Smoking prevalence and health-related lifestyle behaviours according to tobacco use after the smoke-free law in Spain: analysis of Spanish National Health Surveys 2009-2017
e201907042
Keywords:
Smoking, Smoke-free law, Lifestyle, Diet, Physical activity, Alcohol, SpainAbstract
Background: Smoking is one of the health risk factors most associated with population morbidity and mortality. In Spain, legal restrictions have been introduced for the use of tobacco. The objective of this study was to analyse the smoking prevalence in Spain during the period 2009-2017, following the implementation of these legal restrictions, and the relationship and evolution between smoking and other health-related lifestyle factors.
Methods: We analyzed data in 2019 from the European Health Survey in Spain 2009 and National Health Surveys of Spain 2012 and 2017. Smoking, self-perceived health status, weight status and other health-related lifestyle behaviors (physical activity, vegetable intake, fruit intake and alcohol use). A multinomial logistic regression analysis was used to obtain the odds ratio adjusted to sex and age (“odds ratio” and 95% confidence interval).
Results: Smoking decreased by 3.13% during 2009-2012, and by 4.81% during 2009-2017. Smoking population presenting 2 or 3 risk factors in 2009 was OR=1.17 (1.08-1.26), p <0.0001, in 2012 OR=1.23 (1.12-1, 34), p <0.0001, and in 2017 OR=1.32 (1.21-1.44), p <0.0001. For 4 or 5 risk factors it was in 2009 OR=1.51 (1.31-1.74), p <0.0001, in 2012 OR=1.60 (1.42-1.81), p <0.0001, and in 2017 OR=1.70 (1.51-1.92), p <0.0001. For ex-smokers, the probability of presenting 2 or 3 risk factors in 2009 is not significant, in 2012 OR=0.88 (0.80-0.98), p = 0.013, and in 2017 it is not significant. In the case of 4 or 5 risk factors in 2009 it is not significant, in 2012 OR=0.86 (0.75-1.00), p = 0.045, and in 2017 OR=1.15 (1.02 -1.30), p = 0.028.
Conclusions: There is a decrease in the smoking population in Spain during 2009-2017. People who smoke have also an unhealthy lifestyle. People who smoke presented a greater number of health-related risk factors.
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References
Asamblea Mundial de la Salud. Convenio Marco de la OMS para el Control del Tabaco. (2003). http://www.who.int/iris/handle/10665/80175.
Consejo de la Unión Europea. Recomendación del Consejo, de 30 de noviembre de 2009 , sobre los entornos libres de humo DO C 296 de 5.12.2009, pag. 4/14. https://eur-lex.europa.eu/legal-content/ES/ALL/?uri=CELEX:32009H1205(01)&qid=1557867820434.
Fichtenberg CM, Glantz SA. Effect of smoke-free workplaces on smoking behaviour: systematic review. Br Med J. 2002;325(7357):188–91.
Guerrero F, Santonja F-J, Villanueva R-J. Analysing the Spanish smoke-free legislation of 2006: A new method to quantify its impact using a dynamic model. Int J Drug Policy. 2012;22(4):247–51.
Perez-Rios M, Fernandez E, Schiaffino A, Nebot M, Lopez MJ. Changes in the Prevalence of Tobacco Consumption and the Profile of Spanish Smokers after a Comprehensive Smoke-Free Policy. PLoS One. 2015;10(6):e0128305.
Lidón-Moyano C, Fu M, Ballbè M, Martín-Sánchez JC, Matilla-Santander N, Martínez C, et al. Impact of the Spanish smoking laws on tobacco consumption and secondhand smoke exposure: A longitudinal population study. Addict Behav. 2017;75:30–5.
León-Gómez BB, Colell E, Villalbí JR, Barrio G, Domingo-Salvany A. Impact of smoke-free regulations on smoking prevalence trends in Spain. Eur J Public Health. 2017;27(1):123–8.
Baha M, Le Faou A-L. Smokers’ reasons for quitting in an anti-smoking social context. Public Health. 2010;124(4):225–31.
Kelly BC, Vuolo M, Frizzell LC, Hernandez EM. Denormalization, smoke-free air policy, and tobacco use among young adults. Soc Sci Med. 2018;211:70–7.
Di Noia J, Cullen KW, Monica D. Social Desirability Trait Is Associated with Self-Reported Vegetable Intake among Women Enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children. J Acad Nutr Diet. 2016;116(12):1942–50.
