"We don't have the same bodies; we don't react the same way": mothers and adolescent girls' perceptions of the risks and benefits of HPV vaccination in France.

Human Papillomavirus (HPV) vaccination is one of the most publicly mistrusted vaccines in Europe, with countries such as France struggling with low vaccine uptake due to parental questioning of vaccine risks and benefits. However, limited evidence exists on adolescent girls' perceptions of the risks and benefits of HPV vaccination. The aim of this qualitative study was to provide an in-depth exploration and comparison of French mothers (n = 21) and adolescent girls' (n = 36) perceptions of the risks and benefits of HPV vaccination. A thematic analysis showed that adolescent girls and mothers perceived the risks and benefits of HPV vaccination differently, with girls reporting positive and beneficial views and emotions toward vaccination and mothers expressing concerns about possible risks. Adolescent girls also reported that both perceptions and actual risks and benefits may vary from one individual to another. Vaccine safety was also understood differently, with mothers reporting a widespread view that vaccines are unsafe and focusing on controversial side effects and girls discussing short-term consequences of vaccination (e.g. pain, fever) and administration and storage issues. Strategies to improve uptake of HPV vaccination should consider and address both the mothers' and daughters' perceptions and understandings of HPV vaccination.

'I trust them because my mum trusts them': Exploring the role of trust in HPV vaccination decision-making among adolescent girls and their mothers in France.

The success of vaccination programmes relies on high uptake and acceptance of vaccines, which is in part influenced by public trust in vaccines, providers, policy-makers and information. France is one of the countries in the world with the lowest confidence in vaccination, with parents expressing particular concerns about the human papillomavirus (HPV) vaccine. This qualitative study explored the role of trust in HPV vaccination decision-making among mothers and adolescent girls in France. Semi-structured interviews and focus groups were conducted with 15-16-year-old adolescent girls and their mothers in Paris. A thematic analysis based on deductive and inductive coding was conducted. HPV vaccination decision-making was described as a complex and uncertain process, a possible consequence of erosion of trust in the vaccine, in healthcare professionals and health authorities, and in information itself. Due to public criticism of the vaccine and conflicting advice received from medical professionals, the vaccine was perceived as controversial. The mothers' strong trust in doctors did not always increase HPV vaccine acceptance, as doctors themselves failed to recommend or recommended against the vaccine. Furthermore, the perceived mismanagement of previous health events tainted the mothers' trust in health authorities. Contrastingly, while adolescents expressed trust in doctors and health authorities, their trust in their own mothers was stronger. A lack of exposure to positive sources of information (e.g. from doctors, schools or media) contributed to low awareness about HPV vaccination among adolescent girls. While both mothers and girls discussed the importance of trusting themselves, they also acknowledged being influenced by others around them as well as information, often negative, from the internet. Adolescent girls also expressed mistrust about information in general, explaining that any information can be manipulated. Low confidence in HPV vaccination in France can be explained by broader trust issues, which will require long-term efforts to address.

The role of maturity in adolescent decision-making around HPV vaccination in France.

Mothers are often responsible for vaccination decisions in the household. However, their confidence in certain vaccines such as Human Papillomavirus (HPV) vaccines is eroding in some countries. France is one of the countries with the lowest HPV vaccine uptake in Europe, with parents delaying or refusing the vaccine for their adolescent daughters due to safety- and effectiveness-related concerns. Although parental consent is required for vaccination, adolescents' involvement in HPV vaccination decision-making could improve vaccine uptake, with self-consent procedures already introduced in some countries. Adolescents' capacity to engage in decision-making is influenced by their maturity and autonomy in health. This study explored the role of maturity in decision-making around HPV vaccination in France through qualitative interviews with adolescent girls (n = 24) and their mothers (n = 21) and two focus groups with adolescent girls (n = 12). A codebook approach to thematic analysis revealed that adolescent girls' involvement in HPV decision-making is a process that evolved with maturity. As adolescents progressed towards maturity at different speeds, some expressed childlike traits such as impulsive decisions and others described more rational, reflective decision-making. Despite these differences, most adolescents in this study described a passive role in HPV vaccination decision-making, following their parents' lead. However, their expressed desire for information and involvement in discussions indicates that their lack of engagement may not only be due to a lack of maturity but also a result of mothers and doctors excluding them from getting involved. Furthermore, as health behaviours are shaped during adolescence, the influence of vaccine hesitant mothers on their daughters' own views and beliefs could be significant, together with exposure to regular controversies in the mainstream media. Individualised approaches to engage adolescents in decision-making around their own health are needed, for example through strengthening discussions and information around HPV vaccination with parents and doctors.

