The national report on tobacco use 2023| Tabaccologia

On May 31^st of each year, the World Health Organization (WHO) celebrates the World No Tobacco Day (WNTD), with the aim of informing people about the risks associated with the use of tobacco, the commercial practices carried out by large multinationals, the policies to reduce consumption and what people around the world can do to claim their own right to health and a healthy life.

This year’s theme (2023) is “Grow food, not tobacco”. The WTND global campaign aims to raise awareness about alternative crop production and marketing opportunities for tobacco farmers and encourage them to grow sustainable, nutritious crops. It aims to expose the tobacco industry’s efforts to interfere with attempts to substitute tobacco growing with sustainable crops, thereby contributing to the global food crisis. This campaign calls on governments and policy-makers to step up legislation, develop suitable policies and strategies, and enable market conditions for tobacco farmers to shift to growing food crops that would provide them and their families with a better life. The WHO Framework Convention on Tobacco Control (FCTC) offers specific principles and policy options on the promotion of economically viable alternatives for tobacco workers, growers and individual sellers, and on enhancing protection of the environment and the health of people.

On May 31^st, 2023, the XXV National Conference “Tobacco dependence and the National Health Service” was held at the Istituto Superiore di Sanità (ISS - Italian National Institute of Health). The event was an opportunity to explore the topic proposed by the WHO and to present the National Report on tobacco use, 2023.

Smokers in Italy

In collaboration with “Mario Negri” Institute for Pharmacological Research, between the months of February and April 2023, ISS carried out a sample survey aimed at investigating the tobacco and nicotine consumption habits of Italians.

The survey involved a representative sample of the Italian population (15 years and over) selected according to the main socio-demographic variables and the interviews were conducted by anonymously filling in a questionnaire administered with the Computer Assisted Personal Interview (C.A.P.I.) system.

The research found out that smokers in Italy are 10.5 million (20.5% of the population): 6.3 million men (25.1%) and 4.4 million women (16.3%). Compared to 2022 data (smokers were 12.4 million, corresponding to 24.2% of the population), the number of smokers decreased (Figure 1).

The highest prevalence of male smokers was in the 25-44 age group (33%) while the highest prevalence of female smokers was in the 45-64 age group (22.4%).

While the number of smokers has decreased, the number of cigarettes smoked increased: on average, smokers consumed 12.2 cigarettes per day (in 2022 were 11.5 per day) and about a quarter of smokers (24.4%) smoked more than 20 cigarettes per day (in 2022 the smokers with this hard consumption were 20.4%).

With respect to the use of products which are potentially alternative to traditional cigarettes, the survey showed that electronic cigarettes (e-cigs) users (occasional + habitual) are 2.5% of the population (about 1,300,000 people). Dual users, i.e. those consuming both traditional cigarettes and e-cigs, are 85.6%: a percentage of concern showing the increasing level of nicotine dependence caused by the use of both the products. 4.4% of electronic cigarette users (regular or occasional) are people who had never smoked traditional cigarettes before using the e-cig. This data indicates that e-cigs can make nicotine dependent new users that would have never started with traditional cigarettes. With respect to refill liquids, 60.4% of consumers say they use liquids containing nicotine (6.0% use both nicotine and nicotine-free types).

Concerning the heated tobacco products (HTP), the regular or occasional users are 3.7% of the Italian population (about 1,900,000 people). Dual use (HTP and traditional cigarette) is 85.9%, whereas 3.1% of HTP consumers never smoked conventional cigarettes.

ISS conducted a survey, from October to November 2022, to estimate the prevalence and habits consumption among students. The survey involved a representative sample of students attending first grade (11-13 years old) and second grade secondary schools (14-17 years old).

Interviews were conducted by anonymously filling in a questionnaire administered with the Computer Assisted Personal Interview (C.A.P.I.) system.

In this survey, it was observed that 9.6% of 11-13 years old students and 36.6% of 14-17 years old students consume at least one product between conventional tobacco cigarettes, e-cig or HTP (at least once in the month before the survey). In contrast with adults, among young people consumption is higher in females than in males.

