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.

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.

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.

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.

[Health literacy and cancer screening] / 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.

Cancers attributable to tobacco smoking in France in 2015.

Background: The evidence on the carcinogenicity of tobacco smoking has been well established. An assessment of the population-attributable fraction (PAF) of cancer due to smoking is needed for France, given its high smoking prevalence. Methods: We extracted age- and sex-specific national estimates of population and cancer incidence for France, and incidence rates of lung cancer among never smokers and relative risk (RR) estimates of smoking for various cancers from the American Cancer Prevention Study (CPS II). For active smoking, we applied a modified indirect method to estimate the PAF for lung and other tobacco smoking-related cancer sites. Using the RR estimates for second-hand smoking, the proportion of never smokers living with an ever-smoking partner derived from survey, and marital status data, we then estimated the PAF for lung cancer attributable to domestic passive smoking. Results: Overall in France in 2015, 54 142 and 12 008 cancer cases in males and females, respectively, were attributable to active smoking, accounting for 28 and 8% of all cancer cases observed among adult (30+ years) males and females. Additionally, 36 and 142 lung cancer cases, respectively among male and female never smokers, were attributable to second-hand smoke resulting from their partner's active smoking, corresponding to 4.2 and 6.7% of lung cancer cases which occurred in never smoker males and females, respectively. Conclusions: Tobacco smoking is responsible for a significant number of potentially avoidable cancer cases in France in 2015. More effective tobacco control programmes are critical to reduce this cancer burden.

[Interventions for smoking cessation among low socioeconomic status smokers: a literature review]. / Interventions pour l'arrêt du tabac chez les fumeurs de faible niveau socio-économique : synthèse de la littérature.

INTRODUCTION: In most western countries, smoking appears to be highly differentiated according to socio-economic level. Two systematic reviews published in 2014 showed that most of the recommended interventions for smoking cessation, particularly individual interventions, tend to increase social inequalities in health. An analysis of the most recent literature was carried out in order to provide policy makers and stakeholders with a set of evidence on the modalities of interventions to encourage and help disadvantaged smokers quit smoking. METHODS: This review was based on articles published between January 2013 and April 2016. Only studies conducted in European countries or countries in stage 4 of the tobacco epidemic (USA, Canada, Australia, New Zealand) were included. Selected articles were double-screened. RESULTS: Twenty-three studies were identified, including evaluation of media campaigns, face-to-face behavioural support, phone- and web-based support or awareness of passive smoking among children. Some interventions adapted to precarious populations have been shown to be effective. CONCLUSIONS: Some characteristics would facilitate access and improve the support of disadvantaged groups, including a local intervention, a proactive approach and co-construction with targeted smokers.

Chlamyweb Study II: a randomised controlled trial (RCT) of an online offer of home-based Chlamydia trachomatis sampling in France.

BACKGROUND: The number of cases of Chlamydia trachomatis (Ct) diagnosed has increased in the past 15 years in France as well as in other European countries. This paper reports a randomised controlled trial (RCT) to evaluate whether the offer of home-based testing over the internet increased the number of young people tested for chlamydia compared with the current testing strategy and to estimate the number and risks factors of the infected population. This RCT took place as an element of the Chlamyweb Study-a study aiming to evaluate an intervention (the Chlamyweb Intervention) involving the offer of a free self-sampling kit online to sexually active men and women aged 18-24 years in France. METHODS: Participants in the Chlamyweb RCT (n=11 075) received either an offer of a free self-sampling kit (intervention group) or were invited to be screened in primary care settings (control group). Risks ratios were used to compare screening rates between the intervention and control groups. Risk factors were analysed for infected people in the intervention group. RESULTS: The screening frequency was about three times higher among young people who received a self-sampling kit than those who only received a tailored recommendation to be screened (29.2% vs 8.7%). Although rates of screening among men were lower than among women (23.9% vs 33.9%), the intervention effect was greater among men (adjusted risk ratios (aRR)=4.55 vs aRR=2.94). Ct positivity (6.8%) was similar to that observed in STI clinics. It was higher in women (8.3%) than in men (4.4%). CONCLUSIONS: These results invite us to consider the establishment of a large home-based screening programme, although additional studies including economic assessments are needed to evaluate the most appropriate combination of strategies in the French context. TRIAL REGISTRAION NUMBER: AFFSAPS n° IDRCB 0211-A01000-41; Results.

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]. / Publicités alimentaires télévisées à destination des enfants : opinions des parents sur leur impact et leur interdiction.

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.

[Development of an evidence-based media campaign to promote walking among physically inactive women and increased physical activity among adults]. / Construction d'un dispositif de communication scientifiquement fondé visant à promouvoir la marche des femmes peu actives et l'activité physique des adultes.

This paper demonstrates the feasibility of developing a multimodal media campaign-based intervention to promote physical activity using theory, evidence and media campaign construction expertise. An evaluation of this media campaign and its various components is the next stage of this work..

[Effective interventions to prevent health damage related to ultraviolet exposure: a review of the literature]. / Les interventions efficaces en prévention des problèmes de santé liés à l’exposition aux ultraviolets naturels: une synthèse de littérature.

The purpose of this paper is to review the current scientific knowledge on health promotion interventions designed to prevent health damage caused by natural ultraviolet (UV) exposure. The current state of knowledge in this area was assessed using a specific method including a review of literature reviews and a classification of health promotion interventions identified using scientific databases. We found a large number of promising programmes. Briefly, some interventions based on environmental changes and provision of shade were considered to be promising. Health education programmes delivered at school have been proven to be effective in various settings, from nursery school to college. Some parentbased interventions designed to promote children's sun protection behaviours have been shown to be relevant. Appearance-based actions, using for instance photoaging information, may be effective. Finally, some multi-component interventions in community settings appear to be promising. These findings present a number of limitations due to the marked diversity of outcome measures and the general quality of the documents reviewed. Furthermore, most interventions are poorly described in the reviews. The present study should therefore be considered to be a first step that needs to be completed by a more detailed description of the promising interventions and of their transposition to the French context.

[Effective interventions to prevent child injuries: a review of the literature]. / Les interventions efficaces en prévention des accidents de la vie courante chez les enfants: une synthèse de littérature.

Child injuries represent an important public health problem. The aim of this paper is to review the current scientific knowledge on interventions designed to prevent child injuries. The current state of knowledge in this area was assessed by means of a specific method involving a review of literature reviews and a classification of health promotion interventions identified in these reviews (rapid reviews). We found a large number of effective or promising programmes devoted to the prevention of the most common child injuries: drowning, burns, falls, poisoning, electrocution, sports and leisure injuries. Some interventions are based on environmental measures, while others are educational or use law and regulatory processes. Some are primary prevention measures, others are secondary prevention measures, while others are multidimensional and can effectively reduce several types of injuries. For example, home safety education and provision of safety equipment, or home-based parenting interventions, can have an impact on injury rates. These findings present a number of limitations due to the marked diversity of the quality of the documents reviewed. It should also be stressed that interventions that are not listed in this article are not necessarily ineffective: they may simply lack a rigorous evaluation enabling them to be identified in our review.

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.

["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.)."

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).

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.

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.

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.