[Smoking behaviours among staff of two university hospitals in Paris, 2021]. / Tabagisme du personnel de deux hôpitaux de l'Assistance Publique­Hôpitaux de Paris, 2021.

INTRODUCTION: A survey on smoking prevalence was conducted among staff at the Georges Pompidou and Corentin Celton hospitals in the framework of the "smoke-free hospital" project. It aimed to determine the smoking status of different categories of personnel, their desire to be helped to quit and, as regards healthcare staff, whether or not they were encouraging patients who smoked to try to quit. METHODS: From February to May 2021, an anonymous survey was distributed, first on paper in the occupational health unit, and then online in all wards. RESULTS: All in all, 775 people, three quarters of whom were women, participated in the survey (15% of the workforce). Among the respondents, 27% said they smoked: 29.6% of the men and 26.1% of the women. Unsurprisingly, the age group with the highest prevalence was 18-24years. High prevalence was likewise found among technical and administrative staff. More than half of the smokers, who consumed an average of 8 cigarettes a day, were interested in receiving smoking cessation support. As regards smoking cessation support for patients, 49% of medical and nursing staff (70% of the doctors) frequently or systematically advised them to quit. CONCLUSION: Our results illustrate a need to reach high-prevalence categories of smokers in a hospital setting, the objective being to help them to consider quitting, and also a need to train health professionals in smoking cessation counseling.

[Smoking cessation services during "Mois sans tabac": Smokers' profile and effectiveness]. / Consultations de tabacologie pendant le mois sans tabac : profil des fumeurs et sevrage.

INTRODUCTION: In November 2016, France implemented "Mois sans tabac", with the objective of promoting smoking cessation in November for at least one month. This study consisted of: (1) the description of the characteristics of smokers registered in the French cessation database during November 2014-2015 compared to November 2016-2017; (2) the comparison of abstinence factors between the two periods. METHODS: We used data from CDTnet with 4659 registered adults' smokers who came for a first visit in November from 2014 to 2017 and were followed up at least one month. Our endpoint was 1 month-validated abstinence among the 1943 smokers followed up. We performed descriptive analyses of smokers, and predictors of abstinence were determined using a logistic regression model. RESULTS: A 6.9% significant increase of first visits was observed during "Mois sans tabac" versus before Mois sans tabac (P<0.001). Furthermore, more women (56.3% vs. 52.2%) as well as more light smokers (28.7% vs. 23.7%) sought help between these two periods. Finally, in 2016-2017, more smokers consulted by personal initiative than were hospital-referred (45.8% vs. 36.3%) in comparison with 2014-2015. Nevertheless, there was no significant difference of cessation rate between the 2014-2015 group (44.6%) and the 2016-2017 group (45.6%). In multivariate logistic regression, being a light smoker was the only factor that increased the chances of abstinence in 2016-2017 compared to 2014-2015 (OR: 1.68 [1.03-2.75]). CONCLUSION: It seems important to refer smokers to cessation services during Mois sans tabac to reach high rates of abstinence.

[Systematic identification of smokers and tobacco smoking management in the general hospital]. / Repérage systématique et prise en charge du tabagisme à l'hôpital général.

INTRODUCTION: The prevalence of daily smoking in France was 24 % in 2019 and tobacco control remains a major public health issue. A hospital stay provides an opportunity for smoking cessation intervention. Identification and management of smokers during a hospital stay may be variously integrated into electronic health records (EHR). STATE OF THE ART: Smoking status identification, which have included pre-filled forms, check-box, reminders, icons, is heterogeneous. Specific modules in EHR have been implemented for smoking cessation management such as counselling sessions, tobacco cessation prescriptions, smoking cessation guidelines and long-term follow-up. EHR-based intervention to identify and manage smokers with a long-term follow-up for at least one month after hospital discharge has shown an increase in smoking abstinence at 6-12 months. OUTLOOK: Due to the lower quality of free data about smoking status, systematic identification with check-box, reminders or icons in EHR may be more appropriate. Integration of functionalities such as help for prescription, reminders and follow-up of patients would make tobacco cessation management easier for health professionals. CONCLUSION: EHR interventions to identify smokers and manage smoking cessation during hospital stays are an opportunity to increase smoking cessation.

Alcohol withdrawal syndrome management: Is there anything new?

