In the past few days, the newspapers have given ample prominence to the twenty years of the Sirchia law, a law which from a cultural point of view represented a watershed which, according to data from the Ministry of Health, has contributed to reducing the number of smokers1,2. However, today smoking in Italy still affects 10 million people according to Istat3. According to the latest surveys by the Istituto Superiore di Sanità and the Ministry of Health, smokers have increased in recent years also as a result of the Covid pandemic. In 2019/2020, 22% of the population smoked4, a percentage that rose to 26.2% in May 20215, before decreasing again to 24.2% in May 20226.
Faced with these numbers, the need to think at various levels emerges, involving as many actors as possible, to find new and different solutions to an extremely complex problem such as that of smoking.
The first level is that of prevention, especially as regards the youngest. In recent years, with respect to the theme of initiation, attention has focused exclusively on products such as electronic cigarettes and heated tobacco products considered a gateway to nicotine addiction. According to Eurobarometer7, however, 98% of young people start with traditional cigarettes or fine-cut tobacco, as also confirmed by the latest Istat report on smoking8. This means that, in addition to conducting surveys on consumption, it is also necessary to investigate the motivations and identify strategies to dissuade them from starting any tobacco and/or nicotine-based product. Education and information campaigns play a fundamental role and that is why new and more effective ones must be devised by leveraging those young people listen to and trust.
Number of Smokers For Years
The second fundamental level is that of cessation. Considering the substantially stable number of smokers for years, on the one hand we need to ask ourselves why the Anti-Smoking Centers (CAF), born as protections on the territory for smokers, have not given the expected results. In the last year, the toll-free telephone against smoking received only 8,500 calls and it is estimated that there are no more than 13,000 smokers a year who turn to the CAF9. Furthermore, only 9.6% of smokers remain abstinent 6 months after the attempt to quit10. What needs to be done to strengthen the capillarity and quality of the proposal of these centres? Also in this case in a new way, exploiting the many energies of the third sector as well. On the other hand, we need to ask ourselves what role combustion-free technological products can play for smokers who won’t quit. Their adoption has significantly reduced the number of smokers in countries such as the United Kingdom, Sweden, Norway, New Zealand and Japan11,12.
However, there is still too much confusion surrounding these products. Hence the third level of intervention: working, starting from the medical-scientific community, so as not to leave smokers alone and without information, who suffer from this loneliness, as demonstrated by the “1st Report on cigarette smoke and products without combustion in Italia” created by Censis with the contribution of Philip Morris Italia13
There is a need for greater clarity and scientific studies that compare new technological products with cigarettes and other burnt products. New technologies are certainly not risk-free, however they can certainly represent an alternative for those smokers who do not stop smoking, in a logic of potential risk reduction. In fact, although nicotine is addictive and not risk-free, combustion is the main cause of smoking-related pathologies14.
Smoking History of Adults
How many doctors in their experience of smoking history are faced with adult smokers every day who are fully aware of the risks and who in any case do not stop?
The reference to the precautionary principle that comes from many health sectors is understandable, but it must not represent an obstacle to scientific research with a view to a wider benefit for the population concerned. If answers are lacking, they must be sought by promoting new and more advanced comparative scientific clinical studies that form the foundation of an evidence-based medicine. Instead, too often a priori resistance is encountered which goes against the principles of scientific research itself.
The hope is that the new year will bring us new ideas and a different commitment, without the re-proposition of solutions that obviously didn’t work. We need to join forces and act together. Cigarettes can become a thing of the past.
This article is originally published on quotidianosanita.it