Impact of the Spanish smoking laws on tobacco consumption and secondhand smoke exposure: A longitudinal population study

Background: In Spain, two smoke-free laws have been passed after the approval of the WHO-FCTC. This study assesses the impact of these Spanish smoking legislations on the active and passive smoking through a population cohort in Barcelona (Spain). Methods: This is a longitudinal study before and after the implementation of two national smoking bans in Spain in a representative sample (n = 1245) of adults (>= 16 years old) from Barcelona (Spain) surveyed in 2004-2005 and followed-up in 2013-2014. The final sample analyzed was 736 individuals. Both questionnaires (before and after the two laws) included the same variables about active and passive smoking. We calculated the prevalence and the prevalence ratio (PR, with their 95% confidence intervals, 95% CI) of smoking cigarettes and hand rolled tobacco and also the prevalence of exposure to secondhand smoke (SHS) at home, work, public transport, leisure time and at any setting after vs. before Spanish legislations. Results: After the implementation of the two Spanish smoke-free bans, a significant decrease was observed in the smoking prevalence (from 34.5% to 26.1%, PR = 0.76, p < 0.001), in the average cigarettes per day (median from 15.2 to 10.0, p < 0.001), and in the percentage of conventional tobacco consumption (from 92.6% to 74.4%, PR = 0.80,p < 0.001). Furthermore, a significant increase in the use of hand-rolled tobacco (from 6.1% to 30.9%, PR = 5.07, p < 0.001) and other tobacco products (from 17.1% to 32.8%, PR = 1.92, p < 0.001) was observed. In addition, a significant decrease in the self-reported SITS exposure was observed in all the assessed settings (home, work, transport, and leisure time). Conclusions: The implementation of the two smoke-free legislations in Spain is related to a reduction in smoking prevalence and SIB exposure. However, the smoking of other tobacco products, particularly hand-rolled tobacco, has increased among young population.