Trends in Tobacco and Nicotine Use in Italy: exclusive and dual use according to PASSI data
Abstract
Tobacco use remains the leading cause of preventable mortality worldwide and continues to represent a major public health concern in Italy. The rapid spread of new nicotine products, such as e‑cigarettes and heated tobacco products, has altered consumption patterns, highlighting the need for integrated surveillance of exclusive and combined use. This study examines the prevalence, sociodemographic profiles, and temporal trends of cigarette use, electronic device use, and dual product use among the population aged 18–69 years residing in Italy, using data from the PASSI data from 2008–2024.
Analyses are based on nationally representative samples of 70,604 adults using multinomial logistic regression model to assess associations with sociodemographic characteristics. In 2023–2024, 24% of adults were classified as smokers; 19% of respondents were exclusive cigarette smokers, 5% dual users, and 4% exclusive electronic device users. Exclusive cigarette smoking was more common among men (RRR 1.70), socioeconomically disadvantaged groups, and residents in Southern Italy. Exclusive electronic devices use, and dual use were significantly higher among younger adults (RRR 4.34 and RRR 3.80 respectively). Among women, the use of electronic devices was comparable to that observed among men, especially in the exclusive use, whereas gender gap in smoking have always favored women. Since 2014, exclusive cigarette smoking declined (24.7% to 18.4%), while electronic device use increased markedly (exclusive use from 0.4% to 4.0%; dual use from 1.5% to 4.8%). Overall nicotine use, after declining until 2014, has increased in recent years (+3%), particularly among women (+5%) and young adults (+9%). The growing use of new nicotine products may offset gains in tobacco control. Surveillance data highlight the need for comprehensive policies addressing both traditional and emerging products, with particular attention to younger populations and social inequalities.
Key messages: • Smoking is declining in Italy, but use of electronic devices and dual use have risen since 2014, especially among young adults and women, driving a recent increase in overall nicotine use.
• New nicotine products may undermine tobacco control gains; age, gender, and socioeconomic inequalities call for integrated surveillance and comprehensive, equity‑focused policies.
Related
- Nicotine and heavy metal exposure in recent exclusive cigar users: Insights from the U.S. population assessment of tobacco and health study wave 7 (2022−2023)
- Association between tobacco & nicotine product use and allergic rhinitis: a cross-sectional study
- Post-policy evaluation lags of tobacco and nicotine product policies: a systematic review from the United States, Canada, Australia, and the United Kingdom
- Tobacco and nicotine products in Switzerland: a national analysis of market notifications
- Prevalence of tobacco use and nicotine dependence among medical interns in Nepal: A cross-sectional study
BibTeX
@article{minardi2026trends,
title = {{Trends in Tobacco and Nicotine Use in Italy: exclusive and dual use according to PASSI data}},
author = {V Minardi and F Asta and B Contoli and M Masocco},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1885},
url = {https://doi.org/10.1093/eurpub/ckag169.1885},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Trends in Tobacco and Nicotine Use in Italy: exclusive and dual use according to PASSI data
AU - V Minardi
AU - F Asta
AU - B Contoli
AU - M Masocco
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1885
UR - https://doi.org/10.1093/eurpub/ckag169.1885
AB - Tobacco use remains the leading cause of preventable mortality worldwide and continues to represent a major public health concern in Italy. The rapid spread of new nicotine products, such as e‑cigarettes and heated tobacco products, has altered consumption patterns, highlighting the need for integrated surveillance of exclusive and combined use. This study examines the prevalence, sociodemographic profiles, and temporal trends of cigarette use, electronic device use, and dual product use among the population aged 18–69 years residing in Italy, using data from the PASSI data from 2008–2024. Analyses are based on nationally representative samples of 70,604 adults using multinomial logistic regression model to assess associations with sociodemographic characteristics. In 2023–2024, 24% of adults were classified as smokers; 19% of respondents were exclusive cigarette smokers, 5% dual users, and 4% exclusive electronic device users. Exclusive cigarette smoking was more common among men (RRR 1.70), socioeconomically disadvantaged groups, and residents in Southern Italy. Exclusive electronic devices use, and dual use were significantly higher among younger adults (RRR 4.34 and RRR 3.80 respectively). Among women, the use of electronic devices was comparable to that observed among men, especially in the exclusive use, whereas gender gap in smoking have always favored women. Since 2014, exclusive cigarette smoking declined (24.7% to 18.4%), while electronic device use increased markedly (exclusive use from 0.4% to 4.0%; dual use from 1.5% to 4.8%). Overall nicotine use, after declining until 2014, has increased in recent years (+3%), particularly among women (+5%) and young adults (+9%). The growing use of new nicotine products may offset gains in tobacco control. Surveillance data highlight the need for comprehensive policies addressing both traditional and emerging products, with particular attention to younger populations and social inequalities. Key messages: • Smoking is declining in Italy, but use of electronic devices and dual use have risen since 2014, especially among young adults and women, driving a recent increase in overall nicotine use. • New nicotine products may undermine tobacco control gains; age, gender, and socioeconomic inequalities call for integrated surveillance and comprehensive, equity‑focused policies.
SN - 1101-1262
SN - 1464-360X
ER -