French National Public Health Research Articles

Impact of a French social marketing campaign promoting pulse and whole grain consumption: results from a longitudinal cohort study.

Despite the health benefits, fiber intake is insufficient among French adults. To promote the consumption of pulses and whole grains, defined as priority food groups because they are rich in fiber, readily available, and affordable, the French National Public Health Agency implemented a social marketing campaign in 2019 to improve knowledge, self-efficacy, and consumption of pulses and whole grains. To evaluate the short-and long-term effects of this social marketing campaign. A 8-month prospective study was conducted on the Internet. A sample of 4,001 French adults was interviewed before the social media campaign (T0), immediately afterwards (T1), and after 8 months (T2). Analysis was performed on 2,422 adults responding at T1 and T2. Outcomes associated with campaign recall were investigated by mixed models with random effects using generalized estimating equations. Overall, 59.5% of subjects recalled the campaign. In multivariable-adjusted analyses, no significant difference was found in terms of knowledge, self-efficacy, and consumption of pulses and whole grains between those recalling and not recalling the campaign (value of p > 0.05). When the analyses were stratified by educational level (p-interaction<0.10), a significant positive association was found between campaign recall and variation of knowledge about whole grain fiber content in subjects with lower educational level (value of p = 0.002 at T1 and value of p = 0.008 at T2). For small consumers of pulses, subjects recalling the campaign improved both their knowledge (OR [95%CI] = 1.47 [1.14-1.90], value of p = 0.003 at T2) and consumption of pulses (1.44 [1.14-1.86], value of p = 0.002 at T1, 1.50 [1.16-1.94], value of p = 0.002 at T2). This first French social marketing campaign promoting pulses and whole grains had a positive impact on specific subgroups of particular interest in terms of public health (i.e., people with low educational level and small consumers of pulses). These results will allow us to improve the communication materials used for the second edition of this social marketing campaign.

Cost-Effectiveness of Blinatumomab in Pediatric Patients with High-Risk First-Relapse B-Cell Precursor Acute Lymphoblastic Leukemia in France.

Based on the results of the phase III randomized 20120215 trial, the European Medicines Agency granted the approval of blinatumomab for the treatment of pediatric patients with high-risk first-relapsed Philadelphia chromosome-negative B-cell precursor acute lymphoblastic leukemia (ALL). In France, blinatumomab received reimbursement for this indication in May 2022. This analysis assessed the cost effectiveness of blinatumomab compared with high-risk consolidation chemotherapy (HC3) in this indication from a French healthcare and societal perspective. A partitioned survival model with three health states (event-free, post-event and death) was developed to estimate life-years (LYs), quality-adjusted life-years (QALYs) and costs over a lifetime horizon. Patients who were alive after 5 years were considered to be cured. An excess mortality rate was applied to capture the late effects of cancer therapy. Utility values were based on the TOWER trial using French tariffs, and cost input data were identified from French national public health sources. The model was validated by clinical experts. Treatment with blinatumomab over HC3 was estimated to provide gains of 8.39 LYs and 7.16 QALYs. Total healthcare costs for blinatumomab and HC3 were estimated to be €154,326 and €102,028, respectively, resulting in an increment of €52,298. The incremental cost-effectiveness ratio was estimated to be €7308 per QALY gained from a healthcare perspective. Results were robust to sensitivity analyses, including analysis from the societal perspective. Blinatumomab administered as part of consolidation therapy in pediatric patients with high-risk first-relapsed ALL is cost effective compared with HC3 from the French healthcare and societal perspective.

Risk of Admission to the Pediatric Intensive Care Unit for SARS-CoV-2 Delta and Omicron Infections.

