[Society. Why ban cigarette filters?] / Pourquoi faut-il interdire les filtres de cigarettes ?

WHY BAN CIGARETTE FILTERS? Tobacco consumption in the form of cigarettes is still perceived as being so ordinary that its result, the production of cigarette ends and their disposal, has long been invisible and overlooked. A cigarette end is composed of two parts: a remnant of unsmoked tobacco and a single-use plastic filter made of cellulose acetate. These two components are saturated with the many toxic products generated by cigarette combustion. The relatively recent growing awareness of the major contribution of cigarette filters to plastic pollution of soil, waterways, seas, and oceans has led to active national and international debate on the possibility and desirability of banning the use of these filters for environmental purposes. If such a ban were to be considered, it would be essential to anticipate the possible health consequences for cigarette smokers of such a measure. According to the World Health Organization (WHO), cigarette filters have no beneficial effect on smokers'health, and banning them is therefore becoming an ecologicalemergency.

POURQUOI FAUT-IL INTERDIRE LES FILTRES DE CIGARETTES ? La consommation de tabac sous la forme de cigarettes reste considérée comme tellement banale que ses conséquences, la production de mégots et leur élimination, ont longtemps été invisibles et négligées. Un mégot est constitué de deux parties : un reste de tabac non fumé entouré de papier et un filtre plastique à usage unique composé d'acétate de cellulose. Ces deux composants sont imprégnés par les nombreux produits toxiques résultant de la combustion de la cigarette. La prise de conscience, relativement récente, de l'importance majeure de la responsabilité des filtres de cigarettes dans la pollution plastique et chimique des sols, des cours d'eau, des mers et des océans conduit à une réflexion active, nationale et internationale, sur la possible et souhaitable interdiction de l'usage de c es filtres dans un bu t environnemental. Dans l'hypothèse où une telle interdiction serait envisagée, il est nécessaire d'anticiper les éventuelles conséquences sanitaires pour les fumeurs de cigarettes. Selon l'Organisation mondiale de la santé, les filtres de cigarettes n'ont aucun effet bénéfique sur la santé des fumeurs, et leur interdiction devient une urgence écologique.

["Nicotine industry: risk reduction,an exclusively financial objective"]. / "Industriede la nicotine : réduction des risques, un objectif exclusivement financier".

Nicotine industry: harm reduction, an exclusively financial objective The knowledge of tobacco smoking health effects, combined with the implementation of measures efficient on its use, leads to tobacco sale reduction with tobacco industry financial losses that, in order to survive, has to recruit new young consumers, and maintain current smokers' use. The industry promotes a new way for tobacco use that, according to it, would reduce harm: heat-not-burn tobacco. But, there is currently no independent scientific proof for such a harm reduction. In the meantime, it promotes a confusion among electronic cigarettes and heat-not-burn tobacco. Heat-not-burn tobacco is promoted via foundations, NGOs, prestigious third parties, mechanic sports financing, and publicity with a strong marketing targeting young people through social networks. The current French regulation concerning smoked tobacco, including plain pack and high taxes, doesn't apply on heat-not-burn tobacco.

"Industrie de la nicotine : réduction des risques, un objectif exclusivement financier La connaissance des risques liés au tabac fumé associée à la prise de mesures efficaces pour réduire sa consommation conduit à la baisse des ventes avec chute des profits de l'industrie du tabac qui, pour survivre, doit recruter de nouveaux jeunes consommateurs et maintenir les usagers actuels dans leur consommation. L'industrie propose un nouveau mode de consommation qui, selon elle, permettrait de réduire les risques : le tabac chauffé. Or, aucune preuve scientifique indépendante n'existe d'une telle réduction de risques. En même temps, elle entretient la confusion entre cigarettes électroniques et tabac chauffé. Le tabac chauffé est promu par le biais de fondations, associations, relais prestigieux, financement des sports mécaniques et publicités avec un marketing intense ciblant les jeunes par les réseaux sociaux. La réglementation française concernant le tabac fumé ne s'applique pas au tabac chauffé, lui permettant ainsi d'échapper au paquet neutre et autorisant des profits majeurs par taxation plus légère."

The Impact of Tobacco Smoking on Adult Asthma Outcomes.