Patients with alcohol use disorder experience frequently alcohol withdrawal syndrome (AWS), which is a potentially life-threatening condition mainly caused by glutamate overactivity. The aim of therapeutic alcohol withdrawal is the entry into a process of complete and lasting abstinence. Therefore preparing withdrawal is crucial to optimize compliance and efficacy of aftercare. Indeed, performing repeated withdrawal per se without any project of subsequent abstinence may be deleterious, at least because of repeated exposure to glutamate neurotoxicity. Managing AWS mainly consists in anticipating severe withdrawal, decreasing the risk of complications, making this experience as comfortable as possible, preventing from long-term benzodiazepine use, and enhancing motivation to aftercare and long-term abstinence. In particular, there are specific guidelines to choose which benzodiazepine administration approach to adopt (i.e. symptom-triggered, fixed schedule or loading dosage) and which other drugs to deliver (e.g. thiamine, folate, magnesium). Specific precautions should be taken in the elderly.

[Standardized screening of alcohol misuse in emergency wards: The experience of a systematic use of the FACE scale in the European Georges-Pompidou Hospital]. / Repérage standardisé du mésusage de l'alcool au service d'accueil des urgences : l'exemple de la passation systématique du questionnaire FACE à l'hôpital Européen Georges-Pompidou.

INTRODUCTION: By using a standardized and systematic screening with the FACE questionnaire, our aims were : - to determine the prevalence of alcohol misuse (AM) among patients admitted in the emergency department of the European Georges-Pompidou Hospital; - to search for risk factors associated with AM. METHODS: Patients admitted between 9 am and 5 pm were included for 7 consecutive days in June 2017. The variables collected were age, gender, reason for and day of admission, acute alcohol intoxication, benzodiazepines misuse, use of illicit drugs, and the FACE. An AM was defined by a score ≥5 for men and ≥4 for women. Descriptive analyses calculated the prevalence of AM and logistic regressions calculated the risks for AM. RESULTS: A total of 190 men and 221 women were included, with 31% and 19% of them with AM, respectively. The risk of AM was positively associated with male gender, weekend admission and illicit drug use. It was negatively associated with age. The risk of AM was not significantly different according to the reason for admission (trauma versus medical). The risk of AM was not associated with misuse of benzodiazepines. Among the 100 patients with AM, only six had been admitted in acute alcohol intoxication. CONCLUSION: A systematic screening is crucial to identify patients that should benefit from brief intervention or specialized intervention in an addictology unit.

[Interventions for smoking cessation in 2018]. / Les outils du sevrage tabagique en 2018.

Smoking cessation treatments have been proved effective to stop smoking. For pharmacological treatments, nicotine replacement therapies (NRT) as well as bupropion allow to increase 6 month-abstinence rates by more than 80% in comparison with placebo while varenicline prescription doubles success rates in the same conditions. These results mean that for 10 smokers who quit with placebo, 18 are expected to quit with NRT or bupropion and 28 are expected to quit with varenicline. Varenicline is 50% more effective than nicotine patch and 70% more effective than nicotine gum. Nevertheless, a combination including NRT patch and oral nicotine forms is as effective as varenicline, thus leading to encourage the prescription of a combination NRT when NRT are chosen. For these three pharmacological treatments, cardiovascular as well as neuropsychiatric tolerance were not found statistically different from placebo in randomized controlled trials. Yet, bupropion prescription leads to an increasing risk of seizure (1/1000 to 1/1500). For behavioral treatment, motivational interviewing as well as cognitive behavior therapies are been proven to be effective to stop smoking but few smokers have access to this treatment. Smoking cessation mobile application and smartphone application seem to be promising in terms of effectiveness and might be useful to reach more smokers.

Study protocol for a pragmatic randomised controlled trial evaluating efficacy of a smoking cessation e-'Tabac Info Service': ee-TIS trial.

