Health-related quality of life 1 year after a large-scale industrial fire among exposed inhabitants of Rouen, France: 'The Post Fire 76 Health' study.

BACKGROUND: A large-scale industrial fire occurred in Rouen, France, in 2019. This study assessed the health-related quality of life of people exposed to its consequences 1 year later. METHODS: The study population comprised inhabitants of the exposed area and a non-exposed area. A representative sample was randomly selected using a stratified design. Data were collected using a standardized questionnaire to describe fire exposure and to calculate three health-related quality of life scores according to the SF12-v2 scale. After adjustment, descriptive and multivariate analyses were conducted. RESULTS: The sample comprised 4773 participants (response rate 47.7%). In the exposed area, the average mental, physical and overall health scores were 47.5, 52.0 and 73.8 out of 100, respectively. Mean mental and overall health scores were higher in the non-exposed area (49.0 and 76.0, respectively). After adjustment, a lower mental health score was associated with a higher number of perceived types of exposure, reaching -3.72 points [-5.41; -2.04] for five or more different types of perceived exposure. A lower mental health score was associated with soot deposits (-1.04 [-1.70; -0.39]), perceiving odours [(-2.04 [-3.22; -0.86]) up to the day of data collection], and having seen, heard or been awakened by the fire (-1.21 [-1.90; -0.52]). A slightly lower physical health score was associated with soot deposits (-0.57 [-1.07; -0.08]). CONCLUSION: This study highlighted associations between exposure to the consequences of the industrial fire in Rouen and a deterioration of perceived health-related quality of life 1 year later, particularly the mental health dimension.

Patterns of Accidental and Intentional Alcohol Intoxication Initiation among French Young Adults: A Survival Analysis.

Background: The aim of the study was to explore patterns of accidental and intentional intoxication among French young adults who use alcohol. Methodology: The study draws on data from the 2017 French Health Barometer. Cox proportional hazards models were used to explore the factors associated with accidental and intentional alcohol intoxication initiation. Covariates studied were gender, age, employment status, consultation for mental health problems, depression lasting at least two weeks in the past 12 months, and previous tobacco or cannabis use as time-dependent variables. Results: Women accounted for 50.4% of our sample, and the mean age of respondents was 29.2 (standard deviation = 6.3). The prevalence of lifetime accidental intoxication among alcohol users was 77.0% and 17.3% for intentional intoxication. Kaplan-Meier analyses showed that the first intentional intoxication experience occurred later than the first accidental intoxication. Factors associated with accidental intoxication initiation in multivariate analyses were: male gender, age under 30, previous use of tobacco and cannabis, experiencing depression that lasted at least two weeks in the past 12 months, and having consulted for mental health problems in the past 12 months. Economically inactive people and students had a lower risk of experiencing accidental intoxication than those who were employed. Similar correlates were found for intentional intoxication, but being economically inactive was more strongly associated with intentional intoxication initiation. Conclusions: These results suggest the strong potential for alcohol consumption to become hazardous, particularly if tobacco or cannabis are also used. Prevention programs on alcohol must target consumers at the earliest stage and integrate other substances often used in a festive context.

Sleep, substance misuse and addictions: a nationwide observational survey on smoking, alcohol, cannabis and sleep in 12,637 adults.

