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Introduction: Health indicators published over more than 15 years in France show differences in the prevalence of smoking in relation to activity status and socio-professional categories. However, the relationship between smoking and work is not limited to this., Background: Smoking by employees is traditionally regarded as entailing additional costs for businesses, but the actual costs of smoking in the workplace are difficult to assess. Co-exposure to tobacco and the toxic substances encountered in work areas carries an increased risk of developing lung disease, broncho-pulmonary cancer and chronic obstructive pulmonary disease in particular. The workplace can also be an area of exposure to passive smoking that affects employees unequally. In France, the use of tobacco and e-cigarettes in the workplace has been regulated since 2006 and 2016, respectively., Outlook: Workplace smoking cessation programs and smoking bans seem to encourage cessation of smoking. Smoking cessation advice by occupational physicians could work in the same manner. Subjects exposed to occupational carcinogens and tobacco could benefit from low-dose CT screening after a trial period to validate this approach., Conclusion: Workplaces can be areas for the prevention and cessation of smoking., (Copyright © 2019 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

French governments only very recently introduced comprehensive tobacco control policies including several measures recommended by WHO Framework Convention on Tobacco Control, leading to a speeding-up of tobacco smoking decrease, but still with a high current level of use. In the meantime, research confirms that nicotine is highly addictive, that smoking just a cigarette a day is highly detrimental for health, and that health professionals are efficient in helping smokers to give up. These measures are such diverse as tobacco taxes increases, introducing plain packs, promoting November as month without tobacco, getting tobacco cessation medications paid for by health insurances, implementing a comprehensive advertising ban of tobacco products in retailor shops, and increasing protection of public health policies from tobacco industry intrusion. This industry via frenzied marketing reacts by promoting "heat not burn tobacco" as a harm reduction mean, which it is not, and invests in e-cigarettes, whose most recent ones are as addictive as classic tobacco cigarettes., Competing Interests: Les auteurs déclarent n’avoir aucun lien d’intérêts.

Smoking is a major preventable cause of cancers and is increasingly concentrated among the most deprived individuals leading to increasing socioeconomic inequalities in the incidence of cancers linked to smoking. We aimed to estimate the tobacco-attributable cancer burden according to socioeconomic position in France. The analysis was restricted to cancer sites for which tobacco smoking was recognized as a risk factor. Cancer cases by sex, age group and European Deprivation Index (EDI) among people aged 30-74 between 2006 and 2009 were obtained from cancer registries covering ∼20% of the French population. The tobacco-attributable burden of cancer according to EDI was estimated applying the population attributable fraction (PAF) computed with the Peto-Lopez method. The PAF increased from 56% in the least deprived EDI quintile to 70% in the most deprived EDI quintile among men and from 26% to 38% among women. In total, 28% of the excess cancer cases in the four most deprived EDI quintiles in men and 43% in women could be prevented if smoking in these 4 EDI quintiles was similar to that of the least deprived EDI quintile. A substantial smoking-attributable burden of cancer by socioeconomic position was observed in France. The results highlight the need for policies reducing tobacco consumption. More comprehensive interventions integrating the various dimensions of health determinants and proportionate according to socioeconomic position may essentially contribute to the reduction of socioeconomic inequalities in cancer., (© 2018 UICC.)

Objective: The objective of the study was to investigate the joint effect of occupational exposure to asbestos, and tobacco and alcohol consumption, on the risk of laryngeal cancer among men., Methods: We used data from a large population-based case-control study conducted in France. We estimated two-way and three-way interactions between asbestos exposure (never vs ever exposed), tobacco consumption (<20 vs. ≥20 pack-years) and alcohol consumption (<5 vs. ≥5 drinks per day). The interaction on an additive scale was assessed by estimating the relative excess risk due to interaction (RERI) and the attributable proportion due to interaction, and the interaction on a multiplicative scale was assessed by estimating the multiplicative interaction parameter (ψ). Multiplicative interactions were also assessed using fractional polynomials for alcohol drinking, tobacco smoking and asbestos exposure., Results: When compared with light-to-moderate smokers and drinkers never exposed to asbestos, the increase in laryngeal cancer risk was smallest among light-to-moderate drinkers and smokers exposed to asbestos (OR=2.23 (1.08 to 4.60)), and highest among heavy smokers and drinkers ever exposed to asbestos (OR=69.39 (35.54 to 135.5)). We found an additive joint effect between asbestos exposure and alcohol consumption (RERI=4.75 (-4.29 to 11.12)), whereas we observed a more than additive joint effect between asbestos exposure and tobacco consumption (RERI=8.50 (0.71 to 23.81)), as well as between asbestos exposure, and tobacco and alcohol consumption (RERI=26.57 (11.52 to 67.88)). However, our results did not suggest any interaction on a multiplicative scale., Conclusions: Our results suggest that asbestos exposure, in combination with tobacco and alcohol exposure, accounted for a substantial number of laryngeal cancer cases. Our findings therefore highlight the need for prevention in activities, such as construction work, where exposure to asbestos-containing materials remains., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

