An overview of tobacco use in France: Observed trends and new challenges / État des lieux de la situation du tabagisme en France : tendances observées et nouveaux enjeux

This article reports changes in tobacco and vaping consumption in France over the last thirty years and the issues they raise for public authorities in terms of prevention and management of the social and health consequences. This report is the result of a joint analysis by Santé publique France (SpF) and the French Monitoring Center for Drugs and Drug Addiction (OFDT). It shows that there has been a "generational shift" in tobacco consumption and social representations of cigarettes since the mid-2010s, with a sharp decline in tobacco initiation among adolescents, which has become less common and reported at an older age, which was one of the objectives of the national tobacco reduction plans. However, smoking remains fairly stable among adults, predominantly among men, with gaps between men and women persisting since the early 2000s. Beyond the gender gap, social disparities in consumption remain significant, both among youth and adults. However, while the prevalence of smoking is no longer increasing, the prevalence of vaping is rising, which is a public health concern since some of these practices involve nicotine consumption. This also entails the risk of a "renormalization" of the act of smoking, a matter of concern for health authorities in France as in other European countries. The analysis concludes that the statistical information system and qualitative surveys need to be adapted to ensure a reliable monitoring of the situation, taking into account the rapid transformations of the market.

Cet article fait le point sur les évolutions en matière de consommation de tabac et de produits de vapotage, en France, depuis une trentaine d'années, et les enjeux qu'elles soulèvent pour les pouvoirs publics, en termes de prévention et de prise en charge des conséquences sociosanitaires. Produit d'une analyse conjointe de Santé publique France (SpF) et de l'Observatoire français des drogues et des tendances addictives (OFDT), il montre d'abord un « tournant générationnel ¼ dans la consommation de tabac et les représentations sociales de la cigarette depuis le milieu des années 2010, avec un recul marqué de l'expérimentation parmi les adolescents, qui est devenue à la fois moins courante et plus tardive, ce qui était un des objectifs des plans nationaux de réduction du tabagisme successivement mis en place depuis 2014. Le tabagisme reste néanmoins assez stable parmi les adultes, prédominant chez les hommes, avec des écarts entre hommes et femmes qui se maintiennent depuis le début des années 2000. Au-delà du différentiel de genre, les disparités sociales de consommation restent importantes, parmi les jeunes comme à l'âge adulte. Cependant, si la prévalence du tabagisme ne progresse plus, celle du vapotage augmente, ce qui constitue un point d'attention dès lors qu'une partie de ces pratiques induit une consommation de nicotine. Cela induit également le risque d'une « renormalisation ¼ de l'acte de fumer, qui constitue un point de vigilance des autorités sanitaires, en France comme dans d'autres pays européens. L'analyse se conclut sur la nécessité de continuer à adapter le système d'information statistique et les enquêtes qualitatives pour permettre un suivi épidémiologique de la situation qui reste performant.

Patterns of Accidental and Intentional Alcohol Intoxication Initiation among French Young Adults: A Survival Analysis.

Background: The aim of the study was to explore patterns of accidental and intentional intoxication among French young adults who use alcohol. Methodology: The study draws on data from the 2017 French Health Barometer. Cox proportional hazards models were used to explore the factors associated with accidental and intentional alcohol intoxication initiation. Covariates studied were gender, age, employment status, consultation for mental health problems, depression lasting at least two weeks in the past 12 months, and previous tobacco or cannabis use as time-dependent variables. Results: Women accounted for 50.4% of our sample, and the mean age of respondents was 29.2 (standard deviation = 6.3). The prevalence of lifetime accidental intoxication among alcohol users was 77.0% and 17.3% for intentional intoxication. Kaplan-Meier analyses showed that the first intentional intoxication experience occurred later than the first accidental intoxication. Factors associated with accidental intoxication initiation in multivariate analyses were: male gender, age under 30, previous use of tobacco and cannabis, experiencing depression that lasted at least two weeks in the past 12 months, and having consulted for mental health problems in the past 12 months. Economically inactive people and students had a lower risk of experiencing accidental intoxication than those who were employed. Similar correlates were found for intentional intoxication, but being economically inactive was more strongly associated with intentional intoxication initiation. Conclusions: These results suggest the strong potential for alcohol consumption to become hazardous, particularly if tobacco or cannabis are also used. Prevention programs on alcohol must target consumers at the earliest stage and integrate other substances often used in a festive context.

