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OBJECTIVES: Second-hand smoke (SHS) can attain high concentrations in cars. To protect children’s health, nine Canadian provinces have enacted legislation prohibiting smoking in privately owned vehicles when children are present; Quebec is the only province with no such legislation. The objective of this study was to estimate the proportion of smokers in Quebec who smoke while travelling in a private vehicle in which children are present, and to compare the characteristics of smokers who do and do not smoke in cars. METHODS: In 2011–12, 754 daily smokers who recently travelled in a car with children completed a telephone survey in which they reported how frequently they smoked in a car, if there were smoking restrictions, and perceptions about the effectiveness of legislation prohibiting smoking in cars when children are present. RESULTS: Twenty-three percent of daily smokers smoked at least occasionally in their car when children were present. This proportion was higher among smokers who knew that there was no legislation in Quebec prohibiting smoking in cars, compared to smokers who believed that such legislation was already in effect (32% vs. 12%). Smokers with a university degree and those who reported that smoking was prohibited at home were less likely to expose children to SHS in cars. Most daily smokers (75%) believed that legislation would be effective. DISCUSSION: The results of this study suggest that legislation prohibiting smoking in cars is necessary to protect children from SHS, that such legislation would be effective, and that it may be relatively easy to implement.

INTRODUCTION Our objective was to determine if there is effect modification by home smoking bans in the association between parental smoking and cigarette smoking onset in children. METHODS Data on smoking onset, number of parents who smoke, and home smoking rules were collected from children who had never smoked in self-report questionnaires in grades 5, 7, 9, and 11. The association between number of parents who smoke and smoking onset in children was tested in pooled logistic regression in 2 groups defined by the presence or absence of a complete home smoking ban. RESULTS In homes without a complete ban and relative to participants with no parents who smoke, the odds ratio (95% confidence interval [OR (95% CI]) for smoking onset was 1.5 (1.1-1.9) when one parent smoked and 1.4 (1.0-2.1) when both parents smoked. In homes with a complete ban, the OR (95% CI) was 1.6 (1.1-2.3) if one parent smoked, but 4.9 (2.4-9.9) if both parents smoked. CONCLUSION The association between number of parents who smoke and smoking onset in children was modified by the presence of a complete home smoking ban. In homes with a complete smoking ban in which both parents smoke, it may be prudent those parents communicate clearly with their children about their reasons for implementing the ban as well as about their reasons for continuing to smoke.

Introduction Secondhand smoke (SHS) can quickly attain high concentrations in cars, posing health risks to passengers and especially to children. This paper assesses whether there are social disparities in children9s exposure to SHS in privately owned vehicles. Methods On weekday mornings and afternoons from September to November 2011, trained observers were stationed at 100 selected street intersections in Montreal, Canada. For each car transporting at least one passenger aged 0–15 years travelling through the intersection, observers recorded the estimated age of the youngest child in the car, whether any occupant was smoking and the licence plate number of the car. Licence plate numbers were linked to an area material deprivation index based on the postal code of the neighbourhood in which the car was registered. Results Smoking was observed in 0.7% of 20 922 cars transporting children. There was an apparent dose–response in the association between area material deprivation level and children9s exposure to SHS in cars. Children travelling in cars registered in the most disadvantaged areas of Montreal were more likely to be exposed to SHS than children travelling in cars registered in the most advantaged areas (unadjusted OR=3.46, 95% CI 1.99 to 6.01). Conclusions This study revealed social disparities in children9s exposure to SHS in privately owned vehicles.

Objective: Smoking cessation counseling practices may differ between physicians who smoke and those who have quit or never smoked. Method: Of 917 general practitioners (GP) in Montreal mailed self-report questionnaires in 2000 and 2004, 610 provided data on their smoking status and counseling practices. Results: Seven percent were current smokers, 32% were former smokers, and 61% were never-smokers. Current smokers were more interested than never- or former smokers in learning about counseling methods (64%, 56%, 45%, respectively; p=0.018). In multivariable analyses, current smokers were less likely than never-smokers to ascertain the smoking status of their patients (OR 0.6, 95% CI 0.2-1.6); to provide advice on how to quit (OR 0.6, 0.3-1.3); and to provide complete cessation counseling coverage (OR 0.5, 0.2-1.1). Former smokers were more likely to provide adjunct support (OR 1.5, 1.0-2.4). Conclusion: GP smoking status was associated with the content of their cessation interventions with patients who smoke. Taking physician smoking status into consideration in the design of cessation training programs may improve cessation counseling interventions. Key words: Physician smoking; cessation counseling; cross-sectional; mail questionnaire; logistic regression

