Full length articleLower smoking rates and increased perceived harm of cigarettes among French adults one year after comprehensive tobacco control measures
Introduction
Tobacco remains the largest modifiable health risk factor in Europe where it is responsible of an estimated 700,000 deaths every year, despite declining smoking rates (European Parliament, 2016). This is especially true in France, a country notorious for having one of the highest smoking rates in the Western world (Ng et al., 2014). Smoking is also less stigmatized in France compared to other European countries. For example, in France, public support for tobacco control policies, such as keeping tobacco products out of sight in shops and points of sale or increases in taxes on tobacco products is among the lowest in industrialized countries (Directorate-General for Communication, 2015).
After decades of high smoking rates, which stagnated at about 30% (among 18–75 years old: 2010: 29.7%; 2014: 29.4%; 2015: 29.4%) despite many anti-smoking measures (Pasquereau et al., 2018), France recently amplified tobacco control policies. Comprehensive measures were introduced, including plain tobacco packaging (PP), and an increase in graphic health warnings (GHW) on tobacco products, which were first implemented in 2011. Further, there were increases in the reimbursement of certain nicotine replacement treatments, and planned increases in tobacco taxes. Accordingly, since January 1st, 2017, most tobacco products sold in France are in PP with large GHWs, which are meant to contribute to smoking “denormalization”. Further, starting in October 2016, France adapted the British “Stoptober” smoking cessation mass media campaign which encourages smokers to quit smoking (Guignard et al., 2018). With the introduction of these policies, France is now ranked 4th in Europe in terms of tobacco control policies. In 2017, the first significant drop in smoking rates was observed with a 3% decrease in regular smoking among adults as compared with 2016 (Pasquereau et al., 2018).
Perceptions of smoking and smokers are paramount to long-term changes in population levels of tobacco use. To examine the extent to which these evolved in the context of the implementation of PP and larger GHW of tobacco products, we conducted the DePICT study, a repeated cross-sectional survey representative of adults living in France before (2016) and one year after (2017) this policy change. We also examine whether tobacco use and e-cigarette use, as well as perceptions of tobacco use, changed after the introduction of plain tobacco packaging. To determine whether these changes were consistent across different sociodemographic groups, we tested for interactions with sex and educational level, since it is possible that women could find PP and larger GHW less appealing than men, and participants with higher education could may be more responsive to messages about the health impacts of smoking (Moodie et al., 2012).
Section snippets
Depict: study design and recruitment
DePICT (Description des Perceptions, Images, et Comportements liés au Tabagisme) is a nationally representative telephone survey of residents of mainland France that took place in two waves one year apart: end of August to mid-November 2016 and 2017. The target population consisted of all French-speakers aged 18–64 years. Interviews were conducted via landline or mobile telephones by trained interviewers working for a polling institute located in the south of Paris. Randomly-generated telephone
Results
More than 4000 adults were recruited for each study wave, with a total sample of 8470 adults (2016: 4456 - 2017: 4114). Main characteristics of our weighted sample are presented in Table 1.
Discussion
Our study compares smoking-related perceptions and behaviors between 2016 and 2017: before and one year after the intensification of tobacco policies in France via the introduction of PP and larger GHW. We found a significant, but modest, drop in smoking, a significant drop in e-cigarettes use, and significant increases in the perceived harmfulness of smoking and in the fear of the health consequences of tobacco use. Smokers were more likely to report that health messages on tobacco products
Role of funding source
This work was supported by a grant from the French National Cancer Institute (INCA N°2016-097). The funders of the study had no role in study design, data collection, data analysis, data interpretation, writing of the report, or in the decision to submit the article for publication.
Contributors
All authors have contributed significantly to claim authorship and have seen and approved of the manuscript.
Conflict of interest
The authors declare that they have no conflict of interest.
Acknowledgements
We thank members of the DePICT scientific committee: François Beck (OFDT), Renaud Crespin (CNRS), Karine Gallopel-Morvan (EHESP), Gwenn Menvielle (INSERM), Brigitte Metadieu (Association Charonne), Viet Nguyen-Than (ANSP), and Patrick Peretti-Watel (INSERM) for their help in discussing the study protocol, questionnaire, and planned analyses. We also want to acknowledge Carla Estaquio and Antoine Deutsch from the French National Cancer Institute (INCa).
We would also like to acknowledge the MV2
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