[Smoking prevalence and health-related lifestyle behaviours according to tobacco use after the smoke-free law in Spain: analysis of Spanish National Health Surveys 2009-2017.].

Objective: Smoking is one of the health risk factors most associated with population morbidity and mortality. In Spain, legal restrictions have been introduced for the use of tobacco. The objective of this study was to analyse the smoking prevalence in Spain during the period 2009-2017, following the implementation of these legal restrictions, and the relationship and evolution between smoking and other health-related lifestyle factors.

Methods: We analyzed data in 2019 from the European Health Survey in Spain 2009 and National Health Surveys of Spain 2012 and 2017. Smoking, selfperceived health status, weight status and other health-related lifestyle behaviors (physical activity, vegetable intake, fruit intake and alcohol use). A multinomial logistic regression analysis was used to obtain the odds ratio adjusted to sex and age ("odds ratio" and 95% confidence interval).

Results: Smoking decreased by 3.13% during 2009-2012, and by 4.81% during 2009-2017. Smoking population presenting 2 or 3 risk factors in 2009 was OR=1.17 (1.08-1.26), p<0.0001, in 2012 OR=1.23 (1.12-1, 34), p<0.0001, and in 2017 OR=1.32 (1.21-1.44), p<0.0001. For 4 or 5 risk factors it was in 2009 OR=1.51 (1.31-1.74), p<0.0001, in 2012 OR=1.60 (1.42-1.81), p <0.0001, and in 2017 OR=1.70 (1.51-1.92), p <0.0001. For ex-smokers, the probability of presenting 2 or 3 risk factors in 2009 is not significant, in 2012 OR=0.88 (0.80-0.98), p = 0.013, and in 2017 it is not significant. In the case of 4 or 5 risk factors in 2009 it is not significant, in 2012 OR=0.86 (0.75-1.00), p = 0.045, and in 2017 OR=1.15 (1.02 -1.30), p =0.028.

Conclusions: There is a decrease in the smoking population in Spain during 2009-2017. People who smoke have also an unhealthy lifestyle. People who smoke presented a greater number of health-related risk factors.