OBJECTIVES: The objectives of this analysis were to identify the sociodemographic characteristics of water-pipe users in a North American context and to describe concurrent psychoactive substance use. METHODS: Data on sociodemographic characteristics, water-pipe smoking, and use of other psychoactive substances were collected in 2007 through mailed self-report questionnaires completed by 871 young adults, 18 to 24 years of age, who were participating in the Nicotine Dependence in Teens Study, a longitudinal investigation of the natural history of nicotine dependence among adolescents in Montreal, Canada. Independent sociodemographic correlates of water-pipe use were identified in multivariate logistic regression analyses. RESULTS: Previous-year water-pipe use was reported by 23% of participants. Younger age, male gender, speaking English, not living with parents, and higher household income independently increased the odds of water-pipe use. Water-pipe use was markedly higher among participants who had smoked cigarettes, had used other tobacco products, had drunk alcohol, had engaged in binge drinking, had smoked marijuana, or had used other illicit drugs in the previous year. CONCLUSIONS: Water-pipe users may represent an advantaged group of young people with the leisure time, resources, and opportunity to use water-pipes. Evidence-based public health and policy interventions are required to equip the public to make informed decisions about water-pipe use.

Introduction Smoking cessation counseling by health professionals is an effective approach to increase cessation rates among smokers. To guide the development of training and educational interventions, we surveyed six health professional groups including general practitioners (GPs), pharmacists, dentists, dental hygienists, nurses, and respiratory therapists, in order to describe current practices and identify the correlates of smoking cessation counseling. Methods Self-administered questionnaires were mailed to 500 persons randomly selected from the membership lists of active licensed professionals in each health professional group in Quebec. Results Response proportions ranged from 52% (nurses) to 70% (dental hygienists). Compared with other groups, GPs and pharmacists undertook more counseling with patients ready to quit. GPs and respiratory therapists undertook more counseling with patients not ready to quit. Three factors emerged consistently across most groups as positively associated with counseling, including the belief that counseling is the role of health professionals, perceived self-efficacy to engage in effective counseling, and knowledge of community cessation resources. Discussion The correlates of cessation counseling are similar across health professional groups. Interventions that address beliefs that cessation counseling is the role of health professionals, self-efficacy to provide effective counseling, and knowledge of community resources may result in improved cessation counseling practices among health professionals.

Plusieurs interventions favorisant l’abandon du tabac ont été démontrées efficaces et elles sont essentielles à tout programme populationnel qui vise à réduire la morbidité et la mortalité liées aux problèmes de santé engendrés par la fumée de tabac. De telles mesures font partie de la Convention-cadre pour la lutte anti-tabac de l’Organisation mondiale de la Santé : réglementations, politiques fiscales, élimination du commerce illicite, éducation du public, etc. Parmi les nombreuses dispositions contenues dans ce traité, on retrouve également des actions visant la promotion du sevrage tabagique et le traitement adéquat de la dépendance au tabac par les professionnels de la santé. En effet, le tabagisme est responsable de plus de 40 pathologies et 50 % des fumeurs chroniques meurent prématurément de maladies reliées à l’usage du tabac, perdant en moyenne une dizaine d’années de vie. Ainsi, les bénéfices de l’arrêt du tabagisme sur la santé sont considérables. L’objet de cet article est de dresser la liste des interventions disponibles pour aider les fumeurs à renoncer au tabac, les décrire et faire le point sur leur efficacité., Several interventions promoting smoking cessation have proved effective and are essential to any populational program designed to reduce morbidity and mortality related to health problems caused by tobacco smoke. Such measures are part of World Health Organization anti-tobacco treaty: regulations, tax policies, elimination of trafficking, public education, etc. Among the many provisions of this treaty are also actions designed to promote tobacco withdrawal and the appropriate treatment of tobacco dependence by health professionals. Tobacco use is responsible for over 40 pathologies, and 50% of all chronic smokers die prematurely of diseases related to tobacco use, with an average loss of ten years of life. Obviously, the benefits of smoking cessation on health are considerable. This article draws up a list of interventions available to help smokers give up tobacco, describes them and reports on their effectiveness., Se ha demostrado que numerosas intervenciones que favorecen el abandono del tabaco son eficaces y esenciales en todo programa poblacional destinado a reducir la morbididad y la mortalidad relacionadas con los problemas de salud engendrados por el humo del tabaco. Tales medidas integran el Convenio marco para el control del tabaco de la Organización Mundial de la Salud: reglamentaciones, políticas fiscales, eliminación del comercio ilegal, educación del público, etc. Entre las numerosas disposiciones contenidas en este tratado se encuentran también acciones destinadas a promover el abandono del tabaco y el tratamiento adecuado de la dependencia al tabaco por parte de los profesionales de la salud. En efecto, el tabaquismo es responsable de más de 40 patologías y el 50% de los fumadores crónicos mueren prematuramente de enfermedades relacionadas con el uso del tabaco, perdiendo en promedio una decena de años de vida. Los beneficios para la salud del abandono del tabaco son, por lo tanto, considerables. Este artículo se propone desarrollar una lista de intervenciones disponibles para ayudar a los fumadores a abandonar el consumo del tabaco, describirlas y precisar su eficacia.

