Smoking among young people in France

SUMMARY

• Smoking prevalence among young people in France.

• Exposure to passive smoking.

• Smoking and youth health.

• Factors that influence young people to start smoking.

• Prevention.

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Smoking prevalence among young people in France

 

To assess the extent of the tobacco epidemic in a country, several indicators are monitored regularly. These include the prevalence of smoking among adolescents and the characteristics of this smoking.

It is estimated that each year, Around 200,000 young people start smoking in France[1]. Smokers, in their vast majority, start smoking in adolescence and quickly become addicted well before adulthood. The age of onset of smoking occurs at 13 – 14 years oldWhen three children experiment with tobacco, at least two out of three will use tobacco for some part of their lives.[2]

According to the latest ESCAPAD survey among 17-year-olds, at the national level, more A quarter of young people (25.11%) aged 17 are daily smokers and nearly six out of 10 young French people have already tried smokingThis is certainly the lowest level measured through the surveys. ESCAPAD since 2000, but this remains particularly high compared to other countries, particularly Anglo-Saxon ones.

 

Several variables induce differentiated results: gender, school and social situation but also the size of the adolescent's residential area, their region.

Daily tobacco use is more common among boys than girls (26.3% vs 23.8%), At the same time, it is twice as high among apprentices. (47.3%) than among high school students (22.0%). This significant gap is explained by a social component, greater purchasing power for apprentices who receive a salary and easier accessibility to products.[3].

In urban areas with more than 200,000 inhabitants, 21.81% of adolescents declare themselves to be daily smokers, compared to 26.71% of those living in a rural municipality.

Not all countries are at the same stage of development of the tobacco epidemic[4]Despite a relative improvement in recent years, when comparing the situation in France to similar countries, smoking among young people remains particularly high.

For comparison in other French-speaking countries:

• Quebec: according to a 2017 study, 8% of 15-19 year olds consumed tobacco daily and 20% of 20-24 year olds[5]
• Belgium: In 2018, 11% of young people aged 15 to 24 (men and women combined) were daily consumers[6].

In Africa, smoking is a more recent phenomenon and the trend is particularly alarming, but consumption levels are still significantly lower by comparison.

Exposure to passive smoking

Passive smoking is the act of inhaling the smoke released by one or more smokers (from the smoke emitted by the combustion of the cigarette or that exhaled by smokers). By extension, we also speak of passive smoking for the exposure of the fetus to the smoking (active or passive) of the mother.

Tobacco smoke contains more 4,000 chemical substances including irritants, toxic products (carbon monoxide, tars), the addictive substance nicotine. Among the substances listed more than 50 carcinogens[7] have been identified. Extremely harmful to the smoker, smoke is also harmful to the non-smoker.

Passive smoking, while more toxic in a closed environment, is also more toxic in an open environment, particularly in covered places where concentration phenomena can occur.

The Bertrand Decree of 2007 reaffirms the ban on smoking in uncovered areas of public schools, colleges and high schools and extends it to apprentice training centres. It is therefore strictly forbidden to smoke within the premises of the establishment, including playgrounds, and no smoking area may be set up.

Among 17-year-olds, 24.0% reported being exposed to tobacco smoke at home and 62.9% in front of their school in 2017[8].

According to a study published in early 2020 by Santé Publique France, in four years, exposure to second-hand smoke in the home has fallen by almost ten points compared to the previous study in 2014.[9]. Among smokers living in a household with a child under four years old, the trend is particularly clear: the frequency of smoking has halved during this period, going from 31.6 % to 14.4 %. Among those living with a child aged 4 to 18, the proportion has increased from 48.5 % to 23.8 %[10].

It remains, however, that the level of exposure remains high with the associated risks, particularly for still immature organisms. Furthermore, this exposure is marked on a social level and contributes to explaining the continuation over time of differences in smoking according to social category.

Smoking and youth health

In a smoker's life, early initiation is often associated with: (1) a high risk of becoming a daily smoker, more intense smoking, a higher level of addiction, and greater difficulty in quitting; and (2) higher tobacco-related morbidity and mortality, particularly from lung cancer and cardiovascular disease.[11].

Active smoking among children and adolescents leads to serious risks to their respiratory health in the short and long term. Children who smoke are two to six times more likely to cough, sputum, wheeze, and be more short of breath than nonsmokers. Smoking impairs lung growth and triggers a premature decline in lung function, which gradually accompanies the development of chronic obstructive pulmonary disease (COPD).