The most used product among 11-13 years old Italian students is e-cig (prevalence 8.1%), whereas among the 14-17 years old group the most used is conventional tobacco cigarette (22.6%) followed by e-cig (21.5%).

Taking into consideration the subpopulation of consumers who use at least one tobacco or nicotine product, the most commonly used one (either exclusively or in combination with other nicotine or tobacco products) in the 11-13 years old group is again the e-cig (used by 83.6% of the students), followed by the conventional tobacco cigarette (used by 35.2% of the students) and by HTP (13.5%).

In the 14-17 years old group, the most used product (exclusively or in association with other nicotine or tobacco products) is the conventional tobacco cigarette (6.3%) followed by e-cig (59.8%) and HTP (33.2%).

Among the 11-13 years old students consuming tobacco or nicotine, 26.0% are poly-users (consuming more than two products), and this percentage turns higher (38.7%) in the 14-17 years old group.

The “Tobacco Quitline” (Telefono Verde contro il Fumo - TVF)

Tobacco quitline (TVF) is an anonymous and toll free national service, available at the National Centre on Addiction and Doping of ISS since 2000. TVF is a telephone counseling service on tobacco and nicotine dependence and is aimed in particular at smokers, to support them in the process of cessation, at former smokers at risk of relapse and their families.

Since its beginning, TVF has handled 106,000 phone calls, of which 8,047 in the last year of activity (May 2022 - April 2023). Almost all users have known this service from the warnings on cigarette packets (96.0%).

Phone calls come from all over the country but the North region is the most represented area (40.0% of the total calls) and those who call are almost always smokers (90.0%), although there are also calls from families and friends, who seek help for their loved ones to quit smoking (8.0%).

Two-thirds of the users are men (M61.0% vs F39.0%) and all age groups are represented.

The main request of the smokers who contact the Quitline is to receive “help to quit smoking” (92.0%), also following previous unsuccessful cessation attempts: 57.0% of smokers, in fact, declare that they have made at least one attempt to quit. In the last year, the percentage of users asking for information on e-cigs has increased (0.8% in 2022 and 5.5% in 2023).

Each phone call is characterized by a diversified and personalized professional intervention by the team of psychologists who work at the service. Counselling, information and support for the motivation to quit are the most relevant and essential factors of the helping relationship between the counselor and the user.

Territorial tobacco smoking cessation services

Considering user requests, the TVF operates with a view to promoting continuity with the local helthcare system, promoting the activity and facilitating access to the Smoking Cessation Centres (CAF - Centri Anti-Fumo). CAFs are structures dedicated to tobacco control that play a central role in the cessation process, offering specialized and heterogeneous paths based mainly on drug therapies, individual and group interventions, with the assistance of a multidisciplinary team of professionals including doctors, nurses, psychologists. Since 2000, the ISS has been taking care of the census and the annual updating of anagraphic data and the assistance of the Smoking Cessation Centres, creating a national network that is always up-to-date. The census was concluded in May 2023 and 241 “Services” were detected, which is an increasing number compared to the last year: in 2022 the Centres were 223 (although in 2021 there were 268 and in 2019 there were 292) (Figure 2). In the Smoking Cessation Centres multidisciplinary team the most represented professionals are physicians (36%), psychologists (21%) and nurses (18%).

The offer to the people includes integrated interventions: individual counselling is the first proposal of the Smoking Cessation Centres (97.0%), pharmacotherapy (91.0%), individual psychotherapy (39.0%), group psychotherapy (35.0%), and psychoeducational groups (32.0%).

The smoking cessation centres can be accessed in several ways and through different forms of contributions: some of them are completely free of charge and others require the payment of the healthcare ticket.

Figures and tables

Figure 1.Prevalence of cigarette smoking - historical series.

Figure 2.Trend of the Smoking cessation centres (2000-2023).