Gradient of vaccine hesitancy among French men having sex with men: An electronic cross-sectional survey in 2022

In developed countries, vaccinations against hepatitis B (HBV), hepatitis A (HAV), and human papillomavirus (HPV) are often recommended to men who have sex with men (MSM) because of the risky sexual practices in which some engage. Vaccine coverage against these diseases is not optimal in France, probably due in part to vaccine hesitancy (VH). The overall aim of this survey among MSM was to estimate the prevalence of different grades of VH for these vaccines as well as of general VH (toward any vaccine). The specific objectives were to study the sociodemographic correlates of MSM specific and general VH and its association with vaccine uptake. A cross-sectional electronic survey (February-August 2022) collected information from 3,730 French MSM about their perceptions of HBV, HAV, and HPV and their related vaccines, to construct "specific VH" variables. Information about their past vaccination behaviors for any vaccine was used to construct a "general VH" variable, based on the World Health Organization definition. Almost 90% of MSM showed moderate or high specific VH for HBV, HAV, and/or HPV, and 54% general VH. A higher education level and comfortable financial situation were associated with lower grades of specific and general VH. Younger age was associated with less frequent specific VH and more frequent general VH. Specific VH, versus general, was more strongly associated with frequent self-reported non-vaccination against these three disease. Addressing their concerns about vaccines, improving their knowledge of vaccine-preventable sexually transmitted infections, and motivating them to get vaccinated are public health priorities.

A postpartum intervention for vaccination promotion by midwives using motivational interviews reduces mothers' vaccine hesitancy, south-eastern France, 2021 to 2022: a randomised controlled trial

BackgroundDespite childhood vaccine mandates imposed in 2018 in France, parental vaccine hesitancy (VH) remains frequent. Interventions in Quebec, Canada, applying motivational interviewing (MI) techniques have successfully reduced parents' VH for childhood immunisations.AimTo determine whether MI intervention for mothers in maternity wards in the days after birth in France could significantly reduce VH, increase intentions to vaccinate (VI) their child at 2 months and reduce VH social inequalities.MethodsWe conducted a parallel-arm multicentre randomised controlled trial from November 2021 to April 2022 to compare impacts of MI performed by MI-trained midwives (intervention) vs a vaccination leaflet (control). We included 733 mothers from two maternity hospitals in south-eastern France, randomly assigned either arm. The validated Parents Attitudes about Childhood Vaccines questionnaire was used before and after MI or leaflet to assess mothers' VH (13 items, 0-100 score) and VI (1 item, 1-10 score). Difference-in-difference (D-I-D) models were used to estimate net impact of MI vs leaflet for the entire sample and stratified by VH and education level.ResultsMotivational interview intervention reduced mothers' VH score by 33% (p < 0.0001) and increased VI by 8% (p < 0.0001); the effect was largest for the highest initial VH levels. D-I-D analyses estimated net VH decrease at 5.8/100 points (p = 0.007) and net VI increase at 0.6/10 points (p = 0.005). Net VH decrease was highest for high initial VH levels and low education levels.ConclusionsOur results show positive effects of MI intervention, and means of its implementation should be investigated in France.

Motivational interview-based health mediator interventions increase intent to vaccinate among disadvantaged individuals

Coverage for recommended COVID-19 and diphtheria-tetanus-poliomyelitis (DTP) booster shots is often inadequate, especially among disadvantaged populations. To help health mediators (HMs) involved in outreach programs deal with the problems of vaccine hesitancy (VH) in these groups, we trained them in motivational interviewing (MI). We evaluated the effectiveness of this training among HMs on their MI knowledge and skills (objective 1) and among the interviewees on their vaccination readiness (VR) and intention to get vaccinated or accept a booster against COVID-19 and/or DTP (objective 2). Two MI specialists trained 16 HMs in a two-day workshop in May 2022. The validated MISI questionnaire evaluated HMs' acquisition of MI knowledge and skills (objective 1). Trained HMs offered an MI-based intervention on vaccination to people in disadvantaged neighborhoods of Marseille (France). Those who consented completed a questionnaire before and after the interview to measure VR with the 7C scale and intentions regarding vaccination/booster against COVID-19 and DTP (objective 2). The training resulted in HMs acquiring good MI skills (knowledge, application, self-confidence in using it). HMs enrolled 324 interviewees, 96% of whom completed both questionnaires. VR increased by 6%, and intentions to get vaccinated or update COVID-19 and DTP vaccination increased by 74% and 52% respectively. Nearly all interviewees were very satisfied with the interview, although 21% still had questions about vaccination. HMs assimilated MI principles well. MI use in outreach programs appears to show promise in improving vaccine confidence and intentions among disadvantaged people.