For a good night's sleep, we consensually recommend avoiding alcohol, smoking and drugs. However, these addictions are highly prevalent in the general population, and it is difficult to estimate their real impact on sleep. The aim of this study is to clarify the association between sleep habits and disorders, and addictions. The design was a telephone crossover national recurrent health poll survey (Santé publique France, Baromètre santé, 2017; Questionnaire, pp. 53; Saint Maurice) in a representative sample of French adults. There were 12,367 subjects (18-75 years old) who answered the survey. Sleep log items assessed sleep schedules (total sleep time) on work and leisure days: at night, while napping, and over 24 hr using a sleep log. Retained items include: (1) short sleep (≤ 6 hr/24 hr); (2) chronic insomnia (International Classification of Sleep Disorders, 3rd edition criteria); and (3) chronotype (evening-morning-neutral). Psychoactive substances retained included tobacco (current or former users), alcohol (daily consumption and weekly binge drinking), cannabis (Cannabis Abuse Screening Test), and other drugs (consumption during the past year). We found that: (1) daily smokers (lightly or heavily dependent) were more frequently short sleepers than occasional smokers and non-smokers; (2) heavily dependent daily smokers were more likely to suffer from insomnia than other smokers or non-smokers; (3) short sleep and insomnia were not significantly associated with the consumption of alcohol, cannabis or any other drug; (4) the evening chronotype was significantly associated with the consumption of tobacco, alcohol and cannabis. In conclusion, our study highlights significant relationships between the use of psychoactive substances and sleep characteristics among adults, emphasizing the need to take into account each subject individually.

Moving towards a single-frame cell phone design in random digit dialing surveys: considerations from a French general population health survey.

BACKGROUND: Over the last two decades, telephone surveys based on random digit dialing have developed considerably. At the same time, however, the proportion of the population with a cell phone has increased, whereas landline frame coverage has declined, thus raising the possibility of discontinuing landline phone surveys. This paper aims to assess the impact of using a single-frame (SF) cell phone design instead of a dual-frame (DF) design with landlines and cell phones in the context of repeated health surveillance surveys in the general population. We analyze data from a random digit dialing health survey of the French population and assess differences between the DF and the counterfactual SF design that excludes the landline phone sample from the DF design. We evaluate the quality of the two survey designs in terms of survey productivity, response rates, representativeness, balancing of external covariates, and prevalence estimates of key health behavior indicators. RESULTS: Our results show that a SF cell phone survey has several advantages over a combined DF landline and cell phone survey. Cell numbers require fewer call attempts to complete an interview, leading to a substantial reduction in the mean data collection duration and weight dispersion. The global representativeness of the SF design was slightly better than its DF counterpart, although the elderly were underrepresented. After calibration, differences in health behavior estimates were small for the seven health indicators analyzed. CONCLUSIONS: Switching from a DF random telephone survey to a SF cell phone design has a number of practical advantages and would have a minimal impact on general population health surveys for monitoring health behavior at the population level. However, the different aspects of the survey quality had to be studied to make a decision. Further studies are needed to explore the scope of possibilities.

Evolution of Online Health-Related Information Seeking in France From 2010 to 2017: Results From Nationally Representative Surveys.

BACKGROUND: Given the rapid ongoing progression of the internet and increase in health information available from disparate online sources, it is important to understand how these changes impact online health information-seeking behavior of the population and the way of managing one's health. OBJECTIVE: This paper aims at describing the evolution of internet use as a source of health information between 2010 and 2017, as well as the characteristics of online health information seekers, topics of interest, sources of information, and trust in retrieved information and potential impact on behavior. METHODS: Data from the French nationally representative surveys Health Barometers were used (N=4141 in 2010, 4811 in 2014, and 6255 in 2017). Evolutions over time were assessed using chi-square tests. Associations with sociodemographic characteristics and health status were evaluated using logistic regression models. RESULTS: The use of the internet as a source of health information rose between 2010 and 2014 (from 37.3% to 67.9%, P<.001) but decreased significantly in 2017 (60.3%, P<.001). Overall, the profile of health information seekers compared with nonseekers did not change over time. They were more likely to be women, to be younger, to have a higher educational level, to have a higher household income, and to be executives. Between 2014 and 2017, the proportion of those who did not pay attention to the source of information significantly increased to reach 39.7% (P<.001). In 2017 as in 2014, general health-related websites remained the first source of information (38.6%) while institutional websites were the third source (8.1%). Most information seekers trusted the information found online in 2010 (more than 80%), with a slight decrease between 2014 and 2017 (P=.048). Among individual characteristics, trust in the information was the main determinant of the way of managing one's health (odds ratio 4.06, 95% CI 3.26-5.06). CONCLUSIONS: After a rapid growth in the internet use for seeking health information in the 2010 to 2014 period, a decrease was recorded in 2017, in parallel with a decrease in trust in the quality and reliability of information found online. These findings underline the need for public health authorities to increase citizens' eHealth literacy and to provide alternative trustworthy sources combining the popularity and accessibility of general health information websites.