Healthcare workers' attitudes towards hand-hygiene monitoring technology.

BACKGROUND: Automated radio-frequency identification (RFID)-based hand-hygiene monitoring technology was implemented in an infectious disease department to study healthcare workers' (HCWs') practices and to improve hand hygiene. AIM: To assess HCWs' attitudes towards this innovative monitoring device in order to anticipate resistance to change and facilitate future implementation. METHODS: In-depth interviews and an ethnographic approach. FINDINGS: From the perspective of HCWs, while they recognize the usefulness of RFID technology to prevent the transmission of infections to patients, they expressed concerns about risks related to RFID electromagnetic waves, as well as control by their superiors. Overall, HCWs' opinions oscillated between positive feelings characterized by enthusiasm for the possibility of changing their practices using technologies and research, and negative feelings marked by strong criticisms of these technologies and research. These criticisms included blaming hand-hygiene monitoring technology for decontextualizing HCWs' practices. They perceived the technologies through the prism of the local and national contexts in which they are embedded. From their point of view, technologies are primarily in the best interests of the project team. Thus, they affirm and maintain the different interests and objectives between themselves and the project team, crystallizing a conflict of professional norms and values between these two groups. The forms of resistance taken by HCWs were practical as well as oral. CONCLUSION: Innovative technologies should be developed to address HCWs' attitudes surrounding RFIDs. It is crucial to inform HCWs about the nature of these technologies, although some criticisms about monitoring systems are based on more structural causes.

Lyme disease: Insight from social sciences.

This article is a selective literature review of social science works published on Lyme disease that draws on other articles published on similar health hazards. These works present Lyme borreliosis as an "archetypal" example of modern infectious risks. It is an "invisible" risk resulting from interactions between human activities, ecosystems, and pathogens. To tackle this risk, health authorities promote individual-based prevention measures. Perceptions of the general population should thus be better understood: different from the perceptions of experts, the general population's perceptions are socially differentiated, inclined to an "optimism bias", and influenced by personal stories. One should also not forget the dilemmas faced by the general population when contemplating preventive behavior. The "chronic Lyme disease" controversy illustrates the modern disappointment in science, the leveling of the general population's and experts' relative opinions, and the progressive interference of the former with expert matters.

Design of a national and regional survey among French general practitioners and method of the first wave of survey dedicated to vaccination.

OBJECTIVES: France is currently facing a vaccine-hesitancy crisis. We conducted a questionnaire-based telephone interview with a large sample of general practitioners (GPs) as they play a crucial role in the vaccination process. Our main objectives were to study the GPs' vaccination behaviors when it comes to their own vaccination and that of their relatives, and the vaccine recommendations made to their patients. We also aimed to understand their opinion related to the severity of vaccine-preventable diseases and to assess their trust in various sources of information. Finally, we enquired about their opinion in terms of vaccination-related tools that could help them in their daily practice. The article aimed to present the design of this panel and survey. PATIENTS AND METHODS: Four samples of GPs (one national and three regional) were selected among all the French GPs (metropolitan France) using random sampling. Five cross-sectional surveys should be conducted with that panel. The mean targeted sample size is 2350 GPs for each survey. The survey dedicated to vaccination was conducted by telephone or on the Internet. RESULTS: GPs were included in the survey between December 2013 and February 2014. The national sample included 1582 GPs (response rate: 46%) and the three regional samples included 1297 GPs (response rate: 44%). The survey dedicated to vaccination was conducted between April and July 2014; the national sample response rate was 92% (1582/1712). CONCLUSION: The results of the first wave of surveys, conducted on a large sample of French GPs, provide important information to guide the French vaccination policy.