Background Hepatitis B (HB) prevention in the low-endemicity province of Quebec Canada, (population: ~8.2 million; birth cohort ~85,000/year), includes two decades of pre-adolescent school-based immunization, as well as catch-up immunization for those born since 1983 and pre-natal maternal HBsAg screening. To estimate the potential added benefit of routine infant HB immunization, notifiable disease reports were analyzed (1990–2013). Clinical and demographic information about cases was retrieved from standard questionnaires used by local public health units to investigate HB cases. Methods The Quebec provincial registry of notifiable diseases was used to identify confirmed HB cases reported between 1990 and 2013. Clinical and demographic information on cases was retrieved from the standard questionnaires used by local public health units to investigate reported HB cases. Results Between 1990–2013, acute-HB incidence per 100,000 population decreased by 97 % from 6.5 to 0.2. Compared to 1990, incidence fell from 0.6 to zero since 2010 among children ≤9 years of age (yoa), from 3.2 to zero since 2007 in those 10–19 yoa, and from 15 to zero in 2013 among adults 20–29 yoa, previously the age group of highest incidence (all p

Background: The natural course of onset of cigarette use has been conceptualized as progressing sequentially through 5 stages (preparation, trying, irregular use, regular use, nicotine-dependent smoking). However, recent studies suggest that symptoms of nicotine dependence can occur early in the onset process, raising questions about the validity of this model. The objective of our study was to describe the sequence and timing of 12 milestones (6 related to cigarette use and 6 to symptoms of nicotine dependence) during onset of cigarette use. Methods: Grade 7 students in 10 secondary schools in Montreal ( n = 1293) were followed prospectively every 3–4 months for 5 years. Using Kaplan–Meier analysis, we computed the number of months after first puff at which the cumulative probability of attaining each milestone was 25%, among 311 participants who initiated cigarette use during follow-up. Results: Inhalation rapidly followed first puff. The cumulative probability of inhalation was 25% at 1.5 months (95% confidence interval [CI] 1.5–2.5). The cumulative probability (and 95% CI) was 2.5 months (1.5–2.5) for mental addiction, 2.5 (1.0–3.0) for smoking a whole cigarette, 4.5 (2.5–8.8) for cravings, 5.4 (3.8–9.7) for physical addiction, 8.8 (7.0–11.9) for monthly smoking, 11.0 (6.4–16.8) for withdrawal symptoms, 13.0 (10.3–20.5) for tolerance, 19.4 (14.5–31.7) for weekly smoking, 19.5 (14.0–23.9) for lifetime total of 100 cigarettes, 23.1 (19.7–37.6) for daily smoking and 40.6 (35.1–56.0) for conversion to tobacco dependence. Interpretation: Symptoms of nicotine dependence develop soon after first puff and can precede monthly, weekly and daily smoking. Cessation interventions that manage dependence symptoms may be needed soon after first puff.

The analysis reported in this paper was conducted to further explore initially negative findings of a study intended to help orient the development, implementation, and evaluation of smoking cessation programs for junior college students. A total of 69 students (39 males and 30 females) participated in nine focus group discussions held at one French-speaking and one English-speaking college in central Montreal. Three groups consisted of ex-smokers, and the remainder were current smokers. Group participants were asked to react to a series of proposed smoking cessation interventions identified from the literature. Qualitative analysis was undertaken of verbatim transcriptions of five of the focus group discussions, with input from the four others. Second-level analysis of the focus group data suggested that the students' reactions to proposed smoking cessation interventions could be understood using Eriksonian developmental theory, in particular how the cessation programs could contribute to the process of consolidating personal and social identity. Implications for the design of cessation programs were then identified. The results of these exploratory analyses suggested that to attract and maintain participation of college students, smoking cessation interventions should not necessarily be centered on smoking but rather (a) provide opportunities and support for exploration of, and commitment to, personal and social identities that exclude smoking, (b) target naturally occurring social groups while responding to students' needs for social support and validation, and (c) help students cope with stress and life demands and not add to these.

