[Preventing tobacco sales to minors]. / Pour qu'acheter du tabac ne soit plus un jeu d'enfant !

Preventing tobacco sales to minors. Since 2009, selling tobacco products in France to minors less than 18 years of age is forbidden by law, but this law is poorly enforced even though tobacco use mainly begins at adolescence. The aim of this study was to identify measures implemented by foreign countries leading to a better enforcement of tobacco sale ban to minors. The main measures are: organizing tobacco retailers training programs; using automated age-verification systems; requiring a valid photo ID from anyone who looks under the age of 25; developing communication campaigns directed to the general public in order to explain and promote age control for customers. Furthermore, in all studied countries, the only effective controls rely on "mystery shopping" with underage shoppers accompanied by dedicated inspectors, attempting to purchase tobacco products. In case of non-compliance with the law, these controls must lead to dissuasive financial as well as administrative penalties. In all studied countries, an efficient implementation of these measures has led to reduced tobacco sales to minors, and thus contributed to bring down underage smoking.

Pour qu'acheter du tabac ne soit plus un jeu d'enfant ! En France, la vente de tabac est interdite aux moins de 18 ans depuis 2009, mais la loi est peu respectée alors que la plupart des nouveaux fumeurs commencent leur consommation à l'adolescence. Cette étude a pour objectif d'identifier les mesures mises en œuvre par des pays tiers permettant une meilleure application de l'interdiction de vente de tabac aux mineurs. Parmi ces mesures : la formation des détaillants de tabac ; l'utilisation dans les points de vente de systèmes de vérification automatisée de l'âge ; une vérification de l'âge de toute personne ayant l'apparence d'avoir moins de 25 ans ; le développement de campagnes de communication grand public pour expliquer et promouvoir le contrôle de l'âge des clients. Par ailleurs, les inspections « clients mystères ¼ apparaissent dans tous les pays étudiés comme le seul moyen de contrôle efficace. En cas de non-respect de la loi, ces inspections doivent donner lieu à des sanctions réelles et dissuasives, financières et administratives. Dans les pays étudiés, la mise en place conjointe de ces différentes mesures a permis de réduire la vente de tabac aux mineurs et de contribuer ainsi à diminuer le tabagisme des adolescents.

Protocol for creating new warnings on cigarette packs and evaluating their efficacy in a randomised experimental setting.

INTRODUCTION: Tobacco smoking is one of the leading causes of preventable death. This is not inevitable as tobacco control tools have become more powerful and more effective. Among these, warnings on cigarette packs have proven to be somewhat effective. Our objective is to increase the efficacy of antismoking warnings by using innovative psychological approaches and to create an experimental setting for the evaluation of these new warnings based on behavioural indicators. METHODS AND ANALYSIS: First, we created new warnings based on three categories of motivational leverage and on harm reduction. New warnings with innovative texts and pictures were designed for each category and inserted on plain packs. We will then use standard indicators to compare their effect to that of control packs: plain pack without warning, plain pack with conventional warning and branded pack with conventional warning. Second, the novelty of our approach will consist in designing an experimental protocol that uses monetary incentives to evaluate the effect of warnings. Subjects will be able to 'sacrifice' part of their participation defrayal to purchase a good whose subjective value is related to one's attitude towards smoking. These monetarily incentivised measures are designed to assess smokers' immediate/mid-term intention to quit and non-smokers' aversion to smoking. In both cases, the monetary amounts individuals accept to sacrifice may be a more reliable measure than declarative responses, which may be distorted by several hypothetical biases. In the end, we should be able to robustly measure the impact of our new warnings between intervention and control groups by using both traditional indicators and our new monetarily incentivised measure. ETHICS AND DISSEMINATION: The ethics committee of the Groupement des Hôpitaux de l'Institut Catholique de Lille approved the research protocol on 5 July 2019 (CIER 2019-22). Results will be presented at scientific meetings and published.

Does smoke cross the border? Cigarette tax avoidance in France.

This paper examines the impact on cigarette sales of the successive increases in cigarette prices in France from 2002 to 2004. Since the price differential between France and neighboring countries increased over the period in question, cross-border purchases became more financially attractive for smokers living near borders. Results from difference-in-differences estimates indicate that the decrease in cigarette sales observed in French border departments was around 20 % higher from 2004 to 2007 compared to non-border departments. The loss of fiscal revenue due to cross-border shopping since the tax increase amounts to 2 billion euros over the period 2002-2007. Our findings highlight the need for improved coordination of policies aimed at reducing tobacco consumption across European Union countries.

Costs and benefits of improving access to psychotherapies for common mental disorders.

