Eu opean Jou nal o Epidemiology
10: 595-598, 1994,
© 1994
Kluwe Academic Publishe s. P in ed in he Ne he lands',
Pa e ns o smoking in Spain
Resul s om a egional gene al popula ion su ey
M.C.
Del R o
& EJ.
Al a ez
D ugs and Alcohol Resea ch G oup, Facul y o Medicine, Uni e si y o Valladolid, Valladolid, Spain
Accep ed in e ised o m 12 July 1994
Abs ac .
Smoking pa e ns we e examined in 2500
indi iduals, aged 14-70 yea s li ing in Cas ille and
Leon (Spain) in he all o 1992. O hese, 39.6%
we e egula smoke s, 7.2% we e occasional
smoke s, 14.8% we e o me smoke s, and 30.4%
we e non-smoke s. Sex di e ences we e s iking:
he e was a highe p e alence o egula smoke s
among males han emales, males smoked much
mo e, and we e mo e equen ly F ench- ype ciga-
e e smoke s. A compa ison o he p esen igu es
wi h da a om an ea lie su ey ca ied ou in 1989
sugges s ha smoking is dec easing in Spain.
Key wo ds:
Popula ion su eillance, Smoking-epidemiology, Spain
In oduc ion
The in o ma ion a ailable conce ning smoking
pa e ns and igu es o de eloped coun ies show
ha Spain is one o he coun ies in which smoking
is mo e common [1-3]. Di e en c oss-na ional and
egional s udies ca ied ou in Spain h oughou he
1980s showed a p e alence o smoking, anging om
54% o 36% in he di e en s udies [4-10]. An
analysis o smoking ends in ou coun y e ealed
an inc ease in emale smoking [11], and an inc ease
in p e e ence o smoking Vi ginia- ype ciga e es
[12, 13]. I is no ewo hy ha wo o he g oups
mos in ol ed in de eloping an i-smoking policies,
physicians and eache s, showed highe a es o
smoking [1, 14].
As p esumed, hese high smoking a es a e ela ed
o a high economic, social and medical cos . Resea ch
on he economic consequences o obacco consump-
ion in Spain showed ha i smoking we e o
dec ease by 10% in a single yea , Spain would
achie e a sa ing o 0.2% o he g oss domes ic
p oduc [15]. Tobacco- ela ed mo ali y based on
1983 igu es e ealed ha 39,816 dea hs we e ela ed
o smoking in ha yea , 13% o o al dea hs; 20.3%
among males and 5.4% among emales [ 16].
The aim o he p esen s udy was o analyse he
pa e ns o obacco consump ion among he gene al
popula ion o Cas ille and Leon (Spain), he ends
obse ed wi h ega d o ea lie s udies, and o
e alua e hei possible epe cussions on heal h ca e
and public heal h.
Ma e ials and me hods
The ques ionnai e used included i ems on socio-
demog aphic da a and obacco consump ion: smoking
equency, p e e ences, amoun and age a which he
esponden s a ed smoking.
People aged be ween 14 and 70 yea s and li ing
in Cas ille and Leon (Spain) we e he a ge popula-
ion. Cas ille and Leon is he la ges egion in Spain,
accoun ing o nea ly 19% o Spain's size, wi h a
popula ion o abou 2,545,926 inhabi an s in 1991
(abou 6.5% o he Spanish popula ion). The sample
was de i ed om he popula ion census da a o 1991.
A sample o 2,500 indi iduals was selec ed. The
sample was i s s a i ied p opo ionally by he
numbe o he inhabi an s o he communi ies,
acco ding o he c i e ia o he Spanish Ins i u e o
S a is ics: 250,000-500,000 inhabi an s; 100,000-
250,000; 50,000-100,000; 10,000-50,000; and less
han 10,000 inhabi an s. Second, he sample was
classi ied by coun y on he basis o he adminis a-
i e di ision o he egion (nine coun ies in Cas ille
and Leon), p opo iona ely o he popula ion o each
coun y. Thi d, he sample was se ou in age g oups:
14-19 yea s (n = 327), 20-29 (n = 557), 20-39 (n =
415), 40-49 (n = 365), 50-59 (n = 443), and 60-70
yea s old (n = 393) and, inally, by sex in each one
o he men ioned age g oups (males, n = 1,243;
emales, n = 1,257).