État des lieux de la situation du tabagisme en France : tendances observées et nouveaux enjeux.

This article reports changes in tobacco and vaping consumption in France over the last thirty years and the issues they raise for public authorities in terms of prevention and management of the social and health consequences. This report is the result of a joint analysis by Santé publique France (SpF) and the French Monitoring Center for Drugs and Drug Addiction (OFDT). It shows that there has been a "generational shift" in tobacco consumption and social representations of cigarettes since the mid-2010s, with a sharp decline in tobacco initiation among adolescents, which has become less common and reported at an older age, which was one of the objectives of the national tobacco reduction plans. However, smoking remains fairly stable among adults, predominantly among men, with gaps between men and women persisting since the early 2000s. Beyond the gender gap, social disparities in consumption remain significant, both among youth and adults. However, while the prevalence of smoking is no longer increasing, the prevalence of vaping is rising, which is a public health concern since some of these practices involve nicotine consumption. This also entails the risk of a "renormalization" of the act of smoking, a matter of concern for health authorities in France as in other European countries. The analysis concludes that the statistical information system and qualitative surveys need to be adapted to ensure a reliable monitoring of the situation, taking into account the rapid transformations of the market.

Sleep, substance misuse and addictions: a nationwide observational survey on smoking, alcohol, cannabis and sleep in 12,637 adults.

For a good night's sleep, we consensually recommend avoiding alcohol, smoking and drugs. However, these addictions are highly prevalent in the general population, and it is difficult to estimate their real impact on sleep. The aim of this study is to clarify the association between sleep habits and disorders, and addictions. The design was a telephone crossover national recurrent health poll survey (Santé publique France, Baromètre santé, 2017; Questionnaire, pp. 53; Saint Maurice) in a representative sample of French adults. There were 12,367 subjects (18-75 years old) who answered the survey. Sleep log items assessed sleep schedules (total sleep time) on work and leisure days: at night, while napping, and over 24 hr using a sleep log. Retained items include: (1) short sleep (≤ 6 hr/24 hr); (2) chronic insomnia (International Classification of Sleep Disorders, 3rd edition criteria); and (3) chronotype (evening-morning-neutral). Psychoactive substances retained included tobacco (current or former users), alcohol (daily consumption and weekly binge drinking), cannabis (Cannabis Abuse Screening Test), and other drugs (consumption during the past year). We found that: (1) daily smokers (lightly or heavily dependent) were more frequently short sleepers than occasional smokers and non-smokers; (2) heavily dependent daily smokers were more likely to suffer from insomnia than other smokers or non-smokers; (3) short sleep and insomnia were not significantly associated with the consumption of alcohol, cannabis or any other drug; (4) the evening chronotype was significantly associated with the consumption of tobacco, alcohol and cannabis. In conclusion, our study highlights significant relationships between the use of psychoactive substances and sleep characteristics among adults, emphasizing the need to take into account each subject individually.

Price minimizing behaviours by smokers in Europe (2006-20): evidence from the International Tobacco Control Project.

