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Background In many countries, lockdown measures were implemented to curb the COVID-19 pandemic. This situation may have an impact on mental health, tobacco smoking and alcohol consumption. The aim of this research report is therefore to describe changes in tobacco and alcohol consumption in the general French population during the first 2 weeks of lockdown and identify any associated factors. Methods Self-reported changes in smoking and alcohol consumption following the lockdown implemented in France on 17 March 2020 were collected from 2003 respondents aged 18 years and older in an online cross-sectional survey carried out from 30 March to 1 April 2020. Anxiety and depression levels were assessed using the Hospital Anxiety and Depression Scale. Results Among current smokers, 26.7% reported an increase in their tobacco consumption since lockdown and 18.6% reported a decrease, while it remained stable for 54.7%. The increase in tobacco consumption was associated with an age of 18–34 years, a high level of education, and anxiety. Among alcohol drinkers, 10.7% reported an increase in their alcohol consumption since lockdown and 24.4% reported a decrease, while it remained stable for 64.8%. The increase in alcohol consumption was associated with an age of 18–49 years, living in cities of more than 100 000 inhabitants, a high socio-professional category, and a depressive mood. Conclusions The national lockdown implemented in France during the COVID-19 pandemic influenced tobacco and alcohol consumption in different ways according to sociodemographic group and mental health.

Men who have sex with men (MSM) are an HIV key population in Haiti. However, little data exists on that population and on factors associated with this infection. Our study carried out the factors associated with HIV-positive screening among MSM in a community-based rapid testing program in Haiti between 2015 and 2018. Among the 1416 MSM screened, a third reported that it was their very first HIV test and 7.0% had an HIV-positive test. With a median age of 25 years old [21-29], over half of them were living in urban areas (60.7%) and were in financial precarious conditions (68.6%). Multivariate analysis showed that two factors were significantly associated with an HIVpositive result: having had an STI in the last 12 months, strengthened by psychoactive drug use; transactional sex practice in the last 12 months, strengthened by the age between 18 and 20 years old. These results should be taken into account when developing and implementing targeted and comprehensive HIV prevention programs and services for young MSM in Haiti.

Resume Introduction Les medecins generalistes sont des acteurs cles pour le reperage et l’accompagnement des fumeurs et des consommateurs d’alcool depassant les reperes de consommation a moindre risque. En analysant les declarations des patients, cet article vise a estimer la part de la population qui declare avoir deja discute de tabac et d’alcool avec son medecin generaliste ainsi que les facteurs qui y sont associes. Methode L’analyse porte sur un echantillon de 6346 personnes, representatif de la population residant en France metropolitaine, issu des donnees du Barometre de Sante publique France 2017, enquete aleatoire par telephone. Resultats Parmi les personnes âgees de 18 a 75 ans ayant consulte un medecin generaliste au cours des 12 derniers mois (82,5 %), 36,7 % declaraient que le sujet du tabac avait deja ete discute en consultation et 16,8 % celui de l’alcool. Pour les deux substances, etre un homme, etre fumeur ou consommateur d’alcool au-dessus des reperes et avoir une maladie chronique, etaient independamment associes au fait d’etre interroge par son medecin generaliste mais aussi associe a une prise d’initiative plus frequente par les patients. Environ 87 % des 18–75 ans jugeaient normal que leur medecin generaliste leur pose des questions sur l’alcool, plus souvent les hommes et les personnes ayant des revenus eleves. Discussion Les consommations de tabac et surtout d’alcool sont encore peu abordees en consultation selon les patients, alors qu’une part importante de la population jugerait cela normal. Ces resultats montrent qu’il est encore necessaire de renforcer le reperage systematique des consommateurs par les medecins generalistes.

