The social value of gambling: surplus estimates by gambling types for France

We estimate the social surplus of gambling in France by adding three components: consumer surplus, producer surplus and taxation revenue. To estimate consumer surplus, we use the rational benchmark approach, which attributes a loss of welfare (i.e. a negative surplus) to problem gamblers depending on their level of excess spending compared with recreational gamblers. Using data for the year 2019 and considering only legal gambling, we find that the consumer surplus is negative for the gambling activity as a whole. When we add the producer surplus and the taxation revenue to the consumer surplus, we find that the social surplus is more likely to be negative, ranging from - 45 billion euros in the pessimistic scenario to + 6 billion euros in the optimistic scenario. There are, however, important differences between gambling types. The social surplus is negative in all scenarios for poker and sports betting. Conversely, it is positive in all scenarios for draw lotteries and scratch cards.

A "Good" Smoke? The Off-Label Use of Cannabidiol to Reduce Cannabis Use

BACKGROUND

Although cannabis use is common in France, it is still criminalized. Cannabidiol (CBD) products, including CBD-rich cannabis, are legally available. Although previous results suggested that CBD may have benefits for people with cannabis use disorder, there is a lack of data on cannabis users who use CBD to reduce their cannabis consumption. We aimed to identify (i) correlates of this motive, and (ii) factors associated with successful attempts to reduce cannabis use.

METHODS

A cross-sectional online survey among French-speaking CBD and cannabis users was conducted. Logistic regressions were performed to identify correlates of using CBD to reduce cannabis consumption and correlates of reporting a large reduction.

RESULTS

Eleven percent (n = 105) of our study sample reported they primarily used CBD to reduce cannabis consumption. Associated factors included smoking tobacco cigarettes (adjusted odds ratio (aOR) [95% confidence interval (CI)] 2.17 [1.3-3.62], p = 0.003) and drinking alcohol (aOR [95%CI] 1.8 [1.02-3.18], p = 0.042). Of these 105, 83% used CBD-rich cannabis to smoke, and 58.7% reported a large reduction in cannabis consumption. This large reduction was associated with non-daily cannabis use (aOR [95%CI] 7.14 [2.4-20.0], p < 0.001) and daily CBD use (aOR [95%CI] 5.87 [2.09-16.47], p = 0.001). A reduction in cannabis withdrawal symptoms thanks to CBD use was the most-cited effect at play in self-observed cannabis reduction.

CONCLUSIONS

Cannabis use reduction is a reported motive for CBD use-especially CBD-rich cannabis to smoke-in France. More studies are needed to explore practices associated with this motive and to accurately assess CBD effectiveness.

Reasons for using cannabidiol: a cross-sectional study of French cannabidiol users

Background

Cannabidiol and cannabidiol-based products are proliferating in many countries. This recent and rapid diffusion prompts investigating the reasons for its use.

Methods

We analyzed data from an online survey among cannabidiol users in the French general population (n = 1166) selected for their interest in such products. We described the reported reasons for using cannabidiol. We performed logistic regressions to identify the correlates of declaring well-being and other specific reasons for using cannabidiol. We also provided descriptive data regarding the cannabidiol patterns of use.

Results

Well-being was the most cited primary reason for use (27% of the sample). Declaring well-being as a primary reason for using cannabidiol was inversely associated with cigarette smoking, cannabis use, and employment. Among cannabidiol users reporting well-being as their primary reason for use, stress and sleep improvements were the most-cited specific reasons. In the whole study sample, the most common modes of use were smoking cannabidiol-rich cannabis (61%) and ingesting cannabidiol oil sublingually (19%).

Conclusions

In a sample of cannabidiol users from France, well-being was the most-cited primary reason for use, and smoking was the first route of administration. Further research is needed to clarify to what extent expected effects are scientifically sound and to understand country-related specificities regarding patterns of use.

Protocol for creating new warnings on cigarette packs and evaluating their efficacy in a randomised experimental setting

INTRODUCTION

Tobacco smoking is one of the leading causes of preventable death. This is not inevitable as tobacco control tools have become more powerful and more effective. Among these, warnings on cigarette packs have proven to be somewhat effective. Our objective is to increase the efficacy of antismoking warnings by using innovative psychological approaches and to create an experimental setting for the evaluation of these new warnings based on behavioural indicators.

