Understanding political perceptions of tobacco policies and stakeholders in France: A qualitative study with parliamentarians.

Abstract

Introduction: Characterized by persistently high smoking prevalence, France nonetheless faces difficulties in implementing coherent and sustained tobacco control measures. To understand what sustains this situation, we explored how French parliamentarians perceive tobacco, tobacco control policies (with a focus on taxation), and the stakeholders they believe should inform policy decisions.

Methods: As all parliamentarians vote on tobacco control policies, between March and June 2022 we undertook 25 individual interviews with French senators and deputies representing diverse political affiliations and regions. Interviews were analyzed using reflexive thematic analysis, guided by Grounded Theory. The section on tax increases was analyzed deductively. We used NVivo 15 for data management.

Results: Among the 25 parliamentarians (17 senators, 8 deputies), they acknowledged the health and economic harms of tobacco, although some minimized its risks. They were more likely to consider media/educational campaigns and taxation as effective, and tobacco sales ban or plain packaging as not. Most accepted anti-tax arguments promoted by the tobacco industry (illicit trade, ineffectiveness, regressivity), and were more likely to engage with tobacconists than health stakeholders during consultations.

Conclusions: In line with streams identified in the Kingdon's Multiple Streams Framework (problem, policy, political), this study suggests that competing framings of tobacco, weak support for evidence-based measures and a political environment favorable to the tobacco industry, weakened prospects for sustained tobacco control. Our findings highlight the need for further research exploring narratives likely to influence policymakers' support for tobacco control measures.