From pioneers to laggards: an X-ray of smoking in Spain

It is the first public health problem in the country and the first cause of preventable death. It is another pandemic, that of smoking. Although it is difficult to put figures into it, each year it takes about 69,000 lives. The 2005 law and its update in 2010 were pioneers in trying to put an end to this chronic disease, but it has been 11 years in which tobacco companies have launched new products that have been sneaking through the loopholes left by a rule that was it has lagged behind, as doctors and scientists denounce.

The main consumption data is published every two years in the EDADES survey of the Ministry of Health. The 2017 one was presented a year later by the then Minister María Luisa Carcedo. The president of the National Committee for Smoking Prevention (CNPT), Andres Zamorano, says that Carcedo did not explain the data that the study showed: 34% of Spaniards between 15 and 64 years of age used tobacco on a daily basis, the highest percentage since 1999, before the anti-smoking laws and so much collective effort. “We did explain it to ourselves, we didn’t do our homework & rdquor ;, says Zamorano. The latest study, prepared days before the COVID-19 pandemic broke out, lowered the figure to 32.3%. It remains a worrying figure: close to levels prior to the 2005 anti-smoking law (32.8%) and far from the minimum two years later (29.6%).

Zamorano tries to be optimistic: the European health survey in Spain also includes the population over 65 and the percentage of daily consumers drops to 19.8%. “There are 20% of smokers. That means that the remaining 80% we are not.& rdquor ;, he insists. Tobacco is the second most consumed psychoactive substance in Spain after alcohol, and seven out of 10 people have smoked at some time in their lives.

Legal loopholes

It is these new products that escape a law that is becoming obsolete. Heated tobacco brands bypass advertising limitations by advertising the smoking device and not specifically the tobacco. In addition, they have opened stores in some of the most exclusive neighborhoods of the big cities. “Cigarettes smell bad, leave fingers yellow, damage teeth & mldr; these products are perceived as less harmful, and nothing is further from the truth & rdquor ;, indicates Zamorano.

From the Spanish Society of Primary Care Physicians, Raúl de Simón points out that “what can most modify the prevalence of smokers are legislative changes & rdquor ;. “The 2005 law is the historical fact that has helped the most to quit smoking & rdquor ;, sentence.

Minors and tobacco

Leticia, 26, remembers her first puff perfectly. I was 15 years old. The sister of one of her friends gave them the cigarette that they secretly smoked among several, initiating a ritual that would be repeated on weekends. “I thought it gave me personality, because it was something forbidden & rdquor ;, he explains. Luisa Rubio, 64, started smoking at the same age. It was fashion, something “natural”. Barely three cigarettes a day dropped, she stopped when she got pregnant and then started again. The two women, although from different generations, are around a statistic that has remained stable since there is data: the age of onset in tobacco is 16. Zamorano says that when parents are asked at what age they prefer their children to start smoking, 99% – smokers also – indicate that they do not. Despite this, there are still new smokers: in the last year, approximately 340,000 people.

Smokers who have considered quitting have also fallen by five and a half points. They are 61.6% compared to 67.1% in 2017. And an even greater drop: that of those who have considered it and have tried, from 65.5% to 37.2%. “I don’t think I have to quit now & rdquor;, says Leticia, “I am not convinced, I will consider it later & rdquor ;. He acknowledges having the information that previous generations did not have. However, she is one of those who has switched to heated tobacco because she believes that it is a step prior to kicking the habit. “I have it associated with some social events or daily moments that I do not contemplate without a cigarette. I think that, by pondering, those moments with tobacco compensate me more than having to reinvent them without a cigarette in my hand & rdquor ;, he says.

Business and health

In 2010, more than three million packs of tobacco were sold in Spain. In 2020, they have not reached two million. But when a business languishes, substitutes are sought. Nicotine, in any of its forms. Large houses like Philip Morris, the largest in the world, are behind these new products. “Our goal is to replace cigarettes with smokeless products & rdquor;, they indicate on their website. Zamorano denounces that “the tobacco companies are dedicated to sowing doubts to save time & rdquor ;, and he remembers when they added filters to their cigarettes in the 60s.“ What did they filter? People kept dying & rdquor ;.

Related news

Within the EU, Spain is one of the countries where it is most affordable to buy a pack of tobacco: 4.53 euros on average compared to 5.27 in the EU. In addition, among the surrounding countries, it is only cheaper in Greece (€ 4.19). Far away are countries like France, with 9.70 euros, or 6.40 in Belgium. “Some of my patients switch to rolling tobacco because it is cheaper, it has a different taxation & rdquor ;, laments Zamorano, who recalls that one of the demands of the CNPT is equalize taxes for all types of tobacco products and avoid being able to switch from one to the other.

There are regulations that, in the opinion of the CNPT, have given good results in other countries and that we have not put into practice here. “In France, when the price of tobacco rose, a million French people stopped smoking. It’s that simple & rdquor ;, says Zamorano. The recipe is clear. They propose a neutral packaging, a greater investment for smoking cessation treatments and a single command that coordinates all the ministries. In addition, they ask to increase smoke-free spaces, from inside cars to bar terraces and spaces with large crowds of people. For the expert, smoking is fought “Regulating, regulating and regulating & rdquor;. And when it is found that a rule does not work, “it goes back to regular & rdquor ;. Some of these demands appear in the draft of the new Comprehensive Plan against tobacco prepared by the Government. A new impulse to try to end a pandemic against which there is no vaccine other than prevention.