Report of the XX Congress of the Italian Society of Tobaccology| Tabaccologia

Tobacco and more: the problems, the solutions

The XX National Congress of Italian Society of Tabaccology (SITAB) titled “Tobacco and more: the problems, the solutions” took place in the welcoming city of Rimini.

This year’s conference, also celebrating the twentieth anniversary of SITAB, focused on revitalizing policies not only to fight tobacco smoking, both active and passive, but also to address new nicotine electronic products, targeted at an increasingly younger market, which pose new challenges both in terms of prevention and legislation. The conference also featured spaces for innovation dedicated to the “smoke-free beaches” project in Bibione and experiential moments through “psychodrama” workshops and “laughter yoga,” which actively engaged the conference participants. Lastly, the traditional SITAB-Umberto Veronesi Foundation (FUV) awards were handed out for both journalism and scientific research in tobacco science, highlighting SITAB’s activity in clinical, research and disseminating fields about tobacco.

1st Day (17th October)

The event started on the morning of October 17th with greetings from the authorities: the Mayor of Rimini, Jamil Sadegholvaad, shared the experience of introducing a smoking ban on the beach in the municipality (anticipating what was more extensively discussed in a special session of the Congress on the relationship between smoking and beach activities); Dr. Maurizio Grossi, President of the Rimini Medical Association, provided a brief history of cigarette consumption, sharing his personal testimony as a former smoker; Dr. Giulia Silvestrini, Director of Hygiene and Public Health Unit, AUSL Romagna, emphasized the role of the context in promoting smoking cessation, drawing from her personal experience.

The first session, titled “Current Affairs: Tobacco Control, Taxation, Healthcare Costs,” was opened by Dr. Luisa Mastrobattista, who presented the “2024 Report on Smoking in Italy,” outlining the results of a study on young population groups. It emerged that: among students aged 14 to 17, the use of new nicotine products continues to be alarming; over the last year, the consumption of heated tobacco products has increased at the expense of e-cigarettes; among girls, consumption is slightly higher than among their male peers; in comparison to 2022, poly-consumption (i.e., the simultaneous use of traditional cigarettes, electronic cigarettes, and heated tobacco products) doubles to 62.4%; both school performance and intra-family relationships are worse in boys who consume nicotine.

Following this, Dr. Simone Ghislandi presented “Taxation Policies Worldwide,” offering an overview of the excise duties imposed on tobacco products globally. He emphasized that the most effective policy is uniform taxation on all tobacco-related products to avoid consumers switching to cheaper alternatives. The excise taxes in Italy are slightly higher than the European average, with Ireland and France being the most virtuous countries in this regard. Useful would be the introduction of the purpose tax (i.e., that a percentage of the earnings on the sale of tobacco products be allocated to the treatment of smoking-related diseases). In the next presentation, titled “# Supporting the SSN” (SSN - Servizio Sanitario Nazionale, Italian National Health Service,) Dr. Silvano Gallus reminded the audience that fiscal policies are one of the most effective strategies in tobacco control and, as according to the World Health Organization (WHO), increasing the price of tobacco products is the most effective way to reduce consumption. For example, increasing the price of a cigarette pack by one euro would reduce sales by 11%, increase tax revenue by 18%, and would not lead to an increase in illegal trade. Then, Dr. Irene Possenti’s presentation, titled “The Health Costs of Smoking in Italy,” highlighted that: worldwide, 8 million deaths are attributed to active smoking each year; 1 million to passive smoking; for each death, 30 patients live with smoking-related diseases; the healthcare costs are primarily borne by patients aged 70 to 79 years. Lastly, Dr. Donatella Barus, in her presentation on “Information and Advocacy on Taxation,” revealed how external pressures and interference on public opinion can affect legislative choices. Journalism, in particular, can create influences by acting on the frame, informing and raising awareness, creating consensus, and controlling public policies. Other interferences come from tobacco lobbies, which often have covert connections with politics. Codes of conduct and transparency registers are tools to counteract these interferences.

