Impact of smoke-free regulations on smoking prevalence trends in Spain

Background:Studies assessing Spanish smoke-free lawshave found a decrease in second-hand smokeexposure, but theimpact of suchlaws on general smoking trends is not clear. This study proposes to analysetrends in the prevalence of smoking in Spain, including changes by educational level, following the implementation of smoke-free regulations (2005 and 2010). Methods:Seven editions of the Spanish Household Survey on Alcohol and Drugs from1999to 2011 were used to analysethe standardised prevalence of daily smokers,the proportion of ex-daily smokers, and the averagecigarettessmokeddailyin both sexes and by educational level,among the population aged 15-64. The annual percentage of change (APC), and Poisson and linearmultiple regressions were used to identify differences in terms of years and educational levels. Results:The overall prevalence of Spanish daily smokers decreased from 33.5% in 1999 to 30.2% in 2011(APC=-1.7% for men, APC=-1.0% for women).Differences between lowand high educational levels in the prevalence of daily smokers and ex-daily smokers increased. For both sexes, the prevalence ratio (PR) of daily smokers was positive for the years before 2005 and negative afterwards. Conversely, for ex-daily smokers the PR in all years was lower than in 2005.The mean number of cigarettes decreased from 17.6cig/dayin 1999 to 14.2in 2011 (APC=-1.8(95%Confidence Interval:-2.2,-1.3)). Conclusion:Six years after the national smoke-free regulation was implemented, previously reporteddecreasing trends of smoking for both men and women persisted, while inequalities between educational levels increasedin both sexes BBLG was fully supported by the Consejo Nacional de Ciencia y Tecnologıa (CONACYT-Me´xico). This work was also supported by the Spanish National Plan on Drugs (2011/I073), FIS-Redes de investigación cooperativa (grant number RD12/0028/0018) and AGAUR (grant number: 2009 SGR 00718).