Ståhl T, Rütten A, Nutbeam D, Bauman A, Kannas L, Abel T, et al. The importance of the social environment for physically active lifestyle — results from an international study. Soc Sci Med. 2001;52(1):1–10.
Strine TW, Okoro CA, Chapman DP, Balluz LS, Ford ES, Ajani UA, et al. Health-related quality of life and health risk behaviors among smokers. Am J Prev Med. 2005;28(2):182–7.
Lowe R, Norman P, Sheeran P. Milieu matters: Evidence that ongoing lifestyle activities influence health behaviors. PLoS One. 2017;12(6):e0179699.
Haddock CK, Lando H, Klesges RC, Peterson AL, Scarinci IC. Modified tobacco use and lifestyle change in risk-reducing beliefs about smoking. Am J Prev Med. 2004;27(1):35–41.
Instituto Nacional de Estadística. Encuesta Nacional de Salud de España (ENSE). http://www.ine.es/.
Rehm J, Taylor B, Room R. Global burden of disease from alcohol, illicit drugs and tobacco. Drug Alcohol Rev. 2006;25(6):503–13.
Álvarez-Álvarez I, Zazpe I, Pérez de Rojas J, Bes-Rastrollo M, Ruiz-Canela M, Fernandez-Montero A, et al. Mediterranean diet, physical activity and their combined effect on all-cause mortality: The Seguimiento Universidad de Navarra (SUN) cohort. Prev Med. 2018;106:45–52.
Hahn EJ, Rayens MK, Butler KM, Zhang M, Durbin E, Steinke D. Smoke-free laws and adult smoking prevalence. Prev Med. 2008;47(2):206–9.
Nagelhout GE, Willemsen MC, de Vries H. The population impact of smoke-free workplace and hospitality industry legislation on smoking behaviour. Findings from a national population survey. Addiction. 2012;106(4):816–23.
Hublet A, Schmid H, Clays E, Godeau E, Gabhainn SN, Joossens L, et al. Association between tobacco control policies and smoking behaviour among adolescents in 29 European countries. Addiction. 2009;104(11):1918–26.
Federico B, Mackenbach JP, Eikemo TA, Kunst AE. Impact of the 2005 smoke-free policy in Italy on prevalence, cessation and intensity of smoking in the overall population and by educational group. Addiction. 2012;107(9):1677–86.
Catalina Romero C, Gelpi Médez JA, Cortés Arcas MV, Martín Barallat J. Changes in Tobacco Consumption among Workers in Spain since the law 28/2005, Health Measures against Smoking. Rev Esp Salud Publica. 2010;84(2):223–7.
Schuit AJ, van Loon AJM, Tijhuis M, Ocké MC. Clustering of Lifestyle Risk Factors in a General Adult Population. Prev Med. 2002;35(3):219–24.
Moreno-Gómez C, Romaguera-Bosch D, Tauler-Riera P, Bennasar-Veny M, Pericas-Beltran J, Martinez-Andreu S, et al. Clustering of lifestyle factors in Spanish university students: the relationship between smoking, alcohol consumption, physical activity and diet quality. Public Health Nutr. 2012;15(11):2131–9.
Filozof C, Fernandez Pinilla MC, Fernandez-Cruz A. Smoking cessation and weight gain. Obes Rev. 2004;5(2):95–103.
Haveman-Nies A, de Groot LCPGM, van Staveren WA. Dietary quality, lifestyle factors and healthy ageing in Europe: the SENECA study. Age Ageing. 2003;32(4):427–34.
Pérez-Romero S, Gascón-Cánovas JJ, de la Cruz-Sánchez E, Sánchez-Ruiz JF, Parra-Hidalgo P, Monteagudo-Piqueras O. Recesión económica (2006-2012) y cambios en el estado de salud de la población española. Salud Publica Mex. 2016;58(1):41–8.
Chaves C, Castellanos T, Abrams M, Vazquez C. The impact of economic recessions on depression and individual and social well-being: the case of Spain (2006–2013). Soc Psychiatry Psychiatr Epidemiol. 2018;53(9):977–86.
Patrick DL, Cheadle A, Thompson DC, Diehr P, Koepsell T, Kinne S. The validity of self-reported smoking: a review and meta-analysis. Am J Public Health. 1994;84(7):1086–93.
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