Smoke-free campuses (SFCs) are characterized by a ban on smoking and vaping on all higher education premises (indoor and outdoor spaces) and by the smoking cessation support they provide. Although literature has demonstrated the impact of SFCs on smoking among young adults, little is known about the sequences of transformations they activate, the assumptions on what it takes to work and on the motivations and constraints that inform their development. Drawing from the first SFC implemented in France, we report on an analysis of the expected transformations in smokers and their environment generated by the activities on campus. Guided by Mayne's logic model template and tapping into three sources of data (i.e., internal documents, semi-structured interviews with people involved in its implementation, and direct nonparticipant observations), we identified the causal model linking the SFC's activities to its impacts. Our results show that the SFC's activities aim to impose constraints to discourage tobacco use, reduce environmental triggers to smoking, denormalize smoking, and facilitate access to cessation aids through better information and accessibility. The SFC may also influence campus dynamics by fostering cohesion, the campus's appeal, and social interactions within the smoking shelters. The policy is also meant to stimulate similar initiatives in other campuses and institutions in the health sector notably through the training of a new generation of managers. The resulting logic model is an essential tool for the transferability of SFC to other environments and can facilitate the identification of indicators for assessing their impacts and effects.

Abstract Background Smoke-free campuses (SFC) prohibit smoking and vaping on all university grounds and for all users. Despite their effectiveness in reducing smoking prevalence, passive smoking, and denormalizing tobacco use, the complex interplay between the programme activities and their impact on users and campus environments remain unclear. This study aims to improve our understanding of the transformation processes associated with SFC expected outcomes. Methods We conducted a retrospective qualitative study on the first SFC implemented in France by the EHESP School of Public Health. Guided by Mayne’s theory of change framework that includes ten dimensions of an impact pathway (e.g. activities, reach/reaction, capacity, behaviour changes, etc.), the research examined the chain of effects and hypotheses driving this SFC. Our dataset included internal documents (e.g. minutes of meetings, administrative documents) and semi-structured interviews with stakeholders (n = 16) involved in the development and implementation of the analysed SFC. Data is currently being analysed. Results Initial results suggest that the EHESP’s SFC activities included communication initiatives, student ambassadors, cessation support for smokers, installation of smoking shelters on campus periphery, etc. These activities were geared on capacity change (e.g. securing support and compliance among campus users, reduce smoking opportunities, promoting the use of cessation aids) and were intended to drive behaviour change (reducing smoking and facilitating cessation among students and staff). The goal of this SFC was not only to impact behaviors but also to educate future health service managers at EHESP to implement SFC policies and set an example for other institutions in France. Conclusions This study identifies some of the transformations that activities of the EHESP’s SFC can generate in students and staff in order to fulfil its outcomes. It also highlighted its expected impact on other institutions. Key messages • Understanding how a smoke-free campus generates its changes is essential in facilitating transferability of experiences to other universities. • Smoke-free campus policies can also generate a broader impact on other institutions.

We argue that the lessons drawn by Guglielmin and colleagues, from the Health in All Policies (HiAP) approach in the municipality of Kuopio, are of limited use to centralised health systems. There is a need for research more attuned to the circumstances of local governments that have little power over the provision of health programmes; yet can address a range of determinants of population health. In these cases, adopting a state-centric perspective may fail to capture the role of other actors such as non-governmental organizations (NGOs) and local branches of state agencies. Evidence from France shows that centralised health systems can foster HiAP locally through political commitment and dedicated coordination staff whose role is to mobilise and support NGOs, inhabitants, and other local branches of regional and central governments. We highlight, as three important challenges, the issue of legitimacy, funding and positioning of the HiAP instrument in the local government structure.