Children are mainly exposed to passive smoking at home due to parental smoking. Although these exposure levels have generally decreased in France in recent years, such exposure is still common in families with the lowest incomes, as evidenced by the presence of cotinine (a breakdown product of nicotine) in the urine of exposed children.

In very young babies, sudden infant death syndrome is more common when one or both parents smoke in the home.

Main effects of passive smoking on young children[12] :

• Irritation of the eyes, nose and throat
• Increased frequency of nasopharyngitis and otitis
• Increased risk of asthma and respiratory infections (pneumonia and bronchitis)
• Small, but significant, decrease in lung development.

Nicotine addiction

Nicotine is the drug that causes tobacco addiction. Nicotine addiction sets in very quickly in young people, even before they feel the first symptoms of addiction/withdrawal and before they have started smoking every day. As soon as the child feels these first signs, he or she will willingly make many, often unsuccessful, attempts to quit. Addiction is generally evident within two months of starting to smoke.

The addictive power of nicotine is demonstrated by the fact that out of three children/adolescents who smoke a first cigarette "to see" two will be daily smokers for a period of their life.

Factors that influence young people to start smoking[13]-[14]

Smoking initiation is associated with different factors that can interact:

• Smoking in the entourage: family (parents, brothers and sisters) and peers, this factor itself being linked to the variable of social category
• The ease of obtaining cigarettes or other tobacco products: the accessibility of the products and their price level,
• Exposure to the broad promotion of smoking and tobacco products (advertising, sponsorship, product and behavioral placements, etc.), particularly in audiovisual media and social networks.
• Family environment and influence of friends/peers:

The influence of smoking by the father or mother on that of the children, particularly girls, is widely demonstrated.[15]. When both parents smoke, this is further reinforced.

This influence operates on the one hand through the "model" that the parents constitute, and on the other hand through easier accessibility to products available at home.

However, it is important to emphasize that this influence can be attenuated or even partly counteracted.[16]. This is the case when parents who smoke very clearly disapprove of smoking, in particular by explaining to their children that it is a drug and by reporting their personal difficulties in quitting. Addressing the risks of smoking in family discussions and communicating on the subject of health is important, as is establishing strict rules within the home that prohibit smoking.

Educational aspects come into play: supervision of the young person's free time, parents' interest in their child's studies, the young person's attachment to his parents allowing the development of his self-esteem.

In adolescence, peer influence is seen through smoking status, attitudes and social norms.[17].

What appears undeniable is the overestimation by adolescents of the smoking of their peers. This erroneous overestimation is a more powerful determinant than the actual use of tobacco by friends.

• Price and accessibility of products also constitute an essential vector for young people to start smoking and stay smoking.[18].

Young people are more sensitive to prices due to lower purchasing power. When prices increase significantly, initiation decreases and a higher than average proportion of smokers quit.

The price level is a key factor in young people's smoking, as is the more or less easy and varied accessibility of products: number of points of sale, location near schools, existence or not of vending machines, small packets known as children's packets, single sale, free distribution at events, etc.

Over time, the tactics used to attract the next generation of smokers have been numerous and varied depending on the country, many of these practices have however been banned in France in recent years.[19].

• Presence of certain tobacco products near sweets and sodas, and often at eye level of children
• Colorful branding near checkout counters and digital screens displaying cigarette advertisements
• Advertising banner with cigarette brand names sometimes larger than the store name
• Flavored products with attractive aromas including vanilla, lemon, grape or cinnamon, plus menthol
• Sale of cigarettes or other products individually, more affordable for young people.

Tobacco companies have historically tried to circumvent regulations designed to limit marketing to youth.

They quickly turned to the internet and platforms including Facebook and Instagram to continue promoting their products, which is generally prohibited by law. They pay social media influencers to promote and indirectly advertise all of their tobacco products and also their e-cigarette brands.

A large majority of young adolescents are on at least one social media and may therefore find themselves exposed to the direct or indirect promotion of tobacco products.