Effectiveness of a French mass-media campaign in raising knowledge of both long-term alcohol-related harms and low-risk drinking guidelines, and in lowering alcohol consumption

AIMS

To evaluate the effectiveness of a French mass-media campaign in raising knowledge of both long-term alcohol-related harms (LTH) and low-risk drinking guidelines (LRDG), as well as in lowering alcohol consumption.

DESIGN

An 8-month longitudinal survey from February to October 2019, with three waves of on-line data collection (T0 before the campaign, T1 just after it ended and T2 6 months after it ended).

SETTING

France.

PARTICIPANTS

A total of 2538 adult drinkers (aged 18-75 years).

MEASUREMENTS

The main outcomes' variables were LTH knowledge (cancer, hypertension, brain haemorrhage), LRDG knowledge (two guidelines: 'maximum of two drinks a day' and 'minimum of 2 days without alcohol per week'), intention to reduce alcohol consumption and self-declared consumption with respect to the French LRDG. At T1, exposure to the campaign was measured using self-reported campaign recall.

FINDINGS

In T1, we observed significant positive interactions between exposure group based on campaign recall and survey waves on knowledge of (i) the 'maximum two drinks a day' guideline [adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.08-1.62, P = 0.008], (ii) brain haemorrhage (aOR = 1.80, 95% CI = 1.44-2.25, P < 0.001) and (iii) hypertension (aOR = 1.41, 95% CI = 1.09-1.81, P = 0.008) risks. Campaign exposure was also associated with a significant decrease in at-risk drinking in women (aOR = 0.67, 95% CI = 0.50-0.88, P = 0.004). No significant interaction was observed at T1 for the knowledge of the 'minimum of 2 days without alcohol a week' guideline, or of cancer risk. At T2, no significant interaction was observed for the main outcomes' variables.

CONCLUSIONS

There appears to be an association between exposure to a 2019 French mass-media campaign to raise knowledge of long-term alcohol-related harms and low-risk drinking guidelines and reduce alcohol consumption and (i) improved knowledge of the 'maximum two drinks per day guideline', (ii) knowledge of the risks of hypertension and brain haemorrhage and (iii) a reduction in the proportion of people exceeding low-risk drinking guidelines (in the general population only). These associations were only observed over the short term and, in some cases, only for certain segments of the population.

Study protocol for a pragmatic cluster randomized controlled trial to improve dietary diversity and physical fitness among older people who live at home (the "ALAPAGE study")

BACKGROUND

Diet and physical activity are key components of healthy aging. Current interventions that promote healthy eating and physical activity among the elderly have limitations and evidence of French interventions' effectiveness is lacking. We aim to assess (i) the effectiveness of a combined diet/physical activity intervention (the "ALAPAGE" program) on older peoples' eating behaviors, physical activity and fitness levels, quality of life, and feelings of loneliness; (ii) the intervention's process and (iii) its cost effectiveness.

