Press Release N°39/2022 - Smoking: Italy reports almost 800,000 smokers more than in 2019 and the consumption of heated tobacco products has tripled

Press Release N°39/2022 - Smoking: Italy reports almost 800,000 smokers more than in 2019 and the consumption of heated tobacco products has tripled

Pacifici: it is the first significant increase since 2006 and concerns both sexes

The ISS report to mark World No Tobacco Day on 31 May

ISS, 30 May 2022 – Almost one Italian out of four (24.2% of the population) is a smoker: after a long stagnation period, this year we are witnessing a 2% increase. In fact, smokers were 22% in 2019, the last year a survey was carried out before the pandemic. The trend in the 2017-2019 three-year period recorded a constant drop in women smokers but it was not confirmed in 2022: this year we are witnessing an increase in the percentage of smokers that concerns both sexes. There is also an uptrend in the number of people who smoke heated tobacco products: it accounts for 3.3% of the population in 2022 compared to 1.1% in 2019, and more than one person out of three (36.6%) considers them less harmful than traditional cigarettes. These are the most relevant data highlighted in the ISS report released today to mark the World No Tobacco Day promoted by the WHO and that will be celebrated tomorrow. The theme proposed by the World Health Organization for 2022 focuses on the impact of tobacco on the planet, spanning across tobacco growing, production, distribution, and wastes. The campaign also aims to emphasize the tobacco industry’s efforts to appear “eco-sustainable” and improve its own reputation and that of its products by marketing them as environmentally friendly.

“The increase in the number of smokers is a signal that raises concern – said Silvio Brusaferro, president of the ISS – and in respect of which it is important to put in place prevention measures starting with the youngest smokers to assure them a longer life, with less disabilities and qualitatively better for us and for those surrounding us.”

Also the increase in new tobacco products has contributed to modify the trend recorded over the past few years.

“The figures relative to this year – said Roberta Pacifici, Head of the National Center for Addictions and Doping of the ISS – confirm how the pandemic has significantly affected the Italians’ tobacco product and nicotine consumption habits. New tobacco products and E-cigs have added on to the consumption of traditional cigarettes and their consumers are almost exclusively dual users. The misperception of consuming products that are less or even unharmful to health and feeling authorized to use them anywhere, in derogation to the Sirchia law, are undoubtedly affecting the increase in their consumption.”

• The Conference

To mark World No Tobacco Day, the Italian National Institute of Health has organized the 24^th Conference on “Tobacco Smoking and the National Healthcare Service” tomorrow, to be held at its premises at 8:30 AM, and broadcast online on the StarLeaf platform and in live streaming  

• Consumption

There are 12.4 million smokers in Italy, accounting for 24.2% of the population. Ex-smokers amount to 14.9% of the Italian population and non-smokers to 60.9%. The highest prevalence of male smokers is recorded in the 25-44 age group (42.9), while the highest prevalence of female smokers (24.5%) is in the 45-64 age group. The lowest incidence is found in the over-65 age group of both sexes.

Male smokers also represent the highest percentage of those who smoke more than 20 cigarettes a day (25.6% compared to 13.4% among female smokers) while female smokers represent the lowest percentage of cigarettes smoked, with less than 9 cigarettes a day (36.0% compared to 31.4% among male smokers). Almost half of young smokers in the 15-24 age group (49.8%) smoke less than 9 cigarettes a day, even if 45.5% of these smoke between 10 and 19 cigarettes/day.

Geographically, the prevalence of smokers is higher in the South of Italy among both sexes: 32.6% among men, 21.6% among women.

The most widely smoked cigarettes are in packs (84.9%) and hand-rolled (14.9%), although these percentages are dropping compared to the figures recorded in 2019 (90.2% for traditional cigarettes, 18.3% for hand-rolled cigarettes). Hand-rolled cigarettes are significantly more widespread among young males living in the regions of Central Italy.

• Electronic cigarettes and heated tobacco products

In Italy, habitual or occasional E-cig users account for 2.4% of the population or approximately 1,200,000 people. After the downtrend in users recorded in the previous years, they seem to be rebounding in 2022 (they amounted to 2.5% in 2017, 2.1% in 2018, and 1.7% in 2019). 81.9% of E-cig users are cigarette smokers, turning them into dual users of traditional cigarettes and E-cigs. Instead, 2.8% of habitual or occasional smokers are people who have never smoked traditional cigarettes before they starting to use E-cigs.