Background: Tobacco smoking is associated with more severe asthma symptoms, an accelerated decline in lung function, and reduced responses to corticosteroids. Our objective was to compare asthma outcomes in terms of disease control, exacerbation rates, and lung function in a population of asthmatic patients according to their smoking status. Methods: We compared patients' demographics, disease characteristics, and lung-function parameters in current-smokers (CS, n = 48), former-smokers (FS, n = 38), and never-smokers (NS, n = 90), and identified predictive factors for asthma control. Results: CS had a higher prevalence of family asthma/atopy, a lower rate of controlled asthma, impaired perception of dyspnea, an increased number of exacerbations, and poorer lung function compared to NS. The mean asthma control questionnaire's (ACQ) score was higher in CS vs. NS and FS (1.9 vs. 1.2, p = 0.02). Compared to CS, FS had a lower rate of exacerbations, a better ACQ score (similar to NS), a higher prevalence of dyspnea, and greater lung-diffusion capacity. Non-smoking status, the absence of dyspnea and exacerbations, and a forced expiratory volume in one second ≥80% of predicted were associated with controlled asthma. Conclusions: CS with asthma exhibit worse clinical and functional respiratory outcomes compared to NS and FS, supporting the importance of smoking cessation in this population.

[Tobacco control in France: what's new ?] / Lutte contre le tabagisme en France : quoi de nouveau ?

French governments only very recently introduced comprehensive tobacco control policies including several measures recommended by WHO Framework Convention on Tobacco Control, leading to a speeding-up of tobacco smoking decrease, but still with a high current level of use. In the meantime, research confirms that nicotine is highly addictive, that smoking just a cigarette a day is highly detrimental for health, and that health professionals are efficient in helping smokers to give up. These measures are such diverse as tobacco taxes increases, introducing plain packs, promoting November as month without tobacco, getting tobacco cessation medications paid for by health insurances, implementing a comprehensive advertising ban of tobacco products in retailor shops, and increasing protection of public health policies from tobacco industry intrusion. This industry via frenzied marketing reacts by promoting "heat not burn tobacco" as a harm reduction mean, which it is not, and invests in e-cigarettes, whose most recent ones are as addictive as classic tobacco cigarettes.

LUTTE CONTRE LE TABAGISME EN FRANCE: QUOI DE NOUVEAU ?. Les gouvernements français proposent depuis seulement quelques années des programmes complets de mesures contre l'usage du tabac en s'appuyant sur les recommandations de la convention-cadre de l'Organisation mondiale de la santé pour la lutte anti-tabac, ce qui se traduit par une accélération de la baisse de sa consommation, avec toutefois une prévalence encore élevée. Parallèlement, les études confirment que la nicotine est une drogue forte, que fumer une seule cigarette par jour présente des risques sanitaires majeurs, et que les professionnels de santé peuvent aider les fumeurs à arrêter. Les mesures prises sont variées : augmentation des taxes, paquet neutre, Mois sans tabac, remboursement des traitements de la dépendance au tabac, interdiction de la publicité sur les lieux de vente, protection des politiques publiques de l'ingérence de l'industrie du tabac… Cette industrie réagit en promouvant le tabac chauffé via un marketing forcené sur une réduction des risques inexistante, et investit dans les cigarettes électroniques, dont les plus récentes sont aussi addictogènes que les cigarettes classiques.

Efficacy and safety of varenicline for smoking cessation in people living with HIV in France (ANRS 144 Inter-ACTIV): a randomised controlled phase 3 clinical trial.

