IMPORTANCEThe electronic cigarette (EC) has become popular among smokers who wish to reduce their tobacco use levels or quit smoking, but its effectiveness as a cessation aid is uncertain.OBJECTIVE To examine the association of regular EC use with the number of cigarettes smoked per day, smoking cessation among current smokers, and smoking relapse among former smokers. DESIGN, SETTING, AND PARTICIPANTSThe CONSTANCES (Consultants des Centres d'Examens de Santé) cohort study, based in France, began recruiting participants January 6, 2012, and is currently ongoing. Participants were enrolled in CONSTANCES through 2015, and included 5400 smokers (mean [SD] follow-up of 23.4 [9.3] months) and 2025 former smokers (mean [SD] follow-up of 22.1 [8.6] months) at baseline who quit smoking in 2010, the year in which ECs were introduced in France, or afterward. Analyses were performed from February 8, 2017, to October 15, 2018. MAIN OUTCOMES AND MEASURESThe association between EC use and the number of cigarettes smoked during follow-up was studied using mixed regression models. The likelihood of smoking cessation was studied using Poisson regression models with robust sandwich variance estimators. The association between EC use and smoking relapse among former smokers was studied using Cox proportional hazards regression models. All statistical analyses were adjusted for sociodemographic characteristics, duration of follow-up, and smoking characteristics. RESULTSAmong the 5400 daily smokers (2906 women and 2494 men; mean [SD] age, 44.9 [12.4] years), regular EC use was associated with a significantly higher decrease in the number of cigarettes smoked per day compared with daily smokers who did not use ECs ] vs -2.7 [95%CI, -3.1 to -2.4]), as well as a higher adjusted relative risk of smoking cessation (1.67; 95%CI, 1.51-1.84]). At the same time, among the 2025 former smokers (1004 women and 1021 men; mean [SD] age, 43.6 [12.1] years), EC use was associated with an increase in the rate of smoking relapse among former smokers (adjusted hazard ratio, 1.70; 95%CI, 1.25-2.30).CONCLUSIONS AND RELEVANCE This study's findings suggest that, among adult smokers, EC use appears to be associated with a decrease in smoking level and an increase in smoking cessation attempts but also with an increase in the level of smoking relapse in the general population after approximately 2 years of follow-up.
BackgroundPlain packaging (PP) of tobacco products and increased graphic warnings may contribute to lower attractiveness of smoking, particularly among youths. In France, this policy was introduced on 1 January 2017. We examined changes in smoking-related perceptions and behaviours among a nationwide sample of French adolescents before (2016) and 1 year post (2017) implementation.MethodsDePICT is a two-wave cross-sectional national telephone survey of adolescents aged 12–17 years per study wave (2016: n=2046 2017: n=1999). All participants reported smoking-related perceptions, as well as ever and current tobacco use. Smokers were also asked about their perceptions of tobacco brands. Data were weighted to be representative of youths in the French population: adjusted prevalence ratios (PRs, 95% CI) estimating changes between the two study waves were calculated using multivariate log-binomial regression models.ResultsIn 2017, as compared with 2016, French adolescents were more likely to report fear of the consequences of smoking (PR=1.06, 95% CI 1.02 to 1.09) and that smoking is dangerous (PR=1.08, 95% CI 1.05 to 1.11). They were also less likely to report that their friends (PR=0.61, 95% CI 0.54 to 0.70) and family (PR=0.51, 95% CI 0.44 to 0.60) accept smoking. Additionally, smoking initiation significantly decreased (PR=0.96, 95% CI 0.93 to 0.98) and a non-statistically significant drop in current tobacco use was observed (PR=0.93, 95% CI 0.78 to 1.11). Smokers’ attachment to their tobacco brand also decreased (PR=0.47, 95% CI 0.30 to 0.73).ConclusionOur findings suggest that PP and increased graphic warnings could contribute to changes in smoking norms and rates among adolescents.
BackgroundThe scientific literature on the impact of early childcare on children’s behavioural and emotional difficulties shows contrasting results. We studied this association in France, where childcare is of high quality and children enter preschool at the age of 3.Methods1428 children from the EDEN (Etude des Déterminants du développement et de la santé de l’ENfant) mother–child cohort set up in France (Nancy and Poitiers) were followed up since pregnancy to the age of 8 years. Group-based trajectory modelling was used to model their trajectories of behavioural and emotional symptoms (emotional symptoms, peer relationship problems, hyperactivity/inattention, conduct problems, prosocial behaviours) ascertained by three measures (3, 5.5 and 8 years) of the Strengths and Difficulties Questionnaire. Using propensity scores and inverse probability weights (IPWs) to account for selection and confounding factors, we compared children in a childminder’s care or in centre-based childcare (from birth to age 3) with those in informal childcare.ResultsCompared with children in informal childcare, those who attended centre-based childcare had a lower likelihood of having high levels of emotional symptoms (ORIPW-adjusted=0.35, 95% CI 0.17 to 0.71), peer relationship problems (ORIPW-adjusted=0.31, 95% CI 0.15 to 0.67) and low prosocial behaviours (ORIPW-adjusted=0.50, 95% CI 0.28 to 0.90). Those who were looked after by a childminder had a higher likelihood of following a high trajectory of conduct problems (ORIPW-adjusted=1.72, 95% CI 1.05 to 2.81). Attendance of centre-based childcare for more than 1 year was especially protective of high levels of emotional, peer-related difficulties and low prosocial behaviours. Girls and children from a favourable socioeconomic background reaped more benefits of childcare than boys and those from a less favourable background.ConclusionHigh-quality centre-based childcare may be linked to lower levels of emotional symptoms.
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