Prevalence, lived experiences and user profiles in e-cigarette use: A mixed methods study among French college students.

BACKGROUND: Little is known about e-cigarette use in French students. Our aims were to estimate the prevalence of e-cigarette experimentation and current e-cigarette use; describe the reasons for using e-cigarettes; explore the vaping experience and identify the profiles of e-cigarette users. METHODS: We used a sequential, explanatory mixed methods design in a sample of French college students. Quantitative data was collected online for a cross-sectional analysis among 1698 students. Two separate analysis based on the thematic analysis and the Grounded Theory were also performed in 20 semi-structured interviews, focusing former and current smokers also current vapers. RESULTS: The prevalence of e-cigarette experimentation was 39.3% (95% CI: 35.2-44.0) and 5.1% (95% CI: 3.2-8.0) of students were current e-cigarette users. Experimentation was opportunistic while current usage was rational, requiring to acquire a personal electronic device, getting used to its technicality, appreciating its availability, discretion, and learning the practice. In this context, three distinct groups of e-cigarette users were identified, based on assumed identity, tobacco and e-cigarette use, the functions assigned to e-cigarettes, and intentions with regards to vaping in the future. CONCLUSION: Despite some limitations mainly related to the participants self-selection, this research showed that while many smokers and former smokers have tried e-cigarettes in this student population, few have continued to use them continuously. Moreover, these current e-cigarette users were a heterogeneous group. Longitudinal studies are needed in young adult smokers for a better understanding of how their tobacco and e-cigarette use affect each other and change over time.

An evaluation of five regional health information technology-based programmes to improve health and social care coordination: A quasi-experimental controlled before/after mixed design.

OBJECTIVES: Health information technology (HIT) can help coordinate health and social actors involved in patients' pathways. We assess five regional HIT-based programmes ('Territoires de Soins Numériques' or TSN) introduced in France, covering the period 2012-2018. METHODS: This was a quasi-experimental controlled before/after mixed design. We used data from the French National Health Insurance database, qualitative and quantitative surveys, and information extracted from project documents and databases. We assessed the impact of TSN using four main impact indicators: emergency room visits, unplanned hospitalizations, avoidable hospitalizations and rehospitalization within 30 days. We also collected qualitative and secondary quantitative data covering perceived needs, knowledge, use, satisfaction, adoption and understanding of projects, pathway experience, impact on professional practices and appropriateness of hospitalizations. RESULTS: TSN implemented a heterogeneous mix of HIT. Implementation was slower than expected and was not well documented. Users perceived the HIT as having a positive but weak overall effect. There were no significant differences in trends for the main impact indicators, nor on the appropriateness of hospitalizations, but favourable trends on secondary polypharmacy indicators. CONCLUSIONS: If similar innovations take place in future, they should be based on a logical framework that defines causal, measurable links between services provided and expected impacts.

Effectiveness and organizational conditions of effectiveness of telemedicine in nursing homes. A study protocol of a comparative prospective cohort (EFFORT study).

The profile of nursing home (NH) residents has changed over the past decade with more dependency, more severe chronic diseases and more treatments prescribed. For residents, the major consequence is the higher risk of unplanned hospitalization. French guidelines recommend the development of interactive telemedicine (InT) in NHs in order to improve access to care, and to decrease the rate of avoidable unplanned hospitalizations. Methods and analysis: The aim of this study is to analyze the impact of an InT protocol delivered in NHs on the rate of unplanned hospitalizations, and on the quality of life at work and the organizational conditions of effectiveness of telemedicine in NHs. We will perform a mixed methods study combining a cluster non-randomized controlled trial in two matched parallel arms (telemedicine group and control group) and qualitative analysis of the evolution of organizational and professional contexts in NHs. Ethics and dissemination: The study protocol was approved and sponsored by the French Ministry of Health. The study received ethical approval from the Bordeaux University Hospital Institutional Review Board. We will communicate the final results to the public via conferences and results will also be submitted for publication in international peer-reviewed scientific journals. Trial registration number NCT03486977.

Avoiding the stigma. A qualitative study of socially included women's experiences of drug use and dealing, health services and the police in France.

The figure of drug user and dealer is stigmatized, linked to violence and illness. This is due to a reductionist discourse which implements othering processes generating scapegoat figures in the drug world. All drug users and sellers are assimilated with these spoiled identities in the media or in drug policies, while the reality is much more diverse. This article draws on relational sociology to focus on figures who are the antithesis of stereotypes: socially integrated women who use or sell drugs (WUSD) and are invisible to the health and control enforcement agencies. By seeking to avoid the stigma of the drug user's and dealer's identities, how do socially included WUSD distance themselves from the control enforcement agencies and health institutions? This qualitative research is based on 26 semi-structured interviews conducted with socially included WUSD in France. Participants were recruited using a snowball sampling strategy. It appears that the participants normalized their drug use and integrated it into their professional and personal lives. Some were drug user-dealers and had social supply practices, selling the drugs they used to their friends in order to finance their consumption. None of the participants have ever been in contact with harm reduction and addiction services, both because they do not identify with the users of these services, and because these services are not designed to support this population. With the police, the participants play gender games and show their social inclusion to protect themselves from arrest. In both cases, the stigmatized figure of the drug user and drug seller alienate the participants from the health systems and control enforcement agencies. One of the consequences of the othering process is the invisibility of those who do not want to be identified as "others" by the health and law enforcement services. Rethinking drug policy is essential to reach populations that may need information and support.