METHODS AND ANALYSIS

First, we created new warnings based on three categories of motivational leverage and on harm reduction. New warnings with innovative texts and pictures were designed for each category and inserted on plain packs. We will then use standard indicators to compare their effect to that of control packs: plain pack without warning, plain pack with conventional warning and branded pack with conventional warning. Second, the novelty of our approach will consist in designing an experimental protocol that uses monetary incentives to evaluate the effect of warnings. Subjects will be able to 'sacrifice' part of their participation defrayal to purchase a good whose subjective value is related to one's attitude towards smoking. These monetarily incentivised measures are designed to assess smokers' immediate/mid-term intention to quit and non-smokers' aversion to smoking. In both cases, the monetary amounts individuals accept to sacrifice may be a more reliable measure than declarative responses, which may be distorted by several hypothetical biases. In the end, we should be able to robustly measure the impact of our new warnings between intervention and control groups by using both traditional indicators and our new monetarily incentivised measure.

ETHICS AND DISSEMINATION

The ethics committee of the Groupement des Hôpitaux de l'Institut Catholique de Lille approved the research protocol on 5 July 2019 (CIER 2019-22). Results will be presented at scientific meetings and published.

Predicting medical practices using various risk attitude measures

This paper investigates the predictive power of several risk attitude measures on a series of medical practices. We elicit risk preferences on a sample of 1500 French general practitioners (GPs) using two different classes of tools: scales, which measure GPs' own perception of their willingness to take risks between 0 and 10; and lotteries, which require GPs to choose between a safe and a risky option in a series of hypothetical situations. In addition to a daily life risk scale that measures a general risk attitude, risk taking is measured in different domains for each tool: financial matters, GPs' own health, and patients' health. We take advantage of the rare opportunity to combine these multiple risk attitude measures with a series of self-reported or administratively recorded medical practices. We successively test the predictive power of our seven risk attitude measures on eleven medical practices affecting the GPs' own health or their patients' health. We find that domain-specific measures are far better predictors than the general risk attitude measure. Neither of the two classes of tools (scales or lotteries) seems to perform indisputably better than the other, except when we concentrate on the only non-declarative practice (prescription of biological tests), for which the classic money-lottery test works well. From a public health perspective, appropriate measures of willingness to take risks may be used to make a quick, but efficient, profiling of GPs and target them with personalized communications, or interventions, aimed at improving practices.

[Factors associated with investment in an office medicine project by general practice residents]

OBJECTIVE

To identify thefactors associated with investment in an office medicine project by French general practice (GP) residents.

METHODS

We conducted a national survey using a web-based self-administered questionnaire and analyzed the data collected by multiple logistic regressions. The dependent variable was "an office medicine project" The explanatory variables were both individual (socio-demographic and linked to training trajectories) and contextual (related to the available training programmes and the regional medical demography).

RESULTS

The response rate was 48.5%. Out of the 1,695 residents of the study sample, 315 (18.6%) already had a project to setup an office practice during their third cycle ofmedical studies. The main factors associated with this project were (p < 0.05): to receive strong academic support, to live in a rural or semi-rural area, to work as a GP locum, to perform residency training in the same city as the medical training and to perform residency training in a region with a high percentage of GPs 55years and older.

CONCLUSIONS

This study showed that a project to setup an office practice was influenced by both individual and contextualfactors. Special attention should be paid to the means and content of training to ensure better supportfor residents, which could make office general practice more attractive.

Cross-sectional survey: risk-averse French general practitioners are more favorable toward influenza vaccination

OBJECTIVES

We tested the following hypotheses: (i) risk-averse general practitioners (GPs) are more likely to be vaccinated against influenza; (ii) and risk-averse GPs recommend influenza vaccination more often to their patients. In risk-averse GPs, the perceived benefits of the vaccine and/or the perceived risks of the infectious disease might indeed outweigh the perceived risks of the vaccine.

