Daily Report
Tobacco: new products, new challenges
The XIX Congress of the Italian Society of Tobaccology (SITAB), called “Tobacco: new products, new challenges”, took place in the wonderful Florentine setting; for the first time, the national event was preceded, from Monday to Thursday, by the International Congress of the European Network for Smoking and tobacco Prevention (ENSP), the European prevention network to which SITAB is affiliated. The ENSP, represented by Secretary Cornel Radu Loghin and President Florin Mihaltan, awarded some Italian opinion leaders involved in the fight against smoking, including Prof. Girolamo Sirchia, Prof. Silvio Garattini, Prof. Cristian Chiamulera, Dr. Silvano Gallus, and some colleagues from SITAB: Maria Sofia Cattaruzza, Vincenzo Zagà, Roberto Boffi, Giuseppe Gorini.
This year the conference was focused on new tobacco products and the constant increase in their use, in particular the spread of disposable electronic cigarettes among very young people, but also the environmental impact of the production of smoking-related products, the harmfulness of passive smoking and the consequent relaunch of policies to protect the health of non-smokers.
1st Day (12th October)
The Congress began on the afternoon of October 12th with greetings from Prof. Girolamo Sirchia, who praised SITAB for its perseverance and coherence in the fight against smoking and encouraged it to continue with the request for inclusion of new tobacco products (electronic cigarettes, e-cig, and heated tobacco products, HTP) in the anti-smoking law. The greetings continued with the medical director of the Institute for Study, Prevention and Oncology Network (ISPRO) of Florence, Dr. Roberto Gusinu, who introduced the First Session called “New Products, New Challenges”. The first report by Dr. Luciano Ruggia, from Bern (CH), named “The marketing of new products: puff bars and young people: an update” gave an overview of the consumption of young people, with comparisons between the Italian and Swiss situations, highlighting how these products are not harmless and how they are advertised if they were, also taking advantage of captivating packaging. The following report, named “GYTS: Use of new products (e-cigs with and without nicotine and IQOS) by adolescents?”, presented by Dr. Valentina Minardi, illustrated the data (between 2014 and 2022) obtained from a survey (the interview is administered every 4 years to teenagers aged between 13 and 15); it can be seen is that the consumption trend of traditional cigarettes among young people is significantly decreasing, while the consumption of e-cigs (more than doubled since 2014) and HTPs is growing; all products are mostly consumed by girls. Poly-use is relatively frequent.
In the following report, called “Taxation of tobacco and new products: the Altroconsumo Petition”, Dr. Silvano Gallus recalled that tobacco taxation represents the best tobacco control strategy and presented the Altroconsumo petition on the Tobacco Endgame website, which aims at equalizing the taxation of new products with the traditional cigarette, banning the use of new products in indoor environments and banning advertising.
After this, the report “The use of electronic cigarettes in the clinical setting”, by Dr. Giuseppe Gorini highlighted how e-cigs can play a role and be effective in smoking cessation in a controlled clinical context (the available studies, however, did not take into consideration e-cigs sold in Italy and those containing nicotine salts); the report also highlighted that among patients who quit smoking with e-cigs, the risk of relapsing into traditional cigarettes smoking is double.
In the subsequent report, called “The role of electronic cigarettes in the psychological support for quitting of those who ‘want’ and those who ‘must’ quit”, Dr. Alessandro Vegliach has drawn a useful distinction between smokers based on their ability to experience the cessation process in a stimulating or frustrating way, with the research, by the operator, of a the right level of stress (eustress). Therefore, he recalled that a good operator adopts solutions that are not rigid but functional to lead the patient to a result that is possible for them.
The session, chaired by Prof. Maria Sofia Cattaruzza, was closed with the presentation of the SITAB Position Paper about new products, which integrates the one drawn up in 2018.
The SITAB-Umberto Veronesi Foundation Award for Journalism, by Dr. Roberto Boffi, Dr. Donatella Barus (director of FUV magazine), and Prof. Maria Sofia Cattaruzza took place between the first and the second sessions of the day; the winners were Stefania Villa, who won first prize for the “press and web” category with a report that appeared on Altroconsumo on July 11th 2023, called “Disposable e-cigs purchased on the web” and Elena Cestino, for the “audio and video category”, who was awarded the first prize with the service “Free from smoke”, broadcasted on 3 February 2023 on TG RAI Leonardo; two special mentions were awarded to Stefania Cortopassi, who explored the issues of the relationship between smoking and insomnia and the environmental sustainability of e-cigs and to Cristina Da Rold who wrote an article starting from the data (Infodata) relating to smoking to describe such phenomenon.
