Background: The pattern of smoking initiation is of importance in understanding the prevalence of smoking and future trends in tobacco‐related diseases. Objective: To analyse trends of cigarette smoking initiation rates by sex and educational level in Spain. Methods: Pooled data from the 1993, 1995 and 1997 Spanish National Health Interview Surveys were used (16,365 males and 17,478 females aged >15 years). The age and smoking status of each subject were reconstructed for five calendar periods (1948–1952, 1958–1962, 1968–1972, 1978–1982, 1988–1992). Age‐specific (10 to 24 years old) smoking initiation rates were calculated for males and females, and according to level of education (high education: university and secondary school; low education: primary and less than primary). Results: Among males, there was a trend towards earlier age at start of smoking and higher initiation rates between 1958 and 1982, and a subsequent decline in initiation rates, more apparent in males with a higher level of education. Smoking initiation among females was rare until the 1960s, and from the period 1968–1972 onwards a converging pattern with that of males was observed. Women with a higher level of education started smoking before women with low education, but this pattern changed over the period 1978–1982, with higher initiation rates among less educated women during the last period studied. Conclusions: These results help to characterize the tobacco epidemic in Spain, now at the end of stage 3. The observations are in agreement with diffusion‐of‐innovations theory and the social and economic changes from the 1960s onwards in Spain.
Received 16 July 2001. Accepted 4 March 2002.
1Cancer Prevention and Control Unit, Catalan Institute of Oncology, Barcelona, Spain 2Municipal Institute of Public Health of Barcelona, Spain 3Ministry of Health, Generalitat de Catalunya, Spain