International audience; INTRODUCTION In October 2016, the first edition of Mois sans tabac (Tobacco-Free Month) was launched, a campaign which had invited French smokers to challenge themselves to quit smoking for the whole month of November. We aimed to study the effectiveness of this social marketing intervention on quit attempts (QA) in the general French population, and to study possible differences according to sociodemographic characteristics. METHODS This study used data from the 2017 Health Barometer survey, a random survey conducted by telephone on 25319 individuals. It included 6341 respondents who reported that they were daily smokers when the Mois sans tabac campaign was launched in 2016. The association between self-declared exposure to the campaign and making a QA has been studied using multivariate logistic regressions. RESULTS Exposure to the 2016 Mois sans tabac campaign is associated with a QA lasting at least 24 hours in the final quarter of 2016 (AOR=1.32; 95% CI: 1.07–1.63, p

Men who have sex with men (MSM) are an HIV key population in Haiti. However, little data exists on that population and on factors associated with this infection. Our study carried out the factors associated with HIV-positive screening among MSM in a community-based rapid testing program in Haiti between 2015 and 2018. Among the 1416 MSM screened, a third reported that it was their very first HIV test and 7.0% had an HIV-positive test. With a median age of 25 years old [21-29], over half of them were living in urban areas (60.7%) and were in financial precarious conditions (68.6%). Multivariate analysis showed that two factors were significantly associated with an HIVpositive result: having had an STI in the last 12 months, strengthened by psychoactive drug use; transactional sex practice in the last 12 months, strengthened by the age between 18 and 20 years old. These results should be taken into account when developing and implementing targeted and comprehensive HIV prevention programs and services for young MSM in Haiti.Les hommes ayant des relations sexuelles avec des hommes (HSH) constituent une population clé du virus de l’immunodéficience humaine (VIH) en Haïti. Cependant, peu de données existent sur cette population et les facteurs associés à cette infection. Notre étude s’intéresse aux facteurs liés à un test rapide positif au VIH chez les HSH dans le cadre d’un dispositif de dépistage communautaire en Haïti entre 2015 et 2018. Parmi les 1 416 HSH dépistés, un tiers déclaraient leur premier test VIH et 7,0 % avaient un résultat positif. Avec un âge médian de 25 ans [21–29], plus de la moitié d’entre eux vivaient en milieu urbain (60,7 %) et étaient en situation de précarité financière (68,6 %). Une analyse multivariée a montré que deux facteurs étaient significativement associés à un résultat positif au VIH : avoir eu une infection sexuellement transmissible dans les 12 derniers mois, facteur accentué lorsqu’il est combiné à une consommation de produits psychoactifs ; la pratique du sexe transactionnel dans les 12 derniers mois, facteur accentué par l’appartenance à la classe d’âge des 18–20 ans. Ces résultats doivent se traduire dans la mise en place de futurs programmes et services de prévention du VIH vers les jeunes HSH en Haïti.

Background In 2018, smoking rate among French adults was 32.0%. This rate has been slowly decreasing over the past years but remains high compared to other European countries. In addition, smoking habits have changed over time and for instance roll-your-own tobacco (RYO) is both cheaper and seen as less dangerous. It is crucial to keep an eye on these changes in order for public health actors to adapt their actions in the fight against smoking. Methods Data come from the Santé publique France health Barometer, a national representative phone survey. In the 2005, 2010, 2014, 2017 and 2018 editions, respectively 28,224, 25,034, 15,186, 25,319 and 9,074 adults where asked about their smoking habits. Results In 2018, three quarters of smokers smoked cigarettes, over a third smoked RYO and about ten percent smoked hookahs. The proportion of smokers using exclusively RYO tobacco has more than doubled in recent years (from 8.1% in 2010 to 20.5% in 2018). Since 2010, RYO tobacco is taking shares over traditional cigarettes especially among the poorest smokers. In 2018, RYO tobacco users were more often young men or deprived individuals. Conclusions The share of cigarette smokers switching to RYO has increased over the past years. It seems to be both a result of changes in trends and a way for deprived smoker to cope with higher prices for cigarettes. Key messages Public health actions need to take into account the recent increase of popularity of RYO tobacco in France. taxes need to be adjusted in order to level up RYO tobacco prices compared to traditional cigarettes.

