Smoking cessation, a major challenge in France, which still has 12 million daily smokers

The ninth edition of No Tobacco Month, set up by the Ministry of Health and Access to Healthcare and Public Health France, in partnership with Health Insurance, began on 1^er november[1]. No Tobacco Month is part of a set of measures aimed at reducing smoking, which is still very high in France. With 24.5% daily smokers, the management of these latter must remain a public health priority and be part of a comprehensive and offensive approach according to the associations.

Conceived as a collective challenge, the No Tobacco Month encourages smokers to quit smoking during the 30 days of November. Maintaining the smoking cessation for a whole month increases the probability of achieving a definitive result by five. Nearly 117,000 people and 5,200 partners are participating in the No Tobacco Month operation this year, whether they are companies, associations or institutions.

Upon registration, smokers benefit from numerous tools and advice to help them in their quitting process. In particular, they can count on a consultation with a smoking cessation professional, a quitting aid kit with a 40-day program, support to help them not give in and a community within which smokers can rely to share doubts and tips.

Have sufficient healthcare provision to properly support smokers

With nearly 32% smokers among 18-75 year olds in France, a rate of 24.5% daily smokers, smoking remains particularly high in France. It is responsible for 75,000 premature deaths each year, or 13 % of total mortality in the country. However, nearly two out of three smokers (59 %) want to quit smoking.

Santé Publique France (SPF) and anti-smoking associations, such as the National Committee against Smoking (CNCT), remind us that there are proven treatments to help smokers quit. The pharmacological treatments recognized as effective and recommended by the WHO are nicotine substitutes: cutaneous forms (patches), buccal forms (gums, lozenges, inhalers, sprays), nasal forms (sprays), as well as varenicline, bupropion and cytisine.

Tobacco-Free Month is also an opportunity to recall that healthcare professionals have a key role to play in supporting the quitting process. SPF reminds us that support from a healthcare professional increases the chances of successful cessation by 70%. More and more healthcare professionals such as nurses, physiotherapists, and dental surgeons are authorized to prescribe nicotine replacement treatments. However, the CNCT specifies that they are still not sufficiently trained in the management of smoking cessation and that the care offered is not sufficient in relation to needs. The association also advocates for all healthcare professionals to systematically address their patient's smoking status during a consultation.

No Tobacco Month, a particularly cost-effective campaign

In a press release, Santé Publique France indicates that each euro invested in the Smoke-Free Month campaign saves more than 7 euros on health costs due to smoking cessation. In 2023, the OECD conducted an economic evaluation of tobacco control policies in France. Their models show that, if repeated each year, the operation would reduce health costs by an average of 94 million euros per year between 2023 and 2050 (for an annual cost of approximately 12 million euros).

OECD modelling had shown that by 2050, No Tobacco Month would prevent 241,000 cases of lower respiratory infections, 44,000 cases of chronic obstructive pulmonary disease (COPD) and 28,000 cases of cancer.

Since the campaign was launched in 2016, more than 1.34 million French people have signed up. According to a barometer from Santé publique France, around 20,% of the people who participated in No Tobacco Month were still non-smokers six months after quitting.

Warning about alternative methods of stopping that have not been proven

In its press release[2], the CNCT also warns about the many alternative methods that are flourishing and offer "miraculous ways" to quit smoking such as laser, traditional therapies, mindfulness, acupuncture, hypnosis, or even yoga. Many television spots currently broadcast on public channels and social networks highlight the effectiveness of laser therapy, promising to be "innovative and effective at nearly 85% in a single session of approximately one hour". The WHO reminds us that this technique has not been validated and specifies that it is not practiced by doctors.

The CNCT also specifies that the weaning axis must be accompanied by other measures, in particular a strong tax on tobacco products. In the context of the current debates on the Finance Bill (PLF) and the Social Security Financing Bill (PLFSS), the association recalls that tax increases, when they are repeated and significant, are the most effective tool for reducing tobacco consumption, particularly among young people and disadvantaged populations, who are most sensitive to the price argument.

Often highlighted as an effective smoking cessation tool, the electronic cigarette is not one of the recognized methods. In an opinion published on January 4, 2022, the High Council of Public Health (HCSP) recommends that health professionals who support smokers in their efforts to quit smoking do not offer vaping products as a cessation tool.[3]. According to the HCSP, the potential benefits and risks of using electronic cigarettes "are not established to date."

However, electronic cigarettes can be considered by professionals as a second option for certain vulnerable groups, provided that there is no vaping. Indeed, the simultaneous consumption of tobacco products and vaping products is not associated with a reduction in health risks.

Smoking cessation policies lagging internationally

Smoking cessation is one of the main strategies proposed by the World Health Organization (WHO) to combat the tobacco epidemic. Furthermore, Article 14 of the WHO Framework Convention on Tobacco Control (FCTC) and its implementation guidelines call on Parties to: “facilitate the accessibility and affordability of tobacco addiction treatment.” However, the latest WHO report on the global tobacco epidemic shows that smoking cessation policies are still among the least implemented of all FCTC demand reduction measures, with only 23 countries in total providing smoking cessation services in line with best practice, the majority of them high-income countries.

WHO also points out that in the absence of medication or cessation support, only about 4% of attempts to quit smoking are successful, given the highly addictive nature of nicotine.

©Tobacco Free Generation

AE

[1] Communicated, 9th edition of No Tobacco Month: registrations open to take up the challenge of a life without tobacco!, Public Health France, published on October 8, 2024, consulted on November 4, 2024

[2] Communicated, No Tobacco Month: CNCT recalls the need to have sufficient healthcare provision for the 12 million smokers, CNCT, published on October 31, 2024, consulted on November 4, 2024

[3] Opinion of the High Council for Public Health, relating to the benefits and risks of electronic cigarettes, published January 4, 2022, accessed November 4, 2024