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Resume Contexte Cet article discute certaines des ambiguites et contradictions attachees a la definition actuelle de l’hesitation vaccinale. Methode Revue de litterature. Resultats L’hesitation vaccinale designe des comportements de refus de certains vaccins ou leur realisation avec retard dans un contexte ou les services de vaccination fonctionnent. Cette notion est souvent utilisee pour qualifier une categorie heterogene de personnes avec des degres et des motifs varies d’indecision relatifs aux vaccins. Cette heterogeneite ne facilite pas cependant la recherche sur la comprehension de ces phenomenes ni la conception d’interventions pour y remedier. En complement des travaux du groupe de travail SAGE de l’OMS sur l’hesitation vaccinale, nous proposons un cadre theorique base sur certaines des caracteristiques des societes contemporaines qui ont ete mises en evidence par Anthony Giddens et Ulrich Beck. Nous proposons de considerer l’hesitation vaccinale comme un processus de decision influence par la confiance que les personnes placent dans les autorites de sante et la medecine classique et leur degre d’engagement dans le « santeisme » (propension a controler ses comportements de sante pour augmenter son esperance de vie, en utilisant les informations officielles sur la sante). Conclusion Cette approche ouvre de nouvelles perspectives de recherche car, par exemple, elle permettra d’etudier les liens entre differentes formes d’hesitation vaccinale et le statut socio-economique des personnes. Elle sera testee a partir de donnees qualitatives et quantitatives recueillies en population francaise.

Resume Objectif de l’etude L’exposition au radon constitue un risque majeur en sante environnementale, restant mal connu de la population generale. Il s’agit notamment de la seconde cause de cancer du poumon apres le tabagisme. L’objectif de cette enquete transversale retrospective etait de dresser un etat des lieux de la connaissance du radon en tant que tel et en tant que facteur de risque, et d’etudier les differents facteurs sociaux qui y sont associes. Materiel et methodes Le Barometre cancer 2010 a interroge la population francaise. Il s’agissait d’une enquete realisee du 3 avril 2010 au 7 aout 2010 par collecte assistee par telephone et informatique, reposant sur un echantillonnage aleatoire a deux degres de 3359 individus âges de 15 a 75 ans. Resultats Le radon restait encore largement meconnu du grand public, y compris dans les departements identifies comme concernes par ce risque. Parmi les personnes âgees de 15 a 75 ans, seule une sur cinq savait que le radon est un gaz naturel provenant du sol. Cette connaissance s’est averee plus frequente parmi les personnes residant dans un departement concerne par le risque du au radon, parmi les hommes et progresse avec l’âge, le niveau de diplome et le niveau de revenu. Lorsque les personnes se trouvaient confrontees a l’exposition au radon, peu envisageaient d’y remedier par des travaux. Conclusion La reussite d’actions de prevention implique l’adhesion et la collaboration des differents acteurs nationaux et locaux intervenant sur ce sujet. Afin d’ameliorer leur impact pour la prevention des cancers du poumon, il pourrait etre plus efficace de coupler ces actions avec des messages de prevention sur le tabac.

This study investigated patterns of HIV disclosure to significant others (parents, siblings, children, other relatives, friends and colleagues) and describe them in terms of socio-demographic background and other characteristics, including experiences of AIDS-related discrimination. It also assessed the relationship between disclosure patterns and adherence to HAART. We used a cross-sectional survey conducted among a national representative sample of 2,932 HIV-infected people recruited in French hospitals. HIV disclosure patterns were both selective and cumulative: disclosure was more frequent for friends and siblings, while concealment prevailed concerning children, other relatives, and colleagues; but patients who disclosed their seropositivity to one significant other were also more likely to disclose it to other significant others. Patients reporting experiences of discrimination from sexual partners were less likely to be highly adherent, and we also found a significant relationship between uncontrolled disclosure and non-adherence. Patients who have opted for concealment probably consider non-adherence and uncontrolled disclosure as competing risks, but among them a significant minority loses on both counts. Counselling provided to HIV-infected people should not separate the adherence and disclosure issues, and adherence interventions should seek to help patients to manage concurrently disclosure/concealment of their seropositivity and its consequences.