METHODS

We performed a pragmatic cluster randomized controlled trial with two parallel arms (2:1 ratio) among people ≥60 years old who live at home in southeastern France. A cluster consists of 10 people participating in a "workshop" (i.e., a collective intervention conducted at a local organization). We aim to include 45 workshops randomized into two groups: the intervention group (including 30 workshops) in the ALAPAGE program; and the waiting-list control group (including 15 workshops). Participants (expected total sample size: 450) will be recruited through both local organizations' usual practices and an innovative active recruitment strategy that targets hard-to-reach people. We developed the ALAPAGE program based on existing workshops, combining a participatory and a theory-based approach. It includes a 7-week period with weekly collective sessions supported by a dietician and/or an adapted physical activity professional, followed by a 12-week period of post-session activities without professional supervision. Primary outcomes are dietary diversity (calculated using two 24-hour diet recalls and one Food Frequency Questionnaire) and lower-limb muscle strength (assessed by the 30-second chair stand test from the Senior Fitness Test battery). Secondary outcomes include consumption frequencies of main food groups and water/hot drinks, other physical fitness measures, overall level of physical activity, quality of life, and feelings of loneliness. Outcomes are assessed before the intervention, at 6 weeks and 3 months later. The process evaluation assesses the fidelity, dose, and reach of the intervention as its causal mechanisms (quantitative and qualitative data).

DISCUSSION

This study aims to improve healthy aging while limiting social inequalities. We developed and evaluated the ALAPAGE program in partnership with major healthy aging organizations, providing a unique opportunity to expand its reach.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05140330 , December 1, 2021.

PROTOCOL VERSION

Version 3.0 (November 5, 2021).

General practitioners, pregnancy and addictions in France in 2015

Background

Tobacco smoking and alcohol drinking during pregnancy result in serious health hazard for both the baby and the mother. In France, about 17% of pregnant women smoke and 20% consume alcohol. General practitioners (GPs) can have an active role in preventing those behaviors as they often interact with pregnant patients: one quarter of French pregnant women have had at least one antenatal visit with a GP. The aim of our study is to describe French GPs’ practices (screening and counseling) toward pregnant patients regarding tobacco smoking and alcohol drinking.

Methods

In 2015, a telephone survey was set based on a stratified random sampling of metropolitan France GPs. A representative sample of 1,414 French GPs completed the study.

Results

Screening for alcohol consumption at least once for every patient was done by 61% of GPs and for smoking by 82% of GPs. Counselling to quit alcohol consumption was done by 77% of GPs while counselling to quit smoking was done by about 90% of them. GPs’ practices were significantly better among those who had more recent ongoing training. Regular drinkers GPs were less likely to systematically screen for alcohol use and GPs’ alcohol use frequency was adversely related to recommending quitting. Current and former smokers GPs were less likely to recommend quitting to pregnant patients smoking over 5 cigarettes per day.

Conclusions

Screening for alcohol use and smoking during pregnancy is not yet systematic among GPs in France. GPs’ prevention role with pregnant patients could be emphasized, potentially through initial and ongoing trainings adaptation. Besides, as regular alcohol use and smoking are related to unwanted practices, prevention for the benefit of GPs could be even more fruitful.

Key messages

Screening for alcohol use and smoking during pregnancy is not systematically done by French GPs. GPs’ prevention role with pregnant patients could be emphasized, potentially through initial and ongoing trainings adaptation.

Monitoring Fetal Alcohol Spectrum Disorder during the neonatal period in France

Background

Alcohol is a known teratogenic and foetotoxic agent. At birth, only the complete foetal alcohol syndrome (FAS) and at most a suspicion for some incomplete syndromic forms can be diagnosed. Yet, other Consequences of prenatal Alcohol Exposure (CAE) can also be observed and recorded in the neonatal period. Our goal was to describe the frequency of diagnosis codes for FAS and CAE at the national and regional level.

Methods

Between 2006 and 2013, we identified the ICM-10 codes Q860 (FAS) and P043 (CAE) in the hospital records for stays occurring in the 28 first days of life in the French national health insurance database (SNDS). Our “potential Foetal Alcohol Spectrum Disorders group” (pFASD), included the FAS and CAE subgroups. The pFASD prevalence was estimated per 1000 live births at the national and regional levels overall and then comparing: 2006-2009 and 2010-2013.

