Impact of tobacco prices and smoke-free policy on smoking cessation, by gender and educational group: Spain, 1993–2012

• A relationship between tobacco prices and smoking cessation has not been observed.
• Low education women were the exception: quit ratio a fell with the price increase.
• The smoke-free legislation altered the quit-ratio in the short term in all groups.
• In subsequent years the quit-ratio declined except in high education men.

BackgroundTo evaluate the effect of tobacco prices and the implementation of smoke-free legislation on smoking cessation in Spain, by educational level, across the period 1993–2012.MethodsNational Health Surveys data for the above two decades were used to calculate smoking cessation in people aged 25–64 years. The relationship between tobacco prices and smoking quit-ratio was estimated using multiple linear regression adjusted for time and the presence of smoke-free legislation. The immediate as well as the longer-term impact of the 2006 smoke-free law on quit-ratio was estimated using segmented linear regression analysis. The analyses were performed separately in men and women with high and low education, respectively.ResultsNo relationship was observed between tobacco prices and smoking quit-ratio, except in women having a low educational level, among whom a rise in price was associated with a decrease in quit-ratio. The smoke-free law altered the smoking quit-ratio in the short term and altered also pre-existing trends. Smoking quit-ratio increased immediately after the ban – though this increase was significant only among women with a low educational level – and then decreased in subsequent years except among men with a high educational level.ConclusionA clear relationship between tobacco prices and smoking quit-ratio was not observed in a recent period. After the implementation of smoke-free legislation the trend in the quit ratio in most of the socio-economic groups was different from the trend observed before implementation, so existing inequalities in smoking quit-ratio were not widened or narrowed.