Oculo-respiratory syndrome (ORS), a new influenza vaccine associated adverse event, was identified in 2000. The 2000 case definition (ORS-2000) required the presence of bilateral red eyes or respiratory symptoms or facial edema occurring between 2 and 24h following immunization and lastingor=48 h. We compared clinical manifestations of cases outside these timelines. Cases were classified as ORS-early (onset2 h after immunization), ORS-late (onset24 h), ORS-persistors (duration48 h).Overall, the distribution of symptoms was similar between ORS-2000 and other case categories. ORS-early and ORS-late had less ocular involvement, ORS-late and ORS-persistors had more cough and sore throat, ORS-early had more facial edema and ORS-late had less. In comparison to ORS-2000, ORS-early were younger whereas ORS-persistors and ORS-late were significantly older suggesting that clinical manifestations of ORS vary with age with a more rapid induction of symptoms in younger individuals and longer duration for older ones.

We assessed the occurrence of oculo-respiratory syndrome (ORS) following two influenza vaccines: Fluviral (Shire Biologics) or Vaxigrip (Aventis Pasteur). ORS was identified amongst 5.3 and 4.6% of recipients, respectively (P=0.54). With both vaccines, the risk of ORS was much greater in individuals who had ORS the previous year (2000) than in those without such history. In multivariate analysis, the odds ratio for ORS for patients with a prior history of ORS varied between 9.4 and 9.6 (P

ObjectiveTo develop and encourage the adoption of clinical practice guidelines (CPGs) for smoking cessation in Canada by engaging stakeholders in the adaptation of existing high-quality CPGs using principles of the ADAPTE framework.MethodsAn independent expert body in guideline review conducted a review and identified six existing CPGs, which met a priori criteria for quality and potential applicability to the local context. Summary statements were extracted and assigned a grade of recommendation and level of evidence by a second expert panel. Regional knowledge exchange brokers recruited additional stakeholders to build a multidisciplinary network of over 800 clinicians, researchers and decision-makers from across Canada. This interprofessional network and other stakeholders were offered various opportunities to provide input on the guideline both online and in person. We actively encouraged end-user input into the development and adaptation of the guidelines to ensure applicability to various practice settings and to promote adoption.ResultsThe final guideline contained 24 summary statements along with supporting clinical considerations, across six topic area sections. The guideline was adopted by various provincial/territorial and national government and non-governmental organisations.ConclusionsThis method can be applied in other jurisdictions to adapt existing high-quality smoking cessation CPGs to the local context and to facilitate subsequent adoption by various stakeholders.

The Nicotine Dependence in Teens (NDIT) study is a prospective cohort investigation of 1294 students recruited in 1999–2000 from all grade 7 classes in a convenience sample of 10 high schools in Montreal, Canada. Its primary objectives were to study the natural course and determinants of cigarette smoking and nicotine dependence in novice smokers. The main source of data was self-report questionnaires administered in class at school every 3 months from grade 7 to grade 11 (1999–2005), for a total of 20 survey cycles during high school education. Questionnaires were also completed after graduation from high school in 2007–08 and 2011–12 (survey cycles 21 and 22, respectively) when participants were aged 20 and 24 years on average, respectively. In addition to its primary objectives, NDIT has embedded studies on obesity, blood pressure, physical activity, team sports, sedentary behaviour, diet, genetics, alcohol use, use of illicit drugs, second-hand smoke, gambling, sleep and mental health. Results to date are described in 58 publications, 20 manuscripts in preparation, 13 MSc and PhD theses and 111 conference presentations. Access to NDIT data is open to university-appointed or affiliated investigators and to masters, doctoral and postdoctoral students, through their primary supervisor ( www.nditstudy.ca ).

Background. Despite the cost-effectiveness of physician smoking cessation counseling, many physicians do not adhere to current clinical practice guidelines. Methods. A cross-sectional mail survey was conducted in a random sample of general practitioners in Montreal to document cessation-counseling practices and identify correlates of these activities. Results. Of 440 eligible general practitioners, 337 (77%) completed the questionnaire. Despite favorable beliefs/attitudes about cessation counseling, only 10.5% of general practitioners provided “thorough” counseling. While high proportions of general practitioners ascertained smoking status and encouraged patients to quit, relatively few offered adjunct support (i.e., for patients preparing to quit, 49.8% offered follow-up visits; 42.5% offered educational material; 20% referred patients to community resources). Correlates of counseling completeness included high self-efficacy to provide counseling (odds ratio (OR) = 2.0, 95% confidence interval (1.1–3.6)) and favorable beliefs/attitudes about counseling (OR = 3.6 (2.0–6.4)). Correlates of ascertaining smoking status included female gender (OR = 2.3 (1.5–3.5)), high self-efficacy (OR = 3.5 (2.0–5.9)), and favorable beliefs/attitudes (OR = 2.7 (1.6–4.5)). Correlates of offering adjunct support included female gender (OR = 1.9 (1.1–3.2)), awareness of stages of change (OR = 2.4 (1.3–4.4)), and knowledge of community resources to help patients quit (OR = 2.3 (1.3–3.9)). Conclusion. Support, training, and intervention programs to overcome lack of awareness and knowledge, unfavorable beliefs/attitudes, and low self-efficacy could increase and enhance cessation counseling practices among general practitioners.