The second session, called “Smoking, environment, and nutrition” emphasized the relationship between smoking and the environmental impact that it produces at various levels (cultivation, use of fertilizers and pesticides, waste disposal). The works were opened by the report of Dr. Francesca Marinangeli entitled “Potential agricultural conversions of Italian tobacco-growing areas: evaluation, ethics and sustainability”, which brought attention to the fact that approximately 5,300,000 hectares of fertile soil in the world are occupied by tobacco cultivation, contributing to food insecurity and deforestation; therefore, the conversion of tobacco monoculture would lead to important environmental and economic repercussions. This was followed by a speech by Dr. Patrizia Russo, entitled “Impact of tobacco smoke on taste and smell”, which highlighted that, although nicotine produces effects at a morphological level on the nervous pathways responsible of taste and smell, the literature does not provide sufficient clinical studies on this topic and therefore needs to be increased. The following report, entitled “Smoking and nutrition” by Dr. Anna Villarini, underlined how on average smokers follow an unhealthier diet than non-smokers, with greater consumption of meat, fats, and alcohol and less intake of fiber, fruit and vegetables. Furthermore, smoking is a factor for chronic inflammation and nutrition could play a role in this area, with the adoption of a diet that opposes inflammation. Finally, when quitting smoking, a series of strategies can be adopted to counteract the craving for comfort food and the consequent weight gain. The last report, by Dr. Martina Antinozzi, entitled “Tobacco, new products and the intestinal microbiota”, illustrated both how the intestinal microbiota is composed and the effect that cigarette smoking and aerosolization of new products have on it, with a proportional increase in potentially pathogenic bacteria at the intestinal level and an increase in wall permeability to the passage of microorganisms into the organism.
Thursday ended with the presentation of the book: “Quit smoking with taste, without gaining weight. How nutrition can help you never start again” by Roberto Boffi, A. Villarini, and L. Beretta: the book investigates the connection between food and smoking and contains recipes especially created by chef Cesare Battisti.
2nd Day (13th October)
The day opened with the fourth joint session between the main pneumological scientific societies (Associazione Italiana Pneumologi Ospedalieri-Italian Thoracic Socety AIPO-ITS/ETS and Società Italiana di Pneumologia Italian Respiratory Society SIP-IRS) and SITAB, entitled “Smoking and the respiratory system”. The session was opened by the report of Prof. Federico Lavorini, entitled “The impact on mortality of pharmacological treatments and smoking cessation in patients with Chronic Obstructive Pulmonary Disease (COPD)”, which highlighted how both the advent of triple therapy (a combination of three drugs) and smoking cessation have reduced deaths resulting from COPD; abstaining from smoking, in addition to reducing the decline in respiratory function, has a cost/effectiveness ratio that is higher than the use of drugs and has an impact on mortality that is all the more favorable the sooner you stop smoking. Subsequently, Dr. Elisabetta Rosi presented a report entitled “Interstitial lung diseases and smoking”, which underlined how abstention from smoking, even at the beginning of these very demanding pathologies, certainly has a favorable impact on the course of the disease. This was then followed by the report by Prof. Gianna Camiciottoli on the “Effectiveness of biological therapies for severe asthma in smoking patients”, which highlighted that there is no difference in response (measured by the number of exacerbations) to biological therapies between ex-smokers and non-smokers. Finally, the session closed with the report by Dr. Antonella Serafini on “Tobacco smoke and bronchopulmonary microbiota”: contrary to what was thought, the lung is not a sterile organ but has its own microbiota, which however differs in composition between non-smokers and smokers, altering in a pathogenetic sense, with an increase in pathogenic species (which translates into immunosuppression), in the latter.
The Round Table took place during the fifth session: “the relaunch of smoking treatment centers (CTT)” Dr. Francesco Pistelli, in his speech “Post-pandemic overview of the CTTs“ provided an overview of the Anti-Smoking Centres, from their birth in 2000 to the current panorama, with 241 active Centers (ISS source); the major critical issues are represented by the continuous decrease in the number of Centres, the lack of dedicated and trained staff, the absence of inclusion of the cessation process in the LEAs, and the lack of knowledge of their presence among smokers. Dr. Biagio Tinghino, in his speech called “Pharmacists, territorial healthcare reform and smoking”, illustrated the Ministerial Decree 77/2023 and suggested the possible role that pharmacists, with their widespread diffusion across the territory, could have as a first level intervention in assisting citizens who want to quit smoking. In the wake of the previous interventions, Dr. Daniela Galeone also wanted to revisit the possible operational scenarios, talking about “How to relaunch CTTs” and reiterating the centrality of the territory in patient care and, consequently, the integration of CTTs in a local medicine network. In the following report, Dr. Renata Solimini illustrated “The Clinical Guidelines to promote the cessation of smoking” by the ISS, which, unlike the previous version, integrates questions on new styles of nicotine consumption, on the effectiveness of digital interventions, and on the greater impact of the interventions if carried out by personnel specifically trained on smoking cessation. Finally, Dr. Elena Munarini described the psychologist’s role in CTT, underlining how all the Guidelines highlight a multi-professional intervention (integrating the pharmacological approach with the psycho-behavioral one) as more effective.
