Unequal in their living conditions, the French are no less unequal when it comes to tobacco. According to a study published in the weekly epidemiological bulletin of Public Health France (SPF), Wednesday, May 26, not only did tobacco consumption in the general population stop decreasing between 2019 and 2020, but the prevalence of smoking in the third of the population with the lowest incomes fell from 29.8% to 33.3%.
Should we conclude from this that the health crisis has an effect on tobacco consumption? No, according to SPF, for which neither the start of the Covid-19 epidemic, nor the restriction measures, nor even the “Generalized confinement” do not seem to have had “Unfavorable impact” on smoking prevalence in the first half of 2020.
On the other hand, this increase of 3.5 points “Is part of a context of social crisis which started at the end of 2018 with the movement of” yellow vests “”, crisis that has “Strongly concerned with populations of lower socio-economic level”. However, continues SPF, “Among the less privileged populations, cigarettes could be used to manage stress or to overcome daily difficulties, despite the increasing cost of this product”.
In an interview with World, Fabienne El-Khoury, researcher in social epidemiology at the National Institute of Health and Medical Research (Inserm) and at Sorbonne-University, considers that this result is ” not surprising “.
How to explain this resurgence of smoking among the most precarious people, while the price of the package increases continuously?
We were on the right track and we had not seen an increase in tobacco consumption, in a given population, for a little while. This is not surprising and it is not a pattern that can only be observed in France. Addictive behaviors, and smoking in particular, are quite linked to mental health, anxiety and depression. But mental health and financial conditions are themselves closely linked. There is social inequality in mental health, before and after Covid-19.
Due to their living conditions, disadvantaged people face a lack of long-term projection: they may wonder if they are going to be paid next month. It is usually related to a denial of risk. Tobacco is then perceived as one of the rare pleasures: you cannot afford a vacation in Tahiti, but a pack of cigarettes, yes, although it is always more expensive. In addition, quitting smoking causes quite unpleasant symptoms and, under these conditions, disadvantaged people do not want to. Attempts to arrest people in a favorable socio-economic situation are more successful.
What steps can we take?
Targeted interventions that meet the specific needs of disadvantaged people are needed. They are first faced with financial difficulties: even if the nicotine replacement is reimbursed by Social Security, it is not 100% [65 % depuis le 1er janvier 2019] and the remainder at charge represents a budget. The electronic cigarette can be a good substitute, but it represents an initial investment of 50 to 70 euros, sometimes more, and then a monthly budget comparable to that of traditional cigarettes. Personalized advice taking into account the absence of long-term projection is also necessary.
The study suggests that the health restrictions and the first confinement, although deemed to be anxiety-inducing, did not have a significant effect on smoking. Should we rejoice?
That the prevalence remains stable while the trend was downward is a bad result! The Covid has had a deleterious effect on the mental health of French people in the general population, with even greater effects on disadvantaged people.
Public Health France recalls the objective of a first tobacco-free generation in France by 2030. Does this objective seem attainable to you?
Since 2017, the National Tobacco Control Plan has resulted in a huge decrease in consumption in France: less than 1.8 million smokers. It was a fairly stable trend. We know that the measures on the price and reimbursement of nicotine replacement therapy work. This is the subject of a consensus among researchers, but above all it takes a set of measures. France has been rather a good student, with the neutral package, the expansion of health messages on it – dictated by a European directive -, the variations of these messages and the reimbursement of nicotine substitutes as well as consultations for a smoking cessation.
We were quite optimistic, with a downward trend among young people, a drop in the rate of initiation to tobacco: between 2016 and 2017, young people perceived tobacco less favorably, especially girls. We hope that the Covid will not slow down this process. Social inequalities when it comes to tobacco start very early. Young people in disadvantaged schools are less afraid of it. Prevention should target as early as possible. The industry mainly targets young people, and the younger you start, the less likely you are to quit as an adult. The best prevention of smoking is not to start.