INTRODUCTION: A French national smoking cessation service, Tabac Info Service, has been developed to provide an adapted quitline and a web and mobile application involving personalised contacts (eg, questionnaires, advice, activities, messages) to support smoking cessation. This paper presents the study protocol of the evaluation of the application (e-intervention Tabac Info Service (e-TIS)). The primary objective is to assess the efficacy of e-TIS. The secondary objectives are to (1) describe efficacy variations with regard to users' characteristics, (2) analyse mechanisms and contextual conditions of e-TIS efficacy. METHODS AND ANALYSES: The study design is a two-arm pragmatic randomised controlled trial including a process evaluation with at least 3000 participants randomised to the intervention or to the control arm (current practices). Inclusion criteria are: aged 18 years or over, current smoker, having completed the online consent forms, possessing a mobile phone with android or apple systems and using mobile applications, wanting to stop smoking sooner or later. The primary outcome is the point prevalence abstinence of 7 days at 6 months later. Data will be analysed in intention to treat (primary) and per protocol analyses. A logistic regression will be carried out to estimate an OR (95% CI) for efficacy. A multivariate multilevel analysis will explore the influence on results of patients' characteristics (sex, age, education and socioprofessional levels, dependency, motivation, quit experiences) and contextual factors, conditions of use, behaviour change techniques. ETHICS AND DISSEMINATION: The study protocol was reviewed by the ethical and deontological institutional review board of the French Institute for Public Health Surveillance on 18 April 2016. The findings of this study will allow us to characterise the efficacy of e-TIS and conditions of its efficacy. These findings will be disseminated through peer-reviewed articles. TRIAL REGISTRATION NUMBER: NCT02841683; Pre-results.

[Smoking cessation support among persons in situation of precariousness]. / Précarité et sevrage tabagique : réflexions à partir des données de la consultation de tabacologie de l'hôpital européen Georges-Pompidou (AP­HP), Paris.

INTRODUCTION: Underprivileged people smoke more frequently, present with a more severe smoking profile and stop less often than wealthier smokers. They can have difficulties to afford smoking cessation treatments as the French medical insurance coverage system requires smokers to pay it in advance with a later reimbursement. The objective of this study was to compare the characteristics, treatment plans and cessation rates of smokers from disadvantaged population in comparison with smokers in wealthier condition. METHODS: Study population concerned smokers received for a first visit in the smoking cessation service at Georges-Pompidou European Hospital (Paris, France) in 2013. The EPICES score was used to define precariousness. The national file of smoking cessation consultation (CDT) was completed and the nicotine replacement therapy (NRT) prescriptions were detailed, as treatment could be given for free to precarious smokers on a weekly basis. Data were registered in CDTnet, the French national database of smoking cessation services. RESULTS: Precarious smokers (36.8%) presented with a more severe smoking profile and suffered more often from psychiatric disorders than wealthier smokers. They benefited most often from a combination NRT with patch and oral forms. The followed-up precarious smokers attended a greater number of consultations (4.7 against 3.4) and, if they were less often abstainers (22.2% against 41.3%), they were able to significantly reduce their consumption. CONCLUSIONS: Precarious smokers adhere to structured care with aid for access to TSN with a positive consequent impact on consumption.

[Smoking cessation among HIV smokers: Experience of a French hospital-based smoking cessation service]. / Sevrage tabagique chez les patients fumeurs VIH : expérience de la consultation de tabacologie de l'HEGP à Paris.

INTRODUCTION: There is a particular need among HIV-infected patients to stop smoking because of the risk of smoking-related complications and the high prevalence of cigarette smoking among them. Only a few studies have focused on this population in real-world settings. AIM OF THE STUDY: Investigate the effectiveness of a smoking cessation support for HIV-infected patients at the Georges Pompidou University hospital (HEGP) smoking cessation service during the 2011-2012 period. METHODS: A retrospective study of smoking cessation medical records was performed for 39 smokers who had visited for the first time the HEGP smoking cessation service during the 2011-2012 period and declared to be infected by the HIV on their smoking cessation self-questionnaire. The study has described smokers' characteristics and follow-up to measure the abstinence rate, validated by the patient declaration, the registration of the number of days without cigarettes between each visit and a measure of expired carbon monoxide ≤ 5ppm at each visit. We examined smokers lost to follow-up and they have been considered as smokers. Maintained abstinence rates at 3 month-follow-up and at 9 months/one year were registered. RESULTS: The 39 HIV-infected smokers registered in the study were mainly male (30/39), were heavy smokers with a consumption mean of nearly 23 cigarettes per day. One third presented high nicotine dependence with a Fagerström test ≥ 7. A depression history was reported among one third of them. Symptoms of anxiety and depression were declared by 20% and 33% respectively among them. Thirteen percent of them received opioid replacement therapies, 41% were cannabis users (one out of four were daily users) and 10 % declared alcohol abuse. 85% of patients received nicotine replacement therapy (patch and/or oral forms) and 15% varenicline®, along with behavioral support techniques. At 3 month-follow-up, smoking cessation was validated for 20.5% of patients and at 9 months/1 year, smoking cessation rate decreased at 13%. When considering smokers with ≥ 2 visits, the maintained abstinence rates were respectively 27.6 and 17.2%. DISCUSSION AND CONCLUSION: With a severe smoking profile, frequent co-addictions and anxiodepressive symptoms, our results suggest that behavioral techniques combined with nicotine replacement therapy or varenicline® among HIV-infected smokers can help severe smokers to quit. Our data underline the need to take into account the co-addictions and to maintain such patients in treatment to achieve smoking cessation in real-world settings.