The severity of SARS-CoV-2-related diseases in children remains unclear. This study aimed to describe the incidence of French pediatric intensive care units (PICUs) admissions with acute COVID-19, incidental positive SARS-CoV-2 test result, and multisystem inflammatory syndrome in children (MIS-C) during the delta and omicron variant periods. This study used the French PICU registry to obtain data on all patients admitted to 41 French PICUs diagnosed with acute COVID-19, incidental positive SARS-CoV-2 test result, or MIS-C between August 30, 2021 and April 20, 2022. Data regarding the total number of positive SARS-CoV-2 polymerase chain reaction results according to the type of variants were obtained from the French National Public Health Agency. Of 745 children, 244 (32.8%) were admitted for acute COVID-19, 246 (33.0%) for incidental positive SARS-CoV-2 test results, and 255 (34.2%) for MIS-C. The incidence of each group was higher with delta than with omicron. The incidence rate ratios with the delta variant were 7.47 (95% CI, 4.22-13.26) for acute COVID-19, 4·78 (95% CI, 2.30-9.94) for incidental positive SARS-CoV-2 test results, and 10.46 (95% CI, 5.98-18.31) for MIS-C compared to the omicron variant. The median age was 66 (7.7-126.8) months; 314 (42%) patients had comorbidities. Patients with acute COVID-19 and incidental positive SARS-CoV-2 test results had similar proportions of comorbidities. No patient with MIS-C died, whereas the mortality rates in the acute COVID-19 and incidental positive SARS-CoV-2 test results groups were 6.8% and 3.8%, respectively. The incidence of acute COVID-19, incidental positive SARS-CoV-2 test results, and MIS-C admitted to the PICU were significantly higher with the delta variant than with the omicron variant.

Mixed methods (qualitative and quantitative) in environmental epidemiology : an industrial area study, France

Background and aim The Lacq industrial area has been the site of numerous chemical activities over the past 60 years. To assess the impact of these activities on the local population health, the French national public health agency has developed a sequenced and participative approach, combining qualitative and quantitative studies. Methods A qualitative local context study, based on 39 semi-directive interviews with different categories of local stakeholders and residents, was first conducted to identify the perceptions and expectations of local actors regarding the links between health and the environment around the industrial site. Two geographical epidemiological studies were then launched to describe mortality and morbidity (cancers, acute and chronic diseases) near the industrial area. Not clinically assessed health outcomes (irritation symptoms, anxiety), quality of life and their link with environmental disturbances will be assessed with an ongoing individual perceived health survey. Results Social demand, analyzed in the local context study, led to the integration of diseases of concern (e.g. digestive cancers, thyroid disorders), reported by local residents and health professionals, in the mortality and morbidity studies. Furthermore, people’s mistrust of authorities and desire for more transparency on the scientific process were taken into account and participatory citizen workshops were set up to co-create the perceived health survey questionnaire. The mortality study reported non-cancerous respiratory and circulatory excess death rates. Those pathologies will be thoroughly explored in both morbidity (health care system use) and perceived health (irritations, discomfort) surveys for a more comprehensive overview of the population health, closer to their life experience. Conclusion This innovative approach, mixed and participative, developed around Lacq industrial area shows the benefit of sequential mixed methods design in environmental health. It enables to better respond to social demand and to overcome blind spots of health surveillance around industrial areas. Keywords Health, Industrial pollution, mixed methods,

Care pathways in invasive meningococcal disease: a retrospective analysis of the French national public health insurance database

ABSTRACT Invasive meningococcal disease (IMD) carries a high burden in terms of mortality, long-term complications, and cost, which can be significantly reduced by vaccination. The objectives of this case–control study were to document the care pathways of patients with IMD before, during, and after hospitalization and to assess in-hospital complications and long-term sequelae. Cases consisted of all people hospitalized for IMD in France between 2012 and 2017. Controls were matched by age, gender, and district of residence. Data were extracted from the French national public health insurance database on demographics, hospitalizations, mortality and potential sequelae of IMD. Overall, 3,532 cases and 10,590 controls were assessed and followed up for 2.8 years (median). During hospitalization, 1,577 cases (44.6%) stayed in an intensive care unit, 1,238 (35.1%) required mechanical ventilation, and 43 (1.2%) underwent amputation; 293 cases (8.3%) died in hospital and a further 163 (4.6%) died following discharge; 823 cases (25.4% of survivors) presented ≥1 sequela and 298 (9.2%) presented multiple sequelae. The most frequently documented sequelae were epilepsy (N = 205; 5.8%), anxiety (N = 196; 5.5%), and severe neurological disorders (N = 193; 5.5%). All individual sequelae were significantly more frequent (p < .0001) in cases than controls. Hearing/visual impairment and communication problems were conditions that presented the highest risk for cases compared to controls (risk ratios >20 in all cases). In conclusion, this study highlights the importance of providing optimal medical care for patients with IMD, of minimizing the delay before hospitalization, and of effective prevention through comprehensive vaccination programs.