Motivations for using electronic cigarettes in young adults: A systematic review.

Background: The most common reasons why adults use e-cigarettes are to stop or reduce tobacco smoking. However, it is unclear if this reason is evenly distributed between young and older adults. Objectives: describe the motivations for e-cigarette use amongst young adults aged 18-25 and compare the reasons for using e-cigarettes of people who currently or formerly used tobacco products to those who had never smoked tobacco prior e-cigarette use. Methods: PubMed®, Scopus®, Cochrane Library®, SocINDEX®, PsycARTICLES®, Psychology and Behavioral Sciences Collection® and PsycINFO® databases were used. English written articles were screened up to March 2018. Depending on study design, quality was assessed using The STROBE or RATS checklists. Results: Six articles were included in the review, all with a moderate quality of evidence. Independently of smoking status, curiosity was the most frequently reported reason for initiating the use of e-cigarettes in young adults. Reasons for continuing to use e-cigarettes were various. The continued use of e-cigarettes could be either a means to replicate smoking habits, or a way for a different and personalized use of nicotine by inhalation. Conclusions: Reasons for using e-cigarettes in young adults are varied and are not limited to stopping smoking.

Acceptance rate and sociological factors involved in the switch from originator to biosimilar etanercept (SB4).

OBJECTIVE: To study acceptance rate and factors influencing acceptance of the switch from originator etanercept (Enbrel©) to biosimilar etanercept (SB4, Bénépali©) in patients with rheumatic disease. METHODS: Patients with a well-controlled rheumatic disease consulting in our rheumatology department were offered the switch for SB4. After oral and written information concerning biosimilar, free choice to accept the switch was left to the patients. The main outcome was primary switch acceptance rate defined by switch acceptance during the initial consult. Real switch adherence, socio-cultural factors and beliefs influencing switch acceptance rate were retrieved during a telephonic interview at distance from the consultation. RESULTS: Fifty-two patients were eligible for the switch: 32 (62%) with spondyloarthritis and 20 (38%) with rheumatoid arthritis. The primary acceptance rate was 92% (48/52). Patients refusing the switch were more likely to report a bad opinion on generic drugs (100% vs 11%, p < 0.001). Other patient characteristics were roughly identical except for a statistical trend in the refusal group toward older age (61.4vs 50.7years, p = 0.08) and longer disease duration (26vs 12.1years, p = 0.05). Despite initial acceptance, two patients did not begin SB4 after receiving negative information by their regular pharmacist. Real SB4 switch rate was 85% (44/52) and 86% (38/44) of patients reported a good experience of the switch. CONCLUSIONS: Acceptance rate of the switch from originator to biosimilar etanercept is high. Patient information, physician and pharmacist knowledge on biosimilars should be taken into account in order to improve their diffusion.

Exploring Digital Health Use and Opinions of University Students: Field Survey Study.

BACKGROUND: During university, students face some potentially serious health risks, and their lifestyle can have a direct effect on health and health behaviors later in life. Concurrently, university students are digital natives having easy access to the internet and new technologies. Digital health interventions offer promising new opportunities for health promotion, disease prevention, and care in this specific population. The description of the current use of and opinions on digital health among university students can inform future digital health strategies and interventions within university settings. OBJECTIVE: The aim of this exploratory study was to report on university students' use and opinions regarding information and communication technologies for health and well-being, taking into account sociodemographic and self-rated general and mental health correlates. METHODS: This field survey was conducted from March to April 2017. An informed consent form and a paper questionnaire were given to students aged 18 to 24 years in 4 university campuses in Bordeaux, France. The survey was formulated in 3 sections: (1) sociodemographic characteristics and self-rated general and mental health, (2) information about the use of digital health, and (3) opinions about digital health. Data were analyzed using descriptive statistics and tests of independence. RESULTS: A total of 59.8% (303/507 females) students completed the questionnaire. Concerning digital health use, 34.9% (174/498) had at least 1 health app mostly for physical activity (49.4%, 86/174) and general health monitoring (41.4%, 72/174,), but only 3.9% (20/507) of students had a wearable device. Almost all (94.8%, 450/476) had searched for Web-based health-related information at least once in the last 12 months. The most sought health-related topics were nutrition (68.1%, 324/476); pain and illnesses (64.5%, 307/476); and stress, anxiety, or depression (51.1%, 243/476). Although Wikipedia (79.7%, 357/448) and general health websites (349/448, 77.9%) were the most consulted sources, students considered institutional or official websites as the most credible sources (309/335, 92.2%). There were significant differences in digital health use by gender, field, and year of study. No statistically significant association was found between digital health use and self-rated general and mental health status. Concerning opinions on digital health, although 94.1% (475/505) of students estimated that today's digital health cannot replace traditional health services and medical consultations, 44.6% (207/464) of students declared that this could be possible in the future, provided that digital health interventions are promoted by institutional or official entities. CONCLUSIONS: University students are largely using the internet for health information seeking, but using less mobile health apps and very few wearable devices. Our data suggest that digital health has the potential for improving health and well-being at the university, especially if digital health interventions take into account students' profiles, interests, and needs.

