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Les campus sans tabac : définition, impact sur le tabagisme des étudiants, et facteurs clés d'efficacité
No full textInternational audienceLe tabagisme des jeunes en France baisse, mais reste élevé en comparaison d’autres pays. Les campus sans tabac font partie des mesures pertinentes pour réduire cette prévalence. Ils se définissent comme des lieux d’enseignement supérieur où il est interdit de fumer et de vapoter sur l’ensemble du campus (intérieur et extérieur). Ce dispositif se révèle efficace, tant sur les comportements des étudiants (baisse du tabagisme) que sur l’environnement (moins de tabagisme passif et de mégots au sol) et sur la dénormalisation du tabagisme. Il existe des conditions pour atteindre ces objectifs : obtenir un soutien engagé de la direction du lieu d’enseignement supérieur, proposer des aides à l’arrêt gratuites pour les usagers, déployer une stratégie de communication pérenne, faire respecter le dispositif (sanctions, ambassadeurs) et l’évaluer
Effectiveness of a school- and primary care-based HPV vaccination intervention (the PrevHPV study)
No full textInternational audienceBackground HPV vaccine coverage (VC) remains lower than expected in many countries, particularly France. We developed and evaluated the PrevHPV multicomponent intervention to improve HPV VC among French adolescents. The components were ‘education and motivation’ of adolescents in schools, ‘at-school vaccination’, and ‘general practitioners’ (GPs) training’. We evaluated the effectiveness of the intervention two months after it ended. Methods We carried out a pragmatic cluster randomized controlled trial with incomplete factorial design in 14/25 French school districts (July 2021-April 2022). The cluster was the municipality (n = 91). The outcome was HPV VC (≥ 1 dose) two months after the intervention ended among 11-14-year-olds living in participating municipalities (data from the French national reimbursement database and from the trial). We performed two types of analyses: (1) without considering the dose of intervention received, using a linear model with one fixed effect per component, adjusted for baseline HPV VC; (2) a post hoc on-treatment analysis, rerunning the linear model by replacing the fixed effects with a quantitative ‘dose of intervention’ variable calculated for each component using data collected during the trial. Results For the three intervention components, estimates of the effect on VC at two months were greater for the on-treatment analyses than for the analysis that did not consider the intervention dose. For the ‘at-school vaccination’ component, the estimate increased from 5.50 percentage points (pp; p < 0.001) to 11.25 pp (p < 0.001). The ‘GPs’ training’ component reached significance (from -1.46 pp, p = 0.150 to 3.56 pp, p = 0.049). In both types of analyses, no significant effect was observed for ‘education and motivation’ (from -0.08 pp, p = 0.950 to 2.58 pp, p = 0.241). Conclusions Increasing HPV VC among adolescents requires the involvement of various stakeholders and could be achieved by combining interventions in both schools and primary care settings. Key messages • The PrevHPV study is supported by the French health authorities and conducted by a multidisciplinary consortium to tackle a long-lasting public health concern in France. • Offering free HPV vaccination at school significantly increased HPV VC; providing GPs with training and a dcision-aid tool helped increase HPV VC if the GPs completed the training
How does a Smoke-Free campus initiative generates changes in smoking? A theory-based evaluation
No full textInternational audienceBackground Smoke-free campuses (SFC) prohibit smoking and vaping on all university grounds and for all users. Despite their effectiveness in reducing smoking prevalence, passive smoking, and denormalizing tobacco use, the complex interplay between the programme activities and their impact on users and campus environments remain unclear. This study aims to improve our understanding of the transformation processes associated with SFC expected outcomes. Methods We conducted a retrospective qualitative study on the first SFC implemented in France by the EHESP School of Public Health. Guided by Mayne’s theory of change framework that includes ten dimensions of an impact pathway (e.g. activities, reach/reaction, capacity, behaviour changes, etc.), the research examined the chain of effects and hypotheses driving this SFC. Our dataset included internal documents (e.g. minutes of meetings, administrative documents) and semi-structured interviews with stakeholders (n = 16) involved in the development and