Healthcare Resource Consumption and Cost of Invasive Meningococcal Disease in France: A Study of the National Health Insurance Database.

IntroductionInvasive meningococcal disease (IMD) is an uncommon but serious infectious disease. Its economic burden is known to be high but is poorly characterised. The objective of this study was to determine costs, as captured in the healthcare claims database, incurred by all patients hospitalised for IMD in France over a 6-year period.MethodsThis case–control study was performed using the French national public health insurance database (SNDS). Cases comprised all individuals hospitalised with acute IMD in France between 2012 and 2017 inclusive. For each case, three controls were identified, matched for age, gender and region of residence. All healthcare resource consumption by cases and controls during the follow-up period was documented. Costs were analysed for the index hospitalisation in cases, 1 year following the index date and then for 5 years following the index date. Costs were assigned from national tariffs. The analysis was performed from a societal perspective. IMD sequelae were identified from hospital discharge summaries.ResultsA total of 3532 cases and 10,590 controls were evaluated. The mean per capita cost of the index IMD hospitalisation was €11,256, and increased with age and with the presence of sequelae. In the year following the index date, mean per capita direct medical costs were €6564 in cases and €2890 in controls. Annual costs were €4254 in cases without sequelae, €10,799 in cases with one sequela and €20,096 in cases with more than one sequela. In the fifth year of follow-up, mean per capita costs were €2646 in cases and €1478 in controls. The excess cost in cases was principally due to the management of sequelae. Amputation, skin scarring and mental retardation generated per capita costs in excess of €20,000 in the first year and in excess of €10,000 for subsequent years.ConclusionThe economic burden of IMD in France is high and, over the long-term, is driven by sequelae management.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40121-021-00468-w.

Time and spatial trends of operated cryptorchidism in France and environmental hypotheses: a nationwide study from 2002 to 2014.

Is there an evolution in the risk of operated cryptorchidism in France and does local geographical environment appear as an important trigger for this defect? We observed an increase of the risk of operated cryptorchidism in boys under the age of 7 years during the period 2002-2014 and a strong spatial heterogeneity, with the detection of spatial clusters suggesting environmental factors. Epidemiologic data on cryptorchidism are scarce and its etiology is poorly understood. As part of the testicular dysgenesis syndrome, cryptorchidism is suspected to be a male genital developmental disorder caused by endocrine disruptor chemical (EDC) exposure during the prenatal period. This was a retrospective and descriptive study using data from the French national hospital discharge database, in the 2002-2014 study period. We built an indicator to reflect incident cases of operated cryptorchidism in boys under the age of 7 years in metropolitan France, with an algorithm using specific codes for diseases (ICD-10 codes) and surgical acts (CCAM codes). The study population was composed of 89 382 new cases of operated cases of cryptorchidism in boys under the age of 7 years. We estimated the temporal evolution of the incidence rate. We fitted a spatial disease-mapping model to describe the risk of cryptorchidism at the postcode scale. We used Kulldorff's spatial scan statistic and Tango's flexibly shaped spatial scan statistic to identify spatial clusters. The estimated increase in the incidence of operated cryptorchidism from 2002 to 2014 was equal to 36.4% (30.8%; 42.1%). Cryptorchidism displayed spatial heterogeneity and 24 clusters (P < 0.0001) were detected. The main cluster was localized in a former coal mining and metallurgic area in northern France, currently an industrial area. The cluster analysis suggests the role of shared socio-economic and environmental factors that may be geographically determined and intertwined. The industrial activities identified in the clusters are potentially the source of persistent environmental pollution by metals, dioxins and polychlorinated biphenyls. The indicator we used reflects operated cases of cryptorchidism, with an under-evaluation of the health problem. We cannot exclude a possible role of the evolution and local differences in surgical practices in the observed trends. Our inclusion of boys under 7 years of age minimized the biases related to differences in practices according to age. Regarding the environmental hypothesis, this is an exploratory study and should be considered as a hypothesis-generating process for future research studies. To our knowledge, this is the first descriptive study to address nationwide trends of operated cryptorchidism with detection of spatial clusters, with a very large sample allowing great statistical power. Our results generate plausible environmental hypotheses, which need to be further tested. This study was entirely funded by Santé publique France, the French National Public Health Agency. All authors declare they have no actual or potential competing financial interest. N/A.

