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Background The human papillomavirus (HPV) vaccine reduces the burden of cervical and other cancers. In numerous countries, a slow uptakeof this vaccine persists, calling for a better understanding of the structural factors leading to vaccine acceptation. We aimed to assess the attitudes toward HPV vaccination among its intended public to explore its specific characteristics. Methods A random cross-sectional telephone survey of the French general population provided data from a sample of 2426 respondents of the target public: the parents of young women and the young women aged 15-25 themselves. We applied cluster analysis to identify contrasting attitudinal profiles, and logistic regressions with a model averaging method to investigate and rank the factors associated with these profiles. Results A third of the respondents had never heard of HPV. However, most of the respondents who had heard of it agreed that it is a severe (93.8%) and frequent (65.1%) infection. Overall, 72.3% of them considered the HPV vaccine to be effective, but 54% had concerns about its side effects. We identified four contrasting profiles based on their perceptions of this vaccine: informed supporters, objectors, uninformed supporters, and those who were uncertain. In multivariate analysis, these attitudinal clusters were the strongest predictors of HPV vaccine uptake, followed by attitudes toward vaccination in general. Conclusions Tailored information campaigns and programs should address the specific and contrasted concerns about HPV vaccination of both young women and of their parents.

•We assessed French GPs’ attitudes and behaviors about HPV vaccination.•HPV vaccine hesitancy is fairly prevalent among GPs.•Perception of the vaccine risk-benefit balance is the strongest determinant of this behavior. General practitioners (GPs) play a crucial role in human papillomavirus (HPV) vaccine acceptance in France. We sought to study: (1) GPs’ perceptions of its risks and efficacy and their recommendation behavior; (2) the relative importance of factors associated with the frequency of their recommendations. Cross-sectional observational study in 2014 nested in a national panel of 1712 randomly selected GPs in private practice in France (response rate: 92.4%). We used model averaging to analyze the associations of self-reported frequency of GPs’ HPV vaccine recommendations with their perception of its risk-benefit balance and their opinions about the utility of vaccines in general. Overall, 72% of participants reported frequently recommending HPV vaccination; 60% considered that not enough is known about its risks. The model averaging showed that the factors most associated with infrequent recommendation of this vaccine by GPs were: unfavorable perceptions of its risk-benefit balance (OR=0.13; 95%CI=0.09–0.21; partial R2=0.10), a decision not to vaccinate one's own daughter(s) with this vaccine (OR=0.13; 95%CI=0.07–0.24; partial R2=0.05), and doubts about vaccine utility in general (OR=0.78; 95%CI=0.71–0.86; partial R2=0.03). Although nearly three-quarters of French GPs frequently recommended the HPV vaccine, our findings indicate that a substantial percentage of them are hesitant about it. Doubts about its risks and efficacy strongly influence their recommendation behavior. More research is warranted to help design and evaluate tailored tools and multicomponent intervention strategies to address physician's hesitancy about this vaccine.

Human papillomavirus (HPV) vaccination in France is recommended for persons of both sexes up to 19 years of age. This increases to 26 years for men who have sex with men (MSM), as they are considered a high-risk group. Raising the upper age limit for MSM is a targeted sexual healthcare policy because it takes into account the specificities of MSM sexual practices. Assessing MSM’s perceptions of targeted sexual healthcare, using HPV vaccination as an example, is crucial for improving public health policy and HPV recommendations. As part of the French mixed-methods study Vaccigay, we conducted a qualitative study—using semi-structured interviews—with MSM selected by age and HPV vaccination status in 2022. Interviews were transcribed verbatim and thematically analysed using NVivo. Some respondents supported targeted sexual healthcare policy for MSM because they recognised the epidemiological factors involved and wanted healthcare workers to have a non-judgmental attitude toward them. Others did not because they felt it stigmatised MSM; they advocated equal sexual healthcare for everyone. Ultimately, uncertainty about one’s own sexual orientation and difficulty discussing sexuality with doctors were barriers to accessing targeted sexual health care. We recommend improving training of healthcare workers on the specific needs of sexual and gender minorities, increasing the number of sexual health centres that serve these populations, and extending HPV vaccination to all adults up to the age of 26, irrespective of sexual orientation.

