BackgroundRecently, France has intensified tobacco control policies which included gradual increase in tobacco product price and the introduction of plain packaging. However, there has been suggestion that cross-border tobacco purchases from neighbouring countries, with lower tobacco prices, will increase. We examine trends in cross-border tobacco purchases among smokers concurrent with the implementation of tobacco control measures between 2016 and 2017.MethodsDescription des Perceptions, Images, et Comportements liés au Tabagisme is a two-wave cross-sectional national telephone survey of French adults aged 18–64 years, which recruited a total of 2167 smokers (2016: n=1238; 2017: n=929). Data were weighted to be representative of the French adult population. The association between study wave and cross-country tobacco purchases was examined across study waves using a multivariable logistic regression model (adjusted ORs: ORa (95% CI)).ResultsLess than half (38.5%) of smokers declared cross-border tobacco purchases in the last year, which were mostly done on occasional basis: 22.6% purchased tobacco cross-border once or twice yearly. In 2017, as compared with 2016, cross-border tobacco purchases by French smokers decreased (ORa=0.81, 95% CI 0.68 to 0.98). Other factors associated with cross-border tobacco purchases included sex, and driving distance to a border.ConclusionIn France, the increase in tobacco product price and the introduction of plain packaging did not contribute to increasing rates of out-of-country purchases of tobacco products, probably due to the overall decrease in smoking levels. However, a harmonisation of tobacco product prices and plain packaging policies across Europe might further improve tobacco control throughout the continent.

Background Electronic cigarette (e-cigarette) use has spread among adolescents in many countries, however users’ characteristics are not well known. We aimed to compare characteristics of exclusive e-cigarette users to those of exclusive tobacco users and dual users. Methods Data come from a representative sample of 11–19 years old students in Paris, surveyed each year between 2013 and 2017. Current e-cigarette and tobacco use were ascertained in the preceding 30 days. Data were analyzed using random intercept multinomial logistic regression models, exclusive tobacco smokers being the reference group. Results Among the 17,435 students included, 2.3% reported exclusive e-cigarette use, 7.9% exclusive tobacco use and 3.2% dual e-cigarette and tobacco use. Compared to exclusive tobacco smokers, e-cigarette users were: a) less likely to use cannabis (adjusted Odds-Ratio (aOR) = 0.15, 95% confidence interval (95% CI) = 0.09–0.25); b) more likely to initiate smoking with an e-cigarette or a hookah rather than traditional cigarettes (aOR = 2.91, 95% CI = 1.74–4.87 and aOR = 15.99, 95% CI = 8.62–29.67, respectively). Additionally, exclusive e-cigarette users are younger with an aOR = 0.29 (95% CI = 0.17–0.49) among 13–15 years and aOR = 0.11 (95% CI = 0.06–0.21) among > 17 years as compared to 11–13 years. The probability of being an exclusive e-cigarette user is lower among participants whose best friend smokes tobacco (aOR = 0.30, 95% CI = 0.20–0.44). Exclusive tobacco users and dual users have similar profiles. Conclusions Adolescents who only used e-cigarettes had intermediate levels of risk compared to nonusers and those who used tobacco and/or e-cigarettes, suggesting that e-cigarettes use extends to young people at low-risk of using tobacco products.

Background The introduction of new anti-tobacco measures in France (plain tobacco packaging, higher prices) might encourage smokers to buy their tobacco from other sources than tobacco shops. We examine whether these measures increased the likelihood of smokers purchasing tobacco abroad, depending on their driving distance from the border of a neighboring country with lower tobacco prices. Methods DePICT is a two-wave cross sectional national telephone survey examining the French population tobacco-related perceptions and behaviors before and after the introduction of the new measures in 2017. Smokers were asked whether they bought tobacco from abroad in the last 12 months. Shortest driving distances to neighboring countries’ border were calculated using Google Maps (<100 Km, 100-200 Km, 200-300 Km, >300 Km and Ile-de-France (IDF)). Data was weighted to be representative of the population living in France. Multivariate regressions, adjusted on socio-demographic characteristics as well as substance use behaviors, were carried out. Results Compared to smokers living at more than 300 Km from a border, those living near a border, and in IDF were significantly more likely to have bought tobacco from abroad (<100 Km: ORadjusted = 3.98; 100-200 Km: ORadjusted = 2.04; 200-300 Km: ORadjusted = 1.47; IDF: ORadjusted = 1.32). Smokers in wave 2 (n = 929) were significantly less likely than those in wave 1 (n = 1238) to have bought tobacco abroad (ORadjusted = 0.81 [95% CI: 0.69-0.96]). It was mainly smokers who were in a driving distances of 100-200 Km, and 200-300 Km who were significantly less likely to buy abroad across the 2 waves (respectively ORadjusted = 0.56 [95% CI: 0.34-0.92] and ORadjusted = 0.50 [95% CI: 0.27-0.92]). Supplementary analyses showed that it was mainly for men and smokers born in France that the decrease was significant. Conclusions Our results suggest that the new anti-tobacco measures did not increase out of country tobacco purchases by smokers. Key messages The introduction of new anti-smoking measures (increase in price, plain tobacco packaging) did not increase the likelihood of smokers purchasing tobacco from abroad. It was mainly male smokers and smokers born in France that had a decreased likelihood of purchasing tobacco from abroad after the introduction of new anti-tobacco measures.