The prevalence of smoking and exposure to tobacco smoke among men in France has fallen by more than 15 per cent since the mid 1980s, but over the same 20-year period has increased among women. As a result, investigators from the World Health Organization French MONICA (MONItoring trends and determinants in CArdiovascular disease) centre say the divergent smoking trends predict changes in death rates from coronary heart disease in French men and women since 1985 - estimated as a decline in men of 10-15 per cent, but an increase among women of 0.1-3.6 per cent.
Reviewing the smoking trends in France, the investigators say: "The prevalence of smoking in men has been high for the past 60 years and is now tending to fall, whereas women only started to smoke in large numbers much more recently."
Evidence is presented in the latest report of the MONICA investigators published in the December issue of the European Journal of Cardiovascular Prevention and Rehabilitation.(1) The aim of the study was to assess trends in the prevalence of adult smoking habits between 1985-1987 and 2005-2007 in three distinct areas of France and their likely contribution to coronary heart disease death rates.
The results are based on detailed surveys of mid-life adults (aged 35-64 years) in three distinct geographical regions of France: the Lille urban community in the north; the Bas-Rhin department in the east; and the Haute-Garonne department in the south. The surveys were conducted at three time points - 1985-87, 1995-97 and 2005-07 - and involved a total of more than 10,000 subjects.
They were each asked about earlier or current tobacco consumption, the number of cigarettes smoked per day, age at first cigarette, pipe tobacco and cigar consumption, quit attempts, age at quitting, and secondhand exposure. Answers provided not just a snapshot of smoking trends in France, but also a database by which the contribution of tobacco exposure to heart disease mortality risk could be plotted.(2)
The study found:
Smoking among men (aged 35-64 years)
- A significant decrease in current tobacco consumption between 1985-87 and 2005-07 from a prevalence rate of 40 to 24.3 per cent
- Prevalence among former smokers remained steady at 37 per cent
- Prevalence of never-smokers increased from 24.7 to 38.2 per cent
- Age at first cigarette remained stable - at approximately 17.5 years
Smoking among women (aged 35-64 years)
- A slight increase in tobacco consumption between 1985-87 and 2005-07 from 18.9 to 20 per cent
- An increase of prevalence among former smokers from 24.7 to 38.2 per cent
- A marked decrease in the prevalence of never-smokers from 72.4 to 54.6 per cent
- Age at first cigarette decreased from 21.4 years in 1995-97 to 18.8 years in 2005-07
The investigators note that the increase in tobacco exposure among women was mainly seen in the mid-1990s survey, especially in the 35-54 age group; this continued into the 2005-07 survey among the 45-64 age group. Among younger women the proportion of current smokers slightly decreased between the mid-1990s and mid-2000s.
When these figures were introduced to the risk prediction model, the estimated cardiovascular mortality rate was approximately 10 per cent lower in men aged 35-54 years and 15 per cent lower in men aged 55-64 years. However, in women the predicted heart disease mortality rate was higher by up to 4.9 per cent between 1995-97 and 2005-07.
Commenting on the results of the study investigator Dr Jean Dallongeville from the INSERM Institut Pasteur in Lille, France, said: "Men have reduced their exposure to tobacco from 40 to 24.3 per cent, representing a predicted fall in deaths from coronary heart disease. By contrast, women have increased their exposure resulting in a rise in the predicted heart disease death estimate.
These results, he said, may partly explain the decline in coronary heart disease mortality in men over the study period, but not seen in women, but he acknowledged the effect of other factors on trends in heart disease mortality.
The latest survey results showed that in 2005-07 one third of men aged 35-44 and one quarter of women described themselves as current smokers, with no apparent increase in the number of attempts to give up. "To continue the reduction in the level of risk factors for coronary heart disease, pressure must be maintained on anti-tobacco initiatives,' said Dr Dallongeville.
World Health Organization