Nkinsi, 1

Naomi Nkinsi
Issues in Contemporary Spain
Final Paper, summer 2015
Topic: Smoking in Spain

Introduction: Difference in Smoking Rates Between the United States and Spain
Its been only 66 years since the now infamous Camel cigarettes advertisement declared
that, More doctors smoke Camels than any other cigarette, a short 54 years since Audrey
Hepburns classic Breakfast at Tiffanys poster featured the glamorous actress poised elegantly
in a black dress with a cigarette prominently featured in between her fingers, and an even shorter
nine years since James Bond has stopped smoking on screen with the introduction of Daniel
Craig featured as the notorious spy in 20061.In less than a century, the United States has gone
from promoting cigarettes as an effective medication for a multitude of ailments to demanding
that graphic images depicting the negative health effects of smoking cover half the surface area
of a pack of cigarettes2.While smoking was once widely viewed as elegant, the percentage of
Americans smoking had decreased to 18% in 2012 from 42% in 1965 3. In many respects, the
decline of smoking in the United States can be seen as a major public health success.
While smoking is now widely known to have detrimental health effects, it takes only a
short walk to the nearest caf to know that this controversial habit remains a deeply rooted aspect
of the Spanish lifestyle; a stark contrast to its image as a now departed artifact of popular culture
in much of the United States. Although Spain has seen a reduction in tobacco consumption from
32% in 2001 to 24% in 20114, this reduction in daily cigarette consumption has only manifested
in recent years while the decline of smoking in the United States has been progressing for

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decades. This apparent shift is further brought into perspective when we take into consideration
that the smoking rate in Spain still remains higher than the World Health Organizations
estimated 2012 global average rate of smoking; listed as 21% 5. After examining the data
previously presented and the contrast in apparent attitudes towards smoking between the United
States and Spain, one may be wondering what underlying factors drive these differences. This
paper seeks to analyze and address the differences in attitudes towards smoking between the
United States and Spain through the exploration of one the greatest factors effecting smoking
rate: accessibility of cigarettes and space in which to smoke.
Accessibility: Smoking and Cancer in the United States
In the United States, cigarette smoking is known to cause about 33% of all reported
cancer cases and over 90% of lung cancer cases in addition to being the leading preventable
cause of disease, disability and death6. In fact, according to the United States Center for Disease
Control and Prevention (CDC), smoking has been identified as the leading cause of one out of
every 5 U.S. deaths7. Although the health risks posed to those who smoke are undeniably high,
perhaps the most devastating results of cigarette use are the detriments caused to those, often
unknowingly, exposed to second hand smoke. For every life lost due to cigarette smoking in the
United States, there are 30 others whose health and wellness have been seriously affected due to
exposure to second hand smoke6. The CDC estimates that second hand smoke exposure has
caused over 7,300 lung cancer deaths each year in nonsmokers from 2005-2009 and 2,500,000
deaths since 19647.
Since a 1956 Surgeon General study determined a causal relationship between cigarette
smoking and lung cancer, serious efforts have been made both by public health institutions and

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the government to limit the accessibility of cigarettes to the general population 7, however the
Food and Drug Administration (FDA) didnt play a role in the regulation of tobacco products
until 1996. Until this point, the majority of tobacco bans and regulations were instituted through
state and congressional power, most dealing with restricting the sale of tobacco products and the
licensing of distributors.
One such law passed by the Federal Trade Commission was the 1965 Federal Cigarette
Labeling and Advertising Act (FCLAA) which was enacted in order to provide a set of national
standards for the packaging and labeling of cigarettes. Among other things, this law defined a
cigarette as
Any role of tobacco wrapped in paper or in any substance not containing tobacco. Any
roll of tobacco wrapped in any substance containing tobacco which, because of its appearance,
the type of tobacco in the filter, or its packaging labeling, is likely to be offered to, or purchased
by, consumers as a cigarettet8
Under the FCLAA, all cigarettes, as defined earlier, were required to have a statement of
health reading, CAUTION: CIGARETTE SMOKING MAY BE HAZARDOUS TO YOUR
HEALTH, in conspicuous and legible type on the package 9. Anti-smoking messages on the
packages of cigarettes were found to have a significant impact on cigarette sales nationwide as
the public became more aware of the dangers related to these products9. Labeling laws have since
been updated to include graphic images of the health risks of cancer and warnings that include
more explicit language concerning the causative nature of cigarettes in lung cancer and other
chronic diseases2.