In August 2018, the New York Times investigated social media and the tobacco industry’s Instagram influences. The paper listed 123 hashtags associated with tobacco products, which had been viewed 25 billion times worldwide. Moreover, these advertisements are done indirectly. It is notoriously difficult to tell what Facebook calls “branded content.” On Instagram, influencers post glamorous images of vaping products with hashtags such as #idareyoutotryit and captions such as “feeling Vype AF.” Most of the captions and hashtags used play on the same registers as those traditionally used for tobacco promotion. They are an incentive for consumption for young people by inviting them to live life to the fullest through the “daring” consumption of their products. The process of identifying young people with the influencers is essential. The photos, professional in nature, are perfectly staged. Influencers, on vacation, in the evening, with friends, promote the tobacco product or the electronic cigarette in a "nonchalant" way, as if it were self-evident in order to create or maintain the social norm: these products are thus naturally part of the decor. Influencers do not mention the fact that they have been paid, such as "paid promotion of British American Tobacco". This often makes it difficult to identify advertisements.

Prevention

The fight against smoking and the prevention of smoking among young people are a public health priority. Public policies must be both global in order to integrate all facets of the subject but at the same time adopt an individualized approach focused on tobacco products alone.

This is also the meaning of the WHO treaty, the Framework Convention on Tobacco Control.[20], the only international public health treaty that is exclusively devoted to provisions on the fight against smoking. This text has been ratified today by 182 countries worldwide and has the particularity of bringing together all the measures to reduce tobacco consumption that have demonstrated their effectiveness on a scientific level. It thus brings together very diverse provisions ranging from product regulation to the fight against illicit trade in tobacco products, including the prohibition of all forms of tobacco marketing, protective measures against passive smoking, training measures, prevention, promotion of weaning, regulation of packaging, etc. This treaty also includes a general obligation which is the protection of public policies against the tobacco lobby.

This statement is both common sense but is not at all essential in the fight against smoking. What is much more effective in reducing smoking among young people is that adults do not smoke and comply with the general provisions. Thus, a regular increase in tobacco prices through significant tax increases represents one of the most effective vectors to dissuade young people from starting to smoke and encourage them to quit. Studies suggest that young people can be up to three to four times more sensitive to prices than adults.[21].

Designing places of life and daily activities where smoking is prohibited allows smoking to no longer be associated with these activities and helps to emphasize that these are in no way harmless products. Smoke-free places thus de-trivialize the consumption of these products. Banning smoking in vehicles in the presence of minors also protects them from major exposure to passive smoking.

The elimination of all forms of advertising is also essential to break the glamorous world of this consumption that manufacturers want to convey. Eliminating advertising also requires strict regulation of packaging and the introduction of neutral packages on which broad health warnings are affixed.

The current ban on very broad promotion on social networks and audiovisual works constitutes a major issue.

Similarly, reducing the attractiveness of products by banning attractive aromas, including menthol today, makes it more difficult to get started with products. Generally speaking, regulating the composition of products and controlling the activity of manufacturers is essential to prevent them from manipulating their products to make them more addictive and desirable.

The organization of regular information campaigns addressing the problem of smoking from different angles is part of this regular awareness-raising, encouraging people to quit, as is the large-scale annual operation No Tobacco Month. Consistently, the management of treatment to help people quit smoking helps smokers in the difficult process of quitting, and the reduction in the number of smokers and prevalence constitutes an essential denormalization factor to prevent young people from smoking. The latter are also receptive to communication on the damage caused by tobacco to the environment, the handling practices of tobacco manufacturers, the violation of human rights, etc.

Other provisions such as compliance with the ban on the sale of tobacco and nicotine products to minors are directly linked to reducing tobacco consumption among young people. However, in France the effectiveness of this measure remains very low and insufficient to be effective. [22]-[23].

Our country's goal today is to achieve a non-smoking generation by 2032. A non-smoking generation is defined by the fact that fewer than 5% of 17-year-olds have ever experimented with tobacco. To achieve this goal, which other countries have already achieved, it is therefore important to continue and strengthen the implementation of measures that have been shown to be effective in reducing smoking.

Currently, France has a set of important and coherent measures to reduce tobacco consumption. However, it is important that these provisions are implemented. Beyond the texts, there must be a reality on the ground. The measure banning the sale of tobacco products to minors is an illustration of this. For the arsenal of various measures to be effective, all the stakeholders involved - health stakeholders, public officials, parents, educational communities, control bodies, etc. - must fully mobilize and take ownership of all these measures and succeed in breaking this still overly glamorous image of smoking in our country.

Youth smoking is not inevitable. Many countries that had consumption levels comparable to ours and that implemented the right measures have managed to break this consumption and achieve tobacco-free generations to the point that they are now committed to ending tobacco, called the "endgame".

©Generation Without Tobacco

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