HCV and HBV prevalence based on home blood self-sampling and screening history in the general population in 2016: contribution to the new French screening strategy.

BACKGROUND: The advent of effective direct-acting antivirals (DAAs), has prompted an assessment of the French Hepatitis C virus (HCV) screening strategy, which historically targeted high-risk groups. One of the options put forward is the implementation of combined (i.e., simultaneous) HCV, Hepatitis B virus (HBV) and HIV screening for all adults at least once during their lifetime ("universal combined screening"). However, recent national survey-based data are lacking to guide decision-making regarding which new strategy to implement. Accordingly, we aimed to provide updated data for both chronic hepatitis C (CHC) and B (CHB) prevalence and for HCV and HBV screening history, using data from the BaroTest and 2016 Health Barometer (2016-HB) studies, respectively. METHODS: 2016-HB was a national cross-sectional phone based health survey conducted in 2016 among 20,032 randomly selected individuals from the general population in mainland France. BaroTest was a virological sub-study nested in 2016-HB. Data collected for BaroTest were based on home blood self-sampling on dried blood spots (DBS). RESULTS: From 6945 analyzed DBS, chronic hepatitis C (CHC) and B (CHB) prevalence was estimated at 0.30% (95% Confidence Interval (CI): 0.13-0.70) and 0.30% (95% CI: 0.13-0.70), respectively. The proportion of individuals aware of their status was estimated at 80.6% (95% CI: 44.2-95.6) for CHC and 17.5% (95% CI: 4.9-46.4) for CHB. Universal combined screening would involve testing between 32.6 and 85.3% of 15-75 year olds according to whether we consider only individuals not previously tested for any of the three viruses, or also those already tested for one or two of the viruses. CONCLUSIONS: Our data are essential to guide decision-making regarding which new HCV screening recommendation to implement in France. They also highlight that efforts are still needed to achieve the WHO's targets for eliminating these diseases. Home blood self-sampling may prove to be a useful tool for screening and epidemiological studies.

Social distribution of tobacco smoking, alcohol drinking and obesity in the French West Indies.

BACKGROUND: Tobacco smoking, alcohol and obesity are important risk factors for a number of non-communicable diseases. The prevalence of these risk factors differ by socioeconomic group in most populations, but this socially stratified distribution may depend on the social and cultural context. Little information on this topic is currently available in the Caribbean. The aim of this study was to describe the distribution of tobacco smoking, alcohol drinking and obesity by several socioeconomic determinants in the French West Indies (FWI). METHODS: We used data from a cross-sectional health survey conducted in Guadeloupe and Martinique in 2014 in a representative sample of the population aged 15-75 years (n = 4054). All analyses were stratified by gender, and encompassed sample weights, calculated to account for the sampling design and correct for non-response. For each risk factor, we calculated weighted prevalence by income, educational level, occupational class and having hot water at home. Poisson regression models were used to estimate age-adjusted prevalence ratios (PR) and 95% confidence intervals (CI). RESULTS: Current smoking and harmful chronic alcohol use were more common in men than in women (PR = 1.80, 95% CI = 1.55-2.09; PR = 4.53, 95% CI = 3.38-6.09 respectively). On the other hand, the prevalence of obesity was higher in women than in men (PR = 0.67, 95% CI = 0.57-0.79). Higher education, higher occupational class and higher income were associated with lower prevalence of harmful alcohol drinking in men (PR = 0.43, 95% CI = 0.25-0.72; PR = 0.73, 95% CI = 0.53-1.01; PR = 0.72, 95% CI = 0.51-1.03 respectively), but not in women. For tobacco smoking, no variation by socioeconomic status was observed in men whereas the prevalence of current smoking was higher among women with higher occupational class (PR = 1.47, 95% CI = 1.13-1.91) and higher income (PR = 1.50, 95% CI = 1.11-2.03). In women, a lower prevalence of obesity was associated with a higher income (PR = 0.43, 95% CI = 0.33-0.56), a higher occupational class (PR = 0.63, 95% CI = 0.50-0.80), a higher educational level (PR = 0.36, 95% CI = 0.26-0.50) and having hot water at home (PR = 0.65, 95% CI = 0.54-0.80). CONCLUSION: Women of high socio-economic status were significantly more likely to be smokers, whereas alcohol drinking in men and obesity in women were inversely associated with socioeconomic status.

