Do Determinants of Smoking Cessation and Relapse Differ between Men and Women? Data from a French National Study

Introduction: There is limited understanding of different predictors of smoking cessation success (SCS) among women and men, despite well-documented differences in smoking behavior.Methods: Using data from DePICT (Description des Perceptions, Images, et Comportements liés au Tabagisme), a national survey of French adults which recruited 2377 regular and former smokers we investigated whether major determinants of SCS differed by sex. Factors associated with unsuccessful vs. No successful quit attempt; vs. SCS were studied using multivariate multinomial logistic regression analyses stratified by sex.Results: Women and men share some determinants of SCS including no cannabis use, living in a nonsmoker household and importance giving to being a nonsmoker. However, no e-cigarette use, low-to-moderate alcohol consumption, early smoking initiation, and higher education were associated with SCS only among women. No use of nicotine replacement, having family members who smoke, family opinion on smoking and current employment, were associated with SCS only among men. Neutral or negative friends' opinion on smoking or living with a smoker were associated with unsuccessful smoking attempts among men.Conclusions: Our results show differences between determinants of SCS according to sex, which highlights the importance of developing tailored interventions that account for sex/gender differences in smoking cessation.

What differentiates youths who use e-cigarettes from those who smoke traditional tobacco products?

Background

Electronic cigarette (e-cigarette) use has spread among adolescents in many countries, however users’ characteristics are not well known. We aimed to compare characteristics of exclusive e-cigarette users to those of exclusive tobacco users and dual users.

Methods

Data come from a representative sample of 11–19 years old students in Paris, surveyed each year between 2013 and 2017. Current e-cigarette and tobacco use were ascertained in the preceding 30 days. Data were analyzed using random intercept multinomial logistic regression models, exclusive tobacco smokers being the reference group.

Results

Among the 17,435 students included, 2.3% reported exclusive e-cigarette use, 7.9% exclusive tobacco use and 3.2% dual e-cigarette and tobacco use. Compared to exclusive tobacco smokers, e-cigarette users were: a) less likely to use cannabis (adjusted Odds-Ratio (aOR) = 0.15, 95% confidence interval (95% CI) = 0.09–0.25); b) more likely to initiate smoking with an e-cigarette or a hookah rather than traditional cigarettes (aOR = 2.91, 95% CI = 1.74–4.87 and aOR = 15.99, 95% CI = 8.62–29.67, respectively). Additionally, exclusive e-cigarette users are younger with an aOR = 0.29 (95% CI = 0.17–0.49) among 13–15 years and aOR = 0.11 (95% CI = 0.06–0.21) among > 17 years as compared to 11–13 years. The probability of being an exclusive e-cigarette user is lower among participants whose best friend smokes tobacco (aOR = 0.30, 95% CI = 0.20–0.44). Exclusive tobacco users and dual users have similar profiles.

Conclusions

Adolescents who only used e-cigarettes had intermediate levels of risk compared to nonusers and those who used tobacco and/or e-cigarettes, suggesting that e-cigarettes use extends to young people at low-risk of using tobacco products.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13673-0.

Sex differences in cigarette brand purchases among adult smokers: results from the DePICT national repeated survey of French adults (2016-2017)

OBJECTIVE

The tobacco industry has been reported to employ sex-specific marketing strategies, which include different types of tobacco packaging, publicity, as well as price strategies. We examined whether characteristics associated with the purchase of more expensive cigarette brands varied by sex, in the context of the introduction of plain tobacco packaging and the strengthening of tobacco control policies in France.

METHODS

Our study population consists of 1380 regular smokers of manufactured cigarettes from the DePICT study, a nation-wide two-wave survey of French adults aged 18-64 years. Participants were interviewed by telephone in 2016 and 2017. Factors associated with the use of more vs. less expensive cigarette brands were determined by multivariable logistic regression stratified by sex.

RESULTS

Several sex-specific factors were associated with the purchase of more expensive cigarette brands. In women, those factors included higher education, cannabis use, and no use of roll-your-own tobacco. While in men purchase of more expensive cigarette brands was linked to younger age, being born outside of France, living with a non-smoker, and attachment to the cigarette brand.

