RESEARCH PAPER
The effect of policies regulating tobacco consumption on smoking initiation and cessation in Spain: is it equal across socioeconomic groups?
 
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1
Departamento de Métodos Cuantitativos en Economía y Gestión (Universidad de Las Palmas de Gran Canaria). Facultad de Economía, Empresa y Turismo. Campus Universitario de Tafira, Las Palmas de Gran Canaria, Spain
2
Departamento de Economía Aplicada y Métodos Cuantitativos; Instituto Universitario de Desarrollo Regional (Universidad de La Laguna). Facultad de Economía, Empresa y Turismo. Universidad de La Laguna, Campus de Guajara, La Laguna, Spain
Publish date: 2017-01-28
 
Tob. Induc. Dis. 2017;15(January):8
KEYWORDS:
ABSTRACT:
Background:
In Spain, the Law 28/2005, which came into effect on January 2006, was a turning point in smoking regulation and prevention, serving as a guarantee for the progress of future strategies in the direction marked by international organizations. It is expected that this regulatory policy should benefit relatively more to lower socioeconomic groups, thus contributing to a reduction in socioeconomic health inequalities. This research analyzes the effect of tobacco regulation in Spain, under Law 28/2005, on the initiation and cessation of tobacco consumption, and whether this effect has been unequal across distinct socioeconomic levels.

Methods:
Micro-data from the National Health Survey in its 2006 and 2011 editions are used (study numbers: 4382 and 5389 respectively; inventory of statistical operations (ISO) code: 54009), with a sample size of approximately 24,000 households divided into 2,000 census areas. This allows individuals’ tobacco consumption records to be reconstructed over five years before the initiation of each survey, as well as identifying those individuals that started or stopped smoking. The methodology is based on “time to event analysis”. Cox’s proportional hazard models are adapted to show the effects of a set of explanatory variables on the conditional probability of change in tobacco consumption: initiation as a daily smoker by young people or the cessation of daily smoking by adults.

Results:
Initiation rates among young people went from 25% (95% confidence interval (CI), 23–27) to 19% (95% CI, 17–21) following the implementation of the Law, and the change in cessation rates among smokers was even greater, with rates increasing from 12% (95% CI, 11–13) to 20% (95% CI, 19–21). However, this effect has not been equal by socioeconomic groups as shown by relative risks. Before the regulation policy, social class was not a statistically significant factor in the initiation of daily smoking (p > 0.05); however, following the implementation of the Law, young people belonging to social classes IV-V and VI had a relative risk of starting smoking 63% (p = 0.03) and 82% (p = 0.02) higher than young people of higher social classes I-II. On the other hand, lower social class also means a lower probability of smoking cessation; however, the relative risk of cessation for a smoker belonging to a household of social class VI (compared to classes I-II) went from 24% (p < 0.001) lower before the Law to 33% (p < 0.001) lower following the law’s implementation.

Conclusions:
Law 28/2005 has been effective, as after its promulgation there has been a decrease in the rate of smoking initiation among young people and an increase in the rate of cessation among adult smokers. However, this effect has not been equal by socioeconomic groups, favoring relatively more to those individuals belonging to higher social classes.

CORRESPONDING AUTHOR:
Ignacio Abásolo   
Departamento de Economía Aplicada y Métodos Cuantitativos; Instituto Universitario de Desarrollo Regional (Universidad de La Laguna). Facultad de Economía, Empresa y Turismo. Universidad de La Laguna, Campus de Guajara, 38071 La Laguna, Tenerife, Spain
 
