, not reporting recent behavioural changes, not expressing personal fear of smoking-related cancer and low risk awareness. When time-related preferences were introduced into the analysis, the effects of several lower SES indicators (especially a low educational level) became non-significant. Conclusion: The relationship between SES and smoking behaviour, attitudes and beliefs may be partly mediated by time preferences. Time preference is strongly correlated with smoking status, risk perceptions and attitudes towards anti-smoking campaigns. Tobacco control policies should include messages targeting present time-oriented smokers and/or interventions designed to enhance more future-oriented attitudes among smokers. [ABSTRACT FROM AUTHOR]

The article discusses the resistance to quitting smoking among low income smokers in France. Topics include statistics on smokers in France, social manifestations of smoking in France and in comparison with other countries, and the social integration of low income smokers and their lack of inclination to quit smoking.

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: Purpose: In France, a recent law emphasizes patient rights and prohibits unwanted therapies in end-of-life care. As end-of-life home care is increasing, we aimed to assess French district nurses'' attitudes toward terminally ill patients'' autonomy. Materials and Methods: We used data from a nationwide telephone survey conducted in 2005 among a random sample of French district nurses (n = 602). Nurses'' attitudes were assessed with a clinical case describing a patient (randomly defined as a male or a female aged 50 years) having amyotrophic lateral sclerosis (ALS) who urgently needs mechanical ventilation. Nurses were asked whether patient consent was necessary before performing intubation/tracheotomy, and the analysis took into account various covariates, including nurses'' religiosity, nurses'' attitudes toward living wills, and patient sex. Results: Overall, 44% of nurses considered that an ALS patient with respiratory failure should always be intubated (53% for a female patient, 40% for a male patient, P < .01), and after intubation, 27% upheld tracheotomy without considering patient consent as a necessary prerequisite (39% among male nurses, 30% among female nurses, P < .05). Poor communication with terminal patients and hostility toward living will were also predictive of willingness to perform both mechanical ventilation and tracheotomy without patient consent. Conclusions: A significant part of French district nurses may have a disturbing propensity to support intubation and tracheotomy with insufficient attention paid to the patient''s will. Further research should investigate potential causal factors (such as increased workload) as well as sex-related attitudes in nurse-patient relationship. [Copyright &y& Elsevier]

Background: Past studies on smokers' risk perception have produced mixed results. We endorsed a new approach to assess smokers' perceptions of risk by asking them to estimate threshold values for the cancer risk associated with daily consumption of tobacco and number of smoking years. We expected that many smokers would endorse a "risk denial" attitude, with threshold estimates higher than their own smoking consumption and duration. Methodology: A French national telephone survey (n=3820; 979 current smokers) included several questions about smoking behaviours and related beliefs. Results: Among current smokers, 44% considered that smoking can cause cancer only for a daily consumption higher than their own consumption, and an additional 20% considered that the cancer risk becomes high only for a smoking duration higher than their own. Most smokers also agreed with other "risk denial" statements ("smoking is not more dangerous than air pollution," "some people smoke their whole life but never get sick"). Those who considered they smoked too few cigarettes to be at risk were less likely to report personal fear of smoking related cancer. Conclusion: Risk denial is quite widespread among smokers and does not simply reflect a lack of information about health risks related to tobacco. Fully informing smokers about their risks may necessitate changing the way they process information to produce beliefs and limiting their capacity to generate self exempting beliefs. [ABSTRACT FROM AUTHOR]

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]

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]

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This article aims to investigate the effect of French mass media national prevention campaigns on attitudes and behaviours of people living with HIV/AIDS (PLWHAs), with a special emphasis on HIV-related sexual risk behaviours. In 2001, a face-to-face survey was conducted in 32 hospital departments delivering HIV care randomly selected in two French regions (Paris metropolitan area and South-Eastern France). Eligible respondents were HIV-infected outpatients aged 18 or older, and diagnosed for at least 1 year. Overall, 1386 patients were asked to participate and 900 agreed to answer the questionnaire (response rate: 64.9%). Most respondents supported national AIDS information media campaigns; some have found support from these campaigns to talk to relatives or friends about AIDS (19.7%), or to manage their sexual life (24.5%). In multivariate analysis, PLWHAs who declared that these media campaigns have helped them to manage their sexual life were more likely to report condom use in the prior 6 months (“sometimes” vs. “never”: OR?=?2.77 [95% CI?=?1.15?–?6.71]; “always” vs. “never”: 2.46 [1.14?–?5.29]). So mass media general information campaigns can play an efficient role for secondary prevention among PLWHAs and may need to be redesigned to include this goal more explicitly. [ABSTRACT FROM AUTHOR]