Association of Intravenous Immunoglobulins Plus Methylprednisolone vs Immunoglobulins Alone With Course of Fever in Multisystem Inflammatory Syndrome in Children

Multisystem inflammatory syndrome in children (MIS-C) is the most severe pediatric disease associated with severe acute respiratory syndrome coronavirus 2 infection, potentially life-threatening, but the optimal therapeutic strategy remains unknown. To compare intravenous immunoglobulins (IVIG) plus methylprednisolone vs IVIG alone as initial therapy in MIS-C. Retrospective cohort study drawn from a national surveillance system with propensity score-matched analysis. All cases with suspected MIS-C were reported to the French National Public Health Agency. Confirmed MIS-C cases fulfilling the World Health Organization definition were included. The study started on April 1, 2020, and follow-up ended on January 6, 2021. IVIG and methylprednisolone vs IVIG alone. The primary outcome was persistence of fever 2 days after the introduction of initial therapy or recrudescence of fever within 7 days, which defined treatment failure. Secondary outcomes included a second-line therapy, hemodynamic support, acute left ventricular dysfunction after first-line therapy, and length of stay in the pediatric intensive care unit. The primary analysis involved propensity score matching with a minimum caliper of 0.1. Among 181 children with suspected MIS-C, 111 fulfilled the World Health Organization definition (58 females [52%]; median age, 8.6 years [interquartile range, 4.7 to 12.1]). Five children did not receive either treatment. Overall, 3 of 34 children (9%) in the IVIG and methylprednisolone group and 37 of 72 (51%) in the IVIG alone group did not respond to treatment. Treatment with IVIG and methylprednisolone vs IVIG alone was associated with lower risk of treatment failure (absolute risk difference, -0.28 [95% CI, -0.48 to -0.08]; odds ratio [OR], 0.25 [95% CI, 0.09 to 0.70]; P = .008). IVIG and methylprednisolone therapy vs IVIG alone was also significantly associated with lower risk of use of second-line therapy (absolute risk difference, -0.22 [95% CI, -0.40 to -0.04]; OR, 0.19 [95% CI, 0.06 to 0.61]; P = .004), hemodynamic support (absolute risk difference, -0.17 [95% CI, -0.34 to -0.004]; OR, 0.21 [95% CI, 0.06 to 0.76]), acute left ventricular dysfunction occurring after initial therapy (absolute risk difference, -0.18 [95% CI, -0.35 to -0.01]; OR, 0.20 [95% CI, 0.06 to 0.66]), and duration of stay in the pediatric intensive care unit (median, 4 vs 6 days; difference in days, -2.4 [95% CI, -4.0 to -0.7]). Among children with MIS-C, treatment with IVIG and methylprednisolone vs IVIG alone was associated with a more favorable fever course. Study interpretation is limited by the observational design.

The SARS-CoV-2 epidemic, a step towards recognizing the speciality of critical care nursing in France.

The SARS-CoV-2 epidemic, a step towards recognizing the speciality of critical care nursing in France.

Risk factors for invasive meningococcal disease: a retrospective analysis of the French national public health insurance database