[Cannabis cessation interventions offered to young French users: predictors of follow-up]. / Facteurs prédictifs de suivi des jeunes fumeurs de cannabis consultant pour sevrage.

INTRODUCTION: Cannabis use is very problematic among young French people, because of the young age of first consumption and its health consequences. Indeed, the average age of cannabis experimentation is about 15 in France and 49.5% of 17 year-olds report having used cannabis in their lives. To prevent this problem, tobacco and cannabis cessation services are dedicated to handle patients who want to stop tobacco and/or cannabis. Moreover, in 2004, specific medical outpatient services have been implemented to address the problem of young cannabis users. Since their establishment, some studies have reported demographic and clinical characteristics of the patients attending these services, but we still lack data on their follow-up and their medical and psychological care. OBJECTIVE: The aim of this study is to describe the clinical and psychiatric characteristics of young patients referred to tobacco/cannabis cessation consultations or specific young cannabis users' consultations and to evaluate their medical care and monitoring. PATIENTS AND METHODS: We designed a retrospective study in seven cessation clinics in the Paris area between 2005 and 2007. Eligible patients were regular cannabis users aged under 40. An electronic medical database was completed using patients' medical records. Medical files reported demographic and clinical data. Psychiatric disorders were assessed using the HAD and the Beck scores. Nicotine dependence was evaluated by Fagerström's score. The history of addictions, and data about consumption of cannabis, tobacco, alcohol and other drugs were recorded in the medical file. The follow-up of patients was defined by having at least two visits at the medical outpatient services. Tobacco and cannabis cessations were assessed at one-month follow-up. Univariate and multivariate logistic models were used to assess factors associated with patients' follow up and monitoring. RESULTS: Four cessation clinics accepted to participate in our study. One hundred and eight eligible patients were listed during the study period. One hundred and eleven patients (75%) were males and seventy-nine (53%) were employed. The average age of patients was 26 years old (±6.8). Fifty patients (34%) came to the clinic on their own decision, thirty-three (22%) were referred by a hospital and twenty-eight (19%) came because of their family's advice. The mean age of first cannabis consumption was 16 years old (±7.3) and cannabis consumption was most often associated with tobacco use. Fifty-nine percent of patients had anxiety disorders and 28% had depression according to D-HAD score. The dropout rate after first visit was about 40%. The most frequent therapy proposed to young cannabis users was nicotine replacement therapy. Follow-up data were collected for 135 patients and only 85 (37%) patients made at least two visits at the outpatient services. The average number of consultations was five (±3.8). Multivariate analysis found an association between follow-up and previous cannabis cessation (P=0.04), pharmacological treatment of tobacco withdrawal (P=0.04), and antidepressant treatment (P=0.04). Only one quarter of patients had quit cannabis and/or tobacco at one-month follow-up. DISCUSSION: This study describes clinical characteristics of patients attending cannabis consultations in France. As reported in other studies, anxiety disorders and depression are important problems in this population and should be considered during their medical care. The efficacy of specific French medical outpatient services is difficult to evaluate because of the high rate of dropout. Some patients' characteristics seem linked to their monitoring but other studies should be assessed to confirm these results. As pharmacological treatments seem associated with patients' follow-up, new research should be implemented to develop therapeutic solutions for cannabis addiction.

[Proactive bedside counseling of smokers hospitalized in cardiac intensive care unit]. / Intérêt d'une offre systématique d'aide au sevrage chez des fumeurs hospitalisés en service de soins intensifs en cardiologie.

