In 2016, a series of selective tobacco regulations, which did not affect tobacco price, came into force in Italy. To understand how Italians accepted the new norms, we analyzed data from our 2 most recent surveys among those we annually conduct on tobacco.
Methods
In 2015 and 2016, we conducted 2 representative cross-sectional studies focused on the new forthcoming tobacco legislation on a total sample of 6,046 Italians aged ≥15 years.
Results
Overall, 21.4% of Italians (26.0% of men and 17.2% of women) were current smokers, showing a small but significant decrease in smoking prevalence since 2007 (p for trend = 0.004). No change in smoking prevalence was observed over the last decade among the young (i.e., 15-24 years; 20.1% in 2015-2016). Roll-your-own cigarettes were the most frequent tobacco product for 8.3% of adult smokers and 19.7% of young smokers. According to the attitudes of Italians towards the new regulations, 91.3% supported the smoking ban in cars in presence of minors, 90.2% a more stringent enforcement of the tobacco sales-to-minors regulation, 74.3% the introduction of shocking pictorial images on tobacco packs, and 63.2% the removal from the market of small cigarette packs, usually purchased by the young.
Conclusions
Smoking prevalence only marginally decreased over the last decade among adults, but did not decrease among the young. Roll-your-own tobacco is increasingly used by adults and young people. Before the entrance of the new norms, Italians largely supported them, particularly those targeting children.
GallusS., MuttarakR., Martínez-SánchezJ.M., ZuccaroP., ColomboP., La VecchiaC.Smoking prevalence and smoking attributable mortality in Italy, 2010. Prev Med.2011; 52(6): 434–438.
9.
RossoT., BertuccioP., La VecchiaC., NegriE., MalvezziM.Cancer mortality trend analysis in Italy, 1980-2010, and predictions for 2015. Tumori.2015; 101(6): 664–675.
10.
PesceG.Mortality rates for chronic lower respiratory diseases in Italy from 1979 to 2010: an age-period-cohort analysis. ERJ Open Res.2016; 2(1).pii: 00093-2015.
11.
DéganoI.R., SalomaaV., VeronesiG.Acute Myocardial Infarction Trends in Europe (AMITIE) Study Investigators. Twenty-five-year trends in myocardial infarction attack and mortality rates, and case-fatality, in six European populations. Heart.2015; 101(17): 1413–1421.
12.
La VecchiaC., DecarliA., PaganoR.Prevalence of cigarette smoking among subsequent cohorts of Italian males and females. Prev Med.1986; 15(6): 606–613.
13.
Eurobarometer. Special Eurobaroameter 429: Attitudes of Europeans towards tobacco and electronic cigarettes2015.
14.
ISTAT.Aspetti della vita quotidiana: abitudine al fumo.2015. Available from: http://dati.istat.it/. Accessed October 24, 2016.
GallusS., LugoA., ColomboP., PacificiR., La VecchiaC.Smoking prevalence in Italy 2011 and 2012, with a focus on hand-rolled cigarettes. Prev Med.2013; 56(5): 314–318.
19.
BrownA.K., NagelhoutG.E., van den PutteB.Trends and socioeconomic differences in roll-your-own tobacco use: findings from the ITC Europe Surveys. Tob Control.2015; 24(Suppl 3): iii11–iii16.
20.
GilmoreA.B., TavakolyB., HiscockR., TaylorG.Smoking patterns in Great Britain: the rise of cheap cigarette brands and roll your own (RYO) tobacco. J Public Health (Oxf).2015; 37(1): 78–88.
21.
HanewinkelR., RaddenC., RosenkranzT.Price increase causes fewer sales of factory-made cigarettes and higher sales of cheaper loose tobacco in Germany. Health Econ.2008; 17(6): 683–693.
22.
FuM., Martínez-SánchezJ.M., ClériesR.Opposite trends in the consumption of manufactured and roll-your-own cigarettes in Spain (19912020). BMJ Open.2014; 4(12): e006552.
23.
López-NicolásÁ, CobachoM.B., FernándezE.The Spanish tobacco tax loopholes and their consequences. Tob Control.2013; 22(e1): e21–e24.
24.
Centers for Disease Control and Prevention (CDC).Consumption of cigarettes and combustible tobaccoUnited States, 20002011. MMWR Morb Mortal Wkly Rep.2012; 61(30): 565–569.
25.
YoungD., YongH.H., BorlandR.Trends in roll-your-own smoking: findings from the ITC Four-Country Survey (20022008). J Environ Public Health.2012; 2012: 7.
26.
AgakuI.T., AlpertH.R.Trends in annual sales and current use of cigarettes, cigars, roll-your-own tobacco, pipes, and smokeless tobacco among US adults, 20022012. Tob Control.2016; 25(4): 451–457.
27.
Martínez-SánchezJ.M., GallusS., LugoA.Smoking while driving and public support for car smoking bans in Italy. Tob Control.2014; 23(3): 238–243.
28.
SbrogiòL., FrisonG., TagliapietraL.[Observed smoking in car: results of a study of the Regional Health Prevention Service of Veneto, Northern Italy]. Epidemiol Prev.2010; 34(1-2): 43–47.
Canadian Cancer Society.Cigarette package health warnings: international status report.Fourth edition. 2014.
32.
ProjectI.T.C.Health Warnings on Tobacco Packages: ITC Cross-Country Comparison Report.University of Waterloo, Waterloo, Ontario, Canada. 2012.
33.
Monérrez-EspinoJ., LiuB., GreinerF., BrembergS., GalantiR.Systematic review of the effect of pictorial warnings on cigarette packages in smoking behavior. Am J Public Health.2014; 104(10): e11–e30.
34.
BrewerN.T., HallM.G., NoarS.M.Effect of Pictorial Cigarette Pack Warnings on Changes in Smoking Behavior: A Randomized Clinical Trial. JAMA Intern Med.2016; 176(7): 905–912.
35.
NoarS.M., HallM.G., FrancisD.B., RibislK.M., PepperJ.K., BrewerN.T.Pictorial cigarette pack warnings: a meta-analysis of experimental studies. Tob Control.2016; 25(3): 341–354.
GallusS., TramacereI., BoffettaP.Temporal changes of under-reporting of cigarette consumption in population-based studies. Tob Control.2011; 20(1): 34–39.
38.
ChaloupkaF.J., StraifK., LeonM.E.Working Group, International Agency for Research on Cancer. Effectiveness of tax and price policies in tobacco control. Tob Control.2011; 20(3): 235–238.
39.
GallusS., La VecchiaC.Tobacco control: economic aspects of smoking. Prev Med.2012; 55(6): 546–547.
40.
IARC.IARC Handbooks of Cancer Prevention: Tobacco Control. Volume 14. Effectiveness of Price and Tax Policies for Control of Tobacco. Lyon, France: International Agency for Research on Cancer; 2011.
