Home delivery of an injury prevention kit for children in four French cities: a controlled randomized trial.

OBJECTIVES: Home delivery of counselling and safety devices to prevent child injuries could help parents to adopt safe behaviour. The aim of this study was to test a safety kit designed and used in Quebec (Canada). DESIGN AND SUBJECTS: One hundred families from four towns in the Paris suburbs were visited at home by nurses or doctors when their child reached 6-9 months. Selection criteria were: primipara, medical problem, psychological, and/or socioeconomic difficulties. INTERVENTIONS: During the first visit, 50 families (group 1) received counselling and a kit including preventive devices and pamphlets about indoor injuries and ways to avoid them. The other 50 families (group 2) received counselling but not the kit. A second home visit was made 6-8 weeks later. MAIN OUTCOME MEASURES: The number of safety improvements was calculated 6-8 weeks after a first home visit. Perceived usefulness of the kit was collected from families and from interviewers. RESULTS: Between the first and the second visits, safety improvement was significantly higher in the group with the kit. This was mainly related to the risk of fall (p<0.02), fire and burns (p<0.001), poisoning (p<0.01), and suffocation (p<0.001). For improvement related to devices provided in the kit, the difference between the groups was significant: 64.4% improvement in group 1 versus 41.2% in group 2 (p<0.01). The relative risk (RR) of safety improvement between groups was 1.56 (95% confidence interval (CI) 1.35 to 1.80). Even for improvements not related to the kit the difference remained significant: 31.2% in group 1 versus 20.2% in group 2 (p<0.05); RR = 1.54 (95% CI 1.22 to 1.93). CONCLUSION: Routine home visits by social services offer a good opportunity to tackle child injury prevention. Free delivery of prevention kits and counselling allow families to modify their behaviour and homes so as to reduce risks.

[Evaluation of the effectiveness of an injury prevention kit delivery for toddlers in four French cities]. / Evaluation de l'efficacité de la remise d'une trousse de prévention des accidents domestiques de jeunes enfants: essai d'intervention dans quatre communes des Hauts-de-Seine (France).

BACKGROUND: The home delivery of counseling and devices intended to prevent child injuries could help parents to adopt safe behavior more efficiently. The aim of the present study was to adapt and test in France a safety kit designed and used in Quebec (Canada). The intervention program (kit delivery and counseling) was assessed by measuring 6 to 8 weeks after a first home visit the percentage of safety changes adopted by the families included in the survey, compared with the pre-intervention situation; and by evaluating the satisfaction of families with their participation in the survey, and the satisfaction of nurses with the use of this new tool. POPULATION AND METHOD: One hundred families from 4 towns in the Hauts-de-Seine department in the Paris suburbs (Boulogne, Chaville, Sèvres, Ville d'Avray) were selected by the social services for home visits by nurses or doctors, when their child reached the age of 6 to 9 months. Selection criteria were usually primipara, medical problem, psychological and/or socio-economic difficulties. During the first visit, 49 families (group 1) (1 family lost for follow-up) received the usual informative and preventive counseling, and a kit including preventive devices and pamphlets about indoor injuries and ways of avoiding them. The other 50 families (group 2) received counseling but not the kit. Between 6 and 8 weeks later, a second home visit was paid to all selected families. RESULTS: Between the first and the second visits, the percentage of safety improvement was significantly higher in group 1 (with the kit) than in group 2 (without the kit). This improvement mainly related to the risk of fall (P < 0.02), fire and burns (P < 0.001), poisoning (P < 0.01) and suffocation (P < 0.001). When the analysis was focused on safety improvement related to devices provided in the kit, the difference between the 2 groups was significant: 67.8% of safety improvement in group 1 vs 38.1% in group 2 (P < 0.001). The relative risk (RR) was 1,78 (95% confidence interval (CI): 1,18-2,68). Even for items not related to the devices provided, the difference remained significant: 48.6% in group 1 vs 28.8% in group 2 (P < 0.001); RR =1,31 (95% CI: 1,23-1,40). The perceived usefulness of the kit was discussed in a focus group with all nurses and doctors. On the whole, the judgment was very positive, mainly because the kit facilitated the introduction of the notion of accident prevention in the discussion at home. CONCLUSION: As in the canadian survey, our results indicate that routine home visits by the social services offer a good opportunity to introduce the subject of child injury prevention. Free delivery of prevention kit and simple counseling allow often deprived families to modify their behavior and to arrange their apartments so as to reduce risks.