AIM OF THE STUDY: To offer routine information on smoking cessation and bedside counseling to smokers admitted in cardiac intensive care unit. The objective is to encourage cessation and/or use of smoking cessation services after discharge. POPULATION AND METHODS: Thirty-three smokers were admitted in cardiac intensive care unit at the Georges Pompidou European hospital (HEGP) in Paris (France) from 1st March to June 30th 2010. Assessment of tobacco use and offer of counseling and follow-up visits during and after hospital stay. Evaluation of tobacco use by telephone at least six months after discharge. RESULTS: It was found that 30.3% of the patients stopped smoking, mostly without specialized help despite heavy smoking prior to hospitalization. They declared being impressed by their hospital stay. Motives for smoking among continuing smokers were mostly automatic smoking and stress relief. They had declined any smoking aid, despite subsequent hospital stays in cardiac intensive care. Three smokers with a severe profile had died at follow-up. Smokers followed-up at HEGP were in need of nicotine replacement therapy. More than six months after hospital discharge, nearly all smokers remembered being offered bedside counseling to stop smoking. CONCLUSION: This experience reveals the importance of routine bedside counseling for smoking cessation in cardiac intensive care unit. Smokers in this unit often continue smoking even though smoking hinders cardiac rehabilitation.

[Identifying addictive behaviors among adolescents: a school-based survey]. / Repérer les comportements addictifs chez les adolescents : enquête en milieu lycéen.

French epidemiological data show that adolescents today experiment with tobacco at an earlier age than in the 1990s. Half of them combine tobacco consumption with other psychoactive products such as alcohol or cannabis. Tobacco consumption usually begins in adolescence and early smoking initiation is related to stronger nicotine dependence and problems quitting in adulthood. Occasional tobacco consumption rapidly leads to nicotine dependence. The national smoking cessation questionnaire is a tool to assess addictive behaviors among adolescents. It includes validated scales such as the loss of autonomy over tobacco and psychological evaluation. The aim of this school-based study was to assess addictive behaviors among adolescents (specifically loss of autonomy over tobacco) and psychological profile. Data were collected from a cross-sectional study conducted in a high school in the Paris metropolitan area (Nogent-sur-Marne) in 2007 by the smoking cessation team of the Albert-Chenevier Hospital. Three hundred adolescents filled in a questionnaire concerning tobacco, alcohol, and cannabis consumption as well as their psychological profile. Loss of autonomy over tobacco use was evaluated with the Hooked on Nicotine Checklist (HONC). Anxiety and depressive disorders were identified using the Hospital Anxiety and Depression scale (HAD). Self-administered questionnaires were anonymously completed in the classroom by 151 girls and 149 boys aged 15-16 years (mean, 15.4 years): 34% of the adolescents smoked and most of them smoked at least one cigarette a day; 38% had used cannabis at least once in their life and one-third of them smoked more than 10 cannabis joints per month. Adolescents who frequently smoked cannabis had started smoking tobacco earlier than the other smokers (mean, 11.7 years versus 13.2 years). Adolescents often used different tobacco products. Manufactured cigarettes were the most frequently used, followed by shisha (waterpipe) and hand-rolled cigarettes. Among those who only smoked shisha, 76% had declared being non-smokers. Alcohol was the first psychoactive drug experimented by these adolescents; 73% had used alcohol at least once in their life and 10% used alcohol several times a week. According to the HONC, 94% of the smokers had lost control of their tobacco consumption. Concerning anxiety and depressive disorders, anxiety and depression scores were higher among smokers than non-smokers. Less than 6% of never-smokers had a depression score greater than 8 compared to 26% of adolescents smoking cannabis more than 10 times a month. The rapidity of the loss of autonomy among young smokers emphasizes the need for early interventions for tobacco prevention and cessation among adolescents. Tobacco use was often associated with anxiety and depressive symptoms, suggesting a need for professional support. The national smoking cessation questionnaire may be helpful in pediatric wards and consultations.

Smokers' reasons for quitting in an anti-smoking social context.

OBJECTIVE: To examine the impact of the social denormalization of smoking on smokers' motives for quitting and on subsequent abstinence in a context of intensified anti-smoking measures. STUDY DESIGN: This study is based on data from 13,746 French smokers who were registered in cessation services nationwide between September 2006 and September 2007. METHODS: Motives freely reported by smokers on their first visit to a cessation service were explored through open coding. Bivariate methods and multivariate logistic regression analyses were used to assess the association with biochemically validated abstinence at 1 month follow-up. RESULTS: Motives most frequently expressed by smokers were health concerns (55.0%) and cost of smoking (24.2%), but no significant association was found with abstinence. The highest abstinence rates were achieved by smokers motivated by their social network: 'motivated or pressured by others' (20.9%), 'setting a good example' (20.7%) and 'having a smoke-free social network' (20.3%). Smokers could no longer bear the social constraints of smoking: '[my] friends and family have all quit, [I] smoke outside all alone and feel left out' and 'I no longer want people to say with disgust that I smell of tobacco. I would like to be freed from this addiction because I'm ashamed of smoking, not at home but on the street'. CONCLUSION: French smokers' motives for quitting reflect a social unacceptability of smoking which has been buttressed by measures intended to reduce tobacco use. Through smoke-free social networks, the denormalization of smoking appears to improve short-term abstinence.

