DETERMINANTS OF SMOKING CESSATION AND INITIATION IN ITALY, WITH FOCUS ON RESPIRATORY SYMPTOMS AND USE OF ELECTRONIC CIGARETTE

DETERMINANTS OF SMOKING CESSATION AND INITIATION IN ITALY, WITH FOCUS ON RESPIRATORY SYMPTOMS AND USE OF ELECTRONIC CIGARETTE Tobacco smoking represents the main risk factor for respiratory disease. Its prevalence has been decreasing in almost all over the world for the last decade. However, the prevalence of smoking depends not only on the rates of smoking cessation but also on the rates of smoking initiation. It is necessary to understand trends and to analyze thoroughly the determinants of smoking cessation and initiation in the population. Furthermore, smoke-free policies must pay attention to the devices marketed by the manufacturing companies to help people quit smoking, as electronic cigarettes (e-cigarettes). From a public health perspective, the major question dealing with e-cigarette is its relation with tobacco smoking: does e-cig decrease smoking consumption and promote smoking cessation, or does it represent a gateway to nicotine addiction and consequently to tobacco smoking initiation? My PhD research firstly focused on the determinants of smoking cessation and re-initiation in Italy. Finally, I investigated the diffusion of e-cigarette among nursing students in North-Eastern Italy and explored its use as determinant of smoking cessation and initiation. First topic: “Cumulative incidence and determinants of smoking cessation and re-initiation in Italy” Methods: This study focused on three population-based cohorts, enrolled in 1998-2001 within the Italian Study on Asthma in Young Adults (ISAYA) in Verona (Northern Italy) and Sassari (Sardinia), or within the Italian Study on the Incidence of Asthma (ISIA) in Verona in 1998-2001. Subjects answered a questionnaire on respiratory health and smoking habits at baseline and were re-administered the same questions in 2007-2009 after a mean follow-up of 9.1 years. Out of 1874 current smokers and 1166 ex-smokers at baseline, 965 (51.5%) and 735 (63.0%) reported their smoking status at follow-up. Results: In a 9-year follow-up, smoking cessation largely exceeded smoking re-initiation (respectively 32.3% of subjects had stopped smoking among current smokers at baseline and 11.7% had resumed smoking among ex-smokers). Smoking cessation was enhanced in people with asthma, but not in people with allergic rhinitis or chronic cough/phlegm; while the opposite occurred for the smoking re-initiation. Second topic: “Knowledge and use of e-cigarette among nursing students: results from a cross-sectional survey in North-Eastern Italy” Methods: In the year 2015 2020 students, attending nursing courses of the University of Verona in 5 different centres, were anonymously administered a questionnaire focused on e-cigarette use and tobacco smoking habits. 1463 (72.4%) students answered the questionnaire. The influence of e-cigarette ever use on both tobacco smoking initiation in all subjects and smoking cessation among ever smokers was investigated by multivariable logistic models. Results: About one third of responders (30.3%, 95% CI 27.9-32.7%) had ever used e-cigarettes but only 2.1% (1.5-3.0%) in the last month. Very few (2.1%) among those who had never used e-cigarettes were willing to try them. Ever use and current use of e-cigarettes were respectively reported by 57.2% and 4.4% of current tobacco smokers and by 12.0% and 0.6% of never or past smokers (p<0.001). In multivariable analysis the odds of having started smoking was one order of magnitude higher among e-cigarette ever users than never users, who in turn had a three times higher odds of having quitted smoking if ever tobacco smokers. Only 26 students were currently using both electronic and tobacco cigarettes, and most of them declared to use e-cigarette to stop or reduce tobacco smoking. Of note, only three students reported they had completely stopped smoking thanks to e-cigarette. Conclusion: Use of e-cigarettes seemed to be rather rare among Italian nursing students, and mainly restricted to current smokers. E-cigarette was not used as an instrument to stop smoking by nursing students.