Smoking Prevalence Inequalities Among Roma and Non-Roma Population in Spain Between 2006 and 2014


Tobacco consumption is unequally distributed in society. The objective was to identify trends in tobacco use among the General and Spanish Roma populations in 2006 and 2014, years characterized by strengthening of anti-smoking policy in Spain. We calculated prevalences and logistical regression models based on the Spanish National Health Survey (2006/2012) and the National Health Survey of the Roma population (2006/2014). Smoking decreased only in men in the General population (OR 0.885). In the Roma population, there were no significant changes observed for the 2 years studied (OR: men 1.095, and women 1.147). In fact, Roma men smoke 4.2 cigarettes more, and they have a younger age of initial tobacco use. Smoking behavior of the Roma population has not changed, and there has been no reduction in inequalities in tobacco use among the two populations, despite public policies designed to reduce tobacco use in Spain.

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  1. 1.

    World Health Organization. Media Cent. 2017. Accessed 5 Sep 2017.

  2. 2.

    Law 42/2010, of December 30, which modifies Law 28/2005, of December 26, on sanitary measures against smoking and regulating the sale, supply, consumption and advertising of the products of the tobacco. BOE no 318, December 31, 2010 (in Spanish).

  3. 3.

    Spanish Society of Epidemiology. Evaluation of smoking control policies in Spain (Laws 28/2005 and 42/2010) Review of the evidence. 2017; 2017 (in Spanish).

  4. 4.

    Bobakova D, Dankulincova Veselska Z, Babinska I, Klein D, Madarasova Geckova A, Cislakova L. Differences between Roma and non-Roma in how social support from family and friends helps to overcome health care accessibility problems. Int J Equity Health. 2015;14:37. Accessed 12 July 2018.

  5. 5.

    European Union. Roma Health Report. Health status of the Roma population. Data collection in the Member States of the European Union. 2014. Accessed 31 Jan 2019.

  6. 6.

    Latorre-Arteaga S, Gil-González D, Vives-Cases C, la Parra Casado D. Vision and hearing health inequities in the Roma population: a national cross-sectional study in Spain. J Immigr Minor Health. 2016.

    Article  Google Scholar 

  7. 7.

    La Parra-Casado D. Towards equity in health. Reduce inequalities in one generation in the Roma community. IUDESP, Univ. Alicant. 2009. (in Spanish).

  8. 8.

    Communication from the Commission to the European Parliament, The Council, the European Economic and Social Committee and the Committee of the Regions. 2011. Accessed 18 Sept 2018.

  9. 9.

    Fundación Secretariado Gitano. Annual report discrimination and the Roma community for a comprehensive equal treatment. 2017.

  10. 10.

    Bilal U, Beltrán P, Fernández E, Navas-Acien A, Bolumar F, Franco M. Gender equality and smoking: a theory-driven approach to smoking gender differences in Spain. Tob Control. 2016;25:295–300.

    Article  Google Scholar 

  11. 11.

    Ministry of Health. Government of Spain. Second National Survey of Health to the Roma Population 2014. 2016. (in Spanish).

  12. 12.

    Borrell C, Rodríguez-Sanz M. Aspectos metodológicos de las encuestas de salud por entrevista: aportaciones de la Encuesta de Salud de Barcelona 2006. Rev Bras Epidemiol. 2008;11:46–57.

    Article  Google Scholar 

  13. 13.

    Global Adult Tobacco Survey Collaborative Group. Tobacco questions for surveys: a subset of key questions from the Global Adult Tobacco Survey (GATS), 2nd ed. 2011. pp. 1–50. Accessed 10 July 2018.

  14. 14.

    World Health Organisation. Framework convention tobacco control. Indicator compendium. 1st ed. 2013.

  15. 15.

    Whitehead M, Dahlgren G. Concepts and principles for tackling social inequities in health: levelling up Part 1. World Health Organization. 2007. pp. 2–5. Accessed 3 Mar 2018

  16. 16.