BACKGROUND: Effectiveness of tobacco taxation can be undermined through smokers applying price-minimizing behaviours rather than quitting or reducing consumption. Common price-minimizing strategies are buying cheaper tobacco [discount brands or roll-your-own (RYO) tobacco], bulk buying and cross-border purchasing. This study analyses trends in and factors associated with such behaviours in four European countries from 2006 to 2020. METHODS: Data came from adult smokers participating in the International Tobacco Control (ITC) Surveys conducted between 2006 and 2020 in England (9 waves, n = 768-4149), France (4 waves, n = 1415-1735), Germany (5 waves, n = 513-1515) and the Netherlands (10 waves, n = 1191-2177). Country-specific generalized estimating equation regression models were fit to assess trends in smoking RYO tobacco, discount brands, bulk buying and cross-border purchasing within the European Union. RESULTS: Buying discount brands or RYO tobacco was the most common strategy in all countries, except France. Except for buying discount brands, estimates of price-minimizing behaviours were highest in France (2019: RYO = 27.2%, discount brands = 17.3%, bulk buying = 34.1%, cross-border purchasing = 34.2%), and lowest in Germany (2018: RYO = 18.6%, discount brands = 43.7%, bulk buying = 8.0%, cross-border purchasing = 9.8%). Direction and magnitude of trends differed by country, and behaviour. Young smokers were less likely to buy in bulk. Low-income and low-education smokers were more likely to purchase RYO tobacco or discount brands. The association with discount brands was not found for French low-income smokers. CONCLUSIONS: Smoking cheaper tobacco is the most prevalent price-minimizing strategy in three countries (England, Germany and Netherlands), and more prevalent among low-income individuals. Harmonizing prices across products and countries would reduce switching to cheaper tobacco.

Changes in smoking and alcohol consumption during COVID-19-related lockdown: a cross-sectional study in France.

BACKGROUND: In many countries, lockdown measures were implemented to curb the COVID-19 pandemic. This situation may have an impact on mental health, tobacco smoking and alcohol consumption. The aim of this research report is therefore to describe changes in tobacco and alcohol consumption in the general French population during the first 2 weeks of lockdown and identify any associated factors. METHODS: Self-reported changes in smoking and alcohol consumption following the lockdown implemented in France on 17 March 2020 were collected from 2003 respondents aged 18 years and older in an online cross-sectional survey carried out from 30 March to 1 April 2020. Anxiety and depression levels were assessed using the Hospital Anxiety and Depression Scale. RESULTS: Among current smokers, 26.7% reported an increase in their tobacco consumption since lockdown and 18.6% reported a decrease, while it remained stable for 54.7%. The increase in tobacco consumption was associated with an age of 18-34 years, a high level of education, and anxiety. Among alcohol drinkers, 10.7% reported an increase in their alcohol consumption since lockdown and 24.4% reported a decrease, while it remained stable for 64.8%. The increase in alcohol consumption was associated with an age of 18-49 years, living in cities of more than 100 000 inhabitants, a high socio-professional category, and a depressive mood. CONCLUSIONS: The national lockdown implemented in France during the COVID-19 pandemic influenced tobacco and alcohol consumption in different ways according to sociodemographic group and mental health.

Why do apprentices smoke much more than high school students? Understanding educational disparities in smoking with a Oaxaca-blinder decomposition analysis.

BACKGROUND: Educational disparities in daily smoking begin during adolescence and can lead to educational disparities in health among adults. In particular, vocational students including apprentices have higher daily smoking rates compared to non-vocational students. This study aimed to identify the determinants of the gap in daily smoking between French apprentices and high school students aged 17 in 2008 and in 2017. METHODS: We used data from a cross-sectional repeated survey representative of all French adolescents aged 17 in 2008 and 2017. We conducted a non-linear extension of the Oaxaca-Blinder decomposition technique and included the following variables: sociodemographic and familial characteristics, parental smoking, cannabis and alcohol use, suicidal attempt, grade repetition and money received. RESULTS: Daily smoking was about two times higher among French apprentices compared to high school students in 2008. This gap did not decrease between 2008 and 2017. Differences in measured characteristics between the two groups explained this gap partly, from 28.6 to 51.2%. Cannabis and alcohol use, money received and parental smoking contributed the most to the daily smoking gap. CONCLUSIONS: Prevention programs could target cannabis and alcohol use as well as parental smoking to help decrease educational disparities in smoking status among French adolescents.

How to reduce biases coming from a before and after design: the impact of the 2007-08 French smoking ban policy.