The article discusses the findings of a telephone survey which investigated French people's attitude towards drug use. The survey designers used Computer-Assisted Telephone Interviews and were mainly confronted with four types of populations. The four types included, owners of land-line telephones including those on the Red List, owners of only mobile telephones, and those who do not own a telephone. The sample data were acquired to an unpredictable opinion poll to two degrees. It was necessary at first to choose numbers haphazardly in the list of telephone subscribers except those in the red list. To be eligible, a household had to include at least a person from 12 to 75 years old, speaking French and domiciling in the called number.

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]

Since the end of the 1980s, `youth risky behaviours' have become a major issue for public health. The relationship between these behaviours and sporting activity is well-documented but still controversial. This article examines some sociological hypotheses related to this relationship, with data from a pilot survey conducted on a sample of 458 elite-student-athletes (ESAs) aged 16-24, gathered and trained in specialized public centres. We found a significant relationship between motives to do sport and `risky behaviours': ESAs who considered sport as a convivial leisure were more prone to use cannabis, while ESAs who mingled sporting and extra-sporting achievements together were more likely to engage in risky behaviours on the road, possibly because they transposed values from the sporting field (speed, competition) into the `real world'. Moreover, sporting activity may provide opportunities for drug use with peers as well as incentives to use drugs in order to cope with the anxiety induced by high-level competition. Thus `recreational' drugs may be used as `integrative' drugs. [ABSTRACT FROM AUTHOR]

In contemporary societies, risk culture and risk profiling lead to the stigmatization of unhealthy behaviours as ‘risky’. Risk denial theory refers to a cognitive way to deal with risky behaviours and can be considered as an updated variant of Sykes and Matza's neutralization theory. People neutralize the ‘risky’ label using specific techniques that must be added to those previously enlisted by Sykes and Matza. This paper introduces and discusses three techniques of risk denial: scapegoating, self-confidence and comparison between risks. As it is usually defined and studied as a ‘risky behaviour’, cannabis use provides a relevant example to illustrate these types of risk denial, thanks to various ethnographic studies (including Becker's seminal work on marijuana smokers) and quantitative French data from the 1999 European School Survey on Alcohol and Other Drugs (ESPAD). In order to deny the ‘risky’ label, cannabis users scapegoat ‘hard drugs’ users, they emphasize their own ability to control their consumption personally, or they compare cannabis and alcohol risks. The paper concludes with suggestions for further analyses of risk denial. [ABSTRACT FROM AUTHOR]

This article aims to assess the hypothesis of Charlton & Bates about a negative correlation between cigarette smoking and mobile phone ownership among adolescents. This hypothesis is discussed and tested by using data from a national survey conducted in France in 2000 (n = 8414; age 17). The results show that, in France, owning a mobile phone is positively correlated with smoking, and this relationship remains significant once confounding factors are controlled. Thus, cigarette smoking and mobile phone ownership could turn out to be complementary rather than substitutable goods or could be considered as two characteristics of the same lifestyle. [ABSTRACT FROM AUTHOR]

Aims This study aimed at increasing understanding of the relationship between sporting activities and alcohol, cigarette and cannabis use among adolescents, by examining gender, age and the context of sporting practice. Design, setting, subjects The study was a national school survey (n = 10807; ages 14–19 years) conducted in France in 1999. Measures Respondents were asked confidentially by self‐administered questionnaire (pen and paper) about their use of licit and illicit drugs and life‐style (including sporting activities outside school: hours per week, registration in a club, type of sport). Findings The U‐shaped curve between the intensity of physical activities and licit and illicit drug use appeared not to be systematic. It depended mainly on the product and the level of use. It only remained significant for boys and heavy smoking once gender and age effect were taken into account. Conclusion The results stress the need to control for age and gender when the survey participants are teenagers. The relationship between drug use and sporting activity also depends on the type of sport. [ABSTRACT FROM AUTHOR]