Background Annual seasonal influenza vaccination (SIV) is recommended for people with diabetes, but their SIV rates remain far below public health targets. We aimed to identify temporal trajectories of SIV uptake over a 10-year period among French people with diabetes and describe their clinical characteristics. Methods We identified patients with diabetes in 2006 among a permanent, representative sample of beneficiaries of the French National Health Insurance Fund. We followed them up over 10 seasons (2005/06–2015/16), using SIV reimbursement claims and group-based trajectory modelling to identify SIV trajectories and to study sociodemographic, clinical, and healthcare utilization characteristics associated with the trajectories. Results We identified six trajectories. Of the 15,766 patients included in the model, 4344 (28%) belonged to the “continuously vaccinated” trajectory and 4728 (30%) to the “never vaccinated” one. Two other trajectories showed a “progressive decrease” (2832, 18%) or sharp “postpandemic decrease” (1627, 10%) in uptake. The last two trajectories (totalling 2235 patients, 14%) showed an early or delayed “increase” in uptake. Compared to “continuously vaccinated” patients, those in the “progressively decreasing” trajectory were older and those in all other trajectories were younger with fewer comorbidities at inclusion. Worsening diabetes and comorbidities during follow-up were associated with the “increasing” trajectories. Conclusions Most patients with diabetes had been continuously vaccinated or never vaccinated and thus had stable SIV behaviours. Others adopted or abandoned SIV. These behaviour shifts might be due to increasing age, health events, or contextual factors (e.g., controversies about vaccine safety or efficacy). Healthcare professionals and stakeholders should develop tailored strategies that take each group’s specificities into account.

During the early spring of 2020, as the COVID-19 (coronavirus disease 2019) pandemic spread across the globe like a viral tsunami, many countries urgently implemented unprecedented mitigation measures to slow it down, following the example of China, where the disease first emerged at the end of 2019. As a result, more than 3 billion unprepared people worldwide had to cope with living under stringent lockdown measures for weeks or months, depending on the country. Together with the deaths of hundreds of thousands of people from this disease, a frightening emotional shock has touched populations everywhere around the planet. Millions have lost their jobs, others have had their personal lives changed drastically; the elderly, for example, have sometimes been isolated from any visits. To our knowledge, no guidelines to prevent psychological trauma have been proposed, even for the most vulnerable individuals. Nonetheless, before this crisis began, several experts had warned about the potential impact of such measures on the populations’ mental health, based on previous experiences of quarantine, as summarised in a review published, as this pandemic reached Europe and before any lockdowns.1 This warning was confirmed a few days later by the publication of a nationwide study conducted in China reporting that the quarantine triggered a wide variety of psychological disorders.2 In France, one of the hardest hit countries in Europe, a nationwide lockdown started on 17 March and lasted till 11 May. Public health authorities made daily recommendations on how to prevent COVID-19 infection with almost no specific advice on psychological prevention.

HIV cure-related clinical trials (HCRCT) with analytical antiretroviral treatment interruptions (ATIs) have become unavoidable. However, the limited benefits for participants and the risk of HIV transmission during ATI might negatively impact physicians’ motivations to propose HCRCT to patients. Between October 2016 and March 2017, 164 French HIV physicians were asked about their level of agreement with four viewpoints regarding HCRCT. A reluctance score was derived from their answers and factors associated with reluctance identified. Results showed the highest reluctance to propose HCRCT was among physicians with a less research-orientated professional activity, those not informing themselves about cure trials through scientific literature, and those who participated in trials because their department head asked them. Physicians’ perceptions of the impact of HIV on their patients’ lives were also associated with their motivation to propose HCRCT: those who considered that living with HIV means living with a secret were more motivated, while those worrying about the negative impact on person living with HIV’s professional lives were more reluctant. Our study highlighted the need to design a HCRCT that minimizes constraints for participants and for continuous training programs to help physicians keep up-to-date with recent advances in HIV cure research.