The in e iews we e conduc ed by ained assis-
an s in he all o 1992. Abou 300 people in o al
e used o answe he ques ionnai e. Those who
e used o pa icipa e in he su ey we e eplaced by
ano he indi idual o he same age g oup and sex.
Few people, abou 50, s a ed he in e iew bu did
no comple e i . In all cases, he ques ionnai es we e
596
checked la e by a supe iso o comple eness and
accu acy. Ou o 2,700 in e iews ca ied ou , 200
we e ejec ed mainly o no answe ing ele an pa s
o he ques ionnai e o o inconsis en answe s.
The analysis o he da a was ca ied ou in he
Da a P ocessing Cen e a The Uni e si y o
Valladolid, using he s a is ical package SAS, 6.07
e sion (unde he VAX/VMS 5 e sion).
Resul s
Table 1 shows he pe cen ages o egula - daily -
smoke s (39.6%), occasional smoke s (7.2%), o me
smoke s (14.8%) and non-smoke s (38.4%). Signi -
ican di e ences we e ound be ween sexes (p <
0.0001): he e we e mo e males among egula
smoke s and o me smoke s, while he e was a
highe p e alence o non-smoking among emales
han males (Table 1). The highes p e alence o
egula smoke s was ound in hose aged 20-29
(54.9%) and 30-39 yea s old (51~3%); p e alence
dec eased in he wo olde g oups. Regula emale
smoke s we e mo e equen ly ound among he
younge age g oups (Table 1). In addi ion, as age
inc eased so did he numbe o o me smoke s. Non-
smoke s we e mo e equen ly ound among hose
younge han 20 yea s o olde han 50 (Table 1).
An a e age o 16.6 ciga e es pe day was smoked
by egula smoke s (Table 2) and he di e ences by
gende we e s iking: males smoked signi ican ly
mo e han emales (p < 0.0001). Fi een pe cen o
egula smoke s smoked o e 20 ciga e es/day and
44.1% smoked 11-20 ciga e es/day: in bo h cases
highe igu es we e ound among males (p < 0.0001,
Table 2). Sex di e ences we e ound as ega ds
obacco p e e ences (p < 0.0001). Vi ginia- ype
ciga e es we e p e e ed (57.6%, Table 2), howe e
emales smoked Vi ginia- ype ciga e es mo e e-
quen ly han males, while males we e e enly spli
Table 1. Pa e ns o smoking in pe sons 14-70 yea s o age, by gende
Sample dis ibu ion Regula smoke s Occasional smoke s Fo me smoke s Non-smoke s
N (%) (%) (%) (%)
To al Male Female To al Male Female To al Male Female To al Male Female To al Male Female
To al 2500 1243 1257 39.6 46.9 32.3 7.2 7.6 6.7 14.8 18.9 10.8 38.4 26.5 50.2
Age ange
14-19 326 163 163 30.7 28.2 33.1 18.1 17.8 18.4 3.4 3.1 3.7 47.9 50.9 44.8
20-29 557 274 283 54.9 53.7 56.2 7.2 8.7 5.6 7.5 7.3 7.8 30.3 30.0 30.7
30-39 415 203 212 51.3 56.1 46.7 7.9 7.4 8.5 14.0 17.2 10.8 26.7 19.2 34.0
40-49 366 179 187 43.2 63.7 23.5 6.0 5.0 7.0 15.6 17.3 13.9 35.3 14.1 55.6
50-59 443 213 230 31.6 46.9 17.4 3.6 6.1 1.3 20.8 24.4 17.4 44.2 23.0 63.9
60-70 393 211 182 18.3 29.4 5.5 2.3 2.4 2.2 28.2 43.6 10.4 50.9 24.2 81.9
Table 2. Pa e ns o egula smoke s in pe sons 14-70 yea s o age, by gende
Regula smoke s To al Male Female