ABSTRACT Vaccination of at-risk populations against Neisseria meningitidis is an important strategy to prevent invasive meningococcal disease (IMD). The objective of this study was to characterize preexisting risk factors in patients with IMD and to compare their relative importance. This case-control analysis was performed in the French national public health insurance database (SNDS). Cases consisted of all people hospitalized for IMD in France over a six-year period (2012–2017). Controls were matched by age, gender, and district of residence. Medical risk factors were identified from ICD-10 codes in the SNDS. Socioeconomic risk factors studied were low household income and social deprivation of the municipality of residence. Associations of these risk factors with hospitalization for IMD were quantified as odds ratios (ORs) between cases and controls with their 95% confidence intervals (95%CI). The medical risk factors showing the most robust associations were congenital immunodeficiency (OR: 39.1 [95%CI: 5.1–299], acquired immunodeficiency (10.3 [4.5–24.0]) and asplenia/hyposplenia (6.7 [3.7–14.7]). In addition, certain chronic medical conditions, such as autoimmune disorders (5.4 [2.5–11.8]), hemophilia (4.7 [1.8–12.2]) and severe chronic respiratory disorders (4.3 [3.1–6.2]) were also strongly associated, as was low household income (1.68 [1.49–1.80]). In conclusion, this study has documented potential risk factors associated with hospitalization for IMD in a large and comprehensive sample of individuals with IMD in France. Several of the risk factors identified may help identify groups who could benefit from targeted prevention measures (such as vaccination) in order to reduce the burden of IMD.

PIN72 Burden of Influenza-Related and Associated Hospitalizations in France from Season 2010/11 to 2017/18

Each season in France, influenza infection is responsible for an important outbreak conducting to 2-6 million GP visits and leading to several thousands of deaths. Although influenza epidemic is closely monitored by the French national public health agency (Santé publique France), the hospital burden of influenza is still underappreciated. The study objective is to describe the public health and economic burden of influenza at hospital from the season 2010/11 to 2017/18. Data on influenza-associated hospitalizations were extracted from the French national hospital administrative database (PMSI). The number of hospital stays and the corresponding number of hospitalized patients were determined using disease-specific ICD-10 codes (J09/J10/J11) used as main and associated diagnostic. Associated costs were estimated from the payer’s perspective, using French official tariffs. Over the period, 18,979 [min: 8,627; max: 44,024] influenza hospitalizations occurred on average per season. Age distribution of hospitalized patients varied from one season to another: patients aged ≥65 years accounted for 14% of the stays in 2010/11 versus 66% in 2016/17 and 52% in 2017/18. Mean length of stay was 8.3 days, [min: 3 days; max: 10 days] with oldest patients experiencing the longest stays. On average, influenza stays cost 81,9M€ per season [min: 26,4M€; max: 209,7M€]. The mean cost of hospitalization was 4,319€ [min: 1,206€; max: 5,118€]. Influenza is associated with a substantial number of hospitalizations and massive costs each season. Our estimate is expected to be conservative. Additional studies including burden associated with influenza-related and associated complications are needed to have a comprehensive estimate of the burden of influenza at hospital.

Dissemination strategies: experience and lessons learned

Abstract The French national public health agency is building a portal of evidence-based and promising interventions. The aim of this project is to improve the effectiveness and the efficiency of public health interventions. The portal currently contains around 80 descriptive files. But this portal is only part of a system. Each decision maker or project manager interested in an intervention must be able to have access to qualified trainers, to manual and have assistance in quality assessment. It is also necessary to adapt the interventions to each local context without losing the effectiveness demonstrated in the evaluation or initial research. It is essential to document all the local adaptations in a centralized information system and to compare them with a fidelity measure or a monitoring tool. David Chambers has named this type of system an Adaptome (AJPM 2016; 51: S124-S131). Several programs, adapted from international programs (Strengthening families' program, Good behavior game, nurse family partnership), or based on French research (Tabado, ICAPS), are being deployed. The challenges and difficulties of these deployments will be discussed.

Syndromic Surveillance of Acute Gastroenteritis Using the French Health Insurance Database: Discriminatory Algorithm and Drug Prescription Practices Evaluations.

The French national public health agency (Santé publique France) has used data from the national health insurance reimbursement system (SNDS) to identify medicalised acute gastroenteritis (mAGE) for more than 10 years. This paper presents the method developed to evaluate this system: performance and characteristics of the discriminatory algorithm, portability in mainland and overseas French departments, and verification of the mAGE database updating process. Pharmacy surveys with certified mAGE from 2012 to 2015 were used to characterise mAGE and to estimate the sensitivity and predictive positive value (PPV) of the algorithm. Prescription characteristics from these pharmacy surveys and from 2014 SNDS prescriptions in six mainland and overseas departments were compared. The sensitivity (0.90) and PPV (0.82) did not vary according to the age of the population or year. Prescription characteristics were similar within all studied departments. This confirms that the algorithm can be used in all French departments, for both paediatric and adult populations, with stability and durability over time. The algorithm can identify mAGE cases at a municipal level. The validated system has been implemented in a national waterborne disease outbreaks surveillance system since 2019 with the aim of improving the prevention of infectious disease risk attributable to localised tap water systems.

