Perceived priorities for prevention: change between 1996 and 2006 in a general population survey

Background We assessed change between 1996 and 2006 in the opinions of the general public on priorities for the prevention of health problems. Methods Postal questionnaire surveys in 1996 and 2006, in representative samples of the general population of Geneva, Switzerland. Participants indicated, for each of 13 health problems, a priority rating for the spending of prevention resources. Results There were 742 participants in 1996 (response rate 75%) and 1487 in 2006 (response rate 76%). According to participants, in 2006, resources should be spent, with priority, for: the prevention of sexual abuse of children (67% answered ‘high priority'), illegal drugs (58%), AIDS (55%), tobacco smoking (45%), road traffic accidents (43%), alcoholism (42%), family violence (42%), suicide in young people (39%), mammography screening for breast cancer (37%), abuse of medications (27%), cannabis use (24%), poor diet (22%) and lack of physical activity (20%). Between 1996 and 2006, the largest change was observed for tobacco smoking (+18.6% answered ‘high priority'), poor diet (+11.4%), lack of physical activity (+10.8%) and AIDS (-10.8%, P < 0.001 for all change scores). Conclusions Smoking, poor diet and lack of physical activity were more likely to be perceived as priorities in 2006 than in 1996, whereas priority ratings decreased for AIDS. The prevention of sexual abuse of children was perceived as the highest priority by all respondent group

Paradoxical Changes in Alcohol Consumption and CAGE Ratings Between 1996 and 2006 in the General Population of Geneva

Aims: To assess changes between 1996 and 2006 in alcohol use and dependence in the general population of Geneva, Switzerland. Methods: Postal surveys of alcohol consumption patterns in representative samples of the general population were compared. The four-item CAGE (Cut down, Annoyed, Guilty, Eye-opener) screener was used to estimate alcohol dependence. Results: There were 742 participants in 1996 (response rate 75%) and 1487 in 2006 (76%). The proportions of daily drinkers (1996: 18%; 2006: 10%; P14drinks/week) decreased between 1996 (13%) and 2006 (7%; P<0.001). However, decreases in heavy drinking were limited to men aged 30+ and women aged 30-49. The average number of drinks/week decreased from 6.4 in 1996 to 5.0 in 2006 (P<0.001). Perception of safe drinking levels decreased between 1996 (4drinks/day) and 2006 (3drinks/day, P<0.001). The prevalence of alcohol dependence, defined as a CAGE score ≥2, increased among women (1996: 6%; 2006: 14%; P=0.001), but not among men (1996: 18%, 2006: 19%). Two of the CAGE items were endorsed more frequently by women in 2006 than in 1996: ‘guilty' (1996: 9%; 2006: 15%; P=0.018) and ‘should cut down' (1996: 12%; 2006: 18%; P=0.04). Drinking and driving did not change significantly over time (2006: 21% of men, 9% of women). Conclusion: Alcohol consumption, heavy drinking and perceived levels of safe drinking decreased over these 10 years, but not drink driving or alcohol dependence. Paradoxically, alcohol dependence even increased among women, driven by CAGE items ‘guilty' and ‘should cut down', suggesting that changes in CAGE scores reflected changes in the social acceptability of drinking rather than changes in dependenc

Labeling smokers' charts with a "smoker” sticker: Results of a randomized controlled trial among private practitioners

We randomly assigned private practitioners (n=393) to receiving, by mail, a box of "Smoker” stickers and a recommendation to label smokers' charts with these stickers, or to no intervention. Twenty percent of the physicians reported using the stickers and applying them on 43% of their smoking patients' charts. The intervention had no impact on physician reports of the proportion of smokers advised to quit smoking, but physicians who reported using the stickers stated that they advised more smokers to quit after the intervention (89%) than before (80%, P=.02). Thus, self-reports by physicians indicated that use of the stickers was associated with an increased proportion of smokers advised to quit. However, overall, the intervention did not modify physicians' behavio

Collecting Saliva Samples by Mail

Collecting saliva samples by mail can serve numerous purposes in epidemiologic research. The objectives of this study were to assess what proportion of participants in a mail survey would provide a saliva sample and whether incentives could improve participation. In 1995, 2,994 students, faculty, and staff members of Geneva University, Geneva, Switzerland, were randomized to receive, together with a mailed questionnaire about smoking, a saliva vial, a ballpoint pen, the offer of a lottery, or any combination of these. After one mailing and a reminder letter, response rates were 52% among those who had been requested to provide saliva and 63% among controls (p <0.001). In the former group, most respondents (98%) provided a saliva sample. Incentives improved participation only among those who were asked to provide saliva (lottery: +11% response, p = 0.003; pen: +6% response, p = 0.1). The final participation, after up to three reminders, was 76% overall. The authors conclude that while the collection of saliva samples by mail is feasible it tends to decrease response rates. Am J Epidemiol 1998;147:141-