N (%) N (%) N (%)
To al X] = 56.6, p < 0.0001
988 (39.6) 583 (46.9) 405 (32.3)
Tobacco consump ion
1-10 ciga e es/day
11-20
ciga e es/day
O e 20 ciga e es/day
Tobacco p e e ences
F ench- ype ciga e es
Vi ginia- ype ciga e es
F ench and Vi ginia- ype
Ciga s and ciga e es
Pipe obacco
T e age obacco consump ion
(Mean + SD)
S a ing age o smoking
(Mean ± SD)
404 (40.9)
436 (44.1)
148 (15.0)
333 (33.7)
569 (57.6)
42 (4.2)
43 (4.3)
1 (0.1)
16.6 + 11.2
17.2 + 4.5
X 2 = 49.9, p < 0.0001
186 (31.9) 218 (53.8)
289 (49.6) 147 (36.3)
108 (18.5) 40 (9.9)
X] = 83.1, p < 0.0001
247 (42.4) 86 (21.2)
268 (46.0) 301 (74.3)
29 (5.0) 13 (3.2)
38 (6.5) 5 (1.2)
1 (0.2)
F = 42.0, p < 0.0001
18.5 +_ 12.6
F = 0.3, p > 0.05
17.3 + 5.3
13.9 + 8.7
17.1 + 3.2
597
be ween he wo ypes o ciga e es. The mean age
o ini ia ing smoking was 17.2 + 4.5 yea s old (mean
+ SD); he e was no signi ican di e ence be ween
he sexes (p > 0.05, Table 2).
Discussion
The p esen s udy shows ha smoking is equen is
ou egion, and ha he e a e s iking gende
di e ences in obacco consump ion: he e was a
highe p e alence o egula smoking among males
han emales, males smoked signi ican ly mo e and
we e mo e likely o be F ench- ype ciga e e smoke s,
and young emales (< 29 yea s o age) we e mo e
equen ly egula smoke s han males. Fi een
pe cen o egula smoke s, 7.3% o he o al
su eyed, smoked mo e han 20 ciga e es pe day.
A compa ison wi h he esul s o a 1989 su ey
in he same a ge popula ion and using he same
c i e ia, shows ha he numbe o egula smoke s
dec eased a e 1989 by 4.8%, occasional smoke s
and o me smoke s inc eased by 3.3% and 2.7%,
espec i ely, while he numbe o non-smoke s
dec eased sligh ly by 1.1%. Figu e 1 shows hese
end changes be ween he sexes. These end
changes om 1989 o 1992 clea ly sugges a dec ease
in smoking and we epo ed a ma ked dec ease in
60 %
5O %
40 %
30 %
2O %
10 %
0 %
60 %
MALES
non- dally oc :es onal
|o me
smoke s smoke s s nokens smoke ~
I
l g8~
[] lgg2
FEMALES
50%
40 %
30%
2O%
10 %
0%
noo. daily occasional o me
a noke m
smoke s
smoke~s
smoke s
Figu e 1. Changes in smoking om 1989-1992 in pe sons
14-70 yea s o age, by gende .
smoking among uni e si y s uden s om 1984 o
1990 [13]. Howe e , he da a a ailable om egional
and na ional s udies ha e no iden i ied his end:
abou 40.1% we e egula smoke s in 1978 [4], 39%
in 1982 [5]; 41.4% in 1984 [6] and 41% in 1985 [7].
These da a we e ob ained om he mos signi ican
na ional s udies. A dec ease in smoking has been
sugges ed when conside ing he igu es o smoke s
om he Na ional Heal h Su ey o 1987 (38.1%) [8],
and hose ob ained in 1989 in a na ional s udy abou
heal hy li es yles (35.9%) [9]. Ne e heless, igu es
ob ained in o he s udies (1988: 39.4%; 1989: 39.2%)
[1] do no suppo his idea. In any case, he p esen
s udy is he i s one o clea ly show a dec ease in
smoking among he gene al popula ion in he Cas ille
and Leon egion.
