Fumo di sigarette:
l’epidemiologia di una
dipendenza
Carlo La Vecchia
2
3
4
Studio dei medici inglesi, 50
anni di follow-up
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)
5
6
Studio dei medici inglesi, 50
anni di follow-up
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)
7
8
9
10
11
12
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.
13
Lung cancer mortality
14
15
Lung cancer mortality
16
17
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.
18
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.
19
Un decesso su 7-8 oggi in Italia è
dovuto al fumo di tabacco.
20
21
22
23
24
Oral cancer
(Bosetti et al., 2000)
25
Oral cancer
26
27
28
29
30
31
32
33
34
35
36
37
38
39
Myocardial infarction – Stopping
smoking
40
Oral cancer – stopping smoking
(La Vecchia et al., 1999)
41
Smoking in Italy, 2004
Results 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
42
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
3,050
1,509
1,541
Total n° of subjects
43
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
1965
35.4
32.9
12.4
11.7
65.0
60.0
13.3
13.3
6.2
7.7
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
44
Percent prevalence of current smokers according to age
and sex. Italy, 2004.
45.0
35.0
MEN
38.7
40.0
WOMEN
32.9
30.5
30.0
26.7
25.8
25.0
23.0
20.0
18.4
15.0
10.0
7.5
5.0
0.0
15-24
25-44
45-64
>=65
Age group
45
Age-standardized percent prevalence of current smokers
according to education and sex. Italy, 2004.
45.0
40.0
MEN
39.2
WOMEN
34.5
35.0
30.0
26.1
24.0
25.0
23.9
19.2
20.0
15.0
10.0
5.0
0.0
LOW
INTERMEDIATE
HIGH
Level of education
46
Age-standardized prevalence of current smokers
according to education, sex and age. Italy, 2004.
50.0
45.0
47.3
42.5
40.0
LOW
35.0
INTERMEDIATE
HIGH
24.3
23.4
25.0
29.3
29.1
28.4
30.0
21.5
18.9
20.0
15.4
15.0
14.6
10.6
10.0
5.0
0.0
<55 years
≥ 55 years
MEN
<55 years
≥ 55 years
WOMEN
47
Age-standardized prevalence of current smokers
according to geographic area and sex. Italy, 2004.
35
33.3
32.9
MEN
WOMEN
30
26.8
25.2
25
22.8
20.6
20
15
10
5
0
NORTH
CENTER
SOUTH
Geographic area
48
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).
49
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.
50
Percent prevalence of 1,837 current smokers according
to a 6-items Fagerström score. Italy, 2002-2003.
Distribuzione percentuale di 1837 fumatori correnti in relazione allo "score" di dipendenza di Fagerstrom.
Italia, 2002-2003.
Sesso
100%
Classi di età
80%
Livello di
dipendenza
60%
Molto alto
Alto
Intermedio
Basso
40%
Molto basso
20%
0%
Totale
Maschi
Femmine
15-24*
25-44
45-64
≥65
51
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.
52
Comparison between the number of cigarettes smoked
(official legal sales) and the real price of a pack of
cigarettes. Italy, 1970-2001.
110.0
2.40
105.0
2.20
2.00
95.0
90.0
1.80
85.0
1.60
80.0
75.0
1.40
Price of one pack of
cigarettes (€)
Total consumption of tobacco
(x 1,000 tons)
100.0
70.0
1.20
65.0
60.0
1.00
1970
1975
1980
1985
1990
1995
2000
Years
Consumption
Price
53
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.
54
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).
55
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.
56
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).
57
Response to smoking regulation survey. Italy, 2004.
58
59
60
61
62
63
64
65
66
67
68
69