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Fumo di sigarette:l’epidemiologia di una

dipendenza

Carlo La Vecchia

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Un fumatore a vita ha un rischio di morte, in ogni età 3 volte superiore a quello di un non fumatore.

A 90 anni arrivano a 26/100 maschi mai fumatori ma solo 5 fumatori.

(Doll et al. 2004)

Studio dei medici inglesi, 50 anni di follow-up

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Chi smette a 40 anni ha un rischio di morte di poco superiore a chi non ha mai fumato.

Anche chi smette a 50 anni evita oltre la metà del suo rischio di morte da fumo.

(Doll et al. 2004)

Studio dei medici inglesi, 50 anni di follow-up

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La mortalità per tumore del polmone, e degli altri tumori

legati al tabacco, è in diminuzione negli uomini – ma non nelle donne

italiane dal 1988 in poi.

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Lung cancer mortality

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Lung cancer mortality

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I morti totali da fumo sono scesi da circa 90.000 per anno nei primi anni ’90 a circa 75.000 oggi, riflettendo la diminuzione nelle abitudini al fumo nei maschi registrate tra il 1980 e il 1995.

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Di essi, circa 25.000 sono tumori del polmone, circa 15.000 altri tumori

legati al tabacco, 10-15.000 malattie respiratorie non

neoplastiche, 20-25.000 malattie cardio e

cerebrovascolari, e 5-10.000 morti per altre malattie.

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Un decesso su 7-8 oggi in Italia è dovuto al fumo di tabacco.

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25(Bosetti et al., 2000)

Oral cancer

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Oral cancer

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Myocardial infarction – Stopping smoking

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Oral cancer – stopping smoking

(La Vecchia et al., 1999)

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Smoking in Italy, 2004Results from a survey

(DOXA)

Percent distribution and trend of smoking in Italy (2004) Tobacco dependence in the Italian population Economic aspects of smoking Smuggling Cigarette vending machines Smoking laws and regulations

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Percent distribution of smoking in the Italian population aged 15 or over. Italy, 2004 (DOXA).

SMOKING HABIT Total Males Females

Never smokers 55.9 45.2 66.3

Ex-smokers 17.9 24.8 11.2

Current smokers (cigarettes/day)

26.2 30.0 22.5

<15 11.1 11.0 11.2

15-24 12.4 15.0 9.9

25 2.7 4.1 1.3

Total n° of subjects 3,050 1,509 1,541

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Percent prevalence of smoking among adults according to eight DOXA surveys. Italy, 1957-2004.

Calendar year

Total Males Females

% cig/day % cig/day % cig/day

1957 35.4 12.4 65.0 13.3 6.2 7

1965 32.9 11.7 60.0 13.3 7.7 5.8

1975 34.0 N/A 53.2 N/A 16.3 N/A

1990 32.0 16.3 38.3 18.6 25.9 12.1

2001 28.9 16.4 34.8 18.8 23.6 12.2

2002 26.6 16.8 31.1 19.2 22.3 13.1

2003 27.6 16.1 33.2 18.6 22.5 12.2

2004 26.2 15.4 30.0 16.7 22.5 13.7

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Percent prevalence of current smokers according to age and sex. Italy, 2004.

32.9

38.7

25.8

18.4

26.7

30.5

23.0

7.5

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

15-24 25-44 45-64 >=65

Age group

MEN

WOMEN

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Age-standardized percent prevalence of current smokers according to education and sex. Italy, 2004.

39.2

34.5

26.1

19.2

24.0 23.9

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

LOW INTERMEDIATE HIGH

Level of education

MEN

WOMEN

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Age-standardized prevalence of current smokers according to education, sex and age. Italy, 2004.

47.3

23.4 24.3

10.6

42.5

18.9

29.1

15.4

28.4

21.5

29.3

14.6

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

<55 years ≥ 55 years <55 years ≥ 55 years

MEN WOMEN

LOW

INTERMEDIATE

HIGH

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Age-standardized prevalence of current smokers according to geographic area and sex. Italy, 2004.

