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 workshopBarcelona. September 22nd. 2015

•Josep M Suelves

•Guadalupe Ortega

•Araceli Valverde

•Carmen Cabezas

Our priorities• Avoiding environmental

tobacco smoke / normalizing smoke-free environments

• Preventing tobacco use in adolescence

• Promoting cessation• Reducing (social.

gender…) inequalities

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

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.

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%)

Source: Health Survey of Catalonia. DS (2014)

Elaboració ASPCAT. 2015

Prevalence of ePrevalence of ePrevalence of ePrevalence of e----cig use among smokers in cig use among smokers in cig use among smokers in cig use among smokers in Catalonia. 2014Catalonia. 2014Catalonia. 2014Catalonia. 2014

0.4% of Catalans aged

>14. reported using e-cigs

Factory made cigarette sales have been declining. but roll your own (RYO) tobacco dramatically increased

2008200820082008 2014201420142014 ChangeChangeChangeChangeRYO 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 made Factory made Factory made Factory 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

% 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 2014 from 3% in 2006 to 24% in 2014 from 3% in 2006 to 24% in 2014 from 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

*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 distributionCatalonia 2006Catalonia 2006Catalonia 2006Catalonia 2006----2014201420142014

26.2% 39.5% 31.4% 21.9% 7%? Prevalença

fumadors al 2014

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

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?

• 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)

Thank you!