Characteristics of patients and physicians correlated with regular influenza vaccination in patients treated for type 2 diabetes: a follow-up study from 2008 to 2011 in southeastern France.

We studied a cohort of 110 823 patients treated with oral hypoglycaemic agents for type 2 diabetes in southeastern France from 1 January 2008 to 31 December 2011, to identify influenza vaccination coverage trends and the patient and physician correlates of influenza vaccine (IFV) uptake. We used French national health insurance fund (NHIF) databases to identify these patients and collect data on their IFV reimbursement claims (IFVC) and patient and physician characteristics. We used multilevel multivariate polytomous logistic regressions to test the correlates of IFVC. Between 2008 and 2011 the annual IFVC rate varied from 33.7% to 32.3% in the 18-64 age group and from 69.5% to 61.1% in the 65 + age group, among whom we saw a clear trend towards reduced vaccination after 2008. In the younger group, the probability of regular vaccination each year from 2008 to 2011 increased with diabetes severity and duration, comorbidities, and the number of general practitioner and nurse visits; it was higher among patients seeing endocrinologists and lower among low-income patients than in other patients. In the older group, there was no association with either diabetes severity or physician specialty. These results suggest different patterns of correlates of influenza vaccination according to age. Endocrinologists might help to improve IFV uptake in the younger group of patients with type 2 diabetes. Communication strategies regarding influenza vaccination should be adapted to age, and collaboration between healthcare professionals should be reinforced to achieve vaccination objectives for these patients.

[How do we catch flu? Beliefs in France in 2010]. / Comment attrape-t-on la grippe ? Les croyances des Français en 2010.

AIMS: Our goals were to describe beliefs held by French people concerning the contagiosity of influenza and analyze the relationship of these beliefs with vaccination against seasonal flu. METHODS: A subsample (4749 people aged 15-79) of the Health Barometer 2010 responded to questions dealing with influenza. Responses were analyzed using clustering analysis and logistic regression. RESULTS: Overall, observed beliefs were quite good, but also socially differentiated. 'False' beliefs were more frequent among people with a lower socioeconomic status. Those who overestimated the contagiosity of influenza were less likely to have been vaccinated against seasonal influenza in 2008. CONCLUSIONS: The beliefs analyzed here were associated with vaccination behaviors. 'False' beliefs may be difficult to change as they are nevertheless coherent. These beliefs also exhibit social inequalities that should be taken into account when determining preventive measures.

[Knowledge about radon and its associated risk perception in France]. / Connaissance et perception du risque dû au radon en France.

PURPOSE: Radon exposure is a major environmental risk in health. It remains badly known by the general population. It is the second cause of lung cancer, after tobacco smoking. The aim of this cross-sectional general population survey was to describe radon exposure risk knowledge and the socioeconomic factors related to this knowledge. MATERIALS AND METHODS: The Cancer Barometer survey 2010 questioned the French population about its knowledge of radon as such and as health risk factor. This survey was a two-stage random sampling with computer-assisted telephone interview that was performed from April 3, 2010 to August 7, 2010 on a sample of 3,359 people aged 15 to 75 years old. RESULTS: Among people aged 15 to 75 years old, only one in five knows that radon is a natural gas coming from the ground. This knowledge is more frequent among people living in an area that is directly concerned by radon, among men and increases with age, with the level of education and the level of income. Radon risk remains still widely underestimated by the general public, including in areas concerned by this risk. When people were confronted with radon exposure, few intended to remedy by improving their home. CONCLUSION: The success of prevention initiatives implies the support and the collaboration of various national and local actors. To improve their impact for the prevention of lung cancers, it could be more effective to couple these actions with prevention messages on tobacco.

Dramatic change in public attitudes towards vaccination during the 2009 influenza A(H1N1) pandemic in France.