Protocole of a controlled before-after evaluation of a national health information technology-based program to improve healthcare coordination and access to information.

BACKGROUND: Improvement of coordination of all health and social care actors in the patient pathways is an important issue in many countries. Health Information (HI) technology has been considered as a potentially effective answer to this issue. The French Health Ministry first funded the development of five TSN ("Territoire de Soins Numérique"/Digital health territories) projects, aiming at improving healthcare coordination and access to information for healthcare providers, patients and the population, and at improving healthcare professionals work organization. The French Health Ministry then launched a call for grant to fund one research project consisting in evaluating the TSN projects implementation and impact and in developing a model for HI technology evaluation. METHODS: EvaTSN is mainly based on a controlled before-after study design. Data collection covers three periods: before TSN program implementation, during early TSN program implementation and at late TSN program implementation, in the five TSN projects' territories and in five comparison territories. Three populations will be considered: "TSN-targeted people" (healthcare system users and people having characteristics targeted by the TSN projects), "TSN patient users" (people included in TSN experimentations or using particular services) and "TSN professional users" (healthcare professionals involved in TSN projects). Several samples will be made in each population depending on the objective, axis and stage of the study. Four types of data sources are considered: 1) extractions from the French National Heath Insurance Database (SNIIRAM) and the French Autonomy Personalized Allowance database, 2) Ad hoc surveys collecting information on knowledge of TSN projects, TSN program use, ease of use, satisfaction and understanding, TSN pathway experience and appropriateness of hospital admissions, 3) qualitative analyses using semi-directive interviews and focus groups and document analyses and 4) extractions of TSN implementation indicators from TSN program database. DISCUSSION: EvaTSN is a challenging French national project for the production of evidenced-based information on HI technologies impact and on the context and conditions of their effectiveness and efficiency. We will be able to support health care management in order to implement HI technologies. We will also be able to produce an evaluation toolkit for HI technology evaluation. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02837406 , 08/18/2016.

Co-creating and Evaluating a Web-app Mapping Real-World Health Care Services for Students: The servi-Share Protocol.

BACKGROUND: University students aged 18-30 years are a population group reporting low access to health care services, with high rates of avoidance and delay of medical care. This group also reports not having appropriate information about available health care services. However, university students are at risk for several health problems, and regular medical consultations are recommended in this period of life. New digital devices are popular among the young, and Web-apps can be used to facilitate easy access to information regarding health care services. A small number of electronic health (eHealth) tools have been developed with the purpose of displaying real-world health care services, and little is known about how such eHealth tools can improve access to care. OBJECTIVE: This paper describes the processes of co-creating and evaluating the beta version of a Web-app aimed at mapping and describing free or low-cost real-world health care services available in the Bordeaux area of France, which is specifically targeted to university students. METHODS: The co-creation process involves: (1) exploring the needs of students to know and access real-world health care services; (2) identifying the real-world health care services of interest for students; and (3) deciding on a user interface, and developing the beta version of the Web-app. Finally, the evaluation process involves: (1) testing the beta version of the Web-app with the target audience (university students aged 18-30 years); (2) collecting their feedback via a satisfaction survey; and (3) planning a long-term evaluation. RESULTS: The co-creation process of the beta version of the Web-app was completed in August 2016 and is described in this paper. The evaluation process started on September 7, 2016. The project was completed in December 2016 and implementation of the Web-app is ongoing. CONCLUSIONS: Web-apps are an innovative way to increase the health literacy of young people in terms of delivery of and access to health care. The creation of Web-apps benefits from the involvement of stakeholders (eg, students and health care providers) to correctly identify the real-world health care services to be displayed.

Effectiveness of therapeutic communities: a systematic review.

BACKGROUND: Therapeutic communities (TCs) are drug-free residential settings, focused on psychosocial rehabilitation. While TCs are considered an effective method, the bulk of the research evidence is from poorly controlled studies. The goal of this study was to evaluate TC effectiveness in terms of abstinence and to determine if there were predictive factors of abstinence. METHODS: The search used Medline up to January 30, 2011 and was based on a systematic review method. Studies on retention in treatment and/or substance use were considered. RESULTS: Of the 321 studies retrieved from Medline, 12 met selection criteria including overall 3,271 participants from 61 TCs. On average, subjects stayed in TC a third of the planned time. The completion rate ranged from 9 to 56%. All studies showed that substance use decreased during TC, but relapse was frequent after TC. Treatment completion was the most predictive factor of abstinence at follow-up. Surprisingly, psychiatric comorbidities did not appear associated with relapse or with dropout. CONCLUSIONS: There was a drop in consumption after TC, but long-lasting benefits were uncertain. Further studies are needed in order to compare the efficacy of TC programs and other types of treatment settings for substance-related disorders.