Health protective behaviours during the COVID-19 pandemic: Risk adaptation or habituation?

Many epidemiological works show that human behaviours play a fundamental role in the spread of infectious diseases. However, we still do not know much about how people modify their Health Protective Behaviours (HPB), such as hygiene or social distancing measures, over time in response to the health threat during an epidemic. In this study, we examined the role of the epidemiological context in engagement in HPB through two possible mechanisms highlighted by research into decision-making under risk: risk adaptation and risk habituation. These two different mechanisms were assumed to explain to a large extent the temporal variations in the public's responsiveness to the health threat during the COVID-19 pandemic. To test them, we used self-reported data collected through a series of 25 cross-sectional surveys conducted in France among representative samples of the adult population, from March 2020 to September 2021 (N = 50,019). Interestingly, we found that both mechanisms accounted relatively well for the temporal variation in the adoption of social distancing during the pandemic, which is remarkable given their different assumptions about the underlying social cognitive processes involved in response to a health threat. These results suggest that strengthening the incentives to encourage people to maintain health protective behaviours and to counter risk habituation effects is crucial to disease control and prevention over time.

Digital contact tracing during the COVID-19 pandemic in France: Associated factors and reasons for non-use.

OBJECTIVES: To estimate the proportion of users of the TousAntiCovid app(lication) and identify factors associated with its non-use for contact tracing. METHODS: We conducted an online survey of a quota sample of French adults between 8 and 18 January 2021. Three categories of TousAntiCovid use were considered: contact tracing, other or temporary usage, and no use. A weighted multiple logistic regression was performed to analyze the factors associated with these different uses. RESULTS: Among the 1000 respondents, 63.3% declared they had never downloaded the TousAntiCovid app, 23.5% used it for contact tracing. The remaining 13.2% did not enable contact tracing, mainly because of excessive battery consumption and fear of misuse of personal data. Trust in political representatives, financial deprivation and other factors were associated with never downloading the app. CONCLUSION: This study confirms the previously suggested links between trust in political representatives, financial deprivation and the use of contact tracing apps in France.

Regional Differences in COVID-19 Vaccine Hesitancy in December 2020: A Natural Experiment in the French Working-Age Population.

It can be assumed that higher SARS-CoV-2 infection risk is associated with higher COVID-19 vaccination intentions, although evidence is scarce. In this large and representative survey of 6007 adults aged 18-64 years and residing in France, 8.1% (95% CI, 7.5-8.8) reported a prior SARS-CoV-2 infection in December 2020, with regional variations according to an East-West gradient (p < 0.0001). In participants without prior SARS-CoV-2 infection, COVID-19 vaccine hesitancy was substantial, including 41.3% (95% CI, 39.8-42.8) outright refusal of COVID-19 vaccination. Taking into account five characteristics of the first approved vaccines (efficacy, duration of immunity, safety, country of the vaccine manufacturer, and place of administration) as well as the initial setting of the mass vaccination campaign in France, COVID-19 vaccine acceptance would reach 43.6% (95% CI, 43.0-44.1) at best among working-age adults without prior SARS-CoV-2 infection. COVID-19 vaccine acceptance was primarily driven by vaccine characteristics, sociodemographic and attitudinal factors. Considering the region of residency as a proxy of the likelihood of getting infected, our study findings do not support the assumption that SARS-CoV-2 infection risk is associated with COVID-19 vaccine acceptance.

Quantifying healthcare and welfare sector workers' preferences around COVID-19 vaccination: a cross-sectional, single-profile discrete-choice experiment in France.