Trends in the profile of smokers registered in a national database from 2001 to 2006: changes in smoking habits.

OBJECTIVE: In 2001, an electronic medical record system was designed to collect data from smoking cessation services in France. By comparing two periods (2001-2003 and 2004-2006), this study assessed trends in the profile of smokers registered in the database. STUDY DESIGN: A cross-sectional analysis on the 33,219 smokers registered in the database in 2001. METHODS: Sociodemographic details, psychological and medical history, and characteristics of tobacco consumption at baseline were examined. RESULTS: The proportion of young smokers increased from 5.1% to 6.9%, and the proportion of underprivileged smokers increased from 9.3% to 10.9% between 2001-2003 and 2004-2006 (P<0.0001). The medical profile was unchanged, with about 37% of cases with tobacco-related diseases and 31% of cases with past depressive episodes in 2001-2003 and 2004-2006. The main finding was an increase in the mean concentration of carbon monoxide (CO) in expired air [from 18.8 parts per million (ppm) (SD 14.4) to 23.5 ppm (SD 14.1)], despite a decrease in the number of cigarettes smoked per day. The concentration of CO per cigarette also increased from 0.9 (SD 0.9) to 1.3 (SD 1.4). CONCLUSION: As the number of cigarettes smoked per day decreased, the increase in mean concentration of CO per cigarette implies that increases in cigarette prices may have led to new smoking habits and/or compensatory smoking.

[Characteristics of smoker adolescents seeking smoking cessation services]. / Caractéristiques des adolescents fumeurs s'adressant aux consultations de tabacologie.

UNLABELLED: In France, the prevalence of tobacco consumption is 31% for teenagers between 15 and 19 years old. Nevertheless, few French studies have been published on the characteristics of young smokers seeking smoking cessation services. The development of smoking cessation centres in France since 1999 was associated to the setting up of a e-transfer system in order to evaluate the adequacy between these services and the needs of smokers. OBJECTIVE: To analyse the characteristics of smokers aged less than 19 years registered in the smoking cessation services national database. METHODS: A cross-sectional population-based study has been conducted in the smoking cessation services participating in the national database. The study population included 321 young smokers attending the smoking cessation centres during the period 2001-2005. RESULTS: The 321 smokers (mean age 16.6 years) were mostly girls (56.4%). A background of depression was declared by 19% of young smokers and an abnormal result was found for the hospital anxiety depression-screening test among 34% of the population for the anxiety scale and 6% for the depression scale. Mean daily tobacco consumption was 15.3 cigarettes per day and heavy nicotine dependence was found for 24.1% of the population. A nicotine replacement therapy was prescribed for every smoker. CONCLUSION: Nicotine dependence was heavy for 24.1% of the 321 young smokers seeking smoking cessation services. More than 1/3 had an abnormal result for the hospital anxiety depression-screening test. Tailored interventions for smoking cessation should be available for adolescent's smokers, especially school-based services.

[Epidemiology of tobacco smoking]. / Epidémiologie du tabagisme.

INTRODUCTION: The aim of this review is to give an overview on tobacco consumption in France and to describe the mortality and the morbidity related to smoking. STATE OF ART: Following the increase of tobacco prices in 2002-2003, the prevalence of smoking was estimated to 30% in 2004 in France. Tobacco smoking leads to 66,000 deaths annually in France: 59,000 among men and 7 000 among women. Three groups of diseases are linked with smoking: cancers, cardio-vascular diseases and chronic lung diseases. A relation was also established with gravidic or osteoporotic complications. Passive smoking is also involved in numerous diseases such as lung cancer, coronary diseases and strokes. PERSPECTIVES: Smoking cessation conducts to a progressive decrease in morbidity risk. A functional improvement is obtained for patients suffering from chronic lung diseases. CONCLUSIONS: Effective smoking cessation treatments are available and should be systematically offered to smokers.

