Patterns of smoking in Spain. Results from a regional general population survey

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. Re e ences 1. Sanchez L. Tobacco addic ion and con ol in Spain. B J Addic 1991; 86: 701-703. 2. Laugesen M, Meads C. Tobacco ad e ising es ic- ions, p ice, income and obacco consump ion in OECD coun ies, 1960-1986. B J Addic 1991; 86: 1343-1354. 3. Take AR, Cu is SE, Thu ianx MC. Ve la san 6 pou ous dans la gion eu op enne de I'OMS Su eil- lance des p og ~s accomplis, HI: Modes de ie e milieu physique. Re Epid m e San 6 Publ 1990; 38: 3-18. 4. Anonymous. Encues a nacional sob e h ibi o ab~iquico. 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Sasco AJ, Dalla-Vo gia P, Van de Els P. Compa a- i e s udy o an i-somoking legisla ion in coun ies o he Eu opean Economic Communi y, Lyon: In e na ional Agency o Resea ch on Cance , IARC Technical Repo No 8, 1992. 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