Smoking: new products and harm reduction. The evolution of the phenomenon in Italy
Eurispes today presents some of the most important outcomes of the 2023 surveys carried out on “Smoking: new products and harm reduction. The evolution of the phenomenon in Italy”. The Institute thus returns to probe the habits and opinions of smokers in relation to smoking, its impact on health, and the development and diffusion of alternative products to traditional ones. It is enough to consider that, according to ISS data, in 2023 there are 10.5 million smokers in Italy (25.1% of men and 16.3% of women).
The result of this monitoring activity are three separate surveys (the first among “traditional” smokers, the second among e-cig users and, finally, the third among users of heated tobacco) from which emerges a framework characterised by generational and gender differences, conditions that influence the choice of products. The realisation of the surveys was also made possible thanks to the contribution of Philip Morris Italia.
«The results of our surveys – says the President of Eurispes, Gian Maria Fara – confirm three aspects: the first is that there is a constant increase in smokers who declare they have no intention of quitting smoking. The second is linked to smokeless products, the spread of which goes hand in hand with a decrease in traditional cigarettes or with their abandonment. The third aspect concerns the lack of information on new products reported by those who have taken part in sample surveys over the years.
Hence the need, in the perspective of a wider dissemination, to give indications, in addition to the rules already identified by the legislator, on how to regulate certain aspects of the communication and sale of such products so as to combine the protection of minors and non-smokers and the right to information. The Self-Regulatory Code for the communication and sale of smokeless products, which Eurispes presented in June 2022, fits into this perspective.
The Code – explains President Fara – was elaborated by a working table of experts and jurists, some of the most important players in the sector have voluntarily signed up to it and it is still open to possible adherence by other stakeholders. Among the activities put in place with the collaboration of the signing bodies – Philip Morris Italia, Logista, FIT, Anafe and Uniecig – we are kicking off, with today’s conference, a widespread information campaign that will reach tobacco outlets throughout the territory.
Indeed, the logo of the Code and a QR code referring to a more in-depth reading of the contents of the text will be placed in all the windows of those shops that wish to join the initiative. We count in this first phase on reaching about 44,000 tobacconists. Let’s start a small revolution towards greater awareness on the part of shopkeepers and, above all, citizens».
“Traditional” smoking
The majority (68.6%) of the smokers surveyed (1,018 “traditional” smokers) stated that they had never tried to quit smoking, while 31.4% stated that they had.
Concerning the intention to quit smoking in the near future, the respondents expressed themselves as follows: 27.2% stated that they should quit, but do not want to; 26.6% should quit but believe they will not be able to; 18.4% would like to quit, but not in the near future. A percentage of 15.5% state that they do not want to quit at all; 12.2% of the respondents intend to quit smoking within six months. The percentage of smokers saying they would like to quit within six months is constant compared to 2021.
What stands out over the years is the diversification of the offer, which has changed smokers’ habits: traditional cigarettes are being joined by products such as electronic cigarettes and heated tobacco products, which have seen clear and steady growth over the last 5 years. Traditional and innovative products are often used at the same time, or to decrease the use of traditional cigarettes.
E-cigarette
As far as new products are concerned, the e-cig smokers interviewed (316 throughout the territory) became acquainted with the electronic cigarette mainly through word of mouth from friends and acquaintances who were already using it (35.1%) or because it was given to them as a present (20.9%). However, 18.7% became aware of it thanks to articles and magazines, 14.6% through the Internet, 8.2% through retailers and 2.5% through the advice of a health professional.
Compared to the survey conducted in 2021, the Internet and resales counted for less, as did the advice of health professionals (-4.6% compared to 2021). On the other hand, word of mouth from friends and relatives (+6.1%) and articles in magazines (+6.2%) as a vehicle for product knowledge have grown.
More than half of the sample (57.3%) use nicotine-free liquids to vape, while 15.5% prefer liquids with nicotine, and 27.2% of the respondents use both types of liquids. To vape, the over 64s use liquids with nicotine most (20%), followed by smokers between 18 and 24 years of age, with percentages around 18%. In contrast, respondents between 35 and 44 years of age (61.5%) and the 25-34 age group use nicotine-free liquids the most (59,5%). Those who use both liquids, on the other hand, are more likely to be found among the over 64s (40%).
The majority of the sample (58.2%) stated that they had no difficulties in finding comprehensive and reliable information on e-cigarettes (-6% compared to 2021). In contrast, the proportion of those who encountered difficulties in finding such information was 41.8%, a percentage that increased compared to the 2021 survey (+6%).
On the role of the State in relation to possible non-combustion products that are considered scientifically less harmful than conventional ones, 82% of respondents believe that citizens should be allowed to be informed. According to 52.8%, the State should promote information campaigns, 56.6% support the need for tax incentives for such products, and 55.4% for regulatory incentives such as bans and restrictions.
According to 62.7% of respondents, the State should encourage the use of e-cigarettes among smokers who would otherwise continue to smoke anyway. A total of 37.3% of the sample took the opposite view.
Heated tobacco
The survey on heated tobacco involved 3,145 users. The first channel of familiarity with heated tobacco products remains the word of mouth of friends, acquaintances, relatives who are already users (63.7%, up from 2021, but still down from 2020), and sales outlets displaying such products are also confirmed as the second means of familiarity (15.8%, down 7.3% from 2021). The number of respondents who received the product as a gift increased over the last two years, albeit slightly (8.4%), returning more or less to 2020 levels after the slight decrease in 2021. Compared to 2021, consumers who learned about heated tobacco products through the internet (8.2%; -1.1%) and from articles/magazines (2.7%; -2.4%) decreased, but these percentages remain higher than in 2020. By contrast, the proportion of respondents to whom such products were introduced by a healthcare professional is unchanged and very low (1.2%; in 2020 it was 0%).
The adoption of heated tobacco devices has had a positive impact on reducing the consumption of traditional cigarettes. Of the sample, 79.5% stated that they had abandoned traditional cigarettes after switching to smokeless products.
Prior to adopting heated tobacco products, 87% of the respondents smoked traditional cigarettes, 8.8% electronic cigarettes, 2.7% other traditional tobacco products and only 1.5% did not use any products. It can therefore be seen that almost all users of heated tobacco choose it as an alternative to or in addition to a previously used smoking product (98.5%), while very few use it as a first approach.
A total of 62.9% of smokers have tried to quit, while 37.1% have never tried.
The percentage of respondents stating that they have not encountered difficulties in finding comprehensive and reliable information on heated tobacco products (70.7%, +8.3%) has increased since 2021, but for 29.3% it remains difficult to find such information.
Questioning the sample on what behaviour they think it would be right for the State to adopt if it were scientifically proven that non-combustion products are less harmful than conventional ones, it emerges that according to 91.9%, the State would have a duty to promote information campaigns, and the percentage of those who would like to see a reduction in taxation on products certified as less harmful is just as high (90.1%). For 71.6%, it would also be fair to incentivise such products by subjecting them to fewer bans and restrictions than traditional ones, while only a minority would prefer a neutral attitude through the application of the same regulations as for traditional products (39.4%).
A clear majority of respondents (85%) agree that the state and health institutions should encourage smokers who would continue to smoke traditional products to consider switching to heated tobacco (45.9% “probably yes” and 39.1% “absolutely yes”). One in ten respondents believe that it would probably not be right for them to do so (10.1%) and only 4.9% strongly disagree.