DISCUSSION

Factors which predict tobacco purchase patterns are different in women and men, highlighting the need for sex-specific tobacco control initiatives to counter the tobacco industry's gendered marketing.

Decrease in cross-border tobacco purchases despite intensification of antitobacco policies in France

BACKGROUND

Recently, France has intensified tobacco control policies which included gradual increase in tobacco product price and the introduction of plain packaging. However, there has been suggestion that cross-border tobacco purchases from neighbouring countries, with lower tobacco prices, will increase. We examine trends in cross-border tobacco purchases among smokers concurrent with the implementation of tobacco control measures between 2016 and 2017.

METHODS

Description des Perceptions, Images, et Comportements liés au Tabagisme is a two-wave cross-sectional national telephone survey of French adults aged 18-64 years, which recruited a total of 2167 smokers (2016: n=1238; 2017: n=929). Data were weighted to be representative of the French adult population. The association between study wave and cross-country tobacco purchases was examined across study waves using a multivariable logistic regression model (adjusted ORs: ORa (95% CI)).

RESULTS

Less than half (38.5%) of smokers declared cross-border tobacco purchases in the last year, which were mostly done on occasional basis: 22.6% purchased tobacco cross-border once or twice yearly. In 2017, as compared with 2016, cross-border tobacco purchases by French smokers decreased (ORa=0.81, 95% CI 0.68 to 0.98). Other factors associated with cross-border tobacco purchases included sex, and driving distance to a border.

CONCLUSION

In France, the increase in tobacco product price and the introduction of plain packaging did not contribute to increasing rates of out-of-country purchases of tobacco products, probably due to the overall decrease in smoking levels. However, a harmonisation of tobacco product prices and plain packaging policies across Europe might further improve tobacco control throughout the continent.

Out of country tobacco purchases decrease despite a price increase and plain packaging in France

Background

The introduction of new anti-tobacco measures in France (plain tobacco packaging, higher prices) might encourage smokers to buy their tobacco from other sources than tobacco shops. We examine whether these measures increased the likelihood of smokers purchasing tobacco abroad, depending on their driving distance from the border of a neighboring country with lower tobacco prices.

Methods

DePICT is a two-wave cross sectional national telephone survey examining the French population tobacco-related perceptions and behaviors before and after the introduction of the new measures in 2017. Smokers were asked whether they bought tobacco from abroad in the last 12 months. Shortest driving distances to neighboring countries’ border were calculated using Google Maps (<100 Km, 100-200 Km, 200-300 Km, >300 Km and Ile-de-France (IDF)). Data was weighted to be representative of the population living in France. Multivariate regressions, adjusted on socio-demographic characteristics as well as substance use behaviors, were carried out.

Results

Compared to smokers living at more than 300 Km from a border, those living near a border, and in IDF were significantly more likely to have bought tobacco from abroad (<100 Km: ORadjusted = 3.98; 100-200 Km: ORadjusted = 2.04; 200-300 Km: ORadjusted = 1.47; IDF: ORadjusted = 1.32). Smokers in wave 2 (n = 929) were significantly less likely than those in wave 1 (n = 1238) to have bought tobacco abroad (ORadjusted = 0.81 [95% CI: 0.69-0.96]). It was mainly smokers who were in a driving distances of 100-200 Km, and 200-300 Km who were significantly less likely to buy abroad across the 2 waves (respectively ORadjusted = 0.56 [95% CI: 0.34-0.92] and ORadjusted = 0.50 [95% CI: 0.27-0.92]). Supplementary analyses showed that it was mainly for men and smokers born in France that the decrease was significant.

Conclusions

Our results suggest that the new anti-tobacco measures did not increase out of country tobacco purchases by smokers.

Key messages

The introduction of new anti-smoking measures (increase in price, plain tobacco packaging) did not increase the likelihood of smokers purchasing tobacco from abroad. It was mainly male smokers and smokers born in France that had a decreased likelihood of purchasing tobacco from abroad after the introduction of new anti-tobacco measures.