Pr Loïc Josseran: “As soon as the social atmosphere deteriorates, addictive behavior starts to rise again”

According to the latest figures published by Santé Publique France, more than three out of ten people aged 18-75 declared that they smoked (31.9%) and a quarter declared that they smoked daily (25.3%) in metropolitan France in 2021. smoking prevalence increased slightly compared to 2019, while the change in daily smoking is not significant. This slight increase can be partly explained by the health and social crisis. As soon as the social atmosphere deteriorates, addictive behavior starts to rise again. And wrongly, smoking is often seen as a way to relieve stress. Note, however, that Public Health France should communicate an update of these figures tomorrow.

This increase in smoking is more marked among women and the poorest. Is it a shortcut to associate tobacco with the deterioration of mental health?

The increase in smoking among these populations can be partly explained by the stronger impact of the health crisis. Overall, there are indeed links between tobacco and mental health, but other factors and obstacles must be taken into account for these two populations. Psychosocial and socio-economic factors may explain the higher smoking prevalence among the most modest people, in particular because the life difficulties encountered contribute to making cigarettes a means of combating stress, even an emotional crutch, and because socio-economically disadvantaged people have more difficulty projecting themselves into the future and tend to relativize the risks linked to smoking which weigh on their health. Once they have started smoking, they find it all the more difficult to quit because of their remoteness from the healthcare system, but also because of the fear of judgment and the lack of information.

What about women?

The tobacco industry has been targeting women for years through the construction of a glamorous and emancipated image. The tobacco industry has equated its products with women’s emancipation movements to establish smoking as an act of freedom. According to our survey conducted with BVA, 43% of French people still think today that a woman who smokes is a free woman. It is a myth to be deconstructed! Tobacco companies are also betting on the diktat of thinness that weighs on women. Nicotine having effects on appetite, tobacco companies have seized on this argument to sell their products. Smoking cessation is finally more difficult in women, due to many factors, psychosocial or biological in particular. It should also be noted that some women react less well than men to nicotine substitutes. On the other hand, varenicline would represent a more effective treatment than the other treatments, and more effective than in men.

Can we also deduce that the rise in the price of cigarettes has little impact on consumption?

Raising tobacco taxes is an effective solution to saving thousands of lives. The increase in taxation of tobacco products is recognized by the World Health Organization (WHO) as being the most effective lever for the younger generations and the poorest households. It is also a measure in favor of purchasing power: an average French smoker spends 207 euros each month to support his tobacco consumption, and this is an even greater financial burden for the most disadvantaged since smoking can represent up to 30% of household expenses for people living below the poverty line. A French study by the Gustave Roussy Institute has also shown that a 10% increase in the price of a pack of cigarettes leads to a 5% drop in sales. Thus, between 2016 and 2019, smoking fell by an unprecedented 4.5 points because the period corresponds to the implementation of social marketing measures such as neutral packaging, broader reimbursement of nicotine replacement therapy, and a strong and announced tax trajectory to achieve a package price of 10 euros. It is this political will that has made it possible to reduce the number of smokers in France by nearly 2 million.

Are new forms of smoking, including puffs, snus, and pouches, particularly popular with younger people, less dangerous than cigarettes?

We know that 90% of tobacco addictions develop before the age of 18. There is a downward trend in daily smoking among 17-year-old adolescents (-10 points between 2017 and 2022), but also the appearance of new products and modes of consumption. This translates, for example, into daily use of electronic cigarettes which has tripled between 2017 and 2022, rising from 1.9% to 6.2% among 17-year-old adolescents. Other tobacco and nicotine products have arrived on the market more recently and are particularly popular with young people. Some are legal, such as disposable e-cigarettes, or ‘puffs’, and others enjoy a loophole like nicotine pouches, or are banned like snus. Manufacturers’ marketing strategies for these products are aggressive and ostensibly target young people, whether in terms of packaging or the flavors offered. The nicotine in these disposable e-cigarettes is a major concern, as teenage brains are particularly vulnerable to it and addiction can develop within weeks of use; which can be a gateway to smoking. According to a report by the Haut Conseil de Santé Publique, the earlier a young person is exposed to electronic cigarettes, the higher their nicotine addiction will be; which then increases the risk of becoming a smoker. If the electronic cigarette is a possible weaning tool when used optimally, this product should never be used by a non-smoker and even less by minors.

The Minister of Health recently said he was in favor of banning puffs, as did some twenty associations which are calling for this ban. Why is this taking so long?

We welcome the government’s position. We have been working since November 2022 with the leaders of this file to move this subject forward as quickly as possible. Following the publication of our survey on the use of puffs by middle school students, MP Francesca Pasquini announced that she had tabled a bill aimed at banning the sale of this product on French territory. This cross-partisan proposal is now supported by around fifty MPs and this action shows that our messages, alerting to the health and environmental threats of these products, have been heard by the political world. We are very confident that this ban will be enshrined in law by the end of 2023 or very early 2024.

There is an eternal debate around the electronic cigarette. Some evoke a new form of addiction, while others praise its merits for quitting smoking. What is your opinion on the matter?

As mentioned above, we consider that the electronic cigarette can be a weaning tool if it is used in an optimal way – with the support of a health professional in particular. However, its use must be supervised because only less than half of vapers are exclusively vapers. But for it to be a real weaning tool, the electronic cigarette requires exclusive use – not combined with conventional cigarettes. It is also possible to combine it with nicotine substitutes, to adjust the dosage of nicotine and/or help to end the vape in the long term. As such, it is advisable to quit vaping as soon as possible in the absence of data on its long-term effects.

Instead of electronic cigarettes, what methods could help smokers quit smoking?

Being accompanied by a health professional increases the chances of successful weaning by 70%. They can advise on the tools available to reduce the effects of withdrawal and thus make quitting more comfortable and increase the chances of success. But it also seems appropriate to improve access to and information about nicotine substitutes, or to set up financial incentives to reduce the social inequalities caused by smoking. In this respect, and in order to encourage the most disadvantaged smokers to seek help, the Alliance Against Tobacco is calling for the experimentation of means-tested financial incentives. This innovative device, which has already proven itself in Anglo-Saxon countries and even in France with a specific public, aims to reward smoking cessation with a donation, in the form of vouchers or cash. .

What do you recommend so that the curve of tobacco consumption falls in a sustainable way in France?

The ACT-Alliance against tobacco recommends several additional measures to sustainably reduce smoking prevalence. The first step is to ensure that all tobacco products are subject to an ambitious tax policy, in particular by continuously increasing taxes on manufactured cigarettes so that the price of 15 euros is reached in 2027 for a pack of 20 cigarettes, and by gradually aligning the cost of other tobacco products with that of manufactured cigarettes – on a proportional basis. It is also important to limit the interference of the tobacco industry in public health policies, to condition the license and the financial aid paid to tobacconists on compliance with the law, and to set up compulsory training on the addiction to tobacco and its management within the Health courses at the university. It is also necessary to make effective the ban on smoking in places of collective use by generalizing at the national level the actions carried out until now at the local level such as the ‘spaces without tobacco’ near schools, parks, gardens, and beaches. , and introduce the phasing out of the sale of tobacco products to future generations – born after 2014 – from 2032.