INTRODUCTION To determine if smoking cessation counseling practices and related psychosocial characteristics improved among pharmacists between 2005 and 2010. METHODS Data were collected in 2005 and 2010 from randomly selected pharmacists in Quebec, Canada. Participants completed mailed self-report questionnaires on cessation counseling practices and psychosocial characteristics (i.e., belief that counseling is the role of pharmacists, self-efficacy, barriers, and knowledge of community resources). The association between each of year and training (either during or after undergraduate studies) and each outcome was investigated in each sex separately with multiple linear regression models using pooled data across 2005 and 2010. RESULTS Among female pharmacists, cessation counseling for patients ready to quit improved over time. Training during and after undergraduate studies was significantly associated with higher self-efficacy, better knowledge of community resources, and improved counseling for patients ready and not ready to quit. Also, training after studies was significantly associated with more advantageous beliefs about counseling. Among male pharmacists, knowledge of community resources and perceived barriers to counseling improved over time, but there were no significant differences in cessation counseling. Training during and after undergraduate studies was significantly associated with higher self-efficacy. Training during undergraduate studies was also associated with higher counseling score in patients ready to quit, and training after studies was associated with better knowledge of community resources. CONCLUSION Smoking cessation counseling for patients ready to quit improved from 2005 to 2010 among female pharmacists but not among male pharmacists. Training is generally associated with improved counseling and improved cessation-related psychosocial characteristics.

This study describes student perceptions of school staff smoking before and after implementation of legislation prohibiting smoking on school grounds. Students completed self-report questionnaires before (grade 6) and after (grade 7, 9 and 11) the law. The percentage of students reporting that school staff smoked in areas where smoking is forbidden was 19%, 32% and 33% in grade 7, 9 and 11, respectively. The mean(SD) score for the frequency with which students saw school staff smoking decreased after the ban but increased thereafter [2.5(1.1), 1.9(1.0), 2.4(1.1) and 2.3(1.1)] in grade 6, 7, 9 and 11, respectively [ F (2.861,1662.229) = 45.350, P < 0.001]. These data suggest that the effect of the law dissipated over time.

OBJECTIVE: We assessed whether smoking cessation counseling practices and related psychosocial characteristics among respiratory therapists (RTs) improved between 2005 and 2010. METHODS: Data were collected in mailed self-report questionnaires in 2005 and in 2010, in random independent samples of active licensed RTs in Quebec, Canada. RESULTS: The response proportion was 67.6% in 2005 and 59.9% in 2010. There were no substantial differences in mean cessation counseling scores according to year of survey. RTs who reported that they had received cessation counseling training during their studies or after their studies (when they were in practice) had statistically significantly better counseling practices for both patients ready and patients not ready to quit than untrained RTs. In addition, their self-efficacy to provide effective counseling was higher and they perceived fewer knowledge-related barriers to cessation. Further, RTs trained after their studies perceived fewer patient-related and time barriers to cessation counseling, and had better knowledge of community resources. CONCLUSIONS: Although the proportion of RTs trained in smoking cessation counseling during and after studies increased between 2005 and 2010 (from 3% to 14%, and from 17% to 29%, respectively), sustained efforts are needed to increase the number of trained RTs, so that this translates into positive observable changes in counseling practices.

Objectives: To describe levels of tobacco control “effort” in public health organizations across provinces, and to test the hypothesis that “effort” is associated with the prevalence of daily smoking. Methods: Data were drawn from a national survey (Oct 2004-Apr 2005) of all public health organizations engaged in chronic disease prevention in Canada in 2004. We investigated the association between “effort” and decline in smoking prevalence (CTUMS, 1999-2009) across provinces in an ecologic study design. “Effort” was assessed using two indicators: percent of public health organizations engaged in tobacco control, and mean level of involvement in engaged organizations. Results: Of 216 organizations, 88% had undertaken tobacco control activities in the three years prior to data collection and were categorized as “engaged”. Level of involvement in tobacco control was highest in community-at-large settings; and it was generally higher for population- than for individual-level strategies. Nova Scotia reported higher levels of involvement than other provinces. There was substantial variability in “effort” across provinces. High-”effort” provinces (BC, NS, ON, QC) experienced, on average, improvement in the “change in smoking prevalence” score (1999 to 2009). Conclusion: The findings provide evidence that provincial tobacco control “effort” relates to declines in smoking prevalence. Given that smoking remains a critical public health issue, the kinds of data reported herein are needed to inform the debate on how best to invest in tobacco control infrastructure to combat the most important public health threat of our times. Key words: Tobacco control; public health; organizational survey; ecologic study; Canada

