'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

"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

Discrimination against HIV-Infected People and the Spread of HIV: Some Evidence from France

BACKGROUND: Many people living with HIV/AIDS (PLWHA) suffer from stigma and discrimination. There is an ongoing debate, however, about whether stigma, fear and discrimination actually fuel the persisting spread of HIV, or slow it down by reducing contacts between the whole population and high-risk minorities. To contribute to this debate, we analysed the relationship between perceived discrimination and unsafe sex in a large sample of French PLWHAs. METHODOLOGY/PRINCIPAL FINDINGS: In 2003, we conducted a national cross-sectional survey among a random sample of HIV-infected patients. The analysis was restricted to sexually active respondents (N = 2,136). Unsafe sex was defined as sexual intercourse without a condom with a seronegative/unknown serostatus partner during the prior 12 months. Separate analyses were performed for each transmission group (injecting drug use (IDU), homosexual contact, heterosexual contact). Overall, 24% of respondents reported experiences of discrimination in their close social environment (relatives, friends and colleagues) and 18% reported unsafe sex during the previous 12 months. Both prevalences were higher in the IDU group (32% for perceived discrimination, 23% for unsafe sex). In multivariate analyses, experience of discrimination in the close social environment was associated with an increase in unsafe sex for both PLWHAs infected through IDU and heterosexual contact (OR = 1.65 and 1.80 respectively). CONCLUSIONS: Our study clearly confirms a relationship between discrimination and unsafe sex among PLWHAs infected through either IDU or heterosexual contact. This relationship was especially strong in the heterosexual group that has become the main vector of HIV transmission in France, and who is the more likely of sexual mixing with the general population. These results seriously question the hypothesis that HIV-stigma has no effect or could even reduce the infection spread of HIV

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

International audienceBackgroundThis 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.MethodsThe 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.ResultsAlcohol 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.ConclusionsWorkers 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.Position du problèmeÉtude des associations entre conditions d’emploi (contrat à durée déterminée [CDD] ou d’intérim, contraintes physiques et psychologiques, insatisfactions relatives aux conditions de travail), usage abusif d’alcool (repéré par l’Audit-C) et tabagisme quotidien parmi des hommes et des femmes de différentes catégories d’âge.MéthodeL’échantillon aléatoire comprend 13 241 personnes de 18–29, 30–39 et 40–59 ans exerçant un emploi en France, interrogées par téléphone en 2005. Revenu du foyer, niveau de diplôme et catégorie d’emploi ont été pris en compte en plus des conditions d’emploi citées. Les associations ont été estimées à l’aide de régressions logistiques.RésultatsL’abus d’alcool concernait 20,4 % d’hommes et 7,5 % de femmes, le tabagisme 31,2 et 24,2 %. Ces usages étaient associés aux conditions d’emploi étudiées de façon variable suivant le sexe et l’âge. Les facteurs les plus importants était l’insatisfaction pour les hommes jeunes (OR = 1,71 pour l’abus d’alcool et 2,02 pour le tabagisme) et l’emploi en CDD pour les femmes (1,69 et 1,58), ces associations s’inversant dans les générations plus âgées. L’association entre contraintes physiques et psychologiques et usages est apparue plus complexe, mais contrastée par âge et par sexe. Les contraintes psychologiques étaient les plus associées au tabagisme parmi les femmes de moins de 40 ans (OR > 1,6) alors que les contraintes physiques l’étaient le plus chez les hommes (OR proches de 1,3 pour les deux usages).ConclusionsLa prévention devrait prendre en compte la variabilité des associations entre CDD, contraintes professionnelles et usages d’alcool et de tabac suivant l’âge et le sexe