OBJECTIVES: To analyse preferences around promotion of COVID-19 vaccination among workers in the healthcare and welfare sector in Fance at the start of the vaccination campaign. DESIGN: Single-profile discrete-choice experiment. Respondents in three random blocks chose between accepting or rejecting eight hypothetical COVID-19 vaccination scenarios. SETTING: 4346 healthcare and welfare sector workers in France, recruited through nation-wide snowball sampling, December 2020 to January 2021. OUTCOME: The primary outcomes were the effects of attributes' levels on hypothetical acceptance, expressed as ORs relative to the reference level. The secondary outcome was vaccine eagerness as certainty of decision, ranging from -10 to +10. RESULTS: Among all participants, 61.1% made uniform decisions, including 17.2% always refusing vaccination across all scenarios (serial non-demanders). Among 1691 respondents making variable decisions, a strong negative impact on acceptance was observed with 50% vaccine efficacy (compared with 90% efficacy: OR 0.05, 95% CI 0.04 to 0.06) and the mention of a positive benefit-risk balance (compared with absence of severe and frequent side effects: OR 0.40, 0.34 to 0.46). The highest positive impact was the prospect of safely meeting older people and contributing to epidemic control (compared with no indirect protection: OR 4.10, 3.49 to 4.82 and 2.87, 2.34 to 3.50, respectively). Predicted acceptance was 93.8% for optimised communication on messenger RNA vaccines and 16.0% for vector-based vaccines recommended to ≥55-year-old persons. Vaccine eagerness among serial non-demanders slightly but significantly increased with the prospect of safely meeting older people and epidemic control and reduced with lower vaccine efficacy. DISCUSSION: Vaccine promotion towards healthcare and welfare sector workers who hesitate or refuse vaccination should avoid the notion of benefit-risk balance, while collective benefit communication with personal utility can lever acceptance. Vaccines with limited efficacy will unlikely achieve high uptake.

Correlates of intended COVID-19 vaccine acceptance across time and countries: results from a series of cross-sectional surveys.

OBJECTIVE: Describe demographical, social and psychological correlates of willingness to receive a COVID-19 vaccine. SETTING: Series of online surveys undertaken between March and October 2020. PARTICIPANTS: A total of 25 separate national samples (matched to country population by age and sex) in 12 different countries were recruited through online panel providers (n=25 334). PRIMARY OUTCOME MEASURES: Reported willingness to receive a COVID-19 vaccination. RESULTS: Reported willingness to receive a vaccine varied widely across samples, ranging from 63% to 88%. Multivariate logistic regression analyses reveal sex (female OR=0.59, 95% CI 0.55 to 0.64), trust in medical and scientific experts (OR=1.28, 95% CI 1.22 to 1.34) and worry about the COVID-19 virus (OR=1.47, 95% CI 1.41 to 1.53) as the strongest correlates of stated vaccine acceptance considering pooled data and the most consistent correlates across countries. In a subset of UK samples, we show that these effects are robust after controlling for attitudes towards vaccination in general. CONCLUSIONS: Our results indicate that the burden of trust largely rests on the shoulders of the scientific and medical community, with implications for how future COVID-19 vaccination information should be communicated to maximise uptake.

Effectiveness of 'Mois sans tabac 2016': A French social marketing campaign against smoking.

INTRODUCTION: In October 2016, the first edition of Mois sans tabac (Tobacco-Free Month) was launched, a campaign which had invited French smokers to challenge themselves to quit smoking for the whole month of November. We aimed to study the effectiveness of this social marketing intervention on quit attempts (QA) in the general French population, and to study possible differences according to sociodemographic characteristics. METHODS: This study used data from the 2017 Health Barometer survey, a random survey conducted by telephone on 25319 individuals. It included 6341 respondents who reported that they were daily smokers when the Mois sans tabac campaign was launched in 2016. The association between self-declared exposure to the campaign and making a QA has been studied using multivariate logistic regressions. RESULTS: Exposure to the 2016 Mois sans tabac campaign is associated with a QA lasting at least 24 hours in the final quarter of 2016 (AOR=1.32; 95% CI: 1.07- 1.63, p<0.01), with a QA lasting at least 30 days (AOR=1.95; 95% CI: 1.31-2.91, p<0.001), and being abstinent at the time of the interview in 2017 (AOR=2.39; 95% CI: 1.37-4.15, p<0.01). A dose-effect relationship is observed between the frequency of exposure to the campaign and QA, which is mostly explained by the number of sources of exposure (television, radio, posters, the press, the internet and social networks). Although certain priority groups (e.g. manual workers, the unemployed) had poorer recall of the campaign than other groups, the impact of self-reported exposure to the campaign on QA in unemployed people or those with less than high school educational level appears to have been greater. CONCLUSIONS: These analyses suggest the effectiveness of the 2016 Mois sans tabac intervention, in a context of strengthening public tobacco control policies in France, which may have contributed to the drop in smoking observed between 2016 and 2019.