Background: Vaccination against seasonal influenza (SIV) is recommended for patients with diabetes, but their vaccination coverage is unsatisfactory in France and elsewhere. This qualitative survey of people with diabetes sought to explore 1) the extent to which SIV-related behaviour is more or less automatic; 2) reasons they choose/reject SIV; 3) their trust/distrust in authorities, science, and medicine.Methods: We conducted semi-structured in-depth interviews of 19 adults with diabetes in 2014. We recruited them through physicians or patient associations and implemented an analysis of thematic content.Results: Eight patients were vaccinated against flu in the preceding flu season and 11 were not. SIV uptake and refusal were stable over time and justified by multiple arguments. Coupons for free vaccines and regular doctor visits contributed to the habit of vaccination. Vaccination decisions were frequently anchored in past experiences of influenza and its vaccine. Patients often justified non-vaccination with attitudes of trivialisation/relativisation of influenza-associated risks and the perception that these can be controlled by means other than vaccination (e.g., through the avoidance of exposure). Some misbeliefs (e.g., SIV causes influenza) and doubts about SIV effectiveness and safety also existed. Several patients reported increased mistrust of SIV since the A/H1N1 pandemic in 2009. Patients trusted their doctors strongly regardless of their SIV behaviour, but unvaccinated patients had little trust in the government and pharmaceutical companies. Some discordances were found between perceptions and behaviour (e.g., remaining vaccinated despite doubts about SIV effectiveness or remaining unvaccinated despite feelings of vulnerability towards influenza complication), suggesting the existence of some vaccine hesitancy among patients.Conclusion: This study among patients with diabetes suggest that SIV uptake is stable, thanks to a favourable environment. Nonetheless, SIV refusal is also stable over time. Unvaccinated patients used multiple arguments to justify SIV refusal, including compensatory health beliefs. Physicians should take every opportunity to recommend SIV. The necessary individualised patient education regarding SIV requires better physician training in patients priorities. While almost all patients strongly trust their doctors, unvaccinated patients distrust distal stakeholders: it is absolutely essential to restore trust in them and to develop new more effective influenza vaccines. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess the use of non-conventional medicine (NCM) in a representative sample of French patients 2 years after cancer diagnosis.Methods: The study was based on data obtained in the VICAN survey (2012) on a representative sample of 4349 patients 2 years after cancer diagnosis. Self-reported data were collected at telephone interviews with patients. The questionnaire addressed the various types of non-conventional treatments used at the time of the survey.Results: Among the participants, 16.4% reported that they used NCM, and 45.3% of this group had not used NCM before cancer diagnosis (new NCM users). Commonly, NCMs used were homeopathy (64.0%), acupuncture (22.1%), osteopathy (15.1%), herbal medicine (8.1%), diets (7.3%) and energy therapies (5.8%). NCM use was found to be significantly associated with younger age, female gender and a higher education level. Previous NCM use was significantly associated with having a managerial occupation and an expected 5-year survival rate ≥80% at diagnosis; recent NCM use was associated with cancer progression since diagnosis, impaired quality of life and higher pain reports.Conclusion: This is the first study on NCM use 2 years after cancer diagnosis in France. In nearly half of the NCM users, cancer diagnosis was one of the main factors which incited patients to use NCM. Apart from the NCM users' socioeconomic profile, the present results show that impaired health was a decisive factor: opting for unconventional approaches was therefore a pragmatic response to needs which conventional medicine fails to meet during the course of the disease.Implications For Cancer Survivors: Better information of patients and caregivers is needed to allow access to these therapies to a larger population of survivors. [ABSTRACT FROM AUTHOR]

Reaching the last pockets of unvaccinated people is challenging, and has led to the consideration of mandatory vaccination for coronavirus disease 2019 (COVID-19). Our aim was to assess attitudes toward mandatory COVID-19 vaccination in France before the announcement of—and factors associated with opposition to—this type of policy. Between the 10th and 23rd May 2021, we conducted a cross-sectional online survey among a representative sample of the French population aged 18 and over, and a specific sample of the French senior population aged over 65. Among 3056 respondents, 1314 (43.0%) were in favour of mandatory COVID-19 vaccination, 1281 (41.9%) were opposed to such a policy, and 461 (15.1%) were undecided. Among opponents to mandatory COVID-19 vaccination for the general population, 385 (30.05%) were in favour of mandatory COVID-19 vaccination for healthcare workers (HCWs). In multivariate analysis, the age groups 18–24 and 25–34 years were significantly more opposed than the reference group (>75 years old) with respective adjusted odds ratio (aOR) and 95% confidence interval (95%CI) 4.67 (1.73–12.61) and 3.74 (1.57–8.93). Having no intention of getting COVID-19 vaccination was strongly associated with opposition to mandatory vaccination (aOR 10.67, 95%CI 6.41–17.76). In comparison with partisans of the centre, partisans of the far left and green parties were more likely to be opposed to mandatory COVID-19 vaccine, with respective aORs (95%CI) of 1.89 (1.06–3.38) and 2.08 (1.14–3.81). Attitudes toward mandatory COVID-19 vaccination are split in the French general population, and the debate might become politicized. [ABSTRACT FROM AUTHOR]