implementation of the analysed SFC. Data is currently being analysed. Results Initial results suggest that the EHESP’s SFC activities included communication initiatives, student ambassadors, cessation support for smokers, installation of smoking shelters on campus periphery, etc. These activities were geared on capacity change (e.g. securing support and compliance among campus users, reduce smoking opportunities, promoting the use of cessation aids) and were intended to drive behaviour change (reducing smoking and facilitating cessation among students and staff). The goal of this SFC was not only to impact behaviors but also to educate future health service managers at EHESP to implement SFC policies and set an example for other institutions in France. Conclusions This study identifies some of the transformations that activities of the EHESP’s SFC can generate in students and staff in order to fulfil its outcomes. It also highlighted its expected impact on other institutions. Key messages • Understanding how a smoke-free campus generates its changes is essential in facilitating transferability of experiences to other universities. • Smoke-free campus policies can also generate a broader impact on other institutions
Implementation evaluation of a school-based intervention on HPV vaccination (the PrevHPV study)
No full textInternational audienceBackground HPV vaccine coverage (VC) remains lower than expected in many countries, particularly France. We developed and evaluated the PrevHPV multicomponent intervention to improve HPV VC among French adolescents. We evaluated the implementation of the school-based components of the intervention. Methods We carried out a mixed-method study embedded in a cluster randomized controlled trial (July 2021-April 2022; 14/25 French school districts). The cluster was the municipality (n = 91). The school-based components of the intervention were ‘education and motivation’ and ‘at-school vaccination’. Quantitative data were collected through standardized activity reports and self-administered questionnaires; the implementation outcomes were fidelity, dose, reach, acceptability and sustainability. Qualitative data were collected through semistructured group interviews with school staff and analyzed using the Consolidated Framework for Implementation Research. Results We found high rates for: fidelity (e.g., 69% of the targeted classes had two educational sessions and 89% of schools invited all pupils for at-school vaccination, as planned); acceptability (e.g., pupils’ participation satisfying in 90% of the sessions, 96% of vaccinated pupils and 78% of school staff satisfied with at-school vaccination); and sustainability (e.g., respectively 91% and 76% of schools considered conducting sessions and vaccination days during the following year). However, the withdrawal of 1/3 of schools before the trial started and difficulties in mobilizing parents negatively impacted dose and reach. Several facilitators and barriers influenced the implementation of the components; they were related to the components’ design, the characteristics of both the external and internal environment of the school, the numerous stakeholders and individuals involved, and the implementation strategies used. Conclusions These results can guide policy making on school-based HPV vaccine promotion in France and Europe. Key messages • The PrevHPV study is supported by the French health authorities and conducted by a multidisciplinary consortium to tackle a long-lasting public health concern in France. • These findings have practical implications for implementing effective and acceptable school-based interventions in real life to improve HPV vaccine uptake and reduce HPV-associated burdens
Préférences et antécédents de la décision vaccinale chez les professionnels de la santé et la population adulte en France
No full textThe literature on vaccine hesitancy largely reports the importance of the perception of the benefit-risk balance (BRB) in vaccine acceptance. The COVID-19 pandemic and the unprecedented vaccination policies implemented by the French government during a novel vaccine campaign provided an opportunity to assess the impact of COVID-19 certificate or vaccine mandate on future COVID-19 vaccine intention considering the perceived BRB of COVID-19 vaccination, evaluate the 7C-psychological antecedents of vaccination across the novel COVID-19 vaccine campaign, explore preferences around the concept of BRB among the general adult population and among healthcare sector-workers (HCSWs), define and characterize individuals who constantly refused vaccination regardless of BRB attributes. Four different studies were conducted during