The National Report on tobacco and nicotine use 2025: prevalence and habits among Italian students| Tabaccologia

The World Health Organization (WHO) celebrates World No Tobacco Day every year on May 31st, with the aim of highlighting the risks associated with tobacco use and promoting effective policies to reduce its consumption. On this occasion, all countries undertake initiatives to address the tobacco epidemic and its impact on public health.

With the World No Tobacco Day 2025 campaign “Unmasking the appeal: Exposing industry tactics on tobacco and nicotine products” WHO aims to expose the tactics multinational corporations use to make their harmful products appealing. One of the main public health challenges today is indeed the attractiveness of tobacco, nicotine and related products, particularly for young people. The industry constantly looks for ways to make these products more enticing by adding flavors and other agents that alter their smell, taste, or appearance, as well as by using sleek designs, eye-catching colors, and pleasant flavors. These tactics can contribute to increasing the number of early consumers, with the risk of lifelong addiction and serious health consequences, to the benefith of the industry.

On May 30, 2025, the XXVII National Conference “Tobacco Use and the National Health Service” was held at the Istituto Superiore di Sanità (ISS). The event provided an opportunity to explore the theme proposed by WHO and to present the “National report on tobacco and nicotine consumption: prevalence and habits among students/youth,” once again primarily focused on tobacco and nicotine use among Italian students.

The consumption of tobacco and nicotine-containing products among young people

The National Center on Addiction and Doping of the Istituto Superiore di Sanità investigated tobacco and nicotine use among Italian students attending lower and upper secondary schools during the 2024-2025 school year.

Two surveys were conducted, with the technical and financial support of the Ministry of Health - CCM, involving a sample of 3,441 boys and girls aged 11-13, and a sample of 4,861 boys and girls aged 14-17. The sampling methodology was developed to ensure the representativeness of the population of students in Italian schools. Interviews were conducted using a structured anonymous questionnaire: the Paper and Pen Interview (PAPI) system was used in lower secondary schools, and the Computer Assisted Web Interview (CAWI) system in upper secondary schools.

The survey results show that 7.5% of Italian students aged 11-13 (just over 120,000 boys and girls) and 37.4% of those aged 14-17 (almost 865,000 boys and girls) had used at least one tobacco- or nicotine-containing product (conventional cigarettes; Heated Tobacco Products, HTP; or electronic cigarettes, e-cigs) in the 30 days prior to the interview.

Among lower secondary school students, boys consumed more than girls (M 7.6% vs F 6.9%), whereas in upper secondary schools, girls consumed more than boys (M 32.2% vs F 42.1%).

E-cigs are the most widely used product among students in both age groups (6.3% among 11–13-year-olds; 29.9% among 14-17-year-olds), followed by conventional cigarettes (3.2% among 11–13-year-olds; 24.5% among 14-17-year-olds) and HTP (2.7% among 11-13-year-olds; 22.4% among 14-17-year-olds) (Table 1).

Among 14–17-year-old students, the experimentation of nicotine pouches was also investigated. Nicotine pouches are devices designed to release nicotine directly into the mouth. Unlike snus (which is mainly popular in Northern Europe), they do not contain tobacco but rather nicotine salts, flavorings, and other substances.

A total of 8.2% of students reported having tried them “at least once in their lifetime,” with the percentage among boys being more than double that of girls (M 11.8% vs F 4.7%). The average age of first use was just over 15 years.

Consumption habits

The survey results indicate the emergence of concerning consumption patterns in both age groups and across all products studied.

Among 11–13-year-old students who smoke conventional cigarettes, 73.6% reported that they mainly smoke at weekends (with similar percentages recorded for other products), 9% said they smoke at least 20 days a month and 2.7% reported smoking 11 or more cigarettes per day. Among HTP consumers, 9.7% reported using it at least 20 days a month and 3.3% consuming 11 or more sticks per day. Finally, among e-cigs users, 16% reported using them at least 20 days a month and 11.9% said they had taken at least 200 puffs per day.

