The Public Health Agency of Catalonia held a tobacco control workshop in September 2015. Their priorities are avoiding secondhand smoke exposure, preventing youth tobacco use, promoting smoking cessation, and reducing health inequalities. Daily smoking in Catalonia has declined from 47.3% in 1990 to 31.8% in 2014 among men and from 22.4% to 20.3% among women. A study found that a brief intervention reduced infants' exposure to secondhand smoke at home and in cars. The use of roll-your-own cigarettes among smokers increased from 3% in 2006 to 24% in 2014 as factory cigarette sales declined 48.6%. Further strategies were discussed to discourage the shift to roll-your-own cigarettes and

1. Public Health Agency of Catalonia:Public Health Agency of Catalonia:Public Health Agency of Catalonia:Public Health Agency of Catalonia:
Tobacco Control and PreventionTobacco Control and PreventionTobacco Control and PreventionTobacco Control and Prevention
Tobacco control research workshop
Barcelona. September 22nd. 2015
•Josep M Suelves
•Guadalupe Ortega
•Araceli Valverde
•Carmen Cabezas

2. Our priorities
• Avoiding environmental
tobacco smoke /
normalizing smoke-free
environments
• Preventing tobacco use in
adolescence
• Promoting cessation
• Reducing (social.
gender…) inequalities

3. Daily & occasional smoking is declining in CataloniaDaily & occasional smoking is declining in CataloniaDaily & occasional smoking is declining in CataloniaDaily & occasional smoking is declining in Catalonia
...but > 1.6 million are still smoking
Font: Generalitat de Catalunya. Departament de Salut. Programa per a la prevenció i el control del tabaquisme. Enquesta de consum de tabac. alcohol i
drogues 1990.1998.
Enquesta de salut de Catalunya 1994. 2002. 2006. 2010. 2011. 2012. 2013 i 2014.
1990 1994 1998 2002 2006 2010 2011 2012 2013 2014
Men 47.3 42.3 39.3 38.0 34.5 34.1 35.8 34.2 32.2 31.8
Both genders 33.7 30.6 30.9 32.1 29.4 29.5 29.5 28.5 26.5 25.9
Women 22.4 20.7 23.0 26.6 24.3 24.8 23.4 22.9 20.9 20.3
47.3%
26.6%
22.4% 20.3% 23.7% since peak 2002
31.8% 32.8% since 1990

4. Brief Intervention in babies (BIBE)
• Multicentre cluster randomised
clinical trial to assess the
effectiveness of a brief
intervention to reduce exposition
to tobacco smoke in infants aged
0-18 months.
• 1,101 cases recruited in 83
primary care centres (babies
living with at least 1 parent
smoker).
• Exposition to tobacco smoke at
home. in private car and other
environments reported by
parents and assessed by hair
analysis (subsamples) at
baseline and 6 months after
intervention.

5. Brief Intervention in babies (BIBE)
• According to hair
analysis. 79% of babies
were exposed at
baseline (nicotine >=
1ng/mg)
• At follow up. significant
reductions (p<0.01) in
exposure at home
(35.4% in IG, 26.9% in
CG) and in family car
(62.2% vs 53.1%)

6. Source: Health Survey of Catalonia. DS (2014)
Elaboració ASPCAT. 2015
Prevalence of ePrevalence of ePrevalence of ePrevalence of e----cig use among smokers incig use among smokers incig use among smokers incig use among smokers in
Catalonia. 2014Catalonia. 2014Catalonia. 2014Catalonia. 2014
0.4% of Catalans aged
>14. reported using e-cigs

7. Factory made cigarette sales have been
declining. but roll your own (RYO) tobacco
dramatically increased
2008200820082008 2014201420142014 ChangeChangeChangeChange
RYO tobacco (Tons)RYO tobacco (Tons)RYO tobacco (Tons)RYO tobacco (Tons) 1,1461,1461,1461,146 1,2871,2871,2871,287 +12.3%+12.3%+12.3%+12.3%
Factory madeFactory madeFactory madeFactory made
cigarettes (20 cig.cigarettes (20 cig.cigarettes (20 cig.cigarettes (20 cig.
packs)packs)packs)packs)
848,745,585848,745,585848,745,585848,745,585 436,221,182436,221,182436,221,182436,221,182 ----48.6%48.6%48.6%48.6%
Tobacco products’ sales in Catalonia
Font: Elaboració a partir de dades del Comissionat per al Mercat de Tabacs

8. % smokers using RYO cigaretters% smokers using RYO cigaretters% smokers using RYO cigaretters% smokers using RYO cigaretters
RYO cigarettes among smokers:RYO cigarettes among smokers:RYO cigarettes among smokers:RYO cigarettes among smokers:
from 3% in 2006 to 24% in 2014from 3% in 2006 to 24% in 2014from 3% in 2006 to 24% in 2014from 3% in 2006 to 24% in 2014
Tobacco products used by smokersTobacco products used by smokersTobacco products used by smokersTobacco products used by smokers
•Daily & occasional smokers
•Fonts: Enquesta de Salut de Catalunya. DS (2006. 2014)
Elaboració ASPCAT. 2015

9. *Fumadors diaris + ocasionals
Fonts: Enquesta de Salut de Catalunya. DS (2006. 2014)
Percentage of smokers using RYO tobacco. Age distributionPercentage of smokers using RYO tobacco. Age distributionPercentage of smokers using RYO tobacco. Age distributionPercentage of smokers using RYO tobacco. Age distribution
Catalonia 2006Catalonia 2006Catalonia 2006Catalonia 2006----2014201420142014
26.2% 39.5% 31.4% 21.9% 7%?Prevalença
fumadors al 2014

10. EducationEducationEducationEducation Social classSocial classSocial classSocial class
*Fumadors diaris + ocasionals
Fonts: Enquesta de Salut de Catalunya. DS (2006. 2014)
Elaboració ASPCAT. 2015
Percentage of smokers using RYO tobacco.
Educational and socieconomic level.
Catalonia 2006-2014

11. Final remarks and points to discussion (I)
• Brief interventions in primary care are effective to reduce
infant exposition to second hand smoke. This modest but
beneficial effect may be produced just by appropriate
interrogation and advice.
• Primary Health care workers (nurses, family doctors,
paediatricians, midwifes…) are offered practical training on
tobacco smoking brief intervention We have
implemented a Smoke-free Children programme. but how
we can go further?
• Is there a need for new regulations on smoking in
private places such as private cars?

12. • Since 2014. the Catalan Health Survey allow us to
monitor exposition to environmental tobacco smoke
and usage of different tobacco products. including
electronic and roll your own cigarettes.
• We have develop some leaflet on RYO.
• The Catalan Department of Health is promoting
changes in Spanish tax policies to ensure appropriate
taxation of all tobacco products.
• In the meanwhile. Is there a need for health
education or other strategies to discourage shift from
manufactured to RYO cigarettes?
Final remarks and points to discussion (II)

13. Thank you!