REFERENCES (39):
1. World Health Organization. Global Health Risks. Mortality and burden of disease attributable to selected major risks. 2009. http://www.who.int/healthinfo/....
2. Cuesta-Arzamendi JL, Muñagorri I, Arana X. Políticas y legislación en materia de tabaco. Informe (Observatorio Vasco de Drogodependencias) n°20; Vitoria-Gasteiz: Eusko Jaurlaritzaren Argitalpen Zerbitzu Nagusia. Servicio Central de Publicaciones del Gobierno Vasco. 2009.
3. Hyland A, Barnoya J, Corral JE. Smoke-free air policies: past, present and future. Tob Control. 2012;21:154–61.
4. Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, et al. Socioeconomic inequalities in health in 22 European countries [research support, non-U.S. gov’t]. N Engl J Med. 2008;358(23):2468–81.
5. Mackenbach JP. The persistence of health inequalities in modern welfare states: the explanation of a paradox. Soc Sci Med. 2012;75(4):761–9.
6. Eikemo TA, Hoffmann R, Kulik MC, Kulhánová I, Toch-Marquardt M, Menvielle G, et al. How can inequalities in mortality be reduced? a quantitative analysis of 6 risk factors in 21 European populations. EURO-GBD-SE Consortium. PLoS One. 2014;9(11):1–13.
7. Mackenbach JP, Kulhánová I, Bopp M, Deboosere P, Eikemo TA, Hoffmann R, et al. Variations in the relation between education and cause-specific mortality in 19 European populations: a test of the “fundamental causes” theory of social inequalities in health. EURO-GBD-SE Consortium. Soc Sci Med. 2015;127:51–62.
8. Nagelhout GE, De Boer D, Kunst AE, Van der Meer R, De Vries H, Van Gelder BM, et al. Trends in socioeconomic inequalities in smoking prevalence, consumption, initiation, and cessation between 2001 and 2008 in the Netherlands. Findings from a national population survey. BMC Public Health. 2012;12(303):1–9.
9. Bosdriesz JR, Willemsen MC, Stronks K, Kunst AE. Socioeconomic inequalities in smoking cessation in 11 European countries from 1987 to 2012. J Epidemiol Community Health. 2015;69(9):886–92. doi:10.1136/jech-2014-205171.
10. Alves J, Kunst AE, Perelman J. Evolution of socioeconomic inequalities in smoking: results from the Portuguese national health interview surveys. BMC Public Health. 2015;15(311):1–7.
11. Townsend J, Roderick P, Cooper J. Cigarrete smoking by socioeconomic group, sex and age: effects of price, income and health publicity. Br Med J. 1994;309:923–7.
12. Farrelly MC, Bray JW, Pechacek T, Woollery T. Response by adults to increases in cigarette prices by sociodemographic characteristics. South Econ J. 2001;68:156–65.
13. Gruber J, Sen A, Stabile M. Estimating price elasticities when there is smuggling: the sensitivity of smoking to price in Canada. Journal of Health Economics. 2003;821–42.
14. Colman G, Remler DK. Vertical equity consequences of very high cigarette tax increases: if the poor are the ones smoking, how could cigarette tax Increases be progressive?. NBER Work Pap Ser 10906. 2004.
15. Lee JM, Hwang TC, Ye CY, Chen SH. The effect of cigarette price increase on the cigarette consumption in Taiwan: evidence from the national health interview surveys on cigarette consumption. BMC Public Health. 2004;4:61. doi:10.1186/1471-2458-4-61.
16. Levy DT, Chaloupka F, Gitchell J. The effects of tobacco control policies on smoking-rates: a tobacco control scorecard. J Public Health Manag Pract. 2004;10(4):338–53.
17. Nargis N, Ruthbah UH, Hussain AKM, et al. The price sensitivity of cigarette consumption in Bangladesh: evidence from the International Tobacco Control (ITC) Bangladesh Wave 1 (2009) and Wave 2 (2010) Surveys. Tob Control. 2014;23 Suppl 1:i39–47.
18. Huang J, Zheng R, Chaloupka F, et al. Chinese smokers’ cigarette purchase behaviours, cigarette prices and consumption in China: findings from the ITC China survey. Tob Control. 2014;23:67–72.
19. Yao T, Huang J, Sung HY, et al. Who purchases cigarettes from cheaper sources in China? Findings from the ITC China survey. Tob Control. 2014;23:97–101.
20. Cornelius ME, Driezen P, Fong GT, et al. Trends in the use of premium and discount cigarette brands: findings from the ITC US surveys (2002–2010). Tob Control. 2014;23:48–53.
21. Cowie GA, Swift E, Borland R, et al. Cigarette brand loyalty in Australia: findings from the ITC four country survey. Tob Control. 2014;23:73–9.
22. Thomas S, Fayter D, Misso K, Ogilvie D, Petticrew M, Sowden A, et al. Population tobacco control interventions and their effects on social inequalities in smoking: systematic review. Tob Control. 2008;17:230–7.
23. Tang H, Cowling DW, Lloyd JC, Rogers T, Koumjian KL, Stevens CM, et al. Changes of attitudes and patronage behaviors in response to a smoke-free bar law. Am J Public Health. 2003;93:611–7.
24. Becker D, Conner H, Waranch H, Stillman F, Pennington L, Lees P. The impact of a total ban on smoking in the Johns Hopkins children’s center. JAMA. 1989;262:799–802.
25. Willemsen MC. The new EU cigarette health warnings benefit smokers who want to quit the habit: results from the Dutch Continuous Survey of Smoking Habits. Eur J Public Health. 2005;15:389–92.
26. Schaap MM, Kunst AE, Leinsalu M, Regidor E, Ekholm O, Dzurova D, et al. Effect of nationwide tobacco control policies on smoking cessation in high and low educated groups in 18 European countries. Tob Control. 2008;17:248–55.
27. Caballero-Hidalgo A, González B, Pinilla J, Barber P. Factores predictores del inicio y consolidación del consumo de tabaco en adolescentes. Gac Sanit. 2005;19(6):440–7.
28. Hammond D. Smoking behaviour among young adults: beyond youth prevention. Tob Control. 2005;14:181–5.
29. Anger S, Kvasnicka M, Siedler T. One last puff? Public smoking bans and smoking behavior. J Health Econ. 2011;30:591–601.
30. Lightwood JM, Glantz SA. Short-term economic and health benefits of smoking cessation: myocardial infarction and stroke. Circulation. 1997;96(4):1089–96.
31. Mähönen MS, McElduff P, Dobson AJ, Kuulasmaa KA, Evans AE. Current smoking an the risk of non-fatal myocardial infarction in the Who MONICA project populations. Tob Control. 2004;13:244–50.
32. Cox DR. Partial likelihood. Biometrika. 1975;62:269–76.
33. Tsiatis A. A large sample study of Cox’s regresssion model. Ann Stat. 1981;9:93–108.
34. Efron B. The efficency of Cox’s likelihood function for censored data. J Am Stat Assoc. 1977;72:557–65.
35. Harrell FE. In: Robert P, editor. The PHGLM procedure. SUGI supplemental library user’s guide. Hastings: SAS Institute; 1986.
36. Hyland A, Borland R, Li Q, Yong HH, McNeill A, Fong GT, et al. Individual-level predictors of cessation behaviours among participants in the International Tobacco Control (ITC) four country survey. Tob Control. 2006;15(3):iii83–94.
37. Siahpush M, McNeill A, Borland R, Fong GT, Siahpush M, McNeill A, Borland R, Fong GT. Socioeconomic variations in nicotine dependence, self-efficacy, and intention to quit across four countries: findings from the International Tobacco Control (ITC) four country survey. Tob Control. 2006;15(3):iii71–5.
38. World Health Organization. Health Statistics and Information System. 2015. http://www.who.int/healthinfo/....
39. Abásolo I, Tsuchiya A. Is more health always better for society? Exploring public preferences that violate monotonicity. Theory Decis. 2013;74(4):539–63.
 
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