Results

From 2006 to 2013, 3207 neonates were diagnosed with pFASD during the neonatal period, i.e. 0.48 cases per 1,000 live births, including 0.07‰ of FAS. Between 2006-2009 and 2010-2013, pFASD remained stable (p = 0.6). At the regional level, the proportion of pFASD was the most frequent in one of the overseas territories (La Reunion Island, 1.22‰ births) and in the north-eastern part of mainland France (0.90 ‰ births to 1.02 ‰).

Conclusions

This study is the first to produce a national estimate of the frequency of neonatal diagnosis of FAS. It shows a stability of the frequency of pFASD cases recorded over the 2006-2013 period which is certainly underestimated but gives a first minimal estimate of the burden of alcohol use during pregnancy in France.

Key messages

Alcohol use during pregnancy remains a public health issue in France. Estimating the prevalence of FAS is of undeniable priority given the public health implications of these disorders that hinder the development of children exposed, and their avoidable nature.

Alcohol and cancer: risk perception among the French population

Key messages

Population’s beliefs to deny the cancer risks due to alcohol use are common in France. It’s necessary to adress public information about the risks of alcohol.

Building a social marketing Strategy to reduce alcohol-related harm in France

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.

[The impact of a mass media promotion campaign about youth addiction outpatient clinic visits]

AIM

By means of a personalized consultation with a professional, the Consultations Jeunes Consommateurs (CJC) provide the opportunity to young people and their family to take stock of the consumption level and a potential addiction. A mass-media promotion campaign of this service was released twice in 2015. This article aims to evaluate the impact of this campaign on the visibility of the CJC among adolescents' parents and on the access to CJC.

METHODS

Three sources were used: 1/ a study with three independent phases (before the campaign, after the first release, after the second one) by phone with 500, 500 and 531 parents and adolescents in order to evaluate the impact on the CJC visibility among the targets, 2/ the request data from the help line and web service (Drogues Info Service), connected to the campaign, to observe the evolution of profiles and numbers, 3/ a study of the CJC, gathering information from 3747 consultations, to compare profiles of consultants who came thanks to the campaign or not.

RESULTS

Before the campaign, 15.98% of parents had already heard of the CJC. After the releases, this part was unchanged among parents non-exposed to the campaign and greater than 60% among exposed parents. The other sources showed a greater implication of parents and a diversification of consultations' reasons.

CONCLUSION

The campaign offered an increase in awareness of the service among parents (the target audience). Secondary analyses suggest that the campaign has made the use of CJCs easier for parents, but also for cocaine users.

Effectiveness of a web-based intervention to reduce alcohol consumption among French hazardous drinkers: a randomized controlled trial

This study aims to evaluate the effectiveness of a web-based intervention to reduce alcohol consumption among hazardous drinkers. A two-group parallel randomized controlled trial was conducted among adults identified as hazardous drinkers according to the Alcohol Use Disorders Identification Test. The intervention delivers personalized normative feedback and some general information about alcohol. Participants can review their motivations and fears regarding reducing their alcohol intake, set individual goals and monitor their progress via a consumption diary and other tools. Within the control group, participants were provided with the same diary but could not access other services from the program. The primary outcome measure was the absolute difference in weekly alcohol intake (WAI) between baseline and 6-week follow-up. Secondary outcome measures included: relative difference in WAI; difference in excessive drinking and significant WAI reduction (decrease of 10% or more in WAI). One thousand one hundred and forty-seven people participated in the trial and 339 subjects completed it. Relative to the control group, participants in the intervention group reported a significantly greater mean absolute reduction in WAI (-3.3 versus -1.2, P = 0.03). Secondary outcomes also presented significant effects. This trial provides preliminary support to the effectiveness of this program in helping hazardous drinkers reduce their drinking, provided it is completely and regularly used.

[Parents support for the ban on television food advertising to children is particularly high in France, especially compared to the USA. This result should influence political decision-making to restrict food marketing targeting young people]

INTRODUCTION

Massive exposure of children to low-nutrient food advertising combined with the increasing prevalence of obesity have led to growing support for statutory regulations concerning food marketing targeting children. Food and advertising industries lobbies have nevertheless managed to stop such measures in many countries. In this context, civil society support for statutory regulation, especially by parents, is essential. The objective of this study was to describe and analyse factors associated with parents' opinion on the impact and possible banning of food TV advertisements targeting children.