The Diagnostic and Statistical Manual diagnostic criteria for nicotine dependence (DSM-ND) are based on the proposition that dependence is a syndrome that can be diagnosed only when a minimum of 3 of the 7 proscribed features are present. The DSM-ND criteria are an accepted research measure, but the validity of these criteria has not been subjected to a systematic evaluation. To systematically review evidence of validity and reliability for the DSM-ND criteria, a literature search was conducted of 16 national and international databases. Each article with original data was independently reviewed by two or more reviewers. In total, 380 potentially relevant articles were examined and 169 were reviewed in depth. The DSM-ND criteria have seen wide use in research settings, but sensitivity and specificity are well below the accepted standards for clinical applications. Predictive validity is generally poor. The 7 DSM-ND criteria are regarded as having face validity, but no data support a 3-symptom ND diagnostic threshold, or a 4-symptom withdrawal syndrome threshold. The DSM incorrectly states that daily smoking is a prerequisite for withdrawal symptoms. The DSM shows poor to modest concurrence with all other measures of nicotine dependence, smoking behaviors and biological measures of tobacco use. The data support the DSM-ND criteria as a valid measure of nicotine dependence severity for research applications. However, the data do not support the central premise of a 3-symptom diagnostic threshold, and no data establish that the DSM-ND criteria provide an accurate diagnosis of nicotine dependence.

OBJECTIVES: Since October 2000, the nicotine patch, nicotine gum and bupropion have been reimbursed under Quebec’s public drug insurance plan. The objective of this study is to describe use of these medications between October 2000 and December 2004 by smokers covered by the public plan, as well as the costs of reimbursing these medications. METHODS: Data from the Régie de l’assurance maladie du Québec were used to analyze prescriptions for smoking cessation medication issued to persons insured under the public drug insurance plan. RESULTS: Between October 1, 2000, and December 31, 2004, more than 300,000 Quebeckers covered by the public drug insurance plan were reimbursed for smoking cessation medications. This corresponds to a yearly average of 14% of all smokers insured under the public plan. The proportion of employment assistance recipients who used these medications was higher than the proportion of seniors or “other“ insurance plan participants. Nicotine patches were the treatment of choice for most users. A total of $55 million was reimbursed by the public drug insurance plan for the nicotine patch, nicotine gum and bupropion over this four-year period. CONCLUSION: The reimbursement provisions put in place in Quebec in 2000 were successful in reaching financially disadvantaged smokers, at a cost that was comparable with other effective smoking cessation services.

Aims Widely varying estimates of treatment effects have been reported in randomized controlled trials (RCTs) investigating the efficacy of behavioural interventions for smoking cessation. Previous meta-analyses investigating behavioural interventions have important limitations and do not include recently published RCTs. We undertook a meta-analysis of RCTs to synthesize the treatment effects of four behavioural interventions, including minimal clinical intervention (brief advice from a healthcare worker), and intensive interventions, including individual, group, and telephone counselling. Methods and results We searched the CDC Tobacco Information and Prevention, Cochrane Library, EMBASE, Medline, and PsycINFO databases. We included only RCTs that reported biochemically validated smoking cessation outcomes at 6 and/or 12 months after the target quit date. Outcomes were aggregated using hierarchical Bayesian random-effects models. We identified 50 RCTs, which randomized n = 26 927 patients (minimal clinical intervention: 9 RCTs, n = 6456; individual counselling: 23 RCTs, n = 8646; group counselling: 12 RCTs, n = 3600; telephone counselling: 10 RCTs, n = 8225). The estimated mean treatment effects were minimal clinical intervention [odds ratio (OR) 1.50, 95% credible interval (CrI) 0.84–2.78], individual counselling (OR 1.49, 95% CrI 1.08–2.07), group counselling (OR 1.76, 95% CrI 1.11–2.93), and telephone counselling (OR 1.58, 95% CrI 1.15–2.29). Conclusion Intensive behavioural interventions result in substantial increases in smoking abstinence compared with control. Although minimal clinical intervention may increase smoking abstinence, there is insufficient evidence to draw strong conclusions regarding its efficacy.