this thesis, a) a cross-sectional study to explore the impact of the COVID-19 certificate-mandate and perceived vaccination BRB on future vaccine intention among the general population, b) a repeated cross-sectional survey among HCSWs to monitor their psychological antecedents of vaccine acceptance at different stages of the COVID-19 vaccination campaign, c) a discrete choice experiment (DCE) to investigate the vaccination BRB preferences of the general public and HCSWs and d) a vaccine eagerness scale integrated into the previous DCE to define different vaccination behavior profiles around the concept of vaccine BRB. Our findings suggest that the COVID-19 certificate enactment did not effectively persuade elderly people, who would have been those with the greatest potential benefit from vaccination, but that ceding to the strong incentive/mandate was not associated with reduced, but rather increased intention for future COVID-19 vaccination. Among HCSWs, the decision to accept vaccination under the mandate depended solely on the perception of vaccination as a collective action, but not on the vaccination perception of benefits vs. risks. However, as the pandemic and vaccine booster recommendations evolved and as HCSWs gained more experience with the COVID-19 vaccine, they resumed considering vaccine BRB in their vaccine decisions. Our preference study suggested that both the general public and non-university-level HCSWs do not consider the numerical aspect of benefits vs. risks in hypothetical vaccine scenarios, they rather consider qualitative attributes surrounding the BRB concept such as disease frequency and severity, and indirect protection effects. By contrast, we estimated that hypothetical vaccine uptake among university-level HCSWs significantly increases by 40% when vaccination benefit-risk ratio moves from 10:1 to 100:1. Finally, we found that compared to respondents who accepted some but not all scenarios of the single profile DCE, those accepting all scenarios were more likely to have a positive perception the BRB and be motivated by employer's or authorities' incitation to get vaccinated, while those refusing all scenarios were more likely to have low confidence in authorities to manage the epidemic, low confidence in vaccine safety, not perceive vaccine as collective action to stop the epidemic and show reactance to employer's or authorities' incitation to get vaccinated. The research suggests that vaccine campaigns targeting vaccine-reluctant individuals should focus on improving confidence in authorities and confidence in the vaccine (vaccine safety). Additionally, vaccination campaigns should provide information about vaccination as a collective action, emphasizing its indirect protection benefits and the risks of developing the disease.La littérature sur l'hésitation vaccinale souligne l'importance de la balance bénéfice-risque (BBR) dans l'acceptation vaccinale. La pandémie de COVID-19 et les politiques vaccinales en France offrent l'opportunité d'évaluer l'impact du passe sanitaire et de l'obligation vaccinale sur l'intention future de vaccination, d'étudier les antécédents psychologiques 7C au cours de la campagne vaccinale, d'explorer les préférences BBR parmi la population générale et les professionnels de santé, et de caractériser les individus refusant constamment la vaccination indépendamment des attributs BBR. Quatre études ont été réalisées : a) une étude transversale pour analyser l'impact du passe sanitaire sur l'intention vaccinale future ; b) une enquête répétée pour suivre l'évolution des antécédents psychologiques chez les professionnels de santé ; c) une expérience de choix discrets (DCE) pour étudier les préférences BBR ; et d) une échelle de certitude intégrée à la DCE pour définir les profils de comportement vaccinal. Nos résultats suggèrent que la mise en œuvre du passe sanitaire n'a pas efficacement convaincu les personnes âgées, qui auraient été celles bénéficiant le plus de la vaccination, mais que céder à la forte incitation/obligation vaccinale n'était pas associé à une diminution, mais plutôt à une augmentation de la future intention vaccinale contre la COVID-19. Parmi les professionnels de la santé, la décision d'accepter la vaccination sous l'obligation dépendait uniquement de la perception de la vaccination comme une action collective, et non de la perception BBR du vaccin. Cependant, à mesure que la pandémie et les recommandations de rappel vaccinal évoluaient et que les professionnels de la santé acquéraient plus d'expérience avec le vaccin contre la COVID-19, ils ont recommencé à prendre en compte la BBR du vaccin dans leurs décisions vaccinales. Notre étude de préférences