In 2005 and 2010, two ‘anti-smoking’ laws were passed in Spain which, amongst other measures, restricted smoking in public places and at work. Following their implementation, exposure to tobacco smoke amongst non-smokers fell significantly, as did the number of active smokers.
Today, the journal Tobacco Control, published by the BMJ Group, has published a study on the proportion of passive smokers in Spain in 2024, which compares trends with three previous editions and includes information on non-smokers’ exposure to smoke on outdoor terraces, as well as to e-cigarette products. The study, carried out by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), shows for the first time in its data series a trend towards an increase in the number of passive smokers.
To present the study’s main findings and answer questions from journalists, SMC Spain organised a press briefing with three of the authors: Carlos Jiménez-Ruiz, a pulmonologist specialising in tobacco use who has served as coordinator of the Tobacco Use Unit, director of the Tobacco Use Research Programme and president of SEPAR (2018–2021), Inmaculada Gorordo Unzueta, a pulmonologist at Galdakao-Usansolo University Hospital in Bizkaia, a member of SEPAR’s Smoking Section and Smoking Research Programme, and coordinator of the 2024 tobacco survey, and Juan Antonio Riesco Miranda, a pulmonologist at San Pedro de Alcántara Hospital in Cáceres, who has served as coordinator of the Smoking Section and is the current director of SEPAR’s Smoking Research Programme.
What’s new in the fourth edition
SEPAR had carried out three studies on passive smoking between 2005 and 2011, during the period when the latest ‘anti-smoking’ laws were passed in Spain. “It has now been 20 years since the first study. We believe there has been a data gap during this time and decided to replicate the study in a context where the use of electronic devices has also become widespread,” explained Riesco Miranda.
The research “included the same questions as in the previous studies, but added questions regarding the use of and exposure to electronic smoking devices, as well as exposure on outdoor terraces—not only to tobacco smoke, but also to aerosols from these devices. In total, 3,000 interviews were conducted and responses from more than 1,300 non-smokers were included,” summarised Gorordo Unzueta.
As for the results, for the first time in the data series, a trend towards increased exposure to tobacco smoke has been observed. Specifically, the percentage of exposure in the locations studied rose from 21.3 per cent to 23.8 per cent, representing a relative increase of 11.7 per cent. Although the result is not statistically significant, “what is important is that, after 13 years without any changes to the legislation, the downward trend has come to a halt and there appears to be an increase in exposure”, emphasised Jiménez-Ruiz. These figures contrast, for example, with those from 2011 – collected following the law introduced the previous year – which “showed a significant decrease of 44 per cent”.
Furthermore, if bar terraces are taken into account – as the new study does for the first time – “the prevalence of passive smoking rises to 55 per cent”, warned Jiménez-Ruiz, making these spaces the predominant site of exposure to tobacco products. As for aerosols from electronic devices, exposure among non-smokers in 2024 stood at 18.3 per cent, but this figure rises to 38.2 per cent when outdoor seating areas are included.
With regard to these new forms of consumption, “there has been a surge in the use of e-cigarettes, heated tobacco products and nicotine pouches, which is leading to a decline in awareness of second-hand smoke. It is important to warn of the dangers of these new products, which do not help people to give up smoking or reduce harm, and which are just as addictive as conventional cigarettes,” explained Jiménez-Ruiz. Furthermore, “the highest levels of consumption, particularly in the form of electronic devices, are found in the 16–40 age group”, noted Gorordo Unzueta. This is the population group “that most needs protecting, because it has been shown that those who start in this way are at greater risk of becoming users of conventional tobacco”, she added. According to Riesco Miranda, “there is currently a problem of misinformation and a lack of awareness amongst young people on this issue”.
“The introduction of tobacco control legislation led to a significant reduction in the prevalence of passive smoking globally, in bars and restaurants, in schools, at home and at work,” summarised Jiménez-Ruiz. However, he warned that “the law is now becoming outdated, and legislative inaction is compounded by a relaxation in the enforcement of these measures”.
When asked about the repercussions and significance of passive smoking, Gorordo Unzueta pointed out that there are many studies showing its link to lung cancer, heart disease, respiratory infections in children and reduced lung capacity. “We know that in Spain there are around 55,000 deaths a year due to active smoking of conventional tobacco, and 3,000 are due to passive exposure,” she stated.
There is no safe level of exposure to tobacco smoke, not even on terraces or outdoors
Inmaculada Gorordo Unzueta
With regard to bar terraces – currently the main place of exposure to tobacco smoke, according to the new study – the pulmonologist explained that “there is no safe level of exposure to tobacco smoke, not even on terraces or outdoors. Various studies have detected higher levels of nicotine and combustion particles in people exposed to smoke on terraces. It has even been found that these particles can penetrate into the interior of bars”.
Independent reactions to the study
SMC Spain has asked experts who did not take part in the study for their views. Josep Maria Suelves, a researcher at the Behavioural Design Lab at the UOC eHealth Centre, a member of the board of directors of the Public Health Society of Catalonia and the Balearic Islands, and vice-president of the National Committee for the Prevention of Smoking, highlights the positive impact that tobacco regulations had in Spain during the first decade of this century. “These need to be built upon through the introduction of new regulations, which will help to increase the price of tobacco and nicotine products, enable plain packaging to be finally introduced in our country, expand smoke-free and nicotine-free zones, and improve the regulation of the new products that multinational tobacco companies have been promoting, particularly amongst young people and adolescents,” he adds.
For his part, Josep M. Borràs, scientific coordinator of the National Health System’s Cancer Strategy, director of the Catalan Oncology Plan and professor of Preventive Medicine and Public Health at the University of Barcelona, agrees that the study demonstrates, using data from population-based health surveys, that sustained efforts are needed to maintain the progress made in reducing exposure to second-hand smoke at the levels achieved. “The challenge is to continue making progress in controlling exposure and not to lose the ground we have gained,” he says.