We investigated the potential impact of the 2009 influenza A(H1N1) pandemic on attitudes towards vaccination among people aged 18 to 75 years and living in metropolitan France. We used data from three national telephone surveys conducted on representative samples in 2000, 2005 and 2010 (n=12,256, n=23,931, n=8,573 respectively). In France, unfavourable attitudes towards vaccination in general dramatically increased from 8.5% in 2000 and 9.6% in 2005 to 38.2% in 2010. In 2010, among respondents who held unfavourable attitudes towards vaccination, 50% mentioned specifically their opposition to the influenza A(H1N1) vaccine. The sociodemographic profile associated with these attitudes also changed greatly. In particular, unfavourable attitudes towards vaccination in general became significantly more frequent among less educated people in 2010. These attitudes were also correlated with vaccination behaviours. For example, parents who were unfavourable towards vaccination in general were more likely to report that they had at least one child who did not get the measlesmumps- rubella vaccine. As this shift in attitude may have a significant impact on future vaccination coverage, health authorities should urgently address the vaccine confidence gap.

[Does primary prevention contribute to increase social inequalities in health?]. / La prévention primaire contribue-t-elle à accroître les inégalités sociales de santé?

In France, as in many countries, tackling social inequalities in health is a public health priority. However, primary prevention may sometimes contribute to increase such inequalities. This article aims to illustrate this point, considering the cases of smoking and obesity. The implicit hypotheses of prevention regarding its targets are discussed, as well as its stigmatization effects. On the one hand, prevention can increase the social differentiation of risky behaviors, as it is more effective among wealthier and more educated people. On the other hand, prevention policies intending to increase either the financial or the symbolic cost of risky behaviors may also increase social inequalities. Primary prevention needs more reflexivity regarding its potential unintended and deleterious side effects.

Gender and age disparities in the associations of occupational factors with alcohol abuse and smoking in the French working population.

BACKGROUND: This study assessed the associations of short-term employment, physical and psychological occupational demands, and job dissatisfaction with alcohol abuse (using the Audit-C test) and daily smoking among working French men and women in different age groups. METHODS: The sample included 13,241 working people, 18-29, 30-39, and 40-59-years-old, randomly selected in France and interviewed by phone. Occupation, type of employment, physical demands, psychological demands, job dissatisfaction, gender, age, educational level, and income were considered. Data were analyzed with logistic models. RESULTS: Alcohol abuse affected 20.4% of men and 7.5% of women; smoking 32.1% and 24.2%, respectively. Their patterns of association with the occupational factors varied with gender and age. Job dissatisfaction was the leading factor among young men (adjusted odds ratio for alcohol abuse and smoking: 1.71 and 2.02), whereas short-term employment was the leading factor among young women (1.69 and 1.58), this pattern being reversed in older generations. The pattern of associations of physical and psychological demands with outcomes is more complex, but overall psychological demands were more important for women (especially the younger ones) than men, especially for smoking (OR>1.6). Smoking within 5 min after waking was much more common among male and female smokers with these occupational factors, suggesting a potential dependency. CONCLUSIONS: Workers with short-term employment and occupational demands are subject to a higher risk for alcohol abuse and smoking with high gender and age disparities. Gender and age should be considered when designing measures to prevent substance abuse related to occupation.

Widening inequalities in smoking initiation and cessation patterns: a cohort and gender analysis in France.

AIMS: This study investigates the evolution of educational inequalities in smoking initiation and cessation in France according to gender and birth cohort. METHODS: We used a 2005 nationwide survey comprising 25,239 subjects aged 18-75 years. Three cohort groups were defined (born 1930-1945, 1946-1965 or 1966-1987). We compared their smoking histories until age 40 years with time-discrete logistic regressions. Educational differences in initiation and cessation were quantified using odds ratios and relative indices of inequality (RII), and the gender gap using odds ratios (gender ratios). RESULTS: For smoking initiation, in the oldest cohorts, no educational gradient appeared in men, but there was a positive gradient in women (RII=0.19); in the middle cohorts, a negative gradient emerged in men (RII=1.55), while the positive gradient reduced in women (RII=0.74); in the youngest cohorts, there was a strengthening of the negative gradient in men (RII=2.72), and the emergence of a negative gradient for women (RII=1.86). The gender ratio narrowed from the oldest cohorts (3.23) to the youngest (1.09), and diminished with increasing educational level within each cohort. For smoking cessation, the educational gradients were negative in both genders, with wider gaps in the youngest cohorts, and gender ratios below 1 reflecting more marked cessation dynamics in women. CONCLUSION: Women are at an earlier stage in the tobacco epidemic than men for initiation and at a later stage for cessation and social inequalities are widening. We believe that they will not decrease unless gender and the psycho-social aspects of smoking are considered in prevention campaigns.

