Objective: To analyse the variation in demand for tobacco according to price of cigarettes across the European region. Design: Cross-sectional study. Setting: All the 52 countries of the European region. Participants: For each European country, data were collected on annual per adult cigarette consumption (2000), smoking prevalence (most recent), retail price of a pack of local and foreign brand cigarettes (around 2000), the gross domestic product adjusted by purchasing power parities, and the adult population (2000). Main outcome measure: Price elasticity of demand for cigarettes (that is, the change in cigarette consumption according to a change in tobacco price) across all the European countries, estimated by double-log multiple linear regression. Results: Controlling for male to female prevalence ratio, price elasticities for consumption were 20.46 (95% confidence interval (CI) 20.74 to 20.17) and 20.74 (95% CI 21.13 to 20.35) for local and foreign brand, respectively. The inverse relation between cigarette price and consumption was stronger in countries not in the European Union (price elasticity for foreign brand cigarettes of 20.8) as compared to European Union countries (price elasticity of 20.4). Conclusions: The result that, on average, in Europe smoking consumption decreases 5-7% for a 10% increase in the real price of cigarettes strongly supports an inverse association between price and cigarette smoking. E conomic aspects are one of the most important prevention strategies for smoking cessation and against smoking initiation and consumption. [1][2][3][4] The potential impact of tax increases on demand for cigarettes worldwide has been modelled in a report for the World Bank. 5 The model revealed that even modest price increases could have a striking impact on the prevalence of smoking and hence on the number of tobacco related premature deaths. It was estimated that a 10% increase over the average estimated price in each region could lead to 40 million people worldwide quitting smoking, and many more who would otherwise have taken up smoking would be deterred from doing so. 5 The assumptions on which the model was based, concerning price elasticity (that is, the percentage change in cigarette consumption for a 1% change in cigarette price), health impact, and other variables were highly conservative, and consequently the results were likely to underestimate the actual impact.Many studies showed that price elasticity of demand had an appreciable impact on smoking consumption in several developed countries, including the UK (20.36

BackgroundA smoke-free law came into effect in Spain on 1st January 2006, affecting all enclosed workplaces except hospitality venues, whose proprietors can choose among totally a smoke-free policy, a partial restriction with designated smoking areas, or no restriction on smoking on the premises. We aimed to evaluate the impact of the law among hospitality workers by assessing second-hand smoke (SHS) exposure and the frequency of respiratory symptoms before and one year after the ban.Methods and FindingWe formed a baseline cohort of 431 hospitality workers in Spain and 45 workers in Portugal and Andorra. Of them, 318 (66.8%) were successfully followed up 12 months after the ban, and 137 nonsmokers were included in this analysis. We obtained self-reported exposure to SHS and the presence of respiratory symptoms, and collected saliva samples for cotinine measurement. Salivary cotinine decreased by 55.6% after the ban among nonsmoker workers in venues where smoking was totally prohibited (from median of 1.6 ng/ml before to 0.5 ng/ml, p<0.01). Cotinine concentration decreased by 27.6% (p = 0.068) among workers in venues with designated smoking areas, and by 10.7% (p = 0.475) among workers in venues where smoking was allowed. In Portugal and Andorra, no differences between cotinine concentration were found before (1.2 ng/ml) and after the ban (1.2 ng/ml). In Spain, reported respiratory symptom declined significantly (by 71.9%; p<0.05) among workers in venues that became smoke-free. After adjustment for potential confounders, salivary cotinine and respiratory symptoms decreased significantly among workers in Spanish hospitality venues where smoking was totally banned.ConclusionsAmong nonsmoker hospitality workers in bars and restaurants where smoking was allowed, exposure to SHS after the ban remained similar to pre-law levels. The partial restrictions on smoking in Spanish hospitality venues do not sufficiently protect hospitality workers against SHS or its consequences for respiratory health.

Our objective was to examine social class and educational differences in long-term smoking cessation success among a cohort of smokers attending a specialized smoking clinic. We studied sustained abstinence after cessation among 1,516 smokers (895 men and 621 women) treated for smoking cessation between 1995 and 2001 at a university teaching hospital in the metropolitan area of Barcelona, Spain. We calculated 1-year and long-term (up to 8-year) abstinence probabilities by means of Kaplan-Meier curves and the hazard ratio of relapse by means of Cox regression, after adjusting for other predictors of relapse. Overall abstinence probability was .277 (95% CI = .254-.301). Men and women in social classes IV-V had significant hazard ratios of relapse after long-term follow-up (men: 1.36, 95% CI = 1.07-1.72; women: 1.60, 95% CI = 1.24-2.06), as compared with patients in social classes I-II. The same independent effect was observed for education: Men and women with primary or less than primary studies had higher hazard ratios of relapse (men: 1.75, 95% CI = 1.35-2.25; women: 1.92, 95% CI = 1.51-2.46), as compared with patients with a university degree. Similar estimates were obtained after adjustment for stage of change, Fagerström score for nicotine dependence, and type of treatment. Patients of lower socioeconomic status are at higher risk of relapse, and this association is independent of other well-known predictors of relapse. Social differences have to be taken into account in the clinical setting when tailoring specific actions to treat smoking dependence.

Background and objectives-While socioeconomically derived diVerences in health and health services use have long been a subject of study, diVerences based on gender, considered as the explicative variable, have scarcely been quantified from population-based data. The aim of this investigation was to analyse inequalities in health and health care services utilisation between men and women in Catalonia (Spain). Design, setting, participants, and measures-Data from the Catalan Health Interview Survey, a cross sectional survey conducted in 1994, were used. A total of 6604 women and 5641 men aged 15 years or over were included for analysis. Health related variables studied were self perceived health, restriction of activity (past two weeks), and presence of chronic conditions; health services use variables analysed were having visited a health professional (past two weeks), an optometrist (12 months), or a dentist (12 months); and hospitalisation (past 12 months). Age standardised proportions were computed according to gender, and prevalence odds ratios (OR) were derived from logistic regression equations. Main results-Women more frequently rated their health as fair or poor than men (29.8% v 21.4%; OR=1.22; 95% CI: 1.10, 1.34). More women than men reported having restricted activity days (OR=1.86; 95% CI: 1.59, 2.18) and chronic conditions (OR=1.74; 95% CI: 1.60, 1.89). The proportion of women visiting a health professional was slightly greater than that for men (OR=1.20; 95% CI: 1.09, 1.31), as was the proportion of women visiting an optometrist (OR=1.21; 95% CI: 1.11, 1.33), and a dentist (OR=1.43; 95% CI: 1.31, 1.55). The proportion of hospitalisation was lower in women (6.6%) than in men (7.7%; OR=0.73; 95% CI: 0.63, 0.85). When health services use was analysed according to self perceived health, women declaring good health reported a greater probability of consulting a health professional (OR=1.35; 95% CI: 1.20, 1.52). There were no diVerences in respect to hospitalisation, visits to the optometrist and to the dentist. Conclusions-These results indicate a pattern close to the inverse care law, as women, who express a lower level of health and thus would need more health care, are not, however, using health services more frequently than men. (J Epidemiol Community Health 1999;53:218-222) While gender diVerences in health, assessed in terms of mortality and morbidity, have been reported in most developed countries over recent decades, 1-10 less attention has been paid to the pattern of health care services use.