[Characteristics of smokers seeking smoking cessation services: the CDT programme]. / Caractéristiques des fumeurs s'adressant aux consultations de tabacologie. Analyse de la base nationale CDT.

INTRODUCTION: The development of smoking cessation clinics in France since 1999 has been accompanied by the setting up of an electronic database to evaluate the appropriateness of these services to the needs of smokers. The aim of this paper is to analyse the characteristics of smokers registered in the smoking cessation services national database. METHODS: A cross-sectional population-based study was conducted in 40 smoking cessation centres from 20 French regions. The study population included 14,574 smokers attending the smoking cessation centres that participated in building a national computerised database during the period 2001-2003. RESULTS: A significant proportion of the study population was female (51.4%), middle-aged (42.8 years), more highly educated (34% had received further education) and employed (68%). Almost half of the population was considered to be highly dependent on tobacco. Thirty-four percent of smokers had a past medical history of cardiovascular or lung disease. A history of depression was found in nearly one third of the population. CONCLUSIONS: Young people and individuals from deprived backgrounds were underrepresented, but smoking cessation services were being accessed by highly-dependent smokers and smokers with tobacco-related diseases services. More targeted smoking cessation strategies should be considered in order to improve access to smoking cessation services by more deprived groups.

[Public health measures studied in order to reduce antenatal exposure to tobacco: review of literature]. / Les mesures de santé publique susceptibles de réduire l'exposition anténatale au tabagisme: analyse de la littérature.

INTRODUCTION: One of the questions raised by the Consensus conference "Pregnancy and Tobacco" conducted in October 2004 in France concerned the public health measures which should be studied to reduce antenatal exposure to tobacco. METHODS: We conducted a review of the literature on the following topics: smoking cessation interventions, smoking cessation biochemical validation, role of health professionals in smoking cessation and financial coverage of smoking cessation programs for pregnant women. RESULTS: Smoking cessation interventions during pregnancy lead to a lower rate of low birth weight, a reduction of preterm births and an increase in average birth weight. Biochemical validation of smoking cessation is necessary for both scientific and educational purposes. The role of health professionals in smoking cessation has been proved to be effective. CONCLUSION: Implementation of smoking cessation programs tailored for pregnant women is necessary in France, after appropriate training of health professionals. A study should be set up to test the efficacy of Nicotine Replacement Therapy (NRT) on smoking cessation during pregnancy.

[Comparison of insurance coverage of tobacco cessation pharmacotherapies in five countries from the Organisation for Economic Co-operation and Development]. / Comparaison des systèmes de couverture assurantielle des traitements pharmacologiques d'aide au sevrage tabagique dans cinq pays de l'Organisation de Coopération et de Développement Economiques.

BACKGROUND: Reports in the literature demonstrate effectiveness and cost-effectiveness of tobacco treatments including drug and behavioral therapies. The health insurance coverage of smoking cessation treatments could lower financial barriers which limit the access to these services. The purpose of this paper was to compare health insurance coverage for pharmacotherapies for smoking cessation in five countries from the Organisation for Economic Co-operation and Development. METHODS: A literature review was performed using Medline, official websites and Google. A grid was used to analyse articles and reports in order to identify: the public or private coverage of smoking cessation pharmacotherapies; the population groups who were covered; the extent and content of the insurance coverage as well as the practical ways to obtain it and the training and certification of the health staff to prescribe these treatments. RESULTS: Australia, Quebec, the United States, New Zealand and the United Kingdom provide financial coverage for some of the drugs prescribed to stop smoking. The financial coverage depends on the organization of the health care system: universal coverage in Australia, Quebec, New Zealand, and the United Kingdom and private coverage in the United States except for the Medicaid public program. In the United States as well as in the United Kingdom the first population group to benefit from financial coverage of smoking cessation therapy were socially precarious persons. Prescription schemes are recommended in the present programs and persons who receive the treatment are generally requested to attend follow-up visits. All countries studied encourage training of health professionals in tobacco cessation, but except for Australia and New Zealand there is no mandatory registration of physicians who prescribe smoking cessation drugs. CONCLUSION: The financial coverage of smoking cessation pharmacotherapies is often the result of a political decision. Taking into consideration the situation of developed countries, France should first consider the financial coverage of smoking cessation pharmacotherapies for socially precarious persons and populations with tobacco-related diseases. In addition, a population-based study should be conducted in France to measure the efficacy of financial coverage on smoking cessation.