General practitioners (GP) are key players in screening and counselling for smokers and alcohol drinkers exceeding French guidelines for low-risk consumption thresholds. Tackling the subject from the patients' perspective, the authors aim at estimating the proportion of the population having discussed their smoking and alcohol consumption with their GPs, and to pinpoint the factors associated with their having done so.The data (n=6346) are derived from nationwide representative phone survey in mainland France conducted by the French public health monitoring center Baromètre de Santé publique France.Among the persons aged 18-75 having consulted a GP over the last 12 months (82.5%), 36.7% stated that smoking had been discussed in consultation while 16.8% had talked about alcohol use. For both substances, being a man, a smoker, an excessive alcohol user and having a chronic illness were not only independently associated with being questioned by one's doctor, but also with more frequent patient initiative. About 87% considered it normal to be asked by their GP about their alcohol intake, this proportion being higher among men and people with high incomes.Even though a large portion of the population would deem it normal to discuss smoking and alcohol intake in consultation with a GP, the subjects are rarely broached. Our results underline the need to bolster efforts at systematic screening for substance use by GPs.

Background In 2016, Santé publique France, the French national public health agency, launched a social marketing campaign aiming at triggering quit attempts among smokers: “MoisSansTabac”, inspired by the British “Stoptober”. Every year, smokers are encouraged to quit smoking for 30 days in November, health professionals are encouraged to participate in the campaign to support them. In 2018, pharmacists received a poster (“Here, we help smokers stop smoking”) and self-help kits to distribute to smokers. Measuring the perceptions of health professionals is crucial to have a complete overview of the impact of the campaign and to identify ways of improvement. Methods A qualitative evaluation of the 2018 edition has been performed to collect the perceptions of general practitioners (GPs) and pharmacists about the intervention and services provided through the campaign (quitline, website, mobile app, self-help kit). In December 2018, semi-directed interviews were conducted with 24 GPs and 24 pharmacists. A diversity of profiles was ensured (professional settings, geographic area, age, gender, smoking status). A content analysis was performed. Results While health professionals had generally poor awareness of the intervention, their opinions were divided depending on their professions. GPs did not feel sufficiently associated nor did they understand how they could specifically participate during this one-month event while they support smokers all year long. Pharmacists were pleased to be involved: they felt recognized in their role as health counselors although their participation remained low. Help cessation services were positively perceived. Some health professionals expected to have a more clearly defined role and to get evidence on the effectiveness of the intervention. Conclusions To improve the acceptability and effectiveness of “MoisSansTabac”, there is a need to rethink the place of health professionals and how to communicate with them about the campaign. Key messages ’Mois Sans Tabac’ is a social marketing intervention which is considered acceptable by general practitioners and pharmacists but improvements are necessary. Health professionals could get more involved in the campaign if their role was better defined.

Background In France, selling tobacco is strictly supervised and can only be done by official “tobacconists” making the price lever all the more efficient in preventing smoking. However, tobacco prices are rather heterogeneous in Europe and France is surrounded by countries with lower tobacco prices. The aim of our study was to investigate tobacco cross-border purchases by French smokers. Methods Data come from the Santé publique France health Barometer, a national representative phone survey. In the 2014, 2017 and 2018 editions, respectively 4,721, 1,854 and 2,594 smokers where asked about their habits regarding purchasing tobacco. Results In 2018, among adults, 77.8% of cigarette smokers (including RYO cigarettes) made their last purchase from an official French tobacconist and 16.4% made it in a neighboring country. Rates in bordering regions are drastically higher. These figures are quite similar to the ones observed in 2014 while tobacconist purchases had increased in 2017 and abroad purchases had decreased. In 2018, among adults, 44.3% of cigarette smokers stated they had bought tobacco abroad at least once during the past 12 months. Conclusions Our study suggests that the frequency of cross border tobacco purchases by French smokers decreased between 2014 and 2017 while tobacco prices were not modified in France but increased between 2017 and 2018 as French tobacco prices went up. Our study also emphasises the fact that cross border purchases were a lot more common in bordering regions. Key messages Part of French smokers avoid price increases by purchasing tobacco abroad. This public health policy measure could be more efficient if tobacco prices were aligned in Europe.