To describe gender differences in smoking cessation counseling practices among general practitioners (GPs), and to investigate the association between training for cessation counseling and counseling practices according to gender.Data were collected in two cross-sectional mail surveys conducted in independent random samples of GPs in Montreal, the first in 1998, and the second in 2000.Respondents included 653 GPs (71% of 916 eligible). All indicators of smoking cessation counseling practices were more favorable among female GPs. Higher proportions of female GPs had received training (28% vs. 17%, p=0.002), and were aware of mailed print educational materials related to cessation counseling (81% vs. 57%, p0.0001). Training among male GPs was associated with higher scores for ascertainment of smoking status (odds ratio (OR) (95% confidence interval)=1.69 (0.97, 2.96)), provision of advice (OR=2.20 (1.23, 3.95)), and provision of adjunct support (OR=2.86 (1.58, 5.16)). Training was not associated with counseling practices among female GPs.Female GPs may not benefit from formal cessation counseling training to the same extent as male GPs, possibly because they read and integrate the content of (easily available) print educational materials into their clinical practice to a greater extent than male GPs. The gender-specific impact of print educational material and formal training on cessation counseling should be evaluated among GPs.

Background: Oculo-respiratory syndrome (ORS) following influenza vaccination was identified in Canada in 2000. This report describes trends of ORS reported during four consecutive seasons 2000, 2001, 2002 and 2003 in the province of Quebec, Canada. Methods: Data come from the vaccine-associated adverse event (VAAE) passive reporting system of the Province of Quebec. Results: The rate of ORS reported per 100 000 doses distributed declined from 46.6 in 2000 to 34.2, 20.6 and 9 in 2001, 2002 and 2003, respectively. There was no significant difference in rates for ORS between the two vaccines in use in Canada (Fluviral and Vaxigrip) both in 2001 and 2002. During the 4 years, incidence was highest in people aged 40–59 years and declined in older age groups. The clinical profile of ORS has remained remarkably stable over years. Overall, ocular, respiratory symptoms or facial edema were reported by 58%, 84% and 31% of patients, respectively, and 15% had symptoms including all three symptom categories. ORS lasted more than a week in 8–13% of the cases. Conclusion: ORS is an adverse event that occurred with both influenza vaccines used in Canada. Its frequency has declined substantially but is still present after 4 years. It constitutes a clinical entity distinct from anaphylactic allergy. Unlike anaphylaxis, ORS does not constitute an absolute contraindication to further doses.

Background Primary care physicians are potentially important sources of interventions aimed at preventing youth smoking. Yet recent surveys suggest that physician smoking prevention practices are less than optimal. Objectives To document prevention counseling practices and to identify correlates of these activities in a random sample of general practitioners in Montreal, Quebec. Methods A cross-sectional mail survey. Results Of 440 eligible general practitioners (GPs), 337 (77%) completed the questionnaire. General practitioners were more likely to ascertain the smoking status of adolescents (70.9%) than preadolescents (35.7%). Although about half of the GPs offered advice to prevent smoking onset in young adults (48.6%) and adolescents (48.3%), fewer did so for preadolescents (34.4%); only 12.1% advised parents to discuss smoking onset with their children. Correlates of ascertaining smoking status included female sex (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.07-3.41), lower proportion of walk-in patients (OR, 2.73; 95% CI, 1.31-5.80), awareness of the "stage of behavior change'' model (OR, 2.17; 95% CI, 1.18-4.04), and higher self-efficacy (OR, 4.12, 95% CI, 2.00-8.69). Correlates of provision of prevention advice included more hours spent in direct patient care (OR, 1.93; 95% CI, 1.13-3.34), favorable beliefs and attitudes (OR, 1.73; 95% CI, 1.06-2.83), and higher self-efficacy (OR, 4.32; 95% CI, 2.25-8.44). Conclusions Our results point to the need for renewed efforts to enhance preventive efforts in primary care settings. Intervention programs for GPs should emphasize overcoming unfavorable beliefs and attitudes and low self-efficacy. Future research should evaluate the effect of brief prevention counseling adapted to increasingly busy practices.

The aims were to explore adolescent smokers' understanding and their physiological and psychological experience of addiction to nicotine and to assess the content validity of the Hooked on Nicotine Checklist (HONC), a 10-item measure of nicotine dependence in youth. Six focus group interviews were conducted with male and female smokers recruited by school staff from among known smokers at one English and two French high schools in Montreal. Participants were 64 high-school students aged 14-17 years. Measurements were focus group discussion of smoking patterns and levels for self and others; feelings and sensations while smoking; physical and mental experiences of urges, feelings and sensations when smoking is prohibited; the physical, psychological, and social meanings of being hooked, dependent, or addicted; levels of dependence, desire to quit, and quit attempts. Participants readily identified nicotine dependence as relevant to their smoking experience. Dependence was described as the need to smoke, sometimes experienced as sensations of emptiness in the chest or blood and sometimes as a feeling in the mind. Smoking urges were often situationally determined and associated with hunger. With the exception of feeling sad, blue, or depressed on smoking withdrawal, participants endorsed almost all the symptoms in the HONC as relevant to their experience of dependence and identified several other symptoms as well. Adolescents are able to provide self-reports of symptoms of dependence that are consistent with a theoretically driven conceptualization of nicotine dependence. The HONC demonstrates content validity among adolescents but could be improved through removal of the item related to depression on withdrawal and possibly addition of items related to stress and appetite.