In France, daily tobacco consumption increased among adults between 18 and 75 years between 2005 and 2010, particularly women. At 17 age-old, it raised 10% between 2008 and 2011 (32.7% in boys and 30.2% in girls). The number of cigarettes smoked per day decreased between 2005 and 2010 in France, from 15.4 to 13.9 cigarettes smoked per day. But active exposition to cigarette smoke and consequently to cigarette toxins exposure did not change and even increased. Tobacco prevention should follow the World Health Organization Framework Convention on Tobacco Control, which was signed in 2004 by French representatives. Smoking cessation methods include: minimal counseling provided by general practitioners (when given during a medical visit for another motive than smoking cessation, one out of 50 smokers stops); minimal counseling given by any health professional; and the smoking cessation services framework. Evidence-based medications associated with a non-pharmacologic support and with a regular follow-up significantly increase smoking cessation rates. Risk reduction by decreasing progressively tobacco consumption with the help of medications is only suggested nowadays., (Copyright © 2012. Published by Elsevier Masson SAS.)

Maternal tobacco consumption is considered as a risk factor for nonsyndromic oral clefts. However, this risk is moderate and may be modulated by genetic susceptibilities, including variants of the TGFA, TGFB3 and MSX1 developmental genes and polymorphisms of genes of the CYP (1A1, 2E1) and GST (M1, T1) families involved in metabolic pathways of tobacco smoke compounds. This French case-control study (1998-2001; 240 nonsyndromic cases, 236 controls) included a case-parent design (175 triad-families) that made it possible to distinguish the direct effect of the child's genotype and maternally mediated effects. Maternal smoking during the first trimester of pregnancy was not associated with the oral cleft risk in this population, but we observed statistically significant increased risks associated with maternal exposure to environmental tobacco smoke (ETS). No variant of any of the three developmental genes was significantly associated with oral cleft. The fetal CYP1A1*2C variant allele was associated with a statistically significant decreased risk, compared with the homozygous wild-type: relative risk = 0.48, 95% confidence interval: 0.2, 1.0. Suggestive reduced risks were also observed for the maternal CYP1A1*2C allele and the fetal CYP2E1*5 allele. The GSTM1 and GSTT1 deletions appeared to play no role. Our findings suggest some interactions, with the strongest between ETS and CYP1A1 or MSX1 and between maternal smoking and CYP2E1. We did not confirm the maternal smoking-infant GSTT1 null interaction previously reported by other investigators., (Copyright 2008 Wiley-Liss, Inc.)

Objective: In France, cigarette sales have fallen sharply, especially in border areas, since the price increases of 2003 and 2004. It was proposed that these falls were not due to people quitting smoking but rather to increased cross-border sales of tobacco and/or smuggling. This paper aims to test this proposition., Methods: Three approaches have been used. First, cigarette sales data from French sources for the period 1999-2006 were collected, and a simulation of the changes seen within these sales was carried out in order to estimate what the sales situation would have looked like without the presence of foreign tobacco. Second, the statements regarding tobacco consumed reported by the French population with registered tobacco sales were compared. Finally, in order to identify the countries of origin of foreign tobacco entering France, we collected a random sample of cigarette packs from a waste collection centre., Results: According to the first method, cross-border shopping and smuggling of tobacco accounted for 8635 tones of tobacco in 2004, 9934 in 2005, and 9930 in 2006, ie, between 14% and 17% of total sales. The second method gave larger results: the difference between registered cigarette sales and cigarettes declared as being smoked was around 12,000 to 13,000 tones in 2005, equivalent to 20% of legal sales. The collection of cigarette packs at a waste collection centre showed that foreign cigarettes accounted for 18.6% of our sample in 2005 and 15.5% in 2006. France seems mainly to be a victim of cross-border purchasing of tobacco products, with the contraband market for tobacco remaining modest., Conclusion: in order to avoid cross-border purchases, an increased harmonization of national policies on the taxation of tobacco products needs to be envisaged by the European Union.