Between the first and second sessions, the SITAB-FUV Journalism Award was presented by Dr. Giulia Veronesi, Dr. Barus (FUV magazine director), and Prof. Maria Sofia Cattaruzza. The winners were: Stefania Villa, who won the award in the “print and web” category for a piece published in Altroconsumo on June 28, 2024, titled “The Online Jungle of Nicotine Bags,” and Lidia Scognamiglio, who won the award in the “audio and video” category for the piece “Lung cancer: a screening for smokers that saves lives,” aired on TG2 Medicina 33 on June 6, 2024. A special mention was awarded to Michela Laccarino for her article “Cigarettes: a health harm and a scam for the planet,” published on July 9, 2024, in Il Fatto Quotidiano.

The second session featured a roundtable discussion on the topic “Young people, today’s consumption, tomorrow’s scenarios.” Participants included Dr. Valentina Minardi, who presented some results from the PASSI study (Behavioural Risk Factor Surveillance), showing that traditional cigarette use is losing appeal compared to new products (including nicotine pouches), highlighting the few obstacles minors face when purchasing nicotine-based products; Dr. Jocelyne Gianini, who spoke about the introduction in Switzerland, starting 1.1.2024, of a law aimed at standardizing legislation on new products, which can no longer be advertised or distributed for free to young people; Dr. Martina Di Pieri, who presented the Veneto Region’s monitoring system for healthy lifestyles and spoke about targeted interventions for different age groups; Dr. Silvia Iacovacci, who discussed the Unplugged project with student testimonials; Dr. Rosastella Principe, who presented the peer education project by A-MaRe-D (Association for the Prevention of Respiratory Diseases from Drugs) carried out in collaboration with the Provincial Order of Physicians and Dentists of Rome, aimed at secondary school students; and Dr. Franca Rusconi, who spoke about the role of the environment in the health of children and adolescents, emphasizing how early exposure to smoking predisposes individuals to develop respiratory diseases in adulthood.

The “Focus on” of the third session began with the presentation “OSAS and tobacco smoke” where Dr. Valentina Conti highlighted how smoking predisposes individuals to Obstructive Sleep Apnea Syndrome (OSAS) through multiple mechanisms (increased resistance and inflammation of the upper airways, changes in sleep architecture, neuromuscular impairment of the airways), and that people with OSAS tend to smoke more to counteract the lack of concentration and depression typical of sleep deprivation. Next, Dr. Chiara Gasperoni, in her talk “The role of smoking in dementia,” discussed the vascular hypothesis of atherosclerosis, emphasizing how hypoxia from smoking facilitates the activation of β-amylase with amyloid deposition and how chronic oxidative stress affects both the enzymatic and vascular components of dementia. The number of cigarettes smoked would also be proportional to cognitive deficit. The session concluded with Dr. Biagio Tinghino’s presentation “Nicotine replacement therapy and e-cigarettes: effectiveness and risk of addiction,” in which he debunked the myth of using e-cigarettes as a tool to quit smoking, noting that they have instead expanded the pool of consumers and loosened restrictions on smoking in prohibited areas (leading to decreased risk perception among smokers, even regarding secondhand smoke).

The fourth session was dedicated to free communications, covering the following topics: exposure to secondhand smoke in outdoor areas, evaluation of smoking-related damage out of the of pulmonary field, youth smoking and vaping, the use of cytisine and new IT systems in smoking cessation, and experiences of local centers in cessation treatment.

Finally, the fifth session introduced a powerful experiential component: a “psychodrama workshop” applied to the treatment of smokers.

2nd Day (18th October)

The day of October 18 began with the sixth session, “Smoking and gender differences” [a joint session of SITAB, Italian Thoracic Society (ITS-AIPO/ETS), Italian Respiratory Society (IRS/SIP). During the first presentation, Dr. Anna Maria Moretti, in her talk “Legal aspects and smoking-related diseases” retraced the development of gender medicine in Italy, then emphasized how respiratory patterns differ between men and women and how these influence the development of respiratory diseases, with varying frequency between genders [e.g., Chronic Obstructive Pulmonary Disease (COPD) is more prevalent among male smokers than female smokers]. In the next presentation, “Neurobiological foundations” Dr. Liana Fattore discussed the telescoping effect (shorter latency in women between smoking initiation and the development of related diseases compared to men), the different motivations for smoking between sexes (in men, driven by dopaminergic reward mechanisms; in women, as a mood regulator), and differences in nicotinic receptors in terms of quantity, distribution, and gender-related availability. Finally, in the last talk, “The treatment of smoking: are there gender differences?”, Dr. Daniela Bafunno highlighted differences in e-cigarette use (women more for social reasons, men to try quitting smoking), with greater dual use among women. She also emphasized that, in women, stress seems to play a larger role in both smoking initiation and relapse, and that women are more sensitive to social influences.

