Evaluation of the impact of Spanish smoking legislation on tobacco consumption and passive exposure

In Spain, two smoke-free laws have been passed after the approval of the FCTC. In 2005, it came into effect a smoke-free legislation (Law 28/2005). This law was a great advance for public health in Spain; however, it was not complete in terms of health protection to secondhand smoke (SHS) exposure because it allowed smoking in hospitality sectors according to size of venues. The scientific evaluation of this law showed the need to promote a total ban and motivate the modification of the law in 2010 (Law 42/2010), extending the smoke-free regulation to all hospitality venues without exception and to some outdoors areas, including hospital premises, educational campuses, and playgrounds. The objectives of this doctoral thesis were: To assess the impact of the Spanish smoking legislations (Law 28/2005 and Law 42/2010) on tobacco epidemic (changes in consumption, dependence, motivation to quit and smoking cessation) among smokers of a general population cohort through self-reported information and biomarkers. To evaluate the impact of the Spanish tobacco control legislation on exposure to environmental tobacco smoke (self-reported and according to levels of cotinine in saliva) on non-smokers in a cohort population. To analyze the changes in the pattern of passive smoking of the non-smokers (displacement of exposure at workplace and leisure time to home) according to age, sex, and socioeconomic level. To analyze the correlation between the implementation of tobacco control policies and tobacco consumption, particularly rolling tobacco, electronic cigarettes (e-cigarettes) users and the intent to quit smoking in 27 countries of the European Union. To describe the acceptability of the recently implemented tobacco products regulations and to explore their relation with tobacco control legislation levels in Europe. The results of this doctoral thesis has been conducted through seven scientific articles, four of them published in journals indexed in Web of Science and three of them in peer review in journals indexed in Web of Science (please see the Section Scientific Articles of this thesis). Moreover, during my training in this doctoral thesis I got involved in other two articles one published and the other in peer review, both in journals indexed in Web of Science. In conclusion, the implementation of the two smoke-free legislations in Spain is related to a reduction in smoking prevalence and SHS exposure (either using salivary cotinine concentrations or information on self-reported exposure). However, the consumption of other tobacco products, particularly hand-rolled tobacco, has increased specially among young population. A significant increase was found in the salivary cotinine concentration among adult continuing smokers after both Spanish legislations. After the implementation of the two Spanish smoke-free bans, the main setting of SHS is in the leisure time and in work, where most of the exposed ones declared expending most of the time outdoor and not having specific areas for smokers. However, cotinine concentrations in non-smokers were significantly higher only among those declaring exposure to SHS at home after both legislations. The implementation of the two smoke-free legislations in Spain is related to an increasing of voluntary adoption of smoke-free homes (SFH) rules, in particular with an increase in complete SFH rules. In addition, we observed an association between complete indoor SFH adoption and the perceived risk of SHS exposure. In addition, great support for the studied tobacco products regulations was found which were positively related with European tobacco control levels of implementation at both ecological and individual levels