Background: The aim was to assess the relationships between social and material deprivation and the use of tobacco, excessive alcohol and psychotropic drugs by both sexes and in various age groups. Greater knowledge concerning these issues may help public health policy-makers design more effective means of preventing substance abuse., Methods: The sample comprised 6,216 people aged > or 15 years randomly selected from the population in north-eastern France. Subjects completed a post-mailed questionnaire covering socio-demographic characteristics, occupation, employment, income, smoking habit, alcohol abuse and "psychotropic" drug intake (for headache, tiredness, nervousness, anxiety, insomnia). A deprivation score (D) was defined by the cumulative number of: low educational level, manual worker, unemployed, living alone, nationality other than western European, low income, and non-home-ownership. Data were analysed using adjusted odds ratios (ORa) computed with logistic models., Results: Deprivation was common: 37.4% of respondents fell into category D = 1, 21.2% into D = 2, and 10.0% into D > or 3a re men than women reported tobacco use (30.2% vs. 21.9%) and alcohol abuse (12.5% vs. 3.3%), whereas psychotropic drug use was more common among women (23.8% vs. 41.0%). Increasing levels of deprivation were associated with a greater likelihood of tobacco use (ORa vs. D = 0: 1.16 in D = 1, 1.49 in D = 2, and 1.93 in D > or = 3), alcohol abuse (1.19 in D = 1, 1.32 in D = 2, and 1.80 in D > or = 3) and frequent psychotropic drug intake (1.26 in D = 1, 1.51 in D = 2, and 1.91 in D > or = 3). These patterns were observed in working/other non-retired men and women (except for alcohol abuse in women). Among retired people, deprivation was associated with tobacco and psychotropic drug use only in men., Conclusion: Preventive measures should be designed to improve work conditions, reduce deprivation, and help deprived populations to be more aware of risk and to find remedial measures.

Smoking is one most common threat of public health around the world. One of the best way to fight it is legislation. The French legislation is probably one of the more sharp and precise for the non-smokers or youths protection. Historically, the law "Veil" voted for in 1976 has defined the French basis of this sort of prevention. The law "Evin" voted for in 1991 has reinforced the non-smokers protection by the ban of smoking in public places, has decided the ban of advertising and has allowed very significant tobacco prices increases. Following European directives, new health warning appeared on cigarettes boxes in France in 2003. They are more strict, visible than they were before. It's because the law is implemented and because it's in continuous evolution that the French smoking prevalence will have the right evolution.

Background: The association between tobacco smoking and oesophageal cancer is well established. However, some major questions remain unanswered such as the importance of kind of tobacco and smoke inhalation. The aim of this study was to investigate the effect of each kind of tobacco on the risk of squamous cell cancer of the oesophagus in men and to test whether the effect of kind of tobacco is similar whatever the sub-site of cancer. Tobacco consumption was assessed by the number of years of consumption and time since quitting., Methods: We conducted a multicentre case-control study in three university hospitals in France (Caen, Dijon, and Toulouse). From 1991 to 1994, 208 cases and 399 controls, all male, were selected. During the interview, the subject's entire tobacco history was recalled, noting each type of tobacco consumed throughout life., Results: Strong tobacco, dark tobacco and non-filter-tipped cigarettes were associated with an increase in risk whatever the adjustments, whilst light, filter-tipped cigarettes and mild tobacco were not. Hand-rolled cigarettes were more strongly associated with risk than manufactured cigarettes. The effect of hand-rolled cigarettes appeared stronger for the lower third whilst those of strong cigarettes and dark tobacco appeared stronger for the upper third of the oesophagus. The effect of inhaling was confined to the upper third., Conclusions: Our results, emphasizing the role of dark tobacco, hand-rolled cigarettes, strong cigarettes and non-filter-tipped cigarettes are in line with previous publications. Moreover, they suggest that the mechanism underlying the tobacco effect could be different according to the sub-site of cancer.