General Practitioner House Call Network (SOS Médecins): An Essential Tool for Syndromic Surveillance – Bordeaux, France

In the French mainland administrative region Nouvelle-Aquitaine, syndromic surveillance is based on hospital emergency data, mortality data, and data from associations belonging to the SOS Médecins network. The aim of the present article is to describe the functioning of this network and to illustrate its use for syndromic surveillance in Nouvelle-Aquitaine. The SOS Médecins network participates in the syndromic surveillance system SurSaUD, developed by Santé publique France (SpF; the French National Public Health Agency; Saint-Maurice, Paris, France). Near real-time data are automatically transmitted daily to a data server and analyzed by SpF's Nouvelle Aquitaine's regional unit to identify, monitor, and evaluate the impact of expected and unexpected health events in the region. The SOS Médecins network has five local associations spread across the region with 146 participating physicians. Data have been recorded for more than 10 years and represented nearly 481,000 visits in 2017. The resulting database has helped to identify and monitor seasonal epidemics and unexpected events, as well as measure the health impact of these events. The data from the SOS Médecins network are an essential source in syndromic surveillance. They complement surveillance data from other sources. More specifically, mortality and emergency unit traffic reflect the most severe cases, while SOS Médecins data help early detection of epidemics and health events in the general population. The network has shown its responsiveness and its reliability, not only for the surveillance of seasonal epidemics, but also for the detection of unusual signals. It therefore constitutes an essential link in syndromic surveillance in France, and specifically in the Nouvelle-Aquitaine region.

Quantifying the Seasonality and Modeling the Evolution in Time of Carbapenemase-Producing &lt;i&gt;Enterobacteriaceae&lt;/i&gt; Episodes in France Over 2010-2020

Background: Carbapenemase-producing Enterobacteriaceae (CPE) cause resistant healthcare-associated infections that jeopardize healthcare systems and patient safety worldwide. The number of CPE episodes has been increasing in France since 2009 but the dynamics are still poorly understood. Methods: We used a time-series approach to analyze CPE episodes from August 2010 to November 2016 reported to the French national surveillance system. The impact of seasonality was quantified using seasonal-to-irregular ratios. Seven time-series models and three ensemble stacking models (average, convex and linear stacking) were assessed and compared to forecast CPE episodes during 2017-2020. Findings: During 2010-2016, 3559 CPE episodes were observed in France. Compared to the average yearly trend, we observed a 30% increase in the number of CPE episodes in Autumn. We noticed a 1-month lagged seasonality of non-imported episodes compared to imported episodes. Average stacking gave the best forecasts and predicted an increase during 2017-2020 with a peak up to 345 CPE episodes (95% PI[124-1158], 80% PI[171-742]) in September 2020. Interpretation: The observed seasonality of CPE episodes sheds light on potential factors associated with the increased frequency of episodes which need further investigations. Our model predicts that the number of CPE episodes will continue to rise in the coming years in France, mainly due to local dissemination, associated with bacterial carriage of patients in the community which is becoming an immediate challenge to help controlling the outbreak. Funding Statement: French national research agency (ANR) through the SPHINx project. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Ethical and data access approvals for the present study were obtained in accordance with French legislation. The data on CPE episodes used in this study were anonymized and aggregated at the hospital level, which did not permit to identify colonized or infected cases. The study protocol was reviewed and accepted by the French national public health agency, which provided the data.