BACKGROUND: Structured psychotherapies are treatments used in common mental health disorders (CMHDs) that are recommended by international good practice guidelines. Their efficacy and positive impact on health--and thereby on the reduction of related costs for health insurance schemes and society--have been widely demonstrated. However in France, despite the considerable financial burden of CMHDs, psychotherapies with a non-medical psychotherapist are not reimbursed by the health insurance schemes. AIMS OF THE STUDY: To assess the cost of coverage for psychotherapies by the health insurance bodies for adults aged 18 to 75 with CMHDs--depressive or anxious disorders, severe or recurrent--and to estimate the cost-benefit ratio for these psychotherapies for the community. METHODS: The data was derived from l'Enquete Indicateurs de sante mentale dans quatre regions francaises 2005, which is a cross-sectional study on 20,777 adults in the general population. Telephone interviews were backed up by the CIDI-SF. The Sheehan Disability Scale was used to assess the severity of the disorders. The proportion of patients who would agree to and then attend psychotherapies was estimated using the methodology developed in the UK in the Improving Access to Psychological Therapies programme, adapted to the French setting. The number of sessions to be covered was defined according to recommendations by the National Institute for Health and Clinical Excellence. The cost was estimated to be 41 per session, the reimbursement rate was set at 60% for the compulsory health coverage system. The annual costs engendered by CMHDs were estimated to be 4,702 for depressive disorders and 1,500 for anxiety disorders. The remission rate attributable to psychotherapies was estimated to be 30% pm10%. RESULTS: For average series of 10 sessions (anxiety disorders) to 18 sessions (depressive disorders) the yearly cost of psychotherapies would be 514 million Euros, of which 308 million would be covered by the compulsory coverage system, to treat 1.033 million patients, or 2.3% of the population. For patients with depressive disorders, 1 spent by the community for the psychotherapy would enable the community a saving of 1.95 (1.30-2.60), and for anxiety disorders a saving of 1.14 (0.76-1.52). DISCUSSION: This programme for provision of coverage for psychotherapies would have a positive impact for the community as a whole, in terms of quality-of-life, health and absenteeism. Funding psychotherapies proves to be a cost-efficient investment in the short and the long term, and this is backed up further by the fact that the impact of psychotherapies on somatic disorders interacting with CMHDs was not taken into account here. IMPLICATIONS FOR HEALTH POLICIES, HEALTH CARE PROVISION AND USE: Decision-makers in the health insurance schemes will thus have reliable medico-economic data available to assist in decisions for a possible policy for reimbursement of psychotherapies. Financial coverage of psychotherapies would in particular enable access to treatment by people for whom the financial barrier would have prevented access to this treatment. Furthermore, reimbursing sessions with non-medical psychotherapists could also improve conditions of care-provision by mental health professionals. Finally, this model could be replicated in other countries where the health system is sufficiently comparable to that prevailing in France. IMPLICATIONS FOR FUTURE RESEARCH: An in-depth study is required to detail cost and benefit of providing insurance coverage for psychotherapies for the different protagonists involved in this funding, and its effects.

The role of family incomes in cigarette smoking: evidence from French students.

In this paper, we study the smoking behavior of students aged from 18 to 25 using four cross-section data sets collected in France from 1997 to 2006. We focus on the role played by student income and parental resources. We find that both the probability of smoking and the number of cigarettes smoked are positively correlated to family resources. Among students, only wages earned and transfers received from parents increase smoking participation. However, sensitivity to income remains weak since a rise of 1% in income of either the students or their parents leads to an increase in smoking prevalence of about 0.15-0.20%.

Economic constraint and modes of consumption of addictive goods.

BACKGROUND: To see how economic recession, or, more generally, how increased economic constraint amongst drug users may impact their behaviour regarding the mode of drug consumption. METHODS: The theoretical framework is the theory of rational addiction - drug users are considered to be rational and well-informed about the way they use drugs and the consequences of using them. Surveys in the specialist literature dealing with the potential changes in the economic context of drugs users, and with the mechanisms of the bioavailability of psychoactive substances are examined in order to highlight one of the strategies drug users can implement to circumvent economic problems - namely a change in the mode of administration. An examination of ethnographic studies and French data are also used to test our assumptions. RESULTS: Changes in the mode of drug consumption can be the result of a maximization behaviour. Injection is the most effective way to reach a maximum bioavailability of substances. There is evidence in favour of the hypothesis that in times of economic recession, when the economic resources of drug users can decrease, they may prefer injection to other modes of administration in order to maximize the effect of what they have purchased. CONCLUSION: In times of economic recession, harm reduction policy has to be reinforced as injection behaviour can increase. As a result, economic and social policies should be an integral consideration for health policy issues.

Two ways of estimating the euro value of the illicit market for cannabis in France.

INTRODUCTION: The most recent health surveys in general population are used in order to estimate the annual market size for cannabis in France in 2005. METHODS: Two methods for arriving at an estimate are proposed: the first based on reported consumption, the other on reported expenditure on cannabis. RESULTS: The annual sales figure for cannabis in France is between 746 and 832 million euro. Men's expenditure accounts for between 80 and 85% of total expenditure and those aged between 15 and 24 years account for the greatest part of the size of the cannabis market, between 57 and 60%, depending upon the method. CONCLUSIONS: According to these estimates, consumers' average annual expenditure on cannabis is around euro 202 in France, compared to estimates obtained for New Zealand and Holland (euro 124) and the United States (euro 362).