Early Acceptability of a Mobile App for Contact Tracing During the COVID-19 Pandemic in France: National Web-Based Survey.

BACKGROUND: Several countries have implemented mobile apps in an attempt to trace close contacts of patients with COVID-19 and, in turn, reduce the spread of SARS-CoV-2. However, the effectiveness of this approach depends on the adherence of a large segment of the population. OBJECTIVE: The aims of this study were to evaluate the acceptability of a COVID-19 contact tracing mobile app among the French population and to investigate the barriers to its use. METHODS: The Health Literacy Survey 2019 questioned 1003 people in France during the COVID-19 pandemic on the basis of quota sampling. The survey collected sociodemographic characteristics and health literacy data, as well as information on participants' communication with caregivers, trust in institutions, and COVID-19 knowledge and preventive behaviors. The acceptability of a mobile app for contact tracing was measured by a single question, the responses to which were grouped into three modalities: app-supporting, app-willing, and app-reluctant. Multinomial logistic regression analysis was performed to identify the factors associated with the acceptability of a mobile app during the COVID-19 pandemic. RESULTS: Only 19.2% (193/1003) of all participants were app-supporting, whereas half of them (504/1003, 50.3%) were reluctant. The factors associated with willingness or support toward the contact tracing app included lower financial deprivation (app-willing: adjusted odds ratio [aOR] 0.8, 95% CI 0.69-0.93; app-supporting: aOR 0.7, 95% CI 0.58-0.84) and higher perceived usefulness of using a mobile app to send completed health questionnaires to doctors (app-willing: aOR 2.3, 95% CI 1.70-3.26; app-supporting: aOR 3.1, 95% CI 2.04-4.82). Furthermore, the likelihood of supporting the mobile app increased with age over 60 years (aOR 1.9, 95% CI 1.13-3.22), trust in political representatives (aOR 2.7, 95% CI 1.72-4.23), feeling concerned about the pandemic situation (aOR 2.2, 95% CI 1.47-3.32), and knowledge about the transmission of COVID-19 (aOR 2.0, 95% CI 1.39-2.96). CONCLUSIONS: The most socioeconomically precarious people, who are at a higher risk of SARS-CoV-2 infection, are also the most reluctant to using a contact tracing mobile app. Therefore, optimal adherence can only be effective with a targeted discourse on public health benefits to adopt such an app, which should be combined with a reduction in inequalities by acting on structural determinants.

["New approaches and new methods for preventing smoking among adolescents"]. / Nouvelles approches et nouveaux modes de prévention du tabagisme chez les adolescents.

"New approaches and new methods for preventing smoking among adolescents .The design of smoking prevention programs requires a good understanding of the network of influences leading to smoking, whether they are developmental, physiological, psychological, sociological or economic in nature. Prevention programs also need to be rigorously evaluated and then scaled up to benefit as many people as possible. Choosing the most efficient programs would yield a significant return on investment for individuals and society, given the enormous cost of smoking. Regulatory preventive interventions, in schools or in healthcare, in the family environment and media campaigns have shown their interest, and sometimes have been associated with an interesting return on investment. Examples are given, in particular of programs available on French territory. The main challenge is that the overall strategy has a proportionate universalism approach, that is to say a prevention for all, but adapted to the needs and specificities of each category (level of education, gender, etc.)."