BACKGROUND: Tobacco smoking is common in people living with HIV, but high-quality evidence on interventions for smoking cessation is not available in this population. We aimed to assess the efficacy and safety of varenicline with counselling to aid smoking cessation in people living with HIV. METHODS: The ANRS 144 Inter-ACTIV randomised, parallel, double-blind, multicentre, placebo-controlled phase 3 trial was done at 30 clinical hospital sites in France. People living with HIV who had smoked at least ten cigarettes per day for 1 year or longer, were motivated to stop smoking, were not dependent on another psychoactive substance, and had no history of depression or suicide attempt were eligible. Using a computer-generated randomisation sequence, we allocated (1:1) the patients to receive either varenicline titrated to two 0·5 mg doses twice daily or placebo twice daily for 12 weeks, plus face-to-face counselling. Patients and investigators were masked to treatment group allocation. Patients who were not abstinent at week 24 were offered open-label varenicline for 12 additional weeks. The primary outcome was the proportion of smokers continuously abstinent from week 9 to week 48. Smoking status was confirmed by carbon monoxide in exhaled air. Primary analyses were done in both the intention-to-treat (ITT) population and modified ITT (mITT) population, which comprised all patients who took at least one tablet of their assigned study treatment. The safety analyses were done in the mITT population. The trial is registered at ClinicalTrials.gov, number NCT00918307. The trial status is complete. FINDINGS: From Oct 26, 2009, to Dec 20, 2012, of 303 patients assessed for eligibility, 248 patients were randomly assigned to the varenicline group (n=123) or the placebo group (n=125). After randomisation, one participant initially assigned to the placebo group was excluded from the ITT analysis for a regulatory reason (no French health-care coverage). 102 patients in the varenicline group and 111 patients in the placebo group received at least one dose of their assigned treatment and were included in the mITT analysis. In the ITT analysis, varenicline was associated with a higher proportion of patients achieving continuous abstinence over the study period (week 9-48): 18 (15%, 95% CI 8-21) of 123 in the varenicline group versus eight (6%, 2-11) of 124 in the placebo group, adjusted odds ratio (OR) 2·5 (95% CI 1·0-6·1; p=0·041). In the mITT analysis, varenicline was also associated with higher continuous abstinence: 18 (18%, 95% CI 10-25) of 102 versus eight (7%, 2-12) of 111 in the placebo group (adjusted OR 2·7, 95% CI 1·1-6·5; p=0·029). The incidence of depression was 2·4 per 100 person-years (95% CI 0·6-9·5; two [2%] of 102) in the varenicline group and 12·4 per 100 person-years (95% CI 6·9-22·5; 11 [10%] of 111) in the placebo group. 14 (7%) of 213 participants had 18 cardiovascular events: six (6%) of 102 people in the varenicline group and eight (7%) of 111 people in the placebo group. INTERPRETATION: Varenicline is safe and efficacious for smoking cessation in people living with HIV and should be recommended as the standard of care. FUNDING: The French National Institute for Health and Medical Research (INSERM)-French National Agency for Research on AIDS and Viral Hepatitis (ANRS) and Pfizer.

Guidelines on smoking management during the perioperative period.

Smoking is a public health problem of particular importance during the perioperative period, since it exposes patients scheduled for surgery to risk increases of 20% in hospital mortality and 40% in major postoperative complications. In addition, current smoking increases almost all specific surgical complications. The perioperative period offers a genuine opportunity for smoking cessation. The rate of preoperative smoking cessation can be increased significantly by offering behavior management and the prescription of a nicotine substitute before any scheduled surgical intervention. Preoperative smoking cessation should be routinely recommended independently of the timing of the intervention, even though the benefits increase in proportion with the length of cessation. All professionals of the care pathway (general practitioners, surgeons, anesthetists-intensivists, caregivers) must inform smokers of the positive effects of smoking cessation and offer them dedicated management and personalized follow-up. In children, cessation of parental smoking or removal of the child from environmental tobacco smoke as long before surgery as possible is indispensable.

Beliefs and behaviour about smoking among inflammatory bowel disease patients.

BACKGROUND AND AIMS: We investigated the beliefs and behaviours about tobacco among inflammatory bowel disease (IBD) patients. MATERIALS AND METHODS: A questionnaire of 18 items was developed and administered to all consecutive patients followed for IBD at Nancy University Hospital from October 2012 to March 2013. RESULTS: Two hundred and thirty-one patients participated in the survey [Crohn's disease (CD)=171, ulcerative colitis (UC)=60]. Among IBD patients who were smokers at diagnosis, 10.5% of CD patients versus 14.3% of UC patients believed that tobacco could have triggered their IBD; about half the CD smokers at diagnosis were not aware that smoking might promote their disease. Three quarters of smokers after diagnosis knew that tobacco was not beneficial for their CD, whereas all UC were aware that smoking had a beneficial effect on their disease course. About half of the CD patients had stopped smoking during a flare-up. Four former smokers with UC (21.1%) resumed smoking during a relapse. Nearly 90% of IBD current smokers wished to quit smoking. About half the IBD patients were aware of the relation between smoking and IBD, and the Internet was a source for 24.3% of these patients. CONCLUSION: The majority of IBD patients are unaware of the effects of tobacco on their disease. Better information through a therapeutic education programme should be systematically recommended in IBD.

