Knowledge, consumption and attitudes regarding tobacco and tobacco-derived products among more than 1000 French rugby players: still a long way for prevention
Authors: Chague F , Genieux H , Maza M , Bichat F , Braghini N , Saint Jalmes M , Vergely C , Cottin Y , Zeller M 
Published: June 2024

Abstract
Tobacco and tobacco-derived products consumption and risk awareness are only poorly investigated in sport population. Exercising is highly beneficial for general and cardiovascular (CV) health. However, tobacco consumption results in an opposite effect, increasing cardiovascular risk, especially in sport setting.
We aimed to analyse knowledge, consumption and attitudes on CV risk of cigarette smoking among rugby players from a French region through an anonymous online questionnaire.
From April 8th to July 3rd 2023, an anonymous online questionnaire was displayed to the 8368 players aged 12 y and more from the Bourgogne-Franche-Comté region. Among the 1061 (13%) respondents, most were men (82.9%), median age was 22 (IQR 16-30) y. Women were younger than men (21y, IQR (16-29) vs 24 y (IQR 18-33), p= 0.014). Almost one third (32.1%) thought that sport cleans the smoker’s lungs and only less than half of respondents (46.7%) knew it does not. Among the whole population, half (50.5%) have experienced tobacco smoking, including 18.1% of the younger players (&lt; 18y). Since the beginning of the sport season, prevalence of cigarette smoking was high, at 29.1%, with 15.4% of daily consumption. These rates were similar in men and women. Vaping was more frequent in men than in women (17.4% vs 10.5%, respectively, p = 0.02). Among daily vapers (5.1%), 64.8% were dual users. Smokeless tobacco, pouches and heat-not-burn tobacco consumption was infrequent (3.3%, 3.3% and 2.0%, respectively) while hookah was reported at 5.7%. Cigarette smoking within the 2 hours before a match was declared by most smokers (68.1%). Within the 2 hours after a match, this rate was even higher, reaching 83.1%, and was more frequent in women than in men (95.0% vs 80.8%, respectively, p = 0.036). Almost one third (31.7%) of smokers were not aware of the risk of their cigarette consumption; the lower perceived risk was more frequent among younger players and those who smoked lower amounts of cigarettes. In addition, we analysed knowledge and attitudes among referees (68) and coaches (195). Both referees and coaches thought that sport does not clean smokers’ lungs in similar rates than players (p = 0.810). Among referees and coaches, who have a specific social and educative role, respectively 17.6% and 16.4% smoke within the 2 hours before and after a rugby session, i.e. often in the presence of players.
In conclusion, tobacco consumption remains common among rugby players of this French region. In this population, the knowledge of health impact of cigarette smoking is underestimated. Consumption patterns in the setting of a sport session may increase CV risk, be harmful for their peers through second hand smoke, and can be an incentive to smoke. Our findings highlight the urgent need of health education and prevention addressing cigarette smoking in this population; these actions must include referees and coaches as a relevant target.