a suggéré que tant le grand public que les professionnels de santé n'ayant pas un titre universitaire ne prenaient pas en compte l'aspect numérique des bénéfices par rapport aux risques dans des scénarios vaccinaux hypothétiques, mais qu'ils considèrent plutôt des attributs qualitatifs entourant le concept BBR tels que la fréquence et la gravité de la maladie, et les effets de protection indirecte. En revanche, nous avons estimé que l'acceptation hypothétique du vaccin parmi les professionnels de la santé ayant un titre universitaire augmentait significativement de 40% lorsque le ratio bénéfice-risque de la vaccination passait de 10:1 à 100:1. Enfin, nous avons constaté que par rapport aux répondants qui acceptaient certains mais pas tous les scénarios du DCE, ceux qui acceptaient tous les scénarios étaient plus susceptibles d'avoir une perception positive de la BBR et d'être motivés par l'incitation de l'employeur ou des autorités à se faire vacciner, tandis que ceux qui refusaient tous les scénarios étaient plus susceptibles d'avoir une faible confiance dans les autorités pour gérer la pandémie, une faible confiance dans la sécurité des vaccins, et ne percevait pas le vaccin comme une action collective pour arrêter la pandémie. Ils ont de même montré une réactance à l'incitation de l'employeur ou des autorités à se faire vacciner. Nos recherches suggèrent que les campagnes vaccinales visant les individus réticents à la vaccination devraient se concentrer sur l'amélioration de la confiance dans les autorités et la confiance dans le vaccin (sécurité du vaccin). De plus, les campagnes vaccinales devraient fournir des informations sur la vaccination en tant qu'action collective, en mettant l'accent sur les bénéfices de protection indirecte et les risques de développer la maladie
QAI-Sport project : characterization of Indoor Air Quality in sports facilities
No full textInternational audienceIndoor air quality (IAQ) in sports facilities is poorly studied compared to that of housing and other public buildings. One objective of the QAI-Sport project consisted in providing an overview of the organic chemicals and microbiological composition in air of 10 sports halls having different activities: dojos, motor skills rooms and weight rooms. Targeted and non-targeted analytical approaches were applied to provide the broadest possible screening of volatile organic compounds (VOCs), semi-volatile organic compounds (SVOCs) and microbiological contaminants in indoor air and of SVOCs in settled dusts, with a focus on emerging pollutants. Two sampling campaigns were performed in unoccupied and occupied rooms to assess the impact of sporting activity on IAQ.About 50 VOCs were identified and quantified. Composition and concentrations are globally close to those of other indoor environments, with a predominance of carbonyls, especially hexanal. However, some specific and emerging compounds (like benzothiazole, decamethylcyclopentasiloxane and 1-(2-methoxy-1-methyl ethoxy)-2-propanol)) were highlighted. Acetone and 6-methyl-5-hepten-one, emitted by human body, were identified as occupancy tracers. SVOCs were mainly phthalates (DiBP, DBP in air, DEHP, DiNP in dust), organophosphate flame retardants (TCPP in air, EHDPP, TPP in dust) and PAHs (fluorene, phenanthrene in air, pyrene in dust) with particularly high concentrations in one weight room’s dust, probably issued from a recycled rubber flooring. Microbiological contamination is similar to residential ones and Sars-CoV-2 was not detected.The project will further consist in assessing the human exposure to these pollutants in sports halls, identifying their sources and understanding their indoor partitionin
Des baignades urbaines dans un contexte de changement climatique ?: Enjeux et perspectives issues d’une étude cas multiples en France, en Europe et en Amérique du Nord
No full textInternational audienceDans un contexte de changement climatique et d’urbanisation croissante, la baignade en milieu urbain émerge en France comme ailleurs et questionne les leviers aidant à maximiser les bénéfices pour la santé des populations et à minimiser les risques. Le projet pluridisciplinaire URB-bain étudie la faisabilité du retour de la baignade en milieu urbain. Dans une approche Une seule santé, il associe 1/la réalisation d’un portrait sanitaire et environnemental de deux sites de baignade pressentis (Metz, France) et l’étude de risques sanitaires associés à la caractérisation chimique et microbiologique de l’eau 2/une approche socio-historique et politique de l’usage des baignades urbaines en France, en Europe et au Canada. Cette communication présentera les premiers résultats de l’axe 2
