Research line: Tobacco

Spain has made progress in the implementation of tobacco control policies over the past six years. Advertising and smoking bans in workplaces in 2006 were followed by several tax reforms and an extension of the restriction to the bars and restaurants at the beginning of 2011. However about a third of men (31.37%) and more than a fifth of women (22.77%) say smoking (daily or occasionally) according to the latest Health Survey (2011-12). There has been a considerable decrease of almost 4 percentage points in smoking prevalence for men from the Health Survey 2006 (35.33%), but only 1 percentage point for women. Similarly, the percentage of former smokers over those who smoke or have smoked at some point, is 46% for men (44.3% in 2006) but only 35.8% for women, and it has been practically unchanged from 35.5% in 2006.

 Given the still high rate of prevalence in the Spanish population, an important dimension of prevention policies is to promote the cessation of smoking. It is noteworthy that among smokers, 28%, about 4.4 million people, are considering quitting. This group of citizens is a clear target for interventions that help cessation. However, among those who have stopped smoking only 4.2% reported having received professional help in the process.

The objective of this component of the project is twofold: (a) analyze the determinants of cessation, estimating the effectiveness of different existing interventions at national and regional level; and (b) assess the cost-effectiveness of such interventions. To achieve the first objective we will analyze the determinants of cessation, characterizing its socioeconomic gradient, which has been identified as a major explanatory factor of social inequalities in health and identifying the factors likely to be affected by public policies . The geographical dimension looks important. Some of this variation is associated with differences in demographic structure, but the institutional environment, in particular the existence and scope of services for addiction, may be playing a role. To achieve the second objective will use a Markov model, drawing on the previous experience of the research team with this methodology in the context of the UK. This model, informed by evidence from the first target, analyze and evaluate the adequacy of interventions in terms of cost-effectiveness, cost-utility and cost-benefit ratios, and will serve as a tool for transferring the results.

The long-term trends, smoking reduction and increased obesity, are not homogeneous by population subgroups. Lifestyles could potentially increase the gap in socioeconomic inequalities, more in times of economic crisis. Even the best-intentioned policies based on scientific evidence of cost-effectiveness could be biased by self-selection of economic evaluation studies themselves, aimed at justifying individual raher than collective interventions, treatment rather than prevention, and medicines rather than changes in lifestyles. There are, however, enormous potential policies based on individual incentives to change behavior, whose theoretical foundation is Behavioral Economics.

Referring to tobacco, the FEPS aims:

• To identify interventions and programs for addiction to tobacco at regional and local level in Spain through: (a) a review of the literature and interviews with heads of regional health services; and (b) obtaining evidence about the extent of cessation programs from administrative records of regional services and health surveys;

• To estimate the effectiveness of cessation programs and compare the results to those in the international literature: (a) identifying sources of exogenous variation in exposure to smoking cessation programs; (B) estimating causal effects of cessation programs; and (c) comparing the results with international literature;

• Conduct an economic evaluation, (a) building a economic and epidemiological simulation model to assess in terms of cost-effectiveness and cost-utility possible combinations of smoking cessation programs in Spain; and (b) developing a protocol piloting the use of economic evaluation model useful for health officials;

• and last but not least, make proposals for measures to promote cessation, identifying the the most desirable combination of cessation programs in terms of cost-effectiveness and cost-utility, at national and regional levels.

• The rate of smoking cessation in the Spanish population could be improved through a combination of general public health policies and personalized treatments that affect both the intention of quitting and the effective realization of this desire
• There is a socioeconomic gradient in the rate of smoking cessation approach. By facing it through public health intervention it would be possible to reduce the socioeconomic inequalities in health
• The cessation rate is lower in women, in lower education groups and in racial minorities. In each of these instances the factor(s) responsible is potentially different.
• There exist efficient combinations of general policies and personalized smoking cessation treatments. They can be identified through economic evaluation.

COORDINATOR:

• Ángel López Nicolás
  

WORK PACKAGE:

• WP1 Tabaco

PARTICIPANTS:

• María Belén Cobacho Tornel
• José María Ramos Parreño
• María de Lourdes Badillo Amador
• Marta Trapero Bertran
• Jeff Harris