26.8

33.3 32.9

22.8

25.2

20.6

0

5

10

15

20

25

30

35

NORTH CENTER SOUTH

Geographic area

MEN

WOMEN

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Tobacco dependence A six-item Fagerström questionnaire

was used in two surveys on smoking, conducted in 2002-2003.

Subjects were 6,773 individuals representative of the Italian adult population.

27.1% of individuals (1,837) described themselves as current cigarette smokers (32.1% men, 22.4% women).

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Tobacco dependence Of all smokers, 13.8% were classified as

high and only 3.8% as very high dependent.

The proportion of high + very high dependent smokers was 21.4% among men and 12.5% among women.

The proportion of high + very high dependent smokers was 2.8% at age 15-17 and 8.4% at age 18-24.

Only 23% of smokers found it difficult to avoid smoking in places where smoking was forbidden.

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Percent prevalence of 1,837 current smokers according to a 6-items Fagerström score. Italy, 2002-2003.

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Economic aspects of smoking in Italy.

Today 76% of income from cigarette selling are taxes, in line with the other developed countries.

Price elasticity of demand for cigarettes had an appreciable impact on smoking prevalence/consumption in several countries

We estimated in -0.46 the elasticity for cigarette consumption and –0.30 for smoking prevalence.

More than one third of ever smokers in Italy (survey DOXA 2004) had the perception of an intermediate/high influence of cigarette price on tobacco consumption in the young.

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Comparison between the number of cigarettes smoked (official legal sales) and the real price of a pack of cigarettes. Italy, 1970-2001.

60.0

65.0

70.0

75.0

80.0

85.0

90.0

95.0

100.0

105.0

110.0

1970 1975 1980 1985 1990 1995 2000

Years

To

tal

con

sum

pti

on

of

tob

acc

o

(x 1

,000

to

ns)

1.00

1.20

1.40

1.60

1.80

2.00

2.20

2.40

Pri

ce o

f o

ne

pa

ck o

f ci

ga

rett

es

(€)

Consumption Price

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Smuggling in Italy Smuggling has probably increased between

1985 and 1995, but its relevance is not clear.

In the 90’s it has been estimated in 10-30% the proportion of smuggling in the whole tobacco trading

Today we estimated (survey DOXA, 2004) in less then 5% the proportion of smuggling.

However, our estimate was self-reported, thus probably under-reported.

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Cigarette vending machines

In 2003, cigarette vending machines accounted for 15% of tobacco sales to Italian minors who smoked (aged 13-17 years).

To restrict sales, in particular to the youngest, from January 2004, vending machines are closed in Italy between 7 a.m. and 11 p.m.

In 2004, still 37% of smokers uses vending machines (~7.5% of cigarettes bought). 56% (~13.7% of cigarettes bought) when considering younger smokers (15-24 years).

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Main laws and decrees in Italy 1962: (Law) Tobacco advertising forbidden. 1975: (Law) Smoking forbidden in hospitals, schools, public transports,

railway station waiting rooms, cinemas, museums, public libraries, theatres…

1976: (Minister’s Decree) Smoking forbidden in schools, universities, areas of public administration open to the public.

1980: (Decree by the President of the Republic) Smoking forbidden in trains (apart in smoking areas), waiting rooms and railway station stops.

1990: (Minister’s Decree) Health warnings on cigarette packs and amount of nicotine and tar yield.

1991: (Minister’s Decree) Tobacco promotion forbidden on television. 1996: (Judgement by Constitutional Court) Employers must avoid

exposure to passive smoking, to protect worker’s health. 1997: (Law) Cigarettes must have a maximum tar yield of 12 mg. 2004: (Law effective from January 2005) smoking banned in

several public areas, including cafes, restaurants, as well as in the workplace.

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Response to smoking regulation survey. Italy, 2004.

In the survey by DOXA in 2004, for ever-smokers, two specific questions on the support of smoke-free policies were formulated as follow:

Do you agree or not to separate smoking areas in cafes and restaurants… and to ban smoking in their absence?

Do you agree or not to forbid to smoke in all the workplaces?”.

Every question had a structured, four-item score (strongly in favour to strongly against).

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Response to smoking regulation survey. Italy, 2004.

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