Renouncing care in French Guiana: the national health barometer survey.

BACKGROUND: In French Guiana, health inequalities are patent for a broad range of pathologies for all age groups. The objective of the present study was to quantify the proportion of the population that had renounced care in the past year, to study predictive factors, and to compare results with other French territories. METHODS: A two-stage random sample of 2015 individuals aged 15 to 75 years was surveyed by telephone. A descriptive analysis of variables relative to renouncing care, use of health care, screening, and vaccination was initially performed. Multivariate analysis was then used to determine variables associated with renouncing care for financial reasons and renouncing for reasons linked to time were directly estimated using a Poisson model on weighted data. Variables with a significance level < 0.2 in the bivariate analysis were included in the full multivariate model. RESULTS: In French Guiana, during the past 12 months, 30.9% of surveyed persons renounced care whatever the type for financial reasons. Results of the multivariate analysis showed that gender, perceived financial situation, perceived health and complementary insurance status were independent predictive factors of care renouncement for financial reasons. Overall, 24% of the surveyed population declared having renounced to care for time-related motives. The independent predictors for time-related renouncing were different than those for renouncing care for financial reasons: a higher education level and a poor perceived health were independently associated with time-related renouncement; retired persons and students were found to renounce care less frequently than persons with a job. CONCLUSIONS: Renouncing for financial reasons, a major target of the 2016 health law, represented a public health problem in French Guiana. Renouncing for lack of time was an important motive for renouncing, which is aggravated by the insufficient number of health professionals, but may benefit from organizational solutions. There are avenues for improvement of health for the most vulnerable: promote health, act on risk factors, and facilitate the readability and accessibility of the health system. Recent reforms to stabilize health insurance may however have some adverse consequences for migrants.

Factor associated with risky sexual behaviors among the French general population.

Background: Despite prevention programs, a rising incidence of sexually transmitted infections is currently reported in France. Aims: Research factors associated with risky sexual behaviors (RSBs) among the French population. Methods: Subjects aged 15-54 years from the French national survey 'Baromètre santé 2010' were included (n = 16 598). RSB was defined as having multiple partners or failure to use condom at first intercourse with a new partner over past 12 months. Factors associated were identified using one logistic regression by gender. Results: The overall RSB prevalence was 9.5%, being higher among men (P < 0.001). Factors associated with RSB for both genders were young age (OR = 1.5), single status (men: OR = 7.1; women: OR = 6.4), homosexual relations (men: OR = 2.0; women: OR = 3.2), low incomes (men: OR = 1.5; women: OR = 1.4), use of cannabis (men: OR = 1.4; women: OR = 3.0). Men-specific factors were history of STI (OR = 2.5) and alcohol drunkenness (OR = 2.2), and women-specific factors history of suicide attempt (OR = 1.6) and history of sexual assault (OR = 1.6). Conclusions: Confirming most of known determinants of RSB, this study also identified some specific risky patterns for whom preventive actions can be developed: multiusers of psychoactive substances, people living with low incomes, women having sex with women or presenting history of psychological vulnerability (suicide attempts, sexually harassed).

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.