Introduction:
Tobacco smoking causes over 75000 deaths every year in France. Although immigrants and their descendants represent one person in five in the total population, their tobacco use has rarely been reported. Recent epidemiological studies have estimated the prevalence of smoking in major groups of immigrants. However, this topic has not yet been qualitatively investigated.

Objectives:
This study aimed at investigating the tobacco use – including all forms of smoked and smokeless tobacco – in immigrants and their descendants in 3 metropolitan areas in France. The specific objectives were: 1) to document the knowledge, beliefs and representations of immigrants on tobacco use, and 2) to explore the practices and representations on immigrants’ tobacco use of healthcare professionals and social workers in the community.

Methods:
Two complementary methods have been used in 18+ immigrants and their descendants living in France since at least one year: semi-structured individual interviews and focus groups. Healthcare professionals (incl. GPs, nurses and pharmacists) and social workers underwent semi-structured interviews. Interviews were conducted by trained sociologists. Individual and group interviews were recorded and transcribed for thematic analysis.

Results:
The study population comprised 80 participants, including 57 immigrants and 23 descendants, with a sex ratio of one. Thirty-five healthcare and social professionals were interviewed. The immigrant study population was constituted of 50% smokers, and 17% former smokers. Four main themes were identified: tobacco use practices, precariousness, gender and professional practices linked with cessation.

Discussion:
These results provide a unique insight in different immigrant subgroups’ tobacco use: experiences, psychosocial functions of tobacco use, social norms including gender differences, attitudes towards tobacco control means and prevention linked to the potential role of healthcare professionals. These results have informed an epidemiological study that will quantify barriers and levers to the development of tailored tobacco prevention interventions, relying on local professionals.