During the sixth session, Prof. Esteven Fernandez (Barcelona) explain the lectio magistralis “Passive tobacco smoke and e-cigarette emissions in Europe: results of the TackSHS study”: a multicenter study lasting approximately 4 years on the impact of exposure to second-hand smoke (hence the acronym Tackling Second-Hand Smoke), not only from traditional cigarettes but also from new devices, and on the correlation between exposure and disease development, with the possibility of implementing secondary prevention interventions with respect to exposure to second-hand smoke. The results of the study were presented to the European Parliament. Exposure to passive cigarette smoke too, extrapolating the results of the sample and referring them to the general population, ranged from 25% in Ireland to 68% in Bulgaria. The highest exposure was in public recreational places, followed by private homes and workplaces. Even with regards to electronic cigarettes, the percentage of exposed population to second-hand smoke is correlated with the percentage of users; in England 1/3 of the population reported being exposed to the environmental aerosol of e-cigs already in 2018 (a figure that certainly needs to be revised upwards due to the boom in consumption of these new products in recent years). The presence of smoke residues in children’s playgrounds and third-hand smoke present in the vehicle of smokers who claimed not to smoke in their cars was impressive.
The seventh Session, entitled “Passive smoking and relaunching anti-smoking policies” was introduced by Dr. Alessandra Lugo, who illustrated “The European citizens’ initiative for the environment and the first generation without tobacco”, a project launched in Spain and coordinated in Italy by the Mario Negri Institute (Dr. Gallus) and by SITAB (Prof. Cattaruzza), which aims to have, by 2030, the first generation of young Europeans free from tobacco. European Citizens’ Initiatives are a tool through which the population (of at least 7 member states and with at least 1 million signatures) can bring particularly pressing issues to the attention of the European Parliament, which undertakes to legislate on them. To reach a tobacco-free generation, the commitment is to ban the sale of cigarettes approved at the European level for all those born after 2010; other actions, instead, concern the environment (removal of cigarette butts) and the exposure of vulnerable categories, such as children, to passive smoking, with the smoking ban (including e-cigs) extended to playgrounds, swimming pools and terraces of public places. The following report, by Prof. Mario Rende, entitled “Short-term effects of passive smoking”, analyzed the presence, in a clinical setting, of a marker capable of specifically highlighting the exposure to passive smoking in the acute phase; among the various markers, one of the most promising appears to be the p75NTR receptor, an NGF receptor, which undergoes upregulation within 30 minutes of exposure to passive smoking. An increase of this receptor also represents a prognostic index (unfavorable and, in some cases, favorable) for some cancer forms. The session closed with a speech by Dr. Biagio Tinghino, entitled “The treatment of smoking: the role of the pharmacist and the General Pratictioner” which highlighted how, at present, there is still little inclination from general practioners, in investigating their patients’ smoking habits and actively proposing cessation programs; instead, it emphasized how much smokers want to quit (at least 1/3 of them tries over the course of a year) and how well-trained staff, including pharmacists, can represent, through a well-standardized process of taking charge and treatment, a good opportunity to increase the effectiveness of the offered treatments.
The eighth session, dedicated to Research in Tobaccology, saw the awarding of the SITAB-Umberto Veronesi Foundation Award - Scientific Research; The top 3 best research works, among the nine submitted for examination by the commission, by researchers under 40, published in the last 2 years or about to be published, were awarded:
Dr. Noemi Calabrò, of the A.O.U. Sant’Andrea in Rome, won the first prize for the research entitled “Interindividual variability in CYP2A6 activity and chronic obstructive pulmonary disease in smokers: prospects for an early predictive marker”; second prize went to the work of Dr. Jasmine Giovannoli, from ISPRO in Florence, entitled “Lung cancer screening: psychological aspects”; finally, third place was awarded to the research by Dr. Francesca Milani, of the IRCCS San Raffaele in Rome, for the research “DNA damage in smokers with COPD, evidence from the population in the real world”. Afterward, the winners of the Poster session were presented: Dr. Fabio Tarantino, with the research entitled “Adolescents between smoking and nutritional disorders” Dr. Daniela Bafunno, with a work entitled “Binge watching and smoking in adolescents: data from the blam#smokefreemovie program”, Dr. Dominici with a work entitled “Effectiveness of the different therapies used at the Smoking Prevention and Treatment Center of the ASL of Viterbo from 2003 to 2023”, Dr. Chiara Cresci for the research “Motivation, acceptability, attitude towards lung cancer screening among smokers who attend a smoking cessation program: a multicenter study in Italy”.
All the awarded works will be published in the journal Tabaccologia.
The ninth and last session highlighted important aspects in which SITAB plays a leading role: the National School of Tobaccology, presented by its president, Dr. Tinghino, which aims to make tobaccology a University teaching subject, indispensable in the training of all doctors and healthcare workers who work in the field of smoking cessation, with high-profile training activities and the important goal of indexing the journal Tobaccologia, illustrated by Dr. Irene Possenti who, with Dr. Gallus, director of the journal, and the entire editorial team, is working on this prestigious objective.
The last speech, which closed the conference, by Prof. Domenico Rendina, presented a research entitled “Tobacco smoking as a direct and indirect risk factor for osteoporosis”, underlining how bone tissue is constantly being restructured, and tobacco smoking represents a negative factor in bone mineralisation, exposing the smoking subjects to a greater risk of fractures (smoking as a risk factor for osteoporosis).