The National Report on Tobacco use 2024| Tabaccologia

On May 31st 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 and promoting the effective policies to reduce consumption. On this occasion, countries undertake initiatives to address the tobacco epidemic and its impact on public health.

With the 2024 campaign “Protecting Children from Tobacco Industry Interference” WHO aims to raise public awareness of the dangers posed by tobacco industry marketing strategies to protect current and future generations. It also provides young people worldwide the opportunity to demand that tobacco companies stop promoting all their harmful products and that governments adopt new policies that shield young people from the manipulative practices of the tobacco and related industries, including the advertising tactics that appeal to children and adolescents, reaching them through social media and streaming platforms.

On May 31, 2024, the XXVI National Conference “Tobacco Use and the National Health Service” was held at the Istituto Superiore di Sanità (Italian National Institute of Health - ISS). The event was an opportunity to explore the topic proposed by WHO, presenting the National Report on Tobacco Use 2024, focusing mainly on tobacco and nicotine use among Italian students.

The use of tobacco and nicotine products among youth

The survey conducted by the National Centre on Addiction and Doping of the ISS investigated tobacco and nicotine use among Italian high school students during the 2023-2024 school year. The survey involved a representative sample of 6,012 students aged 14 to 17. The interviews were conducted via an anonymous Computer Assisted Web Interview (C.A.W.I.) system.

The results show that about one in three Italian students aged 14 to 17 (30,2%, or nearly 700,000 students) used at least one tobacco or nicotine product in the past 30 days, including traditional cigarettes, electronic cigarettes (e-cig), and heated tobacco products (HTP). Traditional cigarettes are the most used product among students (20,0%), followed by HTP (18,7%) and e-cig (18,5%) (Figure 1). Females consume these products more than males (F 34,8% vs. M 25,9%), with the greatest gender difference observed in HTP use (M 14,2% vs. F 23,6%) (Figure 1).

For all three products, there are significant percentages of heavy users: 9,7% of traditional cigarette smokers smoke more than 10 per day, 7,6% of HTP users consume more than 10 sticks per day, and 19,8% of e-cig users take over 200 “puffs” per day. Poly-use, or the simultaneous use of all these products, has almost doubled compared to the 2022 survey: 62,4% of students reported poly-use compared to 38,7% previously [1].

Most markedly for traditional cigarette, but also for HTP and e-cig, students use is concentrated on weekends or holidays (59.6% for the traditional cigarette, 47,5% for the HTP, 42,6% for the e-cig).

The age at which students first come into contact with nicotine is between 13,5 and 14,5 years old.

Purchasing channels and social acceptability of tobacco or nicotine products

Many students reported that they personally purchased these products from tobacconists (42,5% for traditional cigarettes, 35,3% for HTP, 30,2% for e-cig) despite the ban on sales to minors. Among those who did not personally purchase them, most said they were offered the products (23,0% for traditional cigarettes, 30,8% for HTP, 19.2% for e-cig) or obtained them through relatives or friends (13.9% for traditional cigarettes, 13,6% for HTP, 18,3% for e-cig).

In addition, 42,8% of traditional cigarette smokers, 56,2% of HTP users, and 62,6% of e-cig users reported that vendors never refused to sell them these products due to their age.

In about one-third of cases, parents are aware that their children use a tobacco or nicotine product, although attitudes vary by product type: the proportion of parents who tolerate the consumption of traditional cigarettes is 9,9%, whereas those who tolerate the consumption of HTP are 15,3% and 16,5% tolerate e-cig.

The most common place for students for smoking or vaping is at home, with significantly higher percentages for HTP and e-cig use (41,5% and 47,6%, respectively) compared to traditional cigarette use (28,0%). Many students also smoke/vape at school, despite the ban: 24,1% are traditional cigarette users, 28,8% are HTP users, and 30,3% are e-cig users.

The “Tobacco Quitline”

Tobacco Quitline (TQ) is a national anonymous and free service operated by the National Centre on Addiction and Doping of the ISS since 2000. It provides telephone counselling on tobacco and nicotine addiction, primarily supporting smokers in their cessation journey, as well as their families and former smokers at risk of relapse.

Since its beginning, the TQ has handled 111,000 calls, including 6,931 in the past year (2023). Almost all users have known this service from the warnings on cigarette packets (94,0%). Phone calls come from all over the country, with the North being the most represented area (41% of total calls); most of callers are smokers (90,0%), although there are also calls from families and friends, who seek help for their loved ones to quit smoking (8,0%).

Most TQ callers are males (M 60% vs. F 40%), with the highest call volume from the 56-65 age group (19%) and the lowest among those under 18 (5%) and over 75 (4%). The main request from smokers is for “help to quit smoking” (90%), often due to previous unsuccessful cessation attempts (57% have tried to quit at least once). There has been an increase in inquiries about e-cig and HTP in the past year (1% in 2021, 6% in 2022, and 7% in 2023).

Each call is characterized by a diversified and personalized professional intervention by the team of psychologists, emphasizing welcome, information, and motivational support as key elements of the helping relationship between the expert and the user.

Territorial smoking cessation services

In response to user requests, the TQ promotes continuity with the territorial care system, facilitating access to the Smoking Cessation Centres (SCC). These Centres are dedicated to tobacco control and play a central role in the cessation process, offering specialized and heterogeneous pathways based mainly on pharmacological therapies, individual interventions and group interventions, and for this they make use of different professionals including doctors, professional nurses, psychologists.

Since 2000, the ISS has been in charge of the annual census and update of master data and support services offered by the SCC, creating a constantly updated national network. The census, completed in May 2024, recorded 223 services, a decrease from the 241 active centres in 2023 (Figure 2).

SCC have multidisciplinary teams, with the most common professionals being doctors (27%), psychologists (22%), and nurses (22%).

The services offered to the public include integrated interventions: individual counselling (available in 88% of centres), pharmacological therapy (84%), individual psychotherapy (35%), psychoeducational groups (35%), and group psychotherapy (30%).

Services can be accessed in various ways, with some being free and others requiring a co-payment.

Figures and tables

Figure 1.Prevalence of conventional cigarettes, heated tobacco products and electronic cigarette use: gender distribution.

Figure 2.Smoking Cessation Centres trends (2000-2024).

References

1. Mastrobattista L, Mortali C, Solimini R, Pichini S, Palmi I. Il rapporto nazionale sul tabagismo 2023. Tabaccologia. 2023; XXI(2):22-26. DOI