Background. - Local governments are well-positioned to promote healthy behaviours and environments. In France, since 2009, this role can be reinforced by signature of a Local Health Contract with the Regional Health Agency. This multi-year scheme includes an action plan which may cover four areas: health promo-tion, disease prevention, health care and long-term care. Although approximately 400 Local Health Contracts had been signed by 2018, we found only sparse evidence on the context in which they were formulated and the contents of their action plans. Based on the international literature, the CLoterreS study aimed to develop an instrument characterizing the contracts' action plans, with a specific focus on prevention and health pro-motion. This paper presents an assessment and application of the CLoterreS instrument.Methods. - The instrument was developed and applied in five steps: 1) development of the contextual and thematic variables; 2) pre-testing of a coding chart and its coding guide; 3) consultation with practitioners; 4) assessment of inter-rater agreement; and 5) application of the instrument to a nationally-stratified ran-dom sample of 53 contracts.Results. - While inter-rater agreement by type of variables was satisfactory (k > 0.7), some variables had to be dis-carded due to lack of information or insufficient agreement. The analysis indicates that most of the 53 contracts studied were signed in urban areas, on the scale of a single town or a syndicate of municipalities. The action plans are clearly focused on life circumstances, health promotion and protection or primary prevention of diseases, inso-far as, on average, 73% of the contracts' action forms address at least one of these topics. The proportion of action forms dealing with at least one topic in secondary or tertiary prevention, long-term care or the organisation of health care and services is nevertheless substantial (43%). Illustrations of actions are presented.Conclusion. - Building on internationally recognized evidence-based practice, the CLoterreS instrument has proven useful in characterizing health promotion action plans at the local level. Its use by practitioners could foster a broader vision of the scope of actions that can be implemented through a Local Health Contract and in conjunction with other local prevention and access-to-care schemes.(c) 2022 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Abstract Background There is a consensus on the need to transform the built, economic and socio-cultural environments to promote healthy eating (HE) and physical activity (PA). Yet, limited capacity and the biomedicalisation of public health are often blamed for steering investments towards individual risk factors. In France, local health contracts (LHCs) agreed between a regional health agency (RHA) and a local government could improve health promotion strategies. We examined how LHCs take into account the environmental determinants of HE and PA. Methods Using the CLoterreS national census, we analysed a stratified random sample of 53 LHCs with a view to identify if actions target individual (knowledge, skills, etc.) or environmental (interpersonal, organisational, community or political) determinants. To this end, we developed an instrument drawing from different typologies of action and consensus documents to assess the integration of the socioecological approach in programmes. We ran a series of interviews with RHA staff (n = 39) and local actors (n = 23) to put into context our results. Results Out of 53 LHCs, 42 included at least one action on HE or PA. For these topics, there was a higher proportion of actions targeting individuals (83% and 76% per contract, respectively) than environments (51% and 58%). For the latter, actions on interpersonal determinants (e.g. family) were the most common. However, we also found instances of actions on more distal ones (e.g. to improve nutrition standards in school canteens and walkability). Contextual factors such as local priorities, past experience with health promotion and the involvement of local actors in needs assessment and action planning may influence such orientations. Conclusions LHCs constitute a promising avenue to address the environmental determinants of health-related behaviours. A key feature of this instrument is its capacity to develop intersectoral strategies. Further research will show if LHCs deliver on their action plan. Key messages • Local health contracts facilitate the mobilisation of a broad diversity of NGOs and agencies. • This makes it a promising device for addressing the environmental determinants of HE and PA, provided adequate resources are devoted to stakeholder engagement and local government capacity-building.

Health promotion research is deeply rooted in the principles and values of the health promotion movement and in the Alma-Ata Declaration’s drive towards a new concept of local health systems. Policies and strategies to improve population health by mobilizing local resources and actors are the central objects of investigation and are often subsumed into a larger body of studies that conducts population health intervention research. In this chapter, we reflect on an investigation (the CLoterreS project) of a policy instrument defined in the French national legislation to improve coordination and mobilization of the local actors to reduce inequities in health. We first present the key features of health promotion research and those of our object of investigation followed by an account of how the current context of health promotion research shaped our strategy to strengthen our capacity to study this object and inform policies. We then present some of our main results along with their impact on practice and policy. We found that our practitioner–researcher partnership contributed to enhancing interest for health promotion research and provided a new lexicon of actions at the local level and opportunities to intervene in different policy fora. This partnership also sets our project on a course, thus allowing to grab other research opportunities.

In 2016, the World Health Organization officially recommended sugar-sweetened beverage (SSB) taxation as a strategy to reduce purchases, stimulate product reformulation and generate revenues for health-related programmes. Four years before, France had been one of the first countries to tax SSBs. However, the design of this tax was not considered optimal: its rate was flat, low, identical for SSBs and artificially-sweetened drinks containing no added sugars, and its initial public health justification was set aside in favour of budgetary concerns. In 2018, a new taxation scheme was enacted. Integrated in the Social Security Finance Bill, the tax on SSBs is now linearly indexed to the quantity of added sugars in the drink. In this article, we summarize the lessons learnt from the 2012 soda tax and offer insights on the potential public health benefits of the new tax enacted in 2018. A multidimensional framework aimed at gathering evidence about SSB taxation for public health drove our rational so that we address: (1) the soda tax policy-change process; (2) its impact on price and purchases; (3) the consumer receptiveness to the tax and; (4) its legal framework. We also discuss the potential application of the tax to other foods/nutrients.