The aim of this paper is to present results which illustrate the role of the PRECEDE-PROCEED model in the program planning process. Based on the results of an implementation evaluation of the EMPOWER software which supports health programming efforts, we have developed a metaphore to illustrate the use of the model. The following four functions of the model were identified: direction, coordination, articulation and transmission. Analysis of these functions demonstrated the structuring action of the model on planning. It would be interesting to further study how these four functions operate with or without the support of the software, to explore the influence of other health promotion models in their natural settings and to see in which way the same or other functions might be identified.

To develop effective interventions in the Fabreville Heart Health Program, a behavioral diagnosis was conducted on a sample of 1,600 men 30 to 60 years of age residing in the Fabreville district of Laval, Quebec's second most populous city. The response rate of the self-administered postal questionnaire was 73.5%. The results indicate that dietary fat consumption, smoking and a sedentary lifestyle were more prevalent among the younger respondents, particularly those less-educated. The results underline the importance of segmenting the target population so that heart health interventions can respond to the specific needs of each sub-population. Furthermore, the data seem to suggest the need to adapt educational messages to the target lifestyle habits. The results showed that in terms of diet, consumption of meat and dairy products contributed the most to fat intake. Of the 30% who were smokers, a large proportion would be reluctant to stop the habit; 20% smoked 26 cigarettes or more a day, and more than half had already tried once or more to stop. Although 60% of respondents indicated they engared in physical activity, only 37.0% did it regularly. These results demonstrate the need to clearly target specific behaviours and subgroups in our promotion messages for a healthy heart.

Citation suggérée : Anses (2021). Clostridium botulinum : mise à jour des connaissances sur les différentes formes des types C, D, mosaïque C/D et D/C et E. (saisines 2019-SA-0112 à 2019-SA-0115). Maisons-Alfort : Anses, 170 p; Le botulisme est une maladie neurologique humaine et animale, le plus souvent d’origine alimentaire, provoquée par l’action de neurotoxines bactériennes (toxines botuliques) produites par des bactéries du genre Clostridium et qui se manifeste par des paralysies flasques pouvant aller jusqu’à la paralysie respiratoire et l’arrêt cardiaque. Il existe neuf types de toxines botuliques. Les différents types se répartissent en une quarantaine de sous-types.Chez l’être humain, en France, le botulisme est à déclaration obligatoire depuis 1986. Les cas de botulisme sont majoritairement associés aux types B et A et de manière plus exceptionnelle aux types F et E. Il s’agit d’une maladie rare, avec une incidence en France de 11 à 22 cas/an (période 2013-2016, source Santé Publique France - SPF).Le botulisme animal en France concerne essentiellement les oiseaux (sauvages et domestiques) et les bovins. Les cas chez les bovins sont dus aux types mosaïque D/C (majoritaire), C, mosaïque C/D et rarement D. Au niveau national, l’incidence sur les 10 dernières années est en moyenne d’une dizaine de foyers par an. Chez les oiseaux, les types toxiniques en cause sont C, D, mosaïques C/D et D/C et exceptionnellement le type E. Au niveau national, l’incidence est d’environ 25 foyers par an (volailles et avifaune confondues), avec cependant des variations annuelles parfois notables, comme en 2007 (121 foyers décelés) et 2008 (102 foyers).Une sous-estimation est probable, quelle que soit l’espèce animale envisagée, mais surtout pour l’avifaune3 (sauvage et non captive) où la détection des cadavres d’oiseaux est plus difficile.Bien qu’il s’agisse d’un danger sanitaire de première catégorie en santé animale, il n’y a pas à l’heure actuelle de mesures de police sanitaire établies par la règlementation, lors de la confirmation d’un foyer de botulisme animal, ce qui conduit à une gestion au cas par cas par les directions départementales de la protection des populations (DDPP) et la Mission des Urgences Sanitaires (MUS) de la Direction générale de l’Alimentation. Ces services peuvent s’appuyer sur deux documents émis par l’AFSSA : le rapport sur le botulisme animal établi en 2002 et l’avis rendu en janvier 2009 sur un projet d’arrêté fixant des mesures techniques et administratives relatives à la lutte contre le botulisme aviaire. Ce projet d’arrêté n’a pas été finalisé par le ministère. Les rapports et avis cités étant relativement anciens, la Direction générale de l’Alimentation a saisi l’Anses à la fin du mois de juin 2019 via 4 saisines (saisines 2019-SA-0112 à 2019-SA-0115), dont l’objet est une demande d’actualisation des connaissances et des évaluations de risque pour la santé humaine et/ou animale.