The Role of Novel (Tobacco) Products on Tobacco Control in Italy

Abstract

In Italy, electronic cigarettes have spread since 2010 and heated tobacco products (HTP) since 2016. We investigated their public health consequences on conventional cigarette smoking, taking advantage of a series of cross-sectional studies annually conducted between 2001 and 2019 in Italy. Every year, the sample, including around 3000 individuals, was representative of the general Italian population aged ≥15 years. In Italy, smoking prevalence steadily declined from 29.1% in 2001 to 20.6% in 2013, then increased to 22.0% in 2019. In 2017-2019, current electronic cigarette users were 2.1% and in 2019 current HTP users were 1.1%. Among 498 ever electronic cigarette users, 23.2% started or re-started smoking and 15.7% quit smoking after electronic cigarette use; of 49 ever HTP users, 19.1% started or re-started smoking combusted cigarettes and 14.6% quit smoking after HTP use. The availability of novel products in Italy resulted in a halt of the decreasing trend in smoking prevalence. For the first time, we observed an increase of Italians inhaling nicotine, concurrently with the spread of novel (tobacco) products. More importantly, the use of novel products appears to increase-rather than decrease-the likelihood of smoking conventional cigarettes. Considering this evidence, we see no argument to justify the huge fiscal and regulatory benefits these products continue to have, at least in Italy.

Keywords: Italy; e-cigarette; harm reduction; heat-not-burn tobacco products; heated tobacco products; smoking prevalence.

Figure 1

Trends in the prevalence of current smokers among Italian adults aged ≥15 years, overall and by sex. Italy, 1957–2019. APC: Annual Percent Change; CI: confidence interval; JP: Joinpoint.Squares, triangles and dots represent observed prevalence of current smokers overall and among men and women, respectively. Solid, dashed and dotted lines represent the predicted values obtained from the joinpoint regression models overall and among men and women, respectively. Total: 1957–2001: APC = −0.5% (95% CI: −0.7; −0.2); 2001–2013: APC = −2.8% (95% CI: −3.6; −1.9); 2013–2019: APC = +1.7% (95% CI: −0.5; 4). Men: 1957–2015: APC = −1.7% (95% CI: −1.8; −1.6); 2015–2019: APC = +2.6% (95% CI: −4.1; 9.8). Women: 1957–1990: APC = +4.2% (95% CI: 1.1; 7.4); 1990–2019: APC = −1.5% (95% CI: −2.2; −0.8).

Figure 2

Trends in the prevalence of current smokers among Italian young adults aged 15–24 years, overall and by sex. Italy, 2001–2019. APC: Annual Percent Change; CI: confidence interval; JP: Joinpoint Squares, triangles and dots represent observed prevalence of current smokers overall and among boys and girls, respectively. Solid, dashed and dotted lines represent the predicted values obtained from the joinpoint regression models overall and among boys and girls, respectively. Total: 2001–2019: APC = −3.2% (95% CI: −4.1; −2.2). Boys: 2001—2019: APC = −3.4% (95% CI: −4.5; −2.2). Girls: 2001–2019: APC = −2.9% (95% CI: −4.1; −1.6).

Figure 3

Quarter market share of heated tobacco products (HTP) tobacco (%), Italy, 2016–2019.