Smoking and social inequalities in France, 20 years of evolution: A secondary dataset analysis of health barometers (2026)

Introduction: Since the early 2000s, smoking prevalence has declined overall in France. This study aims to describe the evolution of social inequalities in smoking in relation to anti-smoking policy between 2000 and 2021.
Methods: This study is a secondary analysis of data from Santé Publique France's Health Barometers, cross-sectional telephone surveys conducted between 2000 and 2021 on random samples of the French population aged 18-75 years (between 9074 and 28224 people were surveyed, depending on the edition). Evolutions in prevalence according to socio-economic status (level of education, income, and occupational status) were modeled using Poisson regression.
Results: Overall, social inequalities related to smoking increased between 2000 and 2021, with the prevalence of daily smoking rising among individuals with lower levels of education (from 30% to 32%), lower incomes or unemployed, while declining among more advantaged groups (e.g. from 28% to 17% for individuals with the highest levels of education). The analysis reveals three distinct phases: an increase in inequalities between 2000 and 2016, e.g. the association between smoking and a level of education below high school increased (adjusted interaction term, AIT=1.027; 95% CI: 1.021-1.033, per year) compared to those with a level of education above high school. Disparities then stabilized between 2016 and 2019. Finally, a resumption of the increase in inequalities related to education and income was observed between 2019 and 2021, e.g. over time, the association between smoking and a level of education below high school increased (AIT=1.071; 95% CI: 1.001-1.141).
Conclusions: The 2016-2019 period was marked by the first national tobacco control plan, including numerous measures that addressed social inequalities. Over the same period, smoking declined among all socio-economic groups, and differences in smoking prevalence according to socio-economic status have stabilized, bringing an end to 16 years of increase. Unfortunately, inequality began to rise again in 2020-2021, during the COVID-19 pandemic. [Author's abstract]