Objective: This study aimed to examine factors associated with the prescription of opioid analgesics to terminal cancer patients, including physicians' general attitudes toward morphine and contextual factors.Methods: A survey was conducted among a sample of French general practitioners (GPs) and oncologists. Respondents were asked to describe the last three terminally ill patients they had followed up to death.Results: Overall, 526 GPs and oncologists (global response rate: 57%) described 1,082 cancer patients, among whom 85.4% received opioid analgesics. Among other significant predictors (patient age, cancer type, family assistance), this prescription was less frequent for female patients followed by male physicians (OR = 0.53), and more frequent for patients followed by physicians trained in palliative care (OR = 2.70). On the other hand, physicians' attitudes toward morphine were not associated with prescription of morphine and other opioid analgesics.Significance of results: Although nonprescription of opioid analgesics is only a crude proxy measure for undertreatment of cancer pain, our findings suggest the need to develop training in palliative care in order to standardize practices among GPs and specialists. Our results also highlight the necessity to study pain assessment as an interaction between the physician and the patient, and to consider patients' and physicians' respective genders as a key variable within this interaction.

Our goals were to describe beliefs held by French people concerning the contagiosity of influenza and analyze the relationship of these beliefs with vaccination against seasonal flu.A subsample (4749 people aged 15-79) of the Health Barometer 2010 responded to questions dealing with influenza. Responses were analyzed using clustering analysis and logistic regression.Overall, observed beliefs were quite good, but also socially differentiated. 'False' beliefs were more frequent among people with a lower socioeconomic status. Those who overestimated the contagiosity of influenza were less likely to have been vaccinated against seasonal influenza in 2008.The beliefs analyzed here were associated with vaccination behaviors. 'False' beliefs may be difficult to change as they are nevertheless coherent. These beliefs also exhibit social inequalities that should be taken into account when determining preventive measures.

Radon exposure is a major environmental risk in health. It remains badly known by the general population. It is the second cause of lung cancer, after tobacco smoking. The aim of this cross-sectional general population survey was to describe radon exposure risk knowledge and the socioeconomic factors related to this knowledge.The Cancer Barometer survey 2010 questioned the French population about its knowledge of radon as such and as health risk factor. This survey was a two-stage random sampling with computer-assisted telephone interview that was performed from April 3, 2010 to August 7, 2010 on a sample of 3,359 people aged 15 to 75 years old.Among people aged 15 to 75 years old, only one in five knows that radon is a natural gas coming from the ground. This knowledge is more frequent among people living in an area that is directly concerned by radon, among men and increases with age, with the level of education and the level of income. Radon risk remains still widely underestimated by the general public, including in areas concerned by this risk. When people were confronted with radon exposure, few intended to remedy by improving their home.The success of prevention initiatives implies the support and the collaboration of various national and local actors. To improve their impact for the prevention of lung cancers, it could be more effective to couple these actions with prevention messages on tobacco.

Chronic pain is one major determinant of quality of life among cancer survivors. It is especially true for breast cancer survivors, who frequently endure iatrogenic pain. We conducted in-depth interviews with 25 women recruited in the ELIPPSE cohort, 24 months after their diagnosis, and several months after the end of their treatment. These women gave various meanings to chronic pain (a transient condition, necessary for recovering, or a new and permanent condition) that contribute to 'normalize' pain and to prevent its alleviation. Moreover, health professional sometimes fuel this 'normalization' of pain. Our interviews also showed how participants enduring chronic pain tried to relieve it by adjusting their daily activities and gestures. Finally, our results emphasize both the lack of information given to patients concerning iatrogenic pain and the existing ways to manage it, and the lack of specific training for health professionals.