BACKGROUND: Smoke-free laws aim at protecting against second-hand smoke and at contributing to change smoking behaviors. Impact evaluation studies can help understand to what extent they reach their goals. Simple before and after designs are often used but cannot isolate the effect of the policy of interest. METHODS: The short-term impact of the French smoking ban (2007-08) on smoking behavior outcomes was evaluated among smokers with data from the ITC project. We first conducted a before and after design on the French sample. Second, we added the UK (excluding Scotland) as a control group and finally used external pre-policy data from national surveys to control for bias arising from pre-policy trends. RESULTS: After one year post-implementation, the smoking ban led to a decrease in seeing people smoking in bars, restaurants and workplaces [estimated risk ratios (RR) of 8.81 IC95% (5.34-14.71), 2.02 (1.79-2.31) and 1.24 (1.16-1.33), respectively], as well as an increase in support for the smoke-free policy, but only in bars and restaurants [RR of 1.35 (1.15-1.61) and 1.25 (1.16-1.35)], respectively. No impact was found on smoking behaviors and on having a strict no smoking policy at home. The simple before and after design systematically overestimated the smoking ban's impact [e.g. RR of 29.9 (20.06-44.56) for observed smoking in bar, compared to 13.21 (7.78-22.42) with the control group, and 8.81 (5.34-14.71) with the correction from external data]. CONCLUSION: When data are lacking to conduct quasi-experimental designs for impact evaluation, the use of external data could help understand and correct pre-policy trends.

Cannabidiol use in France in 2022: Results from a nationwide representative sample of adults.

INTRODUCTION: Cannabidiol (CBD) is a non-intoxicating cannabis compound found in diverse commercial products worldwide. However, its use may not be fully harmless. Accordingly, it is important to document the prevalence of CBD use and user characteristics in the general population. METHODS: We conducted a nationwide survey from a random sample of adults living in France using computer-assisted telephone interviews between 2 March and 9 July 2022. We estimated the prevalence of CBD awareness and CBD use, and explored the different routes of administration. We also performed logistic regression models to identify factors associated with past-year CBD use. RESULTS: Based on data from 3229 participants, we estimated that 71.0% (95% confidence interval) (69.0-73.0) of the French adult population had heard of CBD, and 10.1% (8.7-11.4) had used it in the previous year. Past-year CBD use was associated with younger age, a higher educational level, not living in a middle-sized urban unit, tobacco consumption and e-cigarette use. The most common route of administration was smoking (56.1%). DISCUSSION AND CONCLUSION: Past-year CBD use prevalence in France appeared to be as high as that for cannabis. Proper prevention, regulation and control of CBD products is necessary to ensure that people have access to safe and high-quality products. Reliable information on CBD should be sought and disseminated, especially regarding the harms associated with smoking the compound.

Hemorrhagic Strokes Attributable to Chronic Alcohol Consumption and Heavy Episodic Drinking in France.

OBJECTIVES: To estimate the number of cases and deaths related to hemorrhagic stroke (HS) attributable to a chronic alcohol consumption and to heavy episodic drinking (HED) in France. METHODS: A population-attributable fraction (PAF) estimation approach was used. Relative risks for HS with alcohol consumption were extracted from the INTERSTROKE study. Levels of alcohol consumption in the French population were collected from the 2017 Health Barometer. Data on HS morbidity and mortality were extracted from the French National Health Data System (SNDS). RESULTS: We estimated that 7.2% (n = 2,100) and 6.6% (n = 1,900) of cases with HS were attributable to chronic alcohol consumption and HED, respectively. PAFs were higher in men than in women with 11.5% vs 2.6% for a chronic consumption and 10.7% vs 2.1% for HED, respectively. We estimated that 7.0% of HS deaths (n = 1,100) were attributable to chronic alcohol consumption and 5.1% attributable to HED (n = 800). Finally, 16.3% of patients with HS (n = 4,700) and 14.1% of HS deaths (n = 2,300) were attributable to overall chronic alcohol consumption or to monthly HED. DISCUSSION: These results remind the importance of alcohol consumption in the occurrence of HS and the importance of implementing primary and secondary prevention measures, particularly among young people, where HED is most common.

Effectiveness of a French mass-media campaign in raising knowledge of both long-term alcohol-related harms and low-risk drinking guidelines, and in lowering alcohol consumption.