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Though the United States has not currently enacted any nationwide federal smoking bans,
in 1996 President Clinton rolled out the nations first ever comprehensive program to prevent
access to cigarettes and smokeless tobacco from children and adolescents; therefore reducing the
number of Americans who would later develop a nicotine addiction. The program reduced youth
access to tobacco products and the ability to market such products to young people. In addition
to these regulations, the law required major tobacco companies to have education programs
informing young people about the health dangers of smoking through multimedia campaigns 10.
Clintons program was one of the first and most comprehensive programs in the country to
significantly reduce access to tobacco products. President Clinton further limited access to these
products in 1997 when an executive order making all federal workplaces smoke-free was passed
10

. While smoking and the use of tobacco products remains legal in the United States, the

decrease in the number of smokers since the 1960s indicates that laws limiting the marketing and
access of tobacco products have had a significant impact.
Accessibility: Smoking and Cancer in the United States
While international borders and an entire ocean separate the United States and Spain, the
differences in culture and lifestyle do not at all alter the repeatedly scientifically proven evidence
that smoking causes lung cancer and a host of other chronic health conditions. A 2002 study
published in the International Journal of Cancer investigating lung cancer mortality rates in
Spanish men and women found that the mortality rates in men nearly doubled and continued to
rise in accordance with the prevalence of smoking. In fact, the researchers only found a decrease
in the mortality rates of women in the late 1980s which they attributed to decreased exposure to
environmental tobacco in the home as a result of a decrease in smoking rates in men 11. Because
its clear that the causative relationships between smoking and lung cancer remains the same in

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Spain, it is perhaps the higher accessibility of cigarettes in Spain due to lower regulations that
contributes to higher smoking rates despite the health risks.
Although Spain has a comparatively higher smoking rate globally, the nation is not
without its regulations. Smoking was banned from the public in 2006 in a series of smoking
regulations that prohibited smoking in the workplace as well as restaurants and bars larger than
100 square meters in space unless smokers were enclosed in designated hermitically sealed
sections12. While this law greatly restricted smoking throughout the country, when assessing
whether access to smoking has played a role in Spanish smoking rates, these laws must be
considered in the context of similar laws in other countries.
With this in mind, the 2006 regulations did very little to reduce access to smoking
compared to the United States. As discussed earlier in this paper, the first bans of smoking in the
work place in the United States had begun in 1997 with President Clintons executive order.
Following this law, statewide bans began to ban smoking in all work places and public spaces.
Spains first laws prohibiting smoking in public spaces began almost a full decade later despite
overwhelming evidence that second hand smoke has detrimental health effects.
In addition to this, the 2006 legislation allowed for bars and restaurants smaller than 100
square meters in size autonomy regarding smoking regulation; meaning that the owners of these
establishments could individually decide whether smoking should be allowed in their space.
Because this provision was permitted, this piece of legislation was ultimately seen by critics as a
complete failure as almost all small business owners continued to permit smoking in response to
public pressure and du to fear of losing profits in an already declining economy 12. Opponents of
the law argued that ban could lead to the loss of 350,000 jobs in a struggling economy, a

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sentiment that was expressed by the owner of a small bar in Madrid who was quoted by the
Telegraph saying, Its hard enough already with the economic crisis keeping people from
coming in and spending money like they used to. Its part of Spanish culture to light up with a
coffee or a beer and now is not the right time to meddle with that. 12 Ultimately, it was the poor
execution of such regulation and the deeply rooted smoking culture in Spain that contributed to
the ineffectiveness of this piece of legislation.
An update to the 2006 legislation was passed in 2011 and named one of the strictest antismoking laws in the European Union. The law largely added extra provisions to the 2006 piece
but also denied small bars and restaurants the privilege to allow smoking and demanded that
larger restaurants with smoking sections remove them; essentially banning smoking in all public
spaces. The Spanish ministry of health was quick to claim that this law would decrease lives lost
due to second hand smoking, but when considering whether this law truly decreased accessibility
of smoking spaces, it is crucial to be understand the difference between the ordainment of law
and the actual practice of such law. Spains sweeping smoking bans were passed in 2011, but
smoking in public remains exceedingly high; as anyone who has recently traveled to the
European country can attest to. In fact, it is probably more uncommon to enter public spaces in
which people are not smoking than those where second hand smoke is not circulating in the air.
Conclusion: A Comparison of the United States and Spain
In comparing smoking rates in the United States and Spain, it is clear that while both
countries have laws regulating access to cigarettes and smoking spaces, the practice and
enforcement of these laws in Spain is very low compared to the United States perhaps due to
cultural norms such as those expressed by the bar owner in Madrid. It is possible that the

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continued accessibility of cigarettes and smoking spaces in Spain would be due to other nonlegislative factors. While factors such as socioeconomic status, level of education, race, and
gender are widely known in the realm of public health to influence individual participation in
risky behaviors such as smoking, one factor that is just beginning to be explored is the influence
of the level of perceived political corruption on a countrys smoking rates. A 2011 study
investigated factors influencing smoking prevalence across European Union Member States.
Researchers in this study hypothesized that smoking prevalence would be higher in countries
with high levels of public sector corruption and found that smoking rates were, in fact,
significantly higher in countries with more perceived corruption13.
While the results of this study are truly fascinating, it then calls into questions whether
this data could be sued to compare Spain to the United States or rather to just other EU member
countries. Whether we can accurately say that the United States has lower smoking rates due to
lower perceived corruption is yet to be determined, but further studies on this matter could
potentially give groundbreaking insight on this public health issue.

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Works Cited
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12. "Spain Passes Law to Ban Smoking." The Telegraph. Telegraph Media Group. Web. 6
Oct. 2015.

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13. Bogdanovica, Ilze. "What Factors Influence Smoking Prevalence and Smoke Free Policy
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