This study examined the prevalence and characteristics of attempted suicide among a representative sample of French Human Immunodeficiency virus (HIV) infected individuals. In 2003, a face-to-face survey was conducted among people living with HIV/AIDS (PLWHA) selected in a random, stratified sample of French hospital departments. Among solicited individuals, 2,932 agreed to participate and were asked if they had ever AS. Among the respondents, 23% had AS. Female gender, younger age, native French citizenship, reporting household financial difficulties, having been HIV-contaminated through homosexual contact or through injection drug use and suffering from lipodystrophy-related symptoms were all independently associated with AS. HIV-discrimination and the lack of social support from family remained independently associated with AS. Our findings indicate a high level of AS among PLWHA and emphasize the multiple roles of factors associated with living with HIV, together with sociodemographic factors. The results enable the possibility for vulnerable groups to be targeted for specific future interventions in order to prevent attempted suicide.

In France, drug use levels of college students remain quite unknown, mainly because of the lack of representative samples of this specific part of the population. There is also a lack of studies concerning gender and drug use.The Health barometer 2005 is a wide national telephone survey which is representative of the 12-75-year-olds (n=30,514). Among the 18-25-year-olds, 1290 students were surveyed, besides 1480 employed and 538 unemployed people. Various licit and illicit drug use levels of these three groups were compared using logistic regression models for men and women, controlling for age, level of diploma, category of area of residence, living in couple, religion and type of phone equipment. These results were compared with those obtained in the Health Barometer 2000, with exactly the same variables and definitions.Analysis showed that among women, alcohol and cannabis use as well as drunkenness were more frequent among unemployed and college students than among workers. For men, drug use, and especially illicit drug use, appeared more frequent among unemployed. As a consequence, gender differences for alcohol and cannabis use were lower among students than among workers or unemployed. For both sexes, logistic models controlling for age showed that alcohol consumption as well as daily tobacco smoking were less frequent among students than among employed people, contrarily to drunkenness and cannabis use. For almost all drug uses, differences between genders are smaller among students. Except for alcohol and tobacco use, these differences disappeared when controlling for other sociodemographic variables. Compared with data from year 2000, differences among the three groups appeared smaller, especially for drunkenness and cannabis smoking among college students.Alchol and tobacco uses are less frequent among students than active people, employed or not, but there is no significant difference for drunkenness and cannabis use. For both genders, unemployment is associated with increased levels of drug use, but pursuing higher education is associated with an increased level of alcohol and cannabis use among women, which is not the case among men.

This study aimed to assess the prevalence of cigarette, alcohol and cannabis consumption among top-ranked French student athletes aged between 16-24 years old, and to identify correlating factors. Overall, 837 athletes participated in the study (82% response rate). Among females, the amount and duration of sporting activity in which they were engaged on a weekly basis had a negative correlation to cigarette smoking and the occasional use of cannabis. Among males, however, a positive correlation of these factors was observed for cigarette smoking. Other determinants of alcohol, tobacco and cannabis use were the level of athletic competition and whether the athlete practiced a team sport (as opposed to an individual one), with some gender variations. Two major risk factors for young adult athletes were the existence of high psychological distress (for both sexes) and a lack of family support (particularly in the case of males). Further research is needed to investigate the specific motives to use so-called "recreational" drugs among young athletes engaging in high-level competition.

This study aimed to examine factors associated with the prescription of opioid analgesics to terminal cancer patients, including physicians' general attitudes toward morphine and contextual factors.A survey was conducted among a sample of French general practitioners (GPs) and oncologists. Respondents were asked to describe the last three terminally ill patients they had followed up to death.Overall, 526 GPs and oncologists (global response rate: 57%) described 1,082 cancer patients, among whom 85.4% received opioid analgesics. Among other significant predictors (patient age, cancer type, family assistance), this prescription was less frequent for female patients followed by male physicians (OR = 0.53), and more frequent for patients followed by physicians trained in palliative care (OR = 2.70). On the other hand, physicians' attitudes toward morphine were not associated with prescription of morphine and other opioid analgesics.Although nonprescription of opioid analgesics is only a crude proxy measure for undertreatment of cancer pain, our findings suggest the need to develop training in palliative care in order to standardize practices among GPs and specialists. Our results also highlight the necessity to study pain assessment as an interaction between the physician and the patient, and to consider patients' and physicians' respective genders as a key variable within this interaction.