Background: The outbreak of the Covid-19 pandemic and the accompanying lockdown measures have had a major impact on societies around the world, leading to sleep problems for a large part of the population. In order to assess the sustainability of sleeping troubles related to the sanitary crisis, it was crucial to measure its prevalence after the end of the Covid-19 confinement.Methods: As part of an epidemiological survey on Covid and Confinement (COCONEL), we enquired on sleep disorders using two items in 4 repetitive cross-sectional surveys. The first took place during the first week of the French confinement (March 31 to April 2; N = 1005 participants). The second took place in the middle of this period (April 15-17; N = 1005). The two last surveys were held at the end of the confinement (May 7-10; N = 2003) and one month after the end (June 10-12; N = 1736). Using a random constant, the mixed model took into account the longitudinal character of the last two waves (intra-individual correlations for individuals surveyed in waves 3 and 4).Results: The prevalence of sleep problems significantly decreased during the last weeks of the confinement, and this trend was confirmed one month after the end of confinement. One quarter of the population reported that their sleep was better one month after the end of the confinement. Sleep improvement was reported more often by women and people aged less than 65. Such improvement was less frequent among those who were still highly exposed to the pandemic's media coverage after the end of the confinement.Conclusion: The possibility of recovering a good sleep largely depends on the type of sleep disorder. The decrease in sleep problems occurred mainly among people with mild sleep problems during the confinement. Further research is needed to assess the long-term effects of the Covid-19 pandemic and its confinement period on sleep quality in the general population. [ABSTRACT FROM AUTHOR]

• Doctors' attitudes towards HPV vaccine depended on their trust in health authorities. • The lower their trust in health authorities, the higher their hesitancy. • The higher their hesitancy, the more importance they attached to patients' opinion. • Even when favorable to HPV vaccine, they were more or less proactive with patients. • This depended on their professional values regarding their public health role. The contemporary crisis of trust in vaccines has severely impaired acceptance of the HPV vaccine, especially in France, where its uptake culminated at 23.7% in 2018 (complete course at age 16). Physicians' recommendations strongly influence its acceptance/refusal. Our study sought to understand the decision processes leading physicians to recommend this vaccine (or not). Qualitative interviews of French physicians (general practitioners, gynecologists, and pediatricians). We first randomly selected doctors in a national register of medical professionals and then resorted to snowballing to build a convenience sample. We coded the interviews in a thematic analysis built both inductively and deductively from our research questions and data. Two thirds of the participants (19/28) were favorable to HPV vaccination, some (4) opposed it, while the others were hesitant about recommending it. In explaining their opinions, most participants mentioned that they trusted the stakeholders within the vaccination system: the less trust they had, the more critical they were of the vaccine and the more importance they attributed to patients' opinions. We identified three different ways they interacted with patients on this topic: informing and convincing; adapting to patients' opinions; refusing compromise about vaccination. Crossing these various themes, we found 5 types of physicians: dissidents (mistrustful of the healthcare system and HPV vaccine), hesitant (finding it difficult to make up their minds about this vaccination), laissez-faire (letting patients decide by themselves, but very favorable to HPV vaccination), educator (very favorable), and uncompromising vaccinators (refusing debate). Pediatricians were overrepresented among the latter two types. Physicians' judgment was influenced by their trust in the stakeholders involved in designing and implementing the HPV vaccination strategy. In this sense, doctors did not differ substantially from laypeople. They were, nonetheless, strongly influenced by their professional style and ethos. [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]

Context: Chronic pain (CP) is a major concern in cancer survivors. Often under-reported by patients, it is both underassessed and undertreated by care providers.Objectives: To assess CP prevalence and related treatment in cancer survivors five years after diagnosis and to identify factors associated with prescribing opioids among survivors with CP, focusing on access to palliative care (PC).Methods: In 2015-2016, we interviewed 4174 French patients diagnosed with cancer five years previously. Combining patient-reported and clinical-reported outcomes together with medicoadministrative data, we studied factors associated with Step II and Step III opioid prescriptions in cancer survivors with CP. We performed multinomial logistic regression adjusting for various covariates, including self-reported health status variables and inpatient PC.Results: Five years after cancer diagnosis, 63.5% of the respondents reported current CP (i.e., pain lasting three months or more). Of these, 64.6% and 14.4% were prescribed at least one Step II or Step III opioid, respectively. Only 1.9% had had inpatient PC since diagnosis. After adjustment for age, gender, clinical and self-reported variables, we found that the latter were more likely to receive Step III opioids (adjusted relative risk ratio 5.33; 95% CI 1.15, 24.58).Conclusion: This study showed a high prevalence of CP five years after cancer diagnosis. Step III opioids were underprescribed but positively associated with inpatient PC. PC access in France remains limited, especially among cancer survivors. Integrating PC in oncology is essential to provide the best cancer-related symptoms management. [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]

