{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T08:28:47Z","timestamp":1790756927864,"version":"4.1.0"},"reference-count":54,"publisher":"CAIRN","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,22]]},"abstract":"<jats:p>La pr\u00e9valence et la s\u00e9v\u00e9rit\u00e9 du tabagisme sont particuli\u00e8rement \u00e9lev\u00e9es dans les populations en situation de pr\u00e9carit\u00e9 et font du tabagisme un d\u00e9terminant essentiel des in\u00e9galit\u00e9s sociales de sant\u00e9, du fait de son impact particuli\u00e8rement catastrophique sur la sant\u00e9 de ces populations. La r\u00e9duction g\u00e9n\u00e9rale du tabagisme, moins importante dans les populations d\u00e9favoris\u00e9es, contribue \u00e0 accro\u00eetre encore ces in\u00e9galit\u00e9s et le tabagisme a tendance \u00e0 se concentrer dans les populations les plus vuln\u00e9rables. Les relations entre tabac et pr\u00e9carit\u00e9 sont examin\u00e9es en identifiant, sur la base d\u2019une revue de la litt\u00e9rature, les principaux facteurs communs de vuln\u00e9rabilit\u00e9\u00a0: stress et adversit\u00e9 sociale, auto-stigmatisation, faible sentiment d\u2019auto-efficacit\u00e9, fonction sociale du tabagisme, ambivalence de la demande, addictions associ\u00e9es, s\u00e9v\u00e9rit\u00e9 de la d\u00e9pendance au tabac, \u00e9loignement des dispositifs d\u2019aide et de soins\u2026\u00a0Une attention sp\u00e9cifique est pr\u00eat\u00e9e \u00e0 certaines conditions particuli\u00e8res\u00a0: troubles mentaux, addictions (hors-tabac), mal-logement, d\u00e9tention, migrations. Sur cette base, des pistes d\u2019actions sont propos\u00e9es pour am\u00e9liorer l\u2019acc\u00e8s aux soins et leur efficacit\u00e9 chez les personnes concern\u00e9es. Un accent particulier est port\u00e9 sur la mobilisation des professionnels qui ont souvent tendance \u00e0 n\u00e9gliger les questions de tabagisme au regard de la s\u00e9v\u00e9rit\u00e9 imm\u00e9diate des probl\u00e8mes \u00e0 l\u2019origine de la demande des personnes accueillies. Une offre d\u2019accompagnement \u00e0 la r\u00e9duction des risques (vapotage notamment) semble particuli\u00e8rement adapt\u00e9e \u00e0 la demande souvent ambivalente des personnes. L\u2019importance du travail en r\u00e9seau et de l\u2019implication des CSAPA\/CAARUD est \u00e9galement soulign\u00e9e. Sur le plan syst\u00e9mique, tout ceci doit s\u2019accompagner d\u2019un plaidoyer politique pour r\u00e9duire ces in\u00e9galit\u00e9s et d\u00e9terminants sociaux de sant\u00e9.<\/jats:p>","DOI":"10.3917\/spub.pr1.0025","type":"journal-article","created":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T15:04:07Z","timestamp":1701356647000},"page":"69-80","source":"Crossref","is-referenced-by-count":1,"title":["Tabac et pr\u00e9carit\u00e9\u00a0: l\u2019enjeu central de l\u2019acc\u00e8s aux soins"],"prefix":"10.3917","volume":"Vol. 35","author":[{"given":"Jean-Michel","family":"Delile","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2273","reference":[{"key":"rb1","doi-asserted-by":"crossref","unstructured":"1. Hiscock R, et al., Socioeconomic status and smoking: a review. Ann N Y Acad Sci. 2012;1248:107-123.","DOI":"10.1111\/j.1749-6632.2011.06202.x"},{"key":"rb2","unstructured":"2. 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