Manufactured and roll-your-own cigarettes: A changing pattern of smoking in Barcelona, Spain
Introduction
Tobacco kills approximately 6 million people and causes more than half a trillion dollars of economic damage each year (Word Health Organization (WHO), 2013). In Spain, smoking-related deaths among individuals aged ≥35 years account for 14.7% of total mortality (25.1% in men and 3.4% in women) (Banegas et al., 2011).
There is strong evidence that tobacco control policies promoted by the WHO Framework Convention on Tobacco Control (FCTC), when implemented in an integrated way, reduce the prevalence of smoking (Levy et al., 2016; Martinez-Sanchez et al., 2010). In Spain, smoking prevalence rates from 1940 through 2007 showed a decrease after 1980 for men (from 58.5% in 1980 to 31.7% in 2007) and after 2000 for women (from 26.7% in 2000 to 21.9% in 2007) (Bilal et al., 2014). The prevalence rate was 23% in Spain in 2014 (27.6% for men and 18.6% for women) (Ministerio de Sanidad, Servicios Sociales e Igualdad, 2016).
Regulations implemented in recent years have not been shown to have a direct effect on tobacco consumption, and the decline in smoking prevalence and the number of cigarettes consumed describe a continuation of the short- and medium-term temporal evolution observed prior to the introduction of smoke-free legislation (Bajoga et al., 2011, Frazer et al., 2016).
Stepwise smoke-free legislation has been implemented in Spain in the last decade. Law 28/2005, which passed January 1, 2006, banned smoking in all public and work places, with some exceptions in hospitality venues (Fernandez, 2006). Law 42/2010 came into force January 2, 2011, extending the smoking ban to all hospitality venues without exception (bars, cafes, pubs, restaurants, discos, and casinos), and also included some outdoors areas (Fernandez and Nebot, 2011).
In the same time period when the tobacco smoke-free laws were implemented, Spain suffered an economic crisis that seems to have favored an increase in the consumption of other tobacco products subject to lower taxes, making them cheaper alternatives for smokers (Fu et al., 2014, Lopez-Nicolas et al., 2013).
The objective of this study was to describe smoking prevalence and to compare smoker attributes according to the type of tobacco product consumed in the Spanish adult population based on self-reported data and the levels of salivary cotinine in two time periods: 2004–2005 and 2011–2012, before and after smoke-free legislation.
Section snippets
Study design and selection of study participants
This study had a repeated cross-sectional design. We included a representative, random sample by age, sex, and district of the population of Barcelona, Spain. Surveys were conducted before and after the implementation of smoke-free legislation. Pre-legislation data were obtained between March 2004 and December 2005. We used the same strategy to collect post-legislation data between June 2011 and March 2012. We selected participants from the official 2001 (participants in the pre-legislation
Sample and smoking prevalence
We had information on 2552 participants: 1245 subjects in the pre-legislation survey and 1307 in the post-legislation survey. The samples were similar in regards to the proportions of men and women, but we found significant differences in age and education level. Nineteen participants in the pre-legislation survey were excluded because they were <16 years old. Of the self-reported non-smokers (former and never smokers), 110 (62 in the pre-legislation and 48 in the post-legislation surveys) were
Discussion
Our results showed a nonsignificant reduction in smoking prevalence over the period 2004–2005 and the period 2011–2012 from 26.6% to 24.1% in daily smokers. Similar to our results, another study conducted in Spain with national data showed a nonsignificant decrease from 23.4% in 2006 to 20.7% in 2011 (Perez-Rios et al., 2014). A study conducted in Galicia, Spain, also found a decrease in the prevalence of tobacco consuption from 25.4% in 2007 to 21.8% in 2015 (Tarrazo et al., 2016).
We observed
Conclusions
It is necessary to systematically collect data on smoking prevalence and smoking attributes, including types of tobacco product consumed, from representative samples of the population for policymakers to develop efficient tobacco control interventions and recommendations for the population. Considering such an increase of roll-your-own cigarette users and the unclear consequences of their use on health, policymakers should aim to implement tax policies to equalize the prices of different types
Competing interests
None.
Funding
This study was partly funded by the Instituto de Salud Carlos III, Subdirección General de Evaluación y Fomento de la Investigación, PN I+D+i 2008-2011, co-funded by the European Regional Development Fund (Grants PI020261, PI081436, RD06/0020/0089, and RD12/0036/0053) and the Department of Universities and Research, Government of Catalonia (grants 2009SGR192 and 2014SGR999).
Acknowledgments
The authors would like to thank Antonio Agudo, Anna Schiaffino, and Jorge Twose for participating in the pre-legislation study, and Montse Ferré and Lucía Baranda for coordinating the fieldwork in the second study. The authors would also like to thank the field workers for their collaboration, and Chupa-Chups Spain for providing the Smint® candies to facilitate saliva collection.
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