Objective General practitioners (GPs) play a crucial role in human papillomavirus (HPV) vaccine acceptance in France. We sought to study: (1) GPs’ perceptions of its risks and efficacy and their recommendation behavior; (2) the relative importance of factors associated with the frequency of their recommendations. Methods Cross-sectional observational study in 2014 nested in a national panel of 1712 randomly selected GPs in private practice in France (response rate: 92.4%). We used model averaging to analyze the associations of self-reported frequency of GPs’ HPV vaccine recommendations with their perception of its risk-benefit balance and their opinions about the utility of vaccines in general. Results Overall, 72% of participants reported frequently recommending HPV vaccination; 60% considered that not enough is known about its risks. The model averaging showed that the factors most associated with infrequent recommendation of this vaccine by GPs were: unfavorable perceptions of its risk-benefit balance (OR = 0.13; 95%CI = 0.09–0.21; partial R 2 = 0.10), a decision not to vaccinate one's own daughter(s) with this vaccine (OR = 0.13; 95%CI = 0.07–0.24; partial R 2 = 0.05), and doubts about vaccine utility in general (OR = 0.78; 95%CI = 0.71–0.86; partial R 2 = 0.03). Conclusion Although nearly three-quarters of French GPs frequently recommended the HPV vaccine, our findings indicate that a substantial percentage of them are hesitant about it. Doubts about its risks and efficacy strongly influence their recommendation behavior. More research is warranted to help design and evaluate tailored tools and multicomponent intervention strategies to address physician's hesitancy about this vaccine. [ABSTRACT FROM AUTHOR]

The article reports on the proposal to study the influences of lifestyle characteristics and health-related quality of life (HRQL) on unsafe sex with casual partners in a representative sample of HIV-infected gay men in France. It was concluded that risky sexual behavior with casual partners is frequent among HIV-infected gay men. The behavior of this kind is related to poor mental HRQL.

Introduction: Adherence to sun-protection guidelines in developed countries is low, especially among people of low SES. Mechanisms underlying this social differentiation are poorly understood. This study aimed to examine the social differentiation of sun-protection behaviors and of two cognitive factors (knowledge about both sun health and behavioral risk factors for cancer) and to determine if these cognitive factors mediate the association between SES and sun-protection behaviors.Methods: Data came from the 2010 Baromètre Cancer survey (analyzed in 2014), a random cross-sectional telephone survey conducted among the French general population (n=3,359 individuals aged 15-75 years). First, bivariate associations between a composite individual SES indicator (based on education level, occupation, and income) and both sun-protection behaviors and cognitive factors were tested with chi-square tests and ANOVA. Then, confirmatory factor analysis and structural equation modeling were used to test the mediating role of cognitive factors with a multiple mediation model including four latent variables.Results: In bivariate analyses, the individual SES indicator was positively associated with sun-protection behaviors and both cognitive factors. Multiple mediation analyses showed that both cognitive factors partially mediated the effect of individual SES on sun-protection behaviors. The overall proportion of mediated effects was 48%. The direct effect of SES remained significant.Conclusions: These results suggest that interventions aimed at modifying the knowledge and perceptions of people of low SES might help to reduce social differentiation of sun-protection behaviors. Further qualitative research is needed to better understand these cognitive factors and develop suitable prevention messages. [ABSTRACT FROM AUTHOR]

