ArticleTobacco induced diseases2026
Smoking and social inequalities in France, 20 years of evolution: A secondary dataset analysis of health barometers.
Article in Tobacco induced diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionSince 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.
methodsThis 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.
resultsOverall, 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).
conclusionsThe 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.
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