As for heated tobacco products (HTP), these are habitually or occasionally used by 3.3% of the Italian population, amounting to approximately 1,700,000 people. Their consumption has tripled from 1.1% in 2019 to 3.3% in 2022. As for HTP being perceived as a health hazard, despite the majority of smokers (52.2%) think that they are as harmful as traditional cigarettes, 36.6% think that they are less harmful: this perception is more widespread among smokers than it was in 2019 (when it was the opinion of 25.3% of smokers).  In addition, 38.8% of the population (48.4% of smokers) think that this type of product is not inducive to the consumption of traditional cigarettes while 26.1% of Italians (37.2% of smokers) think that exposure to the passive smoke of heated tobacco products is not harmful for health.

• Passive smoking

Allowing guests to smoke at one’s home is a behavior that is closely correlated to the current condition of being a smoker. In fact, smoking in one’s home is not allowed by 45.0% of the smokers (they were 48.9% in 2019), 75.4% of ex-smokers (they were 74.9% in 2019) and 83.5% of non-smokers (they were 80.4% in 2019): this means that smokers’ virtuous behavior is slackening while more ex-smokers and non-smokers do not allow people to smoke in their homes.

Also exposing children to passive smoking in their home is closely correlated to the condition of being a smoker: in fact, while 22.6% of smokers declare exposing their children to passive smoking, this percentage drops to 5.5% among ex-smokers and to 4.7% among non-smokers.

After more than 15 years since the coming into force of the smoking ban law (Sirchia Law), respecting the ban on smoking indoors has become a widespread behavior throughout Italy, where the law is substantially complied with. Unfortunately, the introduction on the market of alternative products to traditional cigarettes (E-cigs and heated tobacco products) and regulations not yet updated to the new market scenarios of these products is once again challenging the habit of behaving respectfully towards non-smokers. In fact, 66.8% of E-cig users (they were 62.6% in 2019) and 74.6% of heated tobacco product users (they were 62% in 2019) feel free to use these products in public places (public or private means of transport, restaurants, cafes, etc.). The growing percentage of users of both types of products willing to violate the smoking bans recorded in 2022 is another clear alert signal relatively to a law that is still too weak in dealing with alternative products to traditional cigarettes. 

• Quit smoking, the ISS platform, and the toll-free number

Giving up smoking represents a big change in the life of tobacco smokers and at times several attempts are necessary before succeeding.

This is why the “Smettodifumare” (“Quit smoking”) platform provides a geolocated map of the Anti-smoking Centers present on the national territory, with easy instructions on how to access it. The platform also contains a new Quit Smoking Handbook, an instrument to read, compile, and customize that gives advice on useful strategies to quit smoking and overcoming the most critical moments. Watch the video on how to consult the handbook.

• Smoking Toll-Free Number

Since it first started operating in 2000, the Smoking Toll-Free Number 800 554088 has taken more than 98,000 telephone calls, with over 8,500 calls just in the last year (1 May 2021- 30 April 2022).

The toll-free number is most active in the North (40% of total calls), followed by the South and the Islands (37%), and finally by Central Italy (23%).

Callers are almost always smokers (92%) although they also include family members and friends asking for help in making their dear ones stop smoking (7%).

Almost all the callers came to know of the Smoking Toll-Free Number from the warnings posted on cigarette packs (97%).

65% of the smokers who call the Service are males and 35% females and they are evenly distributed in different age groups without especially relevant sex differences.

The callers’ main request is for “help to quit smoking” (95%), especially in the light of preceding unsuccessful attempts to give up the habit: in fact, 68% of the smokers report at least one past attempt to quit smoking. Compared to last year, the percentage of callers asking for information on new generation products has doubled from 0.6 % in 2021 to 1.1% in 2022. 

Every call receives a diversified and customized professional reply in which acceptance and providing information and motivation to quit smoking configure as the essential and unavoidable factors in the assistance relationship between the expert and the user.

• Anti-smoking Centers

The ISS makes an annual survey of the Anti-smoking Centers throughout the national territory and the update released in May 2022 records 223 Services, revealing a downtrend in the number of Anti-smoking Centers active in Italy from 268 in 2021 and 292 in 2019.

The Anti-smoking Centers are not evenly distributed across the national territory: 61% of the Services are located in the North of Italy, 17% in the Center and 22% in the South and Islands.

The Services offer integrated treatments and, to this end, rely on different categories of professionals including physicians, nurses, and psychologists. These offer different types of treatments which include: individual counselling (68%), pharmacological therapy (62%), group psychotherapy (30%), individual psychotherapy (30%) and psychoeducational groups (19%).  Compared to last year, there is a drop in the percentage of nurses serving at the Anti-smoking Centers from 22% in 2021 to 12% in 2022, while the number of dedicated medical professionals has risen from 29% in 2021 to 41% in 2022.

Users can access the Services in different ways and through different forms of payment: some services are free for users while others fall under the NHS co-payment system or other types of payment systems (membership fee, or a fee paid to a freelance professional working at a hospital facility).