Pre-Frailty, Frailty, and Multimorbidity: Prevalences and Associated Characteristics from Two French National Surveys.

OBJECTIVE: To estimate the prevalence of pre-frailty, frailty and multimorbidity in individuals without disability in France. To describe independent determinants of each indicators. DESIGN: Two nationally representative cross-sectional French surveys. SETTINGS: Wave 2012 of the Health, Health Care and Insurance Survey (Enquête Santé et Protection Sociale, ESPS) and data from the Disability Healthcare Household section Survey (Enquête Handicap Santé - Ménages, HSM) from 2008. PARTICIPANTS: Two representative samples of the French population aged 55 and older (n=4,328 and n=12,295). MEASUREMENTS: Frailty was assessed using Fried's frailty phenotype and multimorbidity was defined as having had at least two groups of the following groups of comorbidities in the last 12 months (cardio or cerebrovascular disease, diabetes, chronic respiratory disease, arthralgia, depression). Independent determinants were studied using weighted logistic regressions. RESULTS: In the French population over 55 and free of disability, 55 to 62% of individuals were either frail, pre-frail or multimorbid, 22 to 25% being frail or multimorbid. ESPS and HSM prevalences for frailty (11.1% [9.3%-12.1%] and 12.3% [11.5%-13.0%]) and multimorbidity (14.9% [13.6%-16.2%] and 16.8% [15.9%-17.7%]) were consistent across studies. Both frailty and multimorbidity prevalences were associated with age. On the other hand, pre-frailty prevalence varied consistently between studies (from 38 to 48%) and was not significantly associated with age. We found that more than 60% of frail subjects did not present with multimorbidity and around 70% of subjects with multimorbidity were not frail. Determinants of pre-frailty and multimorbidity but not frailty depended on sex. Similar factors were associated with frailty and multimorbidity in women (older age, functional decline, poor mental health, financial difficulties) while only poor mental health was independently associated with both indicators in men. CONCLUSION: Our study highlights that in France, among individuals older than 55 years-old and free of disability, around 25% are either frail or multimorbid; another 30% to 40% being pre-frail. Pre-frailty, frailty and multimorbidity are known to be associated with adverse health outcomes and important economic costs. The health system must adapt to respond to the needs of its aging population. In addition, given the efficient impact of prevention actions, our findings emphasize the need to implement prevention strategies against Frailty and multimorbidity in France.

[Factors associated with suicide attempts by sexual minorities: Results from the 2011 gay and lesbian survey]. / Facteurs associés aux tentatives de suicide chez les minorités sexuelles : résultats de l'enquête presse gays et lesbiennes 2011.

BACKGROUND: Since the 1990s, several studies have found higher rates of suicide attempts in homosexuals and bisexuals than in heterosexuals. The current challenge is to identify risk factors for targeting prevention. The aim of this paper was to determine, for the first time in France, the prevalence of suicide attempts over a 12-month period and associated factors in a population of men and women who self-identified as homosexuals or bisexuals. METHODS: A convenience sample cross-sectional survey was conducted in 2011 using an anonymous self-administered questionnaire made available in the gay press, and Internet sites targeting the gay or lesbian community. Among the persons completing the questionnaire, 10,100 men and 2963 women residing in France answered the questions on suicide attempts. The factors associated with suicide attempts during the previous 12 months were identified by logistic regression. RESULTS: Lifetime prevalence for suicide attempts was 16% in men and 18% in women; 12-month prevalence was 1.6% in men and 1.9% in women. Factors independently associated with suicide attempts in the past 12 months in men and women were lack of occupational activity, victim of sexual abuse, termination of a long-term relationship, excessive alcohol consumption in the past 12 months, depression, and in addition, in men, living in a small locality, victim of verbal or physical aggression and use of anxiolytics. CONCLUSION: According to our results, the fight against homophobia is an important element for the prevention of suicide attempts among homosexual and bisexual men. Indeed, in addition to traditional risk factors for suicide attempt, a significant association was also found with homophobic aggression in the past year.