[Pain and breast cancer among women from the ELIPPSE cohort]. / L'expérience de la douleur parmi des femmes atteintes d'un cancer du sein (cohorte ELIPPSE).

Chronic pain is one major determinant of quality of life among cancer survivors. It is especially true for breast cancer survivors, who frequently endure iatrogenic pain. We conducted in-depth interviews with 25 women recruited in the ELIPPSE cohort, 24 months after their diagnosis, and several months after the end of their treatment. These women gave various meanings to chronic pain (a transient condition, necessary for recovering, or a new and permanent condition) that contribute to 'normalize' pain and to prevent its alleviation. Moreover, health professional sometimes fuel this 'normalization' of pain. Our interviews also showed how participants enduring chronic pain tried to relieve it by adjusting their daily activities and gestures. Finally, our results emphasize both the lack of information given to patients concerning iatrogenic pain and the existing ways to manage it, and the lack of specific training for health professionals.

Suicidal ideation among young French adults: association with occupation, family, sexual activity, personal background and drug use.

BACKGROUND: To assess associations among young adults between suicidal ideation in the previous year and adverse childhood events, occupation, education, tobacco use, alcohol abuse, cannabis use in the previous month, illicit drug use, sexual orientation and activity, depression, physical violence in the previous year, and lifetime forced sexual intercourse. METHODS: A subsample of 4075 French adults aged 18-30 years was drawn from a random national telephone survey in 2005. Major depressive episode and alcohol abuse were assessed using CIDI-SF and AUDIT-C (score above 4). Data were analysed with logistic regressions. RESULTS: Suicidal ideation affected 5.7% of men and 4.9% of women. Among men depression had the highest adjusted odds ratio (ORa=8.06, 5.07-12.79), followed by homosexual intercourse (3.37, 1.62-7.04), absence of sexual activity (2.83, 1.80-4.44); ORa between 1.6 and 2.0 were observed for living alone, daily tobacco smoking, being unemployed, serious health event concerning the father, age 26-30 and bad relationships between parents. Among women, depression had the highest ORa (7.60, 4.70-12.29), followed by lifetime experience of forced sexual intercourse (5.37, 2.89-9.96), having consumed illicit drugs other than cannabis (4.01, 1.48-10.89); ORa between 1.7 and 2.5 were observed for living alone, being unemployed, bad relationship between parents and age 26-30. LIMITATIONS: Cross-sectional survey, sexual orientation inferred from sexual activity. CONCLUSION: Suicide prevention should integrate the fact that besides depression, unemployment, family history, age, and sexual activity and orientation are specific risk factors among men, whereas illicit drug use, violence and forced sexual intercourse are more important among women.

French hospital nurses' opinion about euthanasia and physician-assisted suicide: a national phone survey.

BACKGROUND: Hospital nurses are frequently the first care givers to receive a patient's request for euthanasia or physician-assisted suicide (PAS). In France, there is no consensus over which medical practices should be considered euthanasia, and this lack of consensus blurred the debate about euthanasia and PAS legalisation. This study aimed to investigate French hospital nurses' opinions towards both legalisations, including personal conceptions of euthanasia and working conditions and organisation. METHODS: A phone survey conducted among a random national sample of 1502 French hospital nurses. We studied factors associated with opinions towards euthanasia and PAS, including contextual factors related to hospital units with random-effects logistic models. RESULTS: Overall, 48% of nurses supported legalisation of euthanasia and 29%, of PAS. Religiosity, training in pallative care/pain management and feeling competent in end-of-life care were negatively correlated with support for legalisation of both euthanasia and PAS, while nurses working at night were more prone to support legalisation of both. The support for legalisation of euthanasia and PAS was also weaker in pain treatment/palliative care and intensive care units, and it was stronger in units not benefiting from interventions of charity/religious workers and in units with more nurses. CONCLUSIONS: Many French hospital nurses uphold the legalisation of euthanasia and PAS, but these nurses may be the least likely to perform what proponents of legalisation call "good" euthanasia. Improving professional knowledge of palliative care could improve the management of end-of-life situations and help to clarify the debate over euthanasia.

