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Smoking and tobacco
Research
Effect of the comprehensive smoke-free law on time trends in smoking behaviour in primary healthcare patients in Spain: a longitudinal observational study
  1. Mariona Pons-Vigués1,2,3,
  2. Yolanda Rando-Matos1,4,
  3. Teresa Rodriguez-Blanco1,2,
  4. Josep Lluís Ballvé-Moreno1,4,
  5. Joana Ripoll5,6,
  6. Joan Llobera5,6,
  7. Julio Morán7,
  8. Tomàs López-Jiménez1,2,
  9. Concepción Violán-Fors1,2,
  10. Bonaventura Bolibar1,2
  1. 1 Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
  2. 2 Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
  3. 3 Departament d’Infermeria, Universitat de Girona, Girona, Spain
  4. 4 Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain
  5. 5 Primary Care Research Unit of Mallorca, Baleares Health services-IbSalut, Palma, Spain
  6. 6 Balearic Islands Health Research Institute (IdISBa), Palma, Spain
  7. 7 Equipo de Atención Primaria de Tafalla, Servicio Navarro de Salud, Barasoain, Spain
  1. Correspondence to Dr Mariona Pons-Vigués; mponsv{at}idiapjgol.info

Abstract

Objective This study aimed to analyse the impact of comprehensive smoke-free legislation (SFL) on the prevalence and incidence of adult smoking in primary healthcare (PHC) patients from three Spanish regions, overall and stratified by sex.

Design Longitudinal observational study conducted between 2008 and 2013.

Setting 66 PHC teams in Catalonia, Navarre and the Balearic Islands (Spain).

Participants Population over 15 years of age assigned to PHC teams.

Primary and secondary outcomes measures Quarterly age-standardised prevalence of non-smoker, smoker and ex-smoker and incidence of new smoker, new ex-smoker and ex-smoker relapse rates were estimated with data retrieved from PHC electronic health records. Joinpoint analysis was used to analyse the trends of age-standardised prevalence and incidence rates. Trends were expressed as annual percentage change and average annual percent change.

Results The overall standardised smoker prevalence rate showed a significant downward trend (higher in men than women) and the overall standardised ex-smoker prevalence rate showed a significant increased trend (higher in women than men) in the three regions. Standardised smoker and ex-smoker prevalence rates were higher for men than women in all regions. With regard to overall trends of incidence rates, new smokers decreased significantly in Catalonia and Navarre and similarly in men and women, new ex-smokers decreased significantly and more in men in Catalonia and the Balearic Islands, and ex-smoker relapse increased in Catalonia (particularly in women) and decreased in Navarre.

Conclusions Trends in smoking behaviour in PHC patients remain unchanged after the implementation of comprehensive SFL. The impact of the comprehensive SFL might have been lessened by the effect of the preceding partial SFL.

  • electronic health records
  • joinpoint analysis
  • primary health care
  • smoke-free policy
  • smoking

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2017-020120

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    Footnotes

    • Contributors BB, TR-B, MP-V, JLlB-M and CV-F designed the study and wrote the protocol. YR-M, MP-V and JLlB-M conducted literature searches and provided summaries of previous research studies. BB, JLl, JM, JR and MP-V obtained the data. TR-B and TL-J conducted the statistical analysis. All authors contributed to the interpretation of the results. YR-M and MP-V wrote the first draft of the manuscript. All authors read, contributed and approved the final version of the manuscript.

    • Funding This project has been funded by the Carlos III Health Institute (Ministry of Economy and Competitiveness, Spain) with a grant for research projects on health (PI11/01413) through the Network for Prevention and Health Promotion in Primary Care (redIAPP, RD12/0005/0001; RD16/0007/0001), and by European Union ERDF funds.

    • Competing interests None declared.

    • Ethics approval This study follows the tenets of the Helsinki Declaration and of Good Clinical Research Practice and has been approved by the Ethical and Clinical Research Committee of the IDIAP Jordi Gol. Confidentiality was guaranteed through data encryption and anonymisation in agreement with the data confidentiality Law 15/1999.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.

    • Patient consent for publication Not required.