Learning Objectives: Describe factors stimulating Spain's dramatic increase in female smoking prevalence since 1970.
Abstract: OBJECTIVE: This research is part of a series of international case studies developed by the American Cancer Society to illustrate use of publically available surveillance data for regional tobacco control.
PROBLEM: Between 1960-1990, Spain's cigarette market grew to be the third largest in Western Europe, surpassed only by Germany and Italy. Smoking prevalence among men in Spain has traditionally been high but after the restoration of democracy in 1975, consumer demand for cigarettes among women accelerated significantly in the liberalized social environment and under intensive tobacco industry marketing.
METHODS: A descriptive analysis correlating the rise in Spain's female smoking prevalence, the shift in smoking prevalence from higher to lower socioeconomic groups, and the decreasing age at initiation of smoking during 1948-1997 with tobacco industry efforts to exploit liberalizing social, economic and political conditions as revealed by tobacco industry documents.
RESULTS: Among Spanish women age 20-59, smoking prevalence rose from 2.0% in 1960 to 30.5% in 1990. Internal tobacco industry documents provide evidence that national and multinational tobacco companies cooperated to close Spain's gender gap in smoking prevalence.
DISCUSSION: The rise in Spain's female smoking prevalence after 1975 is a consequence of tobacco industry marketing strategies and social factors, such as women's increasing access to university education, growing participation in the workforce, and changing rules of gender-appropriate behavior. Although this important trend was delayed in Spain compared to many other European countries, Spain's experience precedes countries where female smoking prevalence remains low today - especially in Latin America and Mediterranean countries.
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