Self-report of sexually transmitted infections from 1994 to 2010 by adults living in France.

BACKGROUND: Since 1994, French population-based knowledge, attitudes, beliefs and practices surveys have enabled researchers to estimate trends in sexual behavioural indicators. METHODS: We estimated trends and prevalence of self-reported sexually transmitted infections during the previous 5 years among 16,095 sexually active adults aged 18-54 through five cross-sectional telephone surveys between 1994 and 2010. We then studied the factors associated with participants' most recent sexually transmitted infections other than genital candidiasis. RESULTS: Overall, 2.5% (95% confidence interval: 2.2%-2.9%) of women reported sexually transmitted infections within the previous 5 years, increases being continuously reported between 1998 and 2010. In contrast, men reported lower prevalence of sexually transmitted infections (1.4%; 95% confidence interval: 1.1%-1.7%), which remained stable over time. General practitioners and gynaecologists managed most sexually transmitted infections. Men notified their stable partners about infection less often than women (66% vs. 84%). Self-reported sexually transmitted infections were associated with younger age, multiple sexual partnerships and fear of sexually transmitted infections in both genders, with exclusively homosexual practices in men, and with a high educational level and recent HIV testing in women. CONCLUSION: Self-reported sexually transmitted infections clearly reflect risky sexual behaviours. The lower prevalence of self-reported sexually transmitted infections among men than among women may reflect less access to screening activities for sexually transmitted infections in men.

[New outcome rates for random sampling telephone surveys]. / Pour de nouveaux indicateurs de qualité des enquêtes téléphoniques par sondage aléatoire.

BACKGROUND: Survey non-response rates are important quality indicators. Refusal rates can induce non-response bias in health survey estimates. However, comparisons across surveys highlight inconsistencies in the use of survey outcome categories and in the calculation of response rates. In this paper we discuss the relevance of these indicators and suggest other survey quality indicators. METHODS: Outcome rates from two French random-digit dialing (RDD) telephone surveys are compared : the Nicolle survey on infectious diseases of 4112 individuals conducted in 2006, and the HIV knowledge, attitude, belief and practices (KABP) survey of 5071 individuals in 2004. Based on the same protocol, we describe in details the way the two RDD samples were drawn and how non-response rates were estimated. RESULTS: Non-response rates were different: 36% in Nicolle survey and 18% in KABP survey. However, the quantity of telephone numbers required to obtain one interview was higher in the KABP survey: 2.8 telephone numbers versus 2.1 in the Nicolle survey. The participation rates, aggregating together refusals, break-off and non-reachable numbers, were equivalent for the two surveys. This result occurred because of a greater proportion of unreached calls in the KABP surveys, which is not integrated into the non-response rates commonly used. CONCLUSION: Survey non-response rate is insufficient to estimate the quality of a survey. The need for other indicators has been previously stressed in the literature, notably with the adoption and utilization of the American Association for Public Opinion Research (AAPOR) standard definitions of four indicators. But these indicators are quite complex for evaluating non-response bias between surveys. In addition to the classical refusal rate, two other indicators are proposed in this paper: participation rate (number of complete interviews divided by the number of eligible and of unknown eligibility units) and a liking contact rate (number of unreachable units because of a long absence, break-off or non-answer divided by the number of eligible and of unknown eligibility units). The sum of these three indicators is equal to 100% and thus easier to manipulate when comparing surveys.

[Prevention of unintended pregnancies: toward a dual protection at sexual debut?]. / Prévention des grossesses non prévues chez les jeunes en France : pour une double protection des premiers rapports sexuels ?