The seventh session, titled “Therapies for smoking-related damage: how to treat or counteract them,” was opened by Dr. Marco Contoli’s presentation titled “Chronic bronchitis, COPD, and emphysema: three faces of the same problem – tobacco smoking. Prevention and therapy.” This was followed by Dr. Cristiana Bergamini’s talk “Prevention and new therapeutic advances in head and neck tumors,” which provided an overview of this type of cancer, more common in men than in women and in older populations (although in India, the use of smokeless tobacco increases its incidence among young people). Tumor location and the presence of HPV influence the prognosis: the most unfavorable is in the hypopharynx and in HPV-positive patients. The final presentation was given by Dr. Davide Tassinari, titled “Lung cancer: what possible therapies for the smoking patient?” in which he discussed immunotherapies and illustrated how the responsiveness of lung tumors to this pharmacological treatment varies depending on the type of receptor mutation present (e.g., PDL-1 is associated with greater responsiveness).

The eighth session featured a roundtable discussion titled “Managing tobacco use in closed communities,” with participants from therapeutic communities (Dr. Antonio Boschini from San Patrignano, Dr. Francesca Falcini from Cento Fiori, Dr. Barbara Rigoli from Papa Giovanni XXIII) as well as from prison settings (Dr. Palma Mercurio from the Rimini Correctional Facility). The discussion revealed that smoking is widespread and normalized in both communities and prisons, to the extent that the amount of tobacco distributed to residents is regulated by specific internal rules and can even serve as a form of reward in therapeutic communities. As a result, individuals who enter these environments as non-smokers may sometimes begin using tobacco.

The ninth session, titled “Smoking on beaches,” began with a legislative introduction by Dr. Valentino Gardi, “Harm from secondhand smoke and legal implications,” followed by presentations from Drs. Cinzia De Marco and Ario A. Ruprecht. In their talk, “The Bibione experience: scientific results from field research,” they highlighted how black carbon levels under beach umbrellas are comparable to those in areas with heavy vehicular traffic, while standing five meters downwind from a smoker shows levels similar to those in a restricted traffic zone of a large city. The next speaker, Dr. Pasqualino Codognotto, mayor of San Michele al Tagliamento (VE), in his talk “An important battle won in the interest of all” described the success of the smoking ban on Bibione’s beach, including the installation of designated smoking areas and the resulting sharp reduction in beachgoers’ exposure to secondhand smoke. The final talk in this session “Concrete commitment for the future of our shorelines” was by Dr. Roberta Nesto, Mayor of Cavallino-Treporti, who reaffirmed the commitment of neighboring coastal municipalities to introduce this good practice on their shorelines.

The update in the tenth session, delivered by Dr. Tinghino, focused on the activities of the National School of Tobacco Control, emphasizing the importance of disseminating best practices among both physicians and pharmacists to reach a broader audience of smokers.

Next came the awarding of the SITAB-FUV Prize for Scientific Research. The top three research papers by authors under 40, published in the last two years or pending publication, were recognized. First prize went to Dr. Marco Scala of the Institute for Pharmacological Research Mario Negri IRCCS in Milan for his paper titled “Evaluation of the support for the smoke-free generation and tobacco 21 strategies in the Italian population.” Second place was awarded to Dr. Jacopo Angelini from the Friuli Centrale Health Authority and the University of Udine, for “Endocrinological diseases and the need for pharmacological therapy for smoking cessation: new diagnostic and therapeutic approaches to old problems.” Third place was awarded to Dr. Silvia Biagioni from the Institute of Clinical Physiology-CNR in Pisa for “Nicotine pouches: the first Italian evidence of their spread among students. Preview of ESPAD Italy Data.”

The eleventh and final session was dedicated to “Laughter Yoga,” with an explanation of the benefits of this practice and its specific application in the field of tobacco control, followed by a lively workshop experience involving all participants.