Trends in smoking prevalence by educational level and sex in Italy, 2001–2025: a joinpoint analysis
Abstract
Background: Tobacco smoking remains one of the leading preventable causes of morbidity and mortality worldwide. Educational attainment is a key social determinant of health, strongly associated with smoking behaviours. Assessing time trends in smoking prevalence across educational groups in Italy is crucial to understand how educational level shapes tobacco use patterns over time.
Methods: Annual aggregate data from the ISTAT Multipurpose Household Survey (2001–2025, population aged 14+) were analysed using joinpoint regression with autocorrelation correction to estimate Annual Percent Changes (APC) and Average Annual Percent Changes (AAPC) in current smoking prevalence, stratified by sex and educational level.
Results: Joinpoint analysis revealed significant trend shifts across all groups (2001-2025). Among males, overall prevalence declined substantially over the full period (31.0% in 2001 to 22.9% in 2025, AAPC: −0.39*), with an initial sharp decline (APC: −0.62*, 2001-2006) that slowed progressively and reversed in recent years (APC: +0.13, 2019-2025), driven by diploma (APC: +0.24) and degree holders (APC: +0.14, 2018-2025). Among females, overall prevalence declined more modestly over the full period (16.9% in 2001 to 15.6% in 2025, AAPC: −0.08*), with a reversal in the most recent years (APC: +0.22*, 2019-2025), most marked in diploma (APC: +0.27*) and degree holders (APC: +0.22*, both from 2018-2025). Asterisk denotes statistical significance (p < 0.05).
Conclusions: Despite a long-term decline, smoking prevalence in Italy is rising again in several educational subgroups, particularly among female and male diploma holders. These findings suggest that educational level shapes smoking trajectories in complex and sex-specific ways, underlining the need to further investigate the underlying determinants of smoke behaviour and to develop targeted prevention strategies tailored to specific educational groups.
Key messages: • Smoking prevalence in Italy declined from 2001 but reversed in recent years across several educational subgroups, with statistically significant increases among women.
• Stratified analyses by sex and educational level reveal heterogeneous smoking trajectories, underlining the importance of tailored prevention approaches and further research on underlying determinants.
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BibTeX
@article{scirocco2026trends,
title = {{Trends in smoking prevalence by educational level and sex in Italy, 2001–2025: a joinpoint analysis}},
author = {T Scirocco and S Mao and L Veltro and C Giordano and L Villani},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.257},
url = {https://doi.org/10.1093/eurpub/ckag169.257},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Trends in smoking prevalence by educational level and sex in Italy, 2001–2025: a joinpoint analysis
AU - T Scirocco
AU - S Mao
AU - L Veltro
AU - C Giordano
AU - L Villani
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.257
UR - https://doi.org/10.1093/eurpub/ckag169.257
AB - Background: Tobacco smoking remains one of the leading preventable causes of morbidity and mortality worldwide. Educational attainment is a key social determinant of health, strongly associated with smoking behaviours. Assessing time trends in smoking prevalence across educational groups in Italy is crucial to understand how educational level shapes tobacco use patterns over time. Methods: Annual aggregate data from the ISTAT Multipurpose Household Survey (2001–2025, population aged 14+) were analysed using joinpoint regression with autocorrelation correction to estimate Annual Percent Changes (APC) and Average Annual Percent Changes (AAPC) in current smoking prevalence, stratified by sex and educational level. Results: Joinpoint analysis revealed significant trend shifts across all groups (2001-2025). Among males, overall prevalence declined substantially over the full period (31.0% in 2001 to 22.9% in 2025, AAPC: −0.39*), with an initial sharp decline (APC: −0.62*, 2001-2006) that slowed progressively and reversed in recent years (APC: +0.13, 2019-2025), driven by diploma (APC: +0.24) and degree holders (APC: +0.14, 2018-2025). Among females, overall prevalence declined more modestly over the full period (16.9% in 2001 to 15.6% in 2025, AAPC: −0.08*), with a reversal in the most recent years (APC: +0.22*, 2019-2025), most marked in diploma (APC: +0.27*) and degree holders (APC: +0.22*, both from 2018-2025). Asterisk denotes statistical significance (p < 0.05). Conclusions: Despite a long-term decline, smoking prevalence in Italy is rising again in several educational subgroups, particularly among female and male diploma holders. These findings suggest that educational level shapes smoking trajectories in complex and sex-specific ways, underlining the need to further investigate the underlying determinants of smoke behaviour and to develop targeted prevention strategies tailored to specific educational groups. Key messages: • Smoking prevalence in Italy declined from 2001 but reversed in recent years across several educational subgroups, with statistically significant increases among women. • Stratified analyses by sex and educational level reveal heterogeneous smoking trajectories, underlining the importance of tailored prevention approaches and further research on underlying determinants.
SN - 1101-1262
SN - 1464-360X
ER -