Cigarettes and social differentiation in France: is tobacco use increasingly concentrated among the poor? (2009)

AIMS: This paper aimed to assess whether the increase of social differentiation of smoking is observed in France. DESIGN AND SETTING: Five cross-sectional telephone surveys conducted in France between 2000 and 2007. PARTICIPANTS: The surveys were conducted among national representative samples of French subjects aged 18-75 years (n=12 256, n=2906, n=27 499, n=2887, n=6007 in 2000, 2003, 2005, 2006 and 2007, respectively). We focused on three groups: executives, manual workers and the unemployed. MEASUREMENTS: Time trends of smoking prevalence were assessed, and socio-economic factors (especially occupation and job status) associated with smoking were identified and compared in 2000 and 2005. We also computed respondents' equivalized household consumption (EHI) and their cigarette budget to assess the financial burden of smoking. FINDINGS: Between 2000 and 2007, smoking prevalence decreased by 22% among executive managers and professionals and by 11% among manual workers, and did not decrease among the unemployed. Indicators of an underprivileged social situation were associated more markedly with smoking in 2005 than in 2000. In addition, the falling-off of smoking initiation occurred later and was less marked among manual workers than it was among executive managers and professionals. Finally, in 2005 15% of French smokers devoted at least 20% of their EHI to the purchase of cigarettes, versus only 5% in 2000, and smoking weighted increasingly heavily on the poorest smokers' budgets. CONCLUSIONS: While these results point out an increased social differentiation in tobacco use, they underline the need to design and implement other forms of action to encourage people to quit, in particular targeting individuals belonging to underprivileged groups.