AIMS: To evaluate the effectiveness of a French mass-media campaign in raising knowledge of both long-term alcohol-related harms (LTH) and low-risk drinking guidelines (LRDG), as well as in lowering alcohol consumption. DESIGN: An 8-month longitudinal survey from February to October 2019, with three waves of on-line data collection (T0 before the campaign, T1 just after it ended and T2 6 months after it ended). SETTING: France. PARTICIPANTS: A total of 2538 adult drinkers (aged 18-75 years). MEASUREMENTS: The main outcomes' variables were LTH knowledge (cancer, hypertension, brain haemorrhage), LRDG knowledge (two guidelines: 'maximum of two drinks a day' and 'minimum of 2 days without alcohol per week'), intention to reduce alcohol consumption and self-declared consumption with respect to the French LRDG. At T1, exposure to the campaign was measured using self-reported campaign recall. FINDINGS: In T1, we observed significant positive interactions between exposure group based on campaign recall and survey waves on knowledge of (i) the 'maximum two drinks a day' guideline [adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.08-1.62, P = 0.008], (ii) brain haemorrhage (aOR = 1.80, 95% CI = 1.44-2.25, P < 0.001) and (iii) hypertension (aOR = 1.41, 95% CI = 1.09-1.81, P = 0.008) risks. Campaign exposure was also associated with a significant decrease in at-risk drinking in women (aOR = 0.67, 95% CI = 0.50-0.88, P = 0.004). No significant interaction was observed at T1 for the knowledge of the 'minimum of 2 days without alcohol a week' guideline, or of cancer risk. At T2, no significant interaction was observed for the main outcomes' variables. CONCLUSIONS: There appears to be an association between exposure to a 2019 French mass-media campaign to raise knowledge of long-term alcohol-related harms and low-risk drinking guidelines and reduce alcohol consumption and (i) improved knowledge of the 'maximum two drinks per day guideline', (ii) knowledge of the risks of hypertension and brain haemorrhage and (iii) a reduction in the proportion of people exceeding low-risk drinking guidelines (in the general population only). These associations were only observed over the short term and, in some cases, only for certain segments of the population.

Does the French Évin Law on Alcohol Advertising Content Reduce the Attractiveness of Alcohol for Young People? An Online Experimental Survey.

OBJECTIVE: France's Évin law limits the content of alcohol advertising to purely factual product information. Little research to date has examined the effectiveness of this measure. To address this gap, we investigated the effect on young people of (a) content restrictions in general, (b) more or less strict content regulations, and (c) whether different youth profiles are more or less susceptible to content regulations. METHOD: An online experimental survey on 18- to 25-year-olds in France was conducted (n = 2,163). Participants were exposed to three advertising conditions for four alcohol brands: (a) neutral ads with only bottles and logos (in line with Évin law restrictions); (b) contextual ads (partying and sport iconography) without characters; and (c) contextual ads featuring characters. Participants self-reported their reactions on attention, appeal, product, alcohol consumption perception, image benefits, and perceived behavioral impact. Demographics and alcohol use measures were also collected. RESULTS: For almost all reactions, ads that featured sport or party contexts (with/without characters) generated more positive reactions and more perceived behavioral impact compared with neutral ads. Ads that featured characters had more positive reactions than ads without characters. Women and the youngest segment (18-21 years old) emerged as the most sensitive to contextual ads. CONCLUSIONS: Regulating alcohol advertising content via strongly prohibitive measures, as per France's Évin law in 1991 or similar measures in other countries, is an effective policy direction for protecting vulnerable young people. This approach should be considered by countries that currently have only partial bans on alcohol advertising placement.

Plain packaging on tobacco products in France: Effectiveness on smokers' attitudes one year after implementation.