"Nouvelles approches et nouveaux modes de prévention du tabagisme chez les adolescents .La conception des programmes de prévention du tabagisme nécessite de bien comprendre le réseau d'influences conduisant au tabagisme, qu'elles soient de nature développementale, physiologique, psychologique, sociologique ou économique. Les programmes de prévention doivent également être rigoureusement évalués, puis passés à l'échelle pour qu'ils profitent au plus grand nombre. Le choix des programmes les plus efficients permettrait un retour sur investissement important pour les individus et la société, étant donné le coût énorme du tabagisme. Des interventions préventives réglementaires, en milieu scolaire ou en milieu de soins, en milieu familial et des campagnes médiatiques ont montré leur intérêt, et parfois ont été associées à un retour sur investissement intéressant. Des exemples sont donnés, en particulier des programmes disponibles sur le territoire français. L'enjeu principal est que la stratégie d'ensemble ait une approche d'universalisme proportionnée, c'est-à-dire une offre de prévention pour tous, mais adaptée aux besoins et aux spécificités de chaque catégorie (niveau d'éducation, genre, etc.)."

Changes in smoking and alcohol consumption during COVID-19-related lockdown: a cross-sectional study in France.

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

Modelling the number of avoidable new cancer cases in France attributable to alcohol consumption by following official recommendations: a simulation study.

AIMS: To predict the effects of perfect adherence to the French alcohol consumption guidelines, a maximum of 10 standard alcoholic drinks per week with no more than two standard alcoholic drinks per day, during a 36-year period (2014-50). DESIGN: This simulation study is an adaption of the Sheffield Alcohol Policy Model. The dose-response relationship between alcohol consumption and alcohol-attributable cancer risks was defined by cancer site-specific risk functions, each modelled as a continuous risk. These estimates were used to compute the potential impact fraction (PIF) associated with alcohol consumption by cancer site. SETTING: The French general adult population during a 36-year period (2014-50). PARTICIPANTS: For the baseline scenario, the current distribution of consumption levels, the counterfactual scenario and perfect adherence to the French alcohol consumption guidelines, we generated for each gender and age group 1000 randomly distributed alcohol consumption values from calibrated group-specific gamma distribution. MEASUREMENTS: The predicted number of new cancer cases among men and women in France between 2015 and 2050 that could have been prevented by following the French government's alcohol consumption guidelines. FINDINGS: The simulation predicted that perfect adherence to the French government's alcohol consumption guidelines would prevent, on average, an estimated 15 952 cancer cases per year after the PIF reached its full effect, which would have represented 4.5% of new cancer cases in 2015. The number of averted cancer cases over the study period were highest for oral cavity, oropharynx and hypopharynx cancer (respectively, 118 462, 95% CI = 113 803-123 022 and 11 167, 95% CI = 10 149-12 229] for men and women; liver and intrahepatic bile ducts cancer (123 447, 95% CI = 112 581-133 404 and 2825, 95% CI = 2208,4095); colorectal cancer (89 859, 95% CI = 84 651-95 355 and 12 847, 95% CI = 11 545-14 245); and female breast cancer (61 649, 95% CI = 56 330-67 452). CONCLUSION: This simulation study of the French general population predicted that perfect adherence to the French government's alcohol consumption guidelines (no more than 10 standard alcoholic drinks per week and two per day) would prevent almost 16 000 cancer cases per year.

COVID-19 vaccine hesitancy in a representative working-age population in France: a survey experiment based on vaccine characteristics.