PATIENTS/METHODS

In 2010-2012, we conducted a cross-sectional survey of a nationwide French representative sample of 1136 GPs. Multivariate analyses adjusted for four stratification variables (age, gender, urban/suburban/rural practice location and annual patient consultations) and for GPs' characteristics (group/solo practice, and occasional practice of alternative medicine, e.g., homeopathy) looked for associations between their risk attitudes and self-reported vaccination behavior. Individual risk attitudes were expressed as a continuous variable, from 0 (risk-tolerant) to 10 (risk-averse).

RESULTS

Overall, 69% of GPs reported that they were very favorable toward vaccination in general. Self-reported vaccination coverage was 78% for 2009/2010 seasonal influenza and 62% for A/H1N1 pandemic influenza. Most GPs (72%) reported recommending the pandemic influenza vaccination to at-risk young adults in 2009, but few than half (42%) to young adults not at risk. In multivariate analyses, risk-averse GPs were more often vaccinated against seasonal (marginal effect=1.3%, P=0.02) and pandemic influenza (marginal effect=1.5%, P=0.02). Risk-averse GPs recommended the pandemic influenza vaccination more often than their more risk-tolerant colleagues to patients without risk factors (marginal effect=1.7%, P=0.01), but not to their at-risk patients and were more favorable toward vaccination in general (marginal effect=1.5%, P=0.04).

CONCLUSION

Individual risk attitudes may influence GPs' practices regarding influenza vaccination, both for themselves and their patients. Our results suggest that risk-averse GPs may perceive the risks of influenza to outweigh the potential risks related to the vaccine.

Validity of self-reported vaccination status among French healthcare students

Data on validity of self-reported vaccinations are scarce. This study, performed on healthcare students in Paris (France), aimed to evaluate this validity for occupational vaccinations. The validity of self-reported vaccination status was compared with written information. A total of 432 students were enrolled. Sensitivity rates for BCG, hepatitis B and measles were over 74%. For diphtheria-tetanus-polio and pertussis, sensitivity was below 50%. Specificity was between 70 and 95% for dTP-pertussis, and below 35% for all others. Overall, the validity of self-reported information was low, meaning that checking medical records remains the preferable strategy for assessing immunization status.

Is life satisfaction hump-shaped with alcohol consumption? Evidence from Russian panel data

There has been a growing interest in the study of the shape of the relationship between alcohol consumption and psychological well-being in recent years. Overall, evidence is however still mixed and debated, the type of measures and methods of analysis having been emphasized as key elements in these studies. This paper contributes to this debate by providing new evidence relying on a large-scale population-based study. We used the Russia Longitudinal Monitoring Survey to build an unbalanced panel of 17,953 individuals providing 97,973 observations throughout 10 rounds. We studied the shape of the relationship between alcohol consumption (defined in grams of pure alcohol consumed in the last 30 days) and life satisfaction (measured by a five-item scale) by running a set of regressions. We successively introduced a large number of control variables (age, gender, marital status, occupation, income, health condition, education, living area, smoking status, and body mass index) and individual fixed effects in order to take both potential confounders and unobserved individual heterogeneity into account. Unadjusted analyses indicated a clear hump-shaped relationship between life satisfaction and alcohol use. The association was inverse J-shaped among men and inverse U-shaped among women. When control variables and individual fixed effects were introduced, the hump-shaped curve became increasingly flattened in all samples. Among women, all specifications (linear, quadratic and based on quartile dummies) turned non-significant. The quadratic specification for alcohol use remained however significant in the full sample and among men. In addition, in these two samples, being a fourth quartile drinker was negatively associated with satisfaction.

Factors associated with vaccination for hepatitis B, pertussis, seasonal and pandemic influenza among French general practitioners: a 2010 survey

Our objectives were to describe the vaccine coverage (VC(1)) for some occupational vaccines (hepatitis B, pertussis, seasonal and pandemic influenza) among French General Practitioners (GPs(2)) and to study the factors associated with being vaccinated for each of these four diseases. We surveyed a representative national sample of 1431 self-employed GPs in France. Self-reported VC was 76.9% for 2009/10 seasonal influenza, 73.0% for hepatitis B, 63.9% for pertussis and 60.8% for A/H1N1 pandemic influenza. The factors associated with reporting being vaccinated were quite different from one vaccine to another. For some or all four vaccines, we found a significant positive association (p<0.05) with the following factors in the multivariate analysis: GP's male gender, high volume of activity, no particular mode of exercise (e.g. homoeopathy), no use of Internet at the practice, Continuing Medical Education sessions, discussing the benefits and risks of vaccination with the patients and performing prevention investigations for oneself (lipid profile). Being vaccinated for one vaccine also increased the VC for some or all three other studied vaccines. All these findings argue for public health campaigns using messages adapted to each vaccine.