INTRODUCTION: New packaging of tobacco products, with plain packaging and new enlarged health warnings, was made compulsory in France in 2017. This study aims to measure the impact of new packaging on smokers' embarrassment and their motivation to quit smoking. METHODS: Data from Santé publique France 2016, 2017 and 2018 Health Barometer surveys were used. These randomized surveys were conducted by telephone with samples of 15216 (2016), 25319 (2017), and 9074 (2018) people aged 18-75 years. The association between smokers' embarrassment and the influence of new packaging on motivation to quit smoking was studied using multivariate logistic regressions. RESULTS: After the introduction of new plain packaging, the proportion of smokers who felt embarrassed taking out their pack of cigarettes in plain sight because of its appearance doubled in 2017 (11.9%, 95% CI: 10.2-13.9 vs 5.9%, 95% CI: 4.4-7.8 in 2016, p<0.001) and continued to increase in 2018 (15.5%, 95% CI: 13.7-17.5, p<0.01). In 2018, women were more embarrassed than men (OR=2.0; 95% CI: 1.5-2.6, p<0.001). In 2018, 26.8% (95% CI: 24.6-29.1) of smokers said the appearance of a pack of cigarettes motivated them to quit, and 22.5% (95% CI: 18.3-27.2) ex-smokers cited it as having motivated them to quit. Smokers who were embarrassed by displaying their pack were more likely to be motivated to quit because of the pack's appearance. People with higher incomes were less likely to report motivation to quit due to the pack than people with the lowest income (OR=0.5; 95% CI: 0.3-0.7, p<0.001). CONCLUSIONS: In the French context, the new plain packaging of tobacco products probably had an impact on smokers' perception of tobacco by increasing the embarrassment they felt when they took out their pack of cigarettes in plain sight. It also influenced the motivation to quit smoking, and more generally, it could contribute to the denormalization of tobacco.

Changes in Tobacco and Alcohol Consumption in France during the Spring 2020 Lockdown: Results of the Coviprev and Viquop Surveys.

This study aims to describe changes in tobacco and alcohol consumption in France during the first COVID-19 lockdown in March 2020 and its gradual lifting in May. The associated factors and the reasons reported explaining those changes are also studied. Data came from five waves of the CoviPrev online cross-sectional survey (approximately n = 2000 per wave) and the ViQuoP qualitative survey (n = 60), which took place between April and June. Most people self-reported stable consumption compared to before the lockdown, but 27% to 32% of smokers and 10% to 16% of drinkers had increased their consumption, depending on the wave of the survey. Boredom, stress and the search for pleasure were the main reasons reported. While the sociodemographic factors associated with an increase in tobacco and alcohol use differed according to the product and month, poor mental health was associated with an increase in both products in April and May. Between 10% and 19% of smokers and 22% to 25% of drinkers reported having reduced their consumption for their health or through constraints. The measures taken to manage the spring 2020 epidemic appear to have had contrasting impacts on tobacco and alcohol consumption in France. People whose lifestyles and mental health was most affected appear to have modified their consumption more frequently.

Use of tobacco cessation aids and likelihood of smoking cessation: A French population-based study.

Although smoking prevalence has been decreasing worldwide, sustained tobacco cessation remains a challenging goal for many smokers. Several types of tobacco cessation aids are available such as nicotine replacement therapy (NRT) and electronic cigarette, the effectiveness of the latter is still a matter of debate. This study aims to test differences in successful smoking cessation according to the type of aid used, considering selection and confounding factors. We used data from the 2017 French Health Barometer, a cross-sectional survey conducted by France's Public Health Agency. We studied the relationship between e-cigarette and NRT use and three distinct outcomes collected retrospectively: smoking status 6, 12 and 24 months after the cessation attempt (yes vs no). All results were weighted to be nationally-representative and controlled for propensity scores included via overlap weighting (OW). The use of an e-cigarette was significantly associated with tobacco cessation at 6 months (OWeighted OR = 1.38, 95 % CI: 1.03-1.99) as well as at 12 months (OWeighted OR = 1.61, 95 % CI: 1.13-2.27) and 24 months (OWeighted OR = 1.61, 95 % CI: 1.01-2.57). The use of NRT was negatively associated with tobacco cessation at 12 months (OWeighted OR = 0.62, 95 % CI: 0.43-0.89) and 24 months (OWeighted OR = 0.57, 95 % CI: 0.35-0.92). While the use of an e-cigarette alone or combined with NRT is associated with an increase in the likelihood of smoking cessation, the effects of the use of NRT alone on long-term smoking abstinence are probably limited.

