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Vol. 59. Issue 4.
Pages 195-196 (April 2023)
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Vol. 59. Issue 4.
Pages 195-196 (April 2023)
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Has the Reduction in Tobacco Consumption in Spain Stopped? No, But We Have to Speed It Up
Armando Perugaa,b,c,d, Esteve Fernándeza,c,d,e,
Corresponding author

Corresponding author.
, Raquel Fernándezf, Mónica Pérez-Ríosg,h,i, Francisco Rodríguez-Lozanoj, Cristina Martíneza,c,d,e,k
a Tobacco Control Unit, Cancer Prevention & Control Programme, Institut Català d’Oncologia (ICO), L’Hospitalet de Llobregat, Barcelona, Spain
b Center for Epidemiology & Health Policies, School of Medicine Clínica Alemana, Universidad del Desarrollo, Lo Barnechea, Región Metropolitana, Chile
c Tobacco Control Research Group, Epidemiology & Public Health Programme (EPIBELL), Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
d CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
e School of Medicine & Health Sciences, Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
f Association, Madrid, Spain
g Department of Preventive Medicine & Public Health, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
h Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
i CIBER of Epidemiology & Public Health (CIBERESP), Madrid, Spain
j European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
k Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, USA
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Tables (1)
Table 1. Prevalence (% and 95% confidence interval) of daily smokers (aged ≥15 years old) and proportion of those who smoke ≥20cigarettes/day (% ≥20cig/day) among all smokers in Spain by sex and year, 2009, 2014 and 2020.
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To justify the need to reduce the harm of tobacco through the use of products that do not require combustion, some people say that the measures applied to prevent the initiation of tobacco consumption and to encourage its cessation so far no longer work. The “International Declaration for a smoke-free Spain 2022”,1 argues that the smoking prevalence in our country today is the same as in 2005 when the first tobacco control law was approved. This false stagnation (as we will see below) is the explanation the promoters of the Declaration give to encourage the use of new tobacco and nicotine products such as electronic cigarettes and heated tobacco. Promoters of such products claim that they are less harmful than combustion cigarettes. However, we know that they are not innocuous. This same argument about the false stagnation of the prevalence and the need to promote other tobacco or nicotine products also appear in a Proposal regarding the Europe's Beating Cancer Plan presented by the Popular Party (December 7, 2022) to be discussed in the Health and Consumption Commission of the Spanish Parliament.2

A review of the data from the tobacco macro-surveys in Spain (the National Health Survey and the European Health Survey in Spain) offers a different view of the evolution of smoking (Fig. 1). Specifically, according to the data from the European Health Survey 3 that was carried out in 2009, 2014, and 2020 with more than 20,000 participants aged 15 or over throughout the national territory, it can be observed (Table 1) that between 2009 and 2020 the prevalence of daily smokers fell by almost 8 percentage points among men and nearly 5 among women. Not only the proportion of daily smokers is declining, but those who continue are also, in fact, smoking fewer cigarettes per day. The proportion of males who smoke more than one pack of cigarettes daily has gone from almost 50% in 2009 to just over 25%. And among women who smoke daily, this proportion has gone from nearly 30% to just over 20%. In addition, from 2009 to 2020, the sale of manufactured cigarettes decreased by half, and that of Roll-Your-Own cigarettes dropped by more than 13%. Between 2009 and 2018, the damage caused by smoking in terms of deaths attributable to tobacco use has gone from 54,000 to just under 50,000 per year, 4 a decrease that occurred almost entirely among men.

Fig. 1.

Prevalence (%) of daily smoking among men and women (aged15 years old) in Spain, 1978–2020. Own elaboration from the following sources: 1978: Tobacco National Survery; 1987–2006, 2011, 2017: Spanish National Health Interview Surveys; 2011, 2014, 2020: European Health Surveys in Spain.

Table 1.

Prevalence (% and 95% confidence interval) of daily smokers (aged ≥15 years old) and proportion of those who smoke ≥20cigarettes/day (% ≥20cig/day) among all smokers in Spain by sex and year, 2009, 2014 and 2020.

Sex  Year
  95%CI  % ≥20cig/day  95%CI  % ≥20cig/day  95%CI  % ≥20cig/día 
Both  26.2  25.3–27.0  39.1  23.0  22.2–23.7  30.7  19.8  19.0–20.9  24.7 
Men  31.2  29.8–32.5  47.1  27.6  26.3–28.8  35.6  23.3  22.1–24.7  27.7 
Women  21.3  20.3–22.4  28.4  18.6  17.7–19.5  24.2  16.4  15.5–17.4  20.8 

Own elaboration from the European Health Surveys in Spain 2009, 2011 and 2020.

Available from:

However, the significant reduction in cigarette smoking and the damage it produces in Spain is not a reason for complacency. Such reduction must continue and be accelerated since the burden of morbidity and mortality, in addition to being high, is avoidable. It is, therefore, imperative to multiply the measures to reduce the supply and demand of tobacco products rather than increase the demand for products that are supposedly less harmful but equally addictive, such as electronic cigarettes and heated tobacco. These measures are included in the “Endgame Declaration of tobacco in Spain 2030”,5 recently endorsed by more than sixty health and civil organizations. Of the 30 measures that the declaration proposes, we cite six:

  • 1.

    Create a tobacco-free generation so people who turn 18 after 2025 cannot legally acquire tobacco and similar products.

  • 2.

    Eliminate the sale of tobacco and similar products in vending machines and stores that are not tobacconists.

  • 3.

    Help reconvert the tobacco sector, particularly by promoting economically feasible alternatives to the agricultural production of tobacco leaves.

  • 4.

    Raise taxes on tobacco and similar products throughout the national territory and allocate 2% of the collection to the prevention and control of tobacco.

  • 5.

    Extend the protection against secondhand tobacco smoke to terraces of the hospitality sector and private means of transport, as well as against aerosols from heated tobacco and electronic cigarettes.

  • 6.

    Apply plain packaging to all tobacco and similar products.

For all these reasons, the Government must include these measures in the Comprehensive Plan for the Prevention and Control of Tobacco and modify the existing Law on public health measures against smoking accordingly, to apply with determination and firmness the strategies that will help reduce the scourge of smoking in Spain.

Conflict of interests

The authors state that they have no conflict of interests.

Redacción. Less harm: Declaración internacional por una España sin humo. El Mono Vapeador. Available from: [consulted 7.12.22].
Boletín Oficial de las Cortes Generales. Congreso de los Diputados. Proposición no de ley relativa al nuevo Plan Europeo contra el Cáncer.. Available from: [consulted 22.12.22].
Encuesta Europea de Salud en España. Resultados. Instituto Nacional de Estadística de España. Available from:!tabs-1254736194728 [consulted 7.12.22].
J. Rey-Brandariz, M. Pérez-Ríos, M.I. Santiago-Pérez, I. Galán, A. Schiaffino, L. Varela-Lema, et al.
Trends in smoking-attributable mortality in Spain: 1990–2018.
Eur J Public Health, 32 (2022), pp. 919-925
End Game del Tabaco en España 2030. END GAME DEL TABACO EN ESPAÑA 2030. Available from: [consulted 7.12.22].
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