[Evaluation of measles, mumps and rubella vaccine coverage in 3 year old children in twelve French counties. Time-trends and related factors]. / Evaluation de la couverture vaccinale rougeole-oreillons-rubéole chez les enfants de trois ans dans douze départements français. Evolution temporelle et facteur associés.

BACKGROUND: The aims of our study were to estimate the measle-mumps-rubella (MMR) vaccine coverage in 3 years old children in 12 French countees, to document the evolution between 1997 and 1999 in two groups of 6 countees (pilot group and control group) before and after the implementation of promotion programmes in the pilot group, and to identify factors related to measle-mumps-rubella vaccination. METHODS: Two telephone surveys were carried out in 1997 and 1999 among children randomly selected in the birth rolls of 12 French countees. Parents of 3 years old children were interviewed on measle-mumps-rubella vaccination, knowledge and opinions on vaccinations, utilisation of health care and socio-demographic characteristics. RESULTS: The participation rate was 97% in both surveys. Among the 7382 respondent parents, 98% had immediate access to the child's medical file and could document the vaccine status. The vaccine coverage did not increase significantly between 1997 and 1999 (86.7% versus 87.2%), both in control (89.3% vs. 90.2%) and pilot groups (84.3% vs. 84.3%). A logistic regression model showed that several factors were independently and significantly related to measle-mumps-rubella vaccination (utilisation of homeopathic medicines, mother's age, number of children, physician speciality (general practitioner or pediatrician) and opinion on vaccinations). CONCLUSION: Our study shows that there is a stagnation of vaccine coverage in several French countees, which makes unlikely the national objective of viruses eradication. This epidemiological situation makes very likely outbreaks of measles, mumps and rubella in these countees. National and local pilot programmes did not succeed to promote vaccination in countees with a low measle-mumps-rubella vaccine coverage. Our study identified sub-groups of parents who should be targeted by promotion programmes.

[Food habits, consumption, and knowledge of a low-income French population]. / Habitudes, consommations et connaissances alimentaires des Français en situation de précarité financière.

Behaviors related to nutrition as well as the eating habits of low-income French people are analyzed from data collected by the Nutrition and Health Barometer of the CFES in 1996. French people with monthly incomes of less than 4000 francs appear to go to fast-food restaurants more often than to other types of restaurant (for leisure or work). They appear to eat their three main meals alone more often, to spend less time over the evening meal, to watch television during their noon and evening meals, to have cheese or another dairy product rather than a main dish, and to limit their evening meal to a single dish. They are less numerous than higher-income people to have the "ideal" breakfast. These economically disavantaged French people do their shopping more often in large of medium-sized supermarkets and more often plan their meals according to the family budget. In terms of food they are more numerous to eat neither fruit nor vegetables; they consume less pork, fish and shellfish, dairy products, alcoholic beverages and especially before-dinner drinks. This study shows that the eating behavior of low-income French people is less in conformity with commonly accepted nutritional recommendations. Likewise, the rate of obesity observed among the women from this households appears high.

[Opinions and practices of family physicians regarding measles-mumps-rubella vaccination]. / Opinions et pratiques des médecins généralistes face à la vaccination rougeole-oreillons-rubéole.

BACKGROUND: Measles-mumps-rubella immunization rates among young children depend on the awareness and responsibility of parents and physicians. In order to improve immunization programmes, it is important to enhance our knowledge about attitudes of physicians in regard to MMR immunization. A random sample of 1013 general practitioners was interviewed by telephone in December 1994, with the collaboration of the BVA Institute. The large majority of French physicians (86%) have a favourable opinion about MMR immunization that they systematically propose to each child aged 12-24 months. However, barriers remain among some physicans. Favourable opinion about MMR immunization to infants was less frequent among physicians aged 41-50 years, homeopaths, those practicing in Southern France, those asking for higher payment to patients, those who are treating a small proportion of patients receiving public medical aid, those not convinced about the role of physicians in health education, those who experienced side-effects of immunization and those who are not personnally immunized against hepatitis B. Eradication of measles, mumps and rubella in France will be only achieved through a stronger and well-argumented information of physicians supported by health professional organizations.

