Tobacco, cigarettes, heated tobacco products, ... - Overview

Tobacco, and its main psychoactive agent nicotine, is used in different forms. The manufactured cigarette is the most-consumed tobacco product in France, far ahead of roll-your-own tobacco and cigars and cigarillos.

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Paquet de cigarettes

Introduction/Background

Tobacco comes from a plant whose leaves are dried and fermented to achieve a distinct flavour. It can be consumed as cigarettes, cigars, loose tobacco, roll-your-own, in a pipe, or by chewing.

Tobacco contains nicotine, which possess “stimulating”, anxiolytic, and appetite suppressing effects. Tobacco products contain additives (flavouring and texturing agents). Burning the tobacco leaf creates new compounds (carbon monoxide, tars), which are harmful to your health. Although several thousands of substances are identified in tobacco smoke, only around ten of them contain physiologically active doses: nicotine, carbon monoxide, nitrogen oxides, tars, etc.

Production/Supply

The volumes of tobacco sold are broken down into three sets: legal domestic purchases (in the tobacconist retailer network); legal non-domestic purchases (in another country or in duty free); and illegal purchases. Only legal domestic purchases are regularly monitored by Customs declarations for deliveries to retailers in mainland France. They make up the bulk of the tobacco market.

Supply in the tobacconist retailer network

There are around 40 distributors of tobacco products in France, the main and most well-known being Logista France which distributes the brands of the largest tobacco companies. The other distributors are generally specialised in the distribution of pipe tobacco or cigars. The retail of tobacco products is regulated by Customs administration. The latter is therefore in control when it comes to the sale of tobacco products, with its network relying on 23 000 tobacco companies present in mainland France.

Over the past 15 years, the total sales of tobacco have declined in France, falling from 65 728 tonnes in 2006 to 40 314 tonnes in 2022. This clear trend reflects the sharp decline in smoking observed in France for over a decade, which is part of the broader context of combating smoking (information campaigns, health warnings on cigarette packets, plain (tobacco) packaging, ban of sale to minors, successive price increases, etc.).

Supply outside of the tobacconist retailer network

It is currently estimated that one in five cigarettes used in France was purchased in a neighbour country. These cross-border purchases are driven by the disparity with French prices. This trend is confirmed by observing the decrease in volumes between departments, by 8.3% in border departments, and 3.4% in non-border departments in 2022.

Legal purchases (which are domestic in the tobacco retailer network, and non-domestic abroad and in duty free) remain the most widespread supply mode, notably for cigarettes. The proportion of purchases on the streets does not seem to have significantly increased in recent years, when surveys on purchasing habits query about the place of most recent supply (0.1% in 2014, 0.5% in 2017, 0.4% in 2018, and 0.8% in 2021).

Use in the adolescent population

Among college and high school students

In 2022, the lifetime use of cigarettes concerned just over one in ten junior high school students (11.4%), with a sharp increase between grades (from 4.6% in the sixth grade to 18.8% in the ninth grade). This lifetime use level has decreased by almost half between 2018 and 2022. Recent use (at least one use in the month) and daily use followed a similar development. They concerned 4.8% and 0.9% of junior high school students respectively in 2022.

In 2022, the lifetime use of cigarettes beginning in junior high school became widespread in high school and affected 34% of high school students (going from 30.0% in the tenth grade to 38.5% in the twelfth grade). Daily use concerned 6.2% of high school students, within a continuous increase again between the tenth grade (4.8%) and the twelfth grade (8.2%). In the case of the development of levels of use in junior high school, the majority of levels of use in high school declined between 2018 and 2022. Lifetime use levels fell by almost 20 percentage points (34.0% in 2022 vs 53.0% in 2018), recent use dropped by 8 percentage points, going from 27.3% to 19.6%, while daily use decreased threefold (6.2% vs 17.5%).

At 17 years old

In 2022, the levels of tobacco use among 17-year-olds were the lowest measured for two decades. Almost one in three 17-year-olds (25.1%) stated to have smoked tobacco in the last thirty days, which is an 18.7 percentage point decrease in comparison with 2014. Daily use sharply declined between 2017 and 2022 (15.6% compared to 25.1%) with a slight male predominance (14.2% among girls, and 17.0% among boys).

The levels of use vary between regions: young people living in Île-de-France and in Hauts-de-France, for example, are less affected by the lifetime use, recent use, and daily use of tobacco, while those from western regions are more so. These disparities between regions are often significant: the lifetime use of tobacco varies from 38.2% in Île-de-France to 54.4% in Brittany, daily use varies from 11.6% in Île-de-France to 20.1% in Nouvelle-Aquitaine.

In comparison with other European countries

The Health Behaviour in School-aged Children (HBSC) and European School Survey Project on Alcohol and other Drugs (ESPAD) international surveys enable France to be compared to other European countries for young people aged 11, 13, 15, and 16. Among the latter, daily smoking halved over 20 years, from 31% in 1999 to 12% in 2019. This constant decline in the use of cigarettes is consistent with a majority tendency in Europe. This decrease in smoking was the most remarkable development in the use of psychoactive substances observed among adolescents over the last quarter of a century.