Background E-cigarette (EC) use is controversial because its benefit-risk ratio is still unclear. Since its introduction on the French market at the beginning of the 2010’s, French health authorities have published cautious recommendations. The study aims at describing uses and perceptions about EC among the adult population. Methods Santé Publique France’s Health Barometer, the French national public health agency, is a cross-sectional random survey conducted annually by phone, on a representative sample of the population aged 18-75 y/o in Mainland France. Descriptive analysis and logistic regressions were performed to analyze data collected from the 25,319 respondents of the 2017 edition. Results In 2017 in Mainland France, 3.8% of the population used an EC, 2.7% on a daily basis. Among EC daily users, 60.4% were men, 57.9% had a bachelor degree or higher qualifications. Less than 1% of EC users were never-smokers, 50.3% were daily or occasional smokers, 49.5% were former smokers. The number of daily ex-smokers who did quit smoking ( > = 6 months) and believed that vaping has helped them to, was estimated to be 700,000 since EC has been available in France. EC was perceived as equally or more harmful than regular cigarette by half of the population (51.5%), a proportion that has increased since 2014 (43.4%). Daily smokers perceived EC as more harmful, while being an EC user from high socioeconomic status was associated with the perception that EC is less harmful. The bans on EC in places where smoking is prohibited and on sales of EC to minors ( Conclusions These results show that in France, EC is strongly related to current or past smoking habits. A significant number of ex-smokers believe that EC has helped them quit smoking. Sociodemographic differences in the perception of EC harmfulness suggest social inequalities in access to information. Key messages Electronic cigarette users in France are few and most of them are smokers or former smokers. The perception of electronic cigarettes harmfulness depends on sociodemographic and smoking status.

Background In October 2016, Santé publique France, the National Public Health Agency, launched a social marketing campaign aiming at triggering quit attempts among smokers: “Mois sans tabac”, inspired by the English ’Stoptober’. This campaign sets smokers the objective of being smokefree for one month, in November. It combines a national mass-media communication with provision of cessation help services (quitline, website, mobile application, self-help kit) and local actions, in connection with the health regional agencies. The study aims at evaluating the effectiveness of this intervention. Methods The effectiveness evaluation is based on a specific analysis of the 2017 Health Barometer, a random survey representative of the population living in metropolitan France conducted between January and July 2017 on a sample of 25,319 individuals aged 18-75 years-old. The participation rate was 48.5%. Multivariate logistic regressions allowed testing the association between recall of the campaign and quit attempts (QA) in the last quarter of 2016, adjusted for sociodemographic confounders (N = 6,341). Respondents who attempted to quit were contacted at one-year for a follow-up. Results Nearly one in six daily smokers (15.9% [14.9-17.1]) reported making a 24-hour QA in the last quarter of 2016, and 18.4% [15.5-21.3] of them reported that it was related to Mois sans tabac, which represents approximately 380,000 QA [310,000-440,000] related to the operation. Among smokers who made a QA, 31% have been abstinent for at least 30 days [27%-34%] and 18% [15%-21%] reported they did not smoke anymore in 2017. Recall of Mois sans tabac was associated with QA in the last quarter of 2016 (aOR=1.3 [1.1-1.6], p < 0.01) and with cessation in 2017 (aOR=2.4 [1.4-4.2], p < 0.01), and odds-ratios increased with frequency of exposure and number of sources of information. Conclusions These results show that the first edition of Mois sans tabac was successful in triggering quit attempts among smokers. Key messages Mass-media campaigns for smoking cessation, combined with provision of help services and local actions, can be effective for triggering quit attempts. Importing foreign social marketing programs can be effective.