Participants' sports characteristics related to heavy episodic drinking among French students.

BACKGROUND: The relationships between involvement in sports and alcohol consumption appear to be complex in the alcohol literature. In this study we aimed to examine this link among French students, taking into account their sports characteristics. We also examined variations in alcohol use among sport sciences students between 2002 and 2006, and the difference in alcohol use and heavy episodic drinking among sport sciences, law and pharmacy students. DESIGN: repeated survey; cross-sectional study; SETTING: self-questionnaire survey; PARTICIPANTS: French (south-east France) sport sciences (n=693), law (n=325) and pharmacy (n=338) students (females=58%). RESULTS: In 2002, 38% of the male sport sciences students reported repeated heavy episodic drinking, and this proportion has risen to 48% in 2006 (p<0.05). When compared to law and pharmacy students, female and male sport sciences students were less likely to report repeated heavy episodic drinking (p<0.05). Engaging in physical activity (whether or not it takes place within an institution) and practising martial art were negatively related to heavy episodic drinking (p<0.05). Other factors related to heavy episodic drinking were gender-specific: among males, practising sport in a formal context, team sports, and competitive participation at a departmental or regional level represented risk factors (p<0.05), while practising an individual sport was a protective factor among females (p<0.05). CONCLUSION: This study corroborated the importance to take into account the context of practice and the type of sport practised to examine the link between sport participation and alcohol consumption. The normative context of peer socialization among competitive and team sports participants seemed to play a role in alcohol use. Further studies are needed to confirm the role of this putative factor.

[Role of employment or scholar status and gender: Drug use among 18 to 25 year-olds in France in 2005]. / Le rôle du statut scolaire et professionnel dans les usages de drogues des hommes et des femmes de 18 à 25ans.

BACKGROUND: In France, drug use levels of college students remain quite unknown, mainly because of the lack of representative samples of this specific part of the population. There is also a lack of studies concerning gender and drug use. METHODS: The Health barometer 2005 is a wide national telephone survey which is representative of the 12-75-year-olds (n=30,514). Among the 18-25-year-olds, 1290 students were surveyed, besides 1480 employed and 538 unemployed people. Various licit and illicit drug use levels of these three groups were compared using logistic regression models for men and women, controlling for age, level of diploma, category of area of residence, living in couple, religion and type of phone equipment. These results were compared with those obtained in the Health Barometer 2000, with exactly the same variables and definitions. RESULTS: Analysis showed that among women, alcohol and cannabis use as well as drunkenness were more frequent among unemployed and college students than among workers. For men, drug use, and especially illicit drug use, appeared more frequent among unemployed. As a consequence, gender differences for alcohol and cannabis use were lower among students than among workers or unemployed. For both sexes, logistic models controlling for age showed that alcohol consumption as well as daily tobacco smoking were less frequent among students than among employed people, contrarily to drunkenness and cannabis use. For almost all drug uses, differences between genders are smaller among students. Except for alcohol and tobacco use, these differences disappeared when controlling for other sociodemographic variables. Compared with data from year 2000, differences among the three groups appeared smaller, especially for drunkenness and cannabis smoking among college students. CONCLUSION: Alchol and tobacco uses are less frequent among students than active people, employed or not, but there is no significant difference for drunkenness and cannabis use. For both genders, unemployment is associated with increased levels of drug use, but pursuing higher education is associated with an increased level of alcohol and cannabis use among women, which is not the case among men.