Efficacy of a smoking cessation program in a population of adolescent smokers in vocational schools: a public health evaluative controlled study.

BACKGROUND: To evaluate the public health efficacy of a community-based smoking cessation program (TABADO) among vocational school trainees (15 to 20 years old). METHODS: This prospective, controlled, quasi-experimental study was conducted in eight vocational training centres (VTC) in France. The intervention group underwent the TABADO program, which included a general information session for all students and small-group sessions plus individual counselling and nicotine therapy, if needed, for volunteers in an enhanced program. The control group received no specific intervention other than the educational services usually available. The primary outcome was 30-day point prevalence abstinence at 12 months. RESULTS: The mean age of the 1,814 students included was 16.9 years (SD = 1.0); 84.7% were males. At baseline, 52% were smokers and 5.7% ex-smokers. In the intervention group, 24.6% of smokers volunteered for the enhanced program and 18.1% could be included. By 12-month follow-up, with participants lost to follow-up considered non-abstinent, 10.6% of smokers in the intervention group had become abstinent versus 7.4% in the control group (adjusted p = 0.03; odds ratio [OR] = 1.8; 95% confidence interval [CI] = 1.05-3.0); considering lost to follow-up as missing data, 17% of intervention group participants were abstinent versus 11.9% in the control group (univariate p = 0.08; adjusted p = 0.008; OR = 2.1; 95% CI = 1.2-3.6). CONCLUSION: The TABADO program, targeting teenagers in vocational schools, was effective in producing a higher 12-month abstinence rate among all smokers in the intervention group. TRIAL REGISTRATION: Clinical trial identification number is NTC00973570.

Tobacco advertising through French TV in 2005: frequent illicit broadcasting; its impact on teenagers and young adults.

BACKGROUND: Sports sponsorship is one of the tobacco industry's main strategies to recruit new smokers among teenagers and young adults. METHODS: Monitoring Motor sports illicit broadcasting based on six channels in 2005; Dakar Rally (DR) and China Grand Prix impact evaluated with a one on one questionnaire administered on 12-24-year-old males and females (n = 805). RESULTS: 75,000 TV tobacco sponsoring appearances (90 h) were observed, total value: euro200.10(6); Mild Seven, Marlboro, West, Lucky Strike, Gauloises Blondes accounted for 92% appearances and 95% of euro values, with illegal broadcasting value worth euro19.10(6). A high interest in DR (71%) and Formula One (F1) (66%) was observed among males (versus females; P < 0.001), increasing with age (P < 0.05). Levels of spontaneous and assisted recall of cigarette brands were high among individuals interested in DR and F1, with better recall of brand names (versus non interested; P < 0.01); all individuals made correct associations between tobacco brands and car colors (P < 0.01). A non-significant higher percentage of daily smokers was observed among respondents interested in DR (34 versus 21%; P < 0.01) and F1 (30 versus 24%; P = 0.10). CONCLUSION: This high level of indirect advertising for tobacco through motor sport sponsoring confirms the urgent need for a worldwide absolute ban on tobacco advertising in motor sports.

TABADO: "evaluation of a smoking cessation program among adolescents in vocational training centers": study protocol.

BACKGROUND: Most of the efforts to reduce teenagers' tobacco addiction have focused on smoking prevention and little on smoking cessation. A smoking cessation program (TABADO study), associating pharmacologic and cognitive-behavioural strategy, on a particularly vulnerable population (vocational trainees), was developed. This study aims to evaluate the efficacy of the program which was offered to all smokers in a population aged 15 to 20 years in Vocational Training Centers (VTC). This paper presents the TABADO study protocol. METHODS: The study is quasi-experimental, prospective, evaluative and comparative and takes place during the 2 years of vocational training. The final population will be composed of 2000 trainees entering a VTC in Lorraine, France, during the 2008-2009 period. The intervention group (1000 trainees) benefited from the TABADO program while no specific intervention took place in the "control" group (1000 trainees) other than the treatment and education services usually available. Our primary outcome will be the tobacco abstinence rate at 12 months. DISCUSSION: If the program proves effective, it will be a new tool in the action against smoking in populations that have been seldom targeted until now. In addition, the approach could be expanded to other young subjects from socially disadvantaged backgrounds in the context of a public health policy against smoking among adolescents. TRIAL REGISTRATION: Clinical trial identification number is NTC00973570.