Background Alcohol use ranks among the top three risk factors in France, leading to about 40 000 deaths annually. French health authorities wished to renew the public health message about alcohol consumption and build a social marketing Strategy to lower the social and health consequences of alcohol consumption in France. Objectives Two main steps were followed: 1) gathering a group of experts to provide up-to-date low-risk drinking guidelines, 2) building, testing and implementing a social marketing Strategy based on this expertise. Results In 2017, the group of experts established low-risk drinking Guidelines based on both scientific evidence and socially acceptable risks for the French population. They suggested to increase awareness on alcohol-related harm as well as on the new Guidelines. In 2018, a social marketing Strategy was set up by Santé publique France, the French national public health Agency. Qualitative and quantitative pretests allowed to develop understandable and potentially effective communication materials consisting of the following message: “To protect your health, no more than 2 alcoholic drinks a day, and not every day”. A web-based brief intervention to assess a person’s alcohol consumption was developed, based on a previous tool whose effectiveness had been demonstrated. In 2019, the Campaign was launched: health professionals were informed at first, followed by a national mass media Campaign that was broadcasted for 3 weeks, targeting the general population (TV, radio, press, the Internet). Conclusions It is the first time in France that such a global Strategy is set up to promote an alcohol harm reduction message. A robust evaluation is in progress but this structured approach seems feasible and reproducible abroad. Key messages In France, an alcohol harm reduction Strategy has been built up and implemented, based on scientifically-established Guidelines. The social marketing campaign is rigorously evaluated to assess its impact and portability.

Le protocole de soins est un formulaire qui mentionne les soins et traitements pris en charge a 100 % pour une affection de longue duree et doit faciliter la prise en charge medicale des patients. La qualite de sa redaction peut impacter l’acces et l’adequation aux bons soins. AIDES, association de lutte contre le sida et les hepatites, a constate des disparites et dysfonctionnements dans son utilisation. Pour objectiver les observations de terrain, une enquete a ete realisee aupres des personnes frequentant l’association.Cet article met en perspective les resultats de cette enquete qui visait a determiner le niveau de connaissance et des personnes vivant avec le VIH et/ou une hepatite en contact avec l’association quant a l’usage de ce formulaire. Deux cent vingt-quatre personnes ont rempli le questionnaire.Les resultats confirment les constats de terrain : l’appropriation du protocole de soins par les patients ayant participe est encore limitee, meme dans une population en contact avec une association de malades. Ces constats posent alors la question de l’effectivite de la communication medecin traitant – patient au sujet de cet outil. C’est plus largement le processus de redaction du protocole de soins qui est interroge : quelle place et quel role pour les differentes parties prenantes ? Quelle coordination entre le patient, le medecin traitant et le medecin-conseil de l’Assurance maladie pour etablir un protocole de soins approprie et appropriable par le patient ?

International audience; Before January 2016, Pre-Exposure Prophylaxis (PrEP), a new biomedical HIV-prevention tool, was only available in France via ANRS-Ipergay clinical study but informal use was reported outside this setting. PrEPage qualitative study reports profiles and experiences of participants who used PrEP outside of a biomedical trial before this prevention method was authorized. Between March 2015 and February 2016, a cross-section of twenty-four informal PrEP users, mostly MSM, was recruited to complete in-depth semi-structured interviews. While ANRS-Ipergay was still ongoing (2012-2016), participants described their initiation to PrEP, the way they used it and the difficulties they faced to acquire antiretroviral drugs in an environment where PrEP was still not widely known and often criticized . Through the testimonies, different user profiles and motivation toward informal PrEP use emerged: (a) participants who have increasing difficulties using condoms, (b) "opportunists" who tried PrEP without the intention of using it regularly and (c) participants with a risk aversion who sought additional protection against HIV. Participants chose to use PrEP and/or their usual prevention strategies depending on available supplies, type of partners and individual attitudes toward risk. The feeling of living a safer sex life helped participants to outweigh the fear of possible toxicity and drug resistance. Participants' needs and expectations about PrEP implementation in France were also presented.

International audience

Two challenges were identified to improve the place of PEP in combined prevention: (1) improvement of healthcare professionals’ knowledge, practices and attitudes; and (2) revision of the guidelines concerning first-line prescription, the conditions for access to PEP, and sexual health support. .