•Nurses in France will soon play a more important role in vaccinating the population.•Their self-reported uptake of recommended vaccines is far below official objectives.•More than 40% of nurses were vaccine hesitant, with community nurses less so.•Nurses’ hesitancy mainly focused on seasonal flu, hepatitis B, and HPV vaccines.•Nurses share some of the public's doubts about vaccine safety and benefits. Health care worker vaccine uptake rates are below official targets, and studies demonstrate some are vaccine hesitant. We assessed self-vaccination behavior, vaccine hesitancy (VH), and associated factors in a representative sample of nurses. Cross-sectional questionnaire survey in 2017–18 in southeastern France (5 million inhabitants): community nurses were randomly selected from a list provided by the Inter-Regional Nurses' Council (stratified by gender and district of practice) and interviewed by telephone. Because no such list exists for hospital nurses (74% of all nurses in southeastern France), we randomly selected hospitals, taking their size into account and stratifying by district. Hospital nurses practicing in medicine, surgery, obstetrics, and gynecology departments and present at the time of the survey were included and interviewed face-to face. We measured VH according to the WHO definition (refusal, delay, or acceptance with doubts about at least one vaccine). Interviewers administered the questionnaires. We used multivariable logistic regression to analyze potential associations between VH, vaccine risk perceptions and trust in health authorities. Interviews were completed with 1539 nurses (response rate: 85%). Self-reported vaccine coverage ranged from 27% (seasonal influenza vaccine, recommended, 2016/17 season) to 96% (Bacillus Calmette–Guérin vaccine, mandatory). The VH prevalence rate was 44% (95% confidence interval: 38.7–48.4) and most often concerned seasonal influenza or A(H1N1) vaccines (54%) and the hepatitis B vaccine (18%). VH was significantly more frequent among nurses with low trust in health authorities or high vaccine risk perceptions. Nurses in southeastern France have low levels of self-vaccination acceptance for most recommended vaccines. In addition, they have a high VH prevalence focused on the same vaccines as among the general population. These are important findings given that nurses are in regular contact with patients vulnerable to vaccine-preventable diseases and their VH could negatively influence patients’ vaccination acceptance.

The relations between vaccine hesitancy (VH) and individual socioeconomic status (SES) vary with context and remain poorly understood. We examined associations between parental SES and VH levels and their potential mediation by two attitudinal factors: commitment to making “good” health-related decisions and trust in mainstream medicine. Data come from the 2016 Baromètre santé, a random cross-sectional telephone survey of the French general population. We analyzed a sample comprising 3927 parents of children aged 1–15 years, dividing them into 4 categories according to their VH level. We performed bivariate and then multiple multinomial logistic regression analyses to study associations between parental educational level, income, and VH. We then reassessed the logistic model with a causal steps approach, adding the commitment and trust scores. Vaccine refusers accounted for 26% of parents (95% CI = 25%, 28%), delayers 7% (95% CI = 6%, 8%), and acceptors with doubts 13% (95% CI = 12%, 14%). In bivariate analyses, educational level was associated with VH but income was not, while commitment and trust scores varied significantly with both VH and educational level (p < 0.001). In multivariate analyses, highly educated parents were more prone to be delayers (AOR ≥ Bac + 4 versus < Bac = 1.73, 95% CI = 1.12, 2.69) or refusers (AOR ≥ Bac + 4 versus < Bac = 1.56, 95% CI = 1.19, 2.04) than nonhesitant. These associations did not remain significant after inclusion of the commitment and trust scores in the model. Vaccine refusal and delay are frequent among French parents, especially the more educated. Our results suggest that levels of commitment and trust play a key role in shaping VH. Suitable educational interventions are needed to restore trust in authorities and vaccines. Helping healthcare professionals to communicate better with vaccine-hesitant parents is also essential.