BACKGROUND: Opinion polls on vaccination intentions suggest that COVID-19 vaccine hesitancy is increasing worldwide; however, the usefulness of opinion polls to prepare mass vaccination campaigns for specific new vaccines and to estimate acceptance in a country's population is limited. We therefore aimed to assess the effects of vaccine characteristics, information on herd immunity, and general practitioner (GP) recommendation on vaccine hesitancy in a representative working-age population in France. METHODS: In this survey experiment, adults aged 18-64 years residing in France, with no history of SARS-CoV-2 infection, were randomly selected from an online survey research panel in July, 2020, stratified by gender, age, education, household size, and region and area of residence to be representative of the French population. Participants completed an online questionnaire on their background and vaccination behaviour-related variables (including past vaccine compliance, risk factors for severe COVID-19, and COVID-19 perceptions and experience), and were then randomly assigned according to a full factorial design to one of three groups to receive differing information on herd immunity (>50% of adults aged 18-64 years must be immunised [either by vaccination or infection]; >50% of adults must be immunised [either by vaccination or infection]; or no information on herd immunity) and to one of two groups regarding GP recommendation of vaccination (GP recommends vaccination or expresses no opinion). Participants then completed a series of eight discrete choice tasks designed to assess vaccine acceptance or refusal based on hypothetical vaccine characteristics (efficacy [50%, 80%, 90%, or 100%], risk of serious side-effects [1 in 10 000 or 1 in 100 000], location of manufacture [EU, USA, or China], and place of administration [GP practice, local pharmacy, or mass vaccination centre]). Responses were analysed with a two-part model to disentangle outright vaccine refusal (irrespective of vaccine characteristics, defined as opting for no vaccination in all eight tasks) from vaccine hesitancy (acceptance depending on vaccine characteristics). FINDINGS: Survey responses were collected from 1942 working-age adults, of whom 560 (28·8%) opted for no vaccination in all eight tasks (outright vaccine refusal) and 1382 (71·2%) did not. In our model, outright vaccine refusal and vaccine hesitancy were both significantly associated with female gender, age (with an inverted U-shaped relationship), lower educational level, poor compliance with recommended vaccinations in the past, and no report of specified chronic conditions (ie, no hypertension [for vaccine hesitancy] or no chronic conditions other than hypertension [for outright vaccine refusal]). Outright vaccine refusal was also associated with a lower perceived severity of COVID-19, whereas vaccine hesitancy was lower when herd immunity benefits were communicated and in working versus non-working individuals, and those with experience of COVID-19 (had symptoms or knew someone with COVID-19). For a mass vaccination campaign involving mass vaccination centres and communication of herd immunity benefits, our model predicted outright vaccine refusal in 29·4% (95% CI 28·6-30·2) of the French working-age population. Predicted hesitancy was highest for vaccines manufactured in China with 50% efficacy and a 1 in 10 000 risk of serious side-effects (vaccine acceptance 27·4% [26·8-28·0]), and lowest for a vaccine manufactured in the EU with 90% efficacy and a 1 in 100 000 risk of serious side-effects (vaccine acceptance 61·3% [60·5-62·1]). INTERPRETATION: COVID-19 vaccine acceptance depends on the characteristics of new vaccines and the national vaccination strategy, among various other factors, in the working-age population in France. FUNDING: French Public Health Agency (Santé Publique France).

Determinants of Preventive Behaviors in Response to the COVID-19 Pandemic in France: Comparing the Sociocultural, Psychosocial, and Social Cognitive Explanations.

In absence of effective pharmaceutical treatments, the individual's compliance with a series of behavioral recommendations provided by the public health authorities play a critical role in the control and prevention of SARS-CoV2 infection. However, we still do not know much about the rate and determinants of adoption of the recommended health behaviors. This paper examines the compliance with the main behavioral recommendations, and compares sociocultural, psychosocial, and social cognitive explanations for its variation in the French population. Based on the current literature, these 3 categories of factors were identified as potential determinants of individual differences in the health preventive behaviors. The data used for these analyses are drawn from 2 cross-sectional studies (N = 2,000 in survey 1 and 2,003 in survey 2) conducted after the lockdown and before the peak of the COVID-19 epidemic in France. The participants were drawn from a larger internet consumer panel where recruitment was stratified to generate a socio-demographically representative sample of the French adult population. Overall, the results show a very high rate of compliance with the behavioral recommendations among the participants. A hierarchical regression analysis was then performed to assess the potential explanatory power of these approaches in complying with these recommendations by successively entering sociocultural factors, psychosocial factors, social cognitive factors in the model. Only the inclusion of the cognitive variables substantially increased the explained variance of the self-reported adoption of preventive behaviors (R 2 change = 23% in survey 1 and 2), providing better support for the social cognitive than the sociocultural and psychosocial explanations.

