This article offers an analytical synthesis of international trends in public policies to regulate tobacco in the first quarter of the twenty-first century. It begins with a review of the densification of the repertoire of public action and the affirmation of a strategy that consists of encircling tobacco (designated as an enemy) and attacking it through a variety of material and symbolic tactics. Tobacco regulation is a constantly dynamic process, due to the intensity of the exchanges of blows between protagonists: these agonistic interactions are reflected in framing struggles that lead to a diversification of tobacco qualifications. Tobacco is thus framed as a health issue, but also as an environmental problem and a challenge for social justice. Finally, the article shows how, at the end of a quarter-century of diverse mobilizations, the gradual formulation of a paradigm shift is taking shape, in which the objective of public action is no longer simply to control tobacco, but to eliminate it as a commodity.
This article reports changes in tobacco and vaping consumption in France over the last thirty years and the issues they raise for public authorities in terms of prevention and management of the social and health consequences. This report is the result of a joint analysis by Santé publique France (SpF) and the French Monitoring Center for Drugs and Drug Addiction (OFDT). It shows that there has been a “generational shift” in tobacco consumption and social representations of cigarettes since the mid-2010s, with a sharp decline in tobacco initiation among adolescents, which has become less common and reported at an older age, which was one of the objectives of the national tobacco reduction plans. However, smoking remains fairly stable among adults, predominantly among men, with gaps between men and women persisting since the early 2000s. Beyond the gender gap, social disparities in consumption remain significant, both among youth and adults. However, while the prevalence of smoking is no longer increasing, the prevalence of vaping is rising, which is a public health concern since some of these practices involve nicotine consumption. This also entails the risk of a “renormalization” of the act of smoking, a matter of concern for health authorities in France as in other European countries. The analysis concludes that the statistical information system and qualitative surveys need to be adapted to ensure a reliable monitoring of the situation, taking into account the rapid transformations of the market.
Heated tobacco (HT), a new tobacco product, is presented by the tobacco industry as an effective and safe alternative to cigarettes. Even if the quantities of harmful compounds emitted by HT are lower than those found in cigarette smoke, this reduction in exposure cannot be equated with a reduction in risk. No study has provided evidence that switching from cigarettes to HT reduces the risk of tobacco-related diseases. HT cannot be considered as a cigarette cessation product and was even designed as a product to initiate or return to tobacco consumption. To promote this product, the tobacco industry essentially exploits the concept of harm reduction and, as such, tries in its commercial communication to create confusion between HT and electronic cigarettes, despite these two products having nothing in common. This promotion is based, on the one hand, on the data of internal studies in contradiction with those of independent studies, and, on the other, illegally, on social networks and communication in contradiction with the statements of regulation authorities. HT is a new lure offered by the tobacco industry, intended to maintain its profits in a world that is moving away from “traditional” cigarettes. It should be strictly advised against for both non-smokers and smokers.
While the value of vaping is the subject of scientific debates, the arrival on the market of a marketing product, puffs, intended for adolescents is a new challenge for the health authorities. How can we prevent young people from entering into nicotine addiction without prohibiting the use of vaping by smokers in order to quit cigarettes?
La pandémie de Covid-19 a entraîné une interruption des soins dentaires lors du premier confinement. Cette étude évalue les répercussions de cette période sur la perception de la santé orale et de l’accès aux soins dentaires en France. Une enquête par questionnaire a été menée (COVISTRESS) pour étudier le stress et les comportements de santé des adultes avant, pendant et après le premier confinement, soit au moment de la réponse. Un questionnaire « santé orale » a évalué l’évolution de la perception des difficultés d’accès aux soins dentaires. Entre novembre 2020 et avril 2021, 339 personnes ont répondu au volet « santé orale ». Le score de difficulté perçue d’accès aux soins dentaires (0 à 100) passe de 21,6 ± 26.7 avant la pandémie à 52,9 ± 39,5 pendant le confinement et à 38,1 ± 35,3 après celui-ci. Avant la pandémie, ce score est lié à une perception défavorable de la santé orale et aux difficultés d’accès aux soins de santé. Pendant le confinement, le score est lié à un besoin élevé en soins dentaires (RR=4,1 ; IC95 %=1,2-13,8), à la perception de difficultés d’accès au système de santé (5,06 ; 1,8-14,1), notamment des difficultés de déplacement (3,0 ; 1,1-9,1). Les facteurs expliquant l’évolution des difficultés avant et après le confinement diffèrent selon le temps d’évaluation. Cette étude montre les répercussions négatives de la pandémie sur la perception de l’accès aux soins, dans une population intégrant peu de personnes socialement défavorisées.