Background: Media coverage of Lyme disease (LD) has led to an increase in consultations for presumed LD in Europe. However, LD is confirmed in only 10%-20% of patients, with a significant number remaining in a diagnostic dead-end., Objectives: To reach a deeper understanding of how patients themselves contribute to the diagnostic process. To describe the genesis of the LD hypothesis in care pathways., Methods: In 2019, 30 patients from a prospective cohort consulting in the infectious diseases department at University Hospital in Marseille for presumed LD were recruited for semistructured interviews. The inclusion criteria were: suffering from subjective symptoms for 6 months, no clinical or paraclinical argument suggesting current LD. The patients' medical trajectories were collected using a biographical approach., Results: The diagnosis of LD was primarily triggered by identification with personal testimonies found on the Internet. Most of patients were leading their own diagnostic investigation. The majority of participants were convinced they had LD despite the lack of medical evidence and the scepticism of their referring GP., Conclusion: GPs should first systematically explore patients' aetiologic representations in order to improve adherence to the diagnosis especially in the management of medically unexplained symptoms. Long COVID-19 syndrome challenge offers an opportunity to promote active patient involvement in diagnosis., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objective: The measures put in place to contain the coronavirus epidemic in France have led to fears of a massive increase in the consumption of alcohol, tobacco, and other drugs., Method: Taking advantage of an ongoing weekly Internet survey monitoring living conditions of the French population during the containment, we introduced questions on alcohol and tobacco use 1 month after the start of the first containment. Analyses were conducted with multivariate Poisson regressions., Results: Tobacco consumption remained almost unchanged. By contrast, more than a third of French people did change their weekly alcohol intake: 13% increased it, whereas 21% decreased it, indicating that the containment measures were often taken as an opportunity to reduce alcohol consumption, especially among those who drank less than 4 days per week before. Men were more likely to decrease their alcohol intake and less likely to increase it than women, probably because of a differential impact of the reduction of social activities on gendered social roles. The people most affected were smokers and those living in a dwelling in which someone had been infected, including themselves., Conclusions: The crisis tended to polarize alcohol consumption toward extremes. If the new drinking habits were to continue, the consequences could be beneficial for occasional drinkers but harmful for heavier drinkers., Competing Interests: The authors have no conflicts of interest to declare.

Objective: Between 1 March and 15 June, France experienced the first wave of the COVID-19 pandemic, during which 29 549 deaths occurred among COVID-19 patients, 17 250 of whom died in hospital. Our hypothesis is that crude mortality rates are not sufficient to assess the impact of the epidemic on public health. The objective of this paper is to estimate the potential years of life lost (YLL) of patients who died from COVID-19., Method: We realised a retrospective analysis of the exhaustive sample of COVID-19 PCR-positive patients who died in public hospitals of Marseille during this first wave. Data on demographic characteristics, comorbidities and care pathways were collected from medical records. The Charlson Comorbidity Index (CCI) was used to assess what would have been the probability of dying within 1 year of these patients in the absence of COVID-19 and to estimate total YLL., Results: Among the 1631 patients who were hospitalised for COVID-19, 178 patients died, at an average age of 80 years. According to CCI, 88.8% of the deceased patients had an 85% probability of dying within 1 year before COVID-19. Among the 11.2% who had a lower CCI probability, 18 out of 20 had at least one additional comorbidity known to be a major risk factor of mortality in COVID-19 disease. Cumulative total number of YLL was estimated to be 541 in this deceased population, that is, an average of 3 YLL., Conclusion: Although our results should be interpreted with caution, this analysis confirms that mortality due to COVID-19 translates into a limited number of YLL due to both old age and preexisting comorbidities in the most vulnerable patients. This fact should be better considered in public health management of the pandemic both for risk communication and design of the most appropriate protective measures., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

As the coronavirus disease 2019 (COVID-19) spreads across the world, the rapid distribution of an effective vaccine and its acceptability among the population constitute priorities for health authorities. This study aimed to document attitudes of the general population toward a future vaccine against COVID-19. We used the national COCONEL surveys conducted during the lockdown to identify factors associated with vaccine refusal, in the whole population, and separately among men and women. We investigate the role of socioeconomic and demographic factors as well as exposure to COVID-19. Among the 5,018 participants, 24.0% reported their intention to refuse the vaccine. Thinking this vaccine would not be safe, being against vaccination in general, and perceiving COVID-19 to be harmless were the three main reasons given to explain vaccine refusal. Women were more likely to refuse the vaccine, especially due to a reluctance toward vaccination in general or the perception that a COVID-19 vaccine would not be safe. Some factors associated with the intention to refuse the vaccine were the same among men and women such as a lack of prior vaccination against influenza, and concern over being infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), while others differed slightly according to gender such as age, and high prevalence of COVID-19 in their region of residence. Authorities should therefore guarantee that all the necessary precautions are taken before marketing the vaccine and communicate transparently on the process of its development, and on the coverage rate required to reach herd immunity. Abbreviation : EHI: Equivalized Household Income per month; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2.