    Suarez-Balcazar Y, Mirza MP, Garcia-Ramirez M. Health disparities: understanding and promoting healthy communities. J Prev Interv Community. 2018;46:1–6.

    Article  PubMed  Google Scholar 

  17. 17.

    Ministry of Health. Government of Spain. Report to the Cortes Generales on the evaluation of the impact on public health of Law 42/2010. 2010. Accessed 31 Jan 2019.

  18. 18.

    Escobar-Ballesta M, García-Ramírez M, Miranda D, Petrova-Benedict R. Shedding light on governance for Roma health inequities. J Prev Interv Community. 2018;46:84–99.

    Article  PubMed  Google Scholar 

  19. 19.

    Mackay J, Amos A. Women and tobacco. Respirology. 2003;8:123–30.

    Article  Google Scholar 

  20. 20.

    Gregoraci G, van Lenthe FJ, Artnik B, Bopp M, Deboosere P, Kovács K, et al. Contribution of smoking to socioeconomic inequalities in mortality: a study of 14 European countries, 1990–2004. Tob Control. 2017;26:260–8.

    CAS  Article  Google Scholar 

  21. 21.

    Amos A, Greaves L, Nichter M, Bloch M. Women and tobacco: a call for including gender in tobacco control research, policy and practice. Tob Control. 2012;21:236–43.

    Article  Google Scholar 

  22. 22.

    Arza J. Campaign to prevent tobacco use. Pamplona. 2008. (in spanish).

  23. 23.

    Escobar-Ballesta M, García-Ramírez M, De Freitas C. Taking stock of Roma health policies in Spain: lessons for health governance. Health Policy. 2018;122:444–51.

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    World Health Organisation. WHO framework convention on tobacco control, vol. 1. Geneva: WHO Press. 2005;270–1.

    Google Scholar 

  25. 25.

    Pirie K, Peto R, Reeves GK, Green J, Beral V. The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet. 2013;381:133–41.

    Article  Google Scholar 

  26. 26.

    World Health Organization. Ottawa charter for health promotion. Ottawa: World Health Organization. 1986.

    Google Scholar 

  27. 27.

    Cofiño R, Aviñó D, Benedé CB, Botello B, Cubillo J, Morgan A, et al. Promoción de la salud basada en activos: ¿cómo trabajar con esta perspectiva en intervenciones locales? Gac Sanit 2016;30:93–8.

    Article  Google Scholar 

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We wish to thank the interviewers and associations of the Roma community in Spain for participating in this study.


Ministry of Economy and Competitiveness of Spain, FEDER Funds (“National Health Survey to Roma Population 2013–2014”, Project Ref. PI12/00842), and Ministry of Health, Social Services and Equality of Spain, Carlos III Health Institute. Ministry of Science, Innovation and Universities of Spain, Spanish State Research Agency (AEI), and European Fund for Economic and Regional Development (FEDER): “Comparative impact evaluation: Roma National Integration Strategies”, Project Ref. CSO2017-83787-P. University Research Institute for Gender Studies—IUIEG-, for activities leading to doctoral theses that include a gender perspective. 2017.

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Correspondence to Pablo Caballero.

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Ethical Approval

The research was approved by the Ethics Committee of the University of Alicante (Spain) that carried out the study.

Informed Consent

Those interviewed were informed in writing and verbally of the objective of the survey, the voluntary nature of participation, the protection of anonymity and confidentiality, and of the institution and team responsible for conducting the survey. No incentive for participation was offered to respondents.

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Usera-Clavero, M., La Parra-Casado, D., Caballero, P. et al. Smoking Prevalence Inequalities Among Roma and Non-Roma Population in Spain Between 2006 and 2014. J Immigrant Minority Health 21, 1282–1289 (2019).

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  • Smoking
  • General population
  • Roma population
  • Health survey
  • Public health programs