Effectiveness of 'Mois sans tabac 2016': A French social marketing campaign against smoking.

INTRODUCTION: In October 2016, the first edition of Mois sans tabac (Tobacco-Free Month) was launched, a campaign which had invited French smokers to challenge themselves to quit smoking for the whole month of November. We aimed to study the effectiveness of this social marketing intervention on quit attempts (QA) in the general French population, and to study possible differences according to sociodemographic characteristics. METHODS: This study used data from the 2017 Health Barometer survey, a random survey conducted by telephone on 25319 individuals. It included 6341 respondents who reported that they were daily smokers when the Mois sans tabac campaign was launched in 2016. The association between self-declared exposure to the campaign and making a QA has been studied using multivariate logistic regressions. RESULTS: Exposure to the 2016 Mois sans tabac campaign is associated with a QA lasting at least 24 hours in the final quarter of 2016 (AOR=1.32; 95% CI: 1.07- 1.63, p<0.01), with a QA lasting at least 30 days (AOR=1.95; 95% CI: 1.31-2.91, p<0.001), and being abstinent at the time of the interview in 2017 (AOR=2.39; 95% CI: 1.37-4.15, p<0.01). A dose-effect relationship is observed between the frequency of exposure to the campaign and QA, which is mostly explained by the number of sources of exposure (television, radio, posters, the press, the internet and social networks). Although certain priority groups (e.g. manual workers, the unemployed) had poorer recall of the campaign than other groups, the impact of self-reported exposure to the campaign on QA in unemployed people or those with less than high school educational level appears to have been greater. CONCLUSIONS: These analyses suggest the effectiveness of the 2016 Mois sans tabac intervention, in a context of strengthening public tobacco control policies in France, which may have contributed to the drop in smoking observed between 2016 and 2019.

[Alcohol consumption in France in 2017]. / La consommation d'alcool en France métropolitaine en 2017.

Alcohol consumption in France in 2017. Alcohol consumption was still a very common habit in France: 86.5% of 18-75 years old had drank alcohol during the last 12 months and 40.0% did at least once a week. One quarter of adults stated they consumed above the low-risk alcohol drinking guidelines (no more than 10 drinks per week and 2 drinks per day and alcohol-free days every week). Regardless of the indicator, women consumed less often than men. Besides, alcohol consumption levels and patterns and reasons for use were closely related to the age: the youths drank less often but more intensively than the elder. First alcohol uses are seen in middle school and some regular uses are already established in high school. Overall, pure alcohol intake per capita has been divided by more than two since the sixties but the decline observed every year tends to slow down.

Consommation d'alcool en France métropolitaine en 2017. En 2017, la consommation d'alcool restait une pratique très courante en France : 86,5 % des 18 à 75 ans ont bu de l'alcool au cours des 12 derniers mois et 40,0 % au moins une fois par semaine. Un quart des adultes déclaraient dépasser les repères de consommation à moindre risque (maximum 10 verres par semaine, maximum 2 verres par jour et des jours sans consommation dans la semaine). Quel que soit l'indicateur de consommation, les femmes sont moins fréquemment consommatrices que les hommes. De plus, les niveaux, modes et motifs de consommation sont très liés à l'âge : les plus jeunes consomment moins souvent mais plus intensément que les plus âgés. Les premières expérimentations se font dès le collège, et certains usages réguliers sont déjà en place au lycée. Au global, la quantité d'alcool pur consommé par habitant a été divisé par plus de 2 depuis le début des années 1960, mais la diminution observée presque chaque année tend à se ralentir.

The role of income and psychological distress in the relationship between work loss and smoking cessation: Findings from three International Tobacco Control (ITC) Europe countries.

