[The fight against smoking. The need to consider behavioral dependence]. / Lutte contre le tabagisme en France. L'indispensable prise en compte de la dépendance comportementale.

The prevalence of smoking in France remains very high compared to other developed Western countries. The management of smoking in smokers is often limited to nicotinic substitution, whether medicated or linked to the use of electronic cigarettes or varenicline and advices more or less reliable or helpful. This strategy of aiding smoking cessation, if isolated, leads to a high number of failures. It is therefore necessary to consider behavioral dependence, in the broad sense in three aspects, "behavioral" (the motor Gestures), cognitive (thoughts) and emotional (emotions). Behaviorists distinguish open (motor) and closed behaviors (cognitions and emotions), the latter two, emotions and cognitions, being quite often related. Practical examples of action in this direction are proposed.

[Influence of smoking among family physicians on their practice of giving minimal smoking cessation advice in 2008. A survey of 332 general practitioners in Maine-et-Loire]. / Le tabagisme des médecins généralistes a-t-il une influence sur l'abord du tabac en consultation en 2008 ? Enquête auprès de 332 médecins généralistes du Maine-et-Loire.

INTRODUCTION: Smoking among doctors would be an obstacle to effective smoking prevention, in particular the practice of minimal advice. OBJECTIVES: To assess the smoking habits of general practitioners (GPs) in the department of Maine-et-Loire and to study the link between their smoking status and their practice of minimal smoking cessation advice in 2008 in a legislative context unfavourable to smokers. METHODS: Three hundred and thirty-two GPs in the department of Maine-et-Loire answered a survey (response rate: 60%) investigating their own smoking habits and how they approach patients who smoke. RESULTS: The prevalence of active smoking among general practitioners responders was 18%, 34% were former smokers and 47% had never smoked. Regular smokers (10%) smoked on average 14 cigarettes a day and 51% were nicotine dependent (9% strongly). When consulting, 32% of doctors systematically addressed smoking habits, 20% said that they gave minimal smoking cessation advice regardless of their smoking status. Doctors who smoked were less prone to ask their patients if they smoke (p=0.002) and they believed that their smoking does not influence their practice of giving minimal smoking advice. Moreover, the incentive and coercive measures introduced in 2006 had no influence on the smoking status of physicians, but allowed them to speak more frequently about smoking to their patients. CONCLUSION: Minimal smoking cessation advice is applied systematically by only 20% of physicians regardless of their smoking status. Non-systematic smoking cessation advice benefited from the measures introduced in 2006.

[Pregnant women and smoking: descriptive study and prognostic factors to stop smoking during pregnancy]. / Le tabagisme gravidique. Etude descriptive et facteurs pronostiques d'arrêt du tabac pendant la grossesse.

UNLABELLED: Nicotine addiction (NA) is a serious public health problem. Today, smoking effects on the foetus and the mother are well known; however, studies into smoker's behaviour are lacking. The aim of our paper was to identify factors which influence either NA stopping or continuation during pregnancy. METHODS: It's a descriptive study, using a questionnaire, among pregnant women during prenatal consultation in a university hospital, at home with freelance mid-wives or in mother and infant welfare services (PMI). RESULTS: Two hundred and forty-one questionnaires were analysed. Smoker's behaviour, psycho-environmental factors, co-addictions, were described and compared. One out of four women was smoking during pregnancy and one out of ten was smoking more than 10cigarettes per day. One out of three women who were smokers before pregnancy, stated that they had stopped NA during the year. Only 58/241 readings of exhaled carbon monoxide were performed, which reflects hesitation of medical staff to employ this device. Forty seven women indicated the number of alcohol glasses consumed during pregnancy. The study showed that partner's attitude towards smoking, good or bad mood during pregnancy, number of cigarettes smoked before pregnancy and medical information would appear to be significant factors that influence NA stopping during pregnancy. CONCLUSION: The identification of prognostic factors for NA stopping is of primordial importance, especially among heavy smokers, in order to target the actions necessary to help NA stopping.