RJT was involved in design, analysis and drafting of manuscript. TDC

was involved in conception, design and drafting of manuscript. RB was involved in design and analysis. Funding: Funded in part by cooperative agreement 1U01DD000754-01 from the Centers for Disease Control and Prevention. Competing interests: www.selleckchem.com/products/Vorinostat-saha.html None. Provenance and peer review: Not commissioned; externally peer reviewed. Data sharing statement: Data from this study are publicly available on the Internet through the National Center for Health Statistics.
Smoking is the leading cause of preventable morbidity and premature mortality worldwide.1 As a consequence of the increasing awareness of the population of the harmful effects of smoking and the tobacco control policies promoted by the WHO Framework Convention on Tobacco Control,2 a decrease in cigarette consumption has been observed in many developed countries in the past years. In Western Europe, cigarette consumption dropped by 26% between 1990 and 2009.3

Nevertheless, the use of forms of tobacco other than conventional cigarettes is becoming widespread, because of their lower regulation and prices.4 Although a decreasing conventional manufactured cigarette smoking has been also described in adolescents,5 6 the concurrent use of multiple tobacco products is becoming prevalent among young populations.7 In this sense, the use of rolling tobacco, or roll-your-own (RYO) cigarettes, is increasing in many countries,8 in part because of the widespread belief of minimal hazardous health effects.9 Evidence does not support this belief; on

the contrary, rolling tobacco yields higher nicotine, tar and carbon monoxide levels than manufactured cigarettes.10–12 As in other countries, the economic crisis during the past years in Spain seems to have led to an increase in the consumption of other tobacco products subject to lower taxes and thus being cheaper for smokers.13 The aim of this study is to describe trends in the consumption of manufactured and RYO cigarettes between 1991 and 2012 in Spain, and to project these trends up to 2020. Methods We used the official Spanish data on annual legal sales of tobacco products from the Tobacco Market Commission.14 The Commission collects information on tobacco product sales to smokers from tobacconists. We included data from the Iberian Peninsula & the Balearic Islands and excluded data from Canary Islands and Ceuta & Melilla, because of Batimastat the different taxation rules in these provinces. We considered annual data on manufactured cigarettes and rolling tobacco from 1991, when this latter item was first included in the registries, up to 2012. Information on manufactured cigarettes was first reported in million packs of cigarettes and then in packs of 20 cigarettes. For rolling tobacco, nevertheless, there has been some variability in the way the statement has been made.