BACKGROUND: Despite the expanded range of contraceptive options and the fact that the first acts of intercourse are well protected, abortion rates among young women in France have increased in the last 15 years. These contraceptive failures could result from the lower effectiveness of the condom compared with the pill, and/or the occurrence of contraceptive gaps when switching from the condom to the pill. Adding to the existing literature, this paper explores the conditions by which women and men discontinue using the condom. METHODS: The study sample was comprised of 1552 men and 1849 women under the age of 30, who participated in the National Survey on Sexual Health in France. Respondents answered questions on contraceptive use, duration of condom use, condom discontinuation and the switch to another method of contraception at the time of condom discontinuation in the context of their first and last sexual relationships. RESULTS: Condoms, used by a large majority of respondents during the first acts of intercourse, were rapidly discontinued in favor of other methods, particular the pill, for continuing relationships. However, one in ten respondents (women and men alike) had unprotected intercourse after condom discontinuation, when condom use was discontinued in the first trimester of their relationship. Abortions were more frequent among respondents who reported they did not use a condom at the start of a relationship or among women who did not switch to another form of contraception after discontinuing condom use. CONCLUSION: While condoms are widely used during the first acts of intercourse, the rising abortion rates among young people suggests frequent contraceptive failures, which partly result from unprotected intercourse following condom discontinuation. These results question the dichotomy between HIV campaigns based on condom use and campaigns to reduce unintended pregnancies, which promote use of other forms of contraception, such as the pill. To reduce the incidence of unprotected intercourse, it would be important to promote the use of condoms at sexual debut, both as a contraceptive and preventive method against STIs, and provide counseling about all available contraceptive options, including the use of emergency contraception as a backup option in case of errors of use of the condom.

Cost-effectiveness of the Mpowerment Project, a community-level intervention for young gay men.

OBJECTIVES: Previous evaluation demonstrated that the Mpowerment Project community-level intervention for young gay men reduces HIV risk behaviors. The current analysis was undertaken to estimate the intervention's health and economic outcomes. DESIGN/METHODS: We conducted a retrospective cost-effectiveness analysis. We estimated HIV infections averted, the gain in quality-adjusted life years (QALYs), cost per infection averted, and net cost. Using a population-level model, we portrayed two epidemic scenarios: the first with stable HIV prevalence and the other with rising HIV prevalence. Inputs included behavior change resulting from the intervention and program cost data. Cost was calculated from three perspectives: societal; societal excluding volunteer time; and that of a community-based organization (CBO). Outcomes were calculated for 1, 5 (baseline), and 20 years. RESULTS: The Mpowerment Project averted an estimated 2.0 to 2.3 HIV infections in the first year (according to the epidemic scenario), 5.0 to 6.2 over 5 years, and 9.2 to 13.1 over 20 years. The societal cost per HIV infection averted was estimated at between $14,600 and $18,300 over 5 years. Costs per infection averted were 28% lower when excluding volunteer time and 35% lower from the CBO perspective. Net savings were $700,000 to $900,000 over 5 years from the societal perspective. CONCLUSIONS: The Mpowerment Project is cost-effective compared with many other HIV prevention strategies. The cost per HIV infection prevented is far less than the lifetime medical costs of HIV disease.

Impact on the general public of media campaigns against AIDS: a French evaluation.

The article presents the results of the first national survey in a representative sample of the French population of 18 years of age and over (n = 1000; March 1990) about knowledge, attitudes, beliefs and practices toward HIV infection. It focuses on the impact of the media campaigns about AIDS and condom promotion that were initiated since April 1987 by French public health authorities. A total of 53.2% of respondents were able to correctly quote at least one of the slogans of the campaigns and 48.4% felt they have been personally influenced by the campaigns. Respectively 25.4%, 12.1%, and 11.2% declared that the campaigns have made them more concerned of individual risk of HIV infection and prompted them to condom use and HIV testing. Among heterosexually active respondents, 16.9% declared condom use in the past 12 months, age, marital status, level of education, HIV testing and self-acknowledgement of influence of campaigns being the main factors related to condom use in multidimensional analysis. Respondents who recognise having been influenced by campaigns are less likely to believe in HIV transmission through casual contact and to express discriminatory attitudes toward HIV carriers but more likely to support HIV mandatory screening for the general population. The difficulties to properly evaluate media campaigns for AIDS prevention are discussed as well as the complex trade-offs that general public information has to face between promotion of both individual behavioural change and societal support and empathy for HIV carriers and persons with AIDS.