Self-selection of enrollers at the creation of a managed care organization

Factors affecting choice between a managed care organization (MCO) and a fee-for-service insurance plan were examined when the University of Geneva health insurance plan was transformed into an MCO, in October 1992. A case-control study using a mailed questionnaire (response rate 84%) was conducted to compare former members who joined the MCO (joiners, n=421) to former members who opted out in order to keep fee-for-service coverage (non-joiners, n=222). Non-joiners were more likely to be women (odds ratio (OR) from multivariate model was 1.15, p=0.50), to be born in Switzerland (OR=2.04, p75,000 Swiss francs (OR=2.00, p<0.01), to have a personal physician (OR=1.96, p<0.01) and to have consulted a specialist (OR=1.69, p=0.02) or used unconventional medicine (OR=4.59, p<0.01) in the past year. During the previous year, non-joiners had more health care visits than joiners (14.6 versus 9.1, p=0.01). Non-joiners reported better mental health and fewer complained of persistent fatigue (OR=2.18, p=0.03). The choice of health plan was strongly influenced by socio-demographic characteristics, past patterns of health services utilization and health status. The self-selection process was paradoxical: MCO joiners had used fewer health care visits than non-joiners, but their self-reported health status was worse. The differences we have observed between self-selected populations have important implications for the financial performance of competing health care delivery system

Collecting Saliva by Mail for Genetic and Cotinine Analyses in Participants Recruited through the Internet

The authors assessed whether collection by mail of saliva and buccal cells for genetic analysis was feasible in participants recruited through the Internet. In 2003, 14,773 visitors of a smoking cessation website were invited by e-mail to take part in the study. Salivettes (plastic vials containing a cotton roll) were mailed to participants, for collection of saliva and buccal cells. Because of limited resources, the authors stopped recruitment when 392 participants (3% of 14,733) were registered. They received 315 saliva samples back (80% of 392). Salivary cotinine was analyzed in 145 daily smokers. Cotinine concentration could be assessed in 141 samples (97%) (range 0.7-899ng/ml, median 260ng/ml). DNA extraction was achieved in all the 285 samples in which it was attempted. Quality of DNA was assessed by optical density measurements and by polymerase chain reaction amplification of a gene coding for the α-4 nicotinic receptor, with the detection of a known polymorphism. Successful results were obtained in 235 samples (82% of 285). Thus collecting saliva by mail for cotinine and DNA analysis in participants recruited through the internet produced samples of good quality at a reasonable cost. This approach should be valuable for genetic epidemiology and pharmacogenetic researc

Electronic cigarettes: a survey of users

<p>Abstract</p> <p>Background</p> <p>Little is known about users of electronic cigarettes, or their opinions, satisfaction or how and why they use such products.</p> <p>Methods</p> <p>An internet survey of 81 ever-users of ecigarettes in 2009. Participants answered open-ended questions on use of, and opinions about, ecigarettes.</p> <p>Results</p> <p>Respondents (73 current and 8 former users) lived in France, Canada, Belgium or Switzerland. Most respondents (77%) were men; 63% were former smokers and 37% were current smokers. They had used e-cigarettes for 100 days (median) and drew 175 puffs per day (median). Participants used the ecigarette either to quit smoking (53 comments), to reduce their cigarette consumption (14 comments), in order not to disturb other people with smoke (20 comments), or in smoke-free places (21 comments). Positive effects reported with ecigarettes included their usefulness to quit smoking, and the benefits of abstinence from smoking (less coughing, improved breathing, better physical fitness). Respondents also enjoyed the flavour of ecigarettes and the sensation of inhalation. Side effects included dryness of the mouth and throat. Respondents complained about the frequent technical failures of ecigarettes and had some concerns about the possible toxicity of the devices and about their future legal status.</p> <p>Conclusions</p> <p>Ecigarettes were used mainly to quit smoking, and may be helpful for this purpose, but several respondents were concerned about potential toxicity. There are very few published studies on ecigarettes and research is urgently required, particularly on the efficacy and toxicity of these devices.</p

Measurement invariance of the Marijuana Motives Measure among men and women using Stop Cannabis App

Motives to use cannabis play a central role in the development and maintenance of problematic cannabis use and previous studies stressed sex-related differences on motives to use cannabis. However, motives cannot be validly compared in men and women without first establishing the measurement invariance across sex. Therefore, the aim of the study is to (1) examine for the first time the measurement and structural invariance of the Marijuana Motives Measure (MMM) across sex, and (2) to investigate the motives for cannabis use that best explain problematic use. 2951 (41.7% women) users of the "Stop cannabis" smartphone app of which 99.8% reported having used cannabis in the last three months completed an online MMM and ASSIST to assess the severity of their problematic cannabis use. Multigroup confirmatory factor analyses supported measurement invariance across sex, whereas structural invariance was not confirmed. Indeed, group comparisons indicated that women reported greater coping motives then men whereas men showed greater social motives than women. A multiple linear regression analysis showed that only coping and conformity motives were significantly associated with greater problematic cannabis use, whereas neither sex nor the sex by motives interactions were significantly related to problematic cannabis use. The MMM appears to function comparably across men and women. Therefore, sex-related comparisons on the questionnaire can be considered valid. Coping and conformity motives may play a central role part in the development of marijuana use problems which may hold implications for intervention development and public policy