Halting the decline in smoking, particularly among women and the most vulnerable

After a significant drop in smoking in France between 2014 and 2019, following the adoption of numerous effective anti-smoking measures, the prevalence of 18-75 year-olds stabilized in 2020 and 2021 for daily consumption, but the general prevalence including occasional smokers increased in 2021. Thus, in 2021, in metropolitan France, more than 3 in 10 people aged 18 to 75 reported smoking (31.9% compared to 30.4% in 2019) and a quarter of them were daily smokers (25.3 %). This increase particularly concerns the most vulnerable populations and women.[1].

The data comes from the 2021 Health Barometer of Public Health France (SPF)[2], a telephone survey of a representative sample of the population using a random sample methodology of the French population aged 18 to 75, carried out between February and December 2021, with 24,514 individuals residing in metropolitan France, and 6,519 individuals residing overseas.

A significant increase in female smoking

According to the results, in 2021, 31.9% of people aged 18 to 75 reported smoking tobacco: 34.7% of men and 29.2% of women. The prevalence of daily smoking was 25.3%, or 27.8% among men and 23% among women. There were 20.7% who smoked daily in 2019, or more than one million more smokers in 2021 compared to 2019. According to SPF, these are women who have never smoked before, or who have returned to cigarettes after quitting. In total, there are 15 million smokers in France, including 12 million daily smokers.

Territorial inequalities also remain marked, with daily smoking rates ranging from 21.71 to 29.11 depending on the region of metropolitan France. Only two regions have a prevalence lower than the national average (Île-de-France and Pays de la Loire with 22.41), while Occitanie (28.51) and Provence-Alpes-Côte d'Azur (29.11) have a higher prevalence.

Smoking remains a social marker

The prevalence of daily smoking remains significantly higher in 2021 among people with a lower level of education: 32% of people with no diploma or a diploma below the baccalaureate reported smoking daily compared to 17.1% of those with a diploma above the baccalaureate. They were 29% and 17.7% in 2019

A similar pattern is found for income: 32.3% of people whose income corresponded to the lowest tercile reported smoking daily (29.8% in 2019) compared to 17% for the highest tercile (18.2% in 2019). Among the unemployed, 45.7% (39.9% in 2019) reported smoking daily compared to 26.6% of the employed (25.3% in 2019).

Political disengagement and the health crisis at the origin of the increase

Public Health France explains this increase in smoking, particularly among certain population groups, by a context of social crisis since the end of 2018 in France, accentuated by the Covid19 crisis since 2020. This crisis has led to significant psychological, economic and social consequences, more marked among women and disadvantaged populations.

The agency specifies that women have " experienced a deterioration in their working conditions, and for women working from home, a more frequent presence of children in the same room. The mental load may have increased for women, particularly during lockdowns, with increased management of daily life and family ".

The population's mental health also deteriorated during the crisis. The Coviprev survey (late 2021 wave) showed that a third of the population suffered from anxiety or depression, and cigarettes can be seen, for these people, as a tool to relieve stress. While the majority of smokers did not change their tobacco consumption during the lockdowns, 27% increased it, compared to 19% who reduced it.

The pandemic also impacted tobacco control policies in France, which weakened during this period. Prevention campaigns received less media coverage due to communication focused primarily on COVID-19. Furthermore, both in France and elsewhere, government and public authorities' efforts to limit the influence of the tobacco industry weakened during the pandemic.

According to the Tobacco Industry Interference Index, published at the end of 2021[3], no country has been spared from the interference of the tobacco industry, which has intensified its lobbying, particularly to promote its new nicotine products, including heated tobacco, and lobbied to benefit from regulations favorable to its interests.

©Generation Without Tobacco

AE