Smoking among immigrant groups in metropolitan France: prevalence levels, male-to-female ratios and educational gradients

Myriam Khlat,Stéphane Legleye,Damien Bricard

doi:10.1186/s12889-018-5379-8

Abstract

BackgroundAlthough the French population comprises large and diverse immigrant groups, there is little research on smoking disparities by geographical origin. The aim of this study is to investigate in this country smoking among immigrants born in either north Africa, sub-Saharan Africa or French overseas départements.MethodsThe data originate from the 2010 Health Barometer survey representative of metropolitan France. The subsample of 20,211 individuals aged 18–70 years (born either in metropolitan France or in the above-mentioned geographical regions) was analysed using logistic regression.ResultsBoth immigrants from sub-Saharan Africa and immigrants from overseas départements were protected from smoking compared to the reference population, and the former had a distinctive strongly reversed educational gradient in both genders. Returned former settlers from the French colonies in North Africa (repatriates) had the highest smoking levels. Natives from the Maghreb (Maghrebins) showed considerable gender discordance, with men having both a higher prevalence (borderline significance) and a reversed gradient and women having lower prevalence than the reference population.ConclusionImmigrants from regions of the world in stage 1 of the cigarette epidemic had relatively low smoking levels and those from regions in stage 2 had relatively high smoking levels. Some groups had a profile characteristic of late phases of the cigarette epidemic, and others, some of which long-standing residents, seemed to be positioned at its early stages. The situation for Maghrebins reflected the enduring influence of gendered norms post-migration. Based on their educational gradients, immigrants from overseas départements (particularly men) and Maghrebin women may be at risk of losing their particularly low prevalence. Immigrants from sub-Saharan Africa could retain it. In-depth analysis of smoking profiles of immigrants’ groups is essential for a better targeting of smoking prevention and cessation programs.

Highlights

The French population comprises large and diverse immigrant groups, there is little research on smoking disparities by geographical origin
As education is a major determinant of health behaviours, and especially of smoking [23], we considered the highest level of education as a control variable
Maghrebins Immigrants from this group had a median age of 40 years at the time of the survey and a large proportion had arrived as adults

Summary

Introduction

The French population comprises large and diverse immigrant groups, there is little research on smoking disparities by geographical origin. As immigrants have overall a disadvantaged socioeconomic profile, they are disproportionately represented within the population subgroups which are more concerned by smoking. They seem to escape this social determinism in certain contexts, such as the USA. In this country, there is evidence in favour of a protective effect of immigrant status against smoking [2,3,4], to the point that differences in smoking have even been considered as the major cause of America’s migrant mortality advantage [5]. It has been argued that ignorance of immigrant status in the presentation of national-level statistics may obscure large disparities of relevance for the development of public health prevention programs [4]

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