Comparing Smoking Behaviors Between France and the United States: A Historical and Cultural Analysis




Dang, Christine

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BACKGROUND: The early 20th century represented a time of remarkable growth for the tobacco industry. After the link between smoking and lung cancer was solidified in the mid 20th century, smoking prevalence in developed countries has largely decreased. However, a subset of developed countries has not seen as large a decrease in smoking rates. The reasons for this divergence in smoking prevalence patterns have not been fully explored in the literature. France is one of the countries that has shown a decrease in smoking prevalence, yet their smoking prevalence is still much higher at 30% when compared to other developed countries such as the United States at 16%. These high rates of smoking in the general public also coincide with high rates amongst health professionals. Smoking status in health professionals has real effects on patient care--namely through decreased likelihood to engage in cessation counseling and less favorable perceptions of the importance of counseling. OBJECTIVE: This thesis will explore the effects of American and French government regulations on the usage of tobacco cigarettes in two time periods (1964-2009, and 2009-present day), the cultural ties to smoking and their change over time, prevalence of smoking amongst healthcare professionals, and the public health implications tied with physician smoking status. METHODS: Historical analysis was performed on legislation passed by the American and French government from 1964 - present day, different forms of media promoting tobacco usage, and physician smoking patterns and counseling practices. Sources in both the French and English language were used, and included but were not limited to research articles, book chapters, newspaper articles, and official government reports. RESULTS: The findings of this literature review suggest that compared to the United States, France has higher rates of smoking due to delayed government action at the height of the tobacco epidemic and cultural attachment to cigarette use. Both France and the U.S. have cultural ties to cigarette smoking. However, in France, the association of smoking with national identity through cigarette marketing tactics and the birth of café culture in the 1960s are large reasons why high smoking rates persist. The U.S.'s success in decreasing smoking rates over the latter half of the 20th century could largely be attributed to the stigma created around smoking and tobacco use, increasing the awareness of the medical complications of smoking by cultural icons, and mass public health campaigns. Though more prevalent in France, physician smoking remains an issue in both countries and is associated with decreased rates of cessation counseling and negative perceptions regarding the utility of cessation counseling. However, French patients are more likely to experience these negative downstream effects as France has higher smoking rates amongst physicians. CONCLUSION: This review provides a different perspective from previous literature in that it not only compares French and American government action, but it also analyzes the cultural underpinnings of tobacco use as well as its public health implications. Furthermore, it has revealed many areas in which both the United States and France could improve their public health strategies in combatting the tobacco epidemic as well as reasons why high smoking rates continue to persist in France.

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Pages 1-46 are misnumbered as pages 2-47.

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