Contribution of Coordination Theories to the Determination of Human Factors Associated With Operating Room Perceived Performance
No full textInternational audienceBackground: The efficient and fluid organization of surgical interventions in an operating room (OR) and operating suite (OS) is important as these are among the most expensive units to run in medical-surgical facilities. The complexity of OS organization requires careful coordination, defined here as the directing of individuals' efforts toward achieving common and explicitly recognized goals. There is currently sparse literature on OS coordination, especially in the French context. This study aimed to respond to this gap by reporting on the coordination mechanisms associated with the perceived performance of OS across 4 facilities in an urban setting in France.Methods: We used a qualitative comparative case study based on ethnographic methodology to explore 4 facilities (2 teaching, 1 general, and 1 private). Several investigation techniques were used for data collection (semistructured interviews, participant and nonparticipant observations, and informal interviews) in the OR, the OS, the regulation council (dedicated to adapting the necessary resources to specific procedures and patients' health status), and the OS council (dedicated to strategic and operational OS transformations and adaptations, and responsible for finding solutions to organizational problems). Analysis was guided by Okhuysen and Bachky's theoretical framework on coordination and multi-team systems theory. Data were compared across the 4 facilities and triangulated using the different techniques to ensure coherence and accuracy.Results: Overall, 48 interviews with health care providers and hospital managers and 200 hours of direct observations were performed. The OR exhibited a high degree of coordination, whereas improved perception of performance in the OS depended on managerial competency, trust, and authority. Perceived performance in the regulation council and OS council, on the other hand, depended on the identification of formal objectives by all stakeholders and the development of common understanding (developing agreement, direct information sharing, creating common perspective, substitution, bringing groups together, and storing of knowledge).Conclusions: Based on existing literature on multi-team systems (as represented in the OS organization), this study identifies success factors influencing OS coordination. These include the OS manager's leadership skills; the identification of formal system objectives; and professional differentiation between stakeholders (absence/decrease of a sense of belonging to a multi-team system). This differentiation was related to the high degree of specialization within OS teams, each bringing different norms, cultures, and contingencies that induce dissonance in organization and task performance. Interventions targeting these success factors might improve coordination, and thus performance, in the OS
Heatwaves and Home Births: Impact of Extreme Heat on Delivery Choices in India
No full textInternational audienceBACKGROUND AND AIM[|]We investigate the effect of extreme heat on the place of delivery in India, proposing that such extreme weather events may lead to an increased incidence of births delivered outside health facilities, threatening maternal and neonatal survival.[¤]METHOD[|]Utilizing geocoded data from the 2019-2021 Demographic and Health Survey (DHS) for India, we identified the place of delivery of 230,051 births as home versus health facility. We incorporated gridded wet-bulb temperatures (T-max-wb) corresponding to delivery dates and maternal residences. We defined extreme heat using percentile (>=85th, 90th, 95th) and absolute temperature (>=28, 30, 32 0C) thresholds over varying durations (1-day to 5-day). Our multivariable logistic regression models adjusted for maternal socioeconomic characteristics and geographic factors (age, education, residence, wealth, caste, religion, climate zone) and included a cluster-level random intercept. We tested for effect measure modification in the relationship between heat and place of delivery by caste, religion, wealth, residence, and climate zone, focusing on two extreme temperature definitions (T-max-wb>=90th percentile and T-max-wb>=30 0C, for 5 consecutive days).[¤]RESULTS[|]We find a consistent association between the temperature on the day of delivery and the likelihood of delivering at home across various heat definitions (e.g., adjusted OR=1.14 with 95% CI: 1.06–1.23 for T-max-wb>=32 0C). We found similar associations when T-max-wb exceeded the thresholds for 2 or more consecutive days. We also found that the place of residence and wealth modified this association.[¤]CONCLUSIONS[|]To our knowledge, this is the first study to explore the link between extreme heat and place of delivery globally, emphasizing the need for more research focusing on the impacts of extreme weather events on maternal and newborn health. Our findings call for improved health system preparedness via early warning systems and advanced resource allocation (e.g. additional ambulances) to mitigate some of these effects
