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France, a bad pupil in terms of smoking prevalence

According to the author, the decrease of smoking prevalence that has been characterized in countries like the UK, the USA, Canada or Italy over the last 30 years, is not observed in France that, in contrast, sees a slight increase, attributable to a marked increased prevalence among women.

The absence of reduction in smoking prevalence is mirrored by an absence of reduction in smoking-related mortality that has been estimated to 78,000 people in 2010. Despite a slight decrease of the mortality among males, the striking figure that is presented, here, is a net increase of the mortality of females. In the age range of 35-69 years, the percentage of females dying from tobacco has increased by an order of magnitude over the last 30 years (from 1.7% in 1980 to 15% in 2010).

“If no major change is operated in politics, economy and public health, the prematured deaths related to tobacco use will not evolve in the coming 20-30 years” . -Dr I. Berlin.
Currently, in France, the best estimate of 2012 returns more than 14 millions of smokers. The social cost of tobacco is about €120,000,000, based on 2010’s data, the same order of magnitude as for alcohol. Altogether with illicit drugs, tobacco and alcohol account for €22 billions, roughly 6% of the public expenses in the country.

 

It is urgent, according to Dr Berlin, to take action against smoking in France since solutions exist that had demonstrated a real success in the other industrialized countries. In this context the e-cigarette may bring a puff of fresh air if one could demonstrates that it is efficient as a smoking cessation aid and it prevents the initiation to combustible tobacco.

The e-cigarette, a solution?

The e-cigarette has been tried, in France, by 12 millions of persons (INPES, 2014) and daily vapers account for 3 millions of persons. The French vapers are between 24 and 35 years of age and the e-cigarette touches more males than females. Nicotine use in e-cigarettes is around 86% and only 2% of vapers were not smokers.

Nevertheless, the usefulness of the e-cigarette in smoking cessation is controversial and not robustly established by researchers, even if testimonials of former smokers suggest its frank success.

A benefit-risk analysis for smokers may help authorities making decision on the usefulness of e-cigarettes in smoking cessation

A few questions may help deciding of its usefulness in the fight against smoking, and some reflect potential benefits while other potential risks.

The benefits:

  • Contributes to stop using combusted tobacco products,
  • Inhibits the initiation to combustible tobacco,
  • Reduces the consumption of  combustible cigarettes, provided that:
    • the reduction of the consumption is associated to a long-term reduction of diseases and mortality associated to smoking tobacco,
    • the use of the e-cigarette doesn’t postpone complete tobacco withdrawal.

The risks:

  • Serious and benign side effects linked to the short term use of the e-cigarette, and long-term effects (over several years), health thread due to the chemicals contained in the e-liquids (propylene glycol, glycerin, alcohol, flavors).
  • Initiation to other tobacco products (shisha, cigarettes, pipes…),
  • Initiation to other substances with an addictive character (Cannabis, cocaine, opioids…)

In spite of a strong focus on women due to their higher smoking prevalence in France, only few is known regarding the use of e-cigarette during pregnancy, for example. The same applies for long-term effects since the e-cigarette delivers pharmacologically active substances.

In the current state, the e-cigarette has been regulated as a consumer product, thereby escaping from any systematic survey that could allow a robust determination of a benefit-risk profile. Nevertheless its penetrance into the population is very high and could lead to a decrease of smoking prevalence and incidence provided that its side effects profile is clean. But as a consumer product, all data related to its use and its efficiency as a smoking cessation aid will not be determined and the benefit-risk profile will remain uncertain unless public authorities take actions to improve the knowledge of this popular product.

In contrast, classified as a health product, the e-cigarette may lose its penetrance and popularity but would gain a better scientific knowledge because of mandatory systematic surveys with a focus on the methodology. Such surveys would help refining the benefit-risk profile for smokers.

In a few weeks, a transition will be operated by the implementation of the EU TPD, that will place vaping products like e-cigarettes in an intermediate state between the consumer and health product: an increased level of regulation on its promotion, labelling, composition, use in public places, sale to under-18s, side effects reporting, taxation…


Berlin, I. (2016). Le tabagisme et la cigarette électronique en France. La Presse Médicale. doi:10.1016/j.lpm.2016.02.019

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