METHODS

An online survey of 2,387 parents of children aged 3 to 17 was conducted in 2013. Associations between parents'opinion on food advertising and their socio-demographic characteristics were analysed by multivariate logistic regressions.

RESULTS

The influence of food advertising on children' preferences was perceived by 64.7% of parents, 68.8% of parents were at least occasionally asked by their children to purchase food or beverages seen on television, 43.5% reported that their children influenced their food purchases and 73.7% supported a statutory regulation that would ban advertisements for excessively fatty, salty and sugary beverages and foods during television programmes for children or teenagers. This view was positively associated with high socio-economic status and a high perceived impact of advertising on children's food preferences.

CONCLUSION

Parents support for the ban on television food advertising to children is particularly high in France, especially compared to the USA. This result should influence political decision-making to restrict food marketing targeting young people.

[Determinants of the intention to abstain from or reduce alcohol, tobacco or cannabis use among 15-25 year-olds]

OBJECTIVE

This study was designed to identify the sociodemographic and psychosocial factors (based on the theory of planned behaviour) associated with the intentions of young people to remain non-smokers and refrain from experimental cannabis use, and their intentions to reduce drinking during a party, quit smoking and reduce cannabis use among users.

METHODS

3,652 young people aged 15 to 25 years were interviewed by means of an on-line questionnaire. The sample was recruited from an internet access panel and constructed according to the quota method applied to the following variables: gender, age, region, habitat and head of family occupation.

RESULTS

Each of the psychosocial determinants {attitudes, norms and control) helped to explain the subject's intention not to smoke and/or use cannabis. The presence of a prohibition norm in the family was also associated with a decreased intention to experiment with cannabis. Among substance users, attitude determined the intention to quit or reduce the use of the three substances {tobacco, alcohol and cannabis) and control was involved in the intention to reduce drinking and quit smoking. Finally, norms only influenced the intention to reduce drinking during parties.

CONCLUSION

This study demonstrates the importance of considering psychosocial factors to explain health behaviours and to identify and propose interventions. These results support the priority given to smoking prevention, justify the value of early interventions and confirm the importance of considering social inequalities in health when developing prevention programmes.

Effects of alcoholic beverage control policies and contextual factors on alcohol consumption and its related harms in France from 1960 to 2000

Important social changes such as urbanization, increases in female education and employment, and increased incomes have occurred in France from 1960 to 2000 along with a major decrease in alcoholic beverage consumption (from 25 L pure alcohol per inhabitant 15 years and old to 13 L); especially due to wine consumption decrease. These changes in drinking patterns are associated with significant decreases in alcohol consumption-related harms (liver disease mortality and transport accident mortality). Several alcoholic beverage consumption control policy measures were also created during this period. This study explores the impact of these policies measure on alcohol consumption and alcohol consumption-related harms, adjusted with selected social changes. France's control policy has been associated, partially, with regressive effects on alcohol consumption but not on alcohol consumption-related harms. Study limitations are noted.

[Evidence-based and promising interventions to prevent alcohol use among youth: a literature review]

Although the annual average consumption of pure alcohol in France has decreased since the early sixties, some indicators of alcohol consumption among young people have increased over the past decade. This paper reviews the current knowledge of interventions aimed at preventing alcohol use among children and adolescents. The study used a standard protocol to identify and review the literature and to classify the selected interventions. Twenty-seven interventions were found to have an effect on youth alcohol consumption, including 6 aimed at children under 10 years of age, 9 aimed at young people aged 10-15 years, and 8 aimed at young people over 16 years. A further 4 interventions were designed to tackle the issue of alcohol supply. Most of the interventions (17) target the general population. The study also found that many interventions aimed at children or adolescents involve parent participation. This review demonstrates the complementarity of interventions targeting individuals and those aimed at tackling alcohol supply. It also highlights potential synergies through interventions with an impact on youth alcohol consumption but also on other substance uses and on mental health.