As for 14–17-year-old students who smoke conventional cigarettes, while nearly 60% reported that they mainly smoke at weekends, 40.5% said they smoke at least 20 days a month and 10.3% reported smoking 11 or more cigarettes per day. Among HTP users, almost 48% reported using it at the weekend, but 34.8% said they consumed it at least 20 days a month and 11.9% reported using 11 or more sticks per day. Similarly, 40% of e-cigs users reported using them mainly at weekends, while 35.9% said they used them for at least 20 days a month and 19% reported taking at least 200 puffs a day.

The majority of e-cigs users in both age groups use flavoured products, with the most popular among young people being ‘fruity’ flavors (73.9% of 11–13-year-olds; 82.9% of 14–17-year-olds), followed by ‘fresh and menthol’, ‘sweet and creamy’, and ‘drink and beverage’ flavors. It is important to highlight that flavors make these products especially appealing to young people, partly because they mask the unpleasant taste of nicotine. However, inhaling these flavorings is not risk-free for consumers.

The most concerning finding from the survey, beyond differences linked to gender and age, is the evidence of a generation of poly-users (students who use two or more products simultaneously). This trend, already observed in previous surveys, has been confirmed more strongly than ever before this year, with a sharp increase in related percentages.

Among lower secondary school students (11-13-years-olds), poly-users represent 45.5% of all consumers (compared to 26% in 2022) [1], with 18.3% using all three products at the same time: conventional cigarettes, HTP, and e-cigs. The latter is by far the most widely consumed product (84.8%) (Table 2).

Among 14–17-year-old students, poly-use involves 70.7% of all consumers (compared to 62.4% in 2024 and 38.7% in 2022) [1,2]; of these, 34.5% use all three products simultaneously. E-cigs are also the most widely used product in this age group (79.8%) (Table 2).

The Antismoking HelpLine

The Antismoking HelpLine (Telefono Verde contro il Fumo, TVF) is a national anonymous and toll-free service, active since 2000 in Italy at the National Centre for Addiction and Doping of the ISS.

The service is specifically aimed at tobacco and nicotine users, to support them in the cessation process, as well as their family members and former smokers at risk of relapse.

Since the beginning of its activity, the TVF has handled 118,000 calls, of which 6,497 were received in the last year of activity (2024).

The inclusion of the toll-free number on the packaging of all smoking tobacco products [3,4] means that the main source of awareness about the service is the cigarette packet itself (94% in 2024).

Currently, the toll-free number also appears on the packaging of e-cigs and refill liquids with or without nicotine [5], as well as on the packaging of nicotine pouches [6].

Calls come from all over the country, but the North is the most represented area (37% of total calls).

The service has always been used mainly by smokers, but this trend has increased gradually over the years. In 2024, smokers accounted for 89.8% of users. However, 8.1% of calls were from family members who wanted to help their loved ones quit smoking (8.1%).

Among smokers, it is mainly men who call (63% vs. 37% of females), while among family members, it is mainly women (33% vs. 67% of males). Among smokers, there are no significant differences in terms of age distribution; however, female smokers are mainly concentrated in the 56–65 (24%) and 66–75 (20%) age groups (Figure 1).

The majority of people who contact the service ask for help to quit smoking or to help their loved ones quit, often after previous unsuccessful attempts to stop [2,7].

In 2024, such requests accounted for 92.3% of all calls. Other requests concerned information about smoking cessation Centres nationwide (27.4%), information about the health risks of HTP products, e-cigs and other emerging products (5.9%), and information about health, therapies and legislation regarding bans and protection from second-hand smoke (3.1%). Finally, there were also requests for support from people trying to quit smoking independently.

Through a tailored counselling session, users can receive personalised messages containing scientific information, adapted to their real needs. The aim is to foster independent and informed decision-making processes to help them cope with situations they perceive as problematic [8].

In light of users’ requests, the TVF works to ensure continuity with local healthcare services and promote the activities of Smoking Cessation Centres, facilitating access to them. These facilities are dedicated to fighting tobacco use and offer specialised programmes based mainly on pharmacological treatments, as well as individual and group interventions involving various professionals, such as doctors, registered nurses and psychologists.

Since 2000, the ISS has been responsible for the census and annual update of information on Smoking Cessation Centres, covering details such as registry data, accessibility, type of assessment, and care provided. The census, which was completed in May 2025, recorded 223 Centres, thus confirming the downward trend that had already been observed in previous years [9].

Figure 1.Quitline users: type, gender, and age groups (% values).

References

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