The National Report on Tobacco Use 2022| Tabaccologia

The World Health Organization (WHO) on May 31st of each year celebrates the World No Tobacco Day, with the aim at informing citizens about the risks associated with the use of tobacco, the commercial practices implemented 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.

With the campaign “Tobacco – threat to our environment”, WHO dedicates the theme of World No Tobacco Day 2022 to the impact that tobacco production and processing has on our ecosystems; from cultivation to production, from distribution to waste: all stages of the production chain of tobacco and products derived from it negatively and heavily impact the natural environment. The campaign also aims at highlighting the tobacco industry’s efforts to “greenwash” its reputation and products by marketing themselves as environmentally friendly. The campaign calls on governments and policy makers to step up legislation, including implementing and strengthening existing schemes to make producers responsible for the environmental and economic costs of tobacco product waste.

On May 31st, 2022, the XXIV National Conference Tobacco dependence and the National Health Service was held at the Istituto Superiore di Sanità (ISS). The event was an opportunity to explore the topic proposed by the WHO but also to present the National Report on tobacco use, 2022.

Smokers in Italy

Since 2007, the sale of cigarettes throughout the country has been steadily decreasing and only in 2021 was there a 1.0% reduction compared to the previous year. Moreover, unlike what happened in previous years, in 2021 there was also a contraction in sales of shredded tobaccos (including RYO tobacco): in fact, consumers seem to use more and more frequently alternative products to traditional cigarettes such as electronic cigarettes (e-cig) and heated tobacco products (HTP). In 2021, sales of electronic cigarette refills increased by 779.0% while sales of heated tobacco products increased by 1831.0% compared to 2017 (the first year of detection of the data on sales of these products).

ISS in collaboration with the Istituto di Ricerche Farmacologiche “Mario Negri”, in May 2022 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 (CAPI) system.

The research found out that smokers in Italy are 12.4 million (24.2% of the population): 7.5 million men (30.2%) and 4.9 million women (18.5%). These percentages must be read with particular attention and concern: the prevalence of smokers, which have been stagnating for about 15 years, increased from 22.0% in 2019 to 24.2% in 2022, corresponding to 2 percentage points (about 800,000 more smokers) (Figure 1). The highest prevalence of male smokers was in the 25-44 age group (42.9%) while the highest prevalence of female smokers was in the 45-64 age group (24.5%).

Moreover, the trend observed in 2017-2019 showing a female smokers decrease, has not been confirmed: in 2022, in fact, the percentage of smokers concerning both sexes increased.

On average, 11.5 cigarettes are smoked per day with higher consumption among men (M 12.2 vs F 10.4) and among smokers belonging to the over 65 age group (12.7). The average daily consumption of cigarettes is confirmed to be decreasing, although this decrease actually consists in the reduction of 2 cigarettes in 10 years (it was 13.6 cigarettes/day in 2011), with 20.4% of smokers still consuming more than 20 cigarettes per day.

As regards the use of alternative products to traditional cigarettes, the survey detected that e-cig users (occasional + habitual) are 2.4% of the population (about 1,200,000 people). Dual users, i.e. those consuming both traditional cigarette and electronic cigarette, are 81.9%: a percentage of concern showing the increasing level of nicotine dependence caused by the use of both the products. 2.8% of electronic cigarette users (regular or occasional) are people who had never smoked traditional cigarettes before using the e-cig. This data indicates that electronic cigarette can make nicotine dependent new users that would have never started with traditional cigarettes. With respect to refill liquids, 65.4% of consumers say they use liquids containing nicotine (6.0% use both nicotine and nicotine-free types).

Concerning the heated tobacco products (HTPs), they are used (regularly or occasionally) by 3.3% of the Italian population, approximately 1,700,000 people. Their consumption has tripled, in 2019 was 1.1% and in 2022 is 3.3%. Regarding the perception of the health risk deriving from the use of HTPs, although the majority of smokers (52.2%) believe that they are as harmful as traditional cigarettes, 36.6% believe that they are less: the latter perception has been more widespread among smokers than in 2019 (25.3%).

The Tobacco Quitline

Tobacco Quitline ((Telefono Verde contro il Fumo - 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 98,000 phone calls, of which 8,500 in the last year of activity (May 2021 - April 2022). Almost all users have known this Service from the warnings on cigarette packets (97.0%).

Phone calls come from all over the country but the North is the most represented area (40.0% of the total calls) and those who call are almost always smokers (92.0%), although there are also calls from families and friends, who seek help for their loved ones to quit smoking (7.0%).

Two-thirds of the users are men (M65.0% vs F35.0%), while the phone calls are distributed fairly evenly in the different age groups.

The main request of the smoker who contacts the Quitline is to receive “help to quit smoking” (95.0%), also following previous unsuccessful cessation attempts: 68.0% 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 new generation tobacco products has doubled (0.6% in 2021 and 1.1% in 2022).

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

Starting from 2021, to enhance the effectiveness of smoking cessation support, the service offers proactive telephone counselling. The professional, in compliance with the user privacy legislation, contacts the smoker, following a previously agreed calendar of appointments, to accompany him on a cessation process, or to support him in case of relapse.

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 (CAFs - Centri AntiFumo). 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 CAFs, creating a national network that is always up-to-date. The census was concluded in May 2022, detecting 223 “Services”, and confirming the decreasing trend previously observed: in 2021 in fact the smoking cessation centres in Italy were 268 and 292 in 2019 (Figure 2).

The distribution of the CAFs is not homogeneous on the national territory: 61.0% of Services are located in the North, 17.0% in the Center and 22% in the South and the Islands.

Among the types of intervention, CAFs offer individual counseling (68.0%), drug therapy (62.0%), group psychotherapy (30.0%), individual psychotherapy (30.0%) and psychoeducational groups (19.0%). Compared to last year, the percentage of nurses working in the smoking cessation centres decreased (22.0% in 2021, and 12.0% in 2022), while the medical staff increased (29.0% in 2021, and 41.0% in 2022).

The CAFs 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 or other types of contributions (membership fee, intramoenia).

Figures and tables

Figure 1.Prevalence of cigarette smoking - historical series.

Figure 2.Trend of the Smoking Cessation Centres (2000-2022).