Transition to health democracy in France: occupational therapy for population-based interventions

Abstract Background Health promotion stands as a core value of occupational therapy, a client-centred healthcare profession that achieves this goal by enhancing individuals’ ability to engage in activities that they want to, need to, or are expected to do. Yet, occupational therapists in France have not been working in alliance with Public Health funding or programs in the community to reduce possible illnesses leading to chronic conditions and hospitalizations. There is a need to discuss how these professionals can collaborate with Public Health initiatives to move beyond individual interventions and address population-based needs. This study explores occupational therapists opportunities to develop health promotion practices in France. Methods A participatory action research was conducted with six co-participants using occupational justice-based frameworks and the French National Public Health report on Health Promotion as a ground for discussion which extended over 3 months. Qualitative content analysis and Kemmis’ practice architecture theory was used to understand how practices are shaped by discursive, economic and socio-political circumstances. Results Preliminary results show that occupational justice-based reasoning enables practitioners to shift from an individual to a population needs focus. Yet, the lack of education for this type of practices is evident. The findings highlight prerequisites that need to be fulfilled in order to apply an occupational justice-based approach within health promotion initiatives. Conclusions Working on community settings allows practitioners to comprehend the complex interactions between individuals and context. Public Health field provides an interface between society requirements and populations needs in which occupational therapist could enact health promoting interventions. The practice in this field is emerging and therefore it is relevant to discuss the competencies that should be included within occupational therapy education. Key messages A healthcare system that does not consider its population’s contextual situation is a failing system. France’s welfare transformation requires all professionals to develop community-based initiatives. The findings will support the development of the first guidelines for health promotion occupational therapy practices in France.

Perceptions of health professionnals in a French social marketing campaign against smoking

Abstract Background In 2016, Santé publique France, the French national public health agency, launched a social marketing campaign aiming at triggering quit attempts among smokers: “MoisSansTabac”, inspired by the British “Stoptober”. Every year, smokers are encouraged to quit smoking for 30 days in November, health professionals are encouraged to participate in the campaign to support them. In 2018, pharmacists received a poster (“Here, we help smokers stop smoking”) and self-help kits to distribute to smokers. Measuring the perceptions of health professionals is crucial to have a complete overview of the impact of the campaign and to identify ways of improvement. Methods A qualitative evaluation of the 2018 edition has been performed to collect the perceptions of general practitioners (GPs) and pharmacists about the intervention and services provided through the campaign (quitline, website, mobile app, self-help kit). In December 2018, semi-directed interviews were conducted with 24 GPs and 24 pharmacists. A diversity of profiles was ensured (professional settings, geographic area, age, gender, smoking status). A content analysis was performed. Results While health professionals had generally poor awareness of the intervention, their opinions were divided depending on their professions. GPs did not feel sufficiently associated nor did they understand how they could specifically participate during this one-month event while they support smokers all year long. Pharmacists were pleased to be involved: they felt recognized in their role as health counselors although their participation remained low. Help cessation services were positively perceived. Some health professionals expected to have a more clearly defined role and to get evidence on the effectiveness of the intervention. Conclusions To improve the acceptability and effectiveness of “MoisSansTabac”, there is a need to rethink the place of health professionals and how to communicate with them about the campaign. Key messages ’Mois Sans Tabac’ is a social marketing intervention which is considered acceptable by general practitioners and pharmacists but improvements are necessary. Health professionals could get more involved in the campaign if their role was better defined.

Use and perceptions of electronic cigarette by the adult population in France in 2017

Abstract Background E-cigarette (EC) use is controversial because its benefit-risk ratio is still unclear. Since its introduction on the French market at the beginning of the 2010’s, French health authorities have published cautious recommendations. The study aims at describing uses and perceptions about EC among the adult population. Methods Santé Publique France’s Health Barometer, the French national public health agency, is a cross-sectional random survey conducted annually by phone, on a representative sample of the population aged 18-75 y/o in Mainland France. Descriptive analysis and logistic regressions were performed to analyze data collected from the 25,319 respondents of the 2017 edition. Results In 2017 in Mainland France, 3.8% of the population used an EC, 2.7% on a daily basis. Among EC daily users, 60.4% were men, 57.9% had a bachelor degree or higher qualifications. Less than 1% of EC users were never-smokers, 50.3% were daily or occasional smokers, 49.5% were former smokers. The number of daily ex-smokers who did quit smoking ( &amp;gt; = 6 months) and believed that vaping has helped them to, was estimated to be 700,000 since EC has been available in France. EC was perceived as equally or more harmful than regular cigarette by half of the population (51.5%), a proportion that has increased since 2014 (43.4%). Daily smokers perceived EC as more harmful, while being an EC user from high socioeconomic status was associated with the perception that EC is less harmful. The bans on EC in places where smoking is prohibited and on sales of EC to minors (&amp;lt;18 y/o) were appreciated by 66.9% and 77.5%, respectively. Conclusions These results show that in France, EC is strongly related to current or past smoking habits. A significant number of ex-smokers believe that EC has helped them quit smoking. Sociodemographic differences in the perception of EC harmfulness suggest social inequalities in access to information. Key messages Electronic cigarette users in France are few and most of them are smokers or former smokers. The perception of electronic cigarettes harmfulness depends on sociodemographic and smoking status.