This endency, he decline in smoking habi s, is
mo e appa en in he case o men han women
(Figu e 1). The smoking habi is clea ly diminished
among men and he pe cen age o non-smoke s,
occasional smoke s and o me -smoke s has gone up.
Howe e , his decline has no been obse ed in he
case o women o has been less signi ican han in
he case o men [13]. Also, an inc ease in he numbe
o women who a e occasional smoke s has been
obse ed, which explains why he igu es o non-
smoke s wen down om 1989 o 1992. I mus be
poin ed ou ha women smoke s a e mainly ound
among he younge age-g oups, wi h a highe edu-
ca ional le el and in a highe income b acke [9, 11].
Con a y o men, he numbe o o me -smoke s
among women does no inc ease conside ably wi h
age, which coincides wi h wha has been obse ed
in he las s udies [9].
Vi ginia- ype ciga e es a e hose mos equen ly
smoked, especially among women, while men also
smoke F ench- ype ciga e es. P e ious s udies ha e
shown an inc easing end in p e e ence o smoking
Vi ginia- ype ciga e es in he las yea s [12, 13]. This
co esponds o he da a ob ained om he sale o
ciga e es. In 1990, 2,619 ciga e es we e smoked pe
capi a, 1,147 o F ench- ype and 1,472 o Vi ginia-
ype [17]. In some s udies i has also been ound ha
hose who smoke Vi ginia- ype ciga e es smoke a
g ea e numbe o ciga e es han hose who smoke
F ench- ype ones [12, 18]. The ciga e es di e as
ega ds la ou , a and nico ine con en . Pe haps
nowadays hese di e ences a e less appa en due o
legisla i e egula ions se up o educe he a con en
in ciga e es (maximum allowed 15 mg) [19].
Ciga e es a e he kind o obacco mos equen ly
smoked. Men do no only smoke a g ea e numbe
o ciga e es pe day han women, bu hey a e mos
equen ly 'hea y somoke s' (o e 20 ciga e es/day).
This coincides wi h wha has been obse ed in
p e ious s udies. Pe haps i has o be poin ed ou ha
he pe cen age o hea y smoke s in he p esen s udy
(15%) is sligh ly lowe han in ea lie s udies (1978:
18.5% [4]; 1985: 18% [7]; 1987: 17% [8]; 1989:
598
19.3% [9]), and ha he pe cen age o hea y smoke s
among women is sligh ly highe han in he s udies
men ioned (1978: 3.4% [4]; 1985: 8% [7]; 1987: 6%
[8]; 1989: 8% [9]).
Recen ly, Spain s a ed de eloping heal h policies
issued as pa o he Wo ld Heal h O ganiza ion's
'Heal h Fo All' s a egy. The e o e, because o he
equency o smoking, smoking- ela ed p oblems and
mo ali y, he de elopmen o policies o s op
smoking is ele an . The p esen s udy sugges s an
incipien dec easing end in smoking in ou egion.
Howe e , because o he s ill high igu es o egula
smoke s in Spain, a mo e in ensi e e o will be
needed o educe smoking i he heal h goals o he
yea 2000 a e o be achie ed. A dec ease in smoking
and a change o a i udes owa ds smoking among
gene al p ac i ione s, eache s, and young emales
ep esen s some o he a ge g oups o such e o s.
Acknowledgemen s
This s udy was suppo ed by a g an om he Jun a
de Cas il a y Leon, Conseje a de Sanidad y Bienes a
Social, Valladolid, Spain.
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Add ess o co espondence:
F. Ja ie Al a ez, D ugs and
Alcohol Resea ch G oup, Facul y o Medicine, Uni e si y
o Valladolid, E-47005 Valladolid, Spain
Fax: +34 83 423 022 and +34 83 423 073