07 to 0.92 units of 0.5 g, from 0.04 to 0.58 units nevertheless of 0.8 g and from 0.03 to 0.46 units of 1 g (average APC:

14.1). This represents an increase in the proportion of RYO cigarettes from 0.9% in 1991 to 19.6% in 2012 of overall cigarettes per capita, considering rolled units of 0.5 g (from 0.5% to 13.3% and from 0.4% to 10.8% considering RYO cigarettes of 0.8 and 1 g, respectively). Overall, daily consumption per capita (manufactured plus RYO cigarettes) decreased from 7.6 to 4.7 units (average APC: −2.1), from 7.6 to 4.4 units (average APC: −2.4) and from 7.6 to 4.2 units (average APC: −2.5), depending on the weight of the RYO cigarettes considered. Figure 1 Daily cigarette consumption per capita (units of factory-made and roll-your-own cigarettes) in Spain during 1991–2012 and predictions for the years 2013–2020. Joinpoint analyses (table 1) indicated a decrease in the consumption

of manufactured cigarettes at the beginning of the period (1991–1996), then a period of non-significant rising during 1997–2001, and then a significant downward trend in 2002–2008, which accelerated afterwards in 2009–2012 (APC of −12.6). When we considered only RYO cigarettes, we observed a continuous significant increasing trend of 14.1% for the whole study period (1991–2012). Table 1 Joinpoint analyses of daily cigarette consumption per capita by adult population ≥16 years old in Spain (manufactured cigarettes, roll-your-own cigarettes and both type of cigarettes) over the period 1991–2012 and the corresponding … Figure 1 shows the trends

in daily consumption of units of manufactured and RYO cigarettes, as well as the projections up to 2020. For that year, differences between the consumption of both types of cigarettes taken together (solid line) and the consumption of manufactured cigarettes only (dashed line) reach a 36% increase compared to that observed at the end of the observed period in 2012. By 2020, projections indicate a daily consumption per capita of 1.75 units of manufactured cigarettes and 1.25 units of RYO cigarettes, the latter representing Cilengitide 41.6% of overall cigarettes per capita projected by that year. Discussion Besides a decrease in daily consumption per capita of manufactured cigarettes, we observed an increase in the consumption of RYO cigarettes, thus indicating a shift from one form to another. We found an increasing contribution of the RYO cigarettes to the overall cigarette consumption per capita during 1991–2012. These changes have to be taken into account in future tobacco control policies. They represented 0.9% in 1991 and 19.6% in 2012 of overall cigarette consumption per capita, when considering RYO units of 0.5 g. This trend has also been observed in other developed countries,22–24 including younger populations.