Tobacco and COVID-19: a crisis within a crisis?

During the pandemic, the world's media have publicized preliminary findings suggesting that tobacco use is protective against COVID-19. An ad hoc multidisciplinary group was created to address the major public health implications of this messaging. Key messages of this commentary are as follows: 1) The COVID-19 crisis may increase tobacco consumption and decrease access to healthcare. As a result, smoking-related morbidity and mortality could increase in the coming months and years; 2) Smoking and tobacco-related diseases are prognostic factors for severe COVID-19; and 3) In theory, smokers may be at lower risk of COVID-19 infection because of having fewer social contacts. In conclusion, tobacco control is a greater challenge than ever in the context of the COVID-19 pandemic. Public decision-makers must be vigilant in ensuring that public health practices are consistent and compliant with the principles of the WHO Framework Convention on Tobacco Control. In addition, researchers and the media have a responsibility to be cautious in communicating preliminary results that may promote non-evidence-based research, self-destructive individual behaviours, and commercial agendas.

RéSUMé: Pendant la pandémie, des résultats préliminaires sur l'effet protecteur du tabac sur la COVID-19 ont été largement diffusés dans le monde entier. Dans ce contexte, et en raison des questions de santé publique liées à ce sujet, un groupe multidisciplinaire ad hoc a été créé en réponse aux demandes des institutions de santé publique. Les messages clés de ce commentaire sont les suivants : 1) La crise de la COVID-19 pourrait entraîner une augmentation de la consommation de tabac et une diminution de l'accès aux soins. En conséquence, la morbidité et la mortalité liées au tabagisme pourraient augmenter dans les mois et les années à venir; 2) Le tabagisme et les maladies liées au tabac sont des facteurs pronostiques de formes graves de la COVID-19; et 3) Hypothétiquement, les fumeurs, notamment en réduisant la fréquence et la durée des contacts sociaux, pourraient être moins susceptibles d'être contaminés. En conclusion, même pendant et malgré la crise sanitaire due à la pandémie de la COVID-19, la lutte contre le tabagisme reste plus que jamais un défi. Les décideurs publics doivent être particulièrement vigilants pour assurer la cohérence des pratiques publiques, y compris le respect des principes de la Convention-cadre de l'OMS pour la lutte antitabac. Il incombe également aux chercheurs et aux médias de communiquer avec prudence des résultats préliminaires susceptibles de générer des comportements individuels contre-productifs et d'être instrumentalisés à des fins commerciales.

Effectiveness of the e-Tabac Info Service application for smoking cessation: a pragmatic randomised controlled trial.

OBJECTIVE: To compare the effectiveness of the mobile e-Tabac Info Service (e-TIS) application (app) for helping adult smokers quit smoking with current practices. DESIGN: Pragmatic randomised controlled trial with a 1-year follow-up (2017-2018). SETTING: France, population-wide level. PARTICIPANTS: 2806 adult smokers who wished to quit smoking were recruited via the website of the French National Mandatory Health Insurance fund. Of them, 1400 were randomised to the e-TIS app arm and 1406 were randomised to the current practices arm (control). INTERVENTION: The app involved personalised interactive contacts that included questionnaires, advice, activities and text messages. All contacts were individually tailored and based on each smoker's progress.In the control group, recommended practices for quitting smoking were described on a non-interactive website. PRIMARY AND SECONDARY OUTCOMES MEASURES: The primary outcome was 7-day point prevalence abstinence (PPA) at 6 months. The secondary outcomes included continuous abstinence rates at 6 and 12 months, minimum 24-hour point abstinence at 3 months, minimum 30-day point abstinence at 12 months and number and duration of quit attempts. RESULTS: There was no difference between the e-TIS and control arms for the primary outcome (12.6% vs 13.7% for 7-day PPA at 6 months, p=0.3949, intention-to-treat analysis). However, e-TIS participants with high levels of exposure to the app, which was defined by the completion of at least eight activities or questionnaires, showed higher rates of smoking cessation than the control participants (17.6% vs 12.9% for 7-day PPA at 6 months, p=0.0169, per-protocol analysis). CONCLUSION: Use of the e-TIS app was not associated with a higher rate of smoking cessation. However, high level of exposure to the e-TIS app may have been more effective than current practices. TRIAL REGISTRATION NUMBER: NCT02841683.