INTRODUCTION: The relationship between work loss and smoking has not been studied extensively, and underlying factors are often not examined. The aim of this study was to test two hypotheses. First, work loss is associated with greater intention to quit and more likelihood of smoking cessation, and this relationship is moderated by a decrease in income. Second, work loss is associated with lower quit intention and lower rates of smoking cessation, and this relationship is moderated by an increase in psychological distress. METHODS: We used pooled data from three countries participating in the ITC Project: France, Germany and the Netherlands (n=2712). We measured unemployment, income and psychological distress at two consecutive survey waves, and calculated changes between survey waves. We first conducted multiple logistic regression analyses to examine the association between work loss and smoking cessation behavior. Next, we added income decrease and psychological distress increase to the models. Finally, we added interaction terms of work loss by income decrease and work loss by distress increase to the model. RESULTS: Work loss was not associated with quit intention, quit attempts, and quit success. When income decrease and psychological distress increase were added to the model, we found a positive association between distress increase and quit attempts. The interactions, however, were not statistically significant. CONCLUSIONS: Our results indicate that smokers who become unemployed and face a decrease in income are not less likely to quit smoking than smokers who are employed.

The practices of French general practitioners regarding screening and counselling pregnant women for tobacco smoking and alcohol drinking.

OBJECTIVES: Our study aims to describe French general practitioners' (GPs') practices toward pregnant patients regarding alcohol consumption and smoking and to highlight factors associated with specific practices. METHODS: In 2015, a representative sample of 1414 French GPs completed a telephone survey based on a stratified random sampling. RESULTS: 61% of GPs declared screening for alcohol use and 82% for smoking at least once with each pregnant patient; quitting was not systematically advised either for alcohol or for smoking. GPs' practices were significantly better among those who had more recent ongoing training. GPs who drank regularly were less likely to screen for alcohol use and GPs' drinking frequency was inversely related to recommending quitting. Current and former smokers were less likely to recommend quitting to pregnant patients smoking over five cigarettes per day. CONCLUSIONS: Screening and counselling practices for substance use during pregnancy are heterogeneous among French GPs and are notably related to their personal consumption. GP's role in preventing substance use during pregnancy could be strengthened by actions regarding their own consumption and by modifications in their initial and ongoing training.

Electronic cigarettes, quit attempts and smoking cessation: a 6-month follow-up.

BACKGROUND AND AIMS: There is conflicting evidence that use of e-cigarettes promotes cessation in regular smokers, but contrasting findings may be due to differing definitions of vaping. The aim was to assess whether regular use of e-cigarettes while smoking is associated with subsequent smoking cessation. DESIGN: Baseline internet survey with outcomes measured at 6-month follow-up. SETTING: All French metropolitan territory. PARTICIPANTS: A total of 2057 smokers aged 15-85 years were recruited through an access panel and responded to a 6-month follow-up: 1805 exclusive tobacco smokers and 252 dual users (tobacco plus regular e-cigarette users) at baseline. MEASUREMENTS: The three outcomes assessed at 6 months were: a minimum 50% reduction in the number of cigarettes smoked per day, quit attempts of at least 7 days and smoking cessation of at least 7 days at the time of follow-up. Logistic regressions were performed to model the three outcomes according to regular e-cigarette use at baseline, adjusted for socio-economic variables and smoking behaviours. FINDINGS: Baseline dual users were more likely than baseline exclusive tobacco smokers to have halved cigarette consumption [25.9 versus 11.2%, P < 0.001, adjusted odds ratio (aOR) = 2.6, confidence interval (CI) = 1.8-3.8]. Dual users at baseline were also more likely to have made a quit attempt of at least 7 days (22.8 versus 10.9%, P < 0.001, aOR = 1.8, CI = 1.2-2.6). No significant difference was found for 7-day cessation rates at 6 months (12.5 versus 9.5%, P = 0.18, aOR = 1.2, CI = 0.8-1.9). CONCLUSIONS: Among people who smoke, those also using an e-cigarette regularly are more likely to try to quit smoking and reduce their cigarette consumption during the next 6 months. It remains unclear whether regular e-cigarette users are also more likely to stop smoking.