Note d’appui scientifique et technique de l’Anses relative à l’état des lieux des consignes en cas d'incendies de végétation de grande ampleur pour la protection de la santé des populations et à l’établissement d'une liste socle de substances et méthodes de mesure pour la surveillance des panaches de fumées issus des feux de végétation de grande ampleur
No full textCitation suggérée : Anses. (2024). Etat des lieux des consignes en cas d'incendies de végétation de grande ampleur pour la protection de la santé des populations et établissement d'une liste socle de substances et méthodes de mesure pour la surveillance des panaches de fumées issus des feux de végétation de grande ampleur. (saisine 2023-SA-0154 / 2023-AST-0171) Maisons-Alfort : Anses, 92 p.L’avis de l’Anses de mai 2012 relatif aux effets sanitaires liés à la pollution générée par les feux de végétation à l’air libre (Anses, 2012) a mis en exergue l’impact des émissions de particules produites par ces feux sur la population générale et la population professionnelle, et a formulé des recommandations d’amélioration des connaissances.Les feux de végétation contribuent en effet grandement à la détérioration, a minima ponctuelle, de la qualité de l’air, du fait d’émissions particulaires et gazeuses diverses et toxiques à différents niveaux. Bien que les niveaux de pollution de l’air aient fortement diminué en Europe et en France depuis les années 1990, la contribution des feux de forêt n’a fait que croître sur cette même période. Même si la part de la pollution atmosphérique issue des feux de forêt reste minoritaire, elle serait substantiellement plus toxique que d’autres sources de pollution du fait de sa composition. Cette source de pollution atmosphérique est associée à des excès de risque de mortalité et de morbidité cardiorespiratoires. Elle contribuerait à plusde 13 % de la surmortalité totale en Europe attribuable à la pollution par les particules fines (PM2.5) selon des résultats du projet EXHAUSTION rapportés par l’Organisation de coopération et de développement économique (OCDE). D’après des récents résultats de ce projet, il a été estimé que la surmortalité attribuable à la pollution mesurée par les PM2,5 avait diminué de plus de 50 % en Europe entre 1990 et 2019, tandis que la surmortalité attribuable à la pollution mesurée par les PM2,5 des incendies de végétation avait augmenté dans le même temps de plus de 100 %.Ces dernières années ont été marquées par des feux de grande ampleur de par le monde, parfois qualifiés de « méga-feux », bien que ce qualificatif ne recouvre pas les mêmes réalités en Europe, en Californie ou en Australie par exemple. En France, en juillet 2022, la forêt des Landes de Gascogne a connu les deux plus grands incendies de son histoire simultanément, et au total près de 30 000 hectares ont brûlés en Nouvelle-Aquitaine, un chiffre record depuis les grands incendies de 1949. Ces feux atteignent des dimensions et génèrent des effets qui dépassent le cadre habituel d’action des sapeurs pompiers et peuvent provoquer une réaction en chaîne. Aussi, comme le préconise le guide de doctrine opérationnelle sur les feux de forêts et d’espaces naturels, « il est important d’intégrer dans les réflexions que la lutte contre les méga-feux engendrera un passage de la seule lutte contre le feu à la gestion de la lutte contre les conséquences directes et indirectes du feu dans divers domaines » ; ce qui inclut la gestion de la lutte contre la pollution de l’air générée par ces feux et ses effets sur la santé.Dans le contexte actuel de changement climatique, et dans la perspective des grands évènements sportifs à venir (Jeux Olympiques et Paralympiques en 2024), il apparaît ainsi nécessaire d’actualiser les connaissances en appui à la gestion de ces épisodes de pollution de l’air ambiant ; et ce en dressant dans un premier temps un état des lieux des consignes en France et à l’international en cas d’incendies de végétation de grande ampleur pour la protection de la santé des populations, et en établissant une liste socle de substances et de méthodes de mesurage pour la surveillance des panaches de fumées issus des feux de végétation de grande ampleur