Littératie en santé et prévention du cancer.

In recent years, there has been a noticeable drop in mortality rates from cancer, although cancer remains the primary cause of death in France and in the province of Québec. Several factors contribute to this reduction in mortality rates.First, better cancer screening is provided, and better follow ups are offered when abnormalities are detected. Second, cancer treatments benefit from ongoing developments which provide new treatments and more efficient measures to fight this illness. Last, we must also credit promotional campaigns to adopt healthy habits and lifestyles, particularly the fight against smoking.However, cancer strikes preferentially in some subgroups. In particular, cancer rates are higher and cancer-screening rates are lower in some subgroups, increasing disparities amongst subgroups of the same population. It seems that an insufficient level of literacy could be a factor explaining these discrepancies.This article presents a brief definition of the concept of literacy in general, followed by a definition of health-literacy behaviors and competencies. Then, we will present some data from research and from literature reviews on the potential linkages between literacy and cancer in general, and specific cancers in particular. We will conclude by considering a path to literacy in cancer screening.

Changes in tobacco-related morbidity and mortality in French women: worrying trends.

BACKGROUND: The high prevalence of smoking among French women since the 1970s has been reflected over the past decade by a strong impact on the health of women. This paper describes age and gender differences in France of the impact of smoking on morbidity and mortality trends since the 2000s. METHODS: Smoking prevalence trends were based on estimates from national surveys from 1974 to 2017. Lung cancer incidence were estimated from 2002-12 cancer registry data. Morbidity data for chronic obstructive pulmonary disease (COPD) exacerbation and myocardial infarction were assessed through hospital admissions data, 2002-15. For each disease, number of deaths between 2000 and 2014 came from the national database on medical causes of death. The tobacco-attributable mortality (all causes) was obtained using a population-attributable fraction methodology. RESULTS: The incidence of lung cancer and COPD increased by 72% and 100%, respectively, among women between 2002 and 2015. For myocardial infarction before the age of 65, the incidence increased by 50% between 2002 and 2015 in women vs. 16% in men and the highest increase was observed in women of 45-64-year-olds. Mortality from lung cancer and COPD increased by 71% and 3%, respectively, among women. The estimated number of women who died as a result of smoking has more than doubled between 2000 and 2014 (7% vs. 3% of all deaths). CONCLUSIONS: The increase in the prevalence of smoking among women has a major impact on the morbidity and mortality of tobacco-related diseases in women and will continue to increase for a number of years.

Population health intervention research: the place of theories.

BACKGROUND: An international workshop on population health intervention research (PHIR) was organized to foster exchanges between experts from different disciplines and different fields. This paper aims to summarize the discussions around some of the issues addressed: (1) the place of theories in PHIR, (2) why theories can be useful, and (3) how to choose and use the most relevant of them in evaluating PHIR. METHODS: The workshop included formal presentations by participants and moderated discussions. An oral synthesis was produced by a rapporteur to validate, through an expert consensus, the key points of the discussion and the recommendations. All discussions were recorded and have been fully transcribed. RESULTS: The following recommendations were generated through a consensus in the workshop discussions: (i) The evaluation of interventions, like their development, could be improved through better use of theory. (ii) The referenced theory and framework must be clarified. (iii) An intervention theory should be developed by a partnership of researchers and practitioners. (iv) More use of social theory is recommended. (v) Frameworks and a common language are helpful in selecting and communicating a theory. (vi) Better reporting of interventions and theories is needed. CONCLUSION: Theory-driven interventions and evaluations are key in PHIR as they facilitate the understanding of mechanisms of change. There are many challenges in developing the most appropriate theories for interventions and evaluations. With the wealth of information now being generated, this subject is of increasing importance at many levels, including for public health policy. It is, therefore, timely to consider how to build on the experiences of many different disciplines to enable the development of better theories and facilitate evidence-based decisions.

