France: smoking among immigrant populations is decreasing less quickly than that of the general population

A study by INSERM shows that immigrant populations are more willing to quit smoking but are less able to do so, in a context of voluntary anti-smoking policy and a general decline in smoking. More targeted and adapted support and incentive actions to quit smoking are recommended to remedy this.

Various studies have shown that in terms of health and smoking, immigrant populations in Western Europe have certain particularities. In particular, these populations are more often affected by health inequalities, regardless of education and income levels; being an immigrant or a descendant of an immigrant is now considered a social determinant of health.[1].

Immigrant populations thus suffer more often from health problems, poorer mental health, and are exposed to acculturative stress.[2] and more discrimination. Their socioeconomic situation is generally lower, which distances them from health professionals. In high-income countries, tobacco control measures also seem less effective among immigrant populations than among the general population.[3], particularly for issues of social norms and cultural differences.

Inequality in smoking by geographic origin

A team from the National Institute of Health and Medical Research (INSERM) has studied the effect of public policies to combat smoking on the smoking behavior of immigrant populations in France.[4]She conducted a DePICT (Description of Perceptions, Images, and Behaviors related to Smoking) study by telephone in two waves, one year apart in 2016 and 2017, isolating four regions of geographic origin: people from France, another European country, a country in Africa or the Middle East and finally from another region of the world).

Previous studies have shown that most immigrants from Africa have smoking prevalences that are significantly lower than those observed in France when they arrive in Europe. This prevalence tends to increase over time, particularly among migrant men, whose prevalence exceeds the general prevalence over time, while it tends to remain lower than the general prevalence among migrant women.[5].

The results of the INSERM study confirm a significant decrease in smoking prevalence for the entire population as a result of public policies implemented at the time (plain packaging, expanded health warnings, planned price increases, campaigns encouraging people to quit). This decrease in the general population contrasts with the 6.2% increase in smoking prevalence among individuals from Africa or the Middle East. In addition, the desire to quit smoking and attempts to quit smoking were more common among individuals from these regions, but they were less likely to succeed in quitting smoking.

Bringing immigrant populations closer to the health system

The authors acknowledge that anti-smoking policies have a protective effect on the entire population, including immigrant populations, and are therefore essential. However, they believe that certain public health policies can reinforce social inequalities between the general population and the immigrant population, although their study does not identify which types of public policies would have such an effect. A 2013 study had also highlighted that mass communication campaigns tend to aggravate socioeconomic inequalities; the provision of health resources and tax incentives such as increasing the price of tobacco would, on the contrary, have the effect of reducing them.[6].

The authors of the study also consider that the low success in attempts to quit smoking is due to less access to healthcare facilities for immigrant populations, for both linguistic and socioeconomic reasons. They therefore recommend strengthening specific measures to support smoking cessation among marginalized populations. They also recommend deploying targeted interventions adapted to different generations of immigrant populations, whose consumption profiles and health behaviors can vary greatly. Finally, the authors admit that the size of their immigrant population sample remains small, not allowing for analysis by gender or by population subgroups.

Keywords: immigrant population, geographic origin, public policies, smoking cessation.

©Tobacco Free Generation

M.F.

[1] Castañeda H, Holmes SM, Madrigal DS, Young M‐ED, Beyeler N, Quesada J. Immigration as a Social Determinant of Health. Annual Rev Public Health. 2015;36:375–92.

[2] Stress produced by acculturation, that is, adaptation to another culture.

[3] Thomson K, Hillier-Brown F, Todd A, McNamara C, Huijts T, Bambra C. The effects of public health policies on health inequalities in high-income countries: an umbrella review. BMC Public Health. 2018 Jul 13;18(1):869.

[4] Mahdjoub S, Héron M, Gomajee R, et al. Evolution of smoking rates among immigrants in France in the context of comprehensive tobacco control measures, and a decrease in the overall prevalence. BMC Public Health 23, 500 (2023). https://doi.org/10.1186/s12889-023-15339-x

[5] Khlat M, Legley S, Bricard D. Migration-related changes in smoking among non-Western immigrants in France. Eur J Public Health. 2019 Jun 1;29(3):453-457.

[6] Lorenc T, Petticrew M, Welch V, Tugwell P. What types of interventions generate inequalities? Evidence from systematic reviews. J Epidemiol Community Health. 2013;67:190–3.

National Committee Against Smoking |