The contribution of physicians to childhood injury prevention in France.

OBJECTIVES: The objective of this study was to determine what injury control interventions are currently carried out by physicians and to examine how these interventions could be more effective. SETTING: Surveys were conducted among the three main groups of physicians who provide primary care to children in France--private practice pediatricians (PPPs), well-child clinic pediatricians (WCCPs), and general practitioners (GPs). METHOD: A representative sample of each of the three groups of physicians were interviewed by telephone, using a computer assisted telephone interview system, in December 1993 or February 1994. RESULTS: Responses demonstrated that most physicians felt they could play an important part in injury prevention but that many had inadequate knowledge of injury related mortality rates in children. Most PPPs and WCCPs usually provided counseling on safety in relation to developmental changes in children. Few physicians gave recommendations about appropriate first responses to emergencies. Printed material, designed for parent education, was provided by many PPPs and WCCPs, but was usually absent from the offices of GPs. Participation in group education sessions was common among WCCPs but rare among PPPs and GPs. Many physicians expressed skepticism regarding the efficacy of their interventions in injury control. CONCLUSION: A number of recommendations are made to those in government agencies or elsewhere who could help physicians to improve childhood injury prevention, for instance by regular publication of data on childhood injury mortality, counseling about parent education on this subject, and first aid in emergencies.

[French youths and their health. Opinions, attitudes and behavior]. / Les jeunes français et leur santé. Opinions, attitudes et comportements.

Traditional indicators for exploring the field of adolescent health have proven to be relatively inappropriate. The "Baromètre Santé" (health barometer) was thus designed to study youth between the ages of 18 and 24 in an original way. On one hand it permits the exploration of opinions, attitudes, and behaviour of French youth in a global manner, and on the other hand results may be compared with those of older generations. The study has revealed that French young people have a more pessimistic view of the evolution of their health status than their elders, with accidents being cited by far as the number one fear. The most important difference in perception between adults and young people is the attitudes concerning STD's and AIDS. As far as lifestyle goes, 27% of the young people interviewed admitted to having had troubles with insomnia during the three months preceding the interviews. Three fourths of the youth participating smoke or have smoked in the past, with no difference according to gender. On the other hand, those young people who indicated suffering from a depressive or nervous state were more often smokers than the others. More than one young person in five has tried some kind of drug during the past year, with hashish being by far the most common (99%). Overall the young people interviewed have a more permissive attitude toward drug use than adults studied. A direct link was observed between the consumption of alcohol, illicit drugs and tobacco. These multiple factors may indicate that France is facing a situation in which a part of its youth's behaviour can be considered disturbing.(ABSTRACT TRUNCATED AT 250 WORDS)

[Epidemiology of tobacco smoking in France]. / Epidémiologie du tabagisme en France.

The authors analyse the results of the last national survey on the prevalence of tobacco smoking, carried out by the French Committee for health education in 1992. The smoking percentage is analyzed by sex, age, instruction level and, parents smoking behaviour. These results are also compared with data from previous surveys performed since 1977 in young people and since 1974 in adults. A decreasing trend is noticed in young people from 46% in 1977 to 34% in 1992. This optimistic evolution however has to be relativised, taking into account the increase of the consumption level. For adults, the general trend is the stability of the smoking percentage (40% of the population smoke) but the evolution shows totally different results for males and females. The smoking prevalence is decreasing among men (from 59 to 48%), whereas it is increasing among women (from 28 to 33%). Moreover the smoker percentage among young adult women (18-24 year old) is nearly the same as for young adult men (63.4 vs 63.8%). The data provided by this survey enables the authors to set priorities in the campaign against tobacco smoking.