In 2022, Povaddo– a US-based polling organisation – carried out a survey into public perceptions of different aspects of tobacco control. The online survey, commissioned by PMI (Philip Morris International) included more than 13,500 adults from 13 EU countries where the smoking rate is at a consistent level of between 20 to 40%.
At an event hosted at the Hub Institute in Paris, Povaddo’s president and founder William Stewart presented the main findings of the survey, comparing French views with those of the other countries polled. The presentation was followed by comments and discussion with Jean-Daniel Lévy, Deputy Director of Harris Interactive, a French polling organisation, and Giorgio Rutelli, the Editor-in-Chief of Formiche magazine, which recently published a special issue on prevention and harm reduction in Italy, taking a multi-disciplinary approach bringing together researchers, associations and politicians.
Stewart provided a snapshot of the current situation in France. Smoking rates in France are among the highest in Europe, 25.3% smoke daily despite a steep increase in the price of cigarettes: 70% over ten years. In the 1980s Sweden’s smoking rate was over 30%. Today, thanks to snus and other new products, it is the lowest in Europe – 5,6%, five times less then in France. The UK, where smoking rate was similar to the French one, ago, now, thanks to vaping being encouraged and subsidised, has less than half the smokers of France.
France is now the largest market for illicit cigarettes in the EU accounting for 29% of illegal cigarette consumption, according to a study by KPMG in 2021. By comparison, other European countries which have had more measured increases in tobacco taxation, including Italy, have successfully cut illegal trade. The illicit trade has both damaged revenue from taxation and poses a risk to national security.
French respondents (83%) agreed that extreme tax increases can lead to an increase in illicit tobacco products. This has no doubt been exacerbated by the cost-of-living crisis and the fact that smokers are disproportionately represented among economically disadvantaged groups. Smokers also feel that they are treated unfairly and face a disproportionate tax burden. The French group believed (76%) that governments have failed to take into account the unintended consequences of its approach to tobacco reduction. At the same time the French (74%) are, perhaps unsurprisingly, much more aware than other countries surveyed (65%) of the problem that illicit tobacco and nicotine products present.
Public ahead of public policy
The survey found that the French group had a poorer knowledge of cigarette alternatives, such as e-cigarettes (40%) and heated tobacco products (14%), than their European peers. They also thought that adult smokers should be given accurate, scientifically substantiated information on smoke-free alternatives to cigarettes (69%). The French also seemed to think that taxing alternatives to tobacco in a similar way to tobacco would significantly reduce their appeal, but that the tariff should be enough to dissuade youth or non-smokers (66%).
French survey respondents overwhelmingly hold the view that the current anti-smoking policy (tax increases, restrictions on use and EU packaging rules) did not help smokers (56%, and 16% undecided). Rutelli argued for a new approach, “I think it is necessary to find a new, more effective approach toward the adult smokers who are not willing to quit. Countries need to evaluate the role of technologies and alternative, less harmful products in the fight against smoking, and adult smokers who would otherwise not quit should be made aware of the available smoke-free alternatives.” Rutelli pointed to the example of the UK and New Zealand where alternatives can even be prescribed for smokers.
A survey carried out by Public Health Franceestimated that the number of ex-daily smokers who quit smoking more than six months ago and who believed that e-cigarettes helped them quit could be estimated at around 700,000 people since the arrival of the e-cigarette on the market in France.
“We should engage policymakers, the scientific community, and civil society in a continuous debate on one of the most important public health issues of our time,” said Rutelli.
Lévy said that the media debate in France was, in a sense, focused more on the cultural impact of the French approach to tobacco control. The French media had tended to focus on illegal cross-border trade and the damage of anti-smoking laws had brought to local village bars and bistros. Nevertheless, public health continues to poll as an important issue in French elections and responses to parts of the Povaddo survey suggest that people are more open than policy makers in thinking of new approaches to cessation and harm reduction.
“The results of this survey show that the French public is open to a new policy strategy to tobacco control, because the ‘quit or die’ approach toward adult smokers that relies heavily on tobacco tax increases isn’t working and is, in fact, creating other negative consequences,” said Stewart.
In the conclusion to his presentation, Steward pointed to another survey carried out in 2022 by a different polling organisation. The poll found that the population in general see increasing taxes on tobacco as much less effective than promoting less harmful products. It also found that 61% of smokers agreed that being properly informed about less harmful alternatives would encourage them to stop smoking. The panel also agreed that debate and informed discussion on the real and unforeseen impact of taxation, as well as a better understanding of alternatives should be considered more fully and objectively assessed.