7% of overall cigarettes per capita by the year 2020. Article 6 of the FCTC urges the parties to adopt price and tax measures nevertheless for all tobacco products.2 In Spain, several tax reforms have accompanied the implementation of more restrictive tobacco regulations, but they have been mainly applied to manufactured cigarettes. In recent years, the prices of these products have been remarkably different, with rolling tobacco costing about 50% less than manufactured cigarettes until 2009, when a small tax was introduced. However, an increase in the market share of rolling tobacco has been observed, from 1.6% to 5.1% of sales from 2005 to 2011.13 The decrease

in sales of manufactured cigarettes is possibly in part a collateral effect of the Spanish smoke-free legislation of 2010, reflecting less smoking by adult smokers. The current economic crisis could also have contributed to make some smokers shift from manufactured to RYO cigarettes, especially younger smokers. This shift should be explored in depth in order to develop prevention strategies, especially among young people. A New Zealand study found that the reasons referred by smokers for this shift are, in order of importance, that RYO cigarettes are cheaper, taste better, are more satisfying, reduce the amount smoked and have less harmful

effects.26 With a more detailed knowledge of this shift by population strata, more appropriate strategies may be planned to tackle rolling tobacco consumption and encourage cessation—among them, awareness campaigns and better information to the population on the health effects of rolling tobacco, with an emphasis on youth and socioeconomic deprived areas. Some limitations of our investigation deserve consideration. First, we estimated the cigarette consumption per capita by means of the information available on product sales. This information provides a crude

estimation of the population’s consumption, as it does not distinguish between sales to the Spanish population and sales to the tourists, a common situation especially in the nation’s border and coastal provinces. On the other hand, official sales do not include smuggling, and therefore a variable portion of the consumption is not being considered. Entinostat However, smuggling had hugely decreased in the past decades,27 and in a European survey conducted in 2010 only 3.4% of Spanish smokers self-reported purchase from an illicit source.28 Second, information on tobacco sales is heterogeneous. In the case of manufactured cigarettes, sales were registered in ‘packs’ in the first years (until 2005, packs of 10 and 19 cigarettes existed, although they represented a very small portion of the volume share). The available information on rolling tobacco is more heterogeneous, because the registries on sales during the first years included units of the product and no specification on their weights was provided.