Implementation of a nationwide Waterborne disease outbreak surveillance system in France

Abstract Issue/Problem Waterborne disease outbreaks (WBDOs) remain a public health issue in developed countries, but to date the surveillance of WBDOs in France, mainly based on the voluntary reporting of clusters of acute gastrointestinal infections (AGIs) by general practitioners to health authorities, is characterized by low sensitivity. In this context an integrated and automatized approach to detect WBDO relying on the identification of clusters of medicalized AGI cases sharing a same drinking water networks (DWN) was developed, evaluated in a simulation study and tested in a pilot study by the French National Public Health Agency. Description of the problem Two national big databases support the detection process of potential WBDO: health insurance database for AGI, ministry of health database for drinking water system information. Each detected outbreak has to be investigated regarding environmental criteria during the days before the onset of the outbreak: results on bacterial water monitoring, weather (e.g. heavy rain), technical incidents in the drinking water system (e.g. chlorination breakdown, alarm malfunction). To evaluate the strength of association with drinking water, four levels are proposed based on epidemiological and environmental criteria (strong, probable, possible and undetermined). Results The WBDO surveillance system has been implemented in all french departments since start of 2019 and support by the ministry of health. A web-application, named “EpiGEH”, was also developed to support the surveillance system. A retrospective study between 2010 and 2017 has detected almost 300 to 550 potential WBDO per year while voluntary reporting identified 2 to 3 WBDO each year during the same period. Lessons Such a specific surveillance system should help health authorities to formulate recommendations regarding the management of drinking water systems and propose appropriate preventive measures, in accordance with the water safety plans. Key messages The WBDO surveillance system based from health insurance databases constitutes a daily surveillance system of drinking water quality. The WBDO surveillance system should drastically improve the detection sensitivity by a factor 100 to 200 compared to voluntary reporting.

Building a social marketing Strategy to reduce alcohol-related harm in France

Abstract Background Alcohol use ranks among the top three risk factors in France, leading to about 40 000 deaths annually. French health authorities wished to renew the public health message about alcohol consumption and build a social marketing Strategy to lower the social and health consequences of alcohol consumption in France. Objectives Two main steps were followed: 1) gathering a group of experts to provide up-to-date low-risk drinking guidelines, 2) building, testing and implementing a social marketing Strategy based on this expertise. Results In 2017, the group of experts established low-risk drinking Guidelines based on both scientific evidence and socially acceptable risks for the French population. They suggested to increase awareness on alcohol-related harm as well as on the new Guidelines. In 2018, a social marketing Strategy was set up by Santé publique France, the French national public health Agency. Qualitative and quantitative pretests allowed to develop understandable and potentially effective communication materials consisting of the following message: “To protect your health, no more than 2 alcoholic drinks a day, and not every day”. A web-based brief intervention to assess a person’s alcohol consumption was developed, based on a previous tool whose effectiveness had been demonstrated. In 2019, the Campaign was launched: health professionals were informed at first, followed by a national mass media Campaign that was broadcasted for 3 weeks, targeting the general population (TV, radio, press, the Internet). Conclusions It is the first time in France that such a global Strategy is set up to promote an alcohol harm reduction message. A robust evaluation is in progress but this structured approach seems feasible and reproducible abroad. Key messages In France, an alcohol harm reduction Strategy has been built up and implemented, based on scientifically-established Guidelines. The social marketing campaign is rigorously evaluated to assess its impact and portability.