Use in the adult population

Following a significant decrease in daily smoking between 2014 and 2019, the results of the Health Barometer of Santé publique France shows a stabilisation in the prevalence of smoking. In 2022, in mainland France, over 3 in 10 people aged 18-75 stated to smoke (31.8%) and a quarter stated to smoke daily (24.5%). The prevalence of daily smoking remained higher among men (27.4% in comparison with 21.7% among women). A 14-percentage point difference was observed between people with no qualifications or a qualification lower than a high school diploma (30.8%), and holders of a qualification higher than a high school diploma (16.8%).

In comparison with OECD countries

Within the Organisation for Economic Co-operation and Development (OECD) member countries, 15.9% of people aged 15 and over were smoking on a daily basis in 2021. In 2021, smoking levels varied, from over 25% in France and Turkey to less than 10% in Ireland, Costa Rica, Norway, Mexico, Canada, the United States, New Zealand, and Sweden.

Impacts

All tobacco components affect:

  • the vascular function: tobacco raises blood pressure, increases heart rate, and deteriorates arteries. Coronary risks and deaths from myocardial infarction are two times higher among smokers;
  • the respiratory function: smokers are exposed to problems within the entire respiratory system, notably to the risk of chronic bronchitis and to the risk of lung cancer;
  • the digestive function: nicotine increases gastric acid secretion.

Tobacco limits the oxygen supply to the brain and muscles. It is responsible for headaches, dizziness, and a decreased resistance to exercise. Addiction is confirmed among most smokers, with withdrawal symptoms upon cessation (tension, nervousness, irritability, anxiety, or even depression).

In 2015, the annual number of deaths attributable to smoking was estimated to be around 75 000 (mainly due to cancer). Between 2000 and 2015, the proportion of attributable deaths appeared to decline over time for men, while this same proportion among women continuously increased by over 5% per year on average (Santé publique France).

Treatment

Smoking cessation carried out with the help of a health professional is mainly conducted in primary care settings. The issue of smoking treatment can also be observed from the sales figures for smoking cessation treatments (nicotine replacement therapies in the form of transdermal patches or orally, Zyban® and Champix®).

Sales have sharply increased in recent years due to their reimbursement which is no longer fixed, but under a system of common law, since 1 January 2019. This extension is also accompanied by a diversification of prescribers, given that, since 1 January 2016, nurses, masseur-physiotherapists, midwives, dental surgeons, and occupational health physicians have been able to prescribe nicotine replacement therapies.

In 2022, sales of smoking cessation treatments thus increased by 4.7% in comparison with 2021 (7 391 895 sales in treatment month equivalents). The rate of daily smokers having attempted to quit for at least a week within the last 12 months was down in 2022 (24.7%), while it was around 30% between 2019 and 2021, and around 25% between 2016 and 2019.

Perceptions/Opinions

According to the 2018 Survey on Representations, Opinions and Perceptions regarding psychoactive drugs (EROPP), a third of the French (34%) consider tobacco to be dangerous. After having doubled between 1999 and 2012, this proportion has been at a standstill since 2012 (41%). It is at the daily use stage that tobacco is most dangerous for 51% of French people (in comparison with 47% in 2012).

In 2017, more than nine in ten 17-year-olds (95%) agreed that smoking was dangerous, and there are still nine in ten (93%) determining that those who smoke one packet or more are posing a significant risk. Only 8% of these young people think that smoking occasionally can pose a significant risk. The qualitative survey on Attitudes, Perceptions, Aspirations and Motives surrounding the Introduction to psychoactive substances (ARAMIS) also shows that the image of tobacco is decidedly negative, and that it is highly stigmatised by all the minors surveyed who have gone through their childhood and adolescence under a statutory regime prohibiting the use of cigarettes in all public spaces.

Legal framework and recent public guidelines

Faced with the proven risks that tobacco poses to health, the promotion and sale of tobacco, as well as its use in public spaces, is regulated.

On the international scale: in 2003, the European Union, along with its 25 member states, including France, were signatories of the World Health Organisation (WHO)’s Framework Convention on Tobacco Control (CCLAT) dated 21 May 2003, the first international treaty for health. The law provides an increasingly strict framework on tobacco control.

On a national scale: the different measures taken in France have been subject to progressive roll-out via decrees and by means of various national plans: Cancer plans (2003-2007, 2009-2013, 2014-2019); to which a ten-year strategy spanning from 2021 to 2019 is added; the National Smoking Reduction Programme (PNRT) (2014 to 2019), and the National Tobacco Control Programme (PNLT) from 2018 to 2022, then from 2023 to 2027. The measures focus on several major pillars, such as the general ban on smoking in public spaces, the protection of minors, the restriction of rules on manufacture and trade, and treatment/prevention.

To go further

  • Stanislas Spilka, head of the OFDT's DATA unit comments on alcohol, tobacco and cannabis uses among young and adults in France in the last 25 years. The three products' dynamics are quite divergent: tobacco smoking has declined, but new patterns of alcohol consumption appeared and cannabis use increased gradually. https://youtu.be/mcP35m_Rfcs
  • Tabac et tabagisme en 2020, actualités et nouveaux enjeux – OFDT webinar of 25/11/2020 (in French) https://youtu.be/bMYw94X7XKk