To examine practitioners' opinions on palliative care.Statistical analyses were carried out on data collected from 1000 physicians recruited to participate in a study on knowledge, attitudes and practices with respect to palliative care ("Palliative Care 2002"). A cluster analysis (CAH) was conducted based on responses to nine questions in order to identify homogeneous and contrasting profiles of opinions on palliative care.Two distinctly different categories of profiles emerged. The first one had a restrictive approach to palliative care (n = 387; 38.7%), while the second one supported its expansion (n = 613; 61.3%).A newly revised communication campaign which favoured and recognised palliative care could assist in the dissemination of related practices among physicians.

Despite the introduction of HAART, pain is still a common symptom in people living with HIV/AIDS. For these persons, pain management supplied by palliative care teams may support standard HIV care. This study compares opinions toward palliative care of 83 HIV specialists and 217 oncologists (French national survey: Palliative Care 2002). Data were collected by phone questionnaire. A cluster analysis was carried out in order to identify contrasted profiles of opinions toward palliative care. A logistic regression was performed to test the relationships between identified clusters and physicians' characteristics. With a two-cluster partition, we observed a profile corresponding to a restrictive conception of palliative care. Within this profile, physicians were more prone to consider that palliative care should be used only for terminally-ill patients, and only after all curative treatments have failed, with a restrained prescriptive power for physicians providing palliative care. This conception was associated with reluctance toward morphine analgesia. Once controlled for other physicians' characteristics, HIV specialists were more likely than oncologists to endorse this restrictive conception (OR=1.9, CI 95% [1.1; 3.3]). Thus French HIV specialists should be more informed about the utility of providing palliative care, even for patients who are not in terminal stage.

This article aims to profile dissonant smokers (smokers who want to quit) from various viewpoints: smoking habits, reasons to quit, methods of quitting, health and socio-economic status.We used data from a random phone survey (n=13,685, people aged 12-75, including 2,715 dissonant smokers, interwiewed from November to December, 1999). A cluster analysis was performed in order to identify contrasted profiles of dissonant smokers.33.1% of French aged 12-75 were current smokers, and among them 58.7% were "dissonant smokers" (they want to quit). Five different profiles of dissonant smokers were studied. Two of them (representing 4 million people) gathered moderate and quite healthy smokers, with many previous smoking cessation attempts. They preferred cessation without medical help and they were not very afraid of smoking-related diseases. A third profile (representing two million people) gathered younger smokers, not really committed to quit since they postponed this project for at least one year, but sensitive to cigarette price. The last two profiles brought together smokers who were for the most part addicted to tobacco. They were also more willing to accept medical help in order to quit smoking. One of these profiles gathered smokers (representing one million people) who were very afraid of smoking-related diseases and affected by poor health and social handicaps.The variety of dissonant smokers profiles underlines the need to diversify action against tobacco. Moreover, we have to pay attention to the impact of recent fear-arousing media campaigns. They certainly increase awareness of smoking-related health damages. Nevertheless, concerning addicted smokers who already want to quit but are affected by poor health and social handicaps, such campaigns may only increase psychological distress.

Assess the attitude of the practitioners with regard to the management of patients at the end of their lives, depending on the physician/patient communication and treatment of pain. Method Statistical analysis of the data collected among 1,000 practitioners recruited for a survey on knowledge, attitudes and practices regarding palliative care in 2002.The practitioners who felt "ill at ease" in the management of patients at the end of their life often had a poor opinion regarding morphine and did not systematically their patients of the therapeutic aims.Greater awareness by the practitioners of palliative care would help to improve the quality of care supplied to terminally ill patients.