Fumes-tu encore? Quitting among French and American smokers: 2000-2010.

PURPOSE: This article examines sociodemographic correlates of initiation and quitting among French and American smokers. METHODS: National surveys in France and the United States in 2000, 2005, and 2010 were analyzed of ever smokers, 20-75 years old. Bivariate and multivariate logistic regression analyses were conducted on age of initiation and quitting. RESULTS: Smoking prevalence decreased for Americans each survey year (25.2%, 22.9%, and 17.9%), whereas the comparable figures for the French were 33.9%, 31.5%, and 33.8%. French smokers consumed fewer cigarettes per day (12.9 vs. 14.4 in 2000, 13.5. vs. 16.8 in 2005, and 12.2 vs. 15.1 in 2010), began consuming at a later age, and smoked for a shorter duration. Multiple logistic regression results revealed significant differences in the odds ratios, indicating the relative influence of sociodemographic variables on age of initiation and quitting. CONCLUSIONS: Quitting smoking continues to be a major challenge, varying by similar factors, particularly education, in both France and the United States. POLICY IMPLICATIONS: Public policy initiatives to promote quitting must be strengthened, including the need to address population-specific inequalities and disparities in tobacco use and consequences.

[Risk factors and determinants of health]. / Facteurs de risque et déterminants en santé.

Prevention is everyone's concern. Whether decisions are made on a collective or individual level, they can all help to improve health. Choosing prevention interventions which are proven to be effective and intervening early are two essential elements for an ambitious policy. Particular attention must be paid to behaviour which is known to be harmful for health and on which it is possible to act: diet, smoking and alcohol.

Effectiveness of a Fully Automated Internet-Based Smoking Cessation Program: A Randomized Controlled Trial (STAMP).

Introduction: The Internet offers an interesting alternative to face-to-face and telephone-based support for smoking cessation. This study was designed to assess the effectiveness of a personalized and automated Internet-based program. Methods: French current adult smokers willing to quit within 2 weeks were recruited for a randomized controlled trial. The intervention consisted of an automated program of 45 e-mails ("e-coaching") sent over a 3-month period. The control group received a PDF version of a booklet on smoking cessation. Self-reported 7-day point prevalence smoking abstinence was measured at 6 months (primary outcome), at 3 and 12 months of follow-up (secondary outcomes). Results: 2478 smokers were randomized (1242 for e-coaching, 1236 for the booklet). Cessation rate in the intention-to-treat population was not significantly different between the two groups at 6 and 12 months, but was higher in the e-coaching group at 3 months than in the control group (27.5% vs. 23.5%, p = .02, odds ratio [OR] = 1.24, confidence interval [CI] = [1.03-1.49]). After adjustment for baseline conditions, the effect of the intervention in the per-protocol (PP) sample was significant at 3 months (adjusted odds ratio [aOR] = 1.72 [1.31-2.28], p < .001, N = 1042) and at 6 months (aOR = 1.27 [1.00-1.60], p = .05, N = 1082). GLM repeated measure analyses showed significant group by time interaction in the intent-to-treat and a significant group effect in the PP population. Conclusions: Analyzed intention-to-treat, e-coaching was superior to a booklet at 3 months (end of intervention) but no more superior at 6 and 12 months follow-up. Among those who actually followed the program, the effectiveness is also observed 3 months after the intervention is stopped. Implications: Analyzed intention-to-treat, our French tailored and personalized Internet-based cessation program was superior to a smoking cessation booklet at 3 months (end of intervention) but no more superior at 6 months follow-up. Among those who actually followed the program (PP population), the effectiveness is observed in the short-term but also 3 months after the intervention is stopped.