Opinions et pratiques d’un panel de médecins généralistes français vis-à-vis de la vaccination

En France, la couverture vaccinale est insuffisante. Les médecins généralistes étant des acteurs essentiels de la politique vaccinale, il est utile de connaître leurs opinions et pratiques à ce sujet. Nous avons interrogé 1431 médecins généralistes français et 98% se déclaraient favorables à la vaccination dans leur pratique quotidienne. Leurs couvertures vaccinales étaient de 73% pour l’hépatite B, 64% pour la coqueluche et 77% pour la grippe saisonnière. Les médecins se trouvaient très efficaces pour obtenir l’adhésion pour le vaccin ROR (Rougeole-Oreillons-Rubéole) chez les enfants de moins de deux ans et la grippe saisonnière chez les adultes de moins de 65 ans à risque, mais beaucoup moins pour l’hépatite B chez les adolescents. La mise en place d’un registre national informatisé des vaccinations et de messages de promotion vaccinale différenciés par vaccin semblent les deux voies prioritaires pour améliorer la couverture vaccinale.

Knowledge, attitudes, beliefs and practices of general practitioners towards measles and MMR vaccination in southeastern France in 2012

As a result of sub-optimal immunization levels, measles has re-emerged in the EU since 2008 (30 ,567 cases in 2011), and nearly half of the cases reported are in France. Our objectives were to assess knowledge, attitudes, beliefs and practices of French general practitioners (GPs) towards measles and measles-mumps-rubella (MMR) vaccination. In 2012, we surveyed 329 GPs in southeastern France. Forty-five percent reported that they saw patients with measles in 2011. They considered the risk of complications low among 2-5-year-old children and young adults without co-morbidity. Twenty percent knew that two MMR doses are 99% effective in preventing measles. Nearly all (95%) GPs stated that they verified the MMR status for patients <30 years old in 2011 (42% systematically, 37% often, 15% sometimes). Seventy-nine percent reported proposing MMR vaccination to non-immune relatives in contact with a patient with measles. Participation in continuing medical education courses and considering measles to be a serious disease were independently associated with such post-exposure vaccination. GPs considered the following were potential barriers to the second dose of MMR (MMR2): parents/patients' belief that measles is harmless (80%), parents/patients' fear of the vaccine's side effects (50%), difficulty in documenting vaccination (48%) and lack of reminders for MMR2 (16%). Finally, some GPs also had misconceptions about the severity of measles (13%) and the usefulness of MMR2 (12%), which also served as barriers. In conclusion, it is essential to raise GPs' awareness of this disease and fill any gaps in their knowledge, by providing them with evidence-based information on measles and MMR vaccination.

Is harm reduction profitable? An analytical framework for corporate social responsibility based on an epidemic model of addictive consumption

This article aims to help resolve the apparent paradox of producers of addictive goods who claim to be socially responsible while marketing a product clearly identified as harmful. It advances that reputation effects are crucial in this issue and that determining whether harm reduction practices are costly or profitable for the producers can help to assess the sincerity of their discourse. An analytical framework based on an epidemic model of addictive consumption that includes a deterrent effect of heavy use on initiation is developed. This framework enables us to establish a clear distinction between a simple responsible discourse and genuine harm reduction practices and, among harm reduction practices, between use reduction practices and micro harm reduction practices. Using simulations based on tobacco sales in France from 1950 to 2008, we explore the impact of three corresponding types of actions: communication on damage, restraining selling practices and development of safer products on total sales and on the social cost. We notably find that restraining selling practices toward light users, that is, preventing light users from escalating to heavy use, can be profitable for the producer, especially at early stages of the epidemic, but that such practices also contribute to increase the social cost. These results suggest that the existence of a deterrent effect of heavy use on the initiation of the consumption of an